WEARABLES,  CLIMATE, SNUGGLES, OT

PHILIPINNES

PRETERM BIRTH RATES – PHILLIPINES

Rank: 12  –Rate: 14.9%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

The Philippines is an archipelagic country in Southeast Asia. It is situated in the western Pacific Ocean and consists of around 7,641 islands that are broadly categorized under three main geographical divisions from north to south: LuzonVisayas, and Mindanao. The Philippines is bounded by the South China Sea to the west, the Philippine Sea to the east, and the Celebes Sea to the southwest. It shares maritime borders with Taiwan to the north, Japan to the northeast, Palau to the east and southeast, Indonesia to the south, Malaysia to the southwest, Vietnam to the west, and China to the northwest. The Philippines covers an area of 300,000 km2 (120,000 sq mi) and, as of 2021, it had a population of around 109 million people, making it the world’s thirteenth-most populous country. The Philippines has diverse ethnicities and cultures throughout its islands. Manila is the country’s capital, while the largest city is Quezon City; both lie within the urban area of Metro Manila.

The Philippines is an emerging market and a newly industrialized country whose economy is transitioning from being agriculture-centered to services- and manufacturing-centered. It is a founding member of the United NationsWorld Trade OrganizationAssociation of Southeast Asian Nations, the Asia-Pacific Economic Cooperation forum, the East Asia Summit and a member of the Non-Aligned Movement since 1993. The Philippines’s position as an island country on the Pacific Ring of Fire that is close to the equator makes it prone to earthquakes and typhoons. The country has a variety of natural resources and is home to a globally significant level of biodiversity.

There were 101,688 hospital beds in the country in 2016, with government hospital beds accounting for 47% and private hospital beds for 53%. In 2009, there were an estimated 90,370 physicians or 1 per every 833 people, 480,910 nurses and 43,220 dentists. Retention of skilled practitioners is a problem. Seventy percent of nursing graduates go overseas to work. As of 2007, the Philippines was the largest supplier of nurses for export. The Philippines suffers a triple burden of high levels of communicable diseases, high levels of non-communicable diseases, and high exposure to natural disasters.

There is improvement in patients access to medicines due to Filipinos’ growing acceptance of generic drugs, with 6 out of 10 Filipinos already using generics. While the country’s universal healthcare implementation is underway as spearheaded by the state-owned Philippine Health Insurance Corporation, most healthcare-related expenses are either borne out of pocket or through health maintenance organization (HMO)-provided health plans. As of April 2020, there are only about 7 million individuals covered by these plans.

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

This month’s blog embraces the Philippines, our 71st country-focused blog. Throughout our journey you have inspired and amazed us, touched our hearts and fueled our imaginations. We have explored the breadth of our associations, witnessed the global diversities, similarities, needs, barriers, challenges and resources present within our Preterm Birth community. Kat and I began our journey with eyes wide open, minds full of curiosity, hearts wary yet open, following an unseen but deeply compelling call to serve the Community in some guided capacity.  We always knew we would receive more than we could ever give. We appreciate and thank you for who you are and your presence in our lives. Within your eternal perfection, such goodness, strength and love abide.

COMMUNITY

Socioeconomic Disparities in Adverse Birth Outcomes in The Philippines

Ryan C.V. Lintao Erlidia F. Llamas-Clark Ourlad Alzeus G. Tantengco Open Access Published: April 10, 2022DOI:https://doi.org/10.1016/j.lanwpc.2022.100453

Kaforau et al. reported the burden of adverse birth outcomes and their risk factors in the Pacific Islands region. Preterm birth prevalence was 13.0%, while low birth weight was 12.0%. Malaria, substance use, obesity, and poor antenatal care were the most significant risk factors associated with adverse birth outcomes.

 The Philippines, a lower-middle-income country in the Asia Pacific, continues to experience challenges in addressing adverse birth outcomes. We share the status and the socioeconomic disparities in adverse birth outcomes in the Philippines.

The latest health survey in 2017 showed a 3.0% preterm birth rate in the Philippines.

 Low birth weight (LBW) incidence was 11.9% in 2020.

 Moreover, in a newborn screening cohort from 2015 to 2016, 13.6% were small-for-gestational age.

 Increased antenatal care utilization, essential newborn care, and kangaroo mother care have decreased adverse birth outcomes and neonatal mortality.

 However, health inequalities prevail in the Philippines.

Despite no difference in LBW incidence between urban and rural areas, regional disparities exist. The national capital region, Metro Manila, had the lowest LBW rate (9.0%), while two regions in the southern Philippines had the highest LBW rates (Davao at 20.0%, and Zamboanga at 21.0%).

 Smokers were more likely to have LBW newborns (21.0%) than nonsmokers (14.0%), agreeing with Kaforau and colleagues findings. A cohort study examining maternal second-hand smoke (SHS) exposure showed significantly lower birth weight in the SHS-exposed group.

Pregnant women exposed to SHS had higher parity, lower educational attainment, and lower monthly household income.

Socioeconomic status and its proxy variables (e.g., educational attainment, household income, and occupation) were shown to affect birth outcomes in the Philippines. LBW incidence decreased with higher maternal educational attainment, with 17.7% of mothers who reached primary school level and 12.5% of mothers who reached college level having LBW newborns. Household wealth was a significant determinant of LBW: mothers in the lowest wealth quintile had higher LBW incidence (16.0%) than mothers in the highest quintile (12.5%).

With increasing socioeconomic inequality exacerbated by the ongoing pandemic, underlying social determinants must be recognized and addressed. We call for more research to investigate the country’s social determinants of adverse birth outcomes, which can be used as the basis for evidence-based policies and health services to improve maternal and neonatal outcomes. We also emphasize the need for good governance, gender equality, and equitable access to women’s and reproductive health services (antenatal care, basic emergency obstetric and neonatal care, and family planning) to reduce widening disparities in adverse birth outcomes.

Source:Socioeconomic disparities in adverse birth outcomes in the Philippines – The Lancet Regional Health – Western Pacific

Magnus Haven – Oh, Jo (Official Music Video)

Premiered Jun 26, 2022  Magnus Haven

Jo is a term of endearment among Kapampangans, which means special someone. So the love song pays tribute to that “Jo” or special someone. A statement of love echoing the romantic joy that that “Jo” brings to her partner’s life.

Pregnancy becomes a more vulnerable time with climate change

Wildfires, natural disasters, rising heat can lead to poor health outcomes for the expectant and their babies – By Katherine Kam – April 11, 2022

In the western United States, where massive wildfires have fouled the air with smoke and hazardous levels of pollutants, Santosh Pandipati, an obstetrician in California, counsels pregnant patients to always check air quality before they venture outside to exercise. “You need to plan your outdoor activities when the air quality is better,” he tells them.

In other parts of the country, where hurricanes and floods have displaced pregnant residents, obstetrician Nathaniel DeNicola has advised patients, including those he saw in New Orleans, to pack a preparedness kit.

In case of evacuation, “they might be away from home for a long time,” he said. DeNicola encourages people to include emergency drinking water, extra supplies of medications and a paper copy of their medical records. “If the power’s out, that’s not typically available” now that most records are electronic, he said.

As scientists study how climate change is affecting human health, pregnant people and their unborn babies are emerging as a vulnerable group.

Those who must evacuate during natural disasters are often extremely distressed and might find their pregnancy health care interrupted. “If you have to flee, how do you make sure you continue to have access to your OB/GYN or to the hospital you plan to deliver in?” said Pandipati, who has seen patients who have escaped wildfires. “If you end up needing to go live with family an hour or two hours away, you have a disruption in care.”

Pregnancy & Parenthood

It doesn’t take a catastrophe to create problems. Ongoing exposure to hot temperatures and air pollution might raise the risk of adverse pregnancy outcomes, such as preterm birth and low birth weight.

About 7,000 California preterm births linked to wildfire smoke risks, study says

Spurred by growing evidence on climate-related effects, Pandipati and DeNicola have tailored their medical advice, not to alarm people, but to prepare them. “The reality is that we need to start telling our patients right now that the climate is changing,” Pandipati said. “We need to empower patients.”

In 2016, the American College of Obstetricians and Gynecologists issued a position statement on climate change, calling it “an urgent women’s health concern and a major public health challenge.

Air pollution and heat exposure

Amid widespread changes wrought in the environment, air pollution and heat exposure have been significantly associated with preterm birth, low birth weight and stillbirth in the United States, according to a 2020 review published in JAMA Network Open. Such exposures are becoming increasingly common, according to the paper.

DeNicola, an obstetrician at the Johns Hopkins Health System in Washington, was one of the review’s co-authors.

Exposure to high temperatures can cause dehydration. During pregnancy, dehydration can lead to the release of oxytocin, a hormone that contributes to labor contractions, he said. “The extreme heat could very well be causing an increase in that mechanism,” DeNicola said. “It’s revved up.”

If labor occurs and a baby is born before 37 weeks, it’s a preterm birth, compared with a normal pregnancy of 40 weeks. Some of these newborns may have immature organ systems and experience trouble with breathing, feeding and regulating body temperature. Long term, premature babies might develop other problems, including learning disabilities and hearing or vision problems. The more premature the baby, the more serious the health risks.

Racial disparities in exposure

In the JAMA study, women of all races were at increased risk for poor pregnancy outcomes when exposed to heat and air pollution, but disparities emerged. Black women consistently had the highest risks of preterm birth and low birth weight, said Rupa Basu, an epidemiologist who also co-wrote the JAMA study. She is chief of the air and climate epidemiology section at the California Office of Environmental Health Hazard Assessment.

Because of historical redlining, higher-risk communities might be exposed to more pollution from sources such as freeways, she said. Residents may also dwell within “heat islands,” urban locations that have higher temperatures than outlying areas. “There’s less green space and more buildings and cement and blacktops to really absorb and retain the heat,” Basu said.

Anecdotally, Pandipati said he has seen the effects of heat waves on his patients, some of whom work in agriculture. He consults on high-risk pregnancies as a maternal and fetal medicine specialist with Obstetrix of San Jose. Some women travel to the Bay Area clinic from as far away as California’s Central Valley.

During one record-breaking heat wave before the pandemic, Pandipati noticed many ultrasounds with low levels of amniotic fluid in the womb — a situation that might require doctors to deliver a baby early. “These were moms who were saying that they don’t always have access to air conditioning, they’re often working more manually, either in agriculture or manual labor-type jobs, not always able to stay hydrated adequately,” he said. “I was starting to wonder, wow, I think this is really from the heat waves that we’re experiencing.”

“We just kept monitoring these pregnancies and then things just turned around and the fluid improved. They turned around as the heat wave dissipated,” he said. “We didn’t have to end up delivering them early.”

Air pollution and poor pregnancies

Air pollution, whether from urban pollutants or wildfires, has also been linked to poor pregnancy outcomes.

Air pollution affects preterm birthrates globally, study finds Wildfire pollution may have contributed to as many as 7,000 additional preterm births in California between 2007 and 2012, according to a study that Stanford researchers published in 2021. Wildfire smoke contains fine particulate matter called PM 2.5, which can enter the lungs and bloodstream to create serious health problems. The researchers hypothesized that wildfire pollution might have triggered an inflammatory response that led to preterm delivery.

Weather disasters and mental health

There’s debate about whether human-caused climate change is producing stronger or more frequent hurricanes. But Hurricane Sandy, which struck New York and New Jersey particularly hard in 2012, offered a glimpse into how such devastating superstorms can place severe stress on pregnant people.

In a 2019 study that looked at pregnancy complications in New York after Sandy, researchers found a heightened risk of problems such as early delivery and mental illness. The latter peaked about eight months after the hurricane. In the aftermath of community disasters, post-traumatic stress disorder, depression and anxiety can develop.

Natural disasters trigger a cascade of health consequences, DeNicola said. While there may not be direct cause and effect on birth outcomes, “a lot of it is considered to be because of the stress of the event, either the stress of evacuation or the stress of difficulty getting potable water, the stress of maybe not having the typical indoor living conditions that you’re expecting,” DeNicola said. “You’re not having heat or not having air conditioning.”

“There are a number of physical stressors and psychosocial stressors that come with bracing for a natural disaster like a hurricane and an evacuation,” he said. “People posit, and I think it’s a reasonable concern, that that all prompts some kind of cascade in pregnancy that creates things like preterm contractions.”

A safer pregnancy

Both obstetricians routinely talk to their patients about air and water.

“You need more hydration in pregnancy in general. A woman’s blood volume will increase roughly 50 percent during pregnancy,” DeNicola said. “That’s a lot of extra volume to maintain, so hydration’s really important anyway. I make the extra point that as the seasons get hotter, which happens more often now, you’ll need even more hydration and you need to be aware of things like preterm contractions that are prompted by extreme heat and dehydration.”

Pandipati said he warns patients to watch out for heat waves and to keep an eye on the air quality index, too.

“Ideally, 1 to 50 is good air quality. If you’re starting to get up into the 50 to 100 range, you need to start modifying your activities, doing less outdoor exercise, not as long, not as hard,” he said. “If you’re already not feeling well, you’re coughing, you already have respiratory illness, you shouldn’t be out there.”

Such illnesses include asthma, respiratory allergies and other chronic lung conditions, Pandipati said.

“By the time the AQI is 100, you need to just exercise indoors,” he said. “You need to plan your outdoor activities when the air quality is better, so usually, very early in the morning.” Air quality over 100 begins to enter the unhealthy range.

During wildfires, those who are pregnant must be especially careful about spending time outside, DeNicola said. “During covid, we all wear masks for everything, so it’s kind of redundant,” he said, “but I do mention that wearing a mask is advised and to really limit outdoor activity.”

Basu, the epidemiologist, has advocated for pregnant people to be included in heat advisories. “There are still a lot of heat advisories that don’t include pregnant women, but include other groups, such as the elderly,” she said. Many heat advisories also mention children, people with illnesses, even pets, but not pregnant people.

A natural experiment

A few pregnant patients have asked DeNicola about environmental concerns, but that small number is increasing, he said.

“I have had patients ask about where they should buy their new home because they heard that if you live near coal power plants, that could create worse air quality,” he said. “I’ve had them say similar things related to homes near a highway.”

Pandipati talks to fellow doctors about slipping climate change into the conversation naturally, for instance, while talking about outdoor exercise or staying hydrated during pregnancy. He tells doctors, “You don’t need to be an expert on climate emissions,” he said. “What you need to understand is that those emissions are leading to environmental changes that are now measurably increasing risks to the patients you care for.”

When DeNicola speaks to health-care professionals, he often mentions “a really strong natural experiment,” he said.

Researchers studied preterm birthrates before and after eight coal and oil power plants in California were retired. When the plants shuttered, pollution levels fell. In the 10 years following the closures, the rate of preterm births in the neighboring communities dropped 27 percent, a larger-than-expected reduction.

“When you knock out air pollution over a good 10-year period, the preterm birthrate dropped in a way that no other intervention can achieve,” DeNicola said. “It gives us a bit of hope.”

Doctors can start discussing climate change with pregnant patients, but in the long run, the solutions are much bigger, Pandipati said. “We need to be ensuring that we are enacting policies that stabilize or improve the environment, that really don’t neglect the science.”

“We’ve got to address the problem at the source,” he said. “That’s the real, ultimate preventive care.”

Source:https://www.washingtonpost.com/health/2022/04/11/climate-change-pregnancy-health-babies/

Chemicals Found in Cosmetics, Plastics Linked to Preterm Delivery

July 14, 2022

THURSDAY, July 14, 2022 (HealthDay News) – Phthalates, chemicals that are typically used to strengthen plastics, are in millions of products people use every day, but a new analysis confirms their link to a higher risk for preterm births.

The largest study to date on the topic analyzed data from over 6,000 pregnant women in the United States to better understand the link between phthalate exposure and pregnancy. It found that women with higher concentrations of phthalates in their urine were more likely to deliver preterm babies. Preterm babies, by definition, are delivered three or more weeks before their due date.

“Having a preterm birth can be dangerous for both baby and mom, so it is important to identify risk factors that could prevent it,” said senior study author Kelly Ferguson, an epidemiologist at the U.S. National Institute of Environmental Health Sciences (NIEHS).

For the study, the researchers pooled statistics from 16 studies conducted across the United States that included data on individual phthalate levels as well as the timing of the mothers’ deliveries, with the data spanning from 1983 to 2018. Approximately 9% (or 539) of the women delivered premature babies, with phthalate byproducts detected in over 96% of those urine samples.

The study, published online July 11 in JAMA Pediatrics, examined 11 different phthalates found in the pregnant women, and discovered that four of them were associated with a 14% to 16% greater probability of having a premature baby. The most consistent exposure was linked to a phthalate found commonly in nail polishes and other cosmetics.

“It is difficult for people to completely eliminate exposure to these chemicals in everyday life, but our results show that even small reductions within a large population could have positive impacts on both mothers and their children,” first study author Barrett Welch, a postdoctoral fellow at NIEHS, said in an institute news release.

The effort could be worth it: Reducing the level of phthalates exposure by 50% could prevent preterm births by 12%, on average, the researchers said. The interventions focused on specific changes, such as choosing phthalate-free personal care products, companies reducing the number of phthalates in their products on their own or changing regulations that would reduce exposure to these chemicals.

In the meantime, the researchers suggested avoiding processed food or food wrapped in plastic, instead opting for fresh, home-cooked meals. They also recommended choosing fragrance-free products, which are lower in phthalates. Limiting the amount of product used can also lower exposure.   More information:

Visit the U.S. Centers for Disease Control and Prevention for more on phthalate exposure.

SOURCE: NIH/National Institute of Environmental Health Sciences, news release, July 11, 2022 https://consumer.healthday.com/b-7-14-chemicals-found-in-cosmetics-plastics-linked-to-preterm-delivery-2657652790.html

HEALTHCARE PARTNERS

Forced Retirement Spotlighted as Risk Factor for Physician Suicide

Also time to do away with the “myth of the never-ill physician,”study author says by Shannon Firth, Washington Correspondent, MedPage Today July 5, 2022

Systemic support systems need to be implemented for physicians to prevent work-related stressors that could lead to suicide, a thematic analysis of 200 physician deaths suggested.

Among physician suicides included in the National Violent Death Reporting System database from 2003 to 2018, six themes were found to precede such deaths, including inability to work due to physical health, substance use, mental health issues, relationship conflicts, legal problems, and increased financial stress, all leading to work-related stress, reported Kristen Kim, MD, of the University of California San Diego, and colleagues.

The results further suggested that suicide risk is associated with premature retirement due to health issues that affect employment, they noted in Suicide and Life-Threatening Behavior.

Among 200 physician death narratives, nearly all that reported earlier-than-expected retirement were linked to a physical ailment, Kim told MedPage Today, including a surgeon with a tremor, a physician with dementia, and a physician with alcohol and prescription drug use problems who had lost hospital privileges.

Investigations by state medical boards, employers, and law enforcement were also common in the narratives, and a re-examination of the data found that a majority of the physicians who died by suicide during the study period were unemployed or “pending job loss and typically not by choice,” the authors noted.

While interpersonal conflicts, including those occurring at work, were common, “strained relationships with family members,” often in the context of a divorce or extramarital affair, were even more common, they added.

The study showed “substantial overlap” with a prior study on job-related problems preceding nurse suicides, with a few exceptions. While nurses experienced difficulty accessing mental health supports and medications following job loss, physicians did not. Furthermore, legal issues were a factor in the physician suicide data but not in the nurse data.

Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.

“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” they wrote.

Kim said that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”

To that end, Kim and team offered some anonymous screening tools and “confidential pathways” to treatment, including UC San Diego’s Healer Education Assessment and Referral Program, which links physicians to counseling and outpatient treatment.

In addition, the “Dr. Lorna Breen Health Care Provider Protection Act,” which was signed into law in March, includes funding for hospitals to implement suicide prevention initiatives and to promote help-seeking.

Kim also stressed the urgent need to reform the licensure application process to eliminate “invasive” questions about physicians’ mental health and substance use history, which serve to discourage help-seeking and have unintended consequences for patient care.

For this study, Kim and colleagues used a mixed methods approach combining thematic analysis and natural language processing to develop themes representing narratives of 200 physician suicides included in the National Violent Death Reporting System database from 2003 to 2018.

Of the 200 physicians, mean age was 53, 83.5% were men, 89.5% were white, and 62.5% were married. Over half had mental health problems, 16% had problems with alcohol, 14.5% had other substance use problems, and 22% had physical health problems.

Using natural language processing, the authors confirmed five of the six identified themes — except “incapacity to work due to deterioration of physical health” — which “was likely not identified by natural language processing because physical health issues were described as the various, specific conditions affecting work performance (e.g., back pain, tremor), which were not grouped as a common theme.”

Limitations to the study included the fact that the evaluations were conducted postmortem based on short narratives — usually two paragraphs long — developed following interviews with loved ones.

“We’re using the best available data that we have on the reasons for why they decided to do what they did,” Kim said, but most of the data, with the exception of quotes from suicide notes in the narratives, were not first-hand accounts.

In addition, because most of the physicians in the study were men and white, the results may not be reflective of the work-related stressors of underrepresented minorities.

Furthermore, the database used in the study is voluntary. While the number of states participating rose from six in 2003 to 42 in 2018, including the District of Columbia and Puerto Rico, 10 states still do not report these data.

If you or anyone you know is struggling with a mental health concern or having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Source:https://www.medpagetoday.com/psychiatry/generalpsychiatry/99571

Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care

Front. Pediatr., 23 March 2022
Sec.Neonatology

Gabriel Fernando Todeschi Variane1,2,3*, João Paulo Vasques Camargo2,4, Daniela Pereira Rodrigues2,5, Maurício Magalhães1,2,6 and Marcelo Jenné Mimica7,8

Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

FULL ARTICLE:Frontiers | Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care (frontiersin.org)

Karen M. Puopolo, MD, PhD

CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference

Published on Mar 21, 2022 in CHOP News

Children’s Hospital of Philadelphia (CHOP) is proud to announce that Karen M. Puopolo, MD, PhD, a national leader in the field of neonatology, has received the prestigious Pennsylvania Pediatrician of the Year Award from the American Academy of Pediatrics (AAP) after a unanimous selection by the Pennsylvania AAP Governance Committee and Board of Directors. Each year, this prestigious award is granted to a Pennsylvania pediatrician who exemplifies the ideals of the pediatric profession and participates in activities that reflect the foundation of the chapter.

As an attending neonatologist at CHOP and Chief of the Section on Newborn Medicine at Pennsylvania Hospital, Dr. Puopolo has dedicated her career to quantifying the risk for neonatal infection. She developed a clinical tool known as a sepsis calculator to estimate risk at the individual infant level to avoid unnecessary antibiotic use in neonates. This research has drastically changed newborn care in birth hospitals throughout the U.S. and world. 

Most recently, Dr. Puopolo conducted important research related to the COVID-19 pandemic. Dr. Puopolo led efforts of the national AAP Section on Neonatal Perinatal Medicine (SONPM) to draft clinical guidance on the screening and care of COVID-19-exposed and COVID-19-positive newborns.

“The naming of Dr. Puopolo as the PA AAP Pediatrician of the Year highlights her enormous contributions to perinatal health,” said Eric Eichenwald, MD, Chief of the Division of Neonatology at CHOP. “She embodies the AAP’s commitment to recognize women leaders who go above and beyond to provide excellent, evidenced-based care of newborns. What’s more, Dr. Puopolo’s unwavering dedication to advance the care of neonates during the COVID-19 pandemic has been unsurpassed.”

In addition to her clinical work, Dr. Puopolo serves as Associate Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She has authored hundreds of peer-reviewed publications, scientific abstracts, chapters, and editorials. A member of AAP since 1993, Dr. Puopolo has served many roles within the organization, including as a member of the Committee on Fetus and Newborn and on the Editorial Board of NeoReviews and Pediatrics.

Currently, Dr. Puopolo serves as chair for the AAP Southeastern Central Conference on Perinatal Research, where perinatal trainees can present their research and receive high-quality feedback.

CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference | Children’s Hospital of Philadelphia

Providing A Potential Treatment Option To Infants Where There Is None

Celia Spell   April 21, 2022

A little over 1% of babies born in the U.S. in 2020 fell under the category of very low birthweight, meaning they weighed less than 1,500 grams at birth or 3 pounds, 4 ounces. And considering that the Centers for Disease Control and Prevention says more than 3.5 million babies were born that year, almost 48,500 were considered to be at very low birthweight.

Many of these babies are born premature, at 30 weeks or less, and they have a high chance of having a hemorrhage in their brains shortly after birth, known as a germinal matrix hemorrhage (GMH). Bleeding like this within the substance of the brain is a form of stroke that can lead to a buildup of fluid in the brain known as hydrocephalus – both of which put babies at an increased risk of neurodevelopmental disability, and many don’t survive.

There is currently no medical treatment for GMH, and since these blood vessels are even more delicate when a baby is born prematurely, there is no way to predict or prevent bleeding in the brain after birth.

When Ramin Eskandari, M.D., a pediatric neurosurgeon at MUSC Children’s Health, read about the work that Stephen Tomlinson, Ph.D., vice chair of the Department of Microbiology and Immunology at MUSC, was conducting related to a specific part of the immune system known as the complement system, he thought it might have applications to infants as well.

“We were just having to wait for bad things to happen,” Eskandari said. “And then we had to react to them. We have no treatment for the actual hemorrhage or for preventing the stroke or hydrocephalus that comes after. Tomlinson was looking at adult pathologies in the brain, and we thought it would be a great opportunity to apply his methods to an animal model for premature infants.”

As joint principal investigators for their recent paper in the International Journal of Molecular Sciences, Tomlinson and Eskandari created a mouse model to represent premature infants of very low birthweight and to find treatment options for GMH. Mohammed Alshareef, M.D., a senior neurosurgery resident at MUSC and member of the collaborative lab, discovered that by inhibiting the complement system at a specific site within the brain immediately after a hemorrhage, they could prevent many of the permanent and temporary deficits that accompany hydrocephalus and stroke.

By treating GMH mouse models with the complement inhibitor known as CR2Crry, Tomlinson and Eskandari found improved survival and weight gain, reduced brain injury and incidence of hydrocephalus, and improved motor and cognitive performances in adolescence.

As part of the immune system, the complement system helps antibodies and phagocytic cells activate inflammation and remove microbes and damaged cells from the body, labeling and attacking them. But inflammation activation also leads to the detrimental effects of GMH, and while there is still no way to prevent the initial hemorrhage, Tomlinson and Eskandari are excited about the potential opportunity to prevent the events that occur after the brain bleed.

Cases of GMH are on the rise, and according to Eskandari, this rise is actually due to better care and clinical advancements. With improved prenatal care and better treatment options for premature infants, more babies are surviving being born early. But with more survival, comes higher chances of GMH.

“We’re seeing younger and younger babies viable,” Eskandari said. “I remember when a 23-week-old baby wasn’t viable, and even in the last eight years since my residency, we’re now seeing babies at 20 weeks not only be viable but live full lives and attend school.” It’s these medical advancements that show Eskandari just how important the findings of this study are. And treatment of GMH has the potential to alter an infant’s life course.

Success in inhibiting the complement system has led to a recent boom in research, with over 100 clinical trials currently ongoing, according to Tomlinson. But CR2Crry inhibitor has its own niche. By targeting the therapeutic specifically to the point where the pathology begins, physicians don’t need to knock out the complement system in the entire body, which can lead to increased risk of infections and other immune disorders. They can use less of the inhibitor and target it to a local site, which is safer for patients.

“It’s because this is targeted,” Tomlinson said. “We can actually inject fairly small concentrations directly into the bloodstream to target the injured brain.”

In addition to using the CR2Crry inhibitor to develop a novel therapeutic for premature babies, Eskandari and Tomlinson think it has promise for treating other forms of brain injuries too. “These babies are a really good overall model of how all brain injury could potentially be helped,” Eskandari said. “Having a hemorrhage that leads to stroke and hydrocephalus checks a lot of boxes that we see in many patients.”

Tomlinson’s future research plans include looking at the complement system at different points following an injury in an effort to understand more fully the point at which it becomes part of an injury’s pathology rather than part of its healing process.

Eskandari hopes to host human clinical trials with the human equivalent of the CR2Crry inhibitor at MUSC next. He wants to help his premature patients to live the fullest lives possible. “We want to allow these babies to reach their full potential,” he said.

Source:Providing a potential treatment option to infants where there is none | MUSC | Charleston, SC

PREEMIE FAMILY PARTNERS

It takes a village: NICU parents share their experience as reminder that partners need support, too

Apr 5, 2022

Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner

ALEXANDRA ROTHSTEINJUNE 7, 2022

Some preterm neonatal patients can be discharged from the hospital sooner through the unique Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota.

This one-of-its-kind program in Minnesota allows infants that qualify to receive expert care and monitoring at home through the use of an app on a tablet and a scale. The parent caregiver inputs the baby’s vitals daily, which are then shared and monitored by the baby’s neonatal care team.

The Children’s Minnesota Neonatal Intensive Care Unit (NICU) in St. Paul conducted a pilot study with 20 patients during a one-year period to evaluate how at-home care impacts babies’ ability to learn to feed, rates of breastfeeding and overall patient-family satisfaction. The results of the pilot were overwhelmingly positive and, for one family, meant that a father could spend precious time with his newborn while battling his own illness.

A challenging time

The year of 2021 was a time of mixed emotions for Amanda and Rob Calvin. They were excited to be welcoming their first baby, but Rob was also battling pancreatic cancer. “When we found out about Rob’s diagnosis, he was given one year to live, so we decided to have a child,” Amanda recalled.

The Calvins expected their baby to arrive in early April, but around mid-February, Amanda started having complications from a bleeding disorder she’s had since birth. “My condition had been flaring up with my pregnancy and getting worse to the point where I had to be admitted to the hospital,” Amanda said.

With the pandemic still at its height – and in light of her illness and her husband’s cancer – Amanda had a virtual baby shower from her Minneapolis hospital room. There, she also dealt with another serious health concern called preeclampsia, a severe high blood pressure condition in pregnant women. Amanda had a C-section procedure the day after her baby shower at The Mother Baby Center, a partnership between Allina Health and Children’s Minnesota.

Baby Finn arrived early

On Valentine’s Day 2021, baby Finn entered the world nearly eight weeks early – weighing just 3 pounds and 13 ounces. Finn’s care team rushed the newborn to the NICU at Children’s Minnesota and placed the tiny infant on a breathing machine. Finn spent the next month splitting time between the NICU and the special care nursery.

“I remember all of his caregivers being the most compassionate people and they made sure I knew what was going on,” recalled Amanda, a physician specializing in pulmonary and critical care medicine with HealthPartners Park Nicollet. “I’m an ICU provider and my son was in the ICU. Vital signs for infants are completely different than vital signs for adults. I tried to shut out paying attention to that stuff. There was too much for me to process.”

Time was of the essence

As Finn and Amanda navigated the NICU, Rob continued his fight with pancreatic cancer. “Rob no longer responded to chemo and was about to transition to hospice,” said Amanda. “He was so sick he couldn’t make it to the hospital.”

Preterm babies usually stay in the hospital with their care team until when they would have been full-term to grow, learn how to eat and breathe on their own. But CHAMP allowed Finn to go home a month early. Amanda used the app to stay connected with his care team and took over feeding using a nasogastric (NG) feeding tube that was inserted before heading home.

“It ended up being a major blessing,” Amanda said. “We were stretched thin going back and forth to the hospital. We were making it work. Without this program, we would not have had time together as a family at home in the place where we wanted to be.”

Finn graduated from CHAMP after a week on the special care program. Rob passed away soon after his infant’s graduation. “Rob died six days before Finn’s original due date. Finn got to be home with his dad before he died. I can’t quantify the value of that,” Amanda said while reflecting on her late husband.

Today, Finn is a healthy 1-year-old and meeting or exceeding all of his physical and developmental milestones. “Everybody at Children’s Minnesota went out of their way to make sure Finn was cared for – that we were heard, and they knew what we needed more than we did,” Amanda said while holding back tears. “I can’t thank those people enough. They gave us time we would have never had.”

About CHAMP at Children’s Minnesota

Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota is the only program of its kind in Minnesota. Before heading home, babies have a nasogastric tube (NG) inserted. Families are provided with a scale and a tablet equipped with a program called Locus, which allows parents to input vitals that are shared with their neonatal team. Families are also trained by the team on proper NG and oral feeding techniques as well as CPR.

To qualify for CHAMP, a newborn must be a current Children’s Minnesota NICU patient, be able to breathe without any respiratory or oxygen support, weigh more than four pounds and consistently gain around 30 grams of bodyweight per day.

“Children’s Minnesota will always strive to pioneer cutting-edge programs that continue to put our patients first and keep families as part of their care team – CHAMP accomplishes all of these goals,” explained Dr. Cristina Miller, medical director of the NICU follow-up clinic at Children’s Minnesota, and founder and director of CHAMP. “Even though the babies who qualify for CHAMP are home, their clinical care team still remains at their bedside virtually to ensure they are growing, healthy and thriving.”

“The first question any parent asks when their child is admitted to the NICU is, ‘When can we go home?’ We’re hoping that this method helps families return to their normal daily lives faster, especially with the additional COVID-19 pandemic restrictions that have been in place,” said Dr. Miller. “But even after the pandemic is over eventually, this could be a game changer.”

Source:Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner | Children’s Minnesota (childrensmn.org)

Importance The Of Support For NICU Families

Mar 7, 2020      LivingHealthyChicago

A health complication involving kids can really rock a family’s world- especially when it involves the very youngest in our families. This mother is sharing her family’s story in hopes of raising awareness about the importance of support for NICU families. Plus, we learn about an innovative treatment being utilized to help with a heart health issue that’s more common in premature babies.

Chatting to your premature baby

Talking and listening to children from the moment they are born helps them develop. This is especially true for babies who are born prematurely.

When a child is born prematurely, they might spend some time in the neonatal unit at hospital. Talking to your baby from day one will help the two of you get to know each other. The stimulation of your voice will help your baby develop and bond with you in the early days.

Premature babies will get tired more quickly and sleep more, but there are lots of ways to communicate with your baby such as touch, eye contact and facial expressions are all ways of communicating.

Babies can communicate before they start talking. As soon as your baby is born, they can recognise the sound of your voice.

Tips for talking to your premature baby

  • Kangaroo Care is when your baby is placed skin-to-skin on your chest. The contact will help to form a bond between you. Talk quietly and take time to listen to them – if they make noises try to respond.
  • When you are ready, care staff will support you to do some routine tasks such as nappy changing, tube feeding, or bath time. This is a great time to talk to your baby about what you are doing or sing to them as you are doing it.
  • When your baby is very small, they will like to grasp your finger and enjoy the feeling of your hands on their body.
  • Call them by their name. The sound of your voice will help relax and soothe them.
  • As the weeks go by, your baby will look at you for longer and see your face more clearly. Smile and respond to your baby.
  • It’s never too early to read a story! Choose a baby book and read. Your voice will help your baby relax and fall asleep.
  • Like adults, babies don’t always feel like being sociable. If your baby starts to hiccough, look away or yawn, these are signs they need to rest.

Source:https://wordsforlife.org.uk/activities/chatting-your-premature-baby/?gclid=Cj0KCQjwuO6WBhDLARIsAIdeyDJc64LX9OgyPDeVIz0axNq9FLp1owC2SrE11_QKvuLH9IwTO8A9Q-MaAnkoEALw_wcB

Innovative Music Therapy for the Brain Development of Premature Babies

Apr 3, 2022    HEC Science & Technology

It only takes a few chords to capture Ayla Campbell’s attention. She arrived 16 weeks early, weighing less than two pounds. While staying in MU Health Care’s neonatal intensive care unit, or NICU, Ayla received her first visit from a music therapist Emily Pivovarnik. “Her heart rate would just go down, and her oxygen was going up,” said Angel Campbell, Ayla’s mom. “If someone had told me that this could happen just from singing, I wouldn’t have believed it.” Pivovarnik is a trained music therapist who helps babies eat better, regulate their stress levels and adjust to stimulation. Pivovarnik is part of a team starting a research project to look at the long-term effects of a specific music therapy intervention called multimodal neurological enhancement, or MNE. This therapy combines music, gentle touch and rocking to help a baby’s brain develop. About 135 babies will be involved in the research project. After leaving the hospital, they’ll receive neurodevelopment testing.

Innovative Music Therapy for the Brain Development of Premature Babies – YouTube

Joel Mackenzie used ‘kangaroo care’ to help daughter Lucy, born prematurely. Photo: U. South Australia

Snuggling With Dad: Fathers’ Contact Can Help Preemies Thrive

Ellie Quinlan Houghtaling

THURSDAY, July 14, 2022 (HealthDay News) — Decades of research have shown the power of skin-to-skin contact between preemies and their moms, but would the same technique, dubbed “kangaroo care,” work with fathers?

Yes, claims a new Australian study that found when dads held their premature babies close to their bare chest, they reported feeling a “silent language of love and connection.”

“It’s like when your finger touches a fire, there are receptors there letting you know that it’s hot,” said study author Qiuxia Dong, a nurse and master’s candidate at the University of South Australia. “It’s the same thing [in kangaroo care], when the attachment happens between father and baby or mother and baby, it’s just another reaction.”

First-time father Joel Mackenzie experienced it with his tiny daughter, Lucy, when he was first able to hold her, two weeks into her time in the neonatal intensive care unit (NICU). Mackenzie explained that the NICU experience can be a really isolating one for parents, especially dads who are not often considered by the health care system when it comes to reconnecting with their child after a medical intervention.

“I felt like I was actively fostering her survival and her development by giving her a cuddle,” said Mackenzie, who was one of 10 dads followed in the study.

The findings were published online recently in the Journal of Clinical Nursing.

One expert in neonatal care described how the bonding process works.

“There are biologic phenomenon that exist that allow babies and their parents to bond, and there are hormones that get released that allow you to fall in love,” explained Dr. Robert Angert, a neonatologist at NYU Langone in New York City. “Those are stimulated by all your senses — your sight, but also your smell and touch. If you cut out some of those senses, you’re going to miss out on those opportunities,” he said.

“On the other side, you have anxiety and stress, and those make it harder to fall in love. As they describe in the article, a lot of parents, particularly non-birthing parents, are stressed and anxious and worried about the well-being of their child, especially a baby who’s in the ICU,” Angert added. “Bringing them together safely and in a way that’s helpful to the baby reduces that anxiety to the parent.”

Research has shown that during kangaroo care, the close contact activates nerve receptors in mammals that increase the production of hormones that lower pain and stress for both babies and parents.

The latest study illustrated that: Many of the fathers described the NICU environment as “overwhelming,” but the ability to hold their children next to their skin fostered strong bonds and relaxed them, which helped build confidence and made them very happy.

“It was palpable how much of an impact it had on her,” Mackenzie said. “Of course, it helped me in bonding with her and helping me understand her and what was good for her as a child, but also as well you could almost tell that she almost drew energy from us. She started to move better, she started to develop faster. I’d see her move better on a day-to-day basis. Eat more, be more responsive. Her eyes would open and move and engage more each time we took her out of the crib.”

Having to separate a newborn from its parent for medical reasons isn’t just traumatic for parents, it can have emotional and developmental impacts on the infant as well.

Angert said that “separation is an incredibly traumatic event in the life of a newborn, and I think we underestimate the impact that that event has on a baby. So we have an opportunity here to restore some of that togetherness, and it’s not without good reason that we’re taking the baby away. We’re saving their life. But it’s also good to think about when we can reestablish contact and allow them to give kangaroo care to their babies.”

Parents who go through the NICU process have no doubts about the efficacy of staying by their child’s side when they’re sick. Mackenzie, whose child will celebrate her first birthday next week, said the bonding made all the difference.

“She still has mild lung disease and chronic cerebral palsy, but [the kangaroo care] part of her NICU experience was definitely a contributing factor to where she is now, I have no doubt about it,” Mackenzie said. “Children who’ve gone through this experience definitely have a better chance of survival in my opinion.”

More information: To learn more about skin-to-skin contact benefits between parents and newborns, visit the Cleveland Clinic.

Source:https://consumer.healthday.com/7-14-snuggling-with-dad-fathers-contact-can-help-preemie-baies-thrive-2657647641.html

Occupational Therapy and Infancy: Supporting Families During the Earliest Occupations

Alexis Ferko, B.A., OTS

Occupational Therapy and Infancy: Occupational therapy (OT) is a holistic, client-centered, occupation-based profession focused on assisting individuals to independently participate in daily activities to the best of their ability . Occupational therapy practitioners (OTP) are board certified, have extensive academic training and clinical experience and treat individuals across the lifespan in various settings  while considering the “biological, developmental, and social-emotional aspects of human function in the context of daily occupations”. OTPs utilize the power of occupation to support families and infants in achieving positive outcomes . The first year of an infant’s life is a rapid period of growth; infants are learning how to actively interact with their environment and family system. Occupations of infancy are defined as “any activity or task of value in which the family or setting expects the infant to engage”  including activities of daily living (ADL) like feeding and bathing, health management including social and emotional health promotion and maintenance, rest and sleep, play and social participation . Infants also participate in co-occupations, meaning infants share an occupation with their caregiver; examples such as play and breastfeeding . OTPs also assist families with adapting to new performance patterns including habits, roles, routines, and client factors. OTPs treat infants in settings including hospitals or NICU’s, early intervention (EI), outpatient, and community-based settings. Infants may be referred to OT for concerns with maintaining homeostasis or bonding in the NICU, feeding or sensory concerns, physical development, social-emotional skills, and sleep .

OT in the NICU: Many infants and families have their first experience with OT in the NICU setting. NICU OTPs have extensive knowledge in neonatal medical conditions, development and understand the complex medical needs of infants in this setting . OTPs are members of an interdisciplinary team of professionals including pediatricians, physical therapists (PT), speech-language pathologists (SLP), lactation consultants, respiratory therapists, nurses, midwives, neonatologists, among others. OTPs administer assessments related to sensory processing, motor function, social-emotional development, pain, activities of daily living (ADL), neurobehavioral organization, and environmental screenings to identify and create an appropriate infant and family-centered intervention plan. The primary functions of an OT in the NICU is to focus on developmentally appropriate occupations, maintaining homeostasis (stable vitals, feeding, breathing), self-regulation, sensory development, feeding, motor function, coping and attachment skills, bathing and dressing, and nurturing interactions with caregivers including skin to-skin contact. OTPs utilize various interventions including sensory integration, neurodevelopmental techniques, positioning/handling, infant massage, feeding, bonding, and environmental modifications to minimize stress and overstimulation while in this setting. Therapists must also address the family system by forming a therapeutic relationship with the family. The NICU can cause separation between infant and caregivers especially if there are maternal complications after delivery which can increase stress and instability within the family system . Parent-infant attachments and occupations must be prioritized, including bonding such as skin-to-skin contact, or kangaroo care. Kangaroo care is an essential intervention to support infants in the NICU by having the infant lay on the caregiver’s bare skin. Benefits to this intervention include more stable heart rate, breathing patterns and temperatures, faster weight gain, more successful feeding, and increased bonding. OTPs also consider the Neonatal Integrative Developmental Care Model, meaning therapists are fostering a healing environment in the NICU setting – a setting known to be stressful and overstimulating for infants and their families. Core measures of this model include skin protection, optimizing nutrition, positioning/handling to promote breathing and stability, safeguarding sleep, optimizing nutrition, minimizing stress and pain through environmental and sensory modifications, and partnering with families . Research shows that interventionists who follow this model have better growth development outcomes.

Breastfeeding and Feeding: As of 2020, over 83% of infants are breastfed at some point in their young life. 60% of mothers stop breastfeeding before they intend to stop due to various reasons including latching difficulties, infant weight concerns, lack of work and family support, and concerns with medication while breastfeeding. OT can assist with facilitating breastfeeding which improves parent-infant attachment and bonding and can also reduce postpartum depression . OTPs must consider various aspects of the infant caregiver dyad during breastfeeding including infant arousal state, respiratory ability, overall stability, oral reflexes, oral strength and endurance and caregiver arousal, attention, posture and upper extremity strength, cognition, and cultural values/beliefs related to feeding . It is also important to consider sensory and environmental stimulation, social supports, and bottle/nipple type if the infant is not being breastfed. OTPs can assist breastfeeding caregivers with developing routines and habits to promote breastfeeding and education related to their infant’s hunger and stress cues, positioning, ergonomics, self-regulation, and environmental modifications . Infant interventions include suck training, positioning, and various sensory strategies to promote arousal levels. Environmental and activity modifications include changing the position of feeds, adapting the lighting, touch, sound and using supportive equipment during feeding and adapting the type, thickness or volume of milk and feeding schedule . Feeding is a very important occupation for an infant as it takes up much of their early life and helps facilitate secure attachments to their caregiver as well as promoting self-regulation .

 OT’s Role in Transitioning Home: OT also plays a role in assisting families with the transition from NICU to home. Transition planning begins at NICU admission with OTPs educating families on various interventions and considerations for the infant’s unique medical needs. Upon discharge from the NICU, OTPs may recommend follow-up with EI, outpatient OT or PT, or a feeding clinic to address various concerns including feeding, global developmental delay, ROM or joint limitations, tone management, among others . OTPs also educate families on general infant care like signs of stress and how to relax or calm an infant, feeding strategies, home environment set-up and safe sleep strategies. OTPs also work with lactation consultants to address any concerns or strategies related to breastfeeding.

Early Intervention and Infancy: Infant occupations vary based on family, contextual and cultural factors. OT is a primary service under IDEA Part C and delivers services related to the infant’s individualized family service plan (IFSP) outcomes . Gorga (1989) identified seven areas of occupational therapy treatment practices for infants in EI including motor control, sensory modulation, adaptive coping, sensorimotor development, social-emotional development, daily living skills and play . OT interventions include handling, positioning, adapting the environment, sensory registration, arousal, attention, emotional regulation, cognition, feeding and play activities like reach and grasp. The American Occupational Therapy Association (AOTA) elaborated on various interventions in early intervention including promoting healthy bonding and attachment, family education and training, adapting tasks and the environment, participation in ADLs, rest and sleep and play related to the infant’s IFSP outcomes.

Conclusion: Occupational therapy practitioners are client-centered, occupation-based and address the infant and their family holistically. Various occupations OTPs can address include feeding, bathing, rest and sleep, health management, play and social participation, among others. Breastfeeding is also an important co-occupation OTPs can address in this setting. OT can also work with the family to promote carryover of strategies, encourage developmental care, and optimize infant well-being in the NICU, EI and home setting. Various professions work with occupational therapists on multidisciplinary, transdisciplinary, and interdisciplinary teams including PT,  SLP, pediatricians, lactation consultants, nursing, midwives, neonatologists, and other specialists. These professions would benefit from working with OT to help increase independence, improve overall well-being and participation in infant and family occupations all of which leads to a greater quality of life for both the infant and family.  Occupational therapists serve a unique role in the neonatal intensive care setting by identifying, promoting, and advocating for developmental care practices that aim to support families in participating in these early occupations.

Source:http://neonatologytoday.net/newsletters/nt-jul22.pdf

INNOVATIONS

A Wearable for Monitoring Prenatal Health at Home

An estimated 15 million babies are born prematurely every year, posing a significant risk to both maternal and neonatal health. The EU funded WISH project promotes a novel tool for monitoring the risk of preterm labour at home.

Preterm birth is defined as any live birth before the 37th week of pregnancy and is associated with complications that lead to neonatal and infant mortality. Additionally, premature babies are prone to serious long-term illnesses, lifelong disabilities such as cerebral palsy and respiratory illnesses as well as poor quality of life. Consequently, preterm birth is the cause of great suffering and psychological stress to parents. For further information see the IDTechEx report on Wearable Sensors 2021-2031.

Machine learning to predict preterm birth

Currently, regular medical check-ups and clinical examinations in a hospital setting are the only available solution for expectant women to diagnose preterm labour. However, expecting couples often mistake Braxton Hicks contractions, which occur normally during a healthy pregnancy, as preterm labour contractions. This increases hospital visits and concomitant healthcare costs. To address this issue, the EU-funded WISH project has developed an innovative platform for antepartum maternal and foetal monitoring. “WISH integrates seamlessly into the daily activities of expectant women in a way that will enable remote antepartum monitoring at home,” explains Julien Penders, co-founder and COO of Bloomlife. The WISH system consists of a specifically designed electrode patch, a consumer app, a web-based dashboard and a secure cloud data platform. It measures maternal and foetal health parameters, such as heart rate and uterine activity, through a specific sensor. This real time information is processed using advanced algorithms and machine learning to provide the probability of a woman being in labour.

Clinical validation and prospects

The WISH solution was tested and validated during the project in a two-centre, interventional study on 150 pregnant women. Study participants received a WISH system and were asked to use it at least three nights per week until they gave birth. Results demonstrated that the WISH system had similar accuracy in labour detection with current diagnostic methods used in hospital. “This clearly illustrated the feasibility of applying non-invasive wearable technology at home as an alternative labour management strategy,” emphasises Penders.

Preterm birth is a global health problem and one of the EU healthcare priority areas. The high socioeconomic impact of preterm birth necessitates novel solutions for predicting and prolonging the gestational age at delivery. The WISH project laid the foundation for a new non-invasive approach for preterm labour detection and a much needed tool for high-risk pregnancies. Implementation of WISH is expected to provide essential data for both expectant women and healthcare providers, facilitating more efficient prenatal care across Europe. Importantly, WISH will offer reassurance to women throughout the last stages of pregnancy through the provision of trustworthy information. Future efforts will focus on how to exploit the WISH solution to improve doctor-patient communication, implement preventive actions and timely interventions to reduce preterm births and radically change prenatal care across Europe. Penders envisions pivotal clinical trials will support the CE marking of WISH as a medical device and render it ready for commercialisation.

Source:A Wearable for Monitoring Prenatal Health at Home | Wearable Technology Insights

CDC: Infant outcomes vary by maternal place of birth

JUNE 29, 2022

Maternal characteristics and infant outcomes vary by maternal place of birth, according to a report published in the June issue of Vital and Health Statistics, a publication of the U.S. Centers for Disease Control and Prevention National Center for Health Statistics.

Anne K. Driscoll, Ph.D., and Claudia P. Valenzuela, M.P.H., from the National Center for Health Statistics in Hyattsville, Maryland, describe and compare maternal characteristics and infant outcomes by maternal place of birth among births occurring in 2020.

The researchers found that 21.9 percent of women who gave birth in the United States in 2020 were born outside of the United States. Women born in Latin America accounted for 12.0 and 54.9 percent of all women giving birth and those born outside of the United States, respectively, while women born in Asia accounted for 5.9 and 27.2 percent, respectively. Maternal characteristics varied by region, subregion, and country of birth, with the percentage of women giving birth under age 20 higher for women born in the United States (5.0 percent) than for those born in other regions, and obesity rates varying from 10.7 percent for women born in Asia to 38.1 percent for women born in Oceania. Infant outcomes varied by mother’s place of birth, with preterm birth rates varying from 6.90 to 11.43 percent of infants of women born in Canada and Oceania, respectively. Similar variation was seen for low birthweight and neonatal intensive care unit admission rates.

“The characteristics, residence patterns, and infant outcomes of women born outside the United States vary considerably,” the authors write.

Full Article: https://www.cdc.gov/nchs/data/series/sr_03/sr3-048.pdf https://medicalxpress.com/news/2022-06-cdc-infant-outcomes-vary-maternal.html

NICU Lighting Tech Licensed to NASA Spinoff

Post Date: April 11, 2022

Cincinnati Children’s has licensed technology that mimics sunlight in the NICU of the new Critical Care Building to a NASA spinoff, which is marketing a consumer product called the SkyView Wellness Table Lamp.

California-based Biological Innovations and Optimization Systems LLC, or BIOS, focuses on the biological application of LED lighting for people and plants. 

BIOS announced it has licensed the exclusive rights to the violet light technology invented and developed at Cincinnati Children’s, which optimizes light exposures and can influence circadian rhythms, eye development and metabolism.

The violet light technology is a component in the world’s first full-spectrum, tunable lighting system in a neonatal intensive care unit, which was installed in the Critical Care Building that opened on the Burnet Campus of Cincinnati Children’s in November 2021.

Richard Lang, PhD, director of the Visual Systems Group at Cincinnati Children’s, has worked with colleagues for more than a decade to better understand the role that sunlight plays in fetal development. Their discoveries, coupled with growing scientific knowledge about the importance of circadian rhythms to human health, sparked the idea to install lights in the NICU that could provide the full range of wavelengths found in sunlight.

“Our recent discoveries showed that violet light plays a crucial role in normal human physiology,” Lang said. “This prompted us to work with BIOS lighting to deploy a new human-centric lighting technology in our neonatal intensive care unit. We believe everyone can benefit from human-centric lighting.”

The licensing agreement comes in the wake of global studies by researchers into sleep complaints and circadian disturbances observed during the COVID-19 pandemic, BIOS stated. The science behind the company’s biological lighting expertise was first developed for the International Space Station.

“BIOS is committed to creating human-centric lighting designed to promote health and wellbeing,” Robert Soler, a former NASA engineer who is vice president of biological research and technology for Bios, said in a news release. “When the opportunity arose, we were excited to work with Cincinnati Children’s and co-develop new human-centric lighting technology. We now offer this technology in our SkyView Wellness Table Lamp.”

Source:NICU Lighting Tech Licensed to NASA Spinoff | Research Horizons (cincinnatichildrens.org)

Over the past few weeks extreme heat waves have resulted in record breaking temperatures worldwide. Living in London, I witnessed the impact of the 105-degree temperature on the local community, nature parks,  infrastructure, and public transportation. With tube station, railway, and plane shutdowns due to fires and melting roadways it was clear that this was an event that would mark an obvious need to shift towards increased climate action both within the UK and Worldwide. Millions of residents were encouraged to stay home, avoid attending events and work outside of the home and were provided emergency warning resources and information about ways to stay safe. The impact of this recent climate event has now moved along to the Pacific Northwest Region where many of my family members and friends have reported similar disruptions in their communities as consecutive high temperatures throughout the last week of July into August will reach an all-time high.

Climate change has and will continue to impact every community in a variety of anticipated and unexpected ways. Amongst our global neonatal community studies have shown a direct correlation between the effects of rising temperatures and increased risk for preterm labour. For example, a recent 2020 BMJ meta-analysis study found that “the odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. “ (Cherish et al,2020)

Increased research efforts to investigate the impact of climate change on preterm birth rates and outcomes will be instrumental in addressing collaborative solutions to implement preventative interventions and improved care to those negatively impacted as a result of climate change on maternal and neonatal health. As an active community we can do our part to enhance our knowledge and find creative ways to be a part of the solution towards helping to improve our carbon footprint within our communities and homes.

Personally, I believe our global youth have in many ways led the forefront towards addressing climate change. We have included a few engaging videos discussing ways we can help to address climate change and the experiences of young climate activists like Greta and friends who may inspire us to pick up some new habits and get involved in doing our part to bring about the prioritization of climate action to improve the health of our planet and our livelihood now and in the future.

KAT’S CORNER

Climate Change for Kids | A fun engaging introduction to climate change for kids

Hey Teachers and Parents! In this video we explore climate change for kids. We learn all about the causes of climate change like the greenhouse effect, fossil fuel burning, farming, and even deforestation and why these are big dilemmas in today’s world. We also cover ways that we can help prevent climate change and be friendlier to our environment including: walking, planting trees, using less electricity and other fun ways. We hope you and your students have fun as they learn about climate change and what we can each do to help planet earth. We also invite you to download our FREE climate change lesson plan (for grades 4-6) that is complete with more content, worksheets, activities for kids, and more!

Greta and eight young activists reveal how the climate crisis is shaping their lives | UNICEF

Nine young activists explain how climate change is affecting their lives and who inspires their efforts to make our planet a better place. Greta Thunberg (Sweden) is joined by Alexandria Villasenor (USA), Catarina Lorenzo (Brazil), Carlos Manuel (Palau), Timoci Naulusala (Fiji), Iris Duquesn (France), Raina Ivanova (Germany), Raslene Jbali (Tunisia) and Ridhima Pandey (India).

SURFING In PHILIPPINES BRITISH Mum So HAPPY To Do This

Oct 22, 2020

Surfing in the Philippines was not something that we thought about when planning our holiday. Usually you think of Hawaii’s waves and the surf vibe and culture. So when we realized we’d stumbled into Siargao Island the little Hawaii of the Philippines, we knew one of us had to take to the water and try out a surf lesson. As a British family, most of us didn’t grow up around surf culture because of the cold water and weather so we were so happy to do this here in the bath warm pacific ocean. We booked a private lesson with Racel from Makulay Resort Santa Fe in General Luna. It cost 1400 pesos or around £21 for a two hour teaching session, and Racel is actually a professional competing surfer so it felt even better to get our first experience of surfing in the Philippines with him. I stood up multiple times on the board and I highly recommend lessons with Racel if you find yourself on Siargao Island wanting to learn to surf. If this mum can do it, anyone can!

CDC: Infant outcomes vary by maternal place of birth

 

Tech Emerging, Mortality, FC Care

NORWAY

PRETERM BIRTH RATES – NORWAY

Rank: 172  –Rate: 6.0%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Norway, officially the Kingdom of Norway, is a Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of Jan Mayen and the archipelago of Svalbard also form part of Norway. Bouvet Island, located in the Subantarctic, is a dependency of Norway; it also lays claims to the Antarctic territories of Peter I Island and Queen Maud Land. The capital and largest city in Norway is Oslo.

Norway has a total area of 385,207 square kilometres (148,729 sq mi) and had a population of 5,425,270 in January 2022.[14] The country shares a long eastern border with Sweden at a length of 1,619 km (1,006 mi). It is bordered by Finland and Russia to the northeast and the Skagerrak strait to the south, on the other side of which are Denmark and the United Kingdom. Norway has an extensive coastline, facing the North Atlantic Ocean and the Barents Sea. The maritime influence dominates Norway’s climate, with mild lowland temperatures on the sea coasts; the interior, while colder, is also a lot milder than areas elsewhere in the world on such northerly latitudes. Even during polar night in the north, temperatures above freezing are commonplace on the coastline. The maritime influence brings high rainfall and snowfall to some areas of the country.

Health

Norway was awarded first place according to the UN’s Human Development Index (HDI) for 2013. In the 1800s, by contrast, poverty and communicable diseases dominated in Norway together with famines and epidemics. From the 1900s, improvements in public health occurred as a result of development in several areas such as social and living conditions, changes in disease and medical outbreaks, establishment of the health care system, and emphasis on public health matters. Vaccination and increased treatment opportunities with antibiotics resulted in great improvements within the Norwegian population. Improved hygiene and better nutrition were factors that contributed to improved health.

The disease pattern in Norway changed from communicable diseases to non-communicable diseases and chronic diseases as cardiovascular disease. Inequalities and social differences are still present in public health in Norway today.

In 2013 the infant mortality rate was 2.5 per 1,000 live births among children under the age of one. For girls it was 2.7 and for boys 2.3, which is the lowest infant mortality rate for boys ever recorded in Norway.

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

COMMUNITY

Ten Years of Neonatal Intensive Care Adaption to the Infants’ Needs: Implementation of a Family-Centered Care Model with Single-Family Rooms in Norway

Lene Tandle Lyngstad 1Flore Le Marechal 1Birgitte Lenes Ekeberg1Krzysztof Hochnowski 1Mariann Hval 1Bente Silnes Tandberg1

International Journal of Environmental Research and Public Health  13 May 2022, 19(10):5917
DOI: 10.3390/ijerph19105917 PMID: 35627454 PMCID: PMC9140644

Abstract

Ten years ago, the Neonatal intensive care unit in Drammen, Norway, implemented Single-Family Rooms (SFR), replacing the traditional open bay (OB) unit. Welcoming parents to stay together with their infant 24 h per day, seven days per week, was both challenging and inspiring. The aim of this paper is to describe the implementation of SFR and how they have contributed to a cultural change among the interprofessional staff. Parents want to participate in infant care, but to do so, they need information and supervision from nurses, as well as emotional support. Although SFR protect infants and provide private accommodation for parents, nurses may feel isolated and lack peer support.

Our paper describes how we managed to systematically reorganize the nurse’s workflow by using a Plan-Do-Study-Act (PDSA) cycle approach. Significant milestones are identified, and the implementation processes are displayed. The continuous parental presence has changed the way we perceive the family as a care recipient and how we involve the parents in daily care. We provide visions for the future with further developments of care adapted to infants’ needs by providing neonatal intensive care with parents as equal partners.

FULL ARTICLE:    http://europepmc.org/article/MED/35627454

Sigrid, Bring Me The Horizon – Bad Life

Sigrid

The RHODĒ Study

Rhode Island Cohort Of Adults Born Prematurely

The Rhode Island Cohort Of Adults Born Prematurely — or “RHODĒ” Study — is a longitudinal study following a group of 215 infants born between 1985-1989 in Rhode Island. The study was previously known as the Infant Development Study. Prior waves of data collection occurred at birth, 1 month, 18 months, 30 months, 4 years, 8 years, 12 years, 17 years, and 23 years of age. The 215 originally enrolled infants represent a wide range of gestational ages, birth weights, and illness severity, and includes both preterm and full-term participants.

In response to an Institute of Medicine recommendation for long-term outcome studies for premature infants into young adulthood, we are currently conducting the tenth wave of the study, with participants aged 30-35 years old.

We are fortunate to have retained 96% of the participant sample between ages 17 and 23 years, and 85% since birth. To our knowledge, this is the only U.S. based study to follow preterm and full-term participants from birth into age 30.

Source: https://www.rhodestudy.com/

INNOVATIONS

‘Smart pacifier’ in development with help from WSU Vancouver researchers:2701:45

Clinical trials are still to come, but the academic group hopes the small medical device eventually replaces blood draws, and a lot of wires and electrodes.

Author: kgw.com  Published: 5:43 PM PDT June 11, 2022 Updated: 5:43 PM PDT June 11, 2022

Comparison of the effect of two methods of sucking on pacifier and mother’s finger on oral feeding behavior in preterm infants: a randomized clinical trial

Abstract

Background

Oral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother’s finger on oral feeding behavior in preterm infants.

Methods

This single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother’s finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother’s finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used.

Results

The mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05).

Conclusion

Considering the positive effect of these two methods, especially non-nutritive sucking on mother’s finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit.

Source:https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03352-9

EFCNI involved in new study on blood transfusions in preterm babies

POSTED ON 11 MAY 2022

Most preterm babies admitted to a Neonatal Intensive Care Unit (NICU) receive blood transfusions. Some neonates, however, receive blood transfusions even though these transfusions may not be necessary, cause side effects or even harm. Therefore, the International Neonatal tranSfusion PoInt pREvalence study (INSPIRE) aims to describe the current state and indications for blood transfusions among preterm babies in Europe.

Although most preterm babies receive blood transfusions in the NICU, there are no international guidelines that have been incorporated into clinical practice, and there is significant variation in blood transfusion practice within Europe. Additionally, high-quality data on neonatal transfusion practice in Europe is lacking. The INSPIRE-study will describe current neonatal transfusion practices within Europe. These results will help to improve practice, develop future clinical studies, and inform guideline writing. Additionally, the results may help to reduce unnecessary transfusions through increased awareness of the proper use of transfusions in this vulnerable patient group.

In collaboration with the Neonatal Transfusion Network (NTN), EFCNI coordinates an international parental advisory board (PAB). The PAB is chaired by EFCNI and meets on a regular basis throughout the duration of the project. Furthermore, EFCNI gives advice and provides input on topics related to ethics and patient information throughout the project.

Ongoing updates on the project can also be found on our project page.

Source:https://www.efcni.org/news/efcni-involved-in-new-study-on-blood-transfusions-in-preterm-babies/

Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care

Gabriel Fernando Todeschi Variane1,2,3*, João Paulo Vasques Camargo2,4, Daniela Pereira Rodrigues2,5, Maurício Magalhães1,2,6 and Marcelo Jenné Mimica7,8

Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

Full Article: https://www.frontiersin.org/articles/10.3389/fped.2021.755144/full

Accuracy and Completeness of Intermediate-Level Nursery Descriptions on Hospital Websites

David C. Goodman, MD, MS1,2,3,4Timothy J. Price, MS1David Braun, MD5,6

JAMA Netw Open. 2022;5(6):e2215596. doi:10.1001/jamanetworkopen.2022.15596

Key Points

Question  How completely and accurately do hospital websites describe their level II special care (ie, intermediate care) nurseries?

Findings  In this cross-sectional study of hospital nurseries (including 1.99 million live births and 268 level II units) in 10 large US states that regulate nursery levels of care, state-designated intermediate (ie, level II) units were inaccurately or incompletely described in 39% and 25% of the hospital websites, respectively. There was substantial and statistically significant variation in rates of incompleteness and inaccuracy across states.

Meaning  These results suggest that hospital websites, often the only source of publicly available information describing a hospital’s neonatal unit, do not provide reliable information for prospective parents, referring physicians, and the public to assess the capacity to care for ill newborns.

Abstract

Importance  Birth at hospitals with an appropriate level of neonatal intensive care units is associated with better neonatal outcomes. The primary sources for information about hospital neonatal unit levels for prospective parents, referring physicians, and the public are hospital websites, but the accuracy of neonatal unit capacity is unclear.

Objective  To determine if hospital websites accurately report the capabilities of intermediate (ie, level II) units, which are intended for care of newborns with low to moderate illness levels or the stabilization of newborns prior to transfer.

Design, Setting, and Participants  This cross-sectional study compared descriptions of level II unit capabilities on hospital web pages in 10 large states with their respective state-level designation. Analyzed units were located in the 10 states with the highest number of live births in 2019 (excluding states with no level II regulations) and had active websites as of May 2021.

Main Outcomes and Measures  Hospital websites were assessed for whether there was any mention of the unit, the description of the unit was provided, the unit was identified as a level III or both levels II and III, the terms “neonatal intensive care unit” or “NICU” were used without indicating limits in care available or newborn acuity, or the unit was claimed to provide the most advanced level of care.

Results  A total 28 states had no regulation of nursery unit levels; in the 10 large, regulated states, web descriptions of level II units were incomplete for 39.2% of hospitals (95% CI, 33.3%-45.3%) and inaccurate for 24.6% (95% CI, 19.6%-30.2%). Within incomplete descriptions, 2.6% (95% CI, 1.1%-5.3%) of hospitals did not mention an advanced care unit and 22.0% (95% CI, 17.2%-27.5%) identified a level II unit without providing further description. Within inaccurate descriptions, 25.4% (95% CI, 20.3%-31.0%) of hospitals described the unit as a “neonatal intensive care unit” or “NICU” without any qualification and 9.3% (95% CI, 6.3%-13.5%) claimed that the unit provided the most advanced neonatal care or care to the sickest newborns; 3.0% of hospitals (95% CI, 1.3%-6.0%) stated that their unit was level III and 1.5% (95% CI, 0.4%-3.8%) as level II and III. Across states there was substantial variation in rates of incompleteness and inaccuracy.

Conclusions and Relevance  Incomplete and inaccurate hospital web descriptions of intermediate newborn care units are common. These deficits can mislead parents, clinicians, and the public about the appropriateness of a hospital for sick newborns, which raises important ethical questions.

Source:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793015

PREEMIE FAMILY PARTNERS

Turns out not where but who you’re with that really matters

Terrie Eleanor Inder   Pediatric Research volume 88, pages533–534 (2020)

An understanding of the impact of the environment, including the new enhanced single-family room (SFR) structure, on outcomes in the preterm infant is critical. The study by van Veenendaal et al. in this edition of Pediatric Research expands on others’ work by analyzing a level II neonatal facility SFR setting and concludes that the SFR environment was associated with lower rates of late onset sepsis, mediated by the lower use of intravenous and central venous catheters. The authors hypothesized that the presence of parents, who know their infants well, may have resulted in less antibiotic treatment for symptoms and signs that were interpreted by less familiar medical caregivers as concerning for late onset sepsis. It is important to note that the definition of “sepsis” included any culture positive infant, independent of treatment, and infants treated for ≥7 days with antibiotics after clinical signs of concern for sepsis with negative cultures.

This study compared two epochs from 2012−2014 and 2017−2018 with 1046 infants who were predominantly level II late preterm infants (<37 weeks’ gestation and hospital stay ≥3 days) with average gestational age of 34−35 weeks. During this time of change to SFR environment, Family Integrated Care (FICare) was also introduced with parents being present to provide most of the care for their infants. Their SFR included a full parent bed for the parent to live and sleep in the room with their infant. The major mediator of the reduction in late onset sepsis, from 9.3% in the open bay to 5.3% in the SFR, was an approximately 50% reduction in vascular lines (peripheral and central) and use of parenteral nutrition. Although the reasons for the reduction in line use remain unclear, the authors hypothesized that the presence of the parents resulted in joint decision making and avoidance of painful procedures—both leading to reduced lines and parenteral nutrition. The authors also report a trend toward higher exclusive breastfeeding at discharge and a shorter length of stay.

Although infection rates in the neonatal intensive care unit have been consistently falling over the last two decades, this study informs us that in a less intensively sick population of infants, the SFR environment may reduce the risk of late onset sepsis. Importantly, they define that the association is mediated by invasive vascular access, which may be avoided with parental engagement. This study did not evaluate early breast milk supply in the new SFR setting, but others have noted in a similarly designed study a significant increase in the availability of human milk in the SFR environment being a key driver of SFR-associated improved neurodevelopmental outcomes.

 In contrast to the current study, a study from a typical larger neonatal intensive care unit setting in Texas, USA, found an increased rate of sepsis documented following their renovation to SFR environment in 2015. They analyzed 9995 encounters in their 90-bed unit, with a trend toward increased sepsis rates in the SFR in the moderately preterm infant (OR 1.33, 95% CI 0.7−3.3) that reached significance in the term/post-term infant (OR 1.79, 95% CI 1.2−3.3). It was noted that the trend was reversed toward lower infection rates in the preterm infants <32 weeks. Their definition of sepsis was based on medical records alone and not as carefully curated as the current study.

Single-family room environments have been noted to have numerous advantages, including enhancing parent−infant closeness and engagement in infant care and improved parental psychological wellbeing with reductions in maternal depression and parental stress in both parents. In these studies, based in Scandinavia, parents in the SFR were present 21 h/day compared with 7 h/day previously in the open bay unit. The SFR environment has also been associated with improved neurodevelopmental outcomes following discharge, with an approximate 3-point advantage in cognitive and language scores on Bayley III at 18−24 months. However, in our own neonatal intensive care unit setting in St. Louis, we documented a negative impact of SFR with lower language scores (−8.3 (95% CI −2.4 to 14.2), p = 0.006) and a strong trend toward worsening motor scores at 24 months follow-up. We attributed this to the sensory isolation within the SFR environment if the parental presence and engagement was low. A subsequent study in the same unit in St. Louis by Dr. Pineda’s team demonstrated that the average presence of parents was higher in the SFR environment at 3.6 h/day compared to 2.4 h/day in the open bay environment. Notably, mothers reported more NICU stress in the SFR environment.

A recent meta-analysis of 13 study populations (n = 4793) concluded that there was no clear difference between room environments in cognitive neurodevelopment on the Bayley Scales of Infant and Toddler Development-III at 18–24 months (680 infants analyzed; mean difference 1.04 [95% CI −3.45 to 5.52], p = 0·65; I2 = 42%). However, the authors did note a lower incidence of sepsis (4165 infants analyzed; 108,035 days in hospital [hospitalization days]; risk ratio 0.63 [95% CI 0.50−0.78], p < 0·0001; I2 = 0%) and higher rates of exclusive breastfeeding at discharge (484 infants analyzed; 1.31 [1.07−1.61], p = 0.01; I2 = 0%) in SFRs than in open bay units. No other differences in neonatal outcomes were noted. This meta-analysis combined Scandinavian, Australian, and USA studies.

Differences in these studies point to a clear explanation—it is “not where but who you’re with that really matters” (the lyrics from “The Best of What’s Around” by the Dave Mathews Band). In the studies documenting benefit from the SFR environment, parental presence is almost universal and routinely >12 h in duration with shared decision making. The current study adds to this literature by documenting that such parental engagement may assist in both prevention of invasive vascular devices, that are associated with increased sepsis, and more informed interpretation of their infant’s clinical signs to better define the risk of sepsis. In the current study, it is not possible to untangle the effects of the SFR from the FICare model, with both promoting the presence and engagement of the family in care decisions. It appears that it is this critical combination that renders the benefits seen in this and other studies of the SFR, predominantly reported from Scandinavia.

In contrast, the studies documenting the adverse effects from the SFR environment, typically studies in the settings of large urban NICUs within the USA, parental presence averaged <4 h/day. Although this was increased compared to the open bay environment, it appeared associated with greater NICU stress in the mothers with both greater adult and infant isolation. Thus, without a structured program of parental support and engagement with their infant and shared decision making, this modest increase in parental presence may not offset the deficit in human language exposure which appears critical during the third trimester for language development.

In conclusion, although much effort has been focused on the room type, it appears more pertinent to ask what is happening in any space in which an infant is being cared for in the neonatal intensive care unit. This appears just as relevant for shorter lengths of stay, as shown by the current study. It is worthy of note that it is common for medical rounds or records to lack any systematic documentation or summary review of the nature of the parent’s presence or engagement, other than to discuss in a socially cursory manner. The SFR encourages greater presence of the parents to be “living” with their infant, enabling a family-centered model of care, with the combination in many studies resulting in reduced sepsis, enhanced human milk production, improved parental mental health and attachment and improved infant neurodevelopmental outcomes. To achieve the presence of parents for >12 h, and ideally 24 h/day, in the setting of the USA will require firm advocacy from the neonatal community as a fundamentally important facet of care. It is no longer “nice to have” but a “necessary element of care” for optimal outcomes. The provision of paid parental leave during the time of an infant’s neonatal intensive care course for both parents should be federally mandated as medically necessary, and we must fight for our infants’ right to their parent’s presence. The SFR environment greatly assists parents and staff with such a model of family-centered care but it is only a facilitator of the true key—the parents.

Source:https://www.nature.com/articles/s41390-020-1040-1

Preemies at greater risk for mortality in adulthood

By Svein Inge Meland – Published 23.03.2021

*** It’s important to remember that most people who are born prematurely do well, and that treatment and follow-up are constantly improving, says Professor Kari Risnes at NTNU.

The risk of dying from heart disease, chronic lung disease or diabetes in adulthood is twice as high for preemies —premature infants — as for the general population. Even those who were born just two to three weeks before term have a slightly increased risk.

A new study of mortality among young adults who were premature infants includes 6.3 million adults under the age of 50 in Norway, Sweden, Finland and Denmark. Among this group, 5.4 per cent were preemies, or born before term, according to Professor Kari Risnes at NTNU’s Department of Clinical and Molecular Medicine and St. Olavs Hospital.

Researchers used the national birth registers and compared them with the cause of death registers that all Scandinavian countries have.

“We already know that preemies have increased mortality in childhood and early adulthood. Now we’ve confirmed the risk of death from chronic diseases such as heart disease, lung disease and diabetes before the age of 50,” says Risnes.

Normal cancer and stroke risk

The study shows that the risk of preemies dying before the age of 50 is 40 per cent higher than for the population as a whole. Researchers found that the risk of dying for individuals born before full gestation and who have chronic heart disease, lung disease or diabetes is twice that of the population as a whole. However, this group has no increased risk of death from cancer and stroke.

“We were surprised to see that the risk of death was higher even in people who were born as late as weeks 37 and 38, only a few weeks before full gestation. Although the extra risk was only about 10 per cent, this group makes up about 15 per cent of all births, and we have to try to map the causal relationships here,” says the paediatrician.

Findings should be factored in

Risnes believes that the results from the study should be factored in when doctors assess the patient’s risk of disease and their preventive advice for the patient.

“Our idea is that we should increase awareness in both the general population and among doctors so that the risk can be reduced. We need to recognize that prematurity is a factor to take into account when assessing risk, just like we do with a family history of heart disease, obesity or smoking,” says Risnes.

“It’s important to be aware of additional factors that increase the risk of cardiovascular disease and diabetes, like high blood pressure, obesity, inactivity and high blood sugar, plus the high levels of all these additional factors that we see more of in premature births,” she says.

Early prevention important

“These diseases are often preventable. Good treatment is important and can often be longterm to maintain a good quality of life and avoid illness and death. We should be identifying lifestyle changes from an early age that reduce the risks, like more physical activity and avoiding obesity and smoking,” says Risnes.

One question still to be answered is whether more premature than full-term infants develop these chronic diseases, or if they are just generally less well equipped to survive the diseases.

“We need to try to address this question in the next round of research. It may be that the diseases crop up earlier in premature babies. We don’t have data on this yet,” Risnes says.

In the 1960s and 1970s, only 20 to 30 per cent of the most premature infants reached 15 years of age. Today, their survival rate is over 90 per cent. This means that the strong ones, the survivors, were preemies in Risne’s study of adults.

“With better neonatal medicine, the proportion of the population born prematurely is growing,” says Risne. She believes it will be important to follow this population closely in terms of risk. In the study, individuals born prematurely around 1980 had a slightly higher risk of cardiovascular disease than those born around 1970.

Not genetics or environment

The study doesn’t indicate that the social status of the mother or conditions of upbringing explain the increased risk of mortality. The researchers compared siblings to find out if the excess mortality was due to genetics or socioeconomic conditions.

“We found that risk of death for these diseases was higher for people born prematurely — preemies — than for their full-term siblings. We concluded that the increased risk can’t be fully explained by genes, which siblings have in common, or by socio-economic conditions and living conditions in childhood,” says Risnes.

Most common diseases

Dying in the first 50 years of life is rare. For 30-year-olds, the risk of dying is one in 1 000 per year, for 50-year-olds the risk rises to two in 1 000. Chronic diseases make up a minor percentage of these deaths. The researchers in the EU study chose to look at cancer, heart disease, stroke, chronic lung disease and diabetes because these are the most common chronic diseases that can be fatal.

In the past, it has been difficult to access other nations’ health databases. Risnes is very happy that such access was possible for this study. Robust results are easier to attain with such a large volume of health data. The findings of the study are consistent between countries.

Source:https://norwegianscitechnews.com/2021/03/study-shows-preemies-at-greater-risk-for-disease-mortality-in-adulthood/

Recognising a Grandparent’s Journey

FRIDAY, MAY 22, 2020

When a family travels the difficult journey of welcoming a premature or sick baby into the world, it isn’t just the parents or carers who are impacted.

The whole family feels the reality and shares in the emotions of the experience. None more so than grandparents. Grandparents are often an invisible casualty when a birth does not go to plan and ends in an emergency delivery and admission to the NICU. Grandparents are part of a common phenomenon where there’s a double concern for both the newborn grandchild, and their adult child who is managing this stressful event physically, mentally, and emotionally.

While Grandparents are the most common support system for new parents, the hospital restrictions and fragile health of an NICU baby can create an imbalance of involvement and un-involvement, which is often difficult to avoid. Hence, grandparents may require great flexibility to help in other ways.

One common way to help is in the home, attending to the needs of the siblings, and supporting the family’s routine which is a huge and much-needed help. During this time grandparents provide new parents the opportunity to be with their baby and to also be part of the healthcare team. In a way, they become the scaffolding for parents to be in this very important position for the best outcome for their grandchild.

It’s important to also acknowledge the challenges for grandparents of babies in the hospital during COVID-19 who would have no involvement in the NICU and for some, possibly meeting this new baby for the first-time months later, once discharged. The restrictions that are put into place are there to protect the fragile health of the baby as well as protecting this particular age group from entering a building where patients are being treated for the COVID-19 virus. All of those feelings of fear, worry, and uncertainty are shared by the new parents and extended family, however grandparents are unique and medical staff should understand and welcome them in their supportive presence. They are the unsung heroes of this life-changing event.

We are looking for stories from a grandparents perspective, sharing your experience of having a grandchild in NICU or SCN and watching your own child navigate the challenges of such a journey. If you would like to share your story click HERE.

Source:https://www.miraclebabies.org.au/content/recognising-a-grandparents-journey/gjj5f6

She Had a Preemie — and Then She Started to Ask Important Questions

By Randi Hutter Epstein  & Sarah DiGregorio – Jan. 28, 2020

EARLY:  An Intimate History of Premature Birth and What It Teaches Us About Being Human

Sarah DiGregorio was 28 weeks pregnant when she found out that her baby had stopped growing. Two days later, her daughter, Mira, was delivered via an emergency cesarean section. She weighed 1 pound 13 ounces.

“My body had been trying to kill her,” DiGregorio writes.

“Early” opens like a medical thriller. Newborn Mira is whisked away to a neonatal intensive care unit while her parents are bombarded with statistics, terrified about her future. It closes with Mira, a robust toddler, diving into a pit of foam blocks. This isn’t a spoiler — but the heart of DiGregorio’s illuminating book isn’t just about her family’s journey; it’s an expansive examination of the history and ethics of neonatology.

For most of human history, babies born months too soon were left to die. They were considered less than full-fledged beings, not quite living and therefore not worth saving. Plus, there wasn’t much to be done.

The field of neonatology took off in the second half of the 20th century when a few pediatricians, often against the advice of colleagues, dared to save newborns.

In 1961, Dr. Mildred Stahlman, a Vanderbilt University pediatrician, fitted a premature baby into a miniature iron lung machine. These machines, originally for polio patients, used negative pressure to pull open weak chest muscles to draw air into the lungs. The baby survived. Stahlman then created one of the first neonatal units and trained a cadre of disciples.

By the 1970s, negative pressure machines were replaced with positive pressure ones that worked by inflating the lungs. It was a tricky technique that required threading the tiniest of tubes through the trachea and into the lungs. Dr. Maria Delivoria-Papadopoulos, then a pediatrician at Toronto’s Hospital for Sick Children, was one of the first to try. Seventeen attempts were unsuccessful. Then she saved one baby girl. Her tenacity paved the way for half a million people born prematurely living today.

And yet, DiGregorio reminds us, every advance — every attempt at every advance — brings with it new dilemmas. Such innovations may save a child’s life but can leave them with significant disabilities. A doctor cannot predict how a particular premature baby will fare. Complicating the matter, who’s to say what kind of life is worth fighting for and how much treatment is too much?

In “Early,” we read about neonatologists, bioethicists and parents grappling with the toughest decisions. We meet pediatric palliative care specialists and parents who forgo further treatment and embrace their babies as they die. DiGregorio covers other factors that influence prematurity, such as poverty and racism.

DiGregorio, a food editor and writer, is such a beautiful storyteller, I found myself underlining passages, turning corners of pages and keeping track of the page numbers at the back of the book until I had a hodgepodge of numbers scribbled on top of each other.

She imagines her nonfunctioning placenta as “a beat-up old car, chugging along, belching smoke”; after her emergency C-section, she writes, her body “felt like an empty house that had been vacated in a rush, leaving dirty dishes in the sink.” And later, DiGregorio refers to a 1-year-old as “that sweet spot between baby and toddler.”

By the epilogue, when the narrative returns to DiGregorio’s personal story, readers will appreciate how medicine lurches forward with leaps and mishaps along with the inevitably tense discussions about which path to take and when. All doctors wrestle with these issues, yet they seem particularly poignant when we are dealing with tiny babies. That’s because, as DiGregorio puts it, the field of neonatology has “changed the way we understand what it means to be alive, what it means to be human, and what constitutes a life worth living.”

Randi Hutter Epstein is the writer in residence at the Yale School of Medicine and author of “Aroused: The History of Hormones and How They Control Just About Everything.”

EARLY
An Intimate History of Premature Birth and What It Teaches Us About Being Human

By Sarah DiGregorio
A version of this article appears in print on Feb. 9, 2020, Page 17 of the Sunday Book Review with the headline: Born Too Soon.

Source:https://www.nytimes.com/2020/01/28/books/review/early-sarah-digregorio.html

© Provided by The Boston Globe – Brian and Kristen Sardini with Aila at the Brigham and Women’s Hospital.

NEW FATHER TO CELEBRATE FIRST FATHER”S DAY IN HOSPITAL WITH PREEMIE BORN AT 25 WEEKS

Laura Crimaldi – The Boston Globe

Brian and Kristen Sardini didn’t expect to become parents in time to mark Mother’s Day and Father’s Day this year. Their first baby was due on July 4.

But little Aila had different plans.

The baby girl was born March 26 during her mother’s 25th week of pregnancy. She weighed just over a pound.

On Sunday, the family will mark Brian Sardini’s first Father’s Day with Aila in the Newborn Intensive Care Unit, or NICU, at Brigham and Women’s Hospital.

“It’s the best Father’s Day gift in the world,” he said Saturday. “I’ve always wanted to be a dad and wouldn’t change anything because Aila’s perfect.”

During her three months in the unit, Aila has made tremendous strides, her parents said. The ventilator and continuous positive airway pressure or CPAP machine that Aila once used for breathing are history. A crib has replaced the isolette where she once spent most of her time. She’s tried out breastfeeding and started wearing clothes from the Preemie Store, which sells “micro” sizes for babies who weigh between 1 and 3 pounds.

On Friday night, Aila tipped the scales at just over 4 pounds. She has a collection of colorful, hand-knitted octopuses, which are used in hospitals to comfort premature babies.

What’s more, her parents have already read her the first four books in the “Harry Potter” series and are now halfway through reading her the fifth book, “Harry Potter and the Order of the Phoenix.”

“We started reading her ‘Harry Potter’ when she was, I think, 3 days old,” said Kristen.

Dr. Elisa Abdulhayoglu, the NICU’s medical director, said she was in the room when Aila was born and watched Brian meet his daughter.

“He bent down, looked at his beautiful little girl, and he said, ‘Yup. I’m a daddy’s girl for sure,’” she said. “It was an absolutely beautiful, beautiful moment.”

Good thing beautiful moments don’t require planning. Four days before Aila was born, Kristen said she had an uneventful appointment with her obstetrician. On the following day, the couple, both 27, planned to go to work and turn in a down payment for their new home in Medway.

But that day, they also went to an ultrasound appointment, and got some troubling news. Kristen had pre-eclampsia and needed to be admitted to the hospital for monitoring. Her routine checkup from the day before was suddenly ancient history.

“I had a totally normal OB appointment. My blood pressure was like 112 over 79. Completely normal. No red flags. Nothing wrong,” she said. “Within 24 hours, I was being sent to the Brigham. That’s how quickly this stuff can happen. And it’s really crazy.”

Kristen credits her husband with getting her through the Cesarean section birth.

“He just really helped me stay calm, and just like he said, focus on the task at hand and just take one thing at a time, and not let myself get lost in in mumbo jumbo of everything,” she said.

Before the birth, the couple said they were warned that their daughter wasn’t likely to cry or move when she was born and they wouldn’t have a chance to cut her umbilical cord.

Once again, Aila had something else in mind. She entered the world kicking, waving, and “crying at the top of her lungs,” her parents said. Brian also got to cut the umbilical cord.

“People say that when you see your child for the first time, it’s just an instant, instant bond and your whole life kind of changes,” Brian said. “As cliché as it sounds, it really is what happens.”

At a gestational age of 25 weeks, Abdulhayoglu said Aila is considered young by preterm standards. The majority of preterm babies born in the United States have reached a gestational age of at least 32 weeks, she said. The Brigham’s NICU cares for preterm babies as young as 22 weeks gestation, though, according to Abdulhayoglu.

In the long-term, she said outcomes are “excellent” for babies born at 25 weeks gestation.

“Parents are the true champions for these tiny, preterm babies, and her parents are amazing,” Abdulhayoglu said. “They’re there every day.”

The couple said they don’t know when Aila will be ready to leave the hospital, but they hope to take her home next month.

On Sunday, the couple said they plan to spend most of the day at the hospital with Aila, reading and snuggling. They heaped praise on the nurses, doctors, social workers, and other Brigham employees who have assisted them during Aila’s hospitalization.

Aila shares a room overlooking a courtyard with six other babies and decorated by her nurses with photographs of her and prints of her feet positioned to look like butterfly wings.

On Mother’s Day, Kristen said her daughter’s nurses gave her a mug that read, “Mom,” with Aila’s handprint in the spot for the letter O.

Kristen said she wants her husband to enjoy his first Father’s Day with their daughter.

“I hope that he just has the best day possible,” she said. “He has 100 percent earned it.”

Source:https://www.msn.com/en-us/news/us/new-father-to-celebrate-first-father-e2-80-99s-day-in-hospital-with-preemie-born-at-25-weeks/ar-AAYBZNW?ocid=uxbndlbing

HEALTH CARE PARTNERS

MRI Detects Atypical Brain Development in Premature Babies By News Release – School of Medicine in Boston

Subtle differences in brain structure can be detected by quantitative MRI (qMRI) in premature babies who later develop abnormalities such as autism or cerebral palsy. The study, published in Radiology, demonstrates the potential for qMRI, which obtains numerical measurements, to help improve outcomes for the growing numbers of people born preterm.

Advances in neonatal care have boosted survival rates for children born extremely preterm, defined as fewer than 28 weeks of gestation. With so many preterm infants surviving, there is interest in understanding the effects of preterm birth on brain development. Research has shown that extremely preterm babies face higher risks of brain abnormalities.

“So much of the maturation of brain occurs during the third trimester when the fetus is in the womb’s nourishing environment,” said study co-author Thomas M. O’Shea, MD, from the University of North Carolina in Chapel Hill. “These preterm babies don’t experience that, so it seems likely that there are alterations in the brain maturation during that interval.”

Dr. O’Shea and colleagues at 14 academic medical centers in the US launched a study 20 years ago to better understand the effects of preterm birth. The study, known as the Extremely Low Gestational Age Newborn-Environmental Influences on Child Health Outcomes (ELGAN-ECHO), evolved over the years to include experts in medical imaging like medical physicist Hernán Jara, PhD, professor of radiology at Boston University School of Medicine in Boston.

For the new study, Dr. Jara, Dr. O’Shea, and other ELGAN-ECHO researchers used qMRI. The noninvasive technique generates rich information on the brain without radiation. The researchers used it to assess the brains of adolescents who had been born extremely preterm.

“Quantitative MRI in a large dataset allows you to identify small differences between populations that may reflect microstructural tissue abnormalities not visually observable from imaging,” Dr. Jara said.

The researchers collected data from MRI scanners at 12 different centers on females and males, ages 14 to 16 years. They compared the qMRI results between atypically versus neurotypically developing adolescents. They also compared females versus males. The comparison included common MRI parameters, or measurements, like brain volume. It looked at less commonly used parameters too. One such example was proton density, a measurement related to the amount of water in the brain’s gray and white matter.

“What we aimed to do with qMRI was establish a biological marker that could help us discern these preterm children who had a diagnosis of disorder from those who didn’t,” said study lead author Ryan McNaughton, MS, a PhD student in mechanical engineering at Boston University.

There was no control group of people born after the typical nine months of gestation. Instead, the researchers used the neurotypically developed children for comparison.

Of the 368 adolescents in the study, 252 developed neurotypically while 116 had atypical development. The atypically developing participants had differences in brain structure visible on qMRI. For instance, there were subtle differences in white matter related to proton density that corresponded with less free water.

“This might be the tip of the iceberg since the amount of free water is highly regulated in the brain,” Dr. Jara said. “The fact that this difference was observed more in females than males may also be related to the known comparative resilience of females as demonstrated in findings from earlier ELGAN-ECHO and other studies.”

The researchers collected umbilical cord and blood samples at the beginning of the study. They plan to use them to look for correlations between qMRI findings and the presence of toxic elements like cadmium, arsenic, and other metals. The power of qMRI will allow them to study both the quantity and quality of myelin, the protective covering of nerves that is important in cognitive development. They also want to bring in psychiatrists and psychologists to relate qMRI findings to intelligence, social cognition and other outcomes.

“This project shows how researchers with different expertise can work together to use qMRI as a predictor of psychiatric and neurocognitive outcome,” McNaughton said.

“The teamwork required to get where we are now is pretty astounding,” Dr. O’Shea added. “I’m really grateful for the families, the nursing coordinators, and everyone else who made this possible.”

Source:https://appliedradiology.com/communities/Pediatric-Imaging/mri-detects-atypical-brain-development-in-premature-babies

Dr. Philip Sunshine, founding father of Neonatology, is turning 90!

Jun 12, 2020

Our beloved Dr. Philip Sunshine, one of the founding fathers of Neonatology, is turning 90 years young! His only birthday wish? To help save more babies.

Fascinated? Learn more about Dr. Sunshine here: https://www.youtube.com/watch?v=h4ZjVfN3u0g

Policy Strategies for Addressing Current Threats to the U.S. Nursing Workforce

List of authors. Deena Kelly Costa, Ph.D., R.N., and Christopher R. Friese, Ph.D., R.N.

The Covid-19 pandemic has made it clear that without enough registered nurses, physicians, respiratory therapists, pharmacists, and other clinicians, the U.S. health care system cannot function. Weaknesses in health care staffing are of particular concern when it comes to the workforce of registered nurses, which could well see a mass exodus as the Covid-19 pandemic eases in the United States and the economy recovers. In a 2021 national survey conducted by the American Association of Critical-Care Nurses, 66% of respondents reported having considered leaving the profession, a percentage that is much higher than previously reported rates. Unsafe work environments — which predated the pandemic — are a key contributor to intentions to leave. Clinicians, health system executives, and policymakers have issued calls to address this crisis, but there has been little in the way of tangible federal or state policy action to prevent workforce losses or to build capacity.

Although it may comfort hospital executives to imagine a post-Covid future in which nurses are again willing to accept positions at local pay scales, such a scenario is unlikely to come about anytime soon. Historically, nurses have reduced their working hours or left the workforce during economic growth periods and returned during recessions, when family incomes fall.1 Nurses may again choose reduced employment as Covid-19 pressures ease and economic conditions improve. Moreover, nurses reported pervasive unsafe working conditions before the pandemic, and during Covid, they have cited a range of stressors and traumatic experiences, including furloughs, a lack of adequate protective equipment, increased violence, excessive workloads, and reduced support services. Pressures on the nursing workforce may therefore only worsen as Covid-19 subsides.

Federal and State Policy Approaches to Supporting Nurse Staffing in the United States.

State and federal policy solutions could prevent workforce losses and increase the supply of nurses (see table). Although there are challenges and opportunities for the nursing workforce throughout health care settings, hospitals are a particularly important area of focus.

Preventing the loss of current nurses is an essential component of shoring up the hospital nursing workforce. We contend that there isn’t a shortage of nurses, but a shortage of hospitals that provide nurses with safe work environments and adequate pay and benefits. At the federal level, the Centers for Medicare and Medicaid Services (CMS) could publish regulations, similar to recently announced policies governing skilled nursing facilities, that specify standards (including maximum patient-to-nurse ratios) for ensuring safe nursing care — and could establish financial penalties for hospitals that violate these regulations. Data supporting increased nurse staffing have been available for decades.2

Another federal strategy centers on investing in reimagined, safer health care systems. Congress could appropriate funds to the Agency for Healthcare Research and Quality to support investigator-initiated grants focused on developing new, scalable care-delivery models that are designed to improve outcomes for patients and clinicians. The National Institute for Occupational Safety and Health could expand testing of protective equipment and strategies for improving health care workers’ well-being. Data are needed on care-delivery models that keep patients safe and on approaches for promoting joy and safety in clinical work.

Regulatory bodies, including CMS and CMS-approved accreditors, such as the Joint Commission, could scale back regulations and standards that add to nursing workloads. Although some regulations were temporarily eased during the pandemic, new rulemaking could eliminate especially burdensome provisions that aren’t essential to patient safety. For example, clinical-documentation burden is a frequently cited source of job dissatisfaction and burnout. Documentation requirements, which are interpreted in various ways by different hospitals, could be minimized to reduce burnout and attrition.

States have more flexibility than the federal government when it comes to enacting legislative and regulatory changes to improve work environments and prevent losses in the nursing workforce. In the absence of federal action in this area, state legislation promoting safer nurse-staffing practices — such as laws establishing mandatory patient-to-nurse ratios — is an evidence-based intervention to support patient safety and reduce the likelihood of nurse departures. Studies have reported improved nurse staffing, improved job satisfaction among nurses, and improved patient outcomes in California after the state enacted legislation prohibiting mandatory overtime for nurses and establishing maximum patient-to-nurse ratios.3 Many U.S. hospitals continue to require nurses to work overtime hours, however, and few have mandated staffing ratios. Legislatures in some states have introduced bipartisan bills similar to California’s law that would restrict mandated overtime and implement maximum staffing ratios. When considered at a national scale, mandated staffing ratios face implementation hurdles, since coordination would be required to distribute the nursing workforce equitably throughout the country. But such policies would most likely prevent workforce losses and boost the number of entrants into the profession.

Policies could also support career development among nurses. Studies have documented the negative effects of Covid-19 on the careers of women in particular. Approximately 90% of U.S. nurses are women, and many of them have faced pressures related to family care during the pandemic, amid school and child-care facility closures. To ease nurses’ household burdens, states could offer loan-repayment programs and offset nursing school tuition debt. They could also provide grants or tax benefits to hospitals offering on-site child care, after-school care, or comprehensive dependent-care programs. Finally, states could offer innovation grants to hospitals to develop safer, more supportive workplaces or fund new initiatives to support on-site graduate-school and professional-development programs designed to retain experienced nurses.

Preventing workforce losses is important, but so is increasing the supply of nurses. The United States lacks access to real-time workforce data and expert guidance for evaluating those data and for advising policymakers on workforce shortages. The National Health Care Workforce Commission was authorized as part of the Affordable Care Act, but Congress never funded it. Appropriating funds for this commission would strengthen the country’s ability to respond to the current threat to nurse staffing and prepare for future ones.

A key factor constraining the supply of nurses derives from structural barriers within nursing education. Being hired as a nursing school faculty member requires having an advanced degree, but expert nurses rarely accept faculty positions because salaries are higher for practice roles. Faculty shortages, among other factors, limit nursing school enrollments; over the past decade, schools turned away between 47,000 and 68,000 qualified applicants annually.4 Federal policies could loosen the nursing bottleneck. For example, policymakers could increase financial incentives to recruit nurse educators, expand nursing school loan-forgiveness programs, fund grants for hospitals and nursing schools to share expert nurses as clinician-educators, and develop a nurse faculty corps program to raise salaries in regions with shortages of nurses. Creative financial incentives, such as tuition-remission programs or programs that provide loans at low interest rates, could encourage prospective students to choose nursing careers. Pipeline programs and partnerships among high schools, technical schools, and universities could permit emergency medical technicians, certified nursing assistants, and armed forces corpsmen or medics to apply clinical work hours toward nursing degrees and qualify for targeted scholarships supported by state or federal funds. Expansion of the CMS Graduate Nurse Education demonstration project could substantially increase the number of qualified nurse practitioners, who could also serve as clinical nursing faculty.

State legislation that eliminates onerous scope-of-practice regulations for advanced practice providers would enable nurse practitioners, including midwives, to practice independently and could increase access to health care. In Michigan, Senate Bill 680 would implement these reforms, thereby allowing nurse practitioners to prescribe tests, medications, and services. This bill could increase the state’s supply of clinicians and potentially attract nurses planning to pursue advanced degrees.

Threats to the nursing workforce aren’t new, and neither are proposals to address them.5 Although policies aimed at individual components of this problem could be helpful, a comprehensive package of federal, state, and local efforts would probably be the most effective approach for averting health care system dysfunction and adverse outcomes. We believe federal and state policies should both prevent the loss of current nurses and increase the supply of nurses. Without timely investments in the nursing workforce, the United States may have enough hospital beds for seriously ill patients, but not enough nurses to deliver essential, safe care.

Source:https://www.nejm.org/doi/full/10.1056/NEJMp2202662

Skin injuries to babies in neonatal care could be avoided with new splint, trial shows

by Victoria University of Wellington – MAY 26, 2022

A new device to prevent skin injuries to babies in neonatal intensive care units has been successfully trialed in a study led by Dr. Deborah Harris, a neonatal nurse practitioner at Te Herenga Waka—Victoria University of Wellington.

Most babies admitted to hospital need an intravenous drip to deliver fluids and medications, says Dr. Harris. This drip is secured to the baby’s skin using adhesive tape.

“Removing the adhesive tape is painful and can cause skin injuries and scarring. Skin damage also increases the risk of the baby getting an infection and being in hospital longer. We designed a device called a Pēpi Splint that can be used to secure the drip without the need to apply adhesive tape to the baby’s skin,” Dr. Harris says.

A trial of the Pēpi Splint on 38 babies at Wellington Hospital’s neonatal intensive care unit showed it was effective and avoided the skin damage caused by adhesives.

“The Pēpi Splint held the drips secure for 34 of the 38 babies in our trial. In four cases, the splint became loose either because it hadn’t been secured properly or was dislodged when the baby was removed from the cot for breastfeeding.”

Dr. Harris says the results provide support for a larger randomized controlled trial.

“Skin injuries are common in neonatal units and the damage caused to a baby’s skin by adhesive tape can be considerable. Removing the tape has the potential to strip 70% to 90% of a baby’s epidermis. We hope the Pēpi Splint will help reduce these injuries to newborns.”

The splint is made from medical-grade silicon gel and contains an aluminum mesh, allowing it to be molded to the baby’s limb. Adhesive tape is used on the Pēpi Splint itself to secure it to the drip, but tape is not applied to the baby’s skin.

During the trial, modifications were made to the splint to make it easier to use. “After these changes, clinicians involved in the trial reported the splint was easy to apply,” Dr. Harris says.

Most parents supported the device’s use: 52 of 58 (90%) said they would participate in the study again if they had another eligible baby.

The Pēpi Splint, developed in collaboration with a design engineer, can be washed and sterilized for reuse.

Source:https://medicalxpress.com/news/2022-05-skin-injuries-babies-neonatal-splint.html

PREEMIE RISING STAR!!!

Golden Buzzer: Avery Dixon’s Emotional Audition Moves Terry Crews to Tears | AGT 2022

May 31, 2022  –    #AGT #AmericasGotTalent #Auditions

     America’s Got Talent

Grab your tissues; Avery Dixon’s emotional audition might make you cry. Terry Crews was moved to tears when he heard Avery’s sensational saxophone skills and harrowing story about being bullied.

Kat’s Korner

Fellow Warriors and Preemie Parents,

As per the NTNU St. Olay Hospital’s Study, “ the risk of dying before the age of 50 is 40 percent higher for preemies than for the population as a whole. Researchers found that the risk of dying for individuals born before full gestation and who have chronic heart disease, lung disease, or diabetes is twice that of the population as a whole.” These findings provide valuable information in regard to the morbidity risk of preemie infant survivors and highlight the need for further research. 

Increased diagnosis and early detection of disease conditions that preemie survivors are more prone to experience are critical as our rate of survival is improving and more of us are thriving well into adulthood. While research efforts to improve outcomes, reduce mortality and enhance care for neonates have drastically improved over the past 50 years, few studies have investigated long-term outcomes, health disparities, and the impact of the life-long physical and psychological impact of being premature among the adult population. We need to establish specialist education/credentialing that support workforce opportunities to partake in diagnostics, treatment, research and  development aimed at addressing adult care for preemie infant survivors.

As a community that makes up 11-12% of the global population, we can connect and engage with each other as preemie survivors, promote collaboration between all members of our community, and actively advocate for change in the clinical management of preemie infant survivors to include long-term and specialized care.

If you or someone you know is interested in learning more about ways to connect with our adult preemie community a great resource is the Adult Preemie Advocacy Network, sharing safe space communication platforms for preemie survivors and opportunities to participate in research activities, and partake in advocacy activities to support our resilient community. Check out this great resource below-

Source:https://adultpreemies.com/

Surfing Under the Northern Lights w/ Mick Fanning | Chasing the Shot: Norway Ep 1

Mar 20, 2017

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