Law, Virtual Health, History


Rank: 162  –Rate: 6.6%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Greece, officially the Hellenic Republic, is a country in Southeast Europe. It is situated on the southern tip of the Balkans, and is located at the crossroads of EuropeAsia, and Africa. Greece shares land borders with Albania to the northwest, North Macedonia and Bulgaria to the north, and Turkey to the northeast. The Aegean Sea lies to the east of the mainland, the Ionian Sea to the west, and the Sea of Crete and the Mediterranean Sea to the south. Greece has the longest coastline on the Mediterranean Basin, featuring thousands of islands. The country consists of nine traditional geographic regions, and has a population of approximately 10.4 million. Athens is the nation’s capital and largest city, followed by Thessaloniki and Patras.

Greece has universal health care. The system is mixed, combining a national health service with social health insurance (SHI). 2000 World Health Organization report, its health care system ranked 14th in overall performance of 191 countries surveyed.  In a 2013 Save the Children report, Greece was ranked the 19th out of 176 countries for the state of mothers and newborn babies. In 2010, there were 138 hospitals with 31,000 beds, but in 2011, the Ministry of Health announced plans to decrease the number to 77 hospitals with 36,035 beds to reduce expenses and further enhance healthcare standards. However, as of 2014, there were 124 public hospitals, of which 106 were general hospitals and 18 specialised hospitals, with a total capacity of about 30,000 beds



Remembering Dr. Lorna Breen, an emergency room physician who died by suicide during COVID-19

Feb 28, 2022 

The following episode contains emotional content and a discussion about suicide. It’s intended for mature audiences. Viewer discretion is advised. If you or someone you know is in crisis, please call the National Suicide Prevention Hotline at 800-273-8255 or text ‘HELLO’ to 741741 to get 24/7 support. Corey Feist, co-founder of the Dr. Lorna Breen Heroes’ Foundation, remembers his late sister-in-law, Dr. Lorna Breen, who was a healthcare worker at the New York Presbyterian Hospital during the height of the pandemic. Dr. Lorna Breen died by suicide on April 26, 2020, and Corey shares her story in hopes to normalize conversations around mental health and prioritize the wellbeing of our healthcare workers. To learn more about how you can help support healthcare workers, please visit:


A training program for nurses in North-Eastern Greece

   Full length Article| Volume 66  | E22-E26| Sept 01, 2022


  • Tutoring NICU nurses to recognise basic mesothoracic structures by ultrasound
  • Training improved the ability to accurately identify more lung structures
  • Collaboration of nurses and interdisciplinary teams can benefit high-risk infants



To demonstrate methods and landmarks for mediastinum ultrasound as part of ultrasound examination of the lung for nurses. This will be the first step in their education to detect finally the tubes and lines malpositioning in order to distinguish emergency conditions of the lungs in neonates hospitalized in neonatal intensive care units.

Design and methods

Theoretical and practical interventions were developed to create a 3-month training program based on similar medical courses. The study was approved by the hospital’s ethics committee. The program was performed in the neonatal intensive care unit of a single academic institution. Participating nurse was supervised by a paediatric surgeon and trained in lung ultrasound (a safe method without radiation) by a paediatric radiologist.


During the practical period (2 months), the neonatal intensive care unit nurse examined 50 neonates (25 + 6–40 + 4 weeks gestational age; 21 males) separated into two subgroups of 25 neonates each for each training month. In the first month under supervision, the nurse was trained to recognise the aortic arch, the right pulmonary artery, the esophagus, the tracheal air, and the ‘sliding lung sign’ in the anterior, lateral, and posterolateral aspects of the thoracic cage. In the second month, the nurse recorded the ultrasound examinations. The identified structures were then assessed and graded by the supervising radiologist. The overall estimated success rate (5 landmarks × 25 neonates = 125) was 90.4%.


Although this is the first report of the design of a ‘hands-on,’ lung ultrasound training program for neonatal intensive care unit nurses, our findings demonstrate that it is a safe and useful program for all neonatal intensive care unit nurses because the overall success rate of the 3-month program was determined by accurate identification of basic anatomical structures (90.4%) by the nurse.

Practice implications

This study describes the first educational training program for NICU nurses designed to recognise basic structures in the neonatal mediastinum. If the program is effective, NICU nurses will be able to identify respiratory emergencies. NICU nurses can inform doctors about emergencies according to tubes and lines malpositioning in a timely manner to avoid negative consequences.


Expanding International Access to Children’s Mental Health Care

April 7, 2021

As families everywhere continue to cope with the extraordinary challenges of the coronavirus pandemic, the Child Mind Institute is proud to announce a new initiative to advance children’s mental health treatment.

Supported by a landmark grant from the Stavros Niarchos Foundation (SNF), we are launching an ambitious five-year project to bring our evidence-based clinical expertise to children’s mental health professionals across Greece. The initiative will develop a comprehensive care and referral system that will revolutionize Greek children’s access to the care, support and guidance they need to thrive.

In partnership with local providers, our work with SNF will build children’s mental health infrastructure in Greece through three main avenues:

•  Extensive training and clinical supervision of children’s mental health professionals

•  Development of a national referral center to give providers guidance on complex cases

•  Expansion of technological capacity for telehealth services and specialized online tools

“Every child deserves access to professional, compassionate and dignified health care — including for mental health — and this program represents a significant first step toward a new paradigm for children’s mental health in Greece,” said SNF Co-President Andreas Dracopoulos.

The new grant is part of SNF’s Health Initiative, which aims to ensure access to quality care for everyone in Greece by strengthening the country’s health system. SNF has been a steadfast supporter of the Child Mind Institute since its founding, partnering to address challenges to child mental health for over a decade.

“Building on our rich history and partnership, we have an unparalleled opportunity to transform children’s mental health care in Greece,” said Child Mind Institute Founding President and Medical Director Dr. Harold Koplewicz. “Bringing together the visionary leadership of the Stavros Niarchos Foundation and the proven experience of the Child Mind Institute, we can create an international model for mental health care that will change the trajectory for children and adolescents struggling with their mental health in Greece and beyond.”

For all the latest updates on the Child Mind Institute’s work supporting children and families dealing with mental health and learning challenges, sign up for our newsletters.


wrs x Andromache – If you were alone / Sta matia sou | official video

1,263,884 views     Jul 8, 2022     wrs

Maria Delivoria-Papadopoulos: the legendary pioneer in perinatology and mother of neonatology- Obituary

Pages 3631-3632 | Published online: 27 Sep 2020

Maria Delivoria-Papadopoulos was born in Athens, Greece. The hard times before, during and after World War 2, followed by the Greek civil war, severely affected her leftist family. However, hardships did not prevent her from receiving a scholarship and finishing with distinction her secondary education in the Greek-French School “Saint Josef;” from studying philosophy at the Greek section of the Sorbonne University; from occupying herself with literature, poetry, arts and theater, attending -despite her very limited resources- numerous theatrical performances; from receiving her medical degree from the National and Kapodistrian University of Athens, Medical School. Upon graduation Maria was trained in Pediatrics in “Aghia Sophia” Children’s University Hospital in Athens, where she gained great experience in using the iron lung in children with polio. Later, in Canada and the US, she will be the first clinician worldwide to apply mechanical respiratory support to another category of children: premature neonates.

A special feature of young Maria was her enthusiastic involvement with Girl Guiding, the principles of which, especially the offer to fellow human beings and society as a whole, Maria not only deeply embraced, but applied throughout her life. She quickly gained a high degree and educated a large number of children (me included) and adolescents, among them Princess Sophia, the later queen of Spain.

Her desire to participate to the latest developments in Pediatrics, urged her to move to the US. Nevertheless, the political history of her family was an insurmountable obstacle in getting a visa. Help will come from the highest possible level: the then Head of the body of Greek Girl Guides, Princess Sophia, signifying Maria’s incredible ability to unite opposite ends! Thus, with her husband, physician Christos Papadopoulos, Maria departs from Greece in 1959 to spend 61 years, the rest of her life, in the US, Canada and again the US, becoming a naturalized U.S. citizen in 1970, but always keeping with pride, deep in her heart, her beloved country of origin and her characteristic double Greek name. Extremely arduous, yet so productive years will follow, leading her soon to international recognition.

In the US and Canada, she completed residencies and fellowships in several state and University hospitals, training in Pediatrics, Neonatology, Obstetrics/Gynecology, Physiology and Embryology, thus, in all fields of Perinatal Medicine. She received a post-doctorate degree in Physiology from the University of Pennsylvania, where she spent the next 29 years as a faculty member. Further, she held numerous faculty and hospital appointments in the Philadelphia area. In 2006 she was awarded the Ralph W. Brenner Chair in Pediatrics at St. Christopher’s Foundation for Children.

Maria has given Grand Rounds several times per year at Universities and Medical Centers throughout the U.S, and functioned as Visiting Professor and keynote speaker in innumerous countries in South America, Europe and Asia for over 50 years. She has received a great number of prestigious awards, starting in 1961, e.g. “Teacher of the Year Award” for 1962, 1964, 1973, 1974, 1978, 1992, 1993, 1996, 2004, 2006, “NIH Special Research Fellowship Award 1966”, “NIH Young Investigator Award 1968”, “NIH Career Development Award 1968”, “American Academy of Pediatrics Lifetime Achievement Award”, “National Lifetime Achievement Award from Castle Connolly”, “Legends in Neonatology Award” (2007) together with Mildred Stahlman and Mary-Helen Avery. She was named “Top Doctor” by Philadelphia magazine (2012–2016). She had served several terms for the National Institutes of Health, as well as for many academic and hospital committees; she was a member of numerous scientific societies; had received honorary degrees from three universities (Nancy, Thessaloniki and Athens); was a reviewer for top scientific journals, including the New England Journal of Medicine. Her publications are over a thousand, mostly focusing on neonatal care, neonatal brain injury and neonatal physiology.

Maria’s clinical work was marked by two innovations. The implementation for the first-ever time of mechanical respiratory support to premature neonates in 1963, and a bit later of parenteral fluids to preterms, saving hundreds of thousands of lives. Her pioneering scientific work focused besides respiratory distress syndrome and physiology of pulmonary fluid, on oxygen-hemoglobin binding in adults and fetuses/newborns, cerebral blood flow, mechanisms of hypoxic/ischemic encephalopathy in the fetus and neonate, as well as the mechanisms of cerebral cells apoptosis.

Maria had generously mentored countless young doctors from countries all over the world, devoting them endless time, care and love. Despite her phantastic achievements, she remained a person of exemplary modesty, contemptuous for material goods, with huge charitable activity not only for children but also for any adult in need. She used to spend every summer a month in her favorite Greek island Ithaca, fishing, donating her “catch” to the poor and gratis examining each evening consecutively all children of the island.

This homage to Maria will close with spontaneous words by colleagues, when informed on her passing: “so impressed by her sweetness, smartness and profound culture, but also her firm capability to teach and to carry on research, she as a woman in times when the most was run by men!” (Gian Carlo Di Renzo), “a true trailblazer in our field, a kind, gentle care giver” (Helen Christou), “a unique, wonderful, exemplary, inspiring woman” (Umberto Simeoni), “Maria leaves a great legacy” (Neena Modi), “really impressed by her legacy” (Hugo Lagercrantz), “Maria is an example for all of us” (Vassilios Fanos), “we will strive to honour her” (Mark Hanson).

May she rest in peace!


Health-care workers reveal how pandemic affected their mental health, home lives

Apr 8, 2022    CBC News

Health-care workers say the emotional and physical toll of the COVID-19 pandemic has had an impact on them at work and at home.

Health-care workers reveal how pandemic affected their mental health, home lives – YouTube


New Guidance Encourages Moms to Nurse for Two Years

Michelle Winokur, DrPH    

According to the American Academy of Pediatrics new guidelines, mothers are now encouraged to nurse for two years – up from one year. A mother’s willingness or ability to initiate breastfeeding is dependent on many factors, including support from family, close friends, and the hospital or birth center where the child is born. However, many other barriers can potentially keep moms from exclusively nursing for even six months, long considered the benchmark before introducing “nutritious complementary foods.”

Barriers to Breastfeeding:In recognition of the challenge of a lengthened breastfeeding period, the AAP concurrently released a technical report (2) identifying hurdles and approaches to support nursing moms. Among the challenges moms face are:

Societal judgment: Upwards of 80% of women breastfeed initially, establishing the practice as a “cultural norm.” However, just one-third of infants are nursed beyond one year. (3) This sharp decline can lead to judgment and comments from well-intentioned yet misinformed relations – or strangers – who may not recognize the value of longer-term breastfeeding. Similarly, providers should support nursing beyond one year, though there is evidence that is not always the case.

Workplace barriers: The United States is one of only a handful of upper-income countries that does not guarantee paid maternity leave. Lack of income or loss of job protection forces some moms back to work sooner than they would like. Furthermore, few businesses provide on-site childcare, making it more convenient for moms to nurse during the workday. The country also lacks requirements for workplace breaks and the provision of a clean, private space to nurse or express milk.

Insurance coverage: In most cases, insurance will provide or reimburse for select breast pumps, but coverage varies by plan and is not guaranteed. Similarly, only some insurers cover lactation support. While most hospitals and birth centers provide an initial consultation, many moms require additional guidance and support to continue nursing.

Benefits of Breastfeeding:The benefits of breastfeeding for babies and moms are numerous. Babies who nurse receive immunities from their moms, making them less likely to develop ear infections and less susceptible to stomach bugs. They also experience sudden infant death syndrome at lower rates. Moreover, breastfed babies have a lower risk of developing certain conditions, including asthma, obesity, and type 1 diabetes, as they grow. Moms who nurse likewise reap long-term benefits, including reduced risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure.

There is no better time than now, during National Breastfeeding Month, to reflect on the AAP’s updated guidance and recommit to reducing barriers that discourage moms from breastfeeding. Providers, policymakers, employers, insurers, and communities all have opportunities to support nursing moms and their babies

Source:nt-aug22.pdf (

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Managing relationships after premature birth

Having a premature baby can have a huge impact on the whole family. Here we talk about how you may all feel and what you can do to support each other.

How premature birth may affect the parents

Research has found that both parents of premature babies are more likely to experience extreme stress and mental health problems than parents whose babies arrived full term. 

A lot of parents have told us that they felt a lot of complex emotions after their baby was born, such as helplessness, fear and confusion. Some even feel guilty or wonder if they could have done something to prevent it. Feelings of failure are also common. Some parents feel like their body has failed them or that they have failed at parenthood before they have even started.

Dads and partners may also feel helpless or out of control. Some partners have told us that they felt alienated in the baby unit.

Depending on how long the baby is in hospital, partners may need to go back to work before your baby goes home. This may mean that they can’t spend as much time with the baby as the other parent. This may leave them feeling isolated, scared or stressed that they can’t do more. 

This can create anxiety and tension. Even the healthiest relationships can strain in stressful situations, so try not to let any worries about you as a couple overwhelm you. It’s really important that you stay open and honest with each other about how you feel. Talking to each other about your fears, worries and feelings can help you to support each other better and understand each other. Try to understand things from each other’s point of view and give each other space. 

How premature birth can affect siblings

If you have any older children, they may be affected by the experience of having a new baby brother or sister who is born prematurely. Children are very sensitive to what is going on, and if you are concerned about the baby – even if you don’t talk openly about it – they will probably be aware of this. They are also likely to be confused if the baby needs to stay in hospital for a while.

The way they react will depend on how old they are and their personality. Try to explain what’s happening in a way you think they’ll understand. Try to be as honest with them as you can and be prepared for the possibility that they may have some questions. Let them know that they can talk to you about what’s happening whenever they need to. 

Try to involve them as much as you can. Perhaps they could draw a picture for the new baby or you could take them to buy a present for them. If it’s possible for them to visit their new sibling, explaining what the hospital environment may be like before you go may help.

There are books available that are aimed at siblings of premature babies to help them understand what’s happening. Ask your local bookseller or go online to find recommended books about prematurity for children.

How premature birth can affect grandparents

Grandparents may be feeling anxious for all of you. Try to keep them in the loop about what’s happening. 

They may be keen to help but unsure of what they could do. You could suggest they could do some practical things like make some frozen meals for you, help to keep your house tidy or look after any older children if you have them. 

Managing competing demands after premature birth

Your family and friends will hopefully become a vital support for you during the early weeks and months of your baby’s life.

But because everyone has different needs, having lots of people to worry about can make it stressful too. For example, you may feel that you need to spend all your time at the baby unit, but perhaps you have older children who need your time too. Or perhaps one parent wants to talk about a traumatic birth, but the other is not ready. Or maybe family and friends want to check in and see how you are, but you are feeling too tired or stressed to call or message anyone. 

This can be stressful. You will also be trying to cope with your own feelings so it can be difficult when you feel you need to look after other people too. 

If tensions are rising, try to talk things through. If you can be honest and open about how you’re feeling, it can often help prevent misunderstandings, hurt or resentment later.

How others can help

Family and friends may be an essential support at this difficult time, but not everyone is good at dealing with this sort of situation. You may be surprised by the people who rally round, and disappointed that others offer less support than you hoped for. 

Don’t be afraid to ask for help or take it when it’s offered. They will probably be pleased to help by keeping you company, cooking meals or offering to help with your other children.

If people say unhelpful or insensitive things, try to ignore them. Most people will have no understanding of what you’re going through and would probably be horrified at their own insensitivity if they did.

Celebrating your premature baby’s breakthroughs

Many families find that they are so busy focusing on their baby’s health problems that there is little space to think about the good things. It is important to allow yourself to feel grief when you’re going through hard times. But when your baby has a breakthrough, such as coming off a particular treatment, or going home, it can be helpful to celebrate that too.

Sharing good news

Many parents like to mark these events in some small way and to share them with others. This might simply involve sending out a group text to loved ones telling them the news, sharing a glass of bubbly or having a meal with close friends or family. You might prefer to simply note them down in a journal if you keep one.

Try to hold on to that positive feeling for as long as you can and focus on how far your new family has come already. 

Tommys: Our Story

From a campaign that began in a spare cupboard in St Thomas’ Hospital, Tommy’s is now the largest UK charity researching the causes and prevention of pregnancy complications, miscarriage, stillbirth, premature birth and neonatal death.



Dr. Lorna Breen Health Care Provider Protection Act Signed Into Law

March 18, 2022

On March 18, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act, named for a Columbia emergency medicine physician, into law. The act will provide federal funding for mental health education and awareness campaigns aimed at protecting the well-being of health care workers. 

The new law—the first to provide such funding—is named for Lorna Breen, MD, an emergency medicine physician and faculty member at the Vagelos College of Physicians and Surgeons and NewYork-Presbyterian/Columbia University Irving Medical Center who died by suicide in April 2020 at the peak of the first COVID surge. 

“Health care professionals often forgo mental health treatment due to the significant stigma in both our society and the medical community, as well as due to the fear of professional repercussions,” says Angela Mills, MD, chair of emergency medicine at Columbia University Vagelos College of Physicians and Surgeons. “This law will provide much needed funding to help break down the stigma of mental health care, providing education and training to prevent suicide, address other behavioral health issues, and improve well-being.” 

Health care workers have always experienced extraordinarily high levels of stress. To protect their careers, however, most with mental health issues suffer in silence. The COVID pandemic has only intensified the stress and suffering.

Breen’s death highlighted the need to help front-line health care workers cope with the stress of their jobs. 

The goal of the Dr. Lorna Breen Health Care Provider Protection Act is to prevent suicide, alleviate mental health conditions and substance use disorders, and combat the stigma associated with seeking help. It provides up to $135 million over three years to improve mental health and resiliency and train medical students, residents, nurses, and other professionals in evidence-based mental and substance use disorders strategies. 

Grants will go to medical schools, academic health centers, state and local governments, Indian Tribes and Tribal organizations, and nonprofit organizations.

Health care worker stats 

  • One in five health care workers quit their job during the pandemic.  
  • 400 physicians in the United States die by suicide every year.   
  • 60% of emergency doctors feel burned out  


Virtual nursing programs help hospitals overcome staffing shortages and support onsite nurses in providing patient care.

    September 01, 2022

Healthcare organizations across the U.S. are under tremendous pressure as the growing need for nurses outpaces a shrinking workforce. There have been unprecedented challenges from the large, aging baby boomer population. Nurses are also getting older, with a median age of 52 — 4.7 million are projected to retire by 2030.

“None of us are going to have the complement of nurses that we would like to have moving forward, so we have to get creative with the way that we provide care,” says Jennifer Ball, director of virtual care at Saint Luke’s Health System in Kansas City, Mo.

Healthcare systems like Saint Luke’s are increasingly turning to virtual nursing to address the shortage. Virtual nurses work in remote centers with videoconferencing technology to observe and answer questions from patients, speak with family members and ease the burden on bedside nurses by performing tasks that don’t require physical proximity, such as conducting admissions interviews and providing discharge instructions.

“What better way to retain those experienced nurses who might be thinking of retiring or leaving the field early?” Ball says. “It’s a great way to allow them to continue their careers

There has been a 34 percent increase in the number of virtual nursing programs around the U.S. in the past year, says Laura DiDio, principal at research and consulting firm ITIC. The growth was spurred by the pandemic, “but it shows no signs of slowing down,” she adds.

Virtual nurses support bedside nurses in healthcare facilities, but they can also see patients at home using remote monitoring tools to collect clinical data, DiDio says. During the pandemic, virtual nurses used high-definition cameras and tablets to connect patients in isolation with their loved ones. Digital hospice and palliative care ­visits became commonplace.

“You will always have hands-on bedside care. That’s not going away,” Ball says. “But we must expand the types of caregivers that we have. I think virtual nursing is the wave of the future.”

The Technology Behind Virtual Nursing

Virtual nurses typically operate in remote centers manned with fully loaded workstations. At Saint Luke’s, each workstation uses a mix of multiple monitors, including HP monitors, the Epic Monitor dashboard feature and the Teladoc virtual healthcare platform, which includes a microphone, camera and videoconferencing software. Saint Luke’s also uses LogMeIn (now called GoTo) for remote desktop access so that virtual nurses can document as second nurse.

All the technologies used by Saint Luke’s virtual nurses were in use before the program launched. Even the workstations’ 5-foot adjustable desks were repurposed from an older project, Ball says. “We have been really lucky because we didn’t have to start from scratch with new technology,” she adds.

At Atrium Health in North Carolina, patient rooms use one of two setups to enable observation for its virtual nursing program to support newer nurses. New facilities are designed with audio and video capabilities, so the push of a button calls the virtual nurse, who appears on screen. Older facilities use wheeled poles with mounted cameras, speakers, microphones and monitors. Atrium Health uses the Caregility telehealth platformCerner cameras and software, and Microsoft Teams.

Vanderbilt University Medical Center in Nashville, Tenn., uses mobile devices with audio and video capabilities for its “virtual sitter” program, which allows nurses to monitor multiple patients at once. “They kind of look like a robot that you would see in a cartoon,” Karen Hughart, senior director of nursing informatics at VUMC, says of the devices.

VUMC’s virtual sitter program launched in 2019, when a dramatic increase in patients needing observation — those at risk of falls or other types of harm — coincided with Nashville’s booming economy, making it difficult to hire entry-level patient-care attendants.

“Sometimes, patients just need somebody to redirect them if they start to get out of bed because they’re confused,” Hughart says. “We’re not relying on patients to press their call bell. There’s somebody available to monitor them to determine if the patient needs immediate assistance, and they’re notifying the patient’s bedside nurse directly instead of waiting until the patient has had a bad outcome.”

Virtual sitters, who use 24-inch Dell monitors to observe patients centrally, can even use recorded messages from family members to reorient patients. “Sometimes a voice that they recognize is more effective with redirecting their behaviors,” Hughart adds.

The pandemic placed stressors not only on practicing nurses but also on those in training. “Nursing school students didn’t get the same experience that some of us more seasoned nurses have because their clinical rotations were cut short,” says Becky Fox, Atrium Health’s vice president and chief nursing informatics officer.

Health systems like Atrium and Saint Luke’s assigned experienced virtual nurses to mentor recent graduates. They can walk bedside nurses through procedures, interact with the care team on rounds and even listen in on a patient’s lungs via a remote stethoscope, Fox says.

“Imagine you’re a new graduate, and you’re concerned that your patient is taking a turn for the worse. It helps knowing that you’ve got someone on screen who has your back,” she adds.

Atrium Health has seen call bell volumes go down while patient satisfaction scores have risen, Fox says. It also saw a decrease in the number of rapid response team calls, in which the whole care team rushes to a patient’s bedside amid a crisis, because virtual nurses can spot problems before they escalate.

The organization was already using video capabilities in other areas, such as translators and disease education specialists, to help nurses manage patients’ care. Atrium Health expects the use of video capabilities to develop further.

At VUMC’s virtual sitter program, Hughart sees similar potential. It’s currently in use only in the adult hospital, but VUMC would like to expand virtual care capabilities. Some vendors provide not only the equipment to support such programs, but also the virtual nurses themselves, she adds.

“That’s very attractive to us right now,” Hughart says, “because like a lot of other facilities, we’re struggling to keep pace with the demand for nurses.”

Saint Luke’s has seen many benefits from its virtual nursing program. Patients always have immediate access to someone, and bedside nurses have help with time-consuming tasks, such as ordering meals for patients and completing quality checks.

“Care is delivered on time, and everything is double- and triple-checked,” Ball says. “It allows for a more efficient hospital stay.”

Other staff, such as pharmacists and social workers, have expressed interest in using the virtual center. The four smaller critical-access hospitals in the Saint Luke’s network have already installed virtual care equipment in their rooms to gain greater access to specialists throughout the system. For instance, a diabetes education specialist can now meet with a patient in one location through the videoconferencing tools, and then 30 minutes later, meet with another patient who’s two hours away.

“I think there will be a lot of ways to use this technology in the future, and we’re probably not even aware of everything we can do,” Ball says. “This is an opportunity for us to provide more holistic care to all patients.”


The purpose of the virtual nurse is to work alongside the bedside nurse, but that’s often easier said than done.

“Early on, nursing staff would get frustrated because they felt they either weren’t warned soon enough or they were being interrupted every five minutes to check on patients,” says Hughart. It took months of repeated education and meetings to work through ongoing problems.

Saint Luke’s holds joint training sessions with virtual and bedside nurses so they can learn to collaborate as a team, says Ball.

Here are a few lessons on how to build a successful virtual nursing program:

1. Involve everyone — from clinical staff to IT and quality assurance — from the start.

2. If possible, start in a new facility. “There are always challenges when you go into an existing unit and change the culture,” Ball says.

3. When hiring, look for experienced nurses with strong communication skills.
“You want knowledgeable staff because you’re looking to them to do the teaching and the education for the patients,” Ball adds.

4. Make sure buildings have adequate wireless bandwidth. “We have to continue expanding capacity and building in redundancy to keep up,” Hughart says.

5. Focus on the communication workflows between unit-based nursing staff and staff who monitor patients virtually, Hughart adds. For the technology to have maximum impact, those using it must understand its capabilities and limitations, and there must be collaboration between the onsite and virtual teams that centers patient care.

6. Build strong device support processes, with quick turnaround on repairs for critical equipment, says Becky Fox, vice president and chief nursing informatics officer for Atrium Health.

7. Don’t be afraid to change workflows when starting new programs. “The best ideas on paper don’t always work in real life,” Ball says.


How do children develop after being born very preterm? Four likely outcomes

Children born very preterm can be divided into different subgroups, each with a different profile of developmental outcomes.

   Washington, DC June 28, 2022

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that, among very preterm born children, subgroups can be distinguished with distinct outcome profiles that vary in severity, type, and combinations of deficits.

Children born very preterm, that is, after a pregnancy duration of less than 32 weeks, have a higher risk for difficulties during development than peers who are born after a normal pregnancy duration. What kind of difficulties and to what degree, however, varies strongly from child to child. Nevertheless, very preterm born children are usually considered as one group. According to new research, this assumption is unjustified.

Researchers from the Obstetrical, Perinatal and Pediatric Epidemiology Research Team at Inserm and the French National Institute for Health and Medical Research followed the development of 2,000 very preterm born children from all over France from birth until the age of 5.5 years. Their findings suggested that the population of very preterm born children could be divided into four subgroups, each with a different profile of developmental outcomes.

Almost half of the children (45%) belonged to a subgroup of children who had no difficulties and functioned at similar levels as their full-term born peers. However, 55% of the children belonged to one of three subgroups with suboptimal developmental outcomes. The first subgroup consisted of children who primarily had difficulties in motor and cognitive functioning, whereas a second group of children primarily had difficulties in behavior, emotions, and social relationships. A small subgroup of children had more severe impairments in all domains of development.

“Very little is known about the specific needs of subgroups of very preterm born children,” said lead author Sabrina Twilhaar, PhD. “Our study is the first large-scale study to distinguish very preterm born children based on their profile of outcomes across multiple important developmental domains. After all, how children function in everyday life is not determined only by their IQ or behavior. We now have a better understanding of which difficulties are prominent in different subgroups and which difficulties often occur together. This is important information for the development of targeted interventions.”

The researchers were also interested to know the predictors of these developmental outcomes. They found that children in the three subgroups with suboptimal outcome profiles were more often boys or had parents with a lower level of education or with a non-European migration background. Children who were diagnosed with prematurity-related lung disease (i.e., bronchopulmonary dysplasia) also had a higher risk for suboptimal developmental outcomes.

New insights are highly needed for very preterm born children. Preterm birth rates are increasing as are survival rates, especially among the most immature infants who have the highest risk for impairments. Thus, the number of very preterm born children with impairments growing up in our societies is rising. These impairments generally persist when children get older and there is currently little evidence in support of interventions that meaningfully improve long-term outcomes. These insights may be used to tailor support programs to the specific needs of subgroups of children to improve their effectiveness.

Dr. Twilhaar: “Instead of taking a one-size-fits-all approach, the findings emphasize the importance of taking individual differences much more into account. The average of the population is not representative of the individual children that it consists of. Moving forward, we should thus aim to understand how certain combinations of difficulties arise in specific groups of children, whereas others encounter no difficulties at all. This will aid the development of interventions that are tailored to the actual needs of individual children and target co-occurring problems, but also programs and policy to promote positive development in all children.”

Copies of this paper are available to credentialed journalists upon request; please contact the JAACAP Editorial Office at or +1 202 587 9674. Journalists wishing to interview the authors may contact E. Sabrina Twilhaar, PhD; e-mail:


Osteopathic Manipulative Treatment in Neonatal Intensive Care Units

Cicchitti, L.; Di Lelio, A.; Barlafante, G.; Cozzolino, V.; Di Valerio, S.; Fusilli, P.; Lucisano, G.; Renzetti, C.; Verzella, M.; Rossi, M.C. Osteopathic Manipulative Treatment in Neonatal Intensive Care Units. Med. Sci. 20208, 24.


The aim of this study was to assess the impact of osteopathic manipulative treatment (OMT) on newborn babies admitted at a neonatal intensive care unit (NICU). This was an observational, longitudinal, retrospective study. All consecutive admitted babies were analyzed by treatment (OMT vs. usual care). Treatment group was randomly assigned. Between-group differences in weekly weight change and length of stay (LOS) were evaluated in the overall and preterm populations. Among 1249 babies (48.9% preterm) recorded, 652 received usual care and 597 received OMT. Weight increase was more marked in the OMT group than in the control group (weekly change: +83 g vs. +35 g; p < 0.001). Similar trends were found in the subgroup of preterm babies. A shorter LOS was found in the OMT group vs. the usual care group both in overall population (average mean difference: −7.9 days, p = 0.15) and in preterm babies (−12.3 days; p = 0.04). In severe preterm babies, mean LOS was more than halved as compared to the control group. OMT was associated with a more marked weekly weight increase and, especially in preterm babies, to a relevant LOS reduction: OMT may represent an efficient support to usual care in newborn babies admitted at a NICU.



Using AI to save the lives of mothers and Babies

Thought Leaders -Patricia Maguire-Professor of Biochemistry-University College Dublin As part of our SLAS Europe 2022 coverage, we speak to Professor Patricia Maguire from the University College Dublin about their AI_PREMie technology and how it can help to save mothers and babies lives.

Please could you introduce yourself and tell us what inspired your career in artificial intelligence (AI)?

My name is Patricia Maguire, and I am a professor of biochemistry at University College, Dublin (UCD). Four years ago, I was appointed director of the UCD Institute for Discovery, a major university research institute in UCD, and our focus is cultivating interdisciplinary research. In that role, I first became excited by the possibilities of integrating AI into my research.

AI has seen increased attention in recent years, especially concerning its adoption in healthcare settings. Despite this, obstacles still need to be overcome before it is commonplace within research. What do you believe to be some of the biggest challenges surrounding the adoption of AI in clinical settings?

I think there are two major obstacles to adopting AI in healthcare. The first is that when it comes to the actual deployment of that AI in a clinical setting in the real world, there is a significant gap from that lab-based tech development to getting it deployed in the clinic and operationalized there. The second is that once that AI is operationalized, the frontline staff may have difficulty adopting it. Staff are going to be really busy, and their time is valuable. We need to offer them practical solutions that give them reliable results that augments their clinical decision-making.

You are currently the director of the ConwaySPHERE research group at University College Dublin. Please could you tell us more about this research group and its missions?

I co-direct the UCD Conway SPHERE Research Group with my hematology colleagues, Professor Fionnuala Ní Áinle and Dr. Barry Kevane. Our mission is to understand and help diagnose inflammatory diseases, and we work together as a group of clinicians, academic staff, and scientists, collaborating both nationally and internationally. For AI-PREMie it is a truly transdisciplinary team that we have brought together– encompassing clinicians and frontline staff from the three Dublin maternity hospitals. In doing so, we have covered 50% of all births in Ireland. We have brought these hospitals together with a host of scientists from across University College Dublin and data scientists from industry, namely the SAS Institute and Microsoft. The whole AI-PREMie team’s mission is to get this prototype test to every woman who needs it worldwide because we believe we will save lives.

You are giving a talk at SLAS Europe 2022 titled ‘AI_PREMie: saving lives of mothers and babies using AI.’ What will you be discussing in this talk, and what can people expect?

I will discuss our project AI-PREMie, which brings together cutting-edge biochemical, clinical, and machine learning expertise. By bringing them together, we have developed a new prototype test for risk stratification in preeclampsia.

As demonstrated in your latest research, AI-PREMie can accurately help to diagnose preeclampsia, a serious complication affecting one in ten pregnancies. What are the benefits of accurately diagnosing preeclampsia not only for the women and their babies but also for healthcare settings?

Fifty thousand women and 500,000 babies are lost to preeclampsia every year, and an additional 5 million babies are born prematurely – sometimes very prematurely – because of preeclampsia. It is easy to see how devastating preeclampsia is as a disorder: it affects our most vulnerable in society, their whole families, and their whole communities. If we can diagnose preeclampsia in a much timelier manner, we can deliver efficient, effective healthcare that can have a massive impact on the societal good. Not only will this allow us to prevent premature births, but we can also save lives.

What are some of the benefits of using AI tools such as AI_PREMie in diagnosis compared to current diagnostic methods?

There have been no significant advances in preeclampsia diagnosis. We are still using screening tests that were introduced decades ago. We look at high blood pressure, and we look at protein in the urine when we are screening these women, and sometimes these metrics do not predict the outcome. There is simply no test available to tell a clinician that a woman has preeclampsia. There is also no test to predict how that preeclampsia will progress. This means there is no test to tell a clinician or a midwife when to deliver that baby. AI-PREMie, our prototype test, will hopefully be able to not only diagnose preeclampsia but also predict the future in a sense and tell the clinician the best time to deliver that baby – because every day in utero for that baby counts.

Are you hopeful that with continued innovation within the artificial intelligence space, we will see more clinical practices turning to this technology to help aid healthcare? What would this mean for global health?

The field of AI is moving so fast, and healthcare is trying to keep up with it. I do see a future where our healthcare information will be available to us much like our banking information is securely, maybe even on our mobile phones, and that way, we can move global health to treat disease to a status where we predict disease and prevent disease.

Do you believe that AI_PREMie could also be applied to other clinical diagnoses? What further research would need to be carried out before this could be possible?

The patented biomarkers underlying AI PREMie are derived from the information stored within the platelet of sick, pregnant women, and we have studied that information or that ‘cargo’ stored within the platelet. We know that this is a marker – a form of a barcode – of the health status of an individual. In our lab, we are currently looking at this cargo in other diseases involving inflammation and vascular dysfunction concerning the platelet. Right now, we have projects ongoing on multiple sclerosis, cancer-associated thrombosis, and also COVID-19 to look to see if we can find new biomarkers in the platelets for these diseases.

Are there any particular areas where you are excited to see AI incorporated within the life sciences sector?

We have shown in our project that incorporating AI into data-driven life sciences projects has the potential to be truly transformative. If you look at what is available now, eye diseases can be detected using neural networks of three-dimensional retinal scans, but also in critical care, there are now sepsis warnings based on AI, which has dramatically reduced the number of deaths from sepsis in these hospitals. The potential is just so exciting.

What’s next for you and the ConwaySPHERE research group?

Next year, excitingly, we are planning to take AI PREMie across Ireland – so we want to increase the recruitment and data collection across Ireland and grow the group even more.


Golden Hour Education, Standardization, and Team Dynamics: A Literature Review


The “golden hour” is the critically important first 60 minutes in an extremely low birth weight neonate’s life that can impact both short- and long-term outcomes. The golden hour concept involves several competing stabilization priorities that should be conducted systematically by highly specialized health care providers in both the hospital and transport settings for improvement in patient outcomes. Current literature supports utilizing an experienced team in the golden hour process to improve patient outcomes through standardization, improved efficiency, and positive team dynamics. Although a variety of teaching methods exist to train individuals in the care of extremely low birth weight infants, the literature supports the incorporation of low- or high-fidelity simulation-based training. In addition, initial and ongoing educational requirements of individuals caring for a golden hour-eligible infant in the immediate post-delivery phase, as well as ongoing care in the days and weeks to follow, are justified. Instituting standard golden hour educational requirements on an ongoing basis provides improved efficiency in team function and patient outcomes. The goal of this literature review was to determine whether implementation of golden hour response teams in both the inpatient and transport setting has shown improved outcomes and should be considered for neonatal intensive care units admitting or transporting golden hour eligible infants.

Doak, Alyssa, BSN, RNC-NIC, C-NPT, C-ELBW | Waskosky, Aksana, DNP, APRN, NNP-BC


Maternal, Infant, and Child Health Outcomes Associated with the Special Supplemental Nutrition Program for Women, Infants, and Children

A Systematic Review


The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve maternal and child health outcomes. In 2009, the WIC food package changed to better align with national nutrition recommendations.


To determine whether WIC participation was associated with improved maternal, neonatal–birth, and infant–child health outcomes or differences in outcomes by subgroups and WIC enrollment duration.

Data Sources:

Search (January 2009 to April 2022) included PubMed, Embase, CINAHL, ERIC, Scopus, PsycInfo, and the Cochrane Central Register of Controlled Trials.

Study Selection:

Included studies had a comparator of WIC-eligible nonparticipants or comparison before and after the 2009 food package change.

Data Extraction:

Paired team members independently screened articles for inclusion and evaluated risk of bias.

Data Synthesis:

We identified 20 observational studies. We found: moderate strength of evidence (SOE) that maternal WIC participation during pregnancy is likely associated with lower risk for preterm birth, low birthweight infants, and infant mortality; low SOE that maternal WIC participation may be associated with a lower likelihood of inadequate gestational weight gain, as well as increased well-child visits and childhood immunizations; and low SOE that child WIC participation may be associated with increased childhood immunizations. We found low SOE for differences in some outcomes by race and ethnicity but insufficient evidence for differences by WIC enrollment duration. We found insufficient evidence related to maternal morbidity and mortality outcomes.


Data are from observational studies with high potential for selection bias related to the choice to participate in WIC, and participation status was self-reported in most studies.


Participation in WIC was likely associated with improved birth outcomes and lower infant mortality, and also may be associated with increased child preventive service receipt.


On National Child Day, meet clean water activist Autumn Peltier | CBC Kids News

Nov 20, 2020      CBC Kids News#NationalChildDay#CleanWater#Indigenous

You know something’s wrong when a child speaks up. That’s how Autumn Peltier, a 16-year-old from Wiikwemkoong First Nation in Ontario, framed her fight for clean drinking water in Canada’s Indigenous communities. The teen, who’s originally from Manitoulin Island but currently living in Ottawa, told CBC Kids News she’d rather spend her free time doing normal kid stuff. Instead, she’s making speeches on the international stage about the fact that some Canadians don’t have access to clean water. “Water is a basic human right. Everyone deserves access to clean drinking water, no matter what our race or colour is or how rich or poor we are,” Autumn said. Autumn seized the opportunity to share that message with the world when she addressed the United Nations in 2018 and again in 2019. In 2019, she was also named chief water commissioner by the Anishinabek Nation, which means she speaks on behalf of 40 First Nations in Ontario. As of October, more than 40 Indigenous communities in Canada had boil water advisories in place, which means residents have to boil their water before it’s safe to drink. During the federal election campaign in 2015, Prime Minister Justin Trudeau promised to get rid of all boil water advisories in the country by March 2021. Now leaders in many of those communities are saying Trudeau’s government won’t meet that deadline. In October, the prime minister said more than 100 boil water advisories have been lifted since that promise was made, and his government continues to work “very hard” to reach its goal. As for Autumn, she said the idea that time is running out “keeps me up when I can’t sleep at night.” Click play to watch Autumn tell her story in her own words. CBC Kids News is a website for kids, covering the information you want to know. Real Kids. Real News. Check it out at

Cat Video! Here’s looking at you, kid!

Please celebrate #nicuawarenessmonth and #prematureawarenessmonth this Fall season with our beloved global neonatal community!

We will be highlighting our GRATITUDE towards each of the 12 nations we have explored this past year in our Annual Instagram Post. Each of the themed postings will showcase a homemade national dessert of the country celebrated paired with some fun Fall 2022 fashion.  

While exploring each country’s best desserts we sought to further connect with our Global Preterm Birth/Neonatal Womb Warrior community and  illustrate our GRATITUDE to every one of you! Each of you do/have empowered, educated, inspired and progressed the well-being of our Community in a dynamic myriad of ways. THANK YOU 😊

We invite you to explore our Instagram post @katkcampos to view our gratitude pics!

Country        Dessert            Fall 2022 Fashion                      

  • Morroco- Moroccan Orange Cake-Equestrian/full length body suit   
  • Costa Rica – Costa Rican Orange Pudding-Hot Pink
  • Sudan -Sudanese Peanut Macaroons-White Tee shirt/Tank Top/big clogs
  •  Nigeria – Shuku Shuku  Nigerian Coconut Macaroons-All Over Sheen 
  • Japan – matcha swiss roll-Sporty
  • Serbia -Fresh Fruit Cup-Basics
  •  Peru – Suspiro de limena-Leather on leather
  • Ireland – Chocolate Guinness Mousse-Boardroom minis 
  • Uzbekistan – Tajik Cookies-Maxi skirt
  • Philippines – Filipino Egg Pie-Bomber Jacket
  • Norway -Whipped Crème Krumkake-Oversized Sweater
  • Somalia- Queerbaad Cookies-Abstract 

Christmas surf with friends, last waves of 2019 Greece!

Dec 28, 2019         Αγγελος Περαθωρακης

happy times in the water ,surfing some swell in creta!



Rank: 34  –Rate: 13.2%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Sudan, officially the Republic of the Sudan is a country in Northeast Africa. It shares borders with the Central African Republic to the southwest, Chad to the west, Egypt to the north, Eritrea to the northeast, Ethiopia to the southeast, Libya to the northwest, South Sudan to the south and the Red Sea. It has a population of 45.70 million people as of 2022 and occupies 1,886,068 square kilometres (728,215 square miles), making it Africa’s third-largest country by area, and the third-largest by area in the Arab League. It was the largest country by area in Africa and the Arab League until the secession of South Sudan in 2011, since which both titles have been held by Algeria. Its capital is Khartoum and its most populated city is Omdurman (part of the metropolitan area of Khartoum).

Islam was Sudan’s state religion and Islamic laws were applied from 1983 until 2020 when the country became a secular state. The economy has been described as lower-middle income and largely relies on agriculture due to long-term international sanctions and isolation, as well as a long history of internal instabilities, to some extent on oil production in the oil fields of South Sudan, Sudan is a member of the United Nations, the Arab LeagueAfrican UnionCOMESANon-Aligned Movement and the Organisation of Islamic Cooperation.

Health services in Sudan are provided by the Federal and State Ministries of Heath, military medical services, police, universities, and private sector. The districts or localities which are the closest to people are mainly pro Policies and plans in Sudan are produced at three levels federal, state, and district (also called locality) providing primary health care, health promotion, and encouraging community participation in caring for their health and surrounding environment. They are responsible for water and sanitation services as well. This well-established district system is a key component of the decentralization approach pursued in Sudan which gives in turn a broader space for local management, administration and allow for overcoming the leadership and supervision efforts by superior bodies.

There is one Federal Ministry of Health (FMOH) and 18 State Ministries of Health (SMOH). The federal level is responsible for provision of nation-wide health policies, plans, strategies, overall monitoring and evaluation, coordination, training, and external relations. The state level is concerned with state’s plans, strategies, and based on federal guidelines funding and implementation of plans. While the localities are mainly concerned with implementation and service delivery.


Kat and I intend for our exploration within the preterm birth community to exist on a solid foundation that recognizes, promotes, and celebrates collaboration. This month’s blog highlights the impact, necessity, and joy engagement in collaborative interaction provides. Wishing you joyful collaboration!

  • I can do things you cannot, you can do things I cannot: together we can do great things.”- Mother Teresa
  • When “I” is replaced by  “we”  even “illness” becomes “wellness”.-Scharf
  • It is amazing what you can accomplish if you do not care who gets the credit.”- Harry Truman


Fragile Infant and Family-Centered Developmental Care Evidence-Based Standards: The Value of Systems Thinking

Carol Jaeger, DNP, RN, NNP-BC, Carole Kenner, PhD, RN, FAAN, FNAP, ANEF

Abstract: Infant and Family-Centered Developmental Care (IFCDC) requires systems thinking – a re-examination of all the factors that interact to create/support the implementation of these care practices. This article will explore what systems thinking means and how it must be considered a cornerstone for implementing IFCDC.

Background: Systems thinking is a way to make sense of an institution’s or unit’s component parts, their intra- and interrelationship, and their function over time.  It provides a process to explore those elements that contribute to an outcome.

In healthcare organizations, systems thinking is the big-picture view of the relationship between values, mission, infrastructure, education, practice, innovation, change, evaluation, and the sustainment of care over time.  Further, systems thinking shows the factors that influence culture –the attitudes, relationships, and behavior – of the interprofessional staff, parents, and families. Consequently, the articulated values, mission, evidence-based education, practice, and change process guide the culture and, ultimately, the organization’s or unit’s operational practice.

The Infant and Family Centered Developmental Care (IFCDC) Consensus Committee has been using systems thinking to guide the implementation of IFCDC within the Intensive Care Unit. Assimilating the principles in the mission, vision, values, professional performance, education, clinical practice, continuous improvement process, and sustainment over the continuum of care and time is challenging in intensive hospital settings, at best. Since the onset of the pandemic, systems and systems thinking were, by necessity, interrupted. Implementing strict infection control practices has put limitations on staff, parents, and families access to the intensive care unit (ICU) and the associated disruption of consistent system-wide care practices. Parent and family member presence was severely restricted, personal contact and voice recognition was inadequate, appropriate communication with families was intermittent, and education for continuing care was limited. Relationships between staff and among staff and parents/family members were affected. The “normal” flow of activity was altered, and healthcare team members became siloed in their respective specialty roles and functions. Their interactions with each other and families were done individually and not as a team approach to care. The result was fragmented, often disjointed care approaches, where disciplinary views took precedence over a “big picture” holistic care effort.

In many, if not most, ICUs, the workforce was evaluated and limited to “essential staff” and practice. Continuous improvement processes were focused on safety occurrences; thus, practice improvement was curtailed. Consequently, operational budgets were reduced. Medical, nursing, and interprofessional student access to clinical experiences was eliminated in exchange for a simulation experience, or if clinical rotations did occur, the hospital staff acted as a preceptor instead of the usual clinical faculty. Healthcare interprofessional students graduated with limited patient/family contact.

Why are these changes important to IFCDC implementation from a systems perspective? Because these factors impact the unit’s system and culture of how care is provided. The focal point for care decisions moved from family-centered or baby-focused to one of staff availability and infection thwarting. The worst of the pandemic is over, yet the ramifications from a systems’ thinking view are not.

As the restrictions of the pandemic are released, the unit operational budgets are not as quick to rebound to pre-pandemic levels, and staff shortages across all healthcare professions are common. As new hires enter the workforce, they begin to practice with limited specialized clinical skills and likely little knowledge of IFCDC. They may have never experienced the family as an essential caregiver since entering the workforce. So, their worldview of what is “usual practice” is altered. Care is probably focused more on physical needs and not developmental support. Igniting the excitement for IFCDC practice – often viewed as “fluff” or nice but not necessary to care – is like starting over with the reluctance that comes with fear, apathy, and inertia. With the development of evidence-based standards, IFCDC is essential to care for the baby and family in intensive care, yet with the impact of the pandemic, there have been policy and practice changes that have impeded progress in their implementation.

Regardless of the experience and sensitive approach to the baby’s needs, healthcare staff cannot provide the connection of a parent. The baby’s need for neurophysiological and psychosocial support in the nurturing care of his/her parents is still essential. However, most importantly, staff need to comprehend and demonstrate competence in the skill of connecting and supporting the baby, parents, and family members. This relationship is the sustaining factor throughout the lifespan, and the foundation is established in intensive care. Systems thinking is essential to a leader’s assessment, planning, implementation, improvement, and continual monitoring of the mission, values, practice, outcome, and sustainment of a healthcare organization, an ICU, and thus is instrumental in affecting clinical care for babies and their families. As the pandemic recedes to an endemic, the interprofessional team and parents need to use systems thinking and a trusting, collaborative relationship to re-invest in the essential practice of infant and family-centered developmental care.

Source:nt-jul22.pdf (

Roaa Muhammad Naim – Asyad Al-Lawari – New Sudanese 2021 clips

12,357,089 views – Nov 26, 2020

رؤى محمد نعيم – اسياد اللواري – جديد الكليبات السودانية

Patterns and outcome of neonatal surgery in Sudan

Enas IsmailA. ElnaeemaI. Salih   Published 2019

Background: Sudan is one of the largest countries with a high birth rate (33.1/1000); with 40% of the population being children. Like many low income countries (LIC) neonatal surgery is overlooked, and for surgically affected neonates the situation is well below optimal. This study was conducted to determine the burden of neonatal surgery in Sudan and to find our own figures regarding patterns of disease and outcome. Patient and methodology: This is a prospective descriptive cross sectional hospital based study conducted over a six months period from July-December 2017 from five pediatric surgery units. Results: A total of 202 patients were studied. Males were predominant (54.5%) with a male to female ratio of 1.2:1. Most patients were term babies (78.2%) with normal body weight (2500-3000 g). One hundred thirty patients (64.4%) presented within the first week of life (mean 7.8±7.2). Ninety two percent of the diagnoses were congenital in origin. The most affected system was gastrointestinal (47.7%), but the most striking result is the high incidence of neural tube defects (26.2%). The most common acquired condition is NEC (3.5%). One hundred twenty two patients underwent surgical intervention, 12 of them needed a second intervention during neonatal period. Fifty nine patients (29.2%) needed surgical intervention but surgery was delayed (neural tube defects, HSD, and omphalocele). Fourteen percent of the population needed ICU admission , 6.5 % needed mechanical ventilation, and 12.2% needed TPN, the percentage of patients who actually received these services were (11%), (5%) and (2.5%) respectively. One fifth of the patients (20.8%) died during the study period with sepsis as a major cause of death. Bowel atresia is the most common diagnosis associated with mortality


Using technology to promote safe maternal health practices in Nigeria

Using technology to promote safe maternal health practices in Nigeria


In sub-Saharan Africa, especially Nigeria, maternal and infant mortality remains a persistent and serious health challenge. Information and Communication Technology (ICT) interventions offer an effective approach to alleviate this challenge and improve health outcomes. From the experiences of health workers, this study found that using ICT to care for women during and after pregnancy increased the demand for health services and had a positive effect on maternal-infant deaths. It reaffirms that ICT tools (mobile phones, the Internet, television/digital video disk (DVD) and radio) are important for appointment reminders, communication of health tips and referrals of emergencies. Findings indicate that it is imperative to subsidise the cost of access, repackage messages in a language and style to suit mothers, and harmonise and integrate existing ICT-based projects for nationwide implementation in order to expand access and improve the care of women during and after pregnancy.


The United Nations’ Sustainable Development Goal 3 (SDG 3) specifies the need to ensure healthy lives and promote well-being for all ages. Target 3.1 of the SDG specifically underscores the need to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 from the 533 deaths per 100000 live births currently experienced in Sub-Saharan Africa. To realize this target, both improving access to health care and the use of Information Communication Technology (ICT) to communicate maternal health information have been found to be vital to place health information within reach of this vulnerable group, and therefore save lives. ICT has already proven efficient and valuable for disseminating information and delivering care services to patients in underprivileged groups. To maximize the gains of ICT for maternal and child health care (MCH), an in-depth understanding of the value of ICT tools, especially mobile phones, is imperative to improve practicability, acceptability and evaluation of such interventions. 

Description of study

Having personally suffered a miscarriage and experienced complications at delivery, as well as watched mothers, gasp for breath in childbirth, the pain and misery of mother and infant death is deeply relatable and has inspired this field of inquiry.

The study identified and interviewed health care providers in nine clinics with ICT-based interventions for maternal and child health care in four Nigerian states (Ondo, Imo, Gombe and Kaduna.) The ICT-based interventions or projects for maternal and child health utilize ICT tools (like mobile phones , IPAD, computers) by health care providers to care for pregnant women and nursing mothers with their infants. Data collected were analysed using Nvivo (software program) to identify themes relevant to the objective of the study. The study was initiated in December 2018 and completed in August 2020.

This work is unique because previous Nigerian studies on ICT-based interventions for maternal and child health (MCH) explored the use of ICT mostly from the patient’s perspective. The views and experiences of health care providers in ICT-based projects for MCH add an important perspective of the value of ICT for MCH care; these multiple perspectives will be valuable to scale up existing health care models for ICT-based interventions targeted at pregnant women and mothers with infants.

 This research is based on a solid foundation of literature from field practitioners on the use of ICT to reduce the mortality of mothers and their infants in Nigeria. The imperative to tackle this public health challenge is even more urgent in the pandemic and post-pandemic era, because ICT-enabled remote consultation, information dissemination and education enable less frequent visits to antenatal clinics, thus limiting exposure to infection and ensuring compliance with COVID-19 protocols. The use of ICT has been accelerated by COVID-19 in other sectors, including government, academia and business, to transact business, communicate, counsel, hold meetings and deliver lectures. Perhaps a silver lining of the pandemic may be increased investment in ICT by the government, the private sector and NGOs to accelerate the establishment of a robust ICT infrastructure and to strengthen the capacity of health workers to serve expectant mothers and their babies remotely. 

Study outcomes

The average age of the participants was 45.6 yrs. Participants reported using mobile phones, the Internet, television/digital video disk (DVD), and radio to provide maternal health care. Other tools such as laptops/projectors for PowerPoint slides and public address systems were used during antenatal classes for maternal health education. The same ICT tools were also used for appointment reminders, communicating health tips, and referrals during emergencies. Participants reported challenges such as unreliable power supply, the cost of using ICT and irrelevant calls. Using ICT to care for women during and after pregnancy increased the demand for health services and a decrease in infant mortality In one clinic the turnout increased from 10 to 60 women going for antenatal service in a day which is attributed to an increase in awareness of health information and services provided at the clinic.

Participants (health care providers) report that the use of ICT tools made their jobs more interesting because of the association of ICT tools for patient care with advanced clinics. The health care providers also reported enhanced ability to promptly refer pregnant women and infants during emergencies – for example, one of the respondents highlighted a reduction in infant death within the first week of life noting that after the Safe Motherhood mhealth project was launched, the death of newborns within the first seven days of life had reduced.  Using ICT tools for MCH care also encourages maternal health practices including the uptake of immunization and health facility utilisation.

The study synthesizes information from published literature and field practitioners to provide health care providers, designers of ICT-based interventions for MCH and policymakers data to inform design and formulate policies to expand and improve access to and delivery of care that can save the lives of mothers and infants. 


The major lesson from this study is that it is important to go beyond the perspective of patients to also capture the perspective of health services providers to design, implement, introduce, and evaluate ICT-based interventions.  Harmonised and integrated ICT-based projects must be replicated nationwide to ptimize ICT in order to improve maternal and child health outcomes.


This study provides valuable information to formulate policy and fortify ICT use for maternal and child health care in low resource settings. It also promotes the adoption of healthy practices among pregnant women. The study has also led to my new research project, on communication design (styles, formats and languages) in maternal health for poor, illiterate mothers who often are excluded from e-health interventions for maternal health. Adaptation of e-health strategies for maternal and child health care must account for local context, addressing the views, needs and challenges of all stakeholders.

Source:Using technology to promote safe maternal health practices in Nigeria | The AAS (


No sonographer, no radiologist: New system for automatic prenatal detection of fetal biometry, fetal presentation, and placental location

Published: February 9, 2022


Ultrasound imaging is a vital component of high-quality Obstetric care. In rural and under-resourced communities, the scarcity of ultrasound imaging results in a considerable gap in the healthcare of pregnant mothers. To increase access to ultrasound in these communities, we developed a new automated diagnostic framework operated without an experienced sonographer or interpreting provider for assessment of fetal biometric measurements, fetal presentation, and placental position. This approach involves the use of a standardized volume sweep imaging (VSI) protocol based solely on external body landmarks to obtain imaging without an experienced sonographer and application of a deep learning algorithm (U-Net) for diagnostic assessment without a radiologist. Obstetric VSI ultrasound examinations were performed in Peru by an ultrasound operator with no previous ultrasound experience who underwent 8 hours of training on a standard protocol. The U-Net was trained to automatically segment the fetal head and placental location from the VSI ultrasound acquisitions to subsequently evaluate fetal biometry, fetal presentation, and placental position. In comparison to diagnostic interpretation of VSI acquisitions by a specialist, the U-Net model showed 100% agreement for fetal presentation (Cohen’s κ 1 (p<0.0001)) and 76.7% agreement for placental location (Cohen’s κ 0.59 (p<0.0001)). This corresponded to 100% sensitivity and specificity for fetal presentation and 87.5% sensitivity and 85.7% specificity for anterior placental location. The method also achieved a low relative error of 5.6% for biparietal diameter and 7.9% for head circumference. Biometry measurements corresponded to estimated gestational age within 2 weeks of those assigned by standard of care examination with up to 89% accuracy. This system could be deployed in rural and underserved areas to provide vital information about a pregnancy without a trained sonographer or interpreting provider. The resulting increased access to ultrasound imaging and diagnosis could improve disparities in healthcare delivery in under-resourced areas.

Full Article:

Usefulness of the Parental Electronic Diary During Medical Rounds in a NICU

Taittonen L, Pärus M, Lahtinen M, Ahola J, Bartocci M. Usefulness of the Parental Electronic Diary During Medical Rounds in a NICU. J Perinat Neonatal Nurs. 2022 Jul-Sep 01;36(3):E7-E12. doi: 10.1097/JPN.0000000000000627. PMID: 35894731.

Parental involvement in the care of their baby in family rooms in neonatal intensive care units (NICUs) can be improved. This could be done with an electronic medical report completed by the parents, which is then linked to the patient record system. The parents selected for this study completed an electronic diary during their stay in the NICU, while the staff answered a questionnaire about their opinion on the usefulness of the parents’ diary. The length of stay, length of time the baby spent in Kangaroo care, breastfeeding, time given to breastfeeding, feeling of tiredness, the capability of identifying the newborn’s signals, and parents’ opinion on the diary were variables in the study. The NICU staff’s opinion about the usefulness of the diary in decision-making was sought using a questionnaire. Eleven mothers and three fathers completed the diary. The median time for staying in the ward was 20 hours/day. The median time in Kangaroo care was 3 hours/day. The majority of mothers were breastfeeding on average 5 times per day. The commonest length of time for breastfeeding was 1 to 2 hours/day. The parents felt somewhat tired during their stay. All parents recognized their child’s signals mostly or all the time. Most parents were happy with the diary. The nursing staff’s opinions on the usefulness of the diary too were uniformly positive, whereas the doctors’ opinions varied from positive to critical in nature. In conclusion, the diaries provided us with new information about parents’ perceptions in the NICU. The nurses found the diary useful whereas the doctors were more critical.


Midwives save lives in Sudan

02 July 2021- Anna Sambrook


UK-based charity Kids for Kids is committed to upskilling midwives in Darfur, Sudan thus empowering women to provide safer care for mothers and babies in remote areas

Darfur, Sudan is one of the most deprived and impoverished areas in the world. The people here live lives of unimaginable hardship. At the forefront of climate change, flooding and droughts are a regular occurrence and now inflation is over 363% (Trading Economics, 2021), a result of the ongoing economic crisis. Families are struggling to feed their children and healthcare is a luxury not many people can afford, and in remote villages, it is unavailable. Rural hospitals have, at best, basic and little equipment. While living conditions have improved in other areas of the country, Darfur has been left behind.

Sudan has a Maternal Mortality Rate (MMR) of 295 deaths per 100 000 pregnancies (United Nations Population Fund, 2020), higher than the global average and staggeringly larger than the seven deaths per 100 000 recorded here in the UK. However, Darfur itself has one of the highest MMR rates in the world recording 727 deaths per 100 000 pregnancies in 2013 (Reliefweb, 2014). With Darfur mainly consisting of small, interspersed villages, the nearest hospital is usually several hours away, and can only be accessed via a donkey and cart, leaving many women at risk of death during childbirth from causes that could be prevented. The reason for this high number of maternal deaths is the lack of trained and skilled midwives in rural areas who are able to detect high-risk pregnancies. The most the majority of villages can hope for is an untrained traditional birth attender as there is no other healthcare available.

Kids for Kids has supported children and their families in Darfur for 20 years. By providing community led sustainable projects, Kids for Kids has adopted over 106 villages and helped over 550 000 people. It quickly became apparent to our Founder, Patricia Parker MBE, that something must be done to help expectant mothers in this area get access to trained medical care. Our health projects are a priority to the charity.

Therefore, Kids for Kids funds the training of two midwives from each village, in the regional capital El Fasher. We have also built a training school to enable 40 villages midwives to be trained. Once training is complete, we provide each midwife with leather sandals, a medical kit in a secure tin box to avoid contamination by insects in the desert, a mobile phone and strong cross-bred donkey, the main mode of transport in Darfur and the only way to cross the sand of the desert to reach her patients. A solar lantern is also provided, with no electricity supply in villages deliveries usually take place by the light of a fire.

Every 14 months, Kids for Kids trains 40 midwives. These women are then a beacon of hope to expectant mothers in their villages. They are trained to diagnose high-risk pregnancies, manage difficult births but also help to educate against female genital mutilation (FGM). Although this practice is now illegal in Sudan since 2020, the idea of FGM is ingrained culturally in many villages in Darfur and our midwives are trained to identify and report any instances they may come across. Because they are from the villages in which they work, mothers trust them and it is therefore much more likely that they will not ask to be resewn, or for their daughters to submit to the practise. Additionally, and an unexpected outcome for the charity, is that trained midwives are able to register births. This is inestimably important both for the individual and authorities. During the COVID-19 pandemic when people could not travel to El Fasher to register births, the Kids for Kids’ villages are unique in having births registered.

In the absence of healthcare in villages, and the danger of travel from the moment that conflict erupted in Darfur in 2003, Kids for Kids has also funded two first aid workers in each village. We also provide the drugs for a Revolving Drug Scheme in each community and train the midwives and first aid works in accountability and bookkeeping to enable them to run the scheme. They are overseen by committees we also train in each community and answer to the village as a whole at a review meeting each year.

Although there is an agreement with the State Ministry of Health to share the costs of training with Kids for Kids and to pay salaries once the midwives are trained, the Ministry has not had the funding to pay salaries for some time. Sudan is struggling with huge debts and is striving to recover from years of corruption and neglect by the previous regime. Expectant mothers therefore often pay village midwives in kind—from a chicken or a goat, to goat’s milk or seeds.

Where a village has been running the Kids for Kids’ projects well, they are able to request a health unit. To date, there are eight such brick-built units in our villages but many more are needed.

One of our midwives, Manal, was chosen by her village to undertake the training to become a midwife for her community. She graduated in 2018 and returned to her home village of Hashab Braka.

Manal delivered her first baby during the first week of her return. Since then, Manal delivers 4–5 babies every month in her village but her skills have been needed in the neighbouring villages where access to antenatal care is also limited. Because of her training, Manal now has the skills and confidence to identify difficult births and refers the mothers to the nearest health clinic in Mallit.

By becoming midwives, Manal and other women in Darfur are able to earn a living and are also given status in their communities. A lot of the work of Kids for Kids centres around empowering women and making sure they have a voice in their community.

To date, Kids for Kids have trained over 500 midwives, helping to deliver countless babies, and saving countless lives. Mothers are receiving proper healthcare and support, and maternal mortality rates are decreasing in the villages where we work.

While conditions improve in the villages we partner with, there are still thousands of women who still have no access to antenatal care in Darfur. As a result of the pandemic, many maternal health clinics in the towns closed across the country (United Nations Office for the Coordination of Humanitarian Affairs, 2021). We need to reach more women and we are only able to do so with the help from our supporters.


The benefits of agreeing on what matters most: Team cooperative norms mediate the effect of co-leaders’ shared goals on safety climate in neonatal intensive care units

Kuntz, Ludwig; Scholten, Nadine; Wilhelm, Hendrik; Wittland, Michael; Hillen, Hendrik Ansgar Health Care Management Review: 7/9 2020 – Volume 45 – Issue 3 – p 217-227 doi: 10.1097/HMR.0000000000000220



Safety climate research suggests that a corresponding climate in work units is crucial for patient safety. Intensive care units are usually co-led by a nurse and a physician, who are responsible for aligning an interprofessional workforce and warrant a high level of safety. Yet, little is known about whether and how these interprofessional co-leaders jointly affect their unit’s safety climate.


This empirical study aims to explain differences in the units’ safety climate as an outcome of the nurse and physician leaders’ degree of shared goals. Specifically, we examine whether the degree to which co-leaders share goals in general fosters a safety climate by pronouncing norms of interprofessional cooperation as a behavioral standard for the team members’ interactions.


A cross-sectional design was used to gather data from 70 neonatal intensive care units (NICUs) in Germany. Survey data for our variables were collected from the unit’s leading nurse and the leading physician, as well as from the unit’s nursing and physician team members. Hypotheses testing at unit level was conducted using multivariate linear regression.


Our analyses show that the extent to which nurse–physician co-leaders share goals covaries with safety climate in NICUs. This relationship is partially mediated by norms of interprofessional cooperation among NICU team members. Our final model accounts for 54% of the variability in safety climate of NICUs.


Increasing the extent to which co-leaders share goals is an effective lever to strengthen interprofessional cooperation and foster a safety climate among nursing and physician team members of hospital units.


What’s New in Practice Improvements in Neonatal Care?

Harris-Haman, Pamela DNP, APRN, NNP-BC; Section Editor Advances in Neonatal Care: August 2022 – Volume 22 – Issue 4 – p 281-282 doi: 10.1097/ANC.0000000000001025

In the Practice Improvements in Neonatal Care section of Advances in Neonatal Care (ANC), we encourage authors, novice as well as experienced, to share manuscripts that are fundamental to neonatal nursing practice. Let’s start with what is fundamental. What you do daily is fundamental to the care you provide to your patients?

Practice improvement and quality improvement are the “combined and unceasing efforts of everyone in the caregiving setting to make changes that will lead to better patient outcomes, better system performance, and better professional learning.1,2 This is the responsibility of all healthcare providers. One of which is you, each one of you.

Quality improvement can be related to new caregiving protocols you have learned or experienced. Questions you can ask your team are as follows: “What evidence has shaped the way you provide care?” “Have you made a recent change to your policies?” “What is your unit implementing that has benefited patients?” “What is your unit implementing that is unique, or not so unique, but has had a positive impact or unpredicted outcome?” “What is a concept or disease process that you have difficulty grasping?” “What better way to gain further understanding of that disease process than to write about it?” Educating each other is a fantastic way to learn ourselves, actually one of the best. This means content within this section is not limited to what is defined as solely a quality improvement initiative. Any topic that is fundamental to neonatal intensive caregiving is suitable for this section of the journal.

As nurses we are constantly mindful of safety risks, how to minimize these risks, and prevent errors or events from occurring. Nurses are uniquely positioned to anticipate potential events1 (you know that gut feeling). Who better to provide information to our profession than the nursing providers at the bedside? We need to ask whether this is the best we can do? Is this practice or caregiving protocol in the context of person-centered care and are the experiences of the neonates and their parents used to guide how the practice is implemented. It is important to remember that real outcome measures in healthcare are not what immediately happens but what the neonates and their family experiences over the course of their life because of their time spent in the neonatal intensive care unit (NICU).

Numerous quality improvement initiatives have been developed in the NICU setting. Some of these topics are as follows:

  • Pain assessment
  • Reduction of central line–associated bloodstream infections (CLABSIs)
  • Prevention of sepsis
  • Prevention of necrotizing enterocolitis (NEC)
  • Hand hygiene
  • Mother–infant interactions
  • Human milk nutrition
  • Prevention of unplanned extubations
  • Management of bronchopulmonary dysplasia (BPD)
  • Prevention and management of hypothermia
  • Magnetic resonance imaging without sedation
  • Use of music therapy3

In addition, there are many processes that take place on an hourly, daily, and weekly basis that require standardization, care bundles, checklists, or even pathophysiological explanations relating to their use and development.1 There are diverse topics that you can share your learned experiences on:

  • Improving our practice, by providing general information updates, reviews of the pathophysiology of a disease process, pharmacology principles of a specific medication, or pathophysiology of a certain disease process.
  • Concept analysis of ideas central to neonatal nursing. You may have written one of these during your educational endeavors. To be publishable, you need to make sure the concept analysis is applicable in the real world.
  • Clinical excellence related to specific problems. What has your unit been doing well that had had a positive effect on patient outcomes or that has positively affected parental satisfaction or participation.
  • Descriptions of essential nursing care strategies for specific diagnosis.
  • Neonatal concepts that pertain to all levels of nursing from the novice to the expert or targeted to a specific audience such as the new staff nurse or the advanced practice nurse.
  • Quality improvement projects that promote practice and process improvement.
  • Neonatal assessment processes.

Consider your own units. What is occurring that concerns you? What has been helpful? Look at the effects of the implementation of new care bundles, new equipment, new staffing models, or environmental issues. Work with the unit leadership when something new is implemented in your unit, equipment, practice bundle, or medication. Have you initiated a new task force? Document the effects of this practice. As NICU care provider, you are uniquely positioned to have a positive and lasting effect on the care provided in your institution. Share this with your colleagues. Pat yourselves on the back for the outstanding work you do and care you provide to our tiny patients and their families.

We want to use this section of ANC to capture the excellence of neonatal care that you are providing. Your unique educational and experiential viewpoints and your lived experiences are valuable. We look forward to reading your manuscripts. Many resources are available to assist you on this quest. These are in your units, hospitals, national associations, and this editorial board. Share your knowledge with our readers so that they may gain new knowledge that will enrich and expand their clinical knowledge and continue to improve the care we provide for our tiny precious patients.


Less Invasive Surfactant Delivery Works for Tiniest Newborns

Less requirement for mechanical ventilation adverse in very preterm infants by James Lopilato, Staff Writer, MedPage Today August 9, 2022

For extremely preterm infants with potential respiratory distress syndrome, less invasive surfactant administration (LISA) was associated with a significant decrease in the risk of adverse outcomes, a cohort study found.

There was a drop in requirement for invasive mechanical ventilation between those infants receiving LISA within the first 72 hours of life and those who didn’t (53.6% vs 8.3%), according to the study of over 6,500 infants in Germany.

Often performed early in the delivery room, LISA was safe and associated with decreased risks during the child’s primary stay in hospital:

  • All-cause death (adjusted OR 0.74, 95% CI 0.61-0.90)
  • Bronchopulmonary dysplasia (BPD; adjusted OR 0.69, 95% CI 0.62-0.78, P<0.001)
  • BPD or death (adjusted OR 0.64, 95% CI 0.57-0.72, P<0.001)

Babies undergoing LISA also showed reductions in pneumothorax and retinopathy of prematurity, Christoph Härtel, MD, from University Hospital of Würzburg in Germany, and colleagues reported in JAMA Network Open.

LISA comprises less invasive delivery of surfactant to babies in respiratory distress. Important concepts of LISA include delayed cord clamping, facilitated fetal transition, initial continuous positive airway pressure support, maintenance of spontaneous breathing, caffeine administration, and early skin-to-skin contact, according to Härtel’s team.

The authors noted that LISA had been found to be beneficial for respiratory outcomes in earlier studies. Theirs may be the first large-scale report in “the most vulnerable preterm population,” however.

Last year’s OPTIMIST-A trial showed a nonsignificant trend of better survival in infants born at 25 to 28 weeks who received surfactant treatment.

Härtel and colleagues based their observational cohort study on the German Neonatal Network of 68 tertiary level neonatal ICUs. Infants born from 22 weeks 0 days to 26 weeks 6 days of gestation between April 2009 and December 2020 were eligible.

Data were collected from 6,542 infants (mean gestational age 25.3 weeks, 53.7% boys). Of these newborns, 38.7% received LISA.

Outcomes were adjusted for gestational age, small-for-gestational-age status, sex, multiple birth, inborn status, antenatal steroid use, and maximum fraction of inspired oxygen in the first 12 hours.

Nevertheless, some potential confounders may have been missed by the study authors.

They also acknowledged the potential for indication bias and selection bias, as well as the possibility that LISA does not avoid mechanical ventilation in some babies. “There is still an urgent need to better define those babies at high risk for failing a treatment strategy that includes LISA.”

Randomized clinical trials are needed to assess the effects of prophylactic LISA on vulnerable preterm infants, Härtel’s team suggested.

Less Invasive Surfactant Delivery Works for Tiniest Newborns | MedPage Today

Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks

2022 – Ohnstad MO, Stensvold HJ, Pripp AH On behalf of the Norwegian Neonatal Network, et al, Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks; Correspondence to Dr Mari Oma Ohnstad;  On behalf of the Norwegian Neonatal Network


Objective The aim of the study was to investigate first extubation attempts among extremely premature (EP) infants and to explore factors that may increase the quality of clinical judgement of extubation readiness.

Design and method A population-based study was conducted to explore first extubation attempts for EP infants born before a gestational age (GA) of 26 weeks in Norway between 1 January 2013 and 31 December 2018. Eligible infants were identified via the Norwegian Neonatal Network database. The primary outcome was successful extubation, defined as no reintubation within 72 hours after extubation.

Results Among 482 eligible infants, 316 first extubation attempts were identified. Overall, 173 (55%) infants were successfully extubated, whereas the first attempt failed in 143 (45%) infants. A total of 261 (83%) infants were extubated from conventional ventilation (CV), and 55 (17%) infants were extubated from high-frequency oscillatory ventilation (HFOV). In extubation from CV, pre-extubation fraction of inspired oxygen (FiO2) ≤0.35, higher Apgar score, higher GA, female sex and higher postnatal age were important predictors of successful extubation. In extubation from HFOV, a pre-extubation FiO2 level ≤0.35 was a relevant predictor of successful extubation.

Conclusions The correct timing of extubation in EP infants is important. In this national cohort, 55% of the first extubation attempts were successful. Our results suggest that additional emphasis on oxygen requirement, sex and general condition at birth may further increase extubation success when clinicians are about to extubate EP infants for the first time.

Full Study: Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks | BMJ Paediatrics Op


Building Confidence and Parenting Skills When Your Baby Is in the NICU

Nursing License Map / Building Confidence and Parenting Skills When Your Baby Is in the NICU November 23, 2020

Having a child in the neonatal intensive care unit (NICU) can be a frightening or overwhelming experience for parents. As your newborn receives lifegiving support from NICU equipment and trained professionals, you may struggle to step into your role as parent or feel fearful, helpless or uncertain.

Understanding the inner workings of the NICU and connecting with the support available to families can help you gain confidence, find ways to participate and become an advocate for yourself and your baby. Learn more through the resources below. 

Tips for Parents on Building Caregiving Skills With a NICU Baby

Understand your rights as the parent, including what you can ask for and expect during your baby’s stay; the NICU Baby’s Bill of Rights can be a useful resource.

Practice providing routine care for your baby, including changing clothes and giving baths; let your neonatal nurse practitioner or other provider know if and when you are ready to learn these skills.

Take care of your baby’s laundry if time allows; some parents say taking their baby’s clothes home to wash and bring back to the NICU helps them feel more involved.

Be present for feeding and bath times when possible, and collaborate with your nurse on participating.

Reach out to the lactation consultant if available at your hospital to create a plan for feeding your baby at home.

Choose the pediatrician who will help care for your baby after the NICU.

Notify your insurance provider to add your baby onto your policy.


Common Terms | Nationwide Children’s: Glossary of NICU-related terms organized alphabetically covering NICU equipment, procedures and health indicators.

Glossary of NICU Terms for Parents | National Perinatal Association (PDF, 568.65 KB): Glossary of neonatal terms organized by category, including the NICU team and medications used in the NICU.

Premature Birth: Diagnosis & Treatment | Mayo Clinic: An explanation of tests given to premature babies and treatment options available, including surgery, medication and specialized supportive care.

NICU Staff | March of Dimes: Descriptions of 29 types of staff members who may work in your hospital’s NICU and their roles.


Support Resources for NICU Parents and Loved Ones


Breastfeeding | Office on Women’s Health: A landing page for information on breastfeeding, including breastfeeding positions and guidance on pumping and storing milk.

Breastfeeding in the NICU: Advice from a Lactation Consultant | Hand to Hold: Practical advice for women breastfeeding premature babies and suggestions for loved ones to offer support.

Feeding Difficulties & Your Preemie | Hand to Hold: Information on feeding disorders and feeding therapy that a premature baby may need in their first days and months.

Feeding Your Baby After the NICU | March of Dimes: Answers to commonly asked questions about feeding preemies after a NICU stay, such as how to know when your baby is full and where to find support.

Feeding Your Baby in the NICU | March of Dimes: Description of feeding options for babies in the NICU, including breastfeeding, bottle, a feeding tube or intravenous line (IV).

Find a Lactation Consultant Directory | International Lactation Consultant Association: Online listings of board-certified lactation consultants and services offered, fees and medical coverage information.

How to Bottle Feed a Preemie | Verywell Family: Six tips for bottle feeding a premature baby, offered by a registered nurse in a tertiary-level NICU.

La Leche League Online Support Resources | LLLI: A landing page of breastfeeding resources available online for families around the world, including virtual support groups, publications and printable toolkits.

Nourishing Your Premature Baby in the NICU | Hand to Hold: An article from a neonatal registered dietitian on the feeding and growing processes unique to premature infants.   

Practical Bottle Feeding Tips | American Academy of Pediatrics: Eight tips for safely and successfully bottle feeding an infant. 


Blogs for NICU Parents | National Perinatal Association: List of blogs written by and for parents in the NICU.

For Our Families | Hand to Hold: A landing page of resources for families in the NICU that includes private Facebook communities, counseling services, bereavement support and information on requesting a peer mentor.

Four Ways Preemie Moms Can Say “No Thanks” to Visitors | Preemie Mom Camp: A blog post with advice on declining visitors in the NICU or at home, including sample scripts.

Get Help | La Leche League International (LLLI): Searchable map for finding a local support group with La Leche League, an international organization supporting breastfeeding mothers.

The MyPreemie App for Preemie Parents | Graham’s Foundation: A free app to help parents organize their calendar, track their baby’s progress and create a virtual baby book; available on the App Store and Google Play.

Where to Find Peer-to-Peer Support | National Perinatal Association: A list of organizations that connect families in the NICU or transitioning home with peers who can offer support.


Home After the NICU | March of Dimes: Guidance for parents on the emotional experience of transitioning home, sleep safety, childcare and vaccinations.

Parents Corner: Information That Gives the Support You Need in the NICU | Baby First: Parents’ stories on transitioning home from the NICU and information on what to expect after discharge.

Resources at Home | Nationwide Children’s: A collection of articles on caring for your infant at home and knowing when to call a provider; topics range from burn prevention and infant cardiopulmonary resuscitation (CPR) to fever and fussiness.

Taking Your Preemie Home | KidsHealth: Advice for parents on preparing for discharge from the NICU, safety precautions to take once home and suggestions for self-care.

Transitioning Newborns from NICU to Home | Agency for Healthcare Research and Quality: Collection of fact sheets for families bringing a NICU baby home; topics covered include signs of illness, managing breathing problems, medication safety, immunization schedule and many more.


Affording the NICU: 6 Ways to Reduce the Cost | Hand to Hold: Description of financial safety nets available to help parents of premature babies pay for a NICU stay.

Get Help Paying Your Baby’s Hospital Bills | Verywell Family: Information about the possible costs of a NICU visit for families with and without insurance.

Health Insurance for Your Family | March of Dimes: A guide to understanding health insurance coverage for children under the Affordable Care Act (ACA).  

Insurance for Newborns: Four Lessons From $27,000 Bill | CoPatient: An article about one family’s story with medical bills in the NICU and their suggestions for new parents navigating the NICU experience.

Paying for Your Baby’s NICU Stay | March of Dimes: Guidance for parents on the NICU and insurance coverage and questions to ask your health insurance representative to learn more.


The Best Preemie Clothes for Extra Tiny Babies | What to Expect: Suggestions for where to buy premature baby clothes and accessories that are both comfortable and affordable.

Knitting Tips and Patterns for Preemies | The Spruce Crafts: Guidelines for knitting items for NICU babies, including patterns for socks, caps and baby blankets.

Knots of Love NICU Blanket Patterns | Knots of Love: Crochet and knit patterns for baby blankets specially made for neonatal babies.

Navigating the NICU: What to Bring to the NICU (Printable Checklist) | UnityPoint Health: A packing list for the NICU including clothes for both parents and babies, bedding, toiletries, entertainment and other essentials.


One in 10 New Dads Gets Postpartum Depression. Here’s How to Spot It (and Stop It). | Men’s Journal: An article on postpartum depression presenting in fathers and ways to offer support.

Postpartum Depression | Office on Women’s Health: Resources on postpartum depression in mothers and common types of treatment.

Postpartum Skincare | Lucie’s List: Recommendations for skincare after pregnancy and while breastfeeding, plus nursing-safe options.

Postpartum Support: Your New Life as a Parent | Lucie’s List: Encouragement for new mothers in managing the transition into parenthood and finding professional support when needed.

Self-Care for Parents | Program for Early Parent Support: A list of ideas for parents to meet their own physical, emotional, social and intellectual needs.

Share Your Story | March of Dimes: A landing page for March of Dimes’ blogs, forums and member groups that help parents make connections and find support.

Straight Talk | Lucie’s List: A collection of articles on the challenges of parenting babies and young children, from breastfeeding and sleep regression to tantrums and going back to work.

Taking Care of You: Support for Caregivers | KidsHealth: Tips on recharging and reaching out for help for parents of children with a serious illness.

Your Mental Health and Well-Being Are Important! | National Perinatal Association: A screening questionnaire for postpartum mental health conditions and resources for help with anxiety, depression and post-traumatic stress disorder (PTSD), among others.


Daycare and the Prematurity Factor | Hand to Hold: A discussion of the benefits and drawbacks of different childcare options specifically for preemies.

Finding Child Care for Your Premature Baby | Verywell Family: A consideration of care options for premature babies, including a stay-at-home parent, family caregivers, nannies and au pairs, home childcare and daycare.

Finding Childcare for Your Preemie | Graham’s Foundation: Advice for making childcare arrangements for preemies and their unique needs.

Going Back to Work After a Loss | Share: Ten practical suggestions to help grieving parents ease back into the workplace.

Going Back to Work After a Pregnancy Loss | Harvard Business Review: An article on the challenges that bereaved parents face in returning to work, with self-care strategies and advice for managers and colleagues.  

Resources for Friends and Family

Loved ones can play an important role in helping NICU parents transition into their new roles. Read more in the resources below about supporting parents of neonatal infants during and after a NICU stay.

The resources in this article are for informational purposes only; individuals should consult with a licensed health care provider before taking action.

Last Updated: December 2020


The Wisdom of Trauma, Official Trailer with Dr. Gabor Maté

    Jul 19, 2020     Science and Nonduality

This website has been translated in the following languages: عربىБългарияčeštinaDeutschFrançaisעִברִיתItalianoLietuviškaiMagyarPolskiePortuguêsTürkçe and subtitled in 27 languages.

Watch the movie at The film is available by donation.


Welcoming a new life – Physical therapies for premature baby

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

When a baby is born more than three weeks earlier than the expected delivery date, the baby is referred to as ‘premature’ or “preemie”. Premature babies are at risk of developmental delay as their brains and bodies have to continue to grow rapidly in an external environment, outside of the mother’s womb. The Physiotherapist will assess and review your child regularly to ensure that your baby is developing appropriately for his/her age. Physiotherapists will also be available to assist you with learning how to handle and interact with your baby. Upon discharge, Physiotherapists will continue to monitor your child’s neurological and developmental progress until at least 18 months corrected age when he/she may then continue with therapy or be discharged, depending on his/her needs at that stage.

5 Tips to Support you Dad, in the NICU

Jun 15, 2022   CanadianPreemies


Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth A Pooled Study of 16 US Cohorts

Barrett M. Welch, PhD1Alexander P. Keil, PhD2Jessie P. Buckley, PhD3; et alAntonia M. Calafat, PhD4Kate E. Christenbury, MBA5Stephanie M. Engel, PhD2Katie M. O’Brien, PhD1Emma M. Rosen, MSPH2Tamarra James-Todd, PhD6Ami R. Zota, ScD7Kelly K. Ferguson, PhD1; and the Pooled Phthalate Exposure and Preterm Birth Study Group           JAMA Pediatr. Published online July 11, 2022. doi:10.1001/jamapediatrics.2022.2252

Key Points

Question  Is phthalate exposure during pregnancy associated with preterm birth?

Findings  In this pooled analysis of 16 studies in the US including 6045 pregnant individuals, phthalate metabolites were quantified in urine samples collected during pregnancy. Higher urinary metabolite concentrations for several prevalent phthalates were associated with greater odds of delivering preterm, and hypothetical interventions to reduce phthalate exposure levels were associated with fewer preterm births.

Meaning  In this large observational study, urinary biomarkers of common phthalates used in consumer products were a risk factor for preterm birth.


Importance  Phthalate exposure is widespread among pregnant women and may be a risk factor for preterm birth.

Objective  To investigate the prospective association between urinary biomarkers of phthalates in pregnancy and preterm birth among individuals living in the US.

Design, Setting, and Participants  Individual-level data were pooled from 16 preconception and pregnancy studies conducted in the US. Pregnant individuals who delivered between 1983 and 2018 and provided 1 or more urine samples during pregnancy were included.

Exposures  Urinary phthalate metabolites were quantified as biomarkers of phthalate exposure. Concentrations of 11 phthalate metabolites were standardized for urine dilution and mean repeated measurements across pregnancy were calculated.

Main Outcomes and Measures  Logistic regression models were used to examine the association between each phthalate metabolite with the odds of preterm birth, defined as less than 37 weeks of gestation at delivery (n = 539). Models pooled data using fixed effects and adjusted for maternal age, race and ethnicity, education, and prepregnancy body mass index. The association between the overall mixture of phthalate metabolites and preterm birth was also examined with logistic regression. G-computation, which requires certain assumptions to be considered causal, was used to estimate the association with hypothetical interventions to reduce the mixture concentrations on preterm birth.

Results  The final analytic sample included 6045 participants (mean [SD] age, 29.1 [6.1] years). Overall, 802 individuals (13.3%) were Black, 2323 (38.4%) were Hispanic/Latina, 2576 (42.6%) were White, and 328 (5.4%) had other race and ethnicity (including American Indian/Alaskan Native, Native Hawaiian, >1 racial identity, or reported as other). Most phthalate metabolites were detected in more than 96% of participants. Higher odds of preterm birth, ranging from 12% to 16%, were observed in association with an interquartile range increase in urinary concentrations of mono-n-butyl phthalate (odds ratio [OR], 1.12 [95% CI, 0.98-1.27]), mono-isobutyl phthalate (OR, 1.16 [95% CI, 1.00-1.34]), mono(2-ethyl-5-carboxypentyl) phthalate (OR, 1.16 [95% CI, 1.00-1.34]), and mono(3-carboxypropyl) phthalate (OR, 1.14 [95% CI, 1.01-1.29]). Among approximately 90 preterm births per 1000 live births in this study population, hypothetical interventions to reduce the mixture of phthalate metabolite levels by 10%, 30%, and 50% were estimated to prevent 1.8 (95% CI, 0.5-3.1), 5.9 (95% CI, 1.7-9.9), and 11.1 (95% CI, 3.6-18.3) preterm births, respectively.

Conclusions and Relevance  Results from this large US study population suggest that phthalate exposure during pregnancy may be a preventable risk factor for preterm delivery.


New target for therapies to treat preterm labour

August 9, 2022

Researchers have identified a cause of premature (preterm) labour, an enigma that has long challenged researchers. New research published in The Journal of Physiology suggests a protein, called Piezo1, is responsible for regulating the behaviour of the uterus. Piezo1 keeps the uterus relaxed ensuring that it continues to stretch and expand during the 40 weeks it takes a foetus to grow.

Preterm birth is the single biggest cause of neonatal mortality and morbidity in the UK. Every year around 60,000 babies are born prematurely in the UK. The identification of Piezo1 in the uterus, and its role to maintain relaxation of uterus through stretch-activation during pregnancy, paves the way for drugs and therapies to be developed that could one day treat or delay preterm labour.

The muscular outer layer of the uterus is peculiar because it is the only muscle that it is not regulated by nerves and it must remain dormant for the 40 weeks despite significant expansion and stretch as the foetus develops into a baby. The researchers from University of Nevada USA studied tissue samples of the smooth muscle of the uterus to explore the mechanistic pathways to better understand the dynamics controlling the uterus, how pregnancy is maintained and what maintains quiescence until labour.

Stretching the uterus tissue, to mimic what happens during pregnancy, activates Piezo1 channels. This drives the flow of calcium molecules generating a signalling cascade that activates the enzyme nitric oxide synthase to produce the molecule nitric oxide. This Piezo1 cascade promotes and maintains the dormant state of the uterus.

Piezo1 controls the uterus by working in a dose-dependent manner, where channel activity is stimulated by the chemical Yoda1 and inhibited by a chemical called Dooku1. When Piezo1 is upregulated, the uterus remains in a relaxed state. However, in preterm tissue, the expression of Piezo1 is significantly decreased (downregulated), which ‘switches off’ the dormant signalling to the muscle, so the uterus contracts and initiates labour.

Professor Iain Buxton, Myometrial Research Group at the University of Nevada USA said,

“Pregnancy is the most impressive example of a human muscle enduring mechanical stress for a prolonged period. Finding Piezo1 in the muscular layer of the uterus means the uterus is controlled locally and is coordinated by a stretch-activated mechanism rather than hormonal influence from the ovaries or the placenta, which has been the assumption.

“It is troubling that there are still no drugs available to stop preterm labour. Thanks to the Nobel Prize winning discovery of Piezo proteins, which are responsible for how the body responds to mechanical force, and our investigation we are now closer to developing a treatment. Piezo1 and its relaxation mechanism provide a target for us which we could potentially activate with drugs. We need to test this with further studies and we hope to carry out clinical trials in the future.”

Contraction and relaxation were assessed in tissue samples compared for the following gestational periods: non-pregnant, term non-labouring, term labouring, preterm non-labouring and preterm labouring. The presence of Piezo1 channels was discovered using molecular tools while pregnant tissues contracting in a muscle bath were stimulated with Piezo1 channel activator and inhibitor to characterize the regulation of quiescence.

More research is needed to improve our understanding of how all the molecular signals and steps involved in the Piezo1 channel regulate the relaxation of the uterus and whether more chemicals are working together with Piezo1.  

Full paper title: Novel Identification and Modulation of the Mechanosensitive Piezo1 Channel in Human Myometrium. Link to paper

New target for therapies to treat preterm labour – The Physiological Society (

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