Tanzania, officially the United Republic of Tanzania, is a country in East Africa within the African Great Lakes region. It is bordered by Uganda to the north; Kenya to the northeast; the Indian Ocean to the east; Mozambique and Malawi to the south; Zambia to the southwest; and Rwanda, Burundi, and the Democratic Republic of the Congo to the west. Mount Kilimanjaro, Africa’s highest mountain, is in northeastern Tanzania. According to the 2022 national census, Tanzania has a population of nearly 62 million, making it the most populous country located entirely south of the equator.
Today the country is a presidential constitutional republic with the federal capital located in Government City, Dodoma; the former capital, Dar es Salaam, retains most government offices and is the country’s largest city, principal port, and leading commercial centre Tanzania is a de facto one-party state with the democratic socialist Chama Cha Mapinduzi party in power. The country has not experienced major internal strife since independence and is seen as one of the safest and most politically stable on the continent. Tanzania’s population comprises about 120 ethnic,linguistic, and religious groups. Christianity is the largest religion in Tanzania, with substantial Muslim and Animist minorities. Over 100 languages are spoken in Tanzania, making it the most linguistically diverse country in East Africa; the country does not have a de jure official language, although the national language is Swahili. English is used in foreign trade, in diplomacy, in higher courts, and as a medium of instruction in secondary and higher education, while Arabic is spoken in Zanzibar.
Tanzania has a hierarchical health system which is in tandem with the political-administrative hierarchy. At the bottom, there are the dispensaries found in every village where the village leaders have a direct influence on its running. The health centers are found at ward level and the health center in charge is answerable to the ward leaders. At the district, there is a district hospital and at the regional level a regional referral hospital. The tertiary level is usually the zone hospitals and at a national level, there is the national hospital. There are also some specialized hospitals that do not fit directly into this hierarchy and therefore are directly linked to the ministry of health.
The government has several key plans and policies guiding healthcare provision and development. The Health Sector Strategic Plan III (2009–15) is guided by the Vision 2015 and guides planning for health facilities. The Big Results Now (BRN) was copied from the Malaysian Model of Development and placed health as a key national result area and mainly was for priority setting, focused planning and efficient resource use. There are many other policies aiming at improving the health system and health care provision in Tanzania.
The leading causes of mortality in Tanzania include: HIV 17%, lower respiratory infections 11%, malaria 7%, diarrheal diseases 6%, tuberculosis 5%, cancer 5%, ischemic heart disease 3%, stroke 3%, STDs 3% and sepsis 2%[5] and this shows the double burden of disease the country has to bear.
Source:https://en.wikipedia.org/wiki/Tanzania
GLOBAL PRETERM BIRTH RATES –Tanzania
- Preterm Birth Rate Tanzania – 11 %
- (Global Average: 10.6)
- Source- WHO Tanzania – Healthy Newborn Network
COMMUNITY
Extreme Heat and Preterm Birth Risk—Methodologic Considerations and Policy Implications
Heather H. Burris, MD, MPH1,2,3,4; Allan C. Just, PhD5,6 February 26, 2024
In this issue of JAMA Pediatrics, Ye et al1 report an analysis of more than 1 million births in the Greater Sydney region of New South Wales, Australia, revealing a significant association between extreme heat exposure in the third trimester and preterm birth (PTB). Individuals experiencing temperatures over the 95th percentile for their residential location during their third trimester had 61% higher odds of PTB (adjusted odds ratio [OR], 1.61; 95% CI, 1.55-1.67). There was no significant association of extreme heat in the other 2 trimesters with PTB. Ye and colleagues also observed significant interaction between heat and greenness on the outcome of PTB; individuals with extreme heat exposure had lower odds of preterm birth if they resided in greener areas (interaction P < .05). We commend the authors’ study and its important implications. As the world’s temperatures increase, it is critical not just to document health impacts but to identify targets of intervention, such as greening, that promise to mitigate some of the negative effects of climate change.
The use of publicly available data from global climate reanalysis products, merged with an enormous, local health registry dataset, is novel and impressive. Geographic information systems analyses have become more readily available and are ideal for linkage with population-based datasets, which do not suffer from referral and selection bias inherent to hospital-based and payer databases, respectively. The association of higher temperatures with higher odds of PTB is in the expected direction. However, the magnitude of the association is higher than what is often observed in epidemiologic studies of other exposures with PTB. Maternal smoking is one of the strongest risk factors for PTB. ORs for PTB among individuals who smoke, compared with those who do not, range from 1.2 in a meta-analysis of 20 cohort studies across the world to 1.59 in US population-based data of over 25 million births. We suspect that the large effect estimate of heat exposure with PTB (OR, 1.61) reported in this study may be a result of methodologic challenges of characterizing the relevant etiologic period inherent to PTB studies and highlights the importance of methods to overcome these challenges.
The investigators used a gridded spatiotemporal layer at 0.1° × 0.1° resolution, described as 9 × 103 m, which would translate to approximately 8.1 × 107 m2 when squared, which is how the data are downloaded.5 Addresses were collected within local statistical areas with a median area of 8.3 × 106 m2 and because the gridded temperature predictions did not share boundaries with the statistical areas, the temperature layer was spatially joined with the statistical area layer and averaged. The result is that all individuals within a statistical area unit would be assigned the same temperature value for a given day, masking local neighborhood variation in temperature and leading to potential exposure misclassification. For example, a home near a body of water may be substantially cooler than a home a few blocks inland, yet the 2 would be assigned the same temperature. Furthermore, variability across statistical areas is lost if contained within the same grid. This is a limitation of downscaling. When the greenness layers were added at a finer resolution (250 m), the investigators reported statically significant interaction with higher levels of greening leading to a smaller effect size of the association between extreme heat and PTB. A promising interpretation is that greenness modifies the association between heat and PTB, potentially acting as a protective variable. Another interpretation is that the greenness variable is compensating for measurement error in the heat exposure. It is also possible that greener areas are healthier for many reasons; greenness can be an indicator of fewer emissions from industry or roadways and higher socioeconomic position of the local inhabitants. In the present study, socioeconomic status was averaged across the whole statistical area, which may not be granular enough. Taken together, the significant effect modification by greenness could be confounded by other variables. Use of methods such as propensity score matching of groups with various greenness exposure could limit such confounding.
Extreme heat exposure was defined as greater than the 95th percentile of the mean daily temperature for a given statistical area for each trimester. This is an internally derived ranking system that helps to avoid confounding across statistical areas. By design, in each statistical area, 5% of all births would have extreme heat exposure. Other methods such as the time-stratified, case-crossover study design can overcome confounding by time-invariant factors.7 Exposures in case periods are compared with matched control periods using a case-only analysis and can answer the question “Was it hotter leading up to these PTBs than in other (matched) periods within the same month, for a given population?” Because control periods are potentially both before and after the case period, similar numbers of individuals are eligible for the outcome, and the effects of confounding by long-term or seasonal trends are minimized. The case-crossover study design is useful for responses to acute heat events.
Defining heat exposure is not straightforward and varies across studies. We commend the authors for also considering nighttime temperatures, as high nighttime residential temperatures can be especially harmful given the inability of the body to cool effectively. Additionally, nighttime is when individuals are most likely to be home, which reduces exposure misclassification for residential addresses. Mean temperature may not capture all health impacts of heat. For example, the US Environmental Protection Agency defines heat waves, or extreme heat conditions, as 2 or more consecutive days where the daily minimum (usually nighttime) apparent temperature (temperature adjusted for humidity) exceeds the 85th percentile for days in July and August for a given city.11 Changes in temperature, as well as humidity levels, affect physiologic responses to heat. It is possible that in Greater Sydney, the same numeric temperature on the coast may feel very different from the temperature 2.0 × 105 m inland due to differences in humidity.
Perhaps the most important methodological consideration for this study is that the outcome may have affected exposure estimates because cases of PTB would have fewer third-trimester days than term births. Individuals with PTB have shorter (or even nonexistent) third trimesters and fewer data points to average before giving birth. Paucity of data can lead to less stable temperature averages and increased likelihood of having a third-trimester mean temperature above the 95th percentile, even if heat were not causally related to PTB. In other words, the outcome could be driving the likelihood of having the exposure indicator in the dataset. This may be an alternative explanation for the large effect estimate observed in the study. Solutions to this issue are emerging in the literature. Time-to-event survival analyses account for differential susceptibility at every gestational week and have been used for analysis of air pollution and PTB. These methods could be applied to heat-related studies.
Although it is common to group all PTB as a single outcome, PTB is a heterogeneous phenotype that arises from a diverse set of conditions ranging from placental disorders such as preeclampsia and poor fetal growth to spontaneous labor or rupture of membranes. Pathophysiologic processes may start as early as implantation for preeclampsia and as late as the hours before birth for acute chorioamnionitis-triggered labor. As noted by the authors, heat in any given trimester may have a different impact on each of these conditions, and future work with detailed characterization of PTB phenotypes may elucidate potential mechanistic pathways by which thermal stress could lead to PTB.
As each region of the world wrestles with climate change and extreme heat events, modeling health impacts will be critical for disaster prevention and response planning. An admirable aspect of the current study is the quantification of heat-associated PTBs that might be averted with greenness. Although the estimates rely on accurate modeling, they provide valuable preliminary data with which to make policy and funding prioritization decisions. The next step is to analyze the real-world impact of interventions such as urban greening and tree-planning initiatives to mitigate climate change impacts for maximal health benefit. Although the present study can shed light on the population at highest risk during the summer in Greater Sydney, each community’s experiences will vary based on local climate and heat experiences, air conditioning availability, and other societal resources for adaptation. As demonstrated by these authors, there are widely available, often free, exposure data that can be linked to local, regional, and national registries even in resource-limited settings to understand the impact of heat on health. These available datasets can be used to also model effects of extreme cold events and other climate and weather-related health effects most prevalent in local communities.
In summary, the important study by Ye et al emphasizes the potential impact that residing in a hot community during the third trimester may have on PTB risk. Although alternative methods may result in slightly different effect estimates, it is becoming increasingly apparent that extreme heat is harmful for human health, including during pregnancy. Such data and studies are crucial to inform public health efforts to optimize health across the life span.
Rayvanny Ft Macvoice – MWAMBIENI (Official Music Video)
3,874,132 views – Nov 29, 2023 – #mwambieni #macvoice #NextlevelMusic
A Tanzanian Pediatrician and Advocate’s Take on Tanzania’s Health Workforce and U.S. Global Health Investments
June 16, 2022
By: Scott Weathers, Frontline Health Workers Coalition, IntraHealth International -The Frontline Health Workers Coalition recently sat down to speak with Dr. Namala Mkopi, a Tanzanian doctor, former President of the Medical Association of Tanzania, and current Vice President of the Pediatric Association of Tanzania. Dr. Mkopi has been a tireless advocate for children’s health in Tanzania and global health legislation in the United States. Our conversation has been edited for length and clarity.
Q: Tell us about yourself and the work you’ve done in Tanzania.
A: I am a pediatrician working for the National Hospital in Tanzania. I do some advocacy, hardcore advocacy, that is bringing it to radio and TV, hoping that you reach many people, but of course you don’t – that’s why I call it hardcore. Of course, vaccine advocacy has been one of the things that I really have passion for.
Q: What do health workers experience as they try to administer care in Tanzania? Could you talk about your experience in Tanzania about the obstacles health workers face?
Tanzania has a shortage in human resources for health. That is, there are areas in the same country where you do not have medical doctors and you have other parts of the country with specialists and consultants giving health care to patients. It’s not quite a crisis, but a big problem created internally because of the reallocation of resources. So, as a health care provider from a professional society, I’m trying to talk with the government, negotiate so that they can improve the working environments in hard to reach areas.
Most of the doctors end up staying in bigger cities and towns, because there are resources and comforts. It has a bigger impact as well. You find out patients are being mismanaged and mistreated. The right people are placed elsewhere.
As a health care provider, there are other challenges I face every day. That does not only affect service delivered to the patient, it also affects the morale of the health care provider. They don’t feel enthusiastic, they don’t feel like they can do anything to change because every other intervention that you want for a patient is not there. It creates a status quo and blunts people. They ignore things. A death of a person does not touch them. They are demotivated and not looking forward to coming back to work tomorrow.
Q: You talked about getting doctors in rural areas. What would be your solution for getting doctors out in rural areas?
The remote area is usually not attractive for the best in business. If you’re the best in the business, usually you want to live in a place that matches your status and has services like education for your family.
If you want to change, it’s not impossible, it is very possible. We’ve seen an initiative that gives doctors who are finishing graduate school internships and incentives to work in rural areas, with good salaries compared to town. They employ them, and slowly but surely, they transfer the employment from them to the government and allow them to work in different places. But salaries fall because the government pays less, so it hasn’t been sustainable.
The district is supposed to build capacity so the government facility has enough funds to make sure the doctor is well compensated and stays there.
Q: Tanzania is one of the top recipients of global health investments by United States for a variety of global health issues such as HIV/AIDS treatment or vaccines for women and children. What broader interventions do you think donors like the US could support to build stronger health systems and health workers?
We have to strengthen the system – this is not only financial muscle. It’s more than just infrastructure, it’s how to supervise and make sure that things happen according to the standard. It shouldn’t take American doctors and American medicine. I think the best plan is building capacity – so that the countries responsible can step in.
HEALTHCARE PARTNERS
The National Network of NICU Psychologists: Support Mental Health Needs in the NICU and Beyond
LaTrice L. Dowtin, PhD, Elizabeth Fischer, PhD
The National Network of NICU Psychologists (NNNP) is a collective group of passionate psychologists with the united mission to optimize care for infants and their families in NICU settings through direct family involvement, staff support, research, education, and social justice and equity. This network was unofficially established in 2012 following the “Hynan Calls,” hosted by psychologist Michael Hynan, Ph.D. (Saxton et al., 2020). At this stage, Stephen Lassen and Chavis Patterson (co-chairs for approximately seven years, 2011~2018) volunteered to help organize the budding collaboration between eager NICU psychologists under the mentorship of Mike Hynan (2011– current) and the late Cheryl A. Milford (2011~2020).
In 2019, the NNNP was officially formed as the current organization working under the parent organization, the National Perinatal Association (NPA), striving to be the leading voice and resource for NICU mental health services across the country, led by co-chairs Allison Dempsey and Sage Saxton (2019–2022). As an organization, NNNP’s work is accomplished through fluid collaboration between an executive leadership council and five dedicated committees, each led by psychologist chairs and co-chairs skilled, trained, and experienced in providing high-quality care to infants and families in NICUs. The committees include Social Justice and Equity, Training and Education, Advocacy, Research, and Communications. This collective group provides mentorship to those entering the field of NICU psychology and advocates for the role of psychologists and other mental health providers in NICU settings.
Values and Beliefs: The NNNP operates under core values and beliefs: 1) Psychologists have unique training and skills to optimize medical, socioemotional, and neurodevelopmental outcomes for NICU infants and families. 2) Psychology services should be integrated into every NICU in the United States. 3) Implementing evidence-based, targeted interventions to improve parental, familial, and infant mental health is critical to each child and family’s long-term health and wellbeing. 4) National collaboration among NICU psychologists is essential to state-of the-art education, clinical research, policy development, and change advocacy.
NNNP Initiatives and Contributions: The NNNP is a busy organization actively working to contribute to training, scientific literature, and direct patient care. In the past, group members have come together to publish peer-reviewed articles and cutting-edge book chapters outlining clinical care and psychotherapy interventions for NICU families. One specific area of focus has been addressing traumatic stress in the NICU setting. Members additionally partnered to write a resource book for behavioral health clinicians in neonatal and perinatal settings, offering guidance, direction, and understanding regarding the practice of NICU psychology. During the initial months of the COVID-19 pandemic, the group worked closely with NPA to create support resources for NICU mental health clinicians and families, available on the NPA website. The materials included guidance for parent-infant bonding, coping with the hospitalization during a pandemic, and support for caregivers in this context. Furthermore, the training and education arm of the NICU has launched a series of educational webinars for psychologists and trainees interested in practicing in the NICU setting.
Under the present leadership of co-chairs LaTrice L. Dowtin and Elizabeth Fischer (2022–current), the NNNP continues to have an active agenda for education, research, and advocacy while keeping a running focus on social justice and equity. Currently, the NNNP is working on completing a NICU mental health roadmap to support families through the NICU journey. The advocacy group is actively completing work on an advocacy toolkit that guides clinicians and administrators on their path to developing a NICU psychology program at their institution. The training and education members continue to put out webinars and other training opportunities for membership, focusing on psychology trainees early and transitional career psychologists to help them gain specialized training and consultation in NICU and perinatal mental health. During the annual NPA conference, a retreat is held for psychologists, providing networking, training, and time to develop shared projects further. The NNNP has had an increasing presence in scientific presentations at the NPA conference through platform and poster presentations.
As we look to the future, our focus is on expanding our reach by welcoming new members and continuing our important work through collaboration between members of our organization and other medical and mental health advocacy organizations in infant, postpartum, and perinatal mental health. Together with NPA, we will continue mentoring trainees and those new to the field of NICU mental health to expand the field of clinicians and researchers, improving the care and outcomes for babies and families who share the NICU journey.
Hello Friends 👋 We have a great episode of Journal Club for you this week, where we review the latest papers published in peer-reviewed journals. This week we also have the pleasure of welcoming back to the show the EBNEO team who shares with us their commentary on the two-year outcomes of the OPTIMIST trial. Enjoy this episode.
Check out the Podcast here:
Neurodevelopmental Outcomes After Late Preterm Antenatal Corticosteroids -The ALPS Follow-Up Study
Cynthia Gyamfi-Bannerman, MD, MS1,2; Rebecca G. Clifton, PhD3; Alan T. N. Tita, MD, PhD4; et alSean C. Blackwell, MD5; Monica Longo, MD, PhD6; Jessica A. de Voest, PhD3; T. Michael O’Shea, MD, MPH7; Sabine Z. Bousleiman, MSN, MSPH1; Felecia Ortiz, RN, BSN5; Dwight J. Rouse, MD8; Torri D. Metz, MD, MS9; George R. Saade, MD10,11; Kara M. Rood, MD12; Kent D. Heyborne, MD13; John M. Thorp Jr, MD7; Geeta K. Swamy, MD14; William A. Grobman, MD, MBA15; Kelly S. Gibson, MD16; Yasser Y. El-Sayed, MD17; George A. Macones, MD, MSCE18; for the Eunice Kennedy Shriver Maternal-Fetal Medicine Units Network
Original Investigation April 24, 2024 Key Points
Question Is administration of antenatal corticosteroids to individuals at risk of late preterm delivery, originally shown to improve short-term neonatal respiratory outcomes but with an increased rate of hypoglycemia, associated with adverse childhood neurodevelopmental outcomes at age 6 years or older?
Findings There were no statistically significant differences in the primary outcome, a General Conceptual Abilities score of less than 85, between the betamethasone (17.1%) and placebo (18.5%) groups. No differences in any secondary outcomes were observed.
Meaning In this follow-up study of a randomized clinical trial, antenatal corticosteroids in persons at risk of late preterm delivery were not associated with adverse effects on childhood neurodevelopmental outcomes at age 6 years or older.
Abstract
Importance The Antenatal Late Preterm Steroids (ALPS) trial changed clinical practice in the United States by finding that antenatal betamethasone at 34 to 36 weeks decreased short-term neonatal respiratory morbidity. However, the trial also found increased risk of neonatal hypoglycemia after betamethasone. This follow-up study focused on long-term neurodevelopmental outcomes after late preterm steroids.
Objective To evaluate whether administration of late preterm (34-36 completed weeks) corticosteroids affected childhood neurodevelopmental outcomes.
Design, Setting, and Participants Prospective follow-up study of children aged 6 years or older whose birthing parent had enrolled in the multicenter randomized clinical trial, conducted at 13 centers that participated in the Maternal-Fetal Medicine Units (MFMU) Network cycle from 2011-2016. Follow-up was from 2017-2022.
Exposure Twelve milligrams of intramuscular betamethasone administered twice 24 hours apart.
Main Outcome and Measures The primary outcome of this follow-up study was a General Conceptual Ability score less than 85 (−1 SD) on the Differential Ability Scales, 2nd Edition (DAS-II). Secondary outcomes included the Gross Motor Function Classification System level and Social Responsiveness Scale and Child Behavior Checklist scores. Multivariable analyses adjusted for prespecified variables known to be associated with the primary outcome. Sensitivity analyses used inverse probability weighting and also modeled the outcome for those lost to follow-up.
Results Of 2831 children, 1026 enrolled and 949 (479 betamethasone, 470 placebo) completed the DAS-II at a median age of 7 years (IQR, 6.6-7.6 years). Maternal, neonatal, and childhood characteristics were similar between groups except that neonatal hypoglycemia was more common in the betamethasone group. There were no differences in the primary outcome, a general conceptual ability score less than 85, which occurred in 82 (17.1%) of the betamethasone vs 87 (18.5%) of the placebo group (adjusted relative risk, 0.94; 95% CI, 0.73-1.22). No differences in secondary outcomes were observed. Sensitivity analyses using inverse probability weighting or assigning outcomes to children lost to follow-up also found no differences between groups.
Conclusion and Relevance In this follow-up study of a randomized clinical trial, administration of antenatal corticosteroids to persons at risk of late preterm delivery, originally shown to improve short-term neonatal respiratory outcomes but with an increased rate of hypoglycemia, was not associated with adverse childhood neurodevelopmental outcomes at age 6 years or older.
Nurse/Resident Reciprocal Shadowing to Improve Interprofessional Communication
Kimberly K. Monroe, MD, MS; Jennifer L. Kelley, MSN, RN, CPN, ACCNS-P; Ndidi Unaka, MD, MEd Heather L. Burrows, MD, PhD; Trisha Marshall, MD; Kelli Lichner, MSN, RN, CPN;Harlan McCaffery, MA, MS; Brenda Demeritt, RN, MHA, CPN;Debra Chandler, MSN, RN; Lisa E. Herrmann, MD, MEd – May 2021
OBJECTIVES:
Poor communication is a major contributor to sentinel events in hospitals. Suboptimal communication between physicians and nurses may be due to poor understanding of team members’ roles. We sought to evaluate the impact of a shadowing experience on nurse–resident interprofessional collaboration, bidirectional communication, and role perceptions.
METHODS:
This mixed-methods study took place at 2 large academic children’s hospitals with pediatric residency programs during the 2018–2019 academic year. First-year residents and nurses participated in a reciprocal, structured 4-hour shadowing experience. Participants were surveyed before, immediately after, and 6 months after their shadowing experience by using an anonymous web-based platform containing the 20-item Interprofessional Collaborative Competency Attainment Survey, as well as open-ended qualitative questions. Quantitative data were analyzed via linear mixed models. Qualitative data were thematically analyzed.
RESULTS:
Participants included 33 nurses and 53 residents from the 2 study sites. The immediate post-shadowing survey results revealed statistically significant improvements in 12 Interprofessional Collaborative Competency Attainment Survey question responses for nurses and 19 for residents (P ≤ .01). Subsequently, 6 questions for nurses and 17 for residents revealed sustained improvements 6 months after the intervention. Qualitative analysis identified 5 major themes related to optimal nurse–resident engagement: effective communication, collaboration, role understanding, team process, and patient-centered.
CONCLUSIONS:
The reciprocal shadowing experience was associated with an increase in participant understanding of contributions from all interprofessional team members. This improved awareness may improve patient care. Future work may be conducted to assess the impact of spread to different clinical areas and elucidate patient outcomes that may be associated with this intervention.
FULL ARTICLE
Atle Moen MD PhD | Three challenges to the next generation of neonatologists | Delphi 2023
Jan 17, 2024
Dr. Moen is a senior consultant in neonatology Dept. of Neonatology, Oslo University hospital, Norway. We are grateful for him making the trip from Europe to be with us today. His interests include variability in neonatal care, NICU design and family centered care. Find out more about Delphi at http://www.delphiconference.org Check out the incubator podcast for the latest in the field of neonatology and newborn medicine at www.the-incubator.org
PREEMIE FAMILY PARTNERS
Social communication: What preemies and their families need to know
Making and keeping friends
Making friends and keeping friends can be difficult for any child. Children who were born premature might have particular difficulties with the social communication skills needed to make and keep friends. When people talk about “social communication skills” they are usually referring to what someone does when interacting with other people. These skills can affect how a child makes and keeps friends and how well the child is liked by his/her peers – all of which can have an impact on a child’s enjoyment of school, academic skills, mental health, and communication skill development.
Struggles with social communication are common. When a child has trouble fitting in, it can be stressful for the child and their parents. The child’s difficulties may be related to one or more of the following social communication difficulties:
- The child has not yet developed the social communication skills to interact successfully with their peers in at least some situations. These skills might include paying attention to others, playing in a way that allows others to enjoy the activity; engaging in back-and-forth conversations and considering others’ needs and feelings;
- The child may want to interact and knows what they can do to join their peers but their timing may not be ideal (e.g., telling a joke at a time when people are discussing something serious). This may result in peers moving away from the child;
- The child feels uncomfortable (e.g., shy, anxious) interacting with peers despite having developed the necessary skills. This may lead to the child not trying to join peers;
- The child’s attention is constantly changing, making it difficult for peers to pay attention to each other.
Strategies to help your child develop social communication skills
Problems fitting in and making friends can be complicated, and so solutions might involve using more than one strategy. Social communication support must be tailored to the needs of your child, your family, and school. It is generally true that:
- The goals set and strategies used must be a good match for your child’s particular needs;
- Skills should be taught in ways that allow your child to practise in real life;
- The child must feel successful practising these new skills;
- People close to the child (like parents, peers, and teachers) are involved and can help the child practise these developing skills.
It can be helpful for parents to learn more about social communication skills and strategies that help them develop so they can support their child whenever opportunities to interact arise.
The Neonatal Follow-up Clinic at Sunnybrook can support parents and educators with information and resources to help children develop important social skills.
Navigating the social world
Background on social communication skills
As children get older, there is an unspoken expectation that every child will learn how to successfully navigate the social world. Some children seem to do this well without even trying; they make friends easily, they are well liked by their peers, and they appear to enjoy opportunities to interact with same-aged children. Even the most socially skilled children may struggle along the way. For some children, the struggles can be persistent and a source of stress and worry for the child and their parents. Determining which skills to focus on and which strategies will help the most is an important first step. Professionals with expertise in social communication can help you with this (e.g., speech-language pathologist, occupational therapist, psychologist, behaviour therapist, paediatrician, etc.) We at the Sunnybrook Neonatal Follow-up Clinic can help!
What is the relationship between preterm survivors and social skill development?
Research suggests that preterm survivors are more likely to struggle in some aspects of social functioning as compared to their term born peers.
How can we help social communication skills develop?
It’s hard to know where to start given the amount of information available. It may be helpful to speak to a clinician with expertise in social communication to help find a starting point.
Social communication is made up of many different skills. For children who are not developing those skills as expected, we must target these skills directly. Over the last few years, numerous social communication training programs have been developed. These programs might focus on peer play, peer relationship skills, conversation skills, emotional regulation, etc. Some programs are led by trained facilitators, some are classroom-based and led by the teacher, and some incorporate parents or peers as the facilitators, with support from a clinician.
What can you do to help your child’s social development progress?
You have a very important role in helping your children improve their social communication development. This includes:
- providing a nurturing home environment;
- arranging social activities so that your child can interact with peers;
- advocating for preschool and school environments to help with social skill development;
- seeking out additional professional help when necessary.
If your child is struggling with social communication skills, it may be useful to consider the following questions:
- “When does my child appear most successful socially? Why might this be?”
- “In which situations does my child struggle the most (e.g., after a certain amount of time with peers, before/during/after transitions, with one child, with more than one child, in noisy environments, etc.)?”
What role can my child’s school play?
Educators are in a unique and very important position to effect change in the lives of children. School cultures that promote social interaction can better support social and emotional development.
The promotion of social skill development may be more effective if it is offered in multiple settings, with different people, and at different times.
What does this mean for Neonatal Follow Up (NNFU)?
We are invested in the children and families of our clinic. NNFU can support parents by doing the following:
- Support parents in addressing social communication development early
- Support parent advocacy to work with schools to promote social skill development
- Connect families to appropriate local community supports and services
Preemie Chats – Dr. Rachel Collum – Preemie adults – on March 29, 2024 at 1 pm EDT
CanadianPreemies Mar 29, 2024
Typically, research into prematurity is always about the babies or their families but rarely what happens when those babies grow up! Which is why we feel capturing the voice of adults born pre-term is so important. We’ll be speaking about some of the common issues coming from interviews with adults born pre-term and putting forward our ideas for how professionals can be more aware of some of the long-term impacts of prematurity.
INNOVATIONS
Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol.
Citation: Constantine A, Fantaye AW, Buh A, Obegu P, Fournier K, Kasonde M, et al. (2024) Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol. PLoS ONE 19(3): e0295437. https://doi.org/10.1371/journal. pone.0295437
Abstract Introduction
There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region.
Methods
Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA, PsycINFO, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations.
Discussion
Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilization of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.
Introduction
Maternal health refers to women’s health and well-being during the periods of pregnancy, childbirth and puerperium . Since the adoption of the Declaration of Alma-Ata in 1978, maternal health has become a ubiquitous priority among countless national and international stakeholders, including governments, civil society, multilateral organisations, and the private sector. This priority was emphasized by global commitments and efforts to meet the primary aims of the 1987 Safe Motherhood Initiative, and the targets of the fifth Millennium Development Goal (MDG). Maternal health remained a key priority in the 2030 Agenda for Sustainable Development, through the Sustainable Development Goals (SDGs), as it received major coverage in the third and fifth SDG, to ensure healthy lives and promote well being for all at all ages and to achieve gender equality and empower all women and girls, respectively. In the last 20 years, several global initiatives have been developed to help fast-track progress towards maternal health targets set in the MDGs and SDGs . The development goals and global initiatives galvanized major advocacy, political commitments, and greater financial investments into the annual development assistance for maternal health. This is particularly important as the coronavirus pandemic has hindered progress towards the attainment of SDGs further. The Goals and initiatives have also encouraged the development and implementation of local and national community-based and health facility-based interventions across the continuum of maternal healthcare. These interventions range from training and linking traditional birth attendants to a health system, to establishing maternity waiting homes and mobile maternal health services.
Despite the growing number of global initiatives and meso and micro-level interventions aimed at reducing adverse maternal health outcomes, there remain critical gaps and disparities in access to maternal health services in low and middle income countries (LMICs), especially in sub-Saharan Africa (SSA). The current literature showcases barriers to access and utilization of routine and emergency maternal health services in SSA. This includes physical, topographical and financial barriers, as well as lack of knowledge, trust and awareness of available services. Consequently, the SSA region accounts for the highest burden of maternal deaths, carrying 68% of maternal deaths worldwide every year (UNICEF, 2019). Nevertheless, most SSA countries have seen some progress in maternal health out comes in the last 15 years, compared to previous periods . Most notably, the region had a 45%reduction in the maternal mortality ratio between 1990 and 2015, and varied improvements in access to evidence-based antenatal, childbirth and postnatal care services. This progress is partly attributable to transformative, technological innovations, that have helped to mitigate certain gaps in healthcare systems. Digital health technology has made major inroads throughout SSA, and it is increasingly becoming an integral component of healthcare in many communities. Mobile health (mHealth) technology is a type of digital health that delivers care through mobile technology including mobile phones, tablets or smart watches and has shown immense potential to bridge existing gaps in maternal and essential healthcare service delivery in developing regions.
Many governments and leading national organizations have been enthusiastic about the utility of mHealth devices and applications, as scalable tools, to provide effective, efficient, safe and personalized care to service users . In addition, mHealth devices and applications can be implemented at all levels of a health system, including the home, the community, primary, secondary and tertiary level care. When applied to maternal health, mHealth devices and applications have helped to mitigate geographic, infrastructural and human resource challenges, as well as to improve health provider and patient education. In the last decade, mobile phone adoption has risen rapidly in SSA, a region that has emerged as a major arena for innovative mHealth interventions. Such interventions have demonstrated the utility of mobile phones for reaching hard-to-reach locations with limited infrastructure, and for strengthening communication throughout different levels of a health system. This is significant as global health initiatives targeting maternal health often fail to reach women in underserved rural and remote areas.
Over the past 15 years, a large number of mobile phone interventions have been developed and placed in the market. In accordance, there has been an increase in publications that describe the development, implementation, feasibility and impact of mobile phone interventions on health services. Several reviews have synthesized the emerging evidence on mHealth interventions, including mobile phone interventions, targeting maternal healthcare in SSA and other LMIC regions.
The majority of these reviews are systematic reviews that assess and collate evidence on the feasibility, appropriateness, or effective ness of mobile and other mHealth interventions. Four recent scoping reviews examined the scope, coverage and/or conceptualization of mHealth interventions in LMICs. However, these reviews focus on a specific population, such as community health workers, a specific outcome, such as behavior change, or a specific context, such as the provision of services during disruptive events. There is currently no extensive mapping of the available literature on mobile phone interventions that aim to improve accessibility and utilization of maternal care services across the continuum of maternity care in SSA.
As such, a scoping review is needed to examine the rapidly emerging evidence on mobile phone interventions developed to improve the delivery of maternal care services. The purpose of this scoping review is therefore to examine the nature and extent of mobile phone interventions used to improve maternal healthcare services in SSA. The review will determine the volume and scope of the interventions, and provide an overview of their targeted users, features and functionalities, and degree of integration within maternal healthcare provision systems. The review will also highlight the gaps and challenges in the development and implementation of these interventions, as well as the best practices for addressing these problems. Therefore, the findings of this scoping review will inform future research, and the developments and implementation of new mobile interventions, and/or the refinements to existing mobile phone interventions.
Review question
What mobile phone interventions are available to assist the provision of maternal health ser vices in sub-Saharan Africa?
Methods
This review protocol is reported in accordance with the reporting guidance provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) criteria. This protocol is registered with the Open Science Framework. The scoping review will be guided by the JBI approach to the conduct of scoping reviews described in the JBI Evidence Synthesis Manual. We will use the PRISMA-ScR to guide the development, conduct and reporting of this review.
Patient and public involvement
Public consultation took place during two global health conferences, one in Geneva, Switzerland and another in Lisbon, Portugal, in 2022. The objective of these consultations was to engage a broad audience and to get additional feedback to inform our review questions and nature of data to be extracted. During these consultations, global health practitioners and researchers expressed concern and surprise by the lack of scoping review of digital and mobile health interventions addressing maternal mortality in sub–Saharan Africa. A definite gap in the research was established and potential use for research findings for evidence-based policy implementation was acknowledged. Further, there was concern expressed over the current number of digital health interventions in existence and the lack of coordination, collaboration, and interoperability amongst implementers of these interventions. As such, this scoping review may further assist policy makers to establish a coordinated approach to the implementation of mHealth interventions addressing maternal mortality in SSA in order to align practitioners and increase efficiencies of political, technical and financial investments.
Inclusion criteria
Participants. Studies on the provision of maternal health services for women during pregnancy, childbirth and puerperium through the use of mobile phones. This will include studies involving health service providers such as doctors (including but not limited to obstetricians and gynecologists) nurses, midwives and community health workers (CHWs).
Concept
The concept for this review is the use of mobile phones to assist delivery of maternal health services. Mobile phones include basic phones (with no computing or internet capacity), smart phones and other mobile telephone device with applications and functionalities that can be used to provide services that link the service provider (doctor, nurses/mid wives, CHWetc) to clients without a face-to-face encounter. By maternal health services, we particularly refer to services that are provided to a woman during the periods of pregnancy, childbirth and puerperium. Studies that report the use of mobile phones to deliver any service related to the above-mentioned core services will be considered.
Context
This review will consider studies that have been conducted in both health care facility and community settings in sub-Saharan Africa. Studies conducted on African populations out of the African continent will not be considered given that their inclusion may mask critical contextual constraints that needs to be considered during data analysis. The rationale for sub–Saharan Africa is based on the current burden of maternal mortality.
Types of evidence sources
Studies that used quantitative, qualitative and mixed methods designs will be considered for inclusion. Quantitative study designs of interest will include experimental, quasi-experimental (RCTs and non-RCTs), interrupted time series, and pre post-test studies. Observational studies such as prospective and retrospective cohort studies, cross sectional and case control studies will be identified. Observational studies that are descriptive in nature such as individual case reports and case series, cross sectional studies will also be considered for inclusion.
Qualitative study designs for consideration will not be limited to phenomenology, action research, grounded theory, qualitative description, ethnography and feminist research. Beyond primary research studies, we will consider evidence emanating from systematic reviews, case reports, practice guidelines, text and comment/opinion papers, grey literature, websites and blogs for eligibility.
Information sources and search
Search strategies will be developed by an information specialist (KF) and peer reviewed using the PRESS guideline [67]. The search will be conducted in: MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), APA PsycInfo (OvidSP), Cochrane Central Register of Controlled Trials (OvidSP), Global Health (EBSCOHost), African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts (ProQuest). Each database will be searched from their inception for the concept of “maternal health”, “mobile devices” and “Sub-Saharan Africa” using a combination of subject headings and keywords. Drafting the search strategy was informed by a Cochrane review for the concept of mobile devices, [55] and by consulting the search method from the Cochrane Pregnancy and Childbirth’s Trials Register for the concept of maternal health. No search filters or language limits will be used. In addition, no publication date limits will be applied. The Medline search strategy can be found in the extended data. Additionally, the reference list of all identified sources will be searched for additional studies. Authors of primary studies will be contacted for additional information if necessary. A strategy will be developed to search for unpublished studies and grey literature from databases such as: ProQuest Dissertation and Theses and Google Scholar, websites and digital repositories (mHealth/digital health).
Source of evidence selection
All database results will be sent to Covidence (Veritas Health Innovation Ltd.), where duplicate records will be removed automatically. Following a pilot test, titles and abstracts will then be screened by two or more independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant studies will be retrieved in full, and their citation details will be imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Two or more independent reviewers will assess the full text in detail against the inclusion criteria. Any evidence source that does not meet the inclusion criteria will be excluded and rea sons for exclusion will be reported in the final review report. Any disagreement that arises between the reviewers at each stage of the selection process will be resolved through discussion or with an additional reviewer. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram.
Data extraction
Two independent reviewers will extract data from all included studies using a data extraction tool developed by the review authors (see in extended data). Any disagreement will be resolved by a third reviewer. The tool will be tested during a pilot trial and any relevant modifications will be made and detailed in the review. Any disagreement that arises between the reviewers at each stage of the selection process will be resolved through discussion or with an additional reviewer. If appropriate, authors of papers will be contacted to request missing or additional data, where required.
Data to be extracted will include details such as title, authors, objective, methodology, population characteristics, concept, context, type of evidence source, interventions (including name, type, description, timing of evaluation if available), study results, and gaps and recommendations. In the event of any missing or ambiguous data from a study, the corresponding author of the study will be contacted to retrieve missing or additional data
Data analysis and presentation
Data will be presented using either tables, charts, maps or a combination of these formats depending on the type of results we retrieve. A narrative summary will accompany the tabulated and/or charted results and will describe how the results relate to the review objective and question/s. The first content of the presentation will include details on author and year of publication, type of source, setting, study design, geographic location, delivery format and population. The second set of presentation will dwell on the various existing mobile phones and associated applications used to deliver maternal health services in Africa, services provided, functionalities, effectiveness, impact, challenges, opportunities, gaps, and/or recommendations.
Discussion While most SSA countries have made substantive progress in maternal health outcomes in the last 15 years, progress has been slow. However, transformative, technological innovations, have been reported to have helped to mitigate certain gaps in healthcare systems. Particularly, digital health technology has made major contributions throughout SSA, and it is increasingly becoming an integral component of healthcare in many communities. While mHealth technology has shown immense potential to bridge existing gaps in maternal and essential healthcare service delivery in developing regions, there still remains a gap in evidence on the nature and extent of mobile phone interventions available to assist the provision of maternal health services in sub-Saharan Africa.
An understanding of the nature and extent of mobile phone interventions available to assist the provision of maternal health services is critical to examining the rapidly emerging evidence on mobile phone interventions developed to improve the delivery of maternal care services. Through this scoping review, it is hoped that the volume and scope of the mobile phone interventions, including their targeted users and functionalities will be well understood. Additionally, we hope that through this review, some gaps and challenges in the development and implementation of these interventions, as well as the best practices for addressing these problems will be highlighted and potentially inform future research, and the developments and implementation of new mobile interventions.
Supporting information
Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants-A Randomized Clinical Trial
March 26, 2024 –JAMA. 2024;331(12):1035-1044. doi:10.1001/jama.2024.2302
Key Points
Question Does the timing of inguinal hernia repair influence the likelihood of serious adverse events among preterm infants?
Findings In this randomized clinical trial including preterm infants in the neonatal intensive care unit with an inguinal hernia, 28% in the early hernia repair group vs 18% in the late hernia repair group had at least 1 serious adverse event (risk difference, −7.9%).
Meaning Delaying inguinal hernia repair in preterm infants until after neonatal intensive care unit discharge and when infants were older than 55 weeks’ postmenstrual age appears to reduce the likelihood of serious adverse events.
Abstract
Importance Inguinal hernia repair in preterm infants is common and is associated with considerable morbidity. Whether the inguinal hernia should be repaired prior to or after discharge from the neonatal intensive care unit is controversial.
Objective To evaluate the safety of early vs late surgical repair for preterm infants with an inguinal hernia.
Design, Setting, and Participants A multicenter randomized clinical trial including preterm infants with inguinal hernia diagnosed during initial hospitalization was conducted between September 2013 and April 2021 at 39 US hospitals. Follow-up was completed on January 3, 2023.
Interventions In the early repair strategy, infants underwent inguinal hernia repair before neonatal intensive care unit discharge. In the late repair strategy, hernia repair was planned after discharge from the neonatal intensive care unit and when the infants were older than 55 weeks’ postmenstrual age.
Main Outcomes and Measures The primary outcome was occurrence of any prespecified serious adverse event during the 10-month observation period (determined by a blinded adjudication committee). The secondary outcomes included the total number of days in the hospital during the 10-month observation period.
Results Among the 338 randomized infants (172 in the early repair group and 166 in the late repair group), 320 underwent operative repair (86% were male; 2% were Asian, 30% were Black, 16% were Hispanic, 59% were White, and race and ethnicity were unknown in 9% and 4%, respectively; the mean gestational age at birth was 26.6 weeks [SD, 2.8 weeks]; the mean postnatal age at enrollment was 12 weeks [SD, 5 weeks]). Among 308 infants (91%) with complete data (159 in the early repair group and 149 in the late repair group), 44 (28%) in the early repair group vs 27 (18%) in the late repair group had at least 1 serious adverse event (risk difference, −7.9% [95% credible interval, −16.9% to 0%]; 97% bayesian posterior probability of benefit with late repair). The median number of days in the hospital during the 10-month observation period was 19.0 days (IQR, 9.8 to 35.0 days) in the early repair group vs 16.0 days (IQR, 7.0 to 38.0 days) in the late repair group (82% posterior probability of benefit with late repair). In the prespecified subgroup analyses, the probability that late repair reduced the number of infants with at least 1 serious adverse event was higher in infants with a gestational age younger than 28 weeks and in those with bronchopulmonary dysplasia (99% probability of benefit in each subgroup).
Conclusions and Relevance Among preterm infants with inguinal hernia, the late repair strategy resulted in fewer infants having at least 1 serious adverse event. These findings support delaying inguinal hernia repair until after initial discharge from the neonatal intensive care unit.
Trial Registration ClinicalTrials.gov Identifier: NCT01678638
Source: https://jamanetwork.com/journals/jama/article-abstract/2816629
Breast milk’s secret weapon against RSV revealed in new study
By Dr. Sushama R. Chaphalkar, PhD.Apr 15 2024 Reviewed by Susha Cheriyedath, M.Sc.
In a recent review published in the journal Advances in Nutrition, researchers examined the current evidence on the role of human milk oligosaccharides (HMOs) in protecting infants against respiratory syncytial virus (RSV) infection and disease, highlighting potential mechanisms and future research directions.
Background
RSV, a common cause of pediatric respiratory infections, particularly impacts infants under two years, with significant morbidity and mortality. Beyond the immediate health impact, RSV infection could also affect long-term immune development and overall health outcomes.
The heavy disease burden of RSV infection in infants, coupled with the lack of effective treatments, highlights the urgent need for prophylaxis strategies. Breastfeeding is shown to offer consistent protection against severe RSV disease, potentially owing to the bioactive components in breast milk, including HMOs. Recent studies have associated HMOs with lower respiratory infection risk and reduced viral load and inflammation in infants, highlighting their potential role in preventing and managing RSV infection.
Overview of human milk oligosaccharides
HMOs, abundant in human milk, play diverse roles in infant development. They are synthesized from lactose and can form various structures with additional sugars like GlcNAc, Gal, Fuc, and Neu5Ac. The concentration and composition of HMOs vary among individuals and populations due to genetic and environmental factors. HMOs are resistant to digestion and reach the colon intact, where they modulate the microbiome, inhibit pathogen binding, reduce inflammation, and modulate the immune system, potentially contributing to the prevention of viral infections in breastfed infants.
HMOs reduce the risk of respiratory infections
Clinical studies have explored the association between HMOs and respiratory symptoms in infants, particularly focusing on their potential preventive effects against RSV infection and other respiratory diseases. Lower levels of lacto-N-fucopentaose II (LNFP-II) in maternal milk and infant feces were found to be associated with increased respiratory symptoms in infants. Another study demonstrated that infant formula containing 2’-fucosyllactose (2’-FL) and lacto-N-neotetraose (LNnT) reduced the incidence of lower respiratory tract infections and bronchitis in infants. Additionally, the maternal secretor genotype, which affects the production of α1-2 fucosylated HMOs, was found to be associated with a reduced risk of acute respiratory infections in breastfed infants. However, some studies did not find a significant association between HMOs and respiratory infections. Further research is needed to elucidate the precise mechanisms and effects of HMO consumption on RSV incidence and severity, considering factors such as HMO composition, secretor status, and microbiome composition.
HMOs show antiviral activity
HMOs exhibit antiviral properties by binding to clinically relevant viruses, including rotavirus, norovirus, human immunodeficiency virus (HIV), and influenza. For instance, α1-2 fucosylated HMOs like 2’-FL can occupy norovirus binding sites, reducing infectivity. Additionally, certain HMOs compete with HIV-1 for binding sites on dendritic cells, potentially reducing transmission. Despite human milk’s ability to transmit viruses, it rarely causes disease in infants, likely owing to the antiviral properties of HMOs. The structural diversity of HMOs provides a wide range of protection against viral infections, with implications for preventing diseases like coronavirus disease 2019 (COVID-19). However, research on HMOs’s ability to preclude RSV infection and pro-inflammatory responses remains limited compared to other viruses.
Altering the host’s innate response
Exposure to certain HMOs alters the response of human respiratory and peripheral blood mononuclear cells (PBMCs) to RSV infection. These HMOs are shown to reduce RSV viral load and cytokines linked to disease severity and inflammation in respiratory cells and PBMCs. Infants fed formula containing 2’-FL also exhibit lower plasma levels of inflammatory cytokines when challenged with RSV, similar to breastfed infants. Thus, HMO supplementation may enhance resistance to RSV infection in infants, potentially explaining the reduced risk of severe RSV disease observed in breastfed infants.
Modulation of gut microbiome to mitigate RSV disease severity
The gut-lung axis concept suggests that gut microbiota can influence immune defense against respiratory infections like RSV beyond the gastrointestinal tract. Changes in the gut microbiome and the associated metabolites are found to be linked to the incidence and severity of respiratory infections such as RSV.
Research on infant formula indicates that 2’-FL and LNnT can promote a Bifidobacterium-dominated microbiota in some infants, potentially reducing the need for antibiotics. Additionally, elevated fecal fucosylated glycans, lactate, acetate, and Bifidobacterium are associated with reduced risk of bronchitis or lower respiratory tract infections in infants.
Acetate, produced by gut bacteria in response to specific HMOs, may enhance immune responses against RSV infection. Animal studies demonstrate that acetate supplementation can protect against RSV-induced lung inflammation, and clinical observations in infants with RSV bronchiolitis suggest that high levels of fecal acetate are associated with milder symptoms.
Conclusion and future perspectives
HMOs show promise in combating RSV through multiple mechanisms, including direct antiviral action and gut microbiota modulation. Standardized methods for identifying HMOs are essential. Future studies should optimize designs to investigate HMOs effects on RSV. Extensive birth-cohort studies could provide valuable insights. Key questions include identifying specific HMOs protective against RSV and understanding their mechanisms of action.
Source:Breast milk’s secret weapon against RSV revealed in new study (news-medical.net)
8 ways to help form a bond between preemies and their older siblings
TRINE JENSEN-BURKE
Having a baby in the NICU is a distressing time for parents, and sometimes sibling and their needs can sometimes be a little neglected in the turmoil surrounding a premature birth.
Encouraging bonds to form between preemies and their siblings requires extra thought and consideration when a baby is receiving neonatal care, because the baby is separated from her brother or sister, and certain bonding activities (such as touch) may not be possible.
Preemies and their older siblings
But luckily, there are things you can do to make sure older children get to bond with their teeny siblings.
1. Create a sibling scrapbook
Celebrating the arrival of a newborn baby is part of the acceptance process; a great way of involving your older child is to buy a scrapbook where they can write messages to their baby brother or sister, record milestones and add pictures. The scrapbook will become a focal point for your child’s feelings and maybe even something they can present in show and tell. The book can also be kept as a record to show how far the baby has come.
2. Give your child a homecoming calendar
Siblings of preemies may think that their baby brother or sister is never going to come home. To help with their fears, give your child their own calendar and ask them to mark off the days until the baby comes home.
3. Use videos to introduce baby to their sibling
Parents who have experienced premature birth will know that many neonatal units have a policy of not admitting toddlers and this delays physical contact between siblings. One method of promoting closeness that doesn’t involve physical contact is to keep a video diary and show your child their brother or sister. The advantage of using technology is that your child will be able to see the baby before he or she comes home.
f your neonatal unit uses video messaging, why not ask your nurse to create a personalised video that includes a greeting from your newborn baby to help your older child understand that the new baby loves them and is looking forward to coming home.
4. Bring a small gift for the baby
The act of exchanging gifts can really empower a child struggling to cope with having a baby in the NICU. Why not ask your partner to take your older child shopping and say that they can choose a present for their brother or sister?
5. Join a sibling support club or attend a sibling support day
Some NICUs focus on the needs of siblings by running sibling support clubs. In our research for this blog piece, we read about a unit in New Zealand that has a dedicated play area for siblings near the neonatal unit.
6. Encourage your child to make things for the baby
Not being able to be close to their baby brother or sister is distressing for children, but drawing pictures to go by the baby’s cot side or making something for the baby, will help your child to feel closer to their brother and sister when they are not able to be there.
7. Read books that relate to siblings and the NICU process
Reading books related to the NICU experience will make it easier for you to talk with your child about why their sibling is in a neonatal unit. Make sure that they know it is nobody’s fault that their baby brother or sister is in the NICU. Reading relevant books is also a method you can use to prepare them for the first visit to the NICU so that it is less daunting.
8. Allocate time for baby-talk
Set aside an hour in the morning or in the evening for talking to your older child about your new arrival. Maybe you could talk about the milestone your baby has achieved that day; perhaps he or she has gained weight or had some equipment removed. It’s probably wise to stay away from medical jargon that they won’t understand. Keep in mind that this time is to help your child feel involved and like they are getting to know their sibling.
Also, don’t forget to have fun – you could get creative and use fruits to show your child the size of the baby as he or she progresses. This can be especially useful before the first visit to see their preemie brother or sister, to prepare them for just how small the baby will be.
Source:https://www.herfamily.ie/parenting/8-ways-help-form-bond-preemies-older-siblings-365840
How do you find a child care provider for your baby? Home After the NICU
If you’re going back to work or school, you may need to find a child care provider for your baby. There are lots of different child care options. But not all child care providers can take care of a baby with medical needs. To help you find child care for your baby:
- Ask your baby’s health care provider about finding a child care provider. Ask if she can refer you to a provider who has experience caring for babies with medical needs.
- Ask the NICU staff for suggestions for child care providers.
- Search the internet for day care centers that take babies who have medical needs.
- Find out if your health insurance covers the cost of in-home nursing care for your baby.
NICU babies are more likely to get sick when they’re around other babies, children or adults. If you’re taking your baby to a child care center, make sure the staff follow these rules:
- Caregivers must wash their hands before touching babies or children.
- Caregivers must wash their hands after changing diapers, touching used tissues and going to the bathroom.
- Sick babies and children aren’t allowed to attend child care. Child care centers have rules about when children who have been sick can come back to day care. For example, a child who has had a fever or been sick may not be allow back to the center until they’ve been symptom-free or have been on antibiotics for 24 hours.
If you’re having a child care provider come to your home to care for your baby, let them spend a few days with you and your baby before you go back to work or school. This gives them time to learn how to best take care of your baby and for your baby to adjust to the provider.
Baby and the Puppy | My Pet Dog Song | LiaChaCha Nursery Rhymes & Baby Songs
LiaChaCha – Nursery Rhymes & Baby Songs
The pet dog at home is a good friend of Lia and ChaCha, and they grow up happily together!
SURFING TANZANIA! Drifting Ep. 50
Nov 23, 2022 TANZANIA
SURFING TANZANIA! We didn’t plan to stay in Mchinga for long but when there’s waves, you gotta check it out!! Robin surfed some fun waves while Charlotte practiced filming from a boogie board… We find our way to Mchinga village and learn about village life in Tanzania. We’re the entertainment for the day 😂 A few local children take a liking to Moya and walk back with us to the beach where they then help pull our dingy back into the water. The episode finishes off with some fun and laughter between Robin and Charlotte while having a delicious tuna fish braai!
The Neonatal Womb Warriors 