Somaliland, officially the Republic of is an unrecognised sovereign state in the Horn of Africa, internationally considered to be part of Somalia. Somaliland lies in the Horn of Africa, on the southern coast of the Gulf of Aden. It is bordered by Djibouti to the northwest, Ethiopia to the south and west, and Somalia to the east. Its claimed territory has an area of 176,120 square kilometres (68,000 sq mi), with approximately 5.7 million residents as of 2021. The capital and largest city is Hargeisa. The government of Somaliland regards itself as the successor state to British Somaliland, which, as the briefly independent State of Somaliland, united in 1960 with the Trust Territory of Somaliland (the former Italian Somaliland) to form the Somali Republic.

Since 1991, the territory has been governed by democratically elected governments that seek international recognition as the government of the Republic of Somaliland. The central government maintains informal ties with some foreign governments, who have sent delegations to Hargeisa. Ethiopia also maintains a trade office in the region. However, Somaliland’s self-proclaimed independence has not been officially recognised by any country or international organisation. It is a member of the Unrepresented Nations and Peoples Organization, an advocacy group whose members consist of indigenous peoples, minorities and unrecognised or occupied territories.


Healthcare in Somaliland, as with other Somalia ‘zones’, is largely in the private sector, regulated by the Ministry of Health of the Federal Government of Somalia. The system is largely staffed by undertrained, under-supervised and -paid staff, dependent upon donations from international agencies.

Source: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-5049-2


The self-declared country of Somaliland remains largely unrecognized by the rest of the world. We were not able to gain preterm birth rates for Somaliland.  

We “recognize” Somaliland as a respected member of our global Neonatal Womb Warrior/preterm birth community.

Rank: unknown –Rate: unknown  Estimated # of preterm births per 100 live births 

  (USA – 12 %, Global Average: 11.1%)


These Female Doctors Are Changing the Lives of Fistula Survivors In Somaliland


On one day in March dozens of people gathered in a hospital in Hargeisa, Somaliland. The bright room was decorated with flowers and banners in red, green and white, the colours of Somaliland’s flag. Doctors –foreign and Somali – ministers, medical students, former patients and journalists filed in, greeting each other, standing in little groups and talking animatedly. A man walked to the front, bowed his head, and intoned a prayer over the crackly microphone, and the murmur turned to silence as people took to their seats.

Minutes later, a woman dressed in an elegant blue gown took to the podium. Edna Adan, the face of Somaliland’s healthcare and founder of the hospital where this event took place, is in her 80s, but the passion in her voice and her strong demeanour make her seem decades younger.

We were all gathered to celebrate the 16th anniversary of the Edna Adan Hospital, which has been a shining example of healthcare and education since its inception.

“I always felt there was a need to provide Somalilanders with better healthcare,” says Edna, whose doctor father she credits with inspiring her to pursue medicine. “And that’s why, as a child, I decided I would build a hospital.”

Before she retired in 2002, Edna — who worked with the World Health Organization in the region after a working as a nurse — founded the hospital with the view of drastically reducing child and maternal mortality in the country.

“Women in Somaliland have the world’s highest mortality rates because there are no health facilities and few health professionals,” she says. “Seeing the magnitude of the problem and knowing the limited resources, I decided to put everything I could into reproductive health, and it’s the most rewarding thing that we’ve done.”

Since opening its doors, the hospital has delivered thousands of healthy babies, and its maternal mortality rate is a tiny fraction of the national average. The hospital has also become a centre for the treatment of obstetric fistula, one of the most devastating conditions faced by women in developing countries.

“Fistula can happen when women go through a long labour, and especially when they deliver at home, far from hospitals, in rural areas with no facilities or doctors,” explains 32-year-old Dr. Shukri Mohamed Dahir, Somaliland’s first female fistula surgeon.

“Pressure between the pelvic bone and fetal head kills the tissue of the bladder and rectum, and a small hole develops,” says Dr. Dahir. This hole – the fistula – can cause the woman to uncontrollably leak bodily waste, with shattering health and social consequences.

Shukri studied midwifery and nursing at Edna Adan Hospital, which later sponsored her through medical school. After she graduated in 2011, Dr. Dahir returned to Edna Adan’s hospital to learn about surgery.

“I always wanted to solve women’s problems myself, rather than hand them off to a male doctor to solve,” says Dr. Dahir. “And I also realized how important it was to have woman surgeons so women can feel free.”

Unfortunately, getting her degree wasn’t always enough to convince patients of her expertise: “People were not used to seeing women doctors, and wouldn’t trust us to do the operations. Once, during a consultation with a woman suffering with fistula, I had to pretend to be a student, while my male student posed as the surgeon. After the surgery, I told her I was the one who had cured her, so she let me take over.”

Because of the hospital’s great results, patients are now used to seeing female surgeons, and many of those suffering from obstetric fistula even request to be seen by other women. And, thanks to the Edna Adan University, which was formally established in 2009, it is not only women in the capital who are now receiving world-class healthcare. Graduate doctors from all Somaliland are coming here for training, and returning to their rural clinics with newfound life-saving skills.

“I am glad we are turning 16,” says Dr. Dahir of the hospital. “We have made a huge change in this country.”


Learn how to boost your baby’s brain from a Harvard Professor

Feb 25, 2019    From an international health authority  Learn how experts define health sources in a journal of the National Academy of Medicine 

Dr. Jack Shonkoff, Professor of Child Health and Development at Harvard University, shares his important play tips to boost your child’s brain. In the first 1,000 days of life, a baby’s brain forms 1,000 new connections every second. Just 15 minutes of play can spark thousands of brain connections. Learn more: https://uni.cf/2Sk1yEn

Preterm births cost Australian Government $1.4 billion Annually

Monday, 19 July 2021

A new study has shown that the annual cost of preterm birth to the Australian Government is approximately $1.4 billion with one quarter of this arising from the need for educational assistance for those born too soon.

Conducted by the Women & Infants Research Foundation (WIRF) and the Australian Preterm Birth Prevention Alliance, the study was developed to estimate the costs of preterm birth in the first 18 years of life for a hypothetical cohort of 314,814 children – the number of live births in 2016.

Being born too early is the single greatest cause of death in young children in Australia and all similar societies. It is also one of the major causes of disability, both in childhood and adulthood. These disabilities include cerebral palsy, deafness, blindness and learning and behavioural problems.

Recently published in the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG), the study revealed two thirds of the costs were borne by health care services with costs of preterm birth inversely related to gestational age at birth. Extremely preterm births were most expensive at $236,036 each, very preterm birth at $89,709, and late preterm birth at $25,417.

Chair of the Australian Preterm Birth Prevention Alliance and WIRF’s Chief Scientific Director, Professor John Newnham AM said assessments of economic costs were critical to inform evaluations of interventions aimed at the prevention or treatment of preterm birth.

“Discovering how to safely lower the rate of preterm birth and then evaluating the impact of that effectiveness needs to be one of our highest priorities in contemporary healthcare,” Professor Newnham said.

“The consequences of preterm birth for individuals, families and societies are considerable, both in terms of human suffering and economic consequences.”

Whilst previous international studies had quantified direct medical expenditure, this latest analysis also sought to measure the significant costs to educational services.

“The benefits of preterm birth prevention include fewer children with behavioural and learning problems, including the need for special education assistance,” Professor Newnham said.

 “In our study, additional costs at school were calculated to contribute 25% of the cost of preterm birth. Promotion of programs to safely prevent preterm birth needs to include the educational advantages at school, as well as the profound benefits for families that arise from avoidance of behavioural problems.”

Professor Newnham, the 2020 Senior Australian of the Year, explained that it should no longer be assumed that the high costs of preterm birth are an inevitable consequence of our reproduction.

 “The rate of preterm birth has been rising dramatically in Australia and elsewhere over the last two decades. There are many pathways to untimely early birth, each requiring a different clinical approach, and we have discovered some are now amenable to prevention.” Media Release

In 2014, WIRF launched the WA Preterm Birth Prevention Initiative was launched – the world’s first whole-of-state and whole-of-population program to prevent preterm birth.

Results from the first year of this program revealed a reduction in the rate of preterm birth across WA by 8% and by 20 per cent at the major tertiary level centre – King Edward Memorial Hospital.

The success of the WA program, which has also extended to the ACT as part of their reported 10% reduction of preterm birth rates in 2020, have been underpinned by the development of key interventions to safely lower the rate of early birth.

“When we apply these interventions as part of a multifaceted program across an entire population the rate of preterm birth can be reduced, at least by about 8%. Further advances in potential interventions can be expected to make prevention even more effective,” Professor Newnham said.

“Investing in the prevention of preterm birth is a social and economic investment in our community’s future.”

As accurate data is only available to estimate the costs to 18 years of age, it is reasonable to conclude that the costs to government estimated in the current study represent only a fraction of the eventual overall burden to individuals, families and the nation.

In May 2021, the Australian Government announced $13.7 million in federal funding to bolster the Alliance’s ongoing efforts to lower the rate of preterm birth across Australia.

The funding will support the expansion of a national education and outreach program to safely lower rates of preterm birth in each Australian state and territory.

The study, ‘The health and educational costs of preterm birth to 18 years of age in Australia’, has been published online in the Australian and New Zealand Journal of Obstetrics and Gynaecology.

Authors for the original ANZJOG article are: John Newnham, Chris Schilling, Stavros Petrou, Jonathan Morris, Euan Wallace, Kiarna Brown, Lindsay Edwards, Monika Skubisz, Scott White, Brendan Rynne, Catherine Arrese, and Dorota

Joyful voices to savor from our Somaliland family

Xidigana Geeska Wadani Dhaba Maaha Hargeeisa Book Fair Music Video 2021Jul 29, 2021

Xidigaha Geeska,Najax Nalka,Mubarak October,Suldaan Seeraar, Xariir Axmed, Mursal Muuse, Hodan Abdirahman, Kiin Jamac, Waqal Studio

Breastfeeding status and duration significantly impact postpartum depression risk

Study first to explore current breastfeeding status in association with postpartum depression risk in large national dataset

Date:  September 30, 2021   Source: Florida Atlantic University

According to the United States Centers for Disease Control and Prevention, between 11 and 20 percent of women who give birth each year in the U.S. have postpartum depression symptoms, which is the greatest risk factor for maternal suicide and infanticide. Given that there are 4 million births annually, this equates to almost 800,000 women with postpartum depression each year.

Current biological and psychosocial models of breastfeeding suggest that breastfeeding could possibly reduce a woman’s risk for postpartum depression. However, prior studies only have looked at the initiation of breastfeeding and breastfeeding length. In addition, small and often homogenous samples have yielded ungeneralizable results lacking in statistical power with biased results due to higher levels of education, income, and proportions of white participants compared to the general population of the sampled country.

Researchers from Florida Atlantic University’s Christine E. Lynn College of Nursing and collaborators are the first to examine current breastfeeding status in association with postpartum depression risk using a large, national population-based dataset of 29,685 women living in 26 states

Results of the study, published in the journal Public Health Nursing, demonstrate that postpartum depression is a significant health issue among American women with nearly 13 percent of the sample being at risk. Findings showed that women who were currently breastfeeding at the time of data collection had statistically significant lower risk of postpartum depression than women who were not breastfeeding. In addition, there is a statistically significant inverse relationship between breastfeeding length and risk of postpartum depression. As the number of weeks that women breastfed increased, their postpartum depression decreased. An unexpected finding was that there was no significant difference in postpartum depression risk among women with varying breastfeeding intent (yes, no, unsure).

“Women suffering from postpartum depression, which occurs within four weeks and up to 12 months after childbirth, endure feelings of sadness, anxiety and extreme fatigue that makes it difficult for them to function,” said Christine Toledo, Ph.D., senior author and an assistant professor in FAU’s Christine E. Lynn College of Nursing. “Women with postpartum depression who are not treated also may have negative outcomes, including difficulty bonding with and caring for their children, thoughts of harming themselves or their infant, and also are at an increased risk of substance misuse.”

Woman who have experienced postpartum depression have a 50 percent increased risk of suffering further episodes of postpartum depression in subsequent deliveries. In addition, they have a 25 percent increased risk of suffering further depressive disorders unrelated to childbirth up to 11 years later. Postpartum depression increases maternal morbidity and is associated with increased risks for cardiovascular disease, stroke and type-2 diabetes.

For the study, Toledo and collaborators from the University of Miami School of Nursing and Health Studies, University of North Carolina School of Nursing, Chapel Hill, Seattle University of Nursing, and The University of British Columbia School of Nursing, analyzed dataset from the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire to investigate the association of breastfeeding practices taking into consideration significant covariates such as age, race, marital status, education, abuse before and during pregnancy, cigarette smoking, among others.

“Findings from this important study suggest that breastfeeding is a cost efficient and healthy behavior that can decrease a woman’s risk for postpartum depression,” said Safiya George, Ph.D., dean, FAU Christine E. Lynn College of Nursing. “Nurses in particular play an important role in educating and promoting both the maternal health benefits of breastfeeding and infant benefits such as providing necessary nutrients and protecting them against allergies, diseases and infections.”

Florida Atlantic University. “Breastfeeding status and duration significantly impact postpartum depression risk: Study first to explore current breastfeeding status in association with postpartum depression risk in large national dataset.” ScienceDaily. ScienceDaily, 30 September 2021.


Dr. Gabor Mate, philosopher, doctor and  powerful resource, is accessible to those who seek to explore our inner selves, identify avenues to healing,  and gain  a broader perspective of emotional support and healing pathways.  Not always an easy “listen” and therefore a thought provoking experience, Gabor, as he also travels through his life, shares his insights and  perspectives. Dr. Mate invites contemplation as he suggests that a key component of understanding the effects of trauma is not how it affects what we do so much as how it impacts what we do not do. Definitely food for thought…..

Dr Gabor Maté’s Life Advice Will Change Your Future (MUST WATCH)

                                    Jul 12, 2021  #GaborMaté #MotivationThrive

Dr Gabor Maté’s Life Advice Will Change Your Future (MUST WATCH). Who is Gabor Maté? A renowned speaker, and bestselling author, Dr. Gabor Maté is highly sought after for his expertise on a range of topics including addiction, stress and childhood development.


Videos | LIVE series | Preemie Chats

CPBF – Canadian Premature Babies Foundation

Below you can find our virtual educational sessions tailored to NICU parents and healthcare professionals. The sessions are interactive; you can join LIVE every Friday at 1pm EST either on our Facebook or YouTube pages. This is a great opportunity to chat with experts, researchers, and parents from all over the world. There is an abundant collection of interesting videos, and here are  a few examples:

Prematurity and Autism Spectrum Disorder -Vision Development from Infancy to Childhood -LGBTQ+ in the NICU -Preterm Birth and Adult Health


Below is a great example of a virtual session CPBF provides weekly to educate Preemie Parents and Healthcare Professionals.

An Adult Preemie Tells Her Story

February 2021

Pediatric and Fetal Surgeon, Dr. Timothy Crombleholme Explains Open Fetal Surgery

 Jun 25, 2018Fetal Care Center Dallas

Dr. Timothy M. Crombleholme is a pediatric and fetal surgeon recognized worldwide for his experience in fetoscopic surgery, open fetal surgery, image-guided fetal intervention and EXIT procedures. Dr. Crombleholme emphasizes educating his families about what to expect for the surgical procedure and throughout the pregnancy. “Our families are some of the most relaxed families in the newborn nursery because they have processed everything and have been prepared for the delivery and the challenges the baby faces, and nothing is intimidating to them.”

Fortifying Family Foundations

Assistant Professor Ashley Weber’s intervention empowers parents to care for their premature infants

By Evelyn Fleider –  July 20, 2021

Imagine you are a new mom or dad whose baby was recently born at fewer than 32 weeks old. Your infant needs weeks-long, round-the-clock support in the hospital, but you do not have the job flexibility that allows you to spend time there, a trusted sitter to care for your other child/children or reliable transportation to get you there. You are overwhelmed, emotional and missing out on critical moments at the hospital, when you could get to know your baby and learn to manage their complex care and needs.

Each year, about 100,000 U.S. women give birth to babies considered very or extremely premature who require long-term stays in a neonatal intensive care unit (NICU) and who are at a high risk of developing chronic conditions. But not all parents get the formal training they need to keep their child healthy, which can cause mental health issues for parents. To address the critical need for an effective, streamlined model of parent-driven care, Ashley Weber, PhD, RN, a practicing NICU nurse and assistant professor at the College, is piloting PREEMIE PROGRESS, a video-based intervention that helps parents understand, monitor and manage their infant’s care while in the NICU.

With the financial backing of a National Institutes of Health (NIH) grant, Weber and the College’s Center for Academic Technologies and Educational Resources (CATER) team designed and built the intervention to deliver education to overwhelmed, high-risk parents with low literacy and education through accessible, platformagnostic videos and optional worksheets. Parents can learn by watching the videos or completing worksheets
while doing laundry or caring for other family members at home. Specifically, PREEMIE PROGRESS provides family management skills including negotiated collaboration, care systems navigation, emotion control, outcome expectancy and more.

“Our mortality rates have significantly gone down over the decades, but long-term complications from prematurity have not changed,” Weber says. “We need to decrease the stress and sensory stimulation that babies experience throughout their NICU stay. Also, research shows that babies do best when they’re with their parents.”

Although parent education interventions exist, socioeconomic barriers, such as the lack of mandated paid family leave in the U.S., often prevent parents from participating in these opportunities and learning about their baby’s complex care during their NICU stay. The need to return to work shortly after birth or lack of transportation to the NICU are some of the various obstacles that prevent parents from being able to focus on their baby’s health and deliver the majority of care in the NICU.

“If you can spend large amounts of time in the NICU, you get to learn; nurses educate you on the plan of care and you participate in rounds, getting to know your baby,” Weber says.

“I wanted to build an intervention that could help disadvantaged families learn outside of the NICU, so that when they are able to be in the NICU, they maximize that time and spend it caring for their baby as opposed to playing catch-up.”

Currently, Weber and her team are refining PREEMIE PROGRESS through iterative usability and acceptability testing. In October, they will start testing feasibility and acceptability of the refined intervention and study procedures in a pilot randomized controlled trial with 60 families over the course of two years. They anticipate the intervention will decrease parent depression and anxiety, increase infant weight gain and receipt of mother’s milk and reduce neonatal health care utilization. Weber then plans to submit a competitive R01 for additional funding to conduct an even larger trial.

PREEEMIE PROGRESS has been years in the making for Weber, who in 2018 worked with the College of Nursing’s instructional designers, technology specialists, videographers and graphic designers to create the first prototype. She hopes the project will eventually evolve into a collaborative partnership among NICUs in Cincinnati, Columbus and Cleveland to conduct research trials centered on improving family care.

Weber’s long-term goal is to become a leader in designing, disseminating and implementing sustainable family management programs to improve health outcomes in the NICU. Regardless of her success, she recognizes that the best thing she can do for her patients is to advocate for universal paid family leave, better childcare and transportation infrastructures.

“We can come up with all sorts of interventions for reducing parent and infant stress and changing the way providers deliver care in the NICU, but if a mom doesn’t have the money to pay for a babysitter so she can get to the NICU or doesn’t have paid leave and has to go back to work a week or two after birth, the chances of parent engagement in care are extremely low,” Weber says. “I hope that PREEMIE PROGRESS empowers families who are at a disadvantage through no fault of their own. We want to give NICU families skills they can use for a lifetime, but these broader public health policies to support the social determinants of family success are really needed in order to move family research forward in the NICU.”


A Day in the Life of the NICU

Apr 25, 2017         Medtronic Minimally Invasive Therapies Group

Watch how staff at Rush University Medical Center combats neonatal stress. (14-RE-0016)


Gaps in Palliative Care Education among Neonatology Fellowship Trainees

Catherine Lydia Wraight   Jens C. Eickhoff   Ryan M. McAdams

Published Online:27 Jul 2021https://doi.org/10.1089/pmr.2021.0011


Background: To provide proper care for infants at risk for death, neonatologists need expertise in many areas of palliative care. Although neonatology training programs have implemented a wide variety of palliative care educational programs, the impact of these programs on trainees’ skills and effective communication regarding end-of-life issues remains unclear.

Objective: To determine whether neonatology fellowship programs are providing formal palliative care education and assess whether this education is effective at increasing fellows’ self-reported comfort with these important skills.

Methods: An anonymous survey was sent to program directors (PDs) and fellows of ACGME accredited neonatology fellowship programs in the United States. Using a 5-point Likert scale, participants were asked about the palliative care education they received, and their comfort level with several key aspects of palliative care.

Results: Twenty-four (26%) PDs and 66 (33%) fellows completed the survey. Fourteen PDs (58%) reported including palliative care education in their formal fellowship curriculum, whereas only 20 (30%) responding fellows reported receiving palliative care education. Of the responding fellows, most (80%) reported being uncomfortable or only somewhat comfortable with all assessed areas of palliative care. Fellows who received formal education were more comfortable than those without it in leading goals of care conversations (p = 0.001), breaking bad news (p = 0.048), discussing change in code status (p = 0.029), and grief and bereavement (p = 0.031).

Conclusions: Most fellows report being uncomfortable or only somewhat comfortable with essential areas of palliative care. Formal palliative care education improves fellows’ self-reported comfort with important aspects of end-of-life care. To promote a well-rounded neonatology fellowship curriculum, inclusion of formal palliative care education is recommended.



Stressful events – a byproduct of life for babies in the NICU – may increase their heart rate and blood pressure, while decreasing their oxygen levels.  Even sensory and environmental stimuli we take for granted, such as a simple touch and noise and bright lights, can affect physiologic responses such as heart rate, respiration, and oxygen saturation.

The additive impact of multiple stressors over time may have profound long-term consequences on the lives of NICU babies.  In the rapidly developing perinatal brain, repeated neonatal stress may have long-term effects on the central nervous system,  including effects on neural structure, function, and development.

Doctor and Two Nurses Drive 2 Miles In Texas Snowstorm To Deliver Premature Baby

Mar 4, 2021     Uplifting Stories in a Minute

Despite being only 24 weeks pregnant, Kimberley Arias went into labor in the middle of the Texas snowstorm. Thanks to the help of Dr. John Loyd and nurses Kelly Clause and Nicole Padden who traveled 2 hours in the blizzard, her baby was delivered safely.

The New Graduate Neonatal Nurse Practitioner’s Transition from Bedside to Head-of-the-Bed

By Chandler Williams, DNP NNP-BC

The Neonatal Nurse Practitioner (NNP) role in the neonatal intensive care unit (NICU) is about to mark its 50th birthday. 

According to the Accreditation Council for Graduate Medical Education, there has been an estimated 33% reduction in resident physician NICU rotations (Jnah & Robinson, 2015). This will only increase the need for NNPs in NICUs across the country. A 2020 survey reported that the average NNP is 51 years old, and there are 40 accredited NNP programs in the US with new NNPs entering the workforce every year (Snapp et al., 2021). One thing all these NNPs have in common is the journey of navigating the transition that is from the bedside RN role to the head-of-the-bed NNP role. New graduate NNPs have feelings of anxiety, insecurity, exhaustion, and lack of confidence in decision making.

The transition period can be looked at in terms of the first year of starting as a new graduate NNP; that’s because most NNPs report feelings of competence and viewing themselves as a member of the NICU team at the end of year 1 (Cusson & Strange, 2008). To ease this transition, novice NNPs should seek out mentors, be aware of areas of weakness or fears, seek out strategies to ease the transition, and consider the familiarity of the unit. NNPs are an important part of a neonate’s care team, and easing this transition is important for the future of NNPs’ careers.

There are many strengths and weaknesses of being a new graduate NNP, and it is important to be aware of these strengths to gain confidence through the transition process, as well as the weaknesses to know there is room for growth and to feel not alone. These strengths include strong assessment skills, hard-working, professionalism, previous neonatal nursing experience, compassion, calculations, and internal motivation to learn and excel. Perceived weaknesses include procedural experience, pharmacologic knowledge, limited experience, nervousness about role transition, doubting oneself, and emotional attachments to patients and families (Jnah & Robinson, 2015).

One way that novice NNPs can ease the transition to the workforce is through mentorship. There is an ease in the transition from RN to NNP in those who seek out mentors. A study on mentoring and self-efficacy in the NNP workforce revealed that mentorship facilitates positive self-efficacy for the novice NNP (Jnah & Robinson, 2015). Novice NNPs enter this new world with a passion for neonatal care and a desire to make a difference in the lives of neonates and their families; however, the fear of the unknown can be daunting. Mentorship is a collaborative relationship that is beneficial to both the mentor and the mentee by encouraging the development of long-term relationships between novice NNPs and experienced NNPs. During the orientation period, the novice NNP is generally placed under the guidance of a preceptor assigned to provide direct supervision and teach the novice NNP in their new clinical setting (Jnah & Robinson, 2015). A preceptor differs from a mentor in that a preceptor is time-limited; mentorship has no time limitations. Less experienced NNPs report longing for mentorship and support from other NNPs after their orientation is complete (Beal et al., 1997). Mentorship has reported increased job satisfaction, productivity, and quality of care (Jnah & Robinson, 2015). New graduate NNPs who seek out mentors and invest in these relationships can anticipate an ease in the role transition process.

There are a lot of opinions on whether it is a more difficult transition for a new graduate NNP in the facility or unit where they were an RN versus a new unit. An experienced NNP recruiter once described this phenomenon via a metaphor between ketchup and mustard bottles; stating that a novice NNP on the unit where that person was an RN is like a ketchup bottle that has been emptied and filled  with mustard. Even though this person is now filled with different substance (NNP knowledge), others will continue to look at them as ketchup (or their previous role).

However, there is evidence to suggest that RNs returning to their previous unit as an NNP has an easier transition and were benefited by their previous knowledge of the unit. It is also reported that those who accept jobs on units where they completed clinical practicum had a less difficult transition. These NNPs report a sense of familiarity with the hospital, unit, and staff. Challenges in these instances include initially being less accepted by nurses on the unit and, often, being questioned by staff nurses who expect them to prove themselves in their new role. There is evidence to suggest that NNPs who transition to their new role in a completely different unit from training or previous employment are more readily accepted by the staff but face a learning curve with regard to organizational culture and practice styles and routines (Cusson & Strange, 2008).

Strategies to enhance the role transition include developing good relationships with all staff, finding a mentor, becoming an active member of a professional nursing organization, sharing needs and accepting guidance, developing strategies to decrease stress, staying up-to-date in current evidence, and realizing that feelings of inadequacy are normal and will dissipate throughout the transition. Although each person develops in their identity of their new role, overall being open to support and guidance and being an active part of your new role as an NNP can increase confidence in the development of a role identity. A strong nursing identity is vital because it is associated with a successful NNP practice (Cusson & Viggiano, 2002).

The NNP is an important part of the neonatal care team. The average age of an NNP is decreasing as the NNP workload in the NICU is increasing across the country. New graduate NNPs will continue to transition in the role from bedside to head-of-the-bed, and can find support in this transition through mentors, self-evaluation, and careful examination of areas of strength and weakness. This transition period is just that, a transition, and there are ups and downs throughout this process. It is important to recognize that the progression of graduating from school, seeking employment, studying and obtaining licensure, and credentialling does not happen overnight. There are a lot of feelings of anxiety and worry, because it seems as if we have little control over the timeframe or outcome.

As the NNP progresses through orientation, and even in the first months of being “on their own,” they may feel anxious and inadequate and experience self-doubt, manifested primarily through questioning their knowledge and skills, wondering if they can handle a crisis or worse, and fearing making a fatal mistake or missing an important diagnoses (Cusson & Strange, 2008). As new graduate NNPs enter the workforce, it is important to provide support them throughout this process.



Developing eHealth in neonatal care to enhance parents’ self-management

Annica Sjöström Strand1Björn Johnsson2Momota Hena1Boris Magnusson2Inger Kristensson Hallström1


Background: Discharge from a neonatal care unit is often experienced as a vulnerable time for parents. By communicating through digital technology, it may be possible to improve the support for parents and thereby make the transition from hospital to home less stressful.

Aim: To develop an eHealth device supporting the transition from hospital to home for parents with a preterm-born child in Sweden using participatory design.

Method: Employing a framework of complex interventions in health care using participatory design. Parents of preterm-born infants and professionals at a neonatal department identified specific technical requirements for an eHealth device to be developed in the context of neonatal care and neonatal home care. The prospective end-users – parents and professionals – were continuously involved in the process of designing solution prototypes through meetings, verbal and written feedback, and interviews. The interviews were analysed using thematic analysis.

Results: Technical development was carried out with the perspectives of professionals and parents in mind, resulting in an eHealth application for computer tablets. The findings from the interviews with the parents and professionals revealed three categories: The tablets felt secure, easy to use and sometimes replaced visits to hospital and at home.

Conclusion: The use of participatory design to develop an eHealth device to support a safe transition from hospital to home can benefit parents, the child, the family, and professionals in neonatal care.


“In a Way We Took the Hospital Home”-A Descriptive Mixed-Methods Study of Parents’ Usage and Experiences of eHealth for Self-Management after Hospital Discharge Due to Pediatric Surgery or Preterm Birth

Rose-Marie Lindkvist1Annica Sjöström-Strand1Kajsa Landgren1Björn A Johnsson2Pernilla Stenström34Inger Kristensson Hallström1


The costly and complex needs for children with long-term illness are challenging. Safe eHealth communication is warranted to facilitate health improvement and care services. This mixed-methods study aimed to describe parents’ usage and experiences of communicating with professionals during hospital-to-home-transition after their child’s preterm birth or surgery for colorectal malformations, using an eHealth device, specifically designed for communication and support via nurses at the hospital. The eHealth devices included the possibility for daily reports, video calls, text messaging, and sending images. Interviews with 25 parents were analyzed with qualitative content analysis. Usage data from eHealth devices were compiled from database entries and analyzed statistically. Parents using the eHealth device expressed reduced worry and stress during the initial period at home through effective and safe communication. Benefits described included keeping track of their child’s progress and having easy access to support whenever needed. This was corroborated by usage data indicating that contact was made throughout the day, and more among families living far away from hospital. The eHealth device potentially replaced phone calls and prevented unnecessary visits. The eHealth technique can aid safe self-treatment within child- and family-centered care in neonatal and pediatric surgery treatment. Future research may consider organization perspectives and health economics.


Engaging Frontline Providers Prevents Hypothermia and Improves Communication in the Postoperative Neonate

Guidash, Judith C. BSN, RN, CPHQ; Berman, Loren MD, MHS; Panagos, Patoula G. MD; Sullivan, Kevin M. MD, MBA, FAAP

Advances in Neonatal Care: October 2021 – Volume 21 – Issue 5 – p 379-386 doi: 10.1097/ANC.0000000000000839



Neonates undergoing surgery are at high risk for perioperative hypothermia. Hypothermia has been associated with increased adverse events. Transfer of care from the operating room (OR) to the neonatal intensive care unit (NICU) adds another layer of risk for this population introducing the potential for miscommunication leading to preventable adverse events.


The aim of this quality improvement initiative is to decrease mean postoperative hypothermia rate and achieve compliance with use of a standardized postoperative hand-off in neonates transferred to the NICU from the OR.


An interdisciplinary team identified opportunities for heat loss during the perioperative period. The lack of standardized perioperative communication between the NICU and the OR and postoperative communication between neonatology, anesthesiology, surgery, and nursing were noted. Guidelines for maintaining euthermia in the perioperative period and a standardized interdisciplinary postoperative hand-off communication tool were created.


Mean rate for participation in the hand-off process increased from 78.8% to 98.4% during the study period. The mean hypothermia rate improved from 28.6% to 6.3% (P < .0001) and was sustained.

Implications for Practice: 

Creating a hypothermia guideline and standardizing temperature monitoring can significantly decrease the rate of postoperative hypothermia in neonates. Standardization of transfer of care from OR to NICU increases consistent communication between the services.

Implications for Research: 

Future research and improvement efforts are needed to optimize the management of surgical neonates through their transfers of care.


Nursing Students Create Wearable Night Light

Feb 11, 2021      CBS Pittsburgh

The founders of Lumify Care, Anthony Scarpone-Lambert and Jennifferre Mancillas, have more on the new tool for nurses.

Family-centered music therapy—Empowering premature infants and their primary caregivers through music: Results of a pilot study

Barbara M. Menke, Joachim Hass, Carsten Diener, Johannes Pöschl

Published: May 14, 2021   https://doi.org/10.1371/journal.pone.0250071



In Neonatal Intensive Care Units (NICUs) premature infants are exposed to various acoustic, environmental and emotional stressors which have a negative impact on their development and the mental health of their parents. Family-centred music therapy bears the potential to positively influence these stressors. The few existing studies indicate that interactive live-improvised music therapy interventions both reduce parental stress factors and support preterm infants’ development.


The present randomized controlled longitudinal study (RCT) with very low and extremely low birth weight infants (born <30+0 weeks of gestation) and their parents analyzed the influence of music therapy on both the physiological development of premature infants and parental stress factors. In addition, possible interrelations between infant development and parental stress were explored. 65 parent-infant-pairs were enrolled in the study. The treatment group received music therapy twice a week from the 21st day of life till discharge from hospital. The control group received treatment as usual.


Compared to the control group, infants in the treatment group showed a 11.1 days shortening of caffeine therapy, 12.1 days shortening of nasogastric/ orogastric tube feed and 15.5 days shortening of hospitalization, on average. While these differences were not statistically significant, a factor-analytical compound measure of all three therapy durations was. From pre-to-post-intervention, parents showed a significant reduction in stress factors. However, there were no differences between control and treatment group. A regression analysis showed links between parental stress factors and physiological development of the infants.


This pilot study suggests that a live-improvised interactive music therapy intervention for extremely and very preterm infants and their parents may have a beneficial effect on the therapy duration needed for premature infants before discharge from hospital is possible. The study identified components of the original physiological variables of the infants as appropriate endpoints and suggested a slight change in study design to capture possible effects of music therapy on infants’ development as well. Further studies should assess both short-term and long-term effects on premature infants as well as on maternal and paternal health outcomes, to determine whether a family-centered music therapy, actually experienced as an added value to developmental care, should be part of routine care at the NICU.


Keep Your Brain Young with Music


If you want to firm up your body, head to the gym. If you want to exercise your brain, listen to music.

“There are few things that stimulate the brain the way music does,” says one Johns Hopkins otolaryngologist. “If you want to keep your brain engaged throughout the aging process, listening to or playing music is a great tool. It provides a total brain workout.”

Research has shown that listening to music can reduce anxiety, blood pressure, and pain as well as improve sleep quality, mood, mental alertness, and memory.

The Brain-Music Connection

Experts are trying to understand how our brains can hear and play music. A stereo system puts out vibrations that travel through the air and somehow get inside the ear canal. These vibrations tickle the eardrum and are transmitted into an electrical signal that travels through the auditory nerve to the brain stem, where it is reassembled into something we perceive as music.

Johns Hopkins researchers have had dozens of jazz performers and rappers improvise music while lying down inside an fMRI (functional magnetic resonance imaging) machine to watch and see which areas of their brains light up.

“Music is structural, mathematical and architectural. It’s based on relationships between one note and the next. You may not be aware of it, but your brain has to do a lot of computing to make sense of it,” notes one otolaryngologist.

Everyday Brain Boosts from Music

The power of music isn’t limited to interesting research. Try these methods of bringing more music—and brain benefits—into your life.

Jump-start your creativity

Listen to what your kids or grandkids listen to, experts suggest. Often we continue to listen to the same songs and genre of music that we did during our teens and 20s, and we generally avoid hearing anything that’s not from that era.

New music challenges the brain in a way that old music doesn’t. It might not feel pleasurable at first, but that unfamiliarity forces the brain to struggle to understand the new sound.

Recall a memory from long ago

Reach for familiar music, especially if it stems from the same time period that you are trying to recall. Listening to the Beatles might bring you back to the first moment you laid eyes on your spouse, for instance.

Listen to your body

Pay attention to how you react to different forms of music and pick the kind that works for you. What helps one person concentrate might be distracting to someone else, and what helps one person unwind might make another person jumpy.


Wherever the Art of Medicine is Loved there is also Love of Humanity-Hippocrates

Reflecting on the impact of music therapy on preemie infant survivors and parents highlighted above brings me great joy both as a fellow survivor and a Zumba Instructor. For me music has been a vessel where I am able to tune into feeling emotions internally without the need to express them outwardly or verbally. Learning about the ways in which music therapy may influence the reduction of stressor and physiological development of the parents and preemies is an exciting development.  

The benefits of having therapies like music therapies that allow both the preemies and parents to engage in activities together is empowering. In the many years working as a Zumba fitness instructor, I have witnessed the impact music can have on others. I know for myself it has greatly contributed to my own development as a young child learning to play guitar, and as a teen and adult participating in and teaching Zumba where a variety of international beats is discovered in each class. Likewise, when I have felt uneasy in times of stress and anxiety music has helped me recenter and ground myself in my body. I am thrilled to learn researchers may now have the ability overtime to scientifically measure its tangible impact on the tiny members and parents in our community today.  

My go to music when I am working out and studying is EDM, and for emotional release I may listen to Latin vibes or Alternative pop. What type of music has helped you navigate the waves of your life? Are there songs that aided you along your neonatal community journey? If you are a preemie survivor, I encourage you to consider talking about music with your caregivers/parents. Some interesting stories may be yet to be discovered. 

No surfing in Somaliland but definitely the WAVES to do so.


11/3/2020 by RiyoTv

Hargeisa to berbera somaliland 2020!! beach vlog. 4k drone and GoPro


Peru is a country in western South America. It is bordered in the north by Ecuador and Colombia, in the east by Brazil, in the southeast by Bolivia, in the south by Chile, and in the south and west by the Pacific Ocean. Peru is a megadiverse country with habitats ranging from the arid plains of the Pacific coastal region in the west to the peaks of the Andes mountains extending from the north to the southeast of the country to the tropical Amazon Basin rainforest in the east with the Amazon river.[9] Peru has a population of 33 million, and its capital and largest city is Lima. At 1.28 million km2 (0.5 million mi2), Peru is the 19th largest country in the world, and the third largest in South America.

The sovereign state of Peru is a representative democratic republic divided into 25 regions. Peru is a developing country, ranking 82nd on the Human Development Index, with a high level of human development with an upper middle income level and a poverty rate around 19 percent. It is one of the region’s most prosperous economies with an average growth rate of 5.9% and it has one of the world’s fastest industrial growth rates at an average of 9.6%. Its main economic activities include mining, manufacturing, agriculture and fishing; along with other growing sectors such as telecommunications and biotechnology. Peru ranks high in social freedom; it is an active member of the Asia-Pacific Economic Cooperation, the Pacific Alliance, the Trans-Pacific Partnership and the World Trade Organization; and is considered as a middle power.

Peru has a decentralized healthcare system that consists of a combination of governmental and non-governmental coverage. Five sectors administer healthcare in Peru today: the Ministry of Health (60% of population), EsSalud (30% of population), and the Armed Forces (FFAA), National Police (PNP), and the private sector (10% of population).

In 2009, the Peruvian Ministry of Health (MINSA) passed a Universal Health Insurance Law in an effort to achieve universal health coverage. The law introduces a mandatory health insurance system as well, automatically registering everyone, regardless of age, who living in extreme poverty under Integral Health Insurance (Seguro Integral de Salud, SIS). As a result, coverage has increased to over 80% of the Peruvian population having some form of health insurance. Health workers and access to healthcare continue to be concentrated in cities and coastal regions, with many areas of the country having few to no medical resources. However, the country has seen success in distributing and keeping health workers in more rural and remote regions through a decentralized human resources for health (HRH) retention plan. This plan, also known as SERUMS, involves having every Peruvian medical graduate spend a year as a primary care physician in a region or pueblo lacking medical providers, after which they go on to specialize in their own profession.



Rank: 148 –Rate: 7.3%  Estimated # of preterm births per 100 live births 

  (USA – 12 %, Global Average: 11.1%)


Newborn babies, whose mothers are infected with coronavirus, at the National Perinatal and Maternal Institute. Photograph: Rodrigo Abd/AP

Hidden pandemic’: Peruvian children in crisis as carers die

Mon 16 Aug 2021

With 93,000 children in Peru losing a parent to Covid, many face depression, anxiety and poverty.

When Covid-19 began shutting down Nilda López’s vital organs, doctors decided that the best chance of saving her and her unborn baby was to put her into a coma.

Six months pregnant, López feared she would not wake up, or that if she did, her baby would not be there.

Her partner had already died of the virus, and doctors predicted that López would too.

But whether due to the expertise of the intensive-care unit’s medical team, López’s will to cling to life for her children – or, as she sees it, divine intervention – doctors were able to save the mother and the baby, María Belén, who was three months premature, with an emergency caesarean.

“It really is a miracle of God,” says López, who lives in a settlement of ramshackle wooden and concrete-block houses in the dusty mountains skirting the northern edge of Lima. “Maybe he didn’t want me to die for my kids, so I could continue fighting for them. They are the ones that really need me.”

Mental health in the life of this population is likely to be marked by various breakdowns

The scars remain for López. She has not yet processed the loss of her partner and has to provide for her three children – including 12-year-old twins from a previous marriage – while Covid-19 has impaired her ability to walk.

María Belén, now six months old, is one of an estimated 99,000 children in Peru and 1.6 million globally who have lost a caregiver to Covid-19, according to a study published in the Lancet in July.

Covid-19 orphanhood is a “hidden pandemic”, say researchers. Obscured by the more visible tumult of the pandemic, it is damaging the mental and physical health and economic future of the next generation.

Peru faces a particularly severe crisis. High levels of informal labour, intergenerational housing and poverty have made it fertile ground for the coronavirus. It has recorded 197,000 Covid-19 deaths – the highest number in the world per capita.

By the end of April this year, almost 93,000 Peruvian children – more than one in 100 – had lost a parent, according to the Lancet study.

Experts believe the impact of the pandemic on children has been overlooked as they are usually less badly affected than adults by the illness itself, even though more than 1,000 Peruvian children have died from Covid-19.

Yuri Cutipé, executive director of mental health at Peru’s ministry of health, says: “If we add the loss of a parent or caregiver to the mental health impact of the pandemic in the context of weakening family and community networks and economic shortcomings, mental health throughout the life of this population is likely to be marked by various breakdowns and some complex difficulties.”

Lengthy lockdowns have caused a sharp increase in domestic violence as well as anxiety and depression in children. A third of children in Lima “show a high burden of mental health risk”, according to a study by Peru’s health ministry and Unicef.

Roxana Pingo, coordinator of Save the Children Peru’s (SCP) Covid response programme, says: “Even before you take into account that more than 1,000 children have died from Covid-19 in Peru, they have been extremely affected by depression and anxiety.”

Latin America and the Caribbean had the largest number of children missing school in the world, according to Unicef’s estimates in March. The educational hiatus is accentuating existing chasms in inequality and setting back life prospects for a generation, the UN agency says.

Children try to get a mobile signal during virtual classes in the Puente Piedra shantytown outside Lima. Latin America and the Caribbean have the world’s highest number of children missing lessons. Photograph: Martín Mejía/AP

The pandemic has plunged families who have lost a breadwinner into deeper poverty. López’s partner, a taxi driver, brought in the main wage and she cannot continue her job cleaning at a local college due to her difficulties walking. “We don’t know what to do,” she says. “I don’t see any economic opportunities.”

So many Peruvian families have lost a caregiver that the government approved an “orphan pension” in March. It pays caregivers of children who have lost one or both parents 200 Peruvian soles (£35) a month until the child is 18 years old. “It’s a lifeline,” says López.

But the delivery of pension payments has been slow. For now, López is relying solely on the goodwill of strangers and donations from SCP for food, milk and nappies.

It could take up to six months for a child who has lost a parent to start receiving payments and longer for those who have lost both parents, says Pingo. There are also insufficient funds to cover the programme, so children under five are prioritised.

The sluggish, fragmented response is typical of Peru, says Nelly Claux, SCP’s director of programme impact. The country became a model for child rights in Latin America during the 1990s, thanks to its progressive legislation. But the government often struggles to bring ideas conceived in Lima into reality in the sprawling slums on its periphery or the towns and villages dotted across the Andes.

“We have no lack of legal framework. It’s world-leading,” Claux says. “What we don’t have is cooperation, officials who know what they are doing, and funds.”

An official at a Child Defence Centre (Defensoría Municipal del Niño y el Adolescente or Demuna) told López that many parents and caregivers did not know that they were entitled to the pension. Demuna, a state-funded office that supports children’s rights at a local level, has been distributing flyers at its centres, posting notices on Facebook and going from door to door to raise awareness.

By the end of July, more than 11,000 families were receiving the payment, according to Peru’s ministry for women.

The government estimates that 35,000 children are eligible, which is below the Lancet study’s findings of 99,000. Terre des Hommes, a child development agency, puts that number at 70,000.

Children who lose a caregiver are more likely to be institutionalised in an orphanage or care home, and experience broader short- and long-term adverse effects on their health, safety and wellbeing, say experts.

Girls become more vulnerable to sexual exploitation and boys to illegal mine work. “The Peruvian response must be comprehensive, protecting against damage to mental health, education, exploitation and crime,” says Pingo.

“We know that they are out there and that the quicker we get to them, the more we can help. But we just don’t know where they are. We’ve got to find them.”

Early intervention minimises the impact. But first, they have to find the children. All the while, the list keeps growing. In the week to 10 August, more than 500 Covid deaths were recorded, meaning hundreds more children have likely lost a parent or caregiver.


Respectful Maternity Care and Maternal Mental Health are Inextricably Linked

September 15, 2021 By Sara Matthews

A positive birth experience is not a luxury, but a necessity, said Hedieh Mehrtash, consultant for the Department of Sexual and Reproductive Health and Research at the World Health Organization (WHO), at a panel during the Maternal Mental Health Technical Consultation hosted by the United States Agency for International Development’s (USAID) MOMENTUM Country and Global Leadership, in collaboration with WHO and the United Nations Population Fund

Much is still unknown about the connections between respectful maternity care and maternal mental health outcomes, said Patience Afulani, Assistant Professor at the University of California, San Francisco. Nevertheless, existing research indicates that women who have negative birth experiences are at higher risk of developing post-traumatic stress disorder, postpartum depression, and other perinatal mental health issues. “When women are treated in a way that is responsive to their needs, their preferences, and values; when providers are compassionate and respectful and supportive, a woman feels engaged in their care,” she said. “They feel satisfied. They feel valued. They feel empowered, which promotes positive emotional health.”

There is a complex “cyclic relationship” between respectful maternity care and maternal mental health, said Afulani. For example, due to provider discrimination, women with pre-existing mental health issues may be more likely to have negative birth experiences. Negative birth experiences may also deter women from seeking care in the future, making it less likely that mental health issues will be properly identified and addressed, she said.

Although supporting mothers and parents is incredibly important, “caring for the carers” is also essential, said Mary Ellen Stanton, Senior Maternal Newborn Health Advisor at USAID. Partially due to provider burnout, health care workers often lack the role models, skills, and resources needed to provide the highest standard of respectful care, said Charity Ndwiga, Program Officer III in the Reproductive and Maternal Health Program at the Population Council. When providers are burnt out, they are less able to communicate with and listen to patients. This damages the patient-provider relationship and can worsen health outcomes. In light of this reality, interventions need to target both mothers and providers, said Ndwiga. 

Although supporting mothers and parents is incredibly important, “caring for the carers” is also essential.

Developing measurement tools is a crucial next step, said the panelists. Concerns about the impact of respectful maternity care on maternal mental health outcomes are widespread but evidence remains fairly anecdotal, said Dr. Mary Sando, Chief Executive Officer of the Africa Academy of Public Health. More research will help stakeholders “name and frame” the problem and determine its extent. This knowledge can then be used to develop solutions and inform implementation strategies, she said. For this to happen, research tools need to be consolidated, validated, and standardized, said Mehrtash. Tools must also be critically examined based on the context in which they are being employed, especially given that most mental health instruments were developed in high-income countries and are now being imported to low- and middle-income settings, said Afulani.

Nevertheless, this pursuit of further evidence does not preclude present action, said Afulani. We cannot wait until we have perfect measurement tools in place before beginning to think about the mechanisms driving provider stress and poor maternal outcomes, she said. Instead, stakeholders must recognize the ways in which research and advocacy can support each other and pursue the two in tandem, said Stanton. “Women will tell their stories, while the research provides a growing body of evidence about what works in different environments. That will encourage policymakers and healthcare providers and society at large to tackle these problems with skill, compassion, and respect.”

Learn more about perinatal mental health at the Wilson Center’s Maternal Health Initiative’s upcoming event: Maternal Mental Health: Providing Care and Support in the Perinatal Period


Gravens By Design: Standards, Competencies and Best Practices for Infant and Family Developmental Care in Intensive Care: The Time Has Come

Joy Browne, Ph.D., PCNS, IMH-E(IV)

As evidence mounts to ensure the quality of care for hospitalized infants, and as families become more central to their baby’s caregiving, the time has come for assuring that such data are identified, examined, and standards set for family integration into all aspects of care. Neurodevelopmental and family-centered care now have a scientific base, practical application, and, most importantly, humane caregiving approaches that provide a basis for the development and implementation of neuroprotective standards to intensive care.

Excellence in neonatal care has produced remarkable outcomes in both mortality and morbidity, but optimal neurodevelopmental and social and emotional outcomes for the most vulnerable babies remain elusive. We have learned from basic and developmental science that early nurturing and caregiving impact neurophysiologic and epigenetic outcomes; however, these important findings are only beginning to be fully understood by medical professionals and applied to fragile newborns.

Recent advances in neuroprotection and developmental caregiving have provided significant opportunities to enhance early brain development and subsequent neurodevelopmental outcomes, yet applying those findings in intensive care is inconsistent and spotty at best. Without recognizing the available evidence, application to clinical care, and integration into all aspects of medical and nursing policies and procedures, the potential benefits will be lost. Global recognition of the need for guidelines and standards for developmental care has resulted in the publication of the European Foundation for the Care of Newborn Infants (EFCNI) Standards of Care for Newborn Health

(https://www.efcni.org/health-topics/ in-hospital/developmental-care/) and the Canadian Guidelines for Developmental Care (https://extranet.ahsnet.ca/teams/policydocuments/1/clp-neonatology-devcare-developmental-care-hcs-203-01.pdf). Until recently, the United States has not established standards or guidelines for developmental, family-centered care. Instead, various disciplines and organizations have developed their own expectancies and competencies for intensive care developmental care and family-centered care practices (for example, from NIDCAP, OT, PT, Speech and Parent groups).

In recognizing the need for evidence-based standards, competencies, and practice guidelines for infant and family-centered developmental care, an interprofessional group including representatives from all intensive care practice leading organizations and parents came together in 2015 to begin to determine if evidence for a variety of aspects of developmental care, neuroprotection, and family-centered care warranted identification, development, and publication of standards of care. After review of over 1000 publications, classification of quality of studies, and review by national and international professionals, the Standards, Competencies and Best Practice Guidelines for Infant and Family-Centered Developmental Care (IFCDC) process and articulation were published (1) and made readily available on the web (https://nicudesign.nd.edu/nicu-care-standards/).

Development of the Standards was based on the scientific principles that 1. Baby is an active participant and the primary focus of caregiving, 2. Family as integral and inseparable from the baby, 3. Neuroprotection of the developing brain; 4. Environmental impact, 5. Infant mental health; and 6. Individualized care. These principles can be demonstrated in intensive care only with appreciation for the change process and application to the system in which it is integrated.

The panel additionally identified six content areas that exemplified the aforementioned principles and for which IFCDC is well represented in the literature. The six areas that have ample evidence for the development of standards and competencies for practice include:

• Systems Thinking; • Positioning and Touch; • Sleep and Arousal; • Skin-to-Skin Contact with Intimate Family Members; • Reducing and Managing Pain and Stress in Newborns and Families; and • Feeding, Eating, and Nutrition Delivery.

IFCDC Standards in each content area include measurable competencies, appropriate references, and instruments by which an intensive care professional, administrator, or manager can assess current practice. Additionally, it includes reflective opportunities for improvement of practices, including policy change toward integration into all aspects of intensive caregiving. The evidence is now beyond hearsay and is based on stringent scientific review, so it cannot be relegated to an “add-on practice when the situation is right.”

The panel of professionals agrees that the time has come to become serious about the opportunities that IFCDC affords for optimizing the outcomes of babies and families who experience intensive care at birth, so they not only will survive but thrive. The evidence is based on stringent scientific review, so it cannot be considered “nice but not essential” or an “add-on practice when the situation is right.” The IFCDC standards and competencies are readily accessible and should raise a call to action for intensive care professionals, managers, quality assurance administrators, and families alike.

More information and resources can be found at the website: (https://nicudesign.nd.edu/nicu-care-standards/).

 Reference 1. Browne JV, Jaeger CB, Kenner C. Executive summary: standards, competencies, and recommended best practices for infant- and family-centered developmental care in the intensive care unit. Journal of perinatology : official journal of the California Perinatal Association. 2020;40(Suppl 1):5-10.


Arriba Perú – Daniela Darcourt, Eva Ayllón, Renata Flores, Tony Succar

Premiered Jul 26, 2021   Daniela Darcourt

I really wanted to make a union song, and with that idea in mind, “Arriba Peru” was born. Music is the best language of union. Proof of this is that to my admired Eva Ayllón, as soon as I commented on the idea of ​​the song, she agreed to accompany me on this path and when Renata Flores is added, the sweetness of Quechua and Renata’s enormous interpretive capacity, round off a song of the nos we are all very proud. With the musical direction of Tony Succar, Oscar Cavero and Mudo Venegas, we believe that Arriba Peru manages to express itself in a way that is very exciting for us. A special recognition to the maestro Oscar Cavero, for teaching us so much about our rhythms from the coast and giving this song his unique stamp. I love you dani

Reverting five years of progress: Impact of COVID-19 on maternal mortality in Peru

Camila Gianella, Jorge Ruiz-Cabrejos, Pamela Villacorta, Andrea Castro, Gabriel Carrasco-Escobar (2021)

Bergen: Chr. Michelsen Institute (CMI Brief no. 2021:1) 4 p.

Peru has moved back at least five years on its road to reducing maternal mortality, due to the profound impact COVID-19 has had on the capacity of health services. Our research shows that the health system needs urgent reengineering. Among other things, we recommend including pregnant woman in the COVID-19 risk groups.

Since the early 1990s, Peru has seen a major decline in the maternal mortality ratio. In fact, the country was well on its way to achieving Sustainable Development Goal 3 (SDG3) target 3.1, which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. But the COVID-19 pandemic has led to dramatic setbacks. Peru swiftly implemented strict measures to control the spread of the virus, such as closing borders, restricting freedom of movement nationwide, banning crowds, and closing schools, universities, and churches. It also restricted all non-essential activities or services, including non-emergency primary health services. Despite these actions, it is among the countries with the highest COVID-19 incidence and mortality rates in Latin America and the Caribbean, as well as globally (Johns Hopkins University Coronavirus Resource Center 2020, The Economist 2020). This Brief aims to show the impact that the COVID-19 pandemic has had on the maternal mortality trajectory in Peru.

Maternal health not considered core in COVID response

This analysis contributes to the COVID-19 debate by analysing the pandemic’s direct and indirect impact on maternal mortality in Peru. There are a number of reasons why we focus on maternal mortality. First, in an emergency context where health systems have been put under pressure, it is important to understand what has been prioritised, as well as the different ways in which shutting down essential health services affect different population groups disproportionally. There is an emerging body of literature describing the impact on emergency services, including antenatal and neonatal services (Garrafa, Levaggi et al. 2020, Reinders, Alva et al. 2020). The effect that this has had on health outcomes needs to be understood more thoroughly. Second, the literature describes how maternal mortality indicators are sensitive to the health system’s capacity to provide quality health services, at the primary level, as well as its capacity to refer to complex care. What is more, maternal mortality is sensitive to social inequity and socioeconomic marginalisation. 

Maternal mortality focuses on a group in the population, women, of reproductive age, that in the context of the pandemic has not been identified as a high-risk group by most health authorities, in Peru or worldwide. At the beginning of the pandemic, the main concern around pregnant women was to prevent the exposure of the foetus to the disease. Health agencies did not consider maternal health or mortality risk to be a core issue. Early evidence showed a lower risk for women (grouping all of them and neglecting particular vulnerable groups). Meanwhile, the data collected, mainly from China, and Europe, did not indicate that pregnant women were at higher risk to develop severe symptoms due to SARS-CoV-2. There were almost no reported maternal deaths (Takemoto et al. 2020). Importantly, researchers excluded pregnant women from COVID-19 treatment trials, even when the treatment being evaluated had no or low safety concerns during pregnancy (Taylor, Kobeissi et al. 2020).

Increased risk of maternal deaths

By the end of 2020, evidence was showing that pregnant women were potentially more likely to need intensive care treatment for COVID-19 (Allotey et al. 2020). In addition, conditions related to high-risk pregnancies (such as pre-existing comorbidities, high maternal age, and high body mass index) now seemed to be risk factors for severe COVID-19 (Allotey, Stallings et al. 2020, Zambrano, Ellington et al. 2020). Evidence from low- and middle-income countries that are highly affected by the pandemic, like Iran or Brazil, indicates that there is a possibility of increased risk of maternal deaths due to COVID-19 (Takemoto, Menezes et al. 2020). However, there is still limited information on the effect of the pandemic response on maternal services and maternal health. This is within a context where across the globe, many countries, including middle- and low-income countries, are facing second waves of COVID-19 outbreaks. Therefore, it is important that studies generate evidence to correct COVID-19 responses and protect vulnerable groups of the population. 

As with other health conditions, including COVID-19, maternal mortality is unevenly distributed across Peru. Reports from 2019 show that the Amazon regions of Ucayali, Amazonas, Madre de Dios, and Loreto reported maternal mortality ratios (MMR) that are far above the national indicators (Gil 2018).

The main causes of maternal deaths in Peru are haemorrhage, hypertension (related to eclampsia and pre-eclampsia), and abortion complications. In the case of pregnancy-related death, the causes are suicide, cancer, and respiratory tract infections (Gil 2018, Centro Nacional de Epidemiología Prevención y Control de Enfermedades 2020). In Peru, three out of five maternal deaths occur in the puerperium period (42 days after delivery) (UNFPA 2020). 

Restrictions on preventive and emergency services

Formally, all pregnant women residing in the country have the right to access to antenatal and postnatal health care. In April 2020, Peru’s Ministry of Health (MoH), issued an order to guarantee access to antenatal, perinatal, and postpartum care during the COVID-19 emergency. Yet preventive services, as part of primary health care, were suspended for around two and a half months(Mesa de Consertación de Lucha Contra la Pobreza 2020). Despite the MoH plans, across the country obstetric outpatient services also remained restricted up until the end of 2020(Reinders, Alva et al. 2020, UNFPA 2020). Within the context of COVID-19 second wave, it is still uncertain when the services will be reopened. At the same time, access to emergency health care was also limited for many months due to the absence of health personnel. It has been reported that intensive care units for pregnant women have been reallocated to COVID-19 patients (UNFPA 2020). 

The Ministry of Health has reported an increase in maternal deaths (see Figure 1). However, it is not yet clear how many of these were directly linked to COVID-19 infection and/or as a consequence of lack of timely access to health care. 

Study method and findings

We used the data from the national death registry information system (SINADEF is the Spanish acronym) from 2017 to the 28 November 2020. SINADEF contains individual data on gender, age, district of residence, civil status, insurance, and education at the moment of death, along with the causes of death (direct, underlying, or associated) in ICD-10 codes (World Health Organization 2019). However, 22.72% of registered deaths did not have any cause of death reported. For our analysis, the inclusion criteria for a record to be classified as a ‘maternal death’ was any woman, between the age of 12 and 57 (the oldest reported maternal age by the MoH)(Ministerio de Salud and Centro Nacional de Epidemiología Prevención y Control de Enfermedades 2020), that had at least one cause of death labelled as ‘pregnancy, childbirth and postnatal’, which includes all ICD-10 codes in the range O00–O99. Additionally, a registered death was categorised as a ‘COVID-19 related death’ if at least one of the six causes of death was coded under chapter U07 (ICD-10 code for SARS-CoV-2). After including those that fulfilled these criteria, we selected a total of 442 registered deaths for further analysis. 

Our analysis shows an increase in maternal deaths, from 83 deaths in 2019, up to 146 during 2020 (to November). This is a 75% increase. When adjusted for live births, the increase in maternal mortality ratio (MMR) goes from 17 maternal deaths per 100,000 live births in 2019 to 34 maternal deaths per 100,000 live births. This shows a 102% increase in the data collected by SINADEF. The MMR increased from 62 to 92 when calculated from the MoH totals. This increase represents a major disruption given that maternal mortality in the country had previously reduced two years in a row. 

COVID not the main cause of increase in maternal deaths

Out of the 146 maternal deaths reported in the period included in this analysis, 35 (23.97%) were categorised as COVID-19 cases. The mean age for both groups at the moment of death was similar, with a mean of 31 for COVID-19 cases and a mean of 30 for those for whom COVID-19 was not recorded. The age ranges went form 15 – 45 for COVID cases and 16 – 48 for non COVID cases. 

The data on cause of death indicate that COVID-19 infection was not the main reason behind the increase in maternal deaths. Without the COVID-19 cases, there was an increase of 33% in the number of maternal deaths between 2019 and 2020. Our analysis of causes of death shows that women lacked timely health care. Figure 3 (graph A corresponds to the years 2017–19 while graph B corresponds to 2020), shows an increase on the proportion of cases where preeclampsia/eclampsia appeared as the main, or principal, underlying cause of deaths in 2020. It should be noted that the principal risk factors for death in women with preeclampsia/eclampsia are a lack of prenatal care, associated with chronic hypertension (Amorim, Santos et al. 2001). Lack of antenatal care does not allow timely diagnosis of high-risk pregnancies due to for example preeclampsia. The rise in childbirth complications (including preterm delivery, intrauterine growth restriction, abnormal placenta, detection of congenital malformations, and haemorrhage, among others) also indicates lack of antenatal control for timely diagnosis of some conditions, as well as a lack of access to emergency obstetric care. During the COVID-19 pandemic, health services have been saturated and intensive care units for pregnant women have decreased (UNFPA 2020).

Conclusion and policy recommendations

COVID-19, as a health condition, contributes to maternal mortality. Peru has moved back at least five years on its path to reducing maternal mortality (see Figure 1). Although pre-pandemic trajectories could be recovered once extensive vaccinations have been undertaken, this Brief highlights the weakness of a health system that needs urgent re-engineering to guarantee access to health services to those that require care. 


Following on from this study, the authors make the following recommendations:

  • The need to re-examine COVID-19 risk groups to include pregnant women, and to call governments to develop and implement measures to protect this group of the population from COVID-19 infections. This is especially given that there are valid safety concerns to include pregnant women as priority group for COVID-19 vaccines.
  • That truly comprehensive approaches to pregnant women should be developed. Diseases, such as malaria, have already show the risks that pregnancy creates for women. The health of pregnant women should receive the same level of interest as vertical transmission from the medical community. 
  • In the context of calls for new lockdown measures as a means to control second waves of COVID-19, there is a need to guarantee the provision of essential services such as antenatal care. 
  • It is also important that open data sources inform decisions. SINADEF is a positive example; however, the superposition of different records of death limits the capacity to perform comprehensive analyses. National registers such as SINADEF must include all deaths, including maternal deaths. Some of the weakness of this analysis – for example, the differences between the gross data reported on maternal deaths by the MoH and the data from SINADEF – are rooted in the lack of clarity or omission in the initial reports, and the presence of different overlapping systems. Accurate information on maternal deaths is registered as part of the Surveillance System of the National Center for Epidemiology and Disease Control (CDC-Peru). This information is not open access and is under control of Peru’s Ministry of Health (the team in charge of this study formally asked for access to the information, but the request was not answered). However, as mentioned above, when compared annually, both sources follow a consistent trend. 
  • It is important to assess the impact of COVID-19 pandemic, beyond the number of COVID related deaths. The devastating effects of COVID-19 on health systems are contributing to excess mortality. It is important to understand how this is distributed among the population, which groups are more vulnerable. 



This positive support resource for Preterm Birth Families provides a variety of NICU and Bereavement resources and services. Check them out!

Welcome to Project Sweet Peas


About Us

Project Sweet Peas is a 501(c)3 national non-profit organization coordinated by volunteers, who through personal experience have become passionate about providing support to families of premature or sick infants and to those who have been affected by pregnancy and infant loss.

Project Sweet Peas acknowledges the importance of parental involvement in caregiving and decision-making in the neonatal intensive care unit (NICU), and seeks to promote family-centered care (FCC) competencies in hospitals nationwide. Care packages, hospital events, peer-to-peer support, financial aid, educational materials, and other Project Sweet Peas services, support the cultural, spiritual, emotional, and financial needs of families as they endure life in the NICU.

Project Sweet Peas makes a lifelong commitment to support families experiencing pregnancy and infant loss. In a baby’s last moments, families are encouraged to make cherished memories with custom Project Sweet Peas keepsake items. Healing and remembrance continue to be fostered through programming such as peer-to-peer support, and our annual candlelight vigil.

Through our services, we give from our hearts, to inspire families with the hope of tomorrow.

Source: https://www.projectsweetpeas.com/

Mom’s pandemic pivot helps babies in the NICU

Good Morning America – Jan 13, 2021

After her child underwent heart surgery at 4 months old, Kate Bowen decided to create a line of comfortable clothes for struggling newborns.

Benefits of healthy lifestyle interventions in improving maternal and infant health outcomes


The review reports evidence from meta-analyses on smoking cessation, alcohol reduction, diet and physical activity at reducing the risk of adverse health outcomes. The outcomes vary, yet diet and physical activity appear to be the variables with the most significant impact on maternal and infant health.

Fetal and infant health is related to maternal behaviours during pregnancy. Some adverse pregnancy outcomes such as maternal and perinatal mortality, low birthweight, and preterm birth share common risk factors associated with an unhealthy lifestyle. International guidelines for pregnancy behaviour recommendations exist but need some clarification in some cases like alcohol consumption.

Furthermore, there is a lack of data on recognising similarities or differences between interventions for specific behaviours, which motivated a systematic review of 602 English language meta-analyses published since 2011. The review was set to examine the effectiveness of interventions on improving health-related outcomes for women and infants and explore shared behavioural techniques of those interventions. Pregnant women were the target population for the reviewed papers’ inclusion criteria. As for the intervention, the included papers needed to relate to maternal smoking, alcohol, diet or physical activity behaviours.

At the end of the selection, 332 meta-analyses of maternal health outcomes related to maternal weight, gestational diabetes (GDM), hypertensive disorders, mode of delivery and “others” were analysed. The other 270 meta-analyses presented the infant health outcomes and included fetal growth, gestational age at delivery, mortality and admission to the neonatal intensive care unit (NICU). Moreover, most of the evidence identified with this review was related to diet and physical activity intervention. Unfortunately, there were only two systematic reviews on evidence for smoking interventions and health outcomes, and no reviews on health outcomes from alcohol interventions.

Regarding the outcome itself, physical-activity-only interventions had the most effective impact on maternal health outcomes, reducing GDM. Within the infants’ outcomes, fetal growth and gestational age at delivery were highly impacted. By comparing the behaviours and population subgroups, evidence suggests particular effectiveness of smoking cessation for increasing birthweight. In contrast, diet-only interventions appear most effective at reducing weekly gestational weight gain (GWG). Concerning preterm deliveries, meta-analyses of the effectiveness of diet and physical activity interventions showed a significantly reduced risk of preterm delivery. Other interventions like counselling, feedback, or incentives had no significant effect. Interventions on women with a Body Mass Index (BMI) in the overweight or obese categories had the most considerable GWG and GDM reductions.

Previous reports have shown promising effects of smoking and alcohol interventions at changing maternal health outcomes. This systematic review reports the opposite trend and sets physical activity and diet to be the docking point for improvement. Explanations for the conflicting findings in the meta-analyses might be related to unmeasured factors. It is also worth mentioning that the review’s data gap from lower-middle-income and low-income countries compromises the validity and effectiveness of the interventions strategies globally.

One of the aims of a systematic review of systematic reviews is to describe the current evidence’s extent and gaps to inform future research. There is a clear necessity to conduct further analyses on the benefits of a healthy lifestyle for maternal and infant health outcomes.

Paper available at: MDPI, Journal Nutrients

Full list of authors: Louise Hayes, Catherine McParlin, Liane B Azevedo, Dan Jones, James Newham, Joan Olajide, Louise McCleman and Nicola Heslehurst

DIO: 10.3390/nu13031036

Mom, baby doing great after giving birth on Delta flight to Honolulu with help of doctor, three NICU

May 3, 2021   KHON2 News

It could’ve been a worse case scenario: a woman giving birth to a baby, who arrived early, on an airplane. But a physician and three nurses trained to care for premature babies were on board that same flight — and they did an amazing job to keep mom and baby safe.


COVID-19 Gave Birth to Changes in Neonatal Intensive Care Units

August 20, 2021

Jenny Hayes, MSN, RN, CICMichelle Ferrant, DNP, CNS, RN, RNC-NIC

Testing of the infant of the COVID-19–positive mother requires 2 negative COVID-19 tests 2 days apart. This time delay adds to the challenge of ensuring available isolation beds.

The emergence of the SARS-CoV-2 virus swiftly effected change in every facet of society, with health care delivery being the frontline to the COVID-19 pandemic. This agent of change spared no population. Rapid process changes infiltrated neonatal intensive care units (NICUs) to protect the most vulnerable newborn babies who made their entry into the world during a global pandemic. Just as the virus has adapted to its global host with variant strains, health care delivery in the NICU has adapted with evolving and sustainable practices.

The NICU at the Hospital of the University of Pennsylvania provides care to a level 3 NICU patient population. The American Academy of Pediatrics defines a level 3 NICU as a hospital setting that offers expertise of care providers and specialized equipment needed to provide “comprehensive care for infants born <32 weeks gestation and weighing <1500 g and infants born at all gestational ages and birth weights with critical illness.” Four open bays comprise the 38-bed unit with only 2 negative pressure capable isolation rooms located in 1 of the bays. The NICU includes a separate resuscitation space adjacent to the labor and delivery (L&D) unit with 3 available bed spaces. To adapt to potential census fluctuations, many bed spaces are capable of accommodating overflow and multiple gestation infants in a single-bed space footprint.

Crisis Operations

Operational challenges in the NICU were quickly unveiled with the emergence of COVID-19. Staff illness or exposures to COVID-19 from community and workplace venues resulted in prolonged furlough periods.Severe supply chain shortages in personal protective equipment (PPE) and disinfectant products compounded these operational challenges, prompting conservation and reuse. The NICU was thrust into a crisis capacity mode from a baseline of conventional capacity operations. Unlike other areas of the hospital, the NICU could not reduce admissions or defer scheduled procedures. This prompted emergent planning for contingency operations.

Contingency Operations

To continue safe delivery of care, immediate process changes were developed by a collaborative multidisciplinary team. Expert guidance was enlisted from the NICU and L&D nursing leadership and physician provider teams along with hospital partners from infection prevention and control, lab and pathology services, perioperative services, environmental services (EVS), facilities, and materials management (MM). Internal and external supply chain shortages of disinfectant products prompted EVS and MM to forge a plan to make and distribute disinfectant wipes.

Infection prevention in the NICU begins in the L&D setting. Prior to the availability of universal COVID-19 testing for the antepartum population upon admission, the patient history and physical (H&P) included screening for community exposure to COVID-19 and presence of signs or symptoms of COVID-19 infection. Any positive findings on the H&P resulted in a person under investigation (PUI) for COVID-19 status with laboratory testing to confirm diagnosis.6

Three negative pressure L&D rooms were designated for PUIs or COVID-19–positive patients. An operating room (OR) for cesarean-section deliveries was also designated for this patient population, with terminal cleaning commencing at the end of the case or upon discharge of the patient from the L&D room. A hospital nursing team of subject-matter experts (SMEs) was deployed to enhance PPE training with donning and doffing procedures as well as safe handling of N95 masks that were reused.

An infant who was born to a mother who was a PUI required airborne and contact isolation pending the maternal COVID-19 result. This challenged the limitation of 2 NICU isolation rooms, prompting the conversion of the adjacent open bay to a negative pressure airflow to accommodate a third infant who would require isolation. Precipitous deliveries leave little time for the NICU to prepare for an admission, requiring airborne isolation resources to be in a state of readiness.

The admission of a third patient to the negative pressure bay requires imminent transfer of up to 4 other patients to other locations in the NICU. For this reason, the goal is to preserve this open bay for the most stable patients. Testing of the infant of the COVID-19–positive mother requires 2 negative COVID-19 tests 2 days apart. This time delay adds to the challenge of ensuring available isolation beds.

How to COPE

Because of the highly specialized nature of the neonatal population, the NICU adapted the hospital nursing SME model and implemented a unit specific team of SMEs. This core group of RNs served as trained observers for appropriate donning and doffing of PPE in the delivery room and during the admission and stabilization of the infant in the isolation bed space. This role quickly evolved into a dedicated resource for the interprofessional staff of the NICU. The acronym COPE was coined by a team member,Jennifer Roman, BSN, RN, CBC, to describe the team of COVID-19 operations and patient-care experts. In this role, nurses served as communication liaisons for unit leadership to disseminate the rapid evolution of guidance in the initial wave of the pandemic, which led to rapid process changes.

The COPE team was tasked with remaining knowledgeable on current processes, readily guiding the interprofessional team to unit resources and protocols and providing direct and indirect support to staff. In order to sustain preparedness, the COPE team created specific checklists and supply par levels that are utilized by all staff members to ensure isolation admission spaces are always at the ready. Identifying appropriate supply par levels and paring down admission supplies to the necessities also aided preserving supplies and minimizing waste during the terminal cleaning process of isolation spaces.

This population based SME team allowed for streamlined and systematic information communication to the unit staff members. The COPE team members were able to filter out the overwhelming volume of information being shared hospital-wide, much of which did not pertain to the specialized neonatal patient population, and provide concise, timely, and pertinent information to the neonatal team.

Ongoing assessments of patient and staff safety prevailed as more information about the transmission of SARS-CoV-2 virus and supply chain challenges became available.The interdepartmental collaboration and frequent virtual communications sustained the contingency plans and required resources through the peak of the pandemic, providing a pathway to a new conventional capacity operations model. Increased testing capacity and widespread vaccination for the SARS-Cov-2 virus has alleviated the contingency capacity operations with improved supply chain and decreased staffing burdens.

New Model

Sustained changes in the delivery of care in the NICU have forged new conventional capacity operations in the setting of the COVID-19 pandemic. Negative pressure in L&D rooms is no longer a requirement because updated information became available. A designated OR remains in use for COVID-19 positive patients as intubation may take place. Terminal cleaning procedures follow use of the L&D room or designated OR used for a COVID-19–positive patient. Infant resuscitation continues to be performed in the delivery room or in the OR. Delivery teams for COVID-19–positive patients continue to be limited to essential personnel with N95 masks used in aerosolizing procedures. The responding neonatal team has expanded to include pre-pandemic staff level participation.

Due to the increased potential for a neonate to require an aerosolizing procedure including initial resuscitation steps, neonatal responders continue to utilize N95 masks and viral filters for all neonatal respiratory equipment in L&D. Clean supply carts are maintained outside the room with a “clean” team member to hand off the supplies as needed to the delivery team.A daily checklist for supplies in each NICU isolation room is utilized to ensure capacity for airborne and contact isolation. Universal testing for hospital admissions continues. Visitors and employees are screened for symptoms of COVID-19 infection or exposure to sick contacts upon entry to the facility.

COPE team members continue to provide the necessary emotional support for the interprofessional staff during times of extraordinary stress and anxiety.The team serves as a sounding board for the other staff members and were able to bring forth staff concerns to unit based leadership for discussion and potential solution creation. Having dedicated “experts” who were specific to the unique population and space constrains of the NICU alleviated much of the staff worry, anxiety, and concern related to providing safe patient care. The COPE team continues to support the NICU interprofessional staff and has helped sustain unit readiness throughout several waves of COVID-19.

Other Successes

Surveillance for all hospital acquired infections as required by the state of Pennsylvania continued throughout the pandemic. No central line associated bloodstream infections (CLABSIs) were identified in over 400 days, nor were any other device-associated infections identified. There was no increase in non-device–associated infections. Recent hand hygiene observations conducted by college co-op/volunteer students on all shifts revealed 95% compliance in 175 observations for 1 month.

This infection surveillance data indicates proven success in both contingency and new capacity models, with COVID-19 serving as an agent of change to facilitate improvement in infection prevention.A recently published study demonstrates the increased risk of maternal complications and preterm birth when Covid-19 infection occurs in pregnancy. This is a critical reminder that contingency planning and sustained operations are essential to the needs of our maternal and NICU population. 


Intro to abdominal ultrasound for necrotizing enterocolitis

Video Author: Belinda Chan
Published on: 09.06.2021
Associated with: Advances in Neonatal Care. 21(5):365-370, October 2021

Necrotizing enterocolitis (NEC) can be life threatening and x-ray may miss up to 50% of the early signs of NEC. The use of ultrasound can expedite diagnosis and improve clinical management. This video abstract provides a brief introduction to the use of ultrasound for diagnosis and management of necrotizing enterocolitis.


Being a gift- Multilingual healthcare professionals in neonatal care

Journal of Neonatal Nursing

23 April 2021     KatarinaPatrikssonabStefanNilssondHelenaWigertce



Parents said that they sometimes wished they had a multilingual physician as an interpreter, because the physician would understand the child’s care and treatment and share a language with the parents.


To understand and describe the lived experience of multilingual neonatal healthcare professionals dealing with interpreting in their workplace, performing as interpreters in addition to their regular work.


Interviews with multilingual neonatal healthcare professionals and analysed using a phenomenological reflective lifeworld approach.


Multilingual healthcare professionals understood the interpreting experience as being a gift, comprising three themes: feeling satisfaction – happiness from helping workplace colleagues; identifying with families – empathy from having been in the same situation; and expected to be available – colleagues expected them to provide interpreting services.


This study found that it is common in neonatal care to use multilingual healthcare professionals to interpret communication with parents when language barriers exist.


Stressed Healthcare Workers Face Another Threat: Harassment

by Sophie Putka, Enterprise & Investigative Writer, MedPage Today

September 15, 2021

Healthcare workers across the country, already strained by the demands of caring for COVID-19 patients, face another threat in the workplace: medical conspiracy theorists harassing them with phone calls, and even showing up at their hospitals.

Last week, a Chicago hospital treating known anti-vaxxer and QAnon supporter Veronica Wolski for COVID became the target of such threats.

AMITA Health Resurrection Medical Center reportedly received hundreds of phone calls from Wolski’s followers, demanding she receive alternative medical care, including the antiparasitic ivermectin.

The hospital declined to comment to MedPage Today, but in a statement released to Chicago TV station NBC5, AMITA said it’s following CDC and FDA guidelines in the treatment of COVID-19, and also confirmed earlier this month that it wasn’t administering ivermectin for COVID-19.

Wolski died Monday morning from pneumonia from “novel corona (COVID-19) viral infection” with hypothyroidism, according to a report from the Cook County Medical Examiner’s office.

Fueling the flood of calls to the hospital was a right-wing lawyer, Lin Wood, who harnessed his more than 800,000 Telegram followers with a call to “go to war” against what he called “medical tyranny in our country and around the world,” although he said on his Telegram channel he did not mention ivermectin in connection to Wolski’s treatment. Wood’s message called her death a “medical murder.”

Wolski’s supporters began calling the hospital to complain about her medical care, according to the NBC5 report and Wolski’s Telegram channel.

According to a Freedom of Information officer for Chicago’s Office of Emergency Management and Communications (OEMC), at least nine 911 calls were made related to the incident.

At least one of those calls was from hospital staff on Sunday, who were concerned about an “irate” person who wouldn’t leave the hospital, the officer said.

“Security’s trying to remove them from the location, the person was screaming, people are showing up to the hospital,” the officer said, reading from the call report. “There was a lot going on that day, I guess.”

According to one Telegram user, 20 to 30 cars showed up at Resurrection Hospital.

Other calls, the officer said, were from people calling on Wolski’s behalf, telling dispatchers that the patient was “being held against her will” and that they “wanted to make sure she’s being treated fairly. … There were a bunch of calls about her.”

Though a reporter for the Daily Beast tweeted about police being called “amid bomb threats,” the officer said she didn’t see a record of bomb threats related to the incident. No police reports were filed, according to a representative from the Chicago Police Department.

One of Wolski’s supporters on Telegram wrote in her channel, “The receptionist hung up on me … as soon as I said Veronica Wolski’s name. How freakin rude. We need to start a campaign THAT NO ONE . IF THEY CAN at all HELP it BE ADMITTED TO THAT HOSPITAL.”

Another wrote on September 12, “Resurrection has horrible reception, likely on purpose. Cannot understand menu. CALL POLICE INSTEAD!!!!!!”

Other commenters shared the physical address of the hospital.

With healthcare workers increasingly targeted as misinformation about treatments for COVID-19 swirls, incidents like this one are a cause for concern, experts said.

“We did see a rise in cases of violence and harassment when the COVID-19 pandemic broke out, and such cases continue to this day,” Jason Straziuso, a media representative for the International Committee of the Red Cross, which collected data on violent incidents against healthcare workers related to COVID-19 last year, wrote in an email. “This puts healthcare workers in harm’s way and under increased stress at a time when they are sorely needed, in particular in COVID-19 hotspots.”



Can EEG accurately predict 2-year neurodevelopmental outcome for preterm infants?

Rhodri O Lloyd1,2, John M O’Toole1,2, Vicki Livingstone1,2, Peter M Filan1,2,3, Geraldine B Boylan1,2

Correspondence to Professor Geraldine B Boylan, Department of Paediatrics and Child Health, INFANT Research Centre, University College Cork, Cork T12 DFK4, Ireland; g.boylan@ucc.ie



Establish if serial, multichannel video electroencephalography (EEG) in preterm infants can accurately predict 2-year neurodevelopmental outcome.

Design and patients 

EEGs were recorded at three time points over the neonatal course for infants <32 weeks’ gestational age (GA). Monitoring commenced soon after birth and continued over the first 3 days. EEGs were repeated at approximately 32 and 35 weeks’ postmenstrual age (PMA). EEG scores were based on an age-specific grading scheme. Clinical score of neonatal morbidity risk and cranial ultrasound imaging were completed.


 Neonatal intensive care unit at Cork University Maternity Hospital, Ireland.

Main outcome measures

 Bayley Scales of Infant Development III at 2 years’ corrected age.


Sixty-seven infants were prospectively enrolled in the study and 57 had follow-up available (median GA 28.9 weeks (IQR 26.5–30.4)). Forty had normal outcome, 17 had abnormal outcome/died. All EEG time points were individually predictive of abnormal outcome; however, the 35-week EEG performed best. The area under the receiver operating characteristic curve (AUC) for this time point was 0.91 (95% CI 0.83 to 1), p<0.001. Comparatively, the clinical course AUC was 0.68 (95% CI 0.54 to 0.80, p=0.015), while abnormal cranial ultrasound was 0.58 (95% CI 0.41 to 0.75, p=0.342).


 Multichannel EEG is a strong predictor of 2-year outcome in preterm infants particularly when recorded around 35 weeks’ PMA. Infants at high risk of brain injury may benefit from early postnatal EEG recording which, if normal, is reassuring. Postnatal clinical complications can contribute to poor outcome; therefore, we state that a later EEG around 35 weeks has a role to play in prognostication.


Association of Blood Donor Sex and Age With Outcomes in Very Low-Birth-Weight Infants Receiving Blood Transfusion

Ravi M. Patel, MD, MSc1Joshua Lukemire, PhD2Neeta Shenvi, MS2; et alConnie Arthur, PhD3,4Sean R. Stowell, MD, PhD3,4,5Martha Sola-Visner, MD6Kirk Easley, MApStat2John D. Roback, MD, PhD3,4Ying Guo, PhD2Cassandra D. Josephson, MD3,4

Original Investigation  Pediatrics  September 3, 2021

JAMA Netw Open. 2021;4(9):e2123942. doi:10.1001/jamanetworkopen.2021.23942

Key Points


 Is the sex or age of a blood donor associated with morbidity or mortality in very low-birth-weight infants receiving blood transfusion?


In this cohort study of 181 very low-birth-weight infants at 3 centers, infants receiving red blood cell transfusion from female donors had a lower risk of death or serious morbidity compared with those who received transfusion from male donors. The protective association between female donor and adverse outcomes increased with increasing donor age, but diminished with increasing number of blood transfusions.


These findings suggest that characteristics of blood donors, such as sex and age, may be associated with recipient outcomes in very-low-birth weight infants receiving blood transfusions.



  There are conflicting data on the association between blood donor characteristics and outcomes among patients receiving transfusions.


 To evaluate the association of blood donor sex and age with mortality or serious morbidity in very low-birth-weight (VLBW) infants receiving blood transfusions.

Design, Setting, and Participants  

This is a cohort study using data collected from 3 hospitals in Atlanta, Georgia. VLBW infants (≤1500 g) who received red blood cell (RBC) transfusion from exclusively male or female donors were enrolled from January 2010 to February 2014. Infants received follow-up until 90 days, hospital discharge, transfer to a non–study-affiliated hospital, or death. Data analysis was performed from July 2019 to December 2020.


Donor sex and mean donor age.

Main Outcomes and Measures 

 The primary outcome was a composite outcome of death, necrotizing enterocolitis (Bell stage II or higher), retinopathy of prematurity (stage III or higher), or moderate-to-severe bronchopulmonary dysplasia. Modified Poisson regression, with consideration of covariate interactions, was used to estimate the association between donor sex and age with the primary outcome, with adjustment for the total number of transfusions and birth weight.


In total, 181 infants were evaluated, with a mean (SD) birth weight of 919 (253) g and mean (SD) gestational age of 27.0 (2.2) weeks; 56 infants (31%) received RBC transfusion from exclusively female donors. The mean (SD) donor age was 46.6 (13.7) years. The primary outcome incidence was 21% (12 of 56 infants) among infants receiving RBCs from exclusively female donors, compared with 45% (56 of 125 infants) among those receiving RBCs from exclusively male donors. Significant interactions were detected between female donor and donor age (P for interaction = .005) and between female donor and number of transfusions (P for interaction < .001). For the typical infant, who received a median (interquartile range) of 2 (1-3) transfusions, RBC transfusion from exclusively female donors, compared with male donors, was associated with a lower risk of the primary outcome (relative risk, 0.29; 95% CI, 0.16-0.54). The protective association between RBC transfusions from female donors, compared with male donors, and the primary outcome increased as the donor age increased, but decreased as the number of transfusions increased.

Conclusions and Relevance

 These findings suggest that RBC transfusion from female donors, particularly older female donors, is associated with a lower risk of death or serious morbidity in VLBW infants receiving transfusion. Larger studies confirming these findings and examining potential mechanisms are warranted.


New research on preventing infant deaths due to neonatal sepsis

  Aug 10, 2021

Information about the most effective antibiotics to use in low and middle income countries (LMICs) for neonatal sepsis has been discovered uniquely combining epidemiological, genomic and pharmacodynamic data. The research could be applied to potentially save many lives globally by increasing the effective treatment – currently neonatal sepsis causes an estimated 2.5 million infant deaths annually. This research also highlights economic issues, specifically regarding treatment costs and other barriers to treatment.

The research published today in The Lancet Infectious Diseases, combined microbiology, genomic, epidemiological, pharmacodynamic and economic data for the first time to study the efficacy of various antibiotic treatments for neonatal sepsis in seven Low- and Middle- Income Countries (LMICs) across Africa and South Asia. This research was done by an international network led by the microbiologists at the Division of Infection and Immunity, Cardiff, in collaboration with researchers at the University of Oxford, the paper proposes alternative antibiotics for septic neonates which could drastically decrease new-born mortality. 

This research, funded by the Bill and Melinda Gates Foundation, studied over 36,000 infants over seven countries, making it the largest study of its kind. Data was procured by Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS), a project run by Professor Tim Walsh, which collected data across seven countries between April 2015 and March 2018. Prof. Walsh joined the University of Oxford in 2021 to help established the Ineos Oxford Institute of Antimicrobial Research. BARNARDS collected data from Nigeria, Pakistan, Bangladesh, Rwanda, South Africa, Ethiopia, and India, allowing researchers to have a vast amount of data to analyse. 

Neonatal sepsis causes an estimated 2.5 million infant deaths annually, with LMICs in sub-Saharan Africa and Asia having the highest mortality rates. These countries often have reduced access to resources such as laboratory facilities to assess what sepsis-causing pathogens are present, and to discover more about associated antimicrobial resistance. 

The World Health Organisation recommends the use of ampicillin and gentamicin for the empirical treatment of neonatal sepsis. Whilst these may be effective in Higher Income Countries (HICs), there has long been speculation that they were less effective in LMICs due to different levels of antibiotic resistance and variation in common pathogens. 

Researchers discovered that some sites are already using different antibiotics to those endorsed by the WHO, due to high resistance against these antibiotics. Those prescribed the recommended combination of ampicillin and gentamicin had a survival rate of 75% over 60 days. Conversely, where those prescribed ceftazidime and amikacin had a survival rate of over 90% over the same time period.

Previous research found that globally an estimated 214,000 neonatal sepsis deaths are attributable to resistant pathogens each year, so changing the recommendations to ceftazidime and amikacin could drastically reduce this number.

These findings will lead to additional follow-up studies; not least, intervention studies related to treatment and ensure that sepsis is treated with appropriate antibiotics and Infection Prevention and Control practices. 

The study also investigated the frequency of resistance to various antibiotics, which shows how frequently resistance may arise in susceptible bacteria against different antibiotics. Whilst varied antibiotics have been suggested for neonatal sepsis, this is the first study that has incorporated frequency of resistance data, allowing insight into how quickly a certain antibiotic could become redundant following extensive use, if selected as an alternative, allowing for more accurate recommendations on which antibiotics to be used.

Lead author Kathryn Thomson says, ‘Extremely high resistance (>97%) was found against ampicillin in Gram-negative sepsis causing isolates analysed from BARNARDS sites. Furthermore, only 28.5% of Gram-negative isolates were susceptible to at least one of the combined antibiotic therapy of ampicillin and gentamicin. While this may be a suitable empirical treatment for neonatal sepsis in high income countries, this data showcases that it is not an effective option for LMICs, who have different common pathogens and vastly increased resistance against these antibiotics. Many LMIC sites depend on recommended therapies, due to a lack of microbiology facilities to detect common species or resistance profiles. Therefore, further work is urgently needed to improve the sparsity of data in LMICs regarding prevalence and AMR in neonatal sepsis, a major contributor to neonatal mortality and to determine more effective alternative empirical treatments, taking affordability into account.’

The other factor investigated in this study is economic impact on antibiotic use. The study examined the average earnings of people in LMICs. This was used to contextualise the impact of antibiotic costs on the average person, by comparing average wages with the vast discrepancies in costs of certain antibiotics in different countries. For example, piperacillin-tazobactam costs $2.60 per day in India, which is a massive 76% of the average daily wage. By contrast, it costs $20 a day in Nigeria, representing between 219% and 741% of the average daily wage depending on the area of the country.

The economic data raises questions about who should be responsible for costs of antibiotic treatment, given that more effective alternative antibiotic treatments are often inaccessible in LMICs due to lack of universal healthcare. When asked, six of the seven countries studied stated that the cost of antibiotics influenced which are prescribed. This is shown by the continued wide use of ampicillin and gentamicin, as they are consistently the most affordable antibiotics, despite being considered less effective than other antibiotic regimes for some time now. 

Professor Tim Walsh says, ‘Whilst this study uniquely combined sets of data to help address critical issues around the treatment of neonatal sepsis in LMICs, this study also highlighted gaps and the need for further critical data; not least, how the accessibility and cost of antibiotics impacts on therapeutic treatments and outcomes. The newly established IOI is committed to undertake such studies and establish new and dynamic international networks to provide the rigor of data that will hopefully further our understanding and address one of the most pressing issues in a critical patient population across LMICs.’ 

This raises the ethical dilemma of how to maximise the number of lives saved whilst minimising the economic burden on both the patient and the state.

Follow-up studies will be undertaken by the newly formed Ineos Oxford Institute at the University of Oxford, which will focus on new drug development for both human health and replacement of clinically relevant antibiotic use in agriculture, in addition to studying antibiotic resistance and ways of promoting more responsible and effective uses of antibiotics. 


This month’s recommended resource for personal awareness (a look inside):

Guided Sleep Meditation, Manifest In Your Sleep Spoken Meditation with Sleep Music and Affirmations

Aug 22, 2021                Jason Stephenson – Sleep Meditation Music

A guided sleep meditation to help you manifest your dreams in your sleep. Includes affirmations and sleep music. For a comforting sleep, download your FREE guided sleep meditation!

Trucking Through 2021 – Hello Heroes! 

As nature moves into the Fall season, I am reminded of the importance of finding balance within the transitions life brings our way.   

Immersed in a world experiencing long, ongoing, and unpredictable pandemic challenges I seek to increase my engagement in learning ways to better support the health and wellness of myself and others.   

Many preemies, I included, have a history of being taken care of.  We may feel challenged at times to trust our own intuition, experience, and education to secure our individual and unique self-care capacities and confidence. Awareness and effort are required in order to build and sustain a dynamic foundation of self-care. In other words, let’s take it on!  

My challenges towards managing my own health and well-being include my tendencies to detach from how I am feeling, and “freezing” when I feel I am over-stimulated. This makes sense considering the types of touching and often a lack of positive touch a preterm baby may experience. We had/have no control over our environment and were/are not able to “defend” ourselves from painful physical encounters. The stress/anxiety reactions of detachment and “freeze” are developmental. In order to transition these reactions, we have the responsibility and opportunity to choose to do the work required to gain conscious control. Because there are not strong protocols or treatment resources developed specifically for our community at this time, we need to and can explore, identify,  and engage in positive behavioral and personal development activities.   Be your own sleuth in this regard.

The sun rising over London at 6 AM  beckons  a new day. My morning sanctuary, the Thames River, is a runner’s paradise. Here, I experience my strength and fragilities, the beauty and wonder of an everchanging horizon, and the complexities, creativities, and unpredictable characteristics of mankind.   When I run, I experience me.  As I meditate, I see deeper aspects of  myself and create broader capacities for change. When do you most feel present with yourself?

The Hero within us lies in the small actions we take each day to be authentically present within ourselves and the world around us. We are Warriors.

Surfing Ancient-Style Surfboards In Peru w/Red Bull team

Red Bull Surfing
– Jun 1, 2010

Originally used by fishermen, the caballitos de Totora original surfboards are a versatile tool to navigate the waters of Peru. Sofia Mulanovich together with world-class surfer Sally Fitzgobbons and junior Nadja de Col exchanged their boards for the ancient type to test the surfing quality of these Peruvian boats that have thousands of years of history.

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