ART, November 17, and Tenderness


Rate: 12%      Rank: 55

(US Rate: USA – 12% Rank: 54)


Thailand, officially the Kingdom of Thailand and formerly known as Siam, is a country at the centre of the Southeast Asian Indochinese peninsula composed of 76 provinces. At 513,120 km (198,120 sq mi) and over 68 million people, Thailand is the world’s 50th-largest country by total area and the 21st-most-populous country. The capital and largest city is Bangkok, a special administrative area. Thailand is bordered to the north by Myanmar and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the west by the Andaman Sea and the southern extremity of Myanmar. Its maritime boundaries include Vietnam in the Gulf of Thailand to the southeast, and Indonesia and India on the Andaman Sea to the southwest. It is a unitary state. Although nominally the country is a constitutional monarchy and parliamentary democracy, the most recent coup, in 2014, established a de facto military dictatorship under a junta.

Health and medical care is overseen by the Ministry of Public Health (MOPH), along with several other non-ministerial government agencies, with total national expenditures on health amounting to 4.3 percent of GDP in 2009. Non-communicable diseases form the major burden of morbidity and mortality, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues.




The Prevention of Preterm Birth

The Prevention of Preterm Birth

thai.logoSamitivej Hospitals – Sep 27, 2017

Preterm birth is a major concern in Thailand because the rate of preterm births is about 12% of all births. Preterm babies are at increased risk of death, disability or complications. During prenatal care, the cervical length is measured by transvaginal ultrasound between 18-24 weeks of pregnancy. When the cervical length is less than 2.5 cm, women face the probability of preterm delivery. We can prevent this by giving natural progesterone to at-risk pregnant women. A follow-up examination is then made to determine any cervical length shortening and other possible complications. In the case of a short cervical length, management techniques include using a silicone pessary (made from body friendly silicone) which is placed around the cervix transvaginally, or tightening the cervix with a stitch (cervical cerclage). With the 3P Concept initiated by the Preterm Prevention Clinic, the risk of preterm birth is reduced by 50% (compared to the WHO’s target).


The Lancet editor Richard Horton honored with Roux Prize

Dr. Richard Horton, the “activist editor” of the international medical journal The Lancet, was honored June 10 for his accomplishments as one of the world’s most “committed, articulate, and influential advocates for population health.” He received the Roux Prize, given annually to individuals on the front lines of global health innovation in data science.


Interview: Ryan McAdams, US

In our Interview series, we are grateful to present this interview with  @Ryan McAdams , US, a neonatologist who is also a painter. We were curious to speak with Ryan about his art work, and the intersection of neonatology, child health and arts. By Stefan Johansson – October 3, 2018:

Could you please introduce yourself and where you currently work?

I am Ryan McAdams, the Neonatology Division Chief and Neonatal-Perinatal Medicine Fellowship Program Director at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. I’m married and have two wonderful children.

How did your professional career lead you to this spot?

After my fellowship training in San Antonio, Texas, I worked on a naval base in Okinawa, Japan, as an officer and neonatologist in the United States Air Force. I was the Air Transport director responsible for orchestrating and often going on flights to transport critically ill neonates throughout the Western Pacific who required care in the NICU. I met some amazing people in the military and learned a lot about other cultures. While in Japan, I became passionate about global neonatal health and did volunteer medical work in Mongolia, Cambodia, Zambia, and Malawi. After leaving the Air Force, my wife and I moved to Seattle, Washington, where I accepted a job at the University of Washington and Seattle Children’s Hospital. I continued to do global health work with colleagues in Seattle, mainly working in Uganda, with a focus on using education to empower local providers to deliver quality neonatal care. This global health work helped reinforce my strong belief that every baby everywhere is valuable and deserves the best opportunities to thrive.

While in Seattle, I worked with a talented team of neonatologists, and was fortunate to have numerous opportunities to conduct translational and clinical research focused on understanding perinatal lung and brain injury. After eight enlightening years in Seattle, I was recruited to be the Neonatology Division Chief at the University of Wisconsin, Madison. Since I was born and raised in Wisconsin, I was thankful to be close to my family again.

You are also a painter – please tell us what led you into painting?

As a child, my aunt gave me an oil paint set, which encouraged me to start painting. I have always had a keen interest in the myriad of colors and subtle details that abound in nature, so exploring the world through art has been a gratifying experience. In medical school, I decided painting would be a healthy creative outlet to stay well-rounded in the midst of intense studying. Short on money, I drove my grandmother to a local craft store and used her senior citizen discount to buy a plethora of art supplies. I built an easel and began to paint. At the time, I was a big fan of Salvador Dali, so his surrealistic style influenced my initial approach to painting. Throughout medical school, I often stayed up all night long painting, a method not always ideal for the rigorous demands of medical school. With my first big canvas painting, I entered an art contest in JAMA magazine and my painting “A Grasshopper Which Sprang From Indecision While a 3-Day-Old Peeled Banana Waited to Be Painted (JAMA. 1998; 280:1189) was a Grand Prize winner. This germinal success misinformed my understanding of how complicated, competitive, and cultivated the art world was, a realization that I learned while in my pediatric residency in northern California. I developed a quick sense of humility after peddling my painting portfolio around the art galleries in San Francisco where the exorbitant price tags of authentic Chagall and Miró prints led me to a somewhat disheartening assimilation of my place outside the circle of established artists. This epiphany led to introspection and a self-declaration that my painting needed to serve a purpose to bless others in a way unhindered by any motivation for supplemental income.

While living in Japan, inspired by the woodblock masterpieces of Hokusai, I painted a contemporary series of acrylic paintings featuring a hybrid of themes from famous Japanese prints. I also began working on a collection of paintings illustrating the teachings and ministry of Christ described in the Gospel of Luke, a book written by Luke, who was a physician. As I became more involved in global health, the focus of my art centered on the plight of the impoverished and marginalized children of our world.

Do you have art school training or are you an auto-didact?

While I am certain formal training would have been advantageous, I am a self-taught painter.

Can you expand on your themes in your paintings?

As a neonatologist who has been privileged to do global health medicine and work in large medical centers NICUs, I have witnessed a substantial amount of suffering and death. I have also witnessed the incredible resilience of children and the awe-inspiring dedication and love of their families. These experiences shape why and what I now paint. Themes of social injustice, survival, pain, and grief are the basis for my art since these ageless motifs are still globally preeminent today.

What messages to you want to convey to those viewing your paintings with neonatal themes?

My paintings are an amalgamation of emotions constructed with colors, lines, and textures into a tangible declaration aimed at validating the importance of children who have struggled or died, regardless of the brevity of their life. My hope is that my art will validate the existence of these amazing children and provide insight for the viewer, who can contemplate the stories I have tried to capture in acrylics.

Do you direct the painting to the general public or a more niched “neonatal audience”?

I paint for the general public, recognizing that the medical community may be more accessible to share my work with, but hopeful that any viewer will pause to consider my art.

Are those painting also part of your own processing of experiences?

When I paint a subject or theme related to an intense event, such as the death of a child that I was privileged to care for, this experience provides me a way to work through my emotions and cope with grief. Engaging in this process often requires me to relive difficult experiences in a vivid and immersed manner, which can be quite overwhelming, at times resulting in tears, frustration, scrutiny, and speculation. When I paint a baby or child who died, I approach each painting with deep reverence, often engrossed in deep reflection and prayer about the child’s family, wondering what things would have been like had the child survived. In some ways, the final painting becomes a testimony that substantiates an otherwise untold story, a story that I hope will help others.

After the unexpected death of my father, at a time when my neonatology work schedule was especially onerous and severe sciatica from my herniated disc was a constant torment, I used painting as I means to deal with my pain and grief. My painting, “Self-Portrait” conveys a period of darkness I experienced and now reminds me that my resilience prevailed despite my trying circumstances. I feel that all people have seasons of struggle and sorrow, so finding constructive coping mechanisms is key to overcome anticipated or unexpected adversity. Right before moving to Wisconsin, my mother, a comical and quick-witted woman who was avid reader and art lover, was diagnosed with lung cancer. A year later, after multiple bouts of chemotherapy, she died days after her birthday. Both my parents encouraged my creativity, so although I can no longer show my latest paintings to them, they still inspire me in a way that I feel I am able to share my work with them.

Where have you presented your art?

I have presented my work at small venues including a café, hair salon, church, and at a medical conference. No museums yet, but hopefully someday.

And, those of us wanting to see more of your work – when to we go where?

I have had 8 paintings published in medical journals (see links below), but I do not have a website to view my work, since I have not had sufficient time to develop and maintain a quality site.

For newly graduated colleagues around the world – what would be your advice for their future professional and personal development, with regards to mixing of NICU work and creative work?

I encourage anyone to explore the value of painting from a wellness perspective. Painting is an amazing way to engage your mind and body in an emotional outlet that provides mechanisms to relax, laugh, grieve, reflect, share, process, and cope with the variety of experiences we face in life. I feel everyone has creativity they can express and that a blank canvas should not be a daunting endeavor, but an amicable invitation to express yourself.

And finally, what about your own future plans?

While living in Japan, I conceptualized a way to help support orphans using art. I would love to develop a nonprofit organization where people can purchase online prints of original paintings and then choose a non-governmental organization of their preference to dedicate 100% of the profits to benefit children in need. My grander vision is to establish an international museum dedicated to orphans that would include donated art from global artists and would feature art from orphans around the world. This museum, which would serve as a voice for our most vulnerable children and represent a place where their importance is highlighted, could generate financial resources to support constructive programs, such as academic scholarships, that will help future generations thrive. I am grateful to be a neonatologist, a husband, a father, and an artist, so I look forward to further applying my talents to advocate for children.



Hurray!!!! It’s that time of year thai.heart.jpg Our Neonatal Womb Warrior/Preterm Birth Community benefits  from the Global attention that shines upon us on this significant date.  Prevention is key, and exploration, research  and creating a healthy and connected community will empower us to support the joy and well-being we all desire.


World Prematurity Day is observed on 17 November each year to raise awareness of preterm birth and the concerns of preterm babies and their families worldwide. Approximately 15 million babies are born preterm each year, accounting for about one in 10 of all babies born worldwide. Urgent action is always requested to address preterm birth given that the first country-level estimates show that globally 15 million babies are born too soon and rates are increasing in most countries with reliable time trend data. Preterm birth is critical for progress on Millennium Development Goal 4 (MDG) for child survival by 2015 and beyond, and gives added value to maternal health (MDG 5) investments also linking to non-communicable diseases. For preterm babies who survive, the additional burden of prematurity-related disability may affect families and health systems.


march.jpgWorld Prematurity


pengiun.jpgGlobal and Country-Level Preterm Birth Estimates pengiun

The Global Burden of Preterm Birth affects families in every country. While more than 80 percent of preterm births occur in Asia and sub-Saharan Africa, the problem is universal. In fact, the United States and Brazil are among the top 10 countries with the highest number of preterm births. Preventing deaths among babies born too soon is a major challenge for many countries. But the most urgent action to prevent, diagnose and manage preterm birth is needed in the 10 countries that account for nearly two-thirds of all deaths from preterm birth complications .



hnn.pngWorld Prematurity Day 2019 Message Map

Born too Soon: Providing the right care, at the right time, in the right place

The Healthy Newborn Network (HNN) is an online community dedicated to addressing critical knowledge gaps in newborn health.

Ensure High Quality Care for Every Baby Everywhere


  • Small and sick newborns, most of whom are born preterm, have the highest risk of death and contribute to the majority of the world’s disabled children
  • The most vulnerable newborns are those in marginalized groups, rural areas, urban slum environments and humanitarian settings. Girls are more vulnerable in South Asia
  • Delivering inpatient care for small and sick newborns is often a challenge in low- and mid-income countries– and even more so in humanitarian settings
  • High quality, affordable care (Universal Health Care) before, during and after childbirth for all women and babies can prevent many maternal and newborn deaths.


  • Strengthen and transform health systems at every level
  • Use the evidence by providing quality, equitable access to high-impact evidence-based interventions throughout the life-course. Midwife-led continuity of care reduces preterm birth by 24%.
  • Focus on strengthening the health workforce, especially midwives and nurses with special skills in newborn care
  • Invest in care for women and newborns in humanitarian and fragile settings (The Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings)
  • Engage stakeholders from across humanitarian and development sectors to ensure newborns survive and thrive even in the most difficult circumstances
  • Design, test and scale-up new and innovative service-delivery approaches and cost-effective health-care technologies
  • Engage communities around adherence of quality service and access to care, especially amongst the most vulnerable populations

Provide Nurturing Care for the Best Start in Life


  • Nurturing care is the set of conditions that provide for children’s health, nutrition, security and safety, responsive caregiving and opportunities for early learning
  • Nurturing care promotes physical, emotional and cognitive development
  • Nurturing care promotes skin-to-skin contact between baby and family and ensures baby receives mother’s milk
  • Health providers partnering with parents and families is necessary to provide nurturing care, and improves outcomes for babies
  • Zero separation maintains infant-parent unity and protects the family bond


  • Ensure every small and sick newborn receives nurturing care, including early, essential newborn care
  • Implement simple, cost-effective ways to promote developmentally supportive care, e.g. gentle touch, skin-to-skin care, kangaroo care, age-appropriate stimulation and interaction, protection from noise and bright light, or nesting
  • Ensure health facilities have the guidelines, equipment, supplies, and infrastructure they need to care for preterm babies, including space for families to partner in that care with zero separation, i.e. at all hours and respectful care
  • Initiate early breastfeeding / breastmilk feeding
  • Empower fathers to participate in nurturing care and be included in the family unit in facilities
  • Ensure communication between health providers and families on preterm babies’ special needs, and provide physical and emotional support to the family
  • Champion policies and regulations that support nurturing care and family engagement in the health system, particularly inpatient care of newborns

Empower Women and Adolescent Girls to Deciding for their Health


  • Women and adolescent girls have the right to decide whether, when and with whom they want to have children but are often not able to make these decisions themselves.
  • Early (adolescent/young age), frequent and closely spaced pregnancies increase the risk of preterm birth
  • Women have a right to respectful care before, during and after pregnancy
  • Preconception care is critical to prevention of many adverse birth outcomes
  • In many countries, girls suffer from lack of access to good nutrition and quality healthcare due to gender inequality
  • In many countries, child marriage is an issue for increasing burden of mortalities and morbidities among young girls and their newborns


  • Ensure all women and adolescent girls have information and access to care, including family planning and knowledge around risk factors
  • Empower women and adolescent girls everywhere to make healthy choices
  • Implement high quality, equitable healthcare to women and girls, including midwife-led continuity of care, and nutrition throughout their life-course, irrespective of their pregnancy intentions.
  • Address gender inequalities that impact the ability of women and girls to achieve good health outcomes and realize their human rights and full potential
  • Engage with men and boys to encourage more equitable decision-making and policy support at all levels




Effects of Massage Therapy and Kinesitherapy to Develop Hospitalized Preterm Infant’s Anthropometry: A Quasi-Experimental Study

Author links open overlay panel – María JoséÁlvarezPhD, MSc, PTaDoloresRodríguez-GonzálezRNbMaríaRosónMDbSantiagoLapeñaPhD, MDbJuanGómez-SalgadoPhD, MSc, RNcdDanielFernández-GarcíaPhD, MSc, RNe

Highlights-This study examined the effects of massage and kinesitherapy on the anthropometry of preterm infants.The massage therapy and kinesitherapy protocol improved weight, size and head circumference in preterm infants.Massage therapy is an easy and cost-effective intervention to improve preterm infants’ anthropometric development.


Purpose-The aim of this study was to analyze the efficacy of massage therapy and kinesitherapy on the anthropometric development of hospitalized preterm infants applied by parents.

Design and methods-A prospective quasi-experimental study was designed. Hospitalized preterm infants received a daily 15-minute session of massage therapy and kinesitherapy. The control group received regular medical and nursing care.

Results-The massage therapy and kinesitherapy protocol significantly improved the anthropometric parameters studied: weight (895.7 ± 547.9 vs 541.8 ± 536.2; p < 0.001) size (5.5 ± 4.3 vs. 3.0 ± 3.1; p < 0.001) and head circumference (4.2 ± 3.2 vs 2.4 ± 2.6; p < 0.001).

Conclusions-The implementation of a massage therapy and kinesitherapy protocol is beneficial for the anthropometric development of hospitalized preterm infants.

Practice implications-An easy to administer and cost-effective intervention such as massage therapy and kinesitherapy can improve the anthropometric development of preterm infants and reduce growth-related morbidity in the short, medium, and long term.



foot.jpgWhat is Neonatal Nursing?

National Association of Neonatal Nurses – Loading…

Published on Sep 9, 2019

Learn about and celebrate the meaningful experiences and amazing impact of neonatal nurses inside the walls of the NICU and beyond.


Supporting Our Health Care Family  medical  

The Association of American Medical Colleges has predicted a nationwide shortage of between 40,800 and 104,900 physicians in the USA by the year 2030. The biggest barrier to providing an adequate physician workforce in the USA may be the limits the system itself places on the number of residency spots available to resident physicians, and this is a system issue that could be fixed. A person must ponder why it has not been adjusted (follow the money, of course).  Another consideration may include an evolution-resistant, haze-centered culture limping through the 21st Century. In order to make becoming and working as a physician in the USA a humane and healthy career option, changes are required. Our health care community as a whole is worthy of the same employment law protections and benefits that apply to the Public at large. Cheers to those of you working globally to promote safety, health and wellness within the  provider community.


ne.journal.jpg Perspective

Parenting during Graduate Medical Training — Practical Policy Solutions to Promote Change.

Debra F. Weinstein, M.D., Christina Mangurian, M.D., and Reshma Jagsi, M.D., D.Phil.

Physicians have long grappled with the challenge of integrating professional and non–work-related responsibilities, but this tension demands renewed scrutiny amid growing concerns about physician burnout. Work–life integration is notoriously elusive for graduate medical trainees; residency and fellowship training have historically been all-encompassing. Parenting during clinical training involves particularly difficult challenges. As a substantial number of residents and fellows become parents, their struggles highlight the need for systemic solutions.

Some of the problems faced by trainees with children are predictable, such as sleep deprivation compounded with a newborn at home, lack of accessible and affordable childcare that aligns with trainees’ work hours, and geographic distance from extended family who could otherwise provide support. Other challenges are less obvious but pervasive, including worry that taking parental leave will prolong training or limit career options, guilt about “dumping” work on colleagues, and concern about being regarded as less committed to medicine than colleagues without children. For childbearing mothers, such stresses are compounded by the physical demands of pregnancy and nursing.

Graduate medical education (GME) program directors strive to support trainee-parents amid multiple constraints. Provision of parental leave is constrained by hospitals’ reliance on residents to deliver care and the need to comply with work-hour regulations — both of which limit scheduling flexibility. Programs must also ensure that trainees receive comprehensive education and fulfill board-certification requirements, which may include achieving specific case-log quotas. Assessing residents’ readiness for practice can also be more difficult when family leave reduces opportunities for observation. Finally, efforts to support family leaves can spur equity concerns among trainees.

Program directors are often left to navigate these obstacles without resources or established policies. A recent study revealed that about half of leading teaching hospitals lack an institution-wide parental-leave policy for residents.1 Absent such policies, program directors must navigate the expectations of trainees, faculty members, and department chairs, as well as societal norms, to create their own program wide policy or, worse, resort to negotiating parental leave on an individual basis. Case-by-case negotiations are especially precarious, given the lack of sufficient staffing to insulate other trainees from the effects of their colleagues’ leaves.

Certifying boards add further complexity by setting seemingly arbitrary thresholds for the amount of time trainees must make up after a leave, which vary by specialty. Two of us highlighted this problem more than a decade ago,3 and it remains a substantial obstacle. Delaying graduation to accommodate makeup time creates havoc for trainees seeking jobs and, particularly, for those continuing on to fellowships that operate on the standard academic cycle. Such requirements also pose important logistic problems — especially for small programs that lack sufficient case volume or faculty to accommodate trainees beyond their planned graduation date.

A substantial number of trainees become parents during residency or fellowship programs, amid increasing expectations that both parents take a leave. We believe that structural changes are needed. Steps to support trainee-parents could be taken at the national, institutional, and program levels (see table below).

First,we call on GME oversight organizations to develop a unified, 21st-century approach to parental leave. The Accreditation Council for Graduate Medical Education (ACGME) recently mandated greater transparency regarding parental-leave policies, requiring that relevant information be provided to applicants and included in trainee contracts. Trainees must also be given “timely notice of the effect of leave(s)” on their ability to complete their program and become eligible for board certification.

Such requirements represent important progress, but we believe that standards should be strengthened to ensure that institutions provide paid leave to all parents (distinct from postpartum medical leave, when needed). Twelve weeks of paid leave, as supported by the American Academy of Pediatrics,5 would benefit both parents and children, but 6 weeks could be established as a more feasible initial step.

We also advocate that specialty boards abandon requirements that trainees make up approved absences. In an era of competency-based education, on-time graduation should be allowed after parental or other approved leave as long as trainees are deemed competent for independent practice. Special tracks involving truncated clinical training (such as the American Board of Internal Medicine clinician-investigator pathway) already rely on assessment methods to affirm readiness for practice. Eliminating quotas for procedures or other training activities in favor of competency-based assessments would also be appropriate.

In addition, we recommend that the ACGME, the American Board of Medical Specialties (ABMS), and GME-sponsoring organizations cooperatively track and report aggregated data related to parenting during GME. The number and frequency of births and adoptions; the association between parenting and trainees’ educational experiences and duration, clinical assessments, and academic accomplishments; and the influence of specific policies and resources on trainee well-being and on costs and logistics for teaching hospitals can be used to inform best practices and resource planning. The ACGME and ABMS could also collaborate on facilitating institutional development of part-time GME tracks for trainees seeking a less-intensive professional commitment while building a family.

Second, we urge teaching institutions to promulgate family-friendly policies for trainees and to facilitate access to parenting resources. Until national GME policies include specific parental-leave provisions, written policies should be implemented at the institutional level, rather than by individual programs, to prevent programs with more intensive patient-coverage demands or fewer resources from providing substandard benefits. Codifying 12 weeks of parental leave as institutional policy is important because the Family and Medical Leave Act, which guarantees this benefit, has a 12-month employment-eligibility threshold, thus effectively excluding new trainees. In addition, specifying the duration of paid leave in institutional policies places responsibility for funding these leaves on institutions, rather than on individual programs, and ensures parity throughout specialties.

Providing sufficient staffing to cover resident absences — without placing additional burden on other residents — is another institutional responsibility that can be accomplished by creating deliberate redundancy in resident staffing or funding short-term coverage by other clinicians or moonlighting trainees.

Institutions could also support trainee-parents by providing access to affordable, nearby childcare and backup care and, ideally, space where children can visit briefly with an on-call parent. Allowing regular breaks for nursing mothers and providing convenient lactation facilities (equipped with refrigerators, as well as computers to facilitate multitasking) are essential to enable breast-feeding. Teaching institutions could help cultivate cross-specialty collaboratives for trainee-parents to facilitate information sharing, mutual support, and practical solutions such as shared childcare. Making these additional investments will be extremely difficult for many teaching hospitals facing serious financial constraints, but we believe that such initiatives should be prioritized and used as opportunities for innovation.

Finally, it is important for GME programs to provide trainees with explicit information and thoughtful guidance about integrating parenting and training responsibilities. Clarifying the implications of parental leave in more detail than the ACGME requires — including which rotations or clinical experiences must be made up and which can be omitted, what schedule adjustments are feasible to accommodate pregnant or postpartum residents, and whether “work-from-home” elective rotations are possible — will help trainees make important life decisions and help applicants choose training programs.

Individual GME programs can also develop creative pilots. Examples might include policies that allow trainees to take paid leave on an intermittent or part-time basis. Opportunities for shared residency positions might also be explored.

Family-friendly national standards, transparent local policies, and structural resources are all critical to better supporting trainee-parents. Financial investments should yield ample rewards by promoting trainee recruitment and, more important, by reducing stress and burnout among a vulnerable group of physicians — benefiting not only them, but also their children, their teams, and their patients.





A stay in neonatal care – An animated guide

 The NICU Foundation   Published on Apr 30, 2019

Funded by The NICU Foundation and created in partnership with The South West Neonatal Network, this animation was made to support new parents who find themselves in the unfamiliar environment of a NICU. The animation focuses on the role of parents in the NICU and what they can expect.

For individuals and couples traveling the preterm birth journey, the road ahead can be overwhelming, the pathways and outcomes unknown, while emerging complexities, stress, economic and physical demands require our attention.  You will likely receive ample advice, direction, resource referrals and hopefully helping hands.  Sometimes just considering a simple concept can guide us. Maybe tenderness can light the way forward, kindle a little fire in a heart that feels frozen in time….. 

Tenderness Important for Relationship Satisfaction

By Rick Nauert PhD – Associate News Editor – Last updated: 8 Aug 2018

A new study from the Kinsey Institute at Indiana University reveals that cuddling and caressing are important for long-term relationship satisfaction.

Surprisingly, tenderness was more important to men than to women.

The international study reviewed relationship and sexual satisfaction throughout committed relationships.

Also contrary to expectations of the researchers, men were more likely to report being happy in their relationship, while women were more likely to report being satisfied with their sexual relationship.

The couples, more than 1,000 from the United States, Brazil, Germany, Japan and Spain, were together an average 25 years.

The study is the first to examine sexual and relationship parameters of middle-aged or older couples in committed, long-term relationships.

According to the experts, research efforts to understand the place of sexuality in human lives rarely involves intact couples in ongoing relationships.

“You hear repeated research and commentary about divorce; but it’s important to note that though divorce rates are high in the U.S., couples tend to stay married — more than 50 percent of U.S. couples remain in their first marriage, and that number goes up to 90 percent in Spain,” said Julia Heiman, Ph.D., lead author of the article.

“We know from other research that being in a long-term relationship has some value to health. Perhaps we can learn more about what makes relationships both sustainable and happy.”

Participants in the study were 40- to 70-year-old men and their female partners, either married or living together for a minimum of one year. The study included around 200 couples from each country. The men and women answered gender-specific questionnaires and were assured that their responses would not be shared with their partner.

“This study on heterosexual couples provides a basis for future research on sex and gender, such as how same-sex couples may or may not show similarities and differences in relationship and sexual satisfaction,” Heiman said.

For men, relationship happiness was more likely if the man reported being in good health and if it was important to him that his partner experienced orgasm.

Surprisingly, frequent kissing or cuddling also predicted happiness in the relationship for men, but not for women. Both men and women reported more happiness the longer they had been together, and if they themselves scored higher on several sexual functioning questionnaires.

Across all five nationalities, for both men and women, the Japanese were significantly happier with their relationships than Americans, and Brazilians and Spanish reported less relationship happiness than Americans.

Men and women both were likely to report sexual satisfaction if they also reported frequent kissing and cuddling, sexual caressing by the partner, higher sexual functioning, and if they had sex more frequently.

On the other hand, for men, having had more sex partners in their lifetime was a predictor of less sexual satisfaction.

Men did report more relationship happiness in later years, whereas for women, their sexual satisfaction increased over time. Women who had been with their partner for less than 15 years were less likely to report sexual satisfaction, but after 15 years, the percentage went up significantly.

“Possibly, women become more satisfied over time because their expectations change, or life changes with the children grown,” Heiman said. “On the other hand, those who weren’t so happy sexually might not be married so long.”

Compared with the U.S. men, Japanese men reported significantly (2.61 times) more sexual satisfaction in their relationships. For women, Japanese and Brazilian women were more likely to report being satisfied sexually than Americans.

“We recognize that relationship satisfaction and sexual satisfaction may not be the same thing for all couples, and in all cultures,” Heiman said.

“Our next step is to understand how one person’s health, physical affection and sexual experiences relate to the relationship happiness or sexual satisfaction of his or her partner. So, we hope for more couple-centered than individual-centered understanding on relationship functioning and satisfaction.”

The study is published in the journal Archives of Sexual Behavior.


All the NICU Babies (Beyoncé Parody)

plus.jpgAdvocateHealthCare                Published on Dec 6, 2018

PUT YOUR HANDS UP! Check out “All the NICU Babies,” a Beyoncé parody inspired by “All the Single Ladies!” Make sure to wait until the end for a very special THEN & NOW dedication to some of our NICU graduates.

Victoria Vitale, a music therapist at Advocate Children’s Hospital, and Tess Bottorff, a neonatal nurse at Advocate Children’s Hospital, partnered to write the lyrics to this adorable song. Victoria also recorded the song, and shot/edited the music video that featured some of our tiniest patients.

“In creating ‘All the NICU Babies,’ I hoped to highlight some of the ways in which music therapy benefits patients, families, and staff in the Neonatal Intensive Care Unit,” says Victoria. “Normalizing the ICU environment and returning the caregiver role back to parents at bedside helps decrease perceived stress and improve parent-infant bonding. I wanted to help parents make something meaningful of their hospitalization and feel a sense of mastery and purpose during a time when so much is out of their control. I watched parents smile, laugh, hold, kiss, and dance with their babies. This project has not only helped build a sense of community with our parents, but has significantly boosted morale amongst staff. Music therapy enhances the patient, parent, and staff experience–and this is just one way in which I work as a music therapist in the NICU!”



Prevalence of Survival Without Major Comorbidities Among Adults Born Prematurely

October 22/29, 2019    Casey Crump, MD, PhD1,2; Marilyn A. Winkleby, PhD3; Jan Sundquist, MD, PhD1,2,4; et al Kristina Sundquist, MD, PhD1,2,4

Key Points

Question  What is the prevalence of survival without major comorbidities in adulthood among persons born prematurely?

Findings  In this population-based cohort study of more than 2.5 million persons born in Sweden from 1973 to 1997, 54.6% of those born preterm (gestational age <37 weeks) and 22.3% of those born extremely preterm (22-27 weeks) were alive with no major comorbidities at ages 18 to 43 years, compared with 63.0% of those born full-term. The prevalences were statistically significantly lower in those born at earlier gestational ages vs full-term.

Meaning  Among Swedish persons born prematurely, a large percentage survived into adulthood and had no major comorbidities.


Importance  Preterm birth has been associated with cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood. However, the prevalence of survival without any major comorbidities is unknown.

Objective  To determine the prevalence of survival without major comorbidities in adulthood among persons born preterm vs full-term.

Design, Setting, and Participants  National cohort study of all 2 566 699 persons born in Sweden from January 1, 1973, through December 31, 1997, who had gestational age data and who were followed up for survival and comorbidities through December 31, 2015 (ages 18-43 years).

Exposures  Gestational age at birth.

Main Outcomes and Measures  Survival without major comorbidities among persons born extremely preterm (22-27 weeks), very preterm (28-33 weeks), late preterm (34-36 weeks), or early term (37-38 weeks), compared with full-term (39-41 weeks). Comorbidities were defined using the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Comorbidity Index, which includes conditions that commonly manifest in adolescence or young adulthood, including neuropsychiatric disorders; and the Charlson Comorbidity Index (CCI), which includes major chronic disorders predictive of mortality in adulthood. Poisson regression was used to determine prevalence ratios and differences, adjusted for potential confounders.

Results  In this study population, 48.6% were female, 5.8% were born preterm, and the median age at end of follow-up was 29.8 years (interquartile range, 12.6 years). Of all persons born preterm, 54.6% were alive with no AYA HOPE comorbidities at the end of follow-up. Further stratified, this prevalence was 22.3% for those born extremely preterm, 48.5% for very preterm, 58.0% for late preterm, 61.2% for early term, and 63.0% for full-term. These prevalences were significantly lower for earlier gestational ages vs full-term (eg, adjusted prevalence ratios: extremely preterm, 0.35 [95% CI, 0.33 to 0.36; P < .001]; all preterm, 0.86 [95% CI, 0.85 to 0.86; P < .001]; adjusted prevalence differences: extremely preterm, −0.41 [95% CI, −0.42 to −0.40; P < .001]; all preterm, −0.09 [95% CI, −0.09 to −0.09; P < .001]). Using the CCI, the corresponding prevalences were 73.1% (all preterm), 32.5% (extremely preterm), 66.4% (very preterm), 77.1% (late preterm), 80.4% (early term), and 81.8% (full-term) (adjusted prevalence ratios: extremely preterm, 0.39 [95% CI, 0.38 to 0.41; P < .001]; all preterm, 0.89 [95% CI, 0.89 to 0.89; P < .001]; adjusted prevalence differences: extremely preterm, −0.50 [95% CI, −0.51 to −0.49; P < .001]; all preterm, −0.09 [95% CI, −0.09 to −0.09; P < .001]).

Conclusions and Relevance  Among persons born preterm in Sweden between 1973 and 1997, the majority survived to early to mid-adulthood without major comorbidities. However, outcomes were worse for those born extremely preterm.




New technology helps save premature twins

3.jpgWKYC Channel 3 -Published on May 30, 2019-

Another medical first in Northeast Ohio as Rainbow Babies and Children’s Hospital used a new device to plug blood vessels in the hearts of premature twins.


Peer Reviewed      nt.jpg   NEONATOLOGY TODAY
Peer Reviewed Research, News and Information in Neonatal and Perinatal Medicine

Transforming Pediatric Care with Telehealth Technology                       Kirby Farrell, Lindsey Koshansky, RN, MSN

Remote patient monitoring has transformed healthcare, with evolving technology allowing physicians and patients to con­nect in ways never before possible. But as telehealth has evolved, most platforms have focused on serving aging popu­lations. Pediatrics is a population that has been overlooked by telehealth developers and where an opportunity exists to fun­damentally change the way young patients are treated. This is why the Locus Health platform was created.

Locus Health bridges the gap between hospital and home with an RPM platform that connects parents with their child’s care team after they have been discharged following NICU stays. Locus’ HIPAA-compliant modular construction allows for con­figuration of both the app and dashboards, providing effective remote monitoring for any population — from chronic to com­plex. Locus provides a fully managed, SaaS solution that uti­lizes an iOS-based application to improve the home monitoring of medically complex pediatric patient populations. The plat­form was designed specifically to create operational efficien­cies by seamlessly integrating with the providers’ EMR. Most importantly, it allows doctors to spend more time caring for their patients.

Locus has been proven to reduce the length of hospital stays (1), lower readmission rates, reduce in-person clinic visits, and lower the overall cost of care. These results have led to implementation of the Locus platform at more than 25 leading Children’s Hospitals in the U.S. and Canada. This rapid growth has been possible because the platform was developed by experienced healthcare professionals, notably a team of for­mer NICU nurses, who understand the complexities of daily healthcare and the pressing need to integrate telehealth into care regimens. Building a platform that integrates into existing workflows for doctors, nurses, CIO’s and hospital administra­tors was vital.

Locus Health was developed in conjunction (2) with doctors and nurses at the University of Virginia Health System (UVA) in Charlottesville, VA. where Locus is also headquartered. In ear­ly 2018, Dr. Brooke Vergales, a Neonatologist at UVA, met with the clinical innovation team at Locus Health. Her goal was to tailor the Locus platform for premature infants admitted to the UVA Children’s Hospital’s NICU unit who could be discharged home sooner than the average NICU stay of about 24 days. Lo­cus had been supporting a wide range of pediatric patient pop­ulations at UVA with its remote care management solution, and had already achieved strong improvement in clinical outcomes, including improved mortality and oral feeding rates among pe­diatric patients discharged home with congenital heart disease (CHD).

Dr. Vergales had several key objectives: to improve the quality and timeliness of transition home while ensuring that these pre­mature infants thrived more quickly; to keep the care team con­nected in the same way they would if the infant had remained in the hospital; and to help the NICU improve its ability to admit more complex cases and maintain its high census. Dr. Vergales and the Locus team immediately focused on key metrics for evaluating the success of the program, developing targets for:

  • Enrollment, targeting 10-12% of NICU admissions in the first year of the program, typically infants viewed as “feed­ers and growers” that did not require more complex NICU care in the hospital.
  • Length of Stay (LOS), targeting more than a 5-day de­crease in average length of stay.
  • Transition to Oral Feeding, using nasogastric (NG) tube placement in the home (3), aiming to transition to full oral feeding more quickly than in the hospital-setting, while maintaining targeted weight gain metrics.
  • Quality and clinical satisfaction with a new “Virtual Round­ing” approach, as measured by daily family adherence to program tasks and the quality of data/trends collected.

Parents of the infants enrolled in the program were provided a personalized iPad with the Locus platform and mobile app installed. They were shown how to enter key metrics (e.g. daily weights, daily feeding intake, output, SpO2). In addition, the UVA team provided educational content directly through the Lo­cus iPad app that otherwise would have been sent home in an infrequently used binder of printed papers. Parents were able to utilize secure photo and video capabilities through the Locus app to support critical interaction with the care teams, including support for lactation consults.

Neonatology teams at UVA used the Locus platform to both round virtually on a daily basis and review alert notifications through the mobile app for clinicians, helping them manage by exception, and identify trends outside of acceptable parame­ters well in advance of an emergent event.

Since UVA and Locus launched the program in late spring of 2018, UVA has enrolled more than 50 infants in the program and seen a significant reduction in LOS. The reduction in LOS associated with this approach to home discharge of premature infants from the NICU is dramatic. Industry estimates indicate an average cost to payers of more than $3,000 per day in the NICU, indicating an average payer savings of nearly $25,000 per infant discharged to the Locus platform. At UVA’s initial tar­get enrollment rate of 10-12% of NICU discharges, this equates to about $1.5 to 2M in payer savings annually.

However, the economic benefits of this approach do not only accrue to payers. At UVA, and many other Level III/IV NICUs where capacity constraints exist throughout the year, the ben­efits to the UVA Children’s Hospital associated with discharging these “feeders and growers” more quickly include an increase in average reimbursement per day in the range of $1,500 to $2,000, the result of making a NICU bed available to an infant with more complex care needs. Analysis of UVA reimbursement indicated an incremental revenue opportunity of up to $1M an­nually as a result of this shift toward more complex admissions in the NICU. And while the program has been discharging more families sooner, the UVA NICU has maintained its census con­sistently above 90%.

Most importantly, the quality of care in this approach to NICU discharge management has only improved at UVA Children’s Hospital: infants that would otherwise be monitored for the same potential issues in the hospital clearly are thriving more at home from a feeding and oral skills perspective, they bond with their parents more quickly in a nurturing home environ­ment, and the care teams at UVA have been able to manage and monitor at the same quality standard while making more of the NICU available to infants that truly need in-hospital care.

The feedback from both the care teams (4) and the parents of these infants has been overwhelmingly positive. Flossie Hor­ace, the guardian and grandmother of Elliyon Horace, told CBS News in a report (5) that aired nationally in May 2019, that the Locus Health platform has made her grandson’s home recovery more manageable and reduced the number of times she has had to make the 4-hour round trip journey from her home in Roanoke to UVA in Charlottesville.

“I love the iPad. It helps out a lot. It gave me more assurance that I know what I’m doing,” said Horace.


  1. “Doctors create iPad program to get NICU babies home sooner” by Julie Mazziotta, PEOPLE Magazine, March 13, 2019.
  3. “UVA’s pediatric remote monitoring program Building Hope



sd.pngScience News from research organizations

Point-of-care diagnostic for detecting preterm birth on horizon

Date: October 22, 2019 Source: American Society for Microbiology


A new study provides a first step toward the development of an inexpensive point-of-care diagnostic test to assess the presence of known risk factors for preterm birth in resource-poor areas. The study found that measuring levels of TIMP-1 and D-lactic acid in vaginal secretions may be a noninvasive, cost-effective way to assess the risk for preterm birth due to a short cervix and microbiome composition.

A new study provides a first step toward the development of an inexpensive point-of-care diagnostic test to assess the presence of known risk factors for preterm birth in resource-poor areas. The study found that measuring levels of TIMP-1 and D-lactic acid in vaginal secretions may be a non-invasive, cost-effective way to assess the risk for preterm birth due to a short cervix and microbiome composition. The research is published in mBio, an open-access journal of the American Society for Microbiology.

“We have found that there are components in the vagina, proteins and bacteria, that can be used to identify women who are at elevated risk for preterm birth,” said Larry Forney, PhD, a member of the Institute of Bioinformatics and Evolutionary Studies and Distinguished University Professor in the Department of Biological Sciences, University of Idaho, Moscow, Idaho. “There is a need to have a cost-effective diagnostic that can be used to identify women who are at risk for a preterm birth, so more intensive monitoring and, if needed, the most appropriate therapies can be initiated. The goal is to have a point-of-care diagnostic that people can use in a clinic that doesn’t require any advanced technology, expensive instrumentation, or extremely specialized skills.” Dr. Forney, along with Steven Witkin, PhD, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA and Antonio Moron, MD, PhD, Department of Obstetrics, Federal University of Sao Paulo, Sao Paulo, Brazil, served as principal investigators of the new study.

Complications of preterm birth account for roughly a third of the world’s 3.1 million neonatal deaths each year. For years, clinicians have known that a short cervical length and depletion of Lactobacillus species in the vaginal microbiome are significant risk factors for preterm birth. In prosperous countries, most pregnant women undergo a transvaginal ultrasound at 18 to 24 weeks gestation, to determine cervical length, and women with a short cervix are treated with progesterone, a cerclage, or a cervical pessary, to reduce the likelihood of premature delivery. Similarly, women who show signs of bacterial vaginosis, by microscopy of Gram-stained smears or various diagnostics based on gene amplification, are given antibiotics to restore dominance of lactobacilli and reduce the risk of preterm birth.

In many less prosperous areas of the world, however, the resources to perform a transvaginal ultrasound or characterize the composition of vaginal bacterial communities are unavailable. Often, women in resource-poor countries who are at-risk for preterm birth fall through the cracks. “Women with shortened cervixes can have ascending infections from the vagina into the uterus that can elicit inflammation and trigger contractions and preterm births,” explained Dr. Forney. “If you can identify people at risk, there are standard therapies that can be given, but if you don’t know who is at risk, then you can’t very well have a basis of choosing who should receive the additional therapy.”

In the new study, funded by the Bill and Melinda Gates Foundation, researchers from Idaho, Brazil, and New York City set out to identify low-cost, point-of-care measures that might be used to predict bacteria that dominate the vaginal microbiome and indicate the presence of a shortened cervix. The researchers collected and analyzed vaginal fluid samples from 340 mid-trimester pregnant women to determine correlates of a short cervix. Roughly 10% of women in the study had a short cervix. They found that tissue inhibitor of matrix metalloproteinases (TIMP-1), D-lactic acid, p62, age and race all directly affected cervical length. TIMP-1, p62 and belonging to the black race had strong negative effects on cervical length (standardized regression coefficients of -0.162, -0.094, and -0.181, respectively).

“Measuring levels of TIMP-1 and D-Lactic acid in vaginal secretions might be a straightforward way to assess a woman’s risk for preterm birth,” said Dr. Forney. “Our next step is to do a larger study that includes women in their first trimester so that if the findings are similar, monitoring and possible treatment can begin earlier in gestation.”

The researchers said the work wouldn’t have been possible without the expertise of several disciplines coming together as a team. “This is a prime example of the kind of research that can be done when you bring people in from different disciplines,” said Dr. Forney. “This team of investigators included obstetricians, gynecologists, immunologists, microbial ecologists, and statisticians.”

Story Source:Materials provided by American Society for Microbiology.




strongFor Survivors of Preverbal Trauma

puzzle.jpgPosted on August 4, 2018-  If you have experienced and overwhelming experience as a small child or infant and you may have PTSD. We want to take you beyond coping techniques and get to the root of the problem.

The Instinctual Trauma Response™ (ITR) Method.

The Instinctual Trauma Response™ (ITR) method is an evidence-supported method that focuses on treating the roots of trauma symptoms, ending the triggers that cause them. It is a simple but profound method used to complete a traumatic event and integrate consciousness, body, brain, memory narrative, and parts.

The ITR™ method was developed by Dr. Louis Tinnin, psychiatrist, and his wife, Dr. Linda Gantt, an art therapist, after over 30 years of working in hospitals and out-patient clinics. Together they have helped thousands who found relief after trying many other methods. The ITR method works by directly and intentionally “re-coding” traumatic memories so that they finally are placed in the past. It includes the Graphic Narrative™ process and the Externalized Dialogue™ procedure.

The Graphic Narrative™ Process

The Graphic Narrative process consists of a series of drawings depicting the components of the Instinctual Trauma Response.  They can cover a single event or a series of similar events. The client is coached through these drawings and they can be very simple including just the important aspects of each component including the non-verbal aspects such as feelings, thoughts or body sensations.

The Externalized Dialogue™ Procedure

The Externalized Dialogue procedure is a skill for life. It can be done in a variety of ways including writing, audio recording or video recording.  It allows the true-self to collaborate and negotiate with the parts that were hurt or stuck in the traumas. This procedure can be done before or after the Graphic Narrative process.


KAT’S Corner

“The healthiest form of projection is art.”   Fritz Perls

Check out the website below which offers numerous ideas for exploring our soul searching efforts as we heal from any pre-verbal trauma we may have experienced as preterm birth survivors.  I elected to try a quick exercise (work, school, research are all calling me) in order to engage in this process. My “art” was created at 9 PM at the local Whole Foods over a period of about ten minutes while I devoured my delicious gluten free grilled chicken sandwich.  What I experienced drawing my tree was a childlike joy as pencil and paper collided, a bit of intensity as the drawing took form, and a smile of satisfaction once I set the pencils down! Long term effects? Unknown. A precious moment in time -affirmative!   

My drawing arrow_shape_clip_art_12641 (1).jpg arrow_shape_clip_art_12641 (1).jpgarrow_shape_clip_art_12641 (1).jpg


Draw yourself as a tree. Your roots will be loaded with descriptions of things that give you strength and your good qualities, while your leaves can be the things that you’re trying to change.



thai.pic.jpgKata Beach Surfing Contest 2017 Wrap (29-30 July)-

Published on Aug 1, 2017

All the action from the 2017 Kata Beach Surfing Contest held off Kata Beach in Phuket, Thailand from 29th to 30th July, 2017.











Rate: 10.9%      Rank: 76

         (US Rate: USA – 12% Rank: 54)  


We will not turn our eyes or hearts away from any part of our Community. The burden of suffering for our family members in countries involved in conflict/war increases the hardship to families, providers, and community members as a whole. Significant evidence has shown that armed conflict and political turmoil directly affects the likelihood of increased rates of low birth weight and prematurity birth rates. The refugee crisis, including the Syrian conflict, and other forms of harm onto humanity occurring around the world affects our preterm birth community at all levels. Our blog embraces inclusivity with the intent of connecting the Community as a whole in order to create and empower our pathways to health and wellbeing.

health.syriaImpacts of attacks on healthcare in Syria

Report from Syrian American Medical Society Foundation – Published on 19 Oct 2018

Attacks on medical facilities are a violation of international humanitarian law. Unfortunately, that has not deterred armed forces from systematically and deliberately attacking health centers in Syria.

Between 2011 and 2017, there were 492 attacks on healthcare in Syria, killing 847 medical personnel. From January to July, 2018, another 119 attacks were recorded, mostly affecting East Ghouta, eastern Aleppo, Dara’a, and Idlib.

According to the WHO, 70% of total worldwide attacks on health care facilities, ambulances, services and personnel have occurred within Syria. Many facilities are targeted multiple times; SAMS-supported Kafr Zita Specialty Hospital in Hama was bombed five times in 2017 alone.

These hospitals are not collateral damage from the conflict. Bombardments specifically target health facilities according to experts in Syria, despite efforts to ensure hospital coordinates are known.

On May 3, 2016, the UN Security Council officially condemned attacks on medical facilities and personnel in armed conflict in Resolution 2286, while the WHO created a Surveillance System of Attacks on Healthcare (SSA) in January 2018. Despite these international efforts, the UN reports that attacks on health facilities have actually increased in 2018.

In the first eight months of this year, SSA recorded 97 deaths and another 165 injured healthcare staff and their patients due to attacks on their medical facilities.

Without a safe place to work and often directly targeted in systematic attacks, very few healthcare workers remain to care for their patients. Those who are left are trying to make up for the enormous gap in manpower.

Through 2017, 107 doctors remained to treat the people of East Ghouta – the then-besieged enclave with a population of nearly 400,000. One in six surgeons in Syria works 80-hour weeks. Currently, 38% of health workers have received no formal training at all.

Those remaining still face danger. More than one in 10 health workers report receiving personal threats because of their occupation. In 2017, SAMS lost six dedicated colleagues to aerial attacks. A total of 36 SAMS staff members were killed from 2015 through March of 2018.Patients now fear hospitals and other health facilities as they are a bombing risk. This leaves many Syrians with untreated conditions. Almost half of Syrians would only go to a hospital if their life depended on treatment.

The symbolic Red Cross or Red Crescent markings have been removed from most hospitals in Syria as they are now a literal target. Medical facilities have also moved underground or into caves. This attempt to protect medical workers and their patients didn’t deter attacks on healthcare as a tactic of war in Syria.

Bunker buster bombs have been used to cut through concrete and decimate basement and underground hospitals, which are also vulnerable to chemical attacks. The chemical agents used are heavier than air, sinking to the basements that patients and doctors use for shelter. In March of 2017, SAMS lost one of its own doctors, Dr. Ali Darwish, in a chemical attack targeting his hospital in rural Hama. Dr. Darwish was in the operating room and refused to leave his patient when barrel bombs containing chemical agents were dropped on the entrance of the underground hospital. The gas quickly spread throughout the facility. Dr. Darwish was evacuated to another hospital but could not be saved.

These attacks force hospitals to close down temporarily while they rebuild. Eight facilities have closed permanently because of immense damage. One in four Syrians say that specialized care is not available in their area, a problem SAMS works to fix through the development of special care facilities.

Further, medical aid convoys are forced to endure a long bureaucratic process before shipping and were regularly stripped of certain medical supplies by armed forces while in transit in the early years of the conflict.

Attacking health workers and their treatment centers cripples a health system already in crisis. In February, 2018, attacks on medical facilities disrupted 15,000 medical consultations and 1,500 surgeries.

SAMS currently operates across northern Syria, supporting over 35 medical facilities. Through financial support of facilities and staff, medical education, and procurement and logistics management, SAMS works to ensure quality and dignified care is accessible. SAMS focuses on providing specialty care that is difficult to afford, such as an oncology center, radiology departments, blood banks, psychosocial services, free of charge to patients.

Despite recent challenges and shifting dynamics in the conflict, SAMS has continued to provide lifesaving care in northern Syria, providing nearly 1.5 million medical services from January to September 2018. In response to the potential humanitarian crisis in Idlib, SAMS has procured and distributed over $2.7 million in medications, medical supplies, and equipment to our healthcare facilities across northern Syria, working with implementing partners to conduct cross-border operations.




NIH study suggests higher air pollution exposure during second pregnancy may increase preterm birth risk

Thursday, September 12, 2019

Pregnant women who are exposed to higher air pollution levels during their second pregnancy, compared to their first one, may be at greater risk of preterm birth, according to researchers at the National Institutes of Health. Their study appears in the International Journal of Environmental Research and Public Health.

Preterm birth, or the birth of a baby before 37 weeks, is one of the leading causes of infant mortality in the United States, according to the Centers for Disease Control and Prevention. Although previous studies have found an association between air pollution exposure and preterm birth risk, the authors believe their study is the first to link this risk to changes in exposure levels between a first and second pregnancy.

“What surprised us was that among low-risk women, including women who had not delivered preterm before, the risk during the second pregnancy increased significantly when air pollution stayed high or increased,” said Pauline Mendola, Ph.D., the study’s lead author and a senior investigator in the Epidemiology Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Researchers used data from the NICHD Consecutive Pregnancy Study to examine the risk of preterm birth. They matched electronic medical records of more than 50,000 women who gave birth in 20 Utah hospitals between 2002 and 2010 to data derived from Community Multiscale Air Quality Models, modified based on a model by the Environmental Protection Agency, which estimate pollution concentrations.

Researchers examined exposure to sulfur dioxide, ozone, nitrogen oxides, nitrogen dioxide, carbon monoxide and particles. For nearly all pollutants, exposure was more likely to decrease over time, but 7 to 12% of women in the study experienced a higher exposure to air pollution during their second pregnancy. The highest risks were with increasing exposure to carbon monoxide (51%) and nitrogen dioxide (45%), typically from emissions from motor vehicles and power plants; ozone (48%), a secondary pollutant created by combustion products and sunlight; and sulfur dioxide (41%), mainly from the burning of fossil fuels that contain sulfur, such as coal or diesel fuel.

More research is needed to confirm this association, but improvements in air quality may help mitigate preterm birth risk among pregnant women, Dr. Mendola said.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD leads research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all. For more information, visit

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

NIH…Turning Discovery Into Health®

Reference-Mendola, P. et al. Air pollution and preterm birth: Do air pollution changes over time influence risk in consecutive pregnancies among low-risk women? International Journal of Environmental Research and Public Health, 2019.



Living in a ‘war zone’ linked to delivery of low birth-weight babies.

Evidence for impact on other complications of pregnancy less clear – Nov. 28, 2017     Moms-to-be living in war zones/areas of armed conflict are at heightened risk of giving birth to low birth-weight babies, finds a review of the available evidence published in the online journal BMJ Global Health.

People living in war zones are under constant threat of attack, which has a detrimental effect on their mental and physical health. Their food and water supplies are often disrupted, and healthcare provision restricted, all of which can take a toll on the health of expectant mothers, say the researchers.

To explore this further, the research team looked for studies on the impact of war on pregnancy and found 13 relevant studies, dating back to 1990. These involved more than 1 million women from 12 countries that had experienced armed conflict, including Bosnia, Israel, Libya, and Iraq.

Analysis of the data showed that moms-to-be living in war zones/areas of armed conflict were at heightened risk of giving birth to underweight babies.

But there was less evidence suggesting any impact on rates of miscarriage, stillbirth and premature birth, and few studies looked at other outcomes, such as birth defects.

The researchers point to some caveats. All nine of the studies which looked at the potential impact of war on birthweight had some design flaws.

And five failed to account for potentially influential factors, or provided only limited data on exposure to conflict, although this may reflect the difficulties of collecting data in war-torn areas, suggest the researchers.

None of the studies defined the meaning of war or armed conflict, so making it hard to differentiate between the short and long term impact of various aspects of warfare, they add.

Nevertheless, the most convincing evidence suggests that rates of low birthweight rise among women living in war zones/areas of conflict, they conclude. And this matters, they say.

“The long term health implications of low birthweight are significant, because individuals are at increased risk of [ill health] and [death], and will require increased medical care throughout their lives,” they emphasise.

In light of their findings, they call on healthcare professionals to monitor pregnant women living in war zones more carefully, although they acknowledge the difficulties of doing this in war zones.

But they say: “This will only be possible if warring parties are committed to following the Geneva Convention, refrain from attacking healthcare facilities and workers, and are adequately resourced.

“Until this happens, women and their infants will be at continued risk of adverse outcomes in pregnancy.”

And it is just as important for clinicians in countries not affected by armed conflict to carefully monitor pregnant women who have been displaced by war, they say.

Journal Reference:James Keasley, Jessica Blickwedel, Siobhan Quenby. Adverse effects of exposure to armed conflict on pregnancy: a systematic review. BMJ Global Health, 2017; 2 (4): e000377 DOI: 10.1136/bmjgh-2017-000377










New model mimics persistent interneuron loss seen in prematurity

Date: February 19, 2019  Source: Children’s National Health System

Research-clinicians at Children’s National Health System have created a novel preclinical model that mimics the persistent interneuron loss seen in preterm human infants, identifying interneuron subtypes that could become future therapeutic targets to prevent or lessen neurodevelopmental risks, the team reports Jan. 31, 2019, in eNeuro.

In the prefrontal cortex (PFC) of infants born preterm, there are decreased somatostatin and calbindin interneurons seen in upper cortical layers in infants who survived for a few months after preterm birth. This neuronal damage was mimicked in an experimental model of preterm brain injury in the PFC, but only when the newborn experimental models had first experienced a combination of prenatal maternal immune activation and postnatal chronic sublethal hypoxia. Neither neuronal insult on its own produced the pattern of interneuron loss in the upper cortical layers observed in humans, the research team finds.

“These combined insults lead to long-term neurobehavioral deficits that mimic what we see in human infants who are born extremely preterm,” says Anna Penn, M.D., Ph.D., a neonatologist in the divisions of Neonatology and Fetal Medicine and a developmental neuroscientist at Children’s National Health System, and senior study author. “Future success in preventing neuronal damage in newborns relies on having accurate experimental models of preterm brain injury and well-defined outcome measures that can be examined in young infants and experimental models of the same developmental stage.”

According to the Centers for Disease Control and Prevention 1 in 10 infants is born preterm, before the 37th week of pregnancy. Many of these preterm births result from infection or inflammation in utero. After delivery, many infants experience other health challenges, like respiratory failure. These multi-hits can exacerbate brain damage.

Prematurity is associated with significantly increased risk of neurobehavioral pathologies, including autism spectrum disorder and schizophrenia. In both psychiatric disorders, the prefrontal cortex inhibitory circuit is disrupted due to alterations of gamma-aminobutyric acid (GABA) interneurons in a brain region involved in working memory and social cognition.

Cortical interneurons are created and migrate late in pregnancy and early infancy. That timing leaves them particularly vulnerable to insults, such as preterm birth.

In order to investigate the effects of perinatal insults on GABAergic interneuron development, the Children’s research team, led by Helene Lacaille, Ph.D., in Dr. Penn’s laboratory, subjected the new preterm encephalopathy experimental model to a battery of neurobehavioral tests, including working memory, cognitive flexibility and social cognition.

“This translational study, which examined the prefrontal cortex in age-matched term and preterm babies supports our hypothesis that specific cellular alterations seen in preterm encephalopathy can be linked with a heightened risk of children experiencing neuropsychiatric disorders later in life,” Dr. Penn adds. “Specific interneuron subtypes may provide specific therapeutic targets for medicines that hold the promise of preventing or lessening these neurodevelopmental risks.”

Children’s National Health System. “New model mimics persistent interneuron loss seen in prematurity.” ScienceDaily. (accessed September 26, 2019).




Dr. Weinstein. A surgeon’s struggle with mental health.

dis.jpgPublished on Jan 31, 2019         Physician Mental Health & Suicide

Doctors, physicians, medics, surgeons are not supposed to get sick. But what if they do? Watch this revealing film and read the back story over on…



UWMed GME Wellness Service (SEATTLE)

While this is a UW Medicine specific resource we felt that the resources included and information may be helpful for those working within our healthcare community.

Resources for residents and fellow wellness.

Resident and fellow wellness is an institutional priority in graduate medical education. The GME Wellness Service helps trainees and their significant others/spouses cope with common stressors of training. Our goal is to promote work-life balance and overall wellness by advocating for you and providing you with tools to reduce burnout, depression, relationship stress, and other problems.

We offer FREE and CONFIDENTIAL counseling services and FREE psychiatric consultation for individuals and couples. We help you manage crises, provide new perspectives for handling stress, renew existing scripts, and assess the need for new prescriptions.

To help you make the most of your precious time off, we produce a weekly electronic newsletter called The Wellness Corner, where we share information about GME Wellness activities and other free, fun, and low-cost events around town. To build community across all of our programs, we sponsor evening and weekend events targeted to everyone, and to special interest groups including LGBTs, singles, international trainees, and parents. Popular activities include chocolate factory tours, food events, museum and library tours, kayaking, art walks, movie nights and our annual Peeps Contest. Family-friendly events include a Halloween party, gingerbread-house decorating and an indoor children’s gym. Self-care is encouraged with discounts for massages, facials, sports events and theater tickets.

We also offer deeply discounted classes on Mindfulness Based Stress Reduction (MBSR) and Compassion Cultivation training for trainees and their significant others/spouses, and we provide customized seminars, workshops and support groups upon request.

Daytime and evening counseling is available Monday through Thursday and can be scheduled online at any time. No medical record or bill is generated. Don’t wait for a crisis! Book an appointment if you or your partner is experiencing any of the following:

  • Depression, anxiety, or other mental health concerns
  • Love loss and other relationship problems
  • Career doubts, job stress, burnout
  • Sleep disturbance
  • Perfectionism
  • Adverse event (needle stick, traumatic patient outcome, illness in your family, etc.)
  • Harassment by a partner or a work colleague
  • Conflicts with faculty, attendings, hospital staff or others

Easy online scheduling

We have made it super easy to book counseling appointments.

  • Go to
  • Enter Seattle, WA in the search box
  • Enter GME to bring up the UW GME Wellness Service.
  • Enter Schedule Now to see upcoming appointment options, and choose a time that works for you.

If you are a first-time counseling client, return a completed Wellness Service Intake Form to the counselor you booked an appointment with:,, or They will provide directions to their office location.


To help you function at your very best, we can refer you for:

Psychiatric consultation

The GME Wellness counselors can refer you or your spouse/significant other to our community psychiatrist for a confidential assessment and 3 follow-up appointments, all for FREE. You can renew existing scripts, assess the need for new prescriptions, and get help during a mental health crisis. Our psychiatrist is not part of UW Medicine, and is generally available within 48 hours of referral, however you must see one of the wellness counselors first.

Learning consultation

If you or your life partner struggle with test taking, time management and other academic challenges, our learning specialist can help. FREE for GME trainees and their spouses/significant others. Meet with one of the wellness counselors to determine this need.

Community providers

We can identify other community providers including PCPs, dentists, victim advocates, and more. In cases of impairment due to mental illness or substance abuse, we work closely with the Washington Physicians Health Program (WPHP). We advocate for our trainees to get necessary treatment without losing their medical license or jeopardizing their training status.

Other wellness services and resources

Mindfulness-Based Stress Reduction (MBSR) and Compassion Cultivation: Throughout the year, the GME Wellness Service proudly offers deeply-discounted, Sunday evening, Introductory and Advanced 5-week series on Mindfulness-Based Stress Reduction (MBSR) and Compassion Cultivation. Each of these practices has been shown to reduce anxiety, depression and stress, and to increase empathy towards one’s self, patients, and others. Trainees and their significant others/spouses are eligible to enroll. The Wellness Corner includes information and registration links.

Listservs: To build community and share resources, we have created three listservs: GMEParents, LGBTwellness and GMEInternational. To join, email the GME Office.

Lending Library: Residents and fellows may borrow useful books and other materials on a variety of topics including couples’ communication, time management, grief, perfectionism, mindfulness, managing depression and anxiety, relaxing into restful sleep, etc.

Self-Screening Tools

The following mental health self-screening tools are offered for personal exploration, but they should not be considered an adequate substitute for mental health evaluation. If you would like to discuss your concerns or results further, please schedule an appointment with the GME Wellness Service.




Forward Motion Mindfulness in the Medical Community

UWMaduwmadison – Center for Healthy Minds works to cultivate well-being and relieve suffering through a scientific understanding of the mind. Applying its teachings helps this doctor better cope with the stresses of his profession.




Scientists designed a robot to reduce pain for premature babies

Posted April 2, 2019  tech                                                         

Skin to skin contact is very important for newborns, but is it not always available, especially for premature babies. That is why scientists from British Columbia, Canada, have designed a special robot, which mimics human skin-to-skin contact, helping reduce pain for babies.

Premature babies are very fragile and often have some serious conditions. They have to undergo various medical procedures, many of which are quite uncomfortable and painful. Human skin-to-skin contact is a very effective way to mitigate that and alleviate at least part of that pain. Nurses are trying to provide that, but they are not always available and sometimes baby’s immune system is not strong enough to be held for a longer time. And that’s where this robot comes in.

This robot is a moving sleeping surface, which can be installed in incubators or used separately. It mimics the parent’s heartbeat sounds, breathing motion and the feel of human skin. Scientists compared the effectiveness of this machine to hand hugging and found no difference in reduction of pain-related indicators. Hand hugging is typically used as a method to calm down the baby during blood collection or other similar painful procedures. This study showed that this robot can provide a similar result when parents are not available.

The robot, called Calmer, is covered with a skin-like surface, which moves up and down simulating the breathing of a parent. Its movements can be adjusted and it can mimic individual parent’s heart rate. Calmer fits in an incubator, replacing the normal mattress. It gently rocks the baby, reducing pain and helping it to fall sleep. Scientists tested the device in a study involving 49 premature infants and it seems to be very effective. Scientists say that the Calmer is very important, because previous studies have shown that an early exposure to pain has a negative effect on premature babies’ brain development.

Scientists hope that in the future devices like this will come integrated into incubators. This would reduce the cost and increase availability. Liisa Holsti, lead author of the study, said: “While there is no replacement for a parent holding their infant, our findings are exciting in that they open up the possibility of an additional tool for managing pain in preterm infants”.

Premature babies are very fragile and need continuous care. Effective pain management is very important, because no one wants them to suffer and it is crucial to give their brains a chance of normal development. Calmer could be the device that takes care of the baby, soothes it and helps it sleep when parents are not around.



Source: UBC – Video –  A Robot called Calmer





Bedrest for high-risk pregnancies may be linked to premature birth

Posted September 9, 2019

Newborns whose mothers spent more than one week on bedrest had poorer health outcomes, according to a new study out of the University of Alberta that further challenges beliefs about pregnancy and activity levels.

A team led by cardiovascular health researcher Margie Davenport conducted a review of every available randomized controlled trial of prenatal bedrest lasting more than one week and beginning after the 20th week of gestation.

The researchers found that infants whose mothers had bedrest in developed countries were born 0.77 weeks sooner and had slightly more than double the risk of being born very premature, which is before 35 weeks’ gestation.

“Babies born to mothers with preeclampsia, early labour or twins/triplets are more likely to be delivered preterm or before 37 weeks. In these cases, being delivered five days earlier because of bedrest—that is actually quite a bit of time,” said Davenport. “If babies are delivered before 37 weeks, they’re not fully developed—especially their lungs. They’re more likely to have health issues, both at birth and over the longer term.”

She explained that 20 per cent of pregnant women are prescribed bedrest or are advised to restrict their level of activity during their pregnancy despite previous studies demonstrating that bedrest is associated with adverse outcomes for the mother, including increased rates of depression, thrombosis, blood clots, muscle loss and bone loss.

Davenport noted that much less is known about the impact bedrest has on the baby, so it “continues to be prescribed in hopes that we can improve the health of the baby.”

Brittany Matenchuk, a research assistant with Davenport’s Program for Pregnancy and Postpartum Health, explained that previous studies looking at randomized controlled trials comparing bedrest to no bedrest in high-risk pregnancies showed no positive or negative impacts of bedrest, due to small numbers.

However, the team realized previous results combined a number of studies conducted in Zimbabwe in the 1980s and ‘90s with more current studies conducted in developed countries. Matenchuk said when the researchers separated out the Zimbabwe results were separated out, they noticed a divergent impact.

In the studies conducted in Zimbabwe, bedrest did not affect delivery date, but birth weight was 100 grams heavier in newborns whose mothers had been put on bedrest.

“What’s striking is that the outcomes from Zimbabwe are significantly different,” said Matenchuk. “It’s such a different scenario that they probably shouldn’t have been put together and analyzed together in the first place.”

Rshmi Khurana, a U of A obstetric medicine specialist, said the reasons for the divergent results between regions could range from differences in activity levels and nutrition to exposure to a host of environmental factors.

“All of the women put on bedrest in the Zimbabwe studies were hospitalized, while the studies in the developed countries had a mix of hospitalization and home bedrest,” she said. “Those were also older studies, whereas some of the studies from developed nations were more recent and health care has changed a lot.”

Khurana, who along with Davenport is a member of the Women and Children’s Health Research Institute, said despite the mounting evidence against bedrest and the lack of indication for the measure in any current guidelines, it keeps being prescribed.

“Of course, individual women need to pay attention to their health-care providers’ advice as each situation might be different, but as health providers we really need to think that we might be doing harm to pregnancy by prescribing bedrest,” said Khurana.

She added that being told you should not exercise is not the same as lying in bed.

“Women sometimes think that doing nothing and putting themselves in their little cocoon might be the best thing, but it’s important for expectant mothers to realize there’s potential harm that can happen with that as well,” said Khurana.

Davenport, a Faculty of Kinesiology, Sport, and Recreation researcher, helped develop the 2019 Canadian Guidelines for Physical Activity Throughout Pregnancy, the first fully evidence-based recommendations on physical activity specifically designed to promote fetal and maternal health. The guidelines state that 150 minutes of exercise per week during pregnancy cuts the odds of health complications by a quarter.

While the guidelines outline medical reasons women should not be active during their pregnancy—including having ruptured membranes, persistent vaginal bleeding, a growth-restricted pregnancy, premature labour, pre-eclampsia and uncontrolled thyroid disease—Davenport said women with complicated pregnancies are still encouraged to continue their daily activities as directed by their doctor.

“Activities of daily living include grocery shopping, going to get the mail, gardening, cooking—anything you do in your regular life that is not so intense it would be considered exercising,” she said.

Source: University of Alberta-





Stable home lives improve prospects for preemies

Medical challenges at birth less important than stressful home life in predicting future         psychiatric  health

As they grow and develop, children who were born at least 10 weeks before their due dates are at risk for attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder and anxiety disorders. They also have a higher risk than children who were full-term babies for other neurodevelopmental issues, including cognitive problems, language difficulties and motor delays.

Researchers at Washington University School of Medicine in St. Louis who have been trying to determine what puts such children at risk for these problems have found that their mental health may be related less to medical challenges they face after birth than to the environment the babies enter once they leave the newborn intensive care unit (NICU).

In a new study, the children who were most likely to have overcome the complications of being born so early and who showed normal psychiatric and neurodevelopmental outcomes also were those with healthier, more nurturing mothers and more stable home lives.

The findings are published Aug. 26 in The Journal of Child Psychology and Psychiatry.

“Home environment is what really differentiated these kids,” said first author Rachel E. Lean, PhD, a postdoctoral research associate in child psychiatry. “Preterm children who did the best had mothers who reported lower levels of depression and parenting stress. These children received more cognitive stimulation in the home, with parents who read to them and did other learning-type activities with their children. There also tended to be more stability in their families. That suggests to us that modifiable factors in the home life of a child could lead to positive outcomes for these very preterm infants.”

The researchers evaluated 125 5-year-old children. Of them, 85 had been born at least 10 weeks before their due dates. The other 40 children in the study were born full-term, at 40 weeks’ gestation.

The children completed standardized tests to assess their cognitive, language and motor skills. Parents and teachers also were asked to complete checklists to help determine whether a child might have issues indicative of ADHD or autism spectrum disorder, as well as social or emotional problems or behavioral issues.

It turned out the children who had been born at 30 weeks of gestation or sooner tended to fit into one of four groups. One group, representing 27% of the very preterm children, was found to be particularly resilient.

“They had cognitive, language and motor skills in the normal range, the range we would expect for children their age, and they tended not to have psychiatric issues,” Lean said. “About 45% of the very preterm children, although within the normal range, tended to be at the low end of normal. They were healthy, but they weren’t doing quite as well as the more resilient kids in the first group.”

The other two groups had clear psychiatric issues such as ADHD, autism spectrum disorder or anxiety. A group of about 13% of the very preterm kids had moderate to severe psychiatric problems. The other 15% of children, identified via surveys from teachers, displayed a combination of problems with inattention and with hyperactive and impulsive behavior.

The children in those last two groups weren’t markedly different from other kids in the study in terms of cognitive, language and motor skills, but they had higher rates of ADHD, autism spectrum disorder and other problems.

“The children with psychiatric problems also came from homes with mothers who experienced more ADHD symptoms, higher levels of psychosocial stress, high parenting stress, just more family dysfunction in general,” said senior investigator Cynthia E. Rogers, MD, an associate professor of child psychiatry. “The mothers’ issues and the characteristics of the family environment were likely to be factors for children in these groups with significant impairment. In our clinical programs, we screen mothers for depression and other mental health issues while their babies still are patients in the NICU.”

Rogers and Lean believe the findings may indicate good news because maternal psychiatric health and family environment are modifiable factors that can be targeted with interventions that have the potential to improve long-term outcomes for children who are born prematurely.

“Our results show that it wasn’t necessarily the clinical characteristics infants faced in the NICU that put them at risk for problems later on,” Rogers said. “It was what happened after a baby went home from the NICU. Many people have thought that babies who are born extremely preterm will be the most impaired, but we really didn’t see that in our data. What that means is in addition to focusing on babies’ health in the NICU, we need also to focus on maternal and family functioning if we want to promote optimal development.”

The researchers are continuing to follow the children from the study.

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke and the National Institute of Mental Health of the National Institutes of Health (NIH). Grant numbers R01 HD057098, R01 MH113570, K02 NS089852, UL1 TR000448, K23-MH105179 and U54-HD087011. Additional funding was provided by the Cerebral Palsy International Research Foundation, the Dana Foundation, the Child Neurology Foundation and the Doris Duke Charitable Foundation.

Story Source: Materials provided by Washington University School of Medicine. Original written by Jim Dryden.


Barbara Melotto – “I JUST WAIT FOR YOUR LIFE”

music.sym.jpgVivere Onlus – Coordinamento Nazionale delle Associazioni per la Neonatologia-Published on Feb 22, 2019









Parenteral nutrition for ill and preterm infants – meeting nutritional needs in the NICU

Posted on 13 August 2019  – Interview with Professor Nadja Haiden, Medical University of Vienna, Austria

Babies with a healthy digestive tract usually get their nutrition by drinking breastmilk and digesting. This provides the body with the nutrients necessary for growth and development. However, babies who are born very preterm or have certain illnesses often cannot be fed by mouth or by a feeding tube. In this case, they require so-called parenteral nutrition, which means that nutrients are provided directly into a blood vessel. We spoke with Professor Nadja Haiden from the Medical University of Vienna about the process of parenteral feeding, its benefits and possible challenges.

Question: Professor Haiden, for many people it is hard to imagine receiving nutrients directly into the bloodstream. How do such parenteral mixtures of nutrients for the preterm born babies look like and what kind of nutrients do they contain?

Professor Haiden: Parenteral nutrition is provided as clear or opaque solutions filled in syringes or bags. In some units ready- to- use multi-chamber bags are used.  To protect nutrients from destruction via sunlight these bags, syringes and lines are often coloured (e.g. orange). The solutions contain all essential nutrients such as carbohydrates, amino acids, fat, salts and vitamins. The nutrients are mixed in optimal concentrations according to the infant’s needs and are compounded under sterile conditions.

Q: How do you decide if a baby needs parenteral nutrition and when to stop? Are other people involved in the decision?

Professor Haiden: There are various reasons why parenteral nutrition is applied. In premature babies, the most frequent cause is the immaturity of the gut. The gut isn’t ready to tolerate large quantities of food immediately after birth and has to get accustomed to it slowly. But there are other conditions when the digestive tract has to bypassed for a certain period of time such as malformations need to be fixed via surgery, heart defects or other causes of severe illness. Usually, parenteral nutrition is prescribed by a neonatologist during the daily round after discussion with the attending nurse of the infant. The nurse provides valuable information on the infant’s tolerance against enteral feedings and together they schedule the feeding plan for the next day. In addition, laboratory values help the physician to prescribe the optimal mixture of nutrients for the infant. In some units also dieticians and pharmacists are involved in the prescription process.

Q: Does receiving PN mean that the baby is not getting mother’s milk or formula, during that time?

Professor Haiden: No, the aim is to establish enteral nutrition as soon as possible after birth. Therefore, the infant receives so-called “minimal enteral feedings” in parallel to parenteral nutrition. Minimal enteral feedings are small amounts of mother’s own milk, donor milk or formula which are given every 2-3 hours. Mother’s own milk is the best and optimal nutrition for all babies even the most immature ones. Therefore, we strongly encourage the mother to provide breastmilk and we are happy with each millilitre the mother pumps. Initially, small meals of 0,5-1 ml should get the gut accustomed to enteral feedings and facilitate advancement of enteral nutrition. If these small amounts are well tolerated, the volume of the meals is increased every day and in parallel, the volume of the parenteral nutrition is reduced. The next goal is to achieve full enteral feedings as soon as possible and to end parenteral nutrition. Depending on the immaturity of the baby this period lasts 7 to 21 days.

Q: What difficulties can occur when applying parenteral nutrition to a preterm born baby?

Professor Haiden: Parenteral nutrition might be associated with certain side effects such as infection-related sepsis, thrombosis, parenteral nutrition-related liver disease and failure to thrive.

Q: How can these difficulties be avoided?

Professor Haiden: Hygienic measures such as strict hand hygiene or wearing surgical masks in case anyone is suffering from a cold are important to avoid infections and infection-related sepsis. Failure to thrive can be avoided by reassessment and optimizing the parenteral and enteral nutritional intake. In general, parenteral nutrition should be given as short as possible but as long as necessary- this approach avoids side effects and parenteral nutrition-associated problems.

Q: Is there anything, in particular, you would like the parents to know?

Professor Haiden: The parents are the most important persons for our little patients- it is essential for us to include them in all processes and to provide accurate and reliable information for them. If parents have any questions concerning the local process of parenteral and enteral nutrition please do not hesitate to ask us, physicians or nurses.

Special thanks to Assoc. Prof. Dr Nadja Haiden, MD. MSc. is head of the Neonatal Nutrition Research Team of the Medical University of Vienna




Pre-verbal trauma will affect many in our global Warrior community during our youth and as we age. Despite the fact that lifesaving efforts were lovingly and expertly provided to support our survival, many of us will experience to varying degrees the effects of preverbal trauma. In our search for healing modalities, many practices such as yoga, mindfulness, meditation, forest bathing, EMDR, talking with a friend who may experience similar trauma, engaging with family (those willing to do so) regarding our birth and early life experiences may support our health and wholeness. We have found that finding an expert to provide therapy (hypnotherapy, shamanism, rolfing, body work, etc.) is challenging. In her search to enhance her wellbeing Kat has found that many conscientious providers do not feel they have the skills needed to safely enter the realm of trauma experienced by individuals like her who were  born early and required intensive and prolonged life-saving care in order to survive. As a Community we will benefit from research, the identification of existing and the creation of new modalities of effective treatment for pre-verbal trauma survivors. In the meantime, let’s take time to listen to our bodies and our personal language of feelings our bodies express. We can choose to move forward in this regard with loving self-awareness, step by step, with an intention of self-acceptance, vitality and wholeness. We can do this!



Gabor Maté – Physician- Gabor Maté is a Hungarian-born Canadian physician. He has a background in family practice and a special interest in childhood development and trauma, and in their potential lifelong impacts on physical and mental health, including on autoimmune disease, cancer, ADHD, addictions, and a wide range of other conditions.

Self-Healing and Trauma– listen to Dr. Gabor address participant questions and share with us various pathways to wholeness. Dr. Gabor lists many examples of treatment, practices, and resources to consider as we explore our individual healing choices. This YouTube video is a short presentation from an acclaimed expert in the field of trauma that may make you laugh and think a bit!

ACEs to Assets 2019 – An audience discussion on trauma with                  Dr. Gabor Maté

scotACE-Aware Scotland- Published on Jul 18, 2019

Scotland is in the midst of a growing grassroots movement aimed at increasing public awareness of Adverse Childhood Experiences (ACEs). We now have glaring scientific evidence that childhood adversity can create harmful levels of stress, especially if a child is left to manage their responses to that adversity without emotionally reliable relationships. The vision for ACE Aware Nation is that all 5 million citizens of Scotland should have access to this information. The ‘ACEs to Assets Conference’ was held on 11 June 2019 in Glasgow, drawing an audience of nearly 2000 members of the public keen to explore actions that can be taken to prevent and heal the impacts of childhood trauma.

In this film, we hear thoughts and questions from members of the audience in response to Dr. Mate’s presentation. Those include questions like: ‘What else can I do to make myself a better version of me?’ and ‘How do you see the ACEs Movement intersecting with the consequences of climate change?’


Kat’s Corner- 


For those of you who may have followed our #neonatalwombwarriors instagram @katkcampos fashion series. Listed is a list of the hidden items that were in each photo representing each country that we have featured in our blog. It’s been a fun adventure!  Wishing you all great love, health and joyful living! 💕💗


How Syrian Refugee Ali Kassem Found Solace Through Surfing

SI•Published on Jun 28, 2017 – Sports Illustrated-

Ali Kassem shares how he got into surfing after fleeing Aleppo, Syria and not knowing how to swim.














Provider Wellness, G20, and Joy!


Preterm Birth

RATE: 7.5  Estimated number of preterm births per 100 live births  RANK: 144

                                              (US Rate: USA – 12% Rank: 54)


Bulgaria, officially the Republic of Bulgaria is a country in Southeast Europe. It is bordered by Romania to the north, Serbia and North Macedonia to the west, Greece and Turkey to the south, and the Black Sea to the east. The capital and largest city is Sofia; other major cities are Plovdiv, Varna and Burgas. With a territory of 110,994 square kilometres (42,855 sq mi), Bulgaria is Europe’s 16th-largest country. Since adopting a democratic constitution in 1991, the sovereign state has been a unitary parliamentary republic with a high degree of political, administrative, and economic centralisation. The population of seven million lives mainly in Sofia and the capital cities of the 27 provinces. The population has declined since the late 1980s.

Bulgaria began overall reform of its antiquated health system, inherited from the communist era, only in 1999. In the 1990s, private medical practices expanded somewhat, but most Bulgarians relied on communist-era public clinics while paying high prices for special care. During that period, national health indicators generally worsened as economic crises substantially decreased health funding.

The subsequent health reform program has introduced mandatory employee health insurance through the National Health Insurance Fund (NHIF), which since 2000 has paid a gradually increasing portion of primary health care costs. Employees and employers pay an increasing, mandatory percentage of salaries, with the goal of gradually reducing state support of health care. Private health insurance plays only a supplementary role. The system also has been decentralized by making municipalities responsible for their own health care facilities, and by 2005 most primary care came from private physicians. Pharmaceutical distribution also was decentralized. According to the survey conducted by the Euro health consumer index in 2015 Bulgaria was among the European countries in which unofficial payments to doctors were reported most commonly.

In the early 2000s, the hospital system was reduced substantially to limit reliance on hospitals for routine care. Anticipated membership in the European Union (2007) was a major motivation for this trend. Between 2002 and 2003, the number of hospital beds was reduced by 56 percent to 24,300. However, the pace of reduction slowed in the early 2000s; in 2004 some 258 hospitals were in operation, compared with the estimated optimal number of 140. Between 2002 and 2004, health care expenditures in the national budget increased from 3.8 percent to 4.3 percent, with the NHIF accounting for more than 60 percent of annual expenditures.



G20 leaders: Achieving universal health coverage should top your agenda

June 27, 2019    Leading experts publish commentary in The Lancet on eve of summit in Japan

SEATTLE – G20 leaders meeting in Japan this week should focus on fulfilling their obligations to improve and expand their nations’ health care systems.

In a commentary published today, 20 health data, financing, and policy experts contend that funding for low- and middle-income nations must be increased to address the growing impacts of climate change, wars and conflicts, and a global political trend toward nationalism. They also argue that increased domestic funding is needed to achieve the United Nations’ Sustainable Development Goals (SDGs), including universal health coverage.

“Achieving universal health coverage should be at the top of the agenda for this meeting of world leaders,” said Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine. “The G20 leaders should assess how to encourage channeling resources to improve primary health care, as well as prevention and treatment of non-communicable diseases and to strengthen and support leadership, governance, and accountability across all levels of health systems. We’ve witnessed a decade of plateaued funding, and with the deadline to meet the SDGs just 11 years away, the world is watching.”

Dr. Murray and other authors examined trends in spending for international development between 2012 and 2017, and are urging the G20 leaders to address three questions:

  • How do you allocate funds to deliver equitable health improvement in people’s lives?
  • How do you deliver those funds to strengthen health systems?
  • How do you support domestic spending in poor countries and create more effective partnerships to deliver universal health coverage?

“The landscape of development assistance for health is evolving, and therefore ripe for any desired realignment,” the authors write in the commentary, which was published in the international medical journal The Lancet. “Reductions in child poverty and fertility throughout the world mean that many countries are undergoing demographic and epidemiological transitions, with their populations living longer and enduring a more diverse set of ailments.”

The commentary notes that from 2000 to 2010, development assistance for health grew at a rate of 10% annually, though since 2010, funding growth has plateaued at 1.3% annually. In 2018, $38.9 billion (USD) was provided, with 65.2% coming from G20 members. This $38.9 billion represents 0.05% of the G20 nations’ combined economies.

In addition, the commentary calls out the G20 nations for their levels of funding, the annual rate of change in funding provided between 2012 and 2017, and the health sectors for which those funds were earmarked. Among the highlights:

  • India (43.4%), Brazil (37.2%), and Indonesia (30.9%) had the highest percentage increases in development assistance provided between 2012 and 2017.
  • The greatest decreases in development assistance provided between 2012 and 2017 were in Saudi Arabia (-19.4%), Australia (-16.0%), and Russia (-10.1%).
  • The US’s increase over the same time period was 0.9%, while the UK’s was 2.6%.
  • South Africa was the lowest G20 contributor with $5.2 million spent in 2017, while the US was the highest at $14.4 billion.

“The global health challenges and expansive set of global health goals in the SDGs require a new approach to address pending questions about how development assistance for health can better prioritize equity, efficiency, and sustainability, particularly through domestic resource use and mobilization and strategic partnerships,” the authors write.




Four Steps Leaders Can Take to Increase Joy in Work

Jessica Perlo, MPH, Director, Institute for Healthcare Improvement




NICU Moms Are Struggling With Mental Health Problems — And They Aren’t Getting Help

Up to 70 percent may suffer from postpartum depression. -4/13/2018 

-By Catherine Pearson

Up to an estimated 70 percent of moms whose babies spend time in the NICU may grapple with symptoms of depression — yet there are not good screening measures in place to help them.

A few weeks into her third trimester, Stephanie May, 32, called her OB-GYN. Her back hurt and she was having cramps, all of which sounded fairly typical to the doctor on call. He suggested she take it easy and hydrate, so May settled in for some sleep.

When she woke up, she was in full-on labor and rushed to the emergency room. By the next morning, her daughter Evie was born — nine weeks early. May saw her for about a second before the newborn was whisked up to the neonatal intensive care unit while May stayed behind on the delivery table, stunned.

“When they finally took me up to see her, she was hooked up to all these monitors. I couldn’t see her face. I couldn’t feel her skin. I didn’t know what to do,” May recalled. “My first reaction was to try not to feel anything … I was so afraid I was going to fall in love with this baby and then she would be gone.”

Over the next 54 days, May did her best to adapt to the peculiar rhythms of the NICU. She learned to hold her daughter without tugging at any wires and to stay calm when Evie forgot to breathe — patting her tiny foot or arm as a reminder while monitors blared. She dutifully hooked herself up to the hospital breast pump every few hours, intent on producing exactly the 32 mL of milk her daughter required per feeding.

But as the days wore on, May felt herself being pulled under by anxiety and depression. She worried every time someone coughed or cleared their throat. She worried they would never leave the hospital. Only once did a doctor or nurse ask May how she was holding up emotionally — nearly three weeks into her daughter’s hospital stay.

“He knelt by me and asked, ‘Is there anything I can do for you?” May recalled, quickly adding that the doctors and nurses were wonderful, lest she come across as ungrateful. “It was the first time someone made me feel like a mom and reminded me I had to take care of myself, too.”

Though May believes she suffered from postpartum depression, she never received an official diagnosis.

Based on the most conservative of estimates, 11 percent of moms in the United States suffer from symptoms of postpartum depression (PPD), and postpartum anxiety may be even more common. But NICU moms suffer from postpartum mood issues at much higher rates. There are no hard and fast numbers, but studies have suggested that up to 70 percent of women whose babies spend time in the NICU experience some degree of postpartum depression, while up to one-quarter may experience symptoms of post-traumatic stress disorder.

It’s easy to see why. These women’s babies are sick or premature — or both. They must learn the particular protocols of the NICU, all while hormonal, exhausted and in recovery themselves. NICUs have done a remarkable job of transforming outcomes for the most vulnerable babies, but it has not traditionally been their job to screen and help women. That’s why so many women like May feel like they’ve slipped through the cracks.

“I don’t know if the majority of NICUs have a psychologist on board or a social worker who can provide an assessment,” said Kathleen Hawes, a psychologist who does happen to work in a NICU at Women & Infants Hospital of Rhode Island. Hawes worked on a 2016 study that found that roughly 20 percent of moms who had preterm babies suffered postpartum depression one month after discharge, regardless of how early their infants were born. “I think we’re doing a good job, but we could be doing a better job.”

Unfortunately, screening women isn’t an easy undertaking — even with buy-in from doctors and nurses.

Research has found that NICUs struggle to overcome even simple challenges, like tracking down moms while they’re in the hospital, and then finding ways for nurses to incorporate mental health wellness screening into their typical jam-packed days. At pediatric hospitals, it’s unclear who is trained to see adults, or what degree of liability the hospital then takes on. Whose chart does screening information go on? Who is billed?

“One of the things that has been hard is that medicine is so siloed,” said Dr. Samantha Meltzer-Brody, a perinatal psychiatrist who runs the University of North Carolina’s Center for Women’s Mood Disorders. That’s why neonatal intensive care has not interacted well maternal mental health, she explained.

“That’s what needs to happen, and there’s been a push to make it happen,” Meltzer-Brody added. “You have some places that are doing it well, but to have it systematically rolled out across the U.S. is a big, long, slow process.”

Groups like the American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force now recommend that all women be screened for mood issues at least once in the perinatal period by using one of several questionnaires that can help catch PPD — typically at the six-week postpartum check-up. But such a screening would be one of many things crammed into what is often a 15- or 20-minute appointment that needs to cover a lot of ground.

That was true for Gabriele Ogoley, 28, whose water broke when she was 28 weeks pregnant. After five weeks of bed rest in the hospital, she delivered her son at 32 weeks and slowly slid into depression, which manifested itself primarily in bouts of anger that were totally out of character for her.

Ogoley’s OB-GYN did ask how she was doing at her six-week appointment, but in a casual way, almost like an afterthought.

“It was like, ’How are you? How’s the baby? How’re things?” Ogoley said. Like May, she does not remember being asked at any other point if she was doing OK, despite a long NICU stay.

In fact, it was a friend who had struggled with PPD herself who finally urged her to get help. When Ogoley did finally call her doctor’s office and connect with her nurse, she remembers feeling ashamed.

“I told them, ‘This is really embarrassing for me,’” Ogoley recalled. She didn’t want anyone to think she was a bad mom or unhappy her son was home.

Laura, 42, who requested that only her first name be used to protect her children’s privacy, remembers laughing awkwardly with her OB-GYN about whether she was really experiencing depression or simply having an appropriate response to giving birth to twins 11 weeks early.

“When your baby can die from a cold, that makes the world a very scary place,” she said. “It’s very hard to tell how much of it is a ‘normal’ response to what is happening, and how much of it is, ‘Oh, man, I think I have a problem. I’m really overwhelmed.’”

Indeed, experts say it can be hard to figure out that line — particularly because clinical diagnosis is a somewhat subjective art.

“Almost always, with NICU moms, comes some grief. We don’t treat grief; we support grief, but that emotional process is totally normal,” said Kate Kripke, a clinical social worker and founder of the Postpartum Wellness Center of Boulder. “That is not necessarily a clinical depression or anxiety, even if it might, for a little while, look the same.”

Kripke thinks it would be beneficial to reframe our broader understanding of perinatal mood issues not as an exception to the norm, but almost as the inevitable outcome for women whose biological, psychological and social needs are not sufficiently met. The way Kripke sees it, if women aren’t sleeping; if they’re just eating bad hospital food and can’t bring themselves to leave their babies’ isolettes to go outside; if their hormones are going haywire and they’re finding it hard to connect with friends and family who simply cannot fathom what life in the NICU is like, well, of course they are at risk for developing a more serious mental health disorder.

The failure of the system starts with not adequately screening moms while they are in the NICU, and ends with not allowing them to marshal more resources and support after they have been diagnosed. Laura, for example, didn’t start to realize she was suffering from what she believes was a combination of PPD, PPA and PTSD until at least a year after giving birth — and didn’t get on medication to manage her symptoms until her twins were school-age.

And when May asked for her short-term disability to be extended by two weeks, she was told there was no coverage for a case of the “baby blues.” That was just six week after her daughter was born and still fighting for her life in the NICU.

“A lot of this is about continuing to educate providers on what questions to ask and what to look for and how to set referral systems into place,” Kripke says. “Moms who say, ‘Everyone asked about my baby and no one asked about me’ — that’s atrocious. That is not OK. But that is happening because those people don’t know what to ask.”



B.11 Lullabies soothe NICU babies, and parents too

   UW Medicine Published on Mar 20, 2019

A parent’s voice is nurturing to a baby. In UW Medical Center’s neonatal intensive care unit, Gayle Cloud works with parents to use their voices as therapy. They create custom lullabies for their babies. It helps parents bond with their baby, and it’s a way to soothe the stress of premature birth. In the video below, Cloud works with Danielle and Shannon Turner to write a lullaby for their newborn, Kassie.



“Rwandan National Neonatal Protocol: “Non-electric Infant Warmer”

By Marthe Kubwimana, OPEN Pediatric – Published on Jul 11, 2019

In this chapter of the Rwandan National Neonatal Protocol, Marthe Kubwimana introduces the non-electric infant warmer. She outlines the circumstances when an infant warmer is useful, how it can prevent hypothermia, and how it can be used to complement Kangaroo Mother Care. She also describes the proper techniques for preparation, use, cleaning and storage of the infant warmer.
Initial publication: July 11, 2019.





Research breakthrough to safely monitor preterm babies

August 30, 2019  by University of South Australia Credit: CC0 Public Domain

Researchers at the University of South Australia have successfully trialled new computer vision technology to safely monitor the heart and respiratory rates of premature babies in neonatal units.

In a study led by UniSA neonatal critical care specialist Kim Gibson and engineer Professor Javaan Chahl, the team has demonstrated a new non-contact way to monitor preterm infants in intensive care.

The infants were filmed using high-resolution cameras at close range and their vital physiological data extracted using advanced signal processing techniques that can detect subtle color changes and movement not visible to the human eye.

“Our computer vision system captures subtle signals in a preterm baby, such as invisible skin color variations that can be amplified to measure cardiac activity,” Gibson says. “We can also apply algorithms to magnify movement to give nursing staff a clear picture of what is going on with preterm infants.”

The technology has been successfully trialled at Flinders Medical Centre Neonatal Unit, monitoring 10 premature babies.

The preterm infants were selected as they are prone to episodes of bradycardia (slow heart rate) and apnea (when breathing stops) – conditions which are difficult to monitor without the use of an electrocardiogram which relies on expensive, adhesive electrodes that can damage infants’ fragile skin and leave them vulnerable to infection.

“An unexpected finding was that our system was able to accurately detect apnea when the ECG monitor did not,” Gibson says.

She says further research is needed but preliminary results show that the non-contact system could help monitor the health of preterm babies, particularly when resources are scarce, and the risk of infection is high.

Gibson is the lead author of a paper, “Non-contact heart and respiratory rate monitoring of preterm infants based on a computer vision system” published in Pediatric Research.






Peer Reviewed Research, News and Information in Neonatal and Perinatal Medicine

We found this abstract to be very informative, general yet powerfully instructive. Please enter the website to review the article summarized below and to view the excellent and instructive pictures. This information may be great value to the global healthcare community at large and to our wide  variety of providers serving the moms and babies,  including the global preterm birth community.


Tips for Medical Students and Non-Neonatologists on Physical Examination of the Newborn and Important Aspects of Early Newborn Care

An Irish Perspective Aisling Smith, MD, Robert McGrath, MD, Naomi McCallion, MD, and Tom Clarke, MD

Peer Reviewed-“This paper will outline the Irish approach to good physical examination technique of the newborn for a number of the more challenging and error-prone aspects of the physical exam, which non-neonatal specialists and medical students may find helpful.”

Abstract: Appropriate physical examination technique of the newborn infant is vital to ensure the detection of pathology and the timely instigation of required management. No infant should be viewed as ‘routine,’ and all babies must have a comprehensive physical examination completed prior to discharge home. This paper will outline an Irish approach to good physical examination technique of the newborn for a number of the more challenging and error-prone aspects of the physical exam, which non-neonatal specialists and medical students may find helpful. Introduction Appropriate physical examination technique of the newborn infant is vital to ensure the detection of pathology and the timely instigation of required management or onward referral. Medical students are typically instructed on neonatal physical examination during their paediatric clerkships and may not receive any additional neonatal training prior to graduation. The duration of paediatric and neonatal medical student clerkships varies between Irish universities. Many medical specialties interact with neonatal patients besides neonatal or paediatric departments including ophthalmology, orthopaedics, general surgery, dermatology, and general practice. In particular, approximately 2,950 family doctors (general practitioners, GPs) in Ireland provide essential services for newborn care including 2 and 6 weeks checks, monitoring feeding, weight gain, head growth, and development. (1) Such visits provide a key window of opportunity for the early detection of pathology. The curriculum of the School of Medicine at the Royal College of Surgeons in Ireland (RCSI) is designed to give medical students a sound knowledge of the science and art of medicine. RCSI medical students receive 7 weeks of training in paediatrics during their 4th of 5 years of medical school, of which one week is dedicated specifically to neonatal training in a tertiary maternity hospital. During their week of neonatal clerkship, correct physical examination technique of the newborn is emphasised. Students attend several tutorials detailing neonatal physical examination, have the opportunity to perform neonatal physical examination safely on well infants on the postnatal wards and also have access to online videos teaching comprehensive assessment of the neonatal cardiovascular system, head, face and neck, gastrointestinal system, neurological system, and hip examination. At the end of their paediatric rotations, the students’ neonatal physical examination skills are thoroughly tested via a clinical examination of a well newborn, to ensure high standards of clinical practice and safety after graduation. One of the authors (TC), a professor of neonatology, has noted an improvement in the clinical examination skills of RCSI medical students at the end of their rotation assessments in recent years. The majority of neonatal medical student education is now provided by postgraduate paediatric and neonatal trainees who have taken time out of their specialist training schemes to pursue full-time research for higher degrees. It is probable that education delivered by those pursuing neonatology as a career improves the knowledge base of students regarding the newborn physical examination.

It is critically important that all professionals involved in newborn care, including junior doctors, surgeons, midwives, and advanced nurse practitioners are fully versed in the appropriate physical examination technique of the newborn. No infant should be viewed as ‘routine,’ and all babies must have a comprehensive physical examination completed prior to discharge home. This paper will outline the Irish approach to good physical examination technique of the newborn for a number of the more challenging and error prone aspects of the physical exam, which non-neonatal specialists and medical students may find helpful.

General Inspection of the Newborn Doctors performing newborn examinations should position themselves so that they easily look at both the parents and baby and smile reassuringly, to all, as needed. Well trained doctors will quickly observe the colour, respiratory status, level of alertness, posture, movement, and nutrition status of the infant. The normal baby is typically a pale pink colour. Skin colour should be observed for cyanosis, pallor, jaundice, and plethoric appearance. Central cyanosis should be assessed under the infant’s tongue, is always an abnormal finding and may indicate a congenital heart lesion or lung pathology. Acrocyanosis, cyanosis of the extremities, particularly of the soles of the feet and palms of the hands, is a normal finding and typically caused by the infant being cold. Neonatal pallor warrants a prompt assessment for potential sepsis or anaemia. Neonatal jaundice is a common finding, particularly in breastfed infants. Jaundice which appears before 24 hours of age is pathological until proven otherwise, and appropriate investigations for immune-related haemolysis (Rhesus or ABO incompatibility), congenital infection, sepsis, and biliary obstruction should follow. A plethoric, or ‘ruddy,’ appearance to the baby is usually related to polycythaemia. Polycythaemia is defined as a central haematocrit > 65% and is commonly associated with maternal gestational diabetes mellitus, trisomy 21 and recipients of twin-to-twin transfusion. General inspection of the baby’s respiratory system includes observation for signs of respiratory distress, including tachypnoea (respiratory rate over 60 breaths per minute), nasal flaring, intercostal, and subcostal recession. Grunting, defined as forced expiration against a partially closed glottis, is a significant sign of respiratory distress as the baby is attempting to generate their own positive airway pressure. The level of consciousness of the baby should be automatically assessed during the general inspection. There are 5 levels of consciousness (LOC) that a newborn may assume; alert, hyperalert, lethargic, stuporous, and comatose. An ‘alert’ baby is a normal baby; the baby will assume a semi-flexed posture, move their limbs symmetrically and spontaneously, have spontaneous eye-opening, interact with their environment, and be consolable. A ‘hyperalert’ baby is baby hyperalert to environmental stimuli, often inconsolable, requires frequent soothing, has exaggerated primitive reflexes and feeding difficulties. A baby exhibiting signs of hyperalertness may potentially be withdrawing from maternal medication, prescribed or illicit, or developing central nervous system pathology such as meningitis or encephalitis. The decreased LOC states include lethargy, stuporous and comatose and always require immediate attention. A lethargic baby will be active on handling but will be quiet and non-responsive when not stimulated. A stuporous baby will only respond to noxious stimuli, such as firm sternal rub, while a comatose baby will not respond to noxious stimuli at all. The differential diagnosis for decreased LOC of the newborn is large and includes sepsis, hypoxic ischaemic encephalopathy, meningitis, encephalitis, hypoglycaemia, and inborn errors of metabolism.

***   Enter website link below to view exam details and associated pictures

Useful Advice for New Parents: The newborn physical examination is an excellent opportunity to form a good rapport with parents, provide advice for newborn care, answer questions, and provide reassurance. Breastfeeding should be encouraged, and the benefits of breastmilk promoted to parents; breastfeeding encourages maternal bonding with baby, provides natural and complete nutrition, prevents infection via maternal immunoglobulin and protects against future obesity. (13) The importance of appropriate sleeping practices should be emphasised. The ‘Back to Sleep’ campaign was launched in 1994, and since then, a reduction in over 50% of sudden infant death syndrome (SIDS) cases in the United States has been achieved. (14) As such, all infants should be placed on their backs when going to sleep, with their feet at the bottom of the cot, one breathable blanket to cover them and no pillows or toys in the cot around the baby. Smoking in the household should be discussed as a significant risk factor for SIDS and parents directed to appropriate supports for smoking cessation. Many neonatal units and maternity hospitals implement an infant ‘car seat challenge’ prior to discharge home to assess safe positioning of the infant in the car seat. This is especially relevant for infants born prematurely, who may experience apnoea, bradycardia, and oxygen desaturations if malpositioned in a car seat. (15) The newborn examination may also provide time to mention the value of immunizations, inform parents of the immunization schedule, and correct misconceptions they may have regarding vaccination. In conclusion, a comprehensive physical examination of the newborn is essential. Appropriate training in neonatal physical examination technique for medical students and physicians working outside of neonatology is vital to ensure that newborns interacting with such services are examined thoroughly, and any pathology present promptly identified. We have outlined some of the more challenging aspects of the newborn physical exam, which are often performed incorrectly. We hope these tips may ameliorate such difficulties or errors in technique and be helpful for the nonneonatologist reviewing a newborn infant.

References: 1. Teljeur C, Tyrrell E, Kelly A, O’Dowd T, Thomas S. Getting a handle on the general practice workforce in Ireland. Irish journal of medical science. 2014;183(2):207-213. 2. Devakumar D, Bamford A, Ferreira MU, et al. Infectious causes of microcephaly: epidemiology, pathogenesis, diagnosis, and management. The Lancet Infectious diseases. 2018;18(1):e1Readers






2019 Residents Lifestyle & Happiness Report

Check out the data (residency rewards, challenges, bullying, social life, stress, etc.)


Medscape Physician Lifestyle & Happiness Report 2019

           Keith L. Martin | January 9, 2019 | Specialty comparisons, Happiness, relationships, vacations, exercise, etc.




Perinatal palliative care: Giving parents support when a pregnancy goes wrong-

Posted on 23 July 2019 – Interview with Dr Fauzia Paize

Perinatal palliative care (PPC) is a fairly new subspecialty within palliative care. What are the main ideas behind this new concept?

Dr Paize: Healthcare professionals working in antenatal and neonatal services are accustomed to providing babies and families with sophisticated expert care using high levels of technical skills, communication and knowledge. However, there is a growing need for them to provide a palliative care approach throughout the pathways, which means a shifting of emphasis, ensuring that the baby continues to receive intensive care but reducing the level of highly technical care. This is where perinatal palliative care comes into play: It is all about maximising your time as a family. It helps families to spend time with their baby, improve bonding and build memories, in a more home-like environment and with as little technology dependent care as possible. There is more emphasis on family-centred care to enable parents to create positive memories, for example by having time to hold their baby.

What are the specific questions and challenges when caring for dying babies before, during, and after birth, compared to caring for dying children and adults

Dr Paize: First of all, although national frameworks and clinical pathways for palliative care after birth have been established, we still do not have a unified pathway guiding care for women and families. The uncertainty of prenatal diagnosis is another significant challenge. If a problem is detected before birth, there is the potential for discordance between those findings and the possibility of the affected organs being able to sustain life after birth. This leads to the need for parallel planning – hoping for the best whilst planning for the worst. Another difference to older dying children is that babies can deteriorate and die with great speed, much faster than older children or adults. This also highlights the importance of parallel planning for every eventuality so as to introduce effective and planned palliative care support for these babies and their families. The time parents can spend with their baby alive can be very short and therefore very precious – there is only one chance to get it right, so it is vital to create opportunities for parents to make and share memories of their baby.

In the neonatal setting, mothers are sometimes not fit enough to be transferred to a neonatal unit where care for the baby is to be taken place. Some women, such as those with pre-eclampsia, may be seriously ill themselves. In multiple births, there may be one or more sick babies to take care for, alongside babies who do not have a life-threatening condition. There may be queries about organ donation from the sick baby, something neonatology and the blood transfusion service are still not fully prepared for although they have happened successfully. A baby may die in utero, triggering off bereavement during an ongoing pregnancy.

Another point is, that there are different and often multiple teams and services involved in this particular area of healthcare. There are obstetricians, midwives, neonatal nurses, neonatologists, fetal medicine specialists, sometimes based in different hospitals, so there is a need for high levels of efficient, compassionate, accurate communication to prevent that parents need to repeat their story over and over again. When a newborn baby dies, the family’s grief can be lonely, with few people having met their baby that died very soon after birth. There can be a lack of appreciation of what has happened from their usual support circles. Only few people can understand what they have gone through or know what to say to provide comfort. Finally, we must not forget those pregnancies that are terminated because of significant physical problems of the baby. Those babies are often born alive and may have physical supportive needs if distressed, but families need emotional support following the loss of their baby.

In your view, what are the largest barriers for PPC and what are the best strategies to overcome these barriers?

Dr Paize: There are a lot of barriers to perinatal palliative care. We are a generation that thinks that a positive pregnancy test always leads to a baby and we do not expect babies to die. There is societal expectation that we always take our babies home, we go to a 12 week scan to see when our baby is due and we go to our 20 week scan to find out if we are having a boy or a girl. We do not expect that something could go wrong in pregnancy that can potentially lead us to not take our babies home or have a baby that has significant problems in the long term.

We as healthcare professionals see death as a failure, as we think our job is to diagnose illnesses, treat them and make people healthy. If this is something that we cannot do, we find that very difficult in our sphere of work. We also have to deal with a lack of scientific evidence compared to other areas of intensive care within neonatology. We need more adequate palliative care training and experience for providers, we also need more multidisciplinary trainings so that fetal medicine, midwives and neonatal practitioners can sit down and train together.

As a society, we should promote more discussions about the reality that babies can be very sick and can die. Model programs that show excellent standards of providing perinatal palliative care should be awarded and seen as lighthouse programmes for people to follow.

What is most important when communicating with affected parents?

Dr Paize: Families should be provided with value-neutral information about all options, including termination of pregnancy, continuation with palliative care or continuation of pregnancy with an active postnatal care plan. It is important to discuss openly parents’ priorities, hopes and fears, in order to facilitate shared decision making. It is also vital to talk about the most common eventualities in the process of pregnancy and delivery in general, and the uncertainties of each individual case. Establishing and maintaining trust is crucial in this evolving relationship, so continuity of care with the same clinicians is advised. Items that should be covered include deciding the mode and timing of delivery, monitoring during labour, resuscitation after birth, symptom management and the possibility of transitioning to a community setting if the baby shows signs that they may survive for longer than expected. Families may ask about organ or tissue donation and this should be supported if appropriate with involvement of the local specialist nurses for organ donation.

It is, however, important to know that decisions do not always need to be made at the time of the first meeting, as there is a lot of information to take in when a pregnancy has changed course. Plans can evolve over several meetings and should be formalised in a written advanced antenatal palliative care and birth plan. This plan should ideally be kept in the maternal hand held notes to make sure that information can be shared between fetal medicine, neonatal teams, children’s hospices, palliative care teams, referring centre labour ward and, community midwifery and general practice teams. It is a difficult but very important task to maintain high standards in communication and documentation with all parties at all time.

Families have to make tough ethical decisions sometimes, for example if they need to decide whether to withdraw a life-sustaining treatment. What is your approach to support the families in these extremely difficult moments?

Dr Paize: Families need emotional, spiritual and religious support in these situations, and we need to be mindful of the fact that they are going through something extremely difficult. We need to empower them to use their own support networks and provide support as long as we can. In difficult ethical decisions, it is important that we are honest and open with families, give them written information, connect them with people who have been in a similar situation, and always have our doors open. They should get all the support they need and we need to let them know that they are not alone in these difficult times.

The large majority of neonatal deaths still occur in the hospitals, how can we give parents the opportunity to be with their dying child, in the clinics or at home?

Dr Paize: It is vital to understand the local resources available to families. This will vary and it will be important to only offer what can be delivered in the local area, for example, what local hospice or palliative care teams are and are not able to offer. We need to be aware that taking a baby home with a life-limiting diagnosis, complex medical needs and equipment, can be a truly daunting task. Comprehensive discharge planning is crucial to support a seamless transition to home or to another place of care. The mother’s own care needs will need to be considered, but also the family will need to be prepared for the arrival of the sick sibling. Some hospitals can provide an outreach service which improves continuity of care between settings.

What role can children’s hospices play in this context?

Dr Paize: Children’s hospices working in partnership with local neonatal teams, fetal medicine units, community midwives and palliative care teams have been a revelation in the last 5 years of neonatal palliative care. In this partnership, they can emotionally support families throughout pregnancy and help in the transition to the hospice immediately after discharge from hospital. Families can visit the hospice before their baby is born to decide if this is the place they would like to spend time with their baby and extended family.

Children’s hospices can offer a home away from home setting, allowing families as much privacy or support as possible and providing family-led palliative and end-of-life care to babies with complex needs. They allow some normality in a supported environment, such as being able to sleep in the same room, being able to take the baby into the garden, pushing it in a pram, and spending time as a family. It allows parents to balance their expectations of parenthood and independence with the specialist palliative care. Children’s hospices also offer household services, so families can spend more time with their baby. They also are experienced in memory making, symptom control, supporting families at home as a step down from hospital for those babies that may not die imminently. Hospices also aid in funeral planning, registering the birth and death of their child, and give bereavement support to the extended family including siblings and grandparents.

How can healthcare professionals who work in PPC be compassionate partners for the families and still not be overwhelmed psychologically in these often devastating situations?

Dr Paize: Healthcare professionals sometimes find it difficult to ‘let go’ of the baby and family and may themselves need support. Following the baby’s death, staff may find it helpful to use a range of support methods such as debriefs or reflective practice. This can help to reduce their levels of stress, risk of burnout, compassion fatigue and increase their job satisfaction. It can be helpful to provide psychological support for palliative care staff in neonatal units,  e.g. by a children’s palliative care team.

Dr Fauzia Paize is a Consultant Neonatologist at the Liverpool Women’s Hospital NHS Foundation Trust in the UK. She is also the mother of Jacob who was stillborn at 23 weeks. Having felt the severe pain of baby loss she is committed to improving perinatal palliative, end-of-life and bereavement care. She has implemented a North West strategy to integrate children’s hospices with neonatal units to ensure smoother patient and family journeys. She was the consultant neonatologist for the NICE guideline “End-of-life care for infants, children and young people”, the “Perinatal Pathway for Babies with Palliative Care Needs – Together for Short Lives” and she is one of the authors on the 2016 APPM Master Formulary. She is passionate about supporting parents and staff through the traumas of neonatal intensive care and has led several initiatives in neonatal units trying to make the journey as tolerable as possible for all involved.






Date: August 26, 2019   Source: Boston University School of Medicine

Summary: After decades of research, a new study links optimism and prolonged life. Researchers have found that individuals with greater optimism are more likely to live longer and to achieve ‘exceptional longevity,’ that is, living to age 85 or older.

Researchers from Boston University School of Medicine (BUSM), National Center for PTSD at VA Boston Healthcare System and Harvard T.H. Chan School of Public Health, have found that individuals with greater optimism are more likely to live longer and to achieve “exceptional longevity,” that is, living to age 85 or older.

Optimism refers to a general expectation that good things will happen, or believing that the future will be favorable because we can control important outcomes. Whereas research has identified many risk factors that increase the likelihood of diseases and premature death, much less is known about positive psychosocial factors that can promote healthy aging.

The study was based on 69,744 women and 1,429 men. Both groups completed survey measures to assess their level of optimism, as well as their overall health and health habits such as diet, smoking and alcohol use. Women were followed for 10 years, while the men were followed for 30 years. When individuals were compared based on their initial levels of optimism, the researchers found that the most optimistic men and women demonstrated, on average, an 11 to 15 percent longer lifespan, and had 50-70 percent greater odds of reaching 85 years old compared to the least optimistic groups. The results were maintained after accounting for age, demographic factors such as educational attainment, chronic diseases, depression and also health behaviors, such as alcohol use, exercise, diet and primary care visits.

“While research has identified many risk factors for diseases and premature death, we know relatively less about positive psychosocial factors that can promote healthy aging,” explained corresponding author Lewina Lee, PhD, clinical research psychologist at the National Center for PTSD at VA Boston and assistant professor of psychiatry at BUSM. “This study has strong public health relevance because it suggests that optimism is one such psychosocial asset that has the potential to extend the human lifespan. Interestingly, optimism may be modifiable using relatively simple techniques or therapies.”

It is unclear how exactly optimism helps people attain longer life. “Other research suggests that more optimistic people may be able to regulate emotions and behavior as well as bounce back from stressors and difficulties more effectively,” said senior author Laura Kubzansky, PhD, MPH, Lee Kum Kee Professor of Social and Behavioral Sciences and co-director, Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. The researchers also consider that more optimistic people tend to have healthier habits, such as being more likely to engage in more exercise and less likely to smoke, which could extend lifespan. “Research on the reason why optimism matters so much remains to be done, but the link between optimism and health is becoming more evident,” noted senior author Fran Grodstein, ScD, professor of epidemiology at the Harvard T.H. Chan School of Public Health and professor of medicine at the Channing Division of Network Medicine at Brigham and Women’s Hospital and Harvard Medical School.

“Our study contributes to scientific knowledge on health assets that may protect against mortality risk and promote resilient aging. We hope that our findings will inspire further research on interventions to enhance positive health assets that may improve the public’s health with aging,” added Lee.

Story Source: Materials provided by Boston University School of Medicine.




Please see our 36 day Instagram at handle-katkcampos honoring the 36 countries we have  highlighted in the Neonatal Womb Warriors blog for the past 3 and ½ years. We thank all of you and our brilliant global family for all that we share.



Surfing in the Black Sea. Серфинг в Черном Море.

Alina Alexeeva  Published on Dec 3, 2017    Осень 2017.
Александр Лаврентьев @sashalavrentiev – Алина Алексеева @mayosayn


Bulgarian Beach

At a GLANCE, Teachers, Microbiomes



Rate: 7.3%     Rank: 152

Egypt, officially the Arab Republic of Egypt, is a country spanning the northeast corner of Africa and southwest corner of Asia by a land bridge formed by the Sinai Peninsula. Egypt is a Mediterranean country bordered by the Gaza Strip and Israel to the northeast, the Gulf of Aqaba and the Red Sea to the east, Sudan to the south, and Libya to the west. Across the Gulf of Aqaba lies Jordan, across the Red Sea lies Saudi Arabia, and across the Mediterranean lie Greece, Turkey and Cyprus, although none share a land border with Egypt.

Health in Egypt

Egyptian life expectancy at birth was 73.20 years in 2011, or 71.30 years for males and 75.20 years for females. Egypt spends 3.7 percent of its gross domestic product on health including treatment costs 22 percent incurred by citizens and the rest by the state. In 2010, spending on healthcare accounted for 4.66% of the country’s GDP. In 2009, there were 16.04 physicians and 33.80 nurses per 10,000 inhabitants.

As a result of modernisation efforts over the years, Egypt’s healthcare system has made great strides forward. Access to healthcare in both urban and rural areas greatly improved and immunisation programs are now able to cover 98% of the population. Life expectancy increased from 44.8 years during the 1960s to 72.12 years in 2009. There was a noticeable decline of the infant mortality rate (during the 1970s to the 1980s the infant mortality rate was 101-132/1000 live births, in 2000 the rate was 50-60/1000, and in 2008 it was 28-30/1000).

The total number of Egyptians with health insurance reached 37 million in 2009, of which 11 million are minors, providing an insurance coverage of approximately 52 percent of Egypt’s population.





Please see the wonderful global collaborators pictured below!

GLANCE 1st Founding Committee Meeting

Posted on 02 JULY 2019

In January, EFCNI announced the founding of GLANCE, the Global Alliance for Newborn Care on the annual Parent Organisations Meeting.  After thorough planning and preparations, the first GLANCE Founding Committee Meeting took place in Munich. 14 international parent representatives from Europe, Turkey, Africa, Australia, the United States, Canada and Mexico as well as four EFCNI members, had been working hard in a two days meeting to make progress in structural and organisational regards, settling for areas of activities and deciding on first global awareness campaigns.  Moreover, the group could also elaborate a global Call to Action with eight demands to advance the care for babies born too soon, too small or too sick and the support given to their families.

“My work with EFCNI has not only shown me the disparities in neonatal healthcare we are facing in Europe. In fact, I learnt that there are worldwide issues we, as a European based organisation, are not able to  tackle. We simply cannot speak for babies and families in Asia, Africa or South America, as we do not have any first-hand information about the most pressing needs and are lacking contacts and spokespersons on site. Therefore, we must establish a strong global network to efficiently join forces and to become a powerful voice for these children and their parents.”, stated EFCNI-Chairwoman Silke Mader.

GLANCE strives to expand its network of collaborating partners  in the future, to represent sick newborns and their parents in each region/continent.  We would like to thank all participants of this meeting for their valuable and inspiring input, for the insightful talks and constructive debates. With a lot of work ahead we are certain that together, we have the power to make an impact, helping babies born too soon, too small or too sick and their families – worldwide!

*** Website to be launched in November 2019

GLANCE, the Global Alliance for Newborn Care,  is a global network to represent the interests of babies born too soon, too small or too sick and their families. Initiated and coordinated under the umbrella of EFCNI, GLANCE aims at including parents, from all parts of the world to exchange knowledge and experience. GLANCE aspires to decrease the burden of afflicted families and their preterm and sick newborns to help them thrive beyond survival.


The GLANCE Founding Committee presenting the Call to Action: 1st row (f.l.t.r.): Eleni Vavouraki (Ilitominon, Greece), Nicole Thiele (EFCNI, Germany), Silke Mader (EFCNI, Germany), Ilein Bolaños (Con amor vencerás, Mexico), Ilknur Okay, (El Bebek gül Bebek, Turkey) 2nd row (f.l.t.r.): Silvia Kolossa (EFCNI, Germany), Sarah Fuegenschuh (EFCNI, Germany), Oleksandra Balyasna (Early Birds, Ukraine), Mandy Daly (INHA, Ireland), Kylie Pussell (Miracle Babies Foundation, Australia), Asta Radzevičienė (Neisnesiotukas, Lithuania), Gigi Khonyongwa-Fernandez (Preemie Parent Alliance, USA), Paula Guerra (XXS – Associação Portuguesa de Apoio ao Bebé Prematuro, Portugal), Livia Nagy (Melletted a helyem Egyesület alelnöke, Hungary), Alisson McNulty (TinyLife, Northern Ireland), Selina Bentoom (AFPNC, Ghana), Fabiana Bacchini (CPBF, Canada), Aurelia Abenstein (EFCNI, Germany), not in picture: Nina Nikolova (Our premature babies, Bulgaria)



Like each of us, every Warrior has unique abilities and needs. As research related to the educational  needs of our preterm birth Neonatal Womb Warriors progresses,  our ability to enhance Warrior well being will empower us to identify, create, expand and make available priceless educational tools for the preemie survivor toolbox. Thank you teachers! We appreciate the important contributions you will make to our Warrior community and to our global Community at large.

Preterm Birth Information for Education Professionals

Welcome to the Preterm Birth Information for Education Professionals home page. These five learning resources have been developed to improve your knowledge and confidence in supporting prematurely born children in the classroom.

*** The site allows you to  navigate through the resources by selecting an image for each subject!


  1. What is preterm birth?  
  • To define preterm birth
  • To understand that the more preterm a baby is born, the greater the risk of developmental problems later in life


  1. Educational outcomes following preterm birth
  • To understand that children born preterm are at risk of special educational needs and poor academic attainment
  • To identify which school subjects children born preterm are most likely to struggle with.


  1. Cognitive and motor development following preterm birth 
  • To understand that children born preterm may have difficulties with IQ, processing speed, working memory, and hand-eye coordination
  • To understand how these difficulties may impact on learning


  1. Behavioural, social and emotional outcomes following preterm birth 
  • To understand that children born preterm may be withdrawn, anxious, and inattentive, and have difficulties developing relationships with their peers
  • To understand that children born preterm don’t tend to be disruptive so their needs may be overlooked in the classroom


  1. How can education professionals support preterm children? 
  • To understand what kind of strategies might be helpful for supporting children born preterm
  • To understand that preterm birth is a risk factor and an individual assessment is always necessary to provide appropriate support




Does being born preterm matter at secondary school?

By Maria Burke – 28 March 2019

Research into preterm children’s long-term development and learning could inform strategies for teachers to support their progress.

Children born before 34 weeks gestation are more likely to have poorer reading and math skills than those born at full term, although not every child born prematurely will experience learning or developmental challenges. As medical science advances and more babies survive premature birth, an average primary class will include two preterm children. What does this mean for secondary school teachers, and science teachers, in particular?

David Odd, a neonatal consultant at Southmead Hospital, Bristol, has studied the impact of premature birth on school performance. He recently reported that preterm children have a higher risk of needing special educational support and achieving low GCSE scores than those born at full term, although the impact of prematurity appears to diminish the longer children are at school. He also found that infants born before 32 weeks gestation have the highest risk of poor school outcomes.

What’s more, school entry dates are based on children’s actual birthdates rather than their due dates, which appears to have a measurable impact on preterm students’ exam results in adolescence. David reports that, consequently, this may ‘limit adulthood opportunities’. There is evidence that placing a preterm child in the ‘correct’ school year reduces the possibility of special educational needs (SEN).

‘[The education system] is only just starting to consider the best ways to support these ex-preterm infants as they grow,’ David comments. ‘Preterm birth is common and most teachers will have ex-preterm infants in their classrooms. Training may be useful, but recognition of this group of vulnerable infants is certainly important. Recognising their “true age” and that they have higher risk of additional needs would perhaps be the first step.’ David strongly supports flexibility on school admission age for this group, as his results suggest that this may lead to improved late educational outcomes, particularly for those born extremely preterm.

Struggles with math and science

Preterm children experience particular difficulties with working memory and hand-eye coordination (visuospatial awareness), according to research by Samantha Johnson, a developmental psychologist at the University of Leicester, and Camilla Gilmore, who studies mathematical cognition at the University of Loughborough. This could be why some preterm children find maths challenging at primary level, as reported by the Premature Infants’ Skills in Mathematics (PRISM) study.

Samantha and her colleagues are currently researching mathematics attainment in secondary school (PRISM-2). Early evidence shows that preterm students are still at higher risk of lower attainment than their term-born peers. In particular, they found that students born very preterm tend to struggle more with many aspects of maths, including basic number skills, arithmetic and algebra. ‘Given the close relationship between science and mathematics, it’s likely that science education might also be an area of difficulty,’ Camilla adds.

  • A preterm birth occurs before 37 completed weeks of pregnancy.
  • Each year around 60,000 babies are born preterm in the UK (7% of all births).
  • Of these: 5% are born before 28 weeks (extremely preterm); 11% at 28–32 weeks (very preterm); and 85% at 32–37 weeks (moderate to late preterm).


The team found that the attainment of very preterm children showed little change from primary to secondary school compared with their peers. ‘Although very preterm children don’t seem to catch up with their peers by secondary school, they also don’t seem to fall further behind,’ says Camilla.

Samantha and Camilla believe that students born very preterm who struggle with maths may need different types of support compared with other students who have difficulties. ‘They may benefit from particular strategies that reduce the working memory demands of classroom activities, or extra support with visuospatial skills,’ Camilla says. ‘For example, science subjects may have particularly high visuospatial demands, such as reading information from graphs, drawing diagrams or carrying out practicals, and some preterm children may struggle with this.’

How useful is labelling?

Disclosing preterm birth status would help to identify those who could benefit from more support, says Jenny Retzler, a developmental psychologist at the University of Huddersfield. Jenny explains there is evidence that preterm children with attention problems don’t always receive the SEN support they require. ‘This is thought to partly be down to the fact that these symptoms tend to be tricky to observe,’ Jenny comments. ‘For example, they have difficulty paying attention, or with schoolwork, rather than disruptive behaviour. Jenny points to research suggesting that the majority of teachers and educational psychologists think disclosing preterm birth status could be helpful. ‘Few felt it would cause any negative effects due to labelling,’ she notes.

Jane Essex, a chemistry education lecturer at the University of Strathclyde, disagrees. ‘[Identification] has no meaningful predictive capacity, and provides no guidance on how education should be conducted,’ she says. Jane thinks teachers should only use functional labels to guide practice. Prematurity might be only one reason for slower processing ability. She believes that making adjustments to help a child learn shouldn’t depend on cause but rather their functional significance in learning. ‘So slow processing speeds mean that lists or instructions need to be short, repeated and supported with icons, signs and writing to make them more memorable.’

Rob Butler, a special school science teacher for 20 years, also has reservations. ‘A diagnosis is really only useful to the school if it provides a set of strategies to help the child. There is also a danger that it sets parents up to expect provision that they might not receive, especially within a stretched mainstream school.’

However, many teachers report that they don’t know enough about the difficulties preterm children may face and lack confidence in supporting them, says Samantha. Her team is working with teachers, educational psychologists, parents and young adults born preterm to design an online training resource for teachers. This resource provides information about preterm birth and how it can affect long-term development and learning as well as strategies for teachers to support learning. A recent evaluation of this resource found that teachers’ knowledge and confidence increased after use, Camilla reports. The great news is that this training material will be freely available for teachers ‘very soon’.


The Global Health Network Annual Report 2019 is Now Available to Read Online

Please check out this informative, colorful and progressive publication that describes The GHN as follows:

“The Global Health Network supports health professionals to lead research in the world’s most challenging settings and enables organizations to share best practice and know-how around the globe.

The Global Health Network enables health workers in the world’s most vulnerable regions to undertake health research to drive sustainable health improvements. This is achieved by delivering research capacity development and career support to research teams and frontline healthcare workers, no matter where they are or how resource-constrained their environment”.




The ideal strategy of weaning from nasal continuous positive airway pressure in preterm infants: are we there yet?

Islam Nour – Department of Pediatrics/Neonatology, Mansoura University Children’s Hospital, Mansoura, Egypt – Department of Pediatrics/Neonatology, Mansoura University Children’s Hospital, Mansoura, Egypt

First published: 25 December 2018

The ideal strategy of weaning off nCPAP is not established. Premature discontinuation may lead to atelectasis, apnoea and bradycardia, respiratory distress, prolonged oxygen therapy and ultimately lung injury 1. On the other hand, undue prolonged therapy increases the risk of nasal trauma, gastric distension, pneumothorax and agitation 2.

Previous studies showed conflicting results. Amatya et al. 3 found that more infants in the gradual wean group were successfully weaned off nCPAP as compared with the sudden wean group, with no difference in respiratory morbidity, weight gain, days on nCPAP and length of hospital stay. In contrast, Eze et al. 4 demonstrated that weaning CPAP in very preterm infants via sprinting (gradual increasing spontaneous breathing off nCPAP) versus weaning pressure down were comparable, regarding successful weaning and the occurrence of common neonatal morbidities. Jensen et al. have shown no difference in weight gain velocity from randomisation to 40 weeks PMA and in secondary outcomes between preterm infants born before 32 weeks of gestation, randomised to sudden weaning versus pressure weaning from nCPAP. The discrepancy in the findings of the Jensen et al.’ study and previous studies may be related to differences in gestational age and the severity of respiratory dysfunction, as infants enrolled in Jensen et al. and Amatya et al.’ studies had higher gestational age [median GA 30 (29–31), mean 28.7 ± 1.8 weeks, respectively], compared to Eze et al. [median 26.5 (23.6–30.6) weeks] and had less severe respiratory dysfunction as the need for surfactant was 36, 20%, respectively versus 63–73% in Eze et al. study.

More infants <28 weeks of gestation at birth were successfully weaned from nCPAP during the first attempt in the pressure wean group compared with the sudden wean group. Similarly, Soe et al. 5 found that pressure weaning was more effective than cycling off nCPAP in infants born 24–27 weeks of gestation but not in infants over 28 weeks of gestation at birth. This may indicate that pressure weaning is more appropriate in these infants or that they should have different readiness to wean from nCPAP criteria such as lower FiO2 requirements, lower nCPAP pressure and older postnatal age.

This is the largest RCT to date to compare sudden wean and pressure wean of very preterm infants from CPAP. However, the results of this study should be interpreted with caution, due to some limitations such as:

  • This study has adopted stability criteria for readiness to wean from nCPAP with a relatively high nCPAP pressure <8 cm H2O, in contrast to 4–6 cm H2O used in previous studies 3, 6. We assume that this high pressure may not be ideal for infants born before 28 weeks of gestation;
  • The authors used weight gain velocity from randomisation to term‐equivalent corrected gestational age as a primary outcome. However, weigh gain velocity in preterm infants is not only related to successful weaning off nCPAP but related to many other factors including initial weight percentile, sepsis, cardiovascular disease, feeding intolerance, necrotizing enterocolitis and respiratory requirements 7.

Where do we go from here? In preterm infants <32 weeks of gestation, sudden discontinuation and gradual pressure weaning strategies seem to be equally effective approaches for weaning from nCPAP, and pressure wean may be preferred in infants who <28 weeks of gestation. However, future studies are warranted for refinement of readiness to wean from nCPAP criteria and to study the influence of different nCPAP weaning strategies on long‐term pulmonary and neurodevelopmental outcomes.


URL to the full review on the EBNEO web site-


Homeward Bound: The Discharge of a Technology-Dependent Infant from the NICU

Abstract: Peer Reviewed

Valerie Boebel Toly, PhD, RN, CPNP,, and Carol M. Musil, PhD, RN, FAA

Purpose: An estimated 3.1% of infants discharged from the NICU require ongoing life-saving medical technological equipment such as supplemental oxygen and feeding tubes. The study purpose was to examine mothers’ psychological well-being (e.g., presence of depressive symptoms, posttraumatic stress disorder symptoms) during the three months following their technology dependent infant’s discharge from the NICU. Methods: A longitudinal, descriptive study design was employed to examine maternal psychological well-being a three time points; 2-3 weeks prior to discharge, one and three months post discharge. Convenience sampling was used to recruit 19 mothers of infants dependent on medical technology being discharged from a large Midwest Level 4 NICU in the United States. Results: The total scores for maternal depressive symptoms and posttraumatic stress disorder (PTSD) symptoms indicated over one third of the mothers were experiencing psychological distress at discharge. Nearly one half were at increased risk for clinical depression and PTSD and warranted referral for mental health assistance one month post-discharge. Conclusions: A large percentage of study participants reported considerable psychological distress. It is vitally important to perform mental health assessments prior to the discharge of technology-dependent infants prior to discharge and at regular intervals following discharge and refer for mental health assistance as needed. Such finding indicate the critical need to offer enhanced transition services and education as well as assessment of discharge readiness by the interdisciplinary NICU team.

FULL ARTICLE: egypt.7.jpg  Source:




Reviewed by Kate Anderton, B.Sc. (Editor) Mar 27 2019

Artificial placenta based life support technology breaks its 4 minute mile

A major advancement in pioneering technology based around the use of an artificial womb to save extremely premature babies is being hailed as a medical and biotechnological breakthrough.

Recently published in the medical publication, The American Journal of Obstetrics & Gynecology, the study presents world first data demonstrating the ability of an artificial placenta based life support platform to maintain extremely preterm lamb fetuses (600­700g); equivalent to a human fetus at 24 weeks of gestation.

Head of WIRF’s Perinatal Research Laboratories and Local Chief Investigator, Associate Professor Matt Kemp, said that whilst previous research had demonstrated the feasibility of extended survival with artificial placenta technology in late preterm fetuses, there was no published evidence that demonstrated the use of the platform to support extremely preterm fetuses the eventual clinical target of this technology.

“For several decades there has been little improvement in outcomes of extremely preterm infants born at the border of viability (21­24 weeks gestation),” Assoc Prof Kemp said.

“In the AJOG study, we have proven the use of this technology to support, for the first time, extremely preterm lambs equivalent to 24 weeks of human gestation in a stable, growth normal state for five days.

“This result underscores the potential clinical application of this technology for extremely preterm infants born at the border of viability. In the world of artificial placenta technology, we have effectively broken the 4 minute mile.”

Assoc Professor Matt Kemp said the latest findings represent a significant milestone in the technology’s future implementation into clinical use.

“If we are to improve outcomes for babies born at the border of viability we must recognize that they are not ‘small babies’; rather, they are a unique patient demographic that, due to their extremely underdeveloped lungs and limited cardiovascular capacity, require an entirely different treatment approach from older preterm infants.

“The technology was designed to revolutionize the treatment of severely premature newborns. The goal is to offer a bridge between a natural womb and the outside world to give babies born at the earliest gestational ages more time for their fragile lungs to mature.

“With additional refinement, what today might be considered as futuristic technology might soon not be so futuristic and might be standard of care.”

The EVE Therapy project brings together leading academic researchers from the Women and Infants Research Foundation, The University of Western Australia and Tohoku University Hospital, Japan, and is undertaken in close partnership with one of Japan’s foremost biomedical technology companies, Nipro Corporation.




Johns Hopkins University and University of Manitoba Faculty Awarded Grant to Study Prelacteals’ Impact on Neonatal Microbiome July 8, 2019

In many countries, ritual foods, such as honey and animal milk, are commonly given to newborns before they are first breastfed or early in life. These foods, called prelacteals, may undermine the benefits newborns would otherwise receive from exclusive breastfeeding. Dr. Alain Labrique of the Johns Hopkins School of Public Health and Dr. Meghan Azad of the University of Manitoba received a grant awarded through the Bill & Melinda Gates Foundation “Call-to-Action” to participants of the 2018 Grand Challenges meeting in Berlin, Germany. Building on Labrique and Azad’s prior work, in Bangladesh and Canada, respectively, the study will assess whether prelacteals affect the populations of bacteria in the newborn gut (the microbiome), a first step to understanding how this may affect development and survival.

Immediate and exclusive breastfeeding helps maintain healthy growth in infants and protects them against infections. The gut microbiome is intrinsically involved in both of these processes.  However, in Bangladesh and many other low-resource countries, it is a common cultural practice to give newborns ritual foods, like honey or animal milk, before breastfeeding begins. Labrique and Azad hypothesize that prelacteals interfere in the development of an optimal gut microbe, which, in turn, impedes newborn development.

To test this, they will use a long-standing population research site in rural Bangladesh ( and compare the types and amounts of bacteria in the gut using stool samples from 300 prelacteal-fed or exclusively breastfed infants at 7 days, 28 days and 3 months of life. They will also analyze prelacteal composition to search for pathogens, heavy metal contaminants, as well as examine bacterial populations in the breastmilk and on the skin of the mothers. The study will enable them to quantify the potentially negative impact of this widespread cultural practice, common to over a billion people across the Gangetic floodplain in Bangladesh, India and Pakistan.

Grand Challenges is a family of initiatives of the Gates Foundation fostering innovation to solve key global health and development problems. Meeting participants in Berlin were invited to identify a major global health challenge and submit a two-page proposal describing how they would solve it. “Prelacteals: A Source of Infection and Microbiome Disruption?” will help foster a new collaboration that links cutting-edge population research and state-of-the-art laboratory science, the results of which could lead to important future policy implications.

Labrique, an associate professor in the Department of International Health at the Bloomberg School, is an infectious disease epidemiologist and a globally recognized leader in developing and testing innovations to improve maternal and infant health outcomes. Azad, a Canada Research Chair in Developmental Origins of Chronic Disease and assistant professor in the Department of Pediatrics & Child Health at the University of Manitoba, is an expert in the developmental origins of chronic disease, including asthma, allergies, obesity and diabetes. She uses a trans-disciplinary approach to bridge the traditional pillars of research. Azad also serves as a research scientist at the Children’s Hospital Research Institute of Manitoba (CHRIM).





Preterm babies are less likely to form romantic relationships in adulthood

Posted on 17 July 2019

Adults who were born preterm (under 37 weeks gestation) are less likely to have a romantic relationship, a sexual partner and experience parenthood than those born full term. The meta-analysis by researchers at the University of Warwick with data from up to 4.4 million adult participants showed that those born preterm are 28% less likely to ever be in a romantic relationship.

  • A study of up to 4.4m adult participants has shown that those who were born preterm (under 37 weeks gestation) are less likely to form romantic relationships, have sexual relations or experience parenthood than those who were born full term
  • Research from the University of Warwick suggests it’s partly due to pre-term birth being associated with being more often withdrawn and shy, socially excluded and less likely to take risks in adolescence
  • More needs to be done in schools and by parents to encourage social interactions at younger ages, so when they transition to adulthood they are more likely to meet someone and increase their wellbeing

A meta-analysis conducted by researchers from the Department of Psychology at the University of Warwick, Association of Preterm Birth/Low Birth Weight with Romantic Partnership, Sexual Intercourse and Parenthood in Adulthood: A Systematic Review and Meta-Analysis’ , was published in JAMA Open on 12 July. They have found that adults who were born pre-term are less likely to form romantic relationships than full-term peers.

In the analysis 4.4 million adult participants those born preterm were 28% less likely to form romantic relationships and 22% less likely to become parents, when compared to those born full term.

Those studies that looked at sexual relations of pre-term children found that they were 2.3 times less likely to ever have a sexual partner when compared to full terms.

Those adults who were born very (<32 weeks gestation) or extremely preterm <28 weeks gestation) had even lower chances of experiencing sexual relationships, finding a romantic partner or having children at the same age as those born full term, with   the  extremely pre-term born adults being 3.2 times less likely to ever having sexual relations.

Close and intimate relationships have been shown to increase happiness and well-being both physically and mentally. However, studies also show that forming those relationships is harder for pre-term born adults, as they are usually timid, socially withdrawn and low in risk-taking and fun seeking.

Despite having fewer close relationships, this meta-analysis also revealed that when preterm born adults had friends or a partner, the quality of these relationships was at least as good in preterms compared to full term born adults.

First author of the paper, Dr Marina Goulart de Mendonça from the Department of Psychology at the University of Warwick comments:

“The finding that adults who were born pre-term are less likely to have a partner, to have sex and become parents does not appear to be explained by a higher rate of disability. Rather preterm born children have been previously found to have poorer social interactions in childhood that make it harder for them to master social transitions such as finding a partner, which in turn is proven to boost your wellbeing.”

The senior author, Professor Dieter Wolke, from the Department of Psychology at the University of Warwick adds: “Those caring for preterm children including parent’s health professionals and teachers should be more aware of the important role of social development and social integration for pre-term children. As preterm children tend to be more timid and shy, supporting them making friends and be integrated in their peer group will help them to find romantic partners, have sexual relationships and to become parents. All of which enhances wellbeing.”

Paper available to view at: JAMA Network Open  Full list of authors: Marina Mendonca, Ayten Bilgin, Dieter Wolke


Music helps to build the brains of very premature babies

unicef.jpgUniversité de Genève (UNIGE) –Researchers from the University of Geneva (UNIGE) and the University Hospitals of Geneva (HUG) demonstrate how music specially composed for premature infants strengthens the
development of their brain networks and could limit the neurodevelopmental delays that often affect these children.



Sharing stories offers immeasurable potential for healing individually, within our families and for our healthcare provider, research,  technology, and other Neonatal Womb community members. Choose conversation, writing, dance,  art, music, exercise, meditation, therapy or follow your unique guidance to explore your preterm birth experience. Celebrate you, your journey and those that share your journey…..


Integrating infant mental health into the neonatal intensive care unit

April 3, 2019  –  Children’s Hospital Los Angeles

Psychotherapists attend to mental health needs of NICU families, specifically focusing on the developing relationship between babies and parents.

Bringing a baby into the world involves many firsts — mothers and fathers are discovering their new roles, babies are learning what it means to live outside the womb, and the family is forging a relationship and bonding. What happens when this time of uncertainty is complicated by medical issues?

Many infants born premature or with other complications often forego their first weeks or months at home for a stay in the neonatal intensive care unit. The NICU is designed to deliver critical medical care to babies in need but can be traumatic for infants and their families, alike. In the Early Childhood Mental Health Program at Children’s Hospital Los Angeles, clinical psychologists Marian Williams, PhD, Patricia Lakatos, PhD, and a team of infant-family mental health specialists work towards greater mental health awareness in the NICU.

Infants may not be the first age group called to mind in discussions of mental health. Yet, for babies in critical medical condition, Dr. Lakatos says an “infant mental health-informed perspective” could reduce stress and improve bonding with parents. This means not only focusing on the physical needs of the child but also the emotional and mental needs, not an easy task for newborn infants who cannot make their voices heard.

In an article published in Journal of Clinical Psychology in Medical Settings, Dr. Lakatos, Dr. Williams, and co-authors Tamara Matic, MD, and Melissa Carson, MD, advocate for a third component of the NICU family — the relationship between baby and parents. “A lot of mental health work in NICUs currently focus on either the mental health of parents or on the baby’s development,” says Dr. Williams, who is also the Director of the Stein Tikun Olam Infant-Family Mental Health Initiative at CHLA. “We also want to focus on the relationship between babies and their parents.”

Many parents of children in intensive care units experience symptoms of post-traumatic stress, which can threaten bonding with a newborn baby. In order to support the developing relationship between parents and their new baby, the CHLA infant mental health team turned to a model of intervention that has demonstrated success in families who have undergone trauma. Child-Parent Psychotherapy — or CPP — addresses the parent-child relationship directly, nurturing and advocating for it in its own right.

With funding from the Stein Tikun Olam Infant-Family Health Initiative, Drs. Williams and Lakatos, and the team were able to adapt CPP to the NICU setting at Children’s Hospital Los Angeles. Their publication describes how the established, evidence-based CPP model can be used to nurture developing infant-parent relationships in the NICU. While it has been implemented in other settings, CPP is not commonly integrated into NICU patient care.

CPP is a flexible model that has multiple levels of intervention, depending upon individual family needs. Sessions with trained CPP providers can vary in number or duration, with the aim of restoring a developmental trajectory for parent and child. CPP providers advocate for mental health needs of parents and babies, working alongside their medical and social work colleagues. “When babies are in the hospital, we need to think about them, their parents, and their relationships,” says Dr. Lakatos.

Appropriately, NICU medical staff focus on the acute physical needs of the child. Dr. Williams sees clinical psychologists in a necessary, complementary role. “These babies are eventually going home,” she says. “They are missing out on their bonding time, but there is great potential for resilience. Being mindful of the stressors these families are facing helps them feel understood and can set them on a positive trajectory.”

Materials provided by Children’s Hospital Los Angeles.



KAT’S Corner

On September 1, 2019 we are launching a 36 day Instagram at handle-katkcampos honoring the 36 countries we have  highlighted in the Neonatal Womb Warriors blog for the past 3 and ½ years. We identified 36 global fashion “trends” for Fall 2019 and paired them with a country we have “visited” to date.  The pairing was blind (two sets of folded up paper with fashion and country names chosen blindly from two separate bowls) and we are including an item made by or representing each country somewhere in the photo shoot.  Although this Instagram series is meant to be a fun tribute illustrating our gratitude and love for the community at large, the healthcare challenges related to preterm birth are extremely serious. Our goal is to continue to shine a light on our amazing global preterm birth community so that we can work together to identify our  needs and resources, create solutions, support and enhance the wellbeing of ALL of our community partners.

Surfing In Egypt


Coral Surfing Egypt-Published on Aug 23, 2016












Our efforts to gain information regarding our Neonatal Womb community in the Russian Federation was difficult, as gaining information in general outside of the US currently seems to be. Our’s and yours beat together within the rhythms of the universe, the water that touches your shores falls as rain on our garden flowers, the air we breathe is ours to share.

 We cherish you, our family.





Russia or the Russian Federation is a transcontinental country in Eastern Europe and North Asia. At 17,125,200 square kilometres (6,612,100 sq mi), Russia is by a considerable margin the largest country in the world by area, covering more than one-eighth of the Earth’s inhabited land area, and the ninth most populous, with about 146.79 million people as of 2019[update], including Crimea. About 77% of the population live in the western, European part of the country. Russia’s capital, Moscow, is one of the largest cities in the world and the second largest city in Europe; other major cities include Saint Petersburg, Novosibirsk, Yekaterinburg and Nizhny Novgorod.

The Russian Constitution guarantees free, universal health care for all its citizens. In practice, however, free health care is partially restricted because of mandatory registration. While Russia has more physicians, hospitals, and health care workers than almost any other country in the world on a per capita basis, since the dissolution of the Soviet Union the health of the Russian population has declined considerably as a result of social, economic, and lifestyle changes; the trend has been reversed only in the recent years, with average life expectancy having increased 5.2 years for males and 3.1 years for females between 2006 and 2014.


Estimated number of preterm births per 100 live births  Rate: 7% RANK: 155

(US Rate: USA – 12% Rank: 54)




The changes in preemie care that may have helped the world’s smallest babies survive

By Dr. Shailja Mehta – Jun 3, 2019

What is believed to be the world’s smallest newborn baby to survive entered the world nearly four months earlier than planned, weighing 8.6 ounces – about the size of a juice box.

Baby Saybie was born at the Sharp Mary Birch Hospital in San Diego. She was transferred to the Neonatal Intensive Care Unit (NICU), where care is given to newborns who need special attention, and finally sent home after 5 months of treatment.

Premature babies like Saybie, who were unlikely to survive if they were born just a few decades ago, are thriving thanks to advances in modern medicine.

Dr. Jonathan Blau, a neonatologist at Staten Island University Hospital, told ABC News that the NICU usually handles the monitoring and treatment of newborns who are at risk for survival. A NICU team usually consists of a neonatologist, a specialized nurse, and a respiratory specialist who arrive and prepare a baby warmer even before the baby is delivered. When the baby is born it is taken to a warmer where heat and oxygen are provided.

Very small premature babies like Saybie are usually hooked up to a tube connected to a breathing machine, and a team constantly monitors their heart rate and blood pressure. “They also get medicines, hydration through IVs, x-rays, and antibiotics,” said Dr. Blau.

All babies undergo dramatic body system changes after birth. Some of these include breathing on their own, changes in the heart structure and direction of blood flow in large vessels. Healthy babies born after 9 months of gestation typically do not need medical help to go through these changes. But premature babies or those with health problems can have difficulty making that transition into the world.

Survival rates for premature babies vary based on the length of pregnancy, weight and sex of the baby, and whether they received a specific medication to help quicken their lung maturity before birth.

A developing fetus goes through important growth throughout pregnancy, including in the final months and weeks, according to the CDC. For example, the brain, lungs, and liver develop during the final weeks of pregnancy. Babies born too early, especially before 32 weeks, have higher rates of death and disability. In 2015, preterm birth and low birth weight accounted for about 17% of infant deaths.

According to Dr. Blau, preemies born at 24 weeks now have a 50% chance of survival. That chance goes up with increasing gestational age. Once the fetus reaches 28 weeks, over 90% of preterm babies survive.

It has been standard to provide lifesaving treatment to a baby born at 24 weeks, according to Dr. Blau, but now doctors are using new technology to try to save babies born ever earlier in some cases.

Care for premature babies has developed immensely over the last few decades, and it’s hard to believe less than a century ago, preemies were sent home with their parents, often with no medical intervention.

The first American NICUs providing specialized newborn care were designed in 1960s by Dr. Louis Gluck, around the same time doctors were learning more about the spread of infection.

Dr. Gluck’s research showed that bathing babies and washing hands reduced the number of bacterial infections. His discovery transformed the NICU layout from babies isolated in cubicles to one large room filled with newborns in their incubators.

In the 1970s, doctors discovered the benefits of mothers holding their babies after giving birth. Dr. Heidelise Als, a specialist in newborn infant behavior, created the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), and encouraged family involvement and individualized care plans for each baby.

Families began staying overnight in the hospital, and were encouraged to participate in “skin to skin” bonding, sometimes also called “kangaroo care,” where the baby is held closely or placed on the mother’s chest to maximize skin contact. Increased skin contact in the NICU has many benefits for the baby including reducing stress levels, helping with growth, controlling the heart rate and regulating breathing.

Technology to better treat premature babies continues to be developed today. Earlier this year, a team of scientists at Northwestern created and are testing soft, flexible wireless sensors for babies to monitor their vital functions, replacing long cords, and found that they were just as accurate and allowed better parent-child interaction.

“We have more sophisticated ventilators that have allowed some of the smallest babies to survive,” Dr. Blau said.

With a growing base of professional knowledge about neonatal care and constant improvements in technology, Dr. Blau thinks the future is bright.

“In addition to lifesaving care for our youngest newborns, we will strive to maximize developmental outcomes so these children can live happy and healthy childhoods.”

*** Dr. Shailja Mehta is a Female Pelvic Reconstructive Medicine and Surgery Fellow at Yale University, working with the ABC News Medical Unit


Universal Health Coverage Day 2019


On 12 December 2012, the United Nations General Assembly endorsed a resolution urging countries to accelerate progress toward universal health coverage (UHC) – the idea that everyone, everywhere should have access to quality, affordable health care – as an essential priority for international development. In 2017, the international community celebrated 12 December as the first International Universal Health Coverage Day.

International Universal Health Coverage Day aims to raise awareness of the need for strong and resilient health systems and universal health coverage with multi-stakeholder partners. Each year on 12 December, UHC advocates raise their voices to share the stories of the millions of people still waiting for health, champion what we have achieved so far, call on leaders to make bigger and smarter investments in health, and encourage diverse groups to make commitments to help move the world closer to UHC by 2030.






Neonatology Considerations for the Pediatric Surgeon

Updated: Mar 11, 2019  Author: Ibrahim SI Mohamed, MB, BCh, DISP(Fr); Chief Editor: Robert K Minkes, MD, PhD

Neonatal Gestational Age and Birth Weight

As a prerequisite to determine whether neonates fall into reference ranges, all infants are classified on the basis of gestational age (GA) and birth weight (BW).

Early ultrasonography (US) improved the accuracy of pregnancy dating, but discrepancies in dates, physical examination findings, and size necessitate further evaluation. If antenatal care has been lacking, physical assessment remains the primary clinical determinant of GA. GA is noted in completed weeks after the onset of the last menstrual period (LMP).

A term infant is an infant who is born after 37 completed weeks (i.e., ≥37 0/7 weeks’ gestation). A preterm infant is born before 37 completed weeks (i.e., < 37 weeks’ gestation). A post term infant is born after 42 0/7 weeks’ gestation.

Several terms are used to classify neonates according to BW, as follows:

  • Low birth weight (LBW) neonates weigh less than 2500 g, either because of prematurity, because they are small for their gestational age, or both
  • Very low birth weight (VLBW) neonates weigh less than 1500 g (3 lb 5 oz) at birth [1]
  • Extremely low birth weight (ELBW) neonates weigh less than 1000 g (2 lb 3 oz) at birth

These classifications aid the clinician in predicting clinical courses and outcomes.

Small for gestational age (SGA) neonates are those whose BW is less than the 10th percentile for their gestational age. These infants are more prone to hypoxemia and meconium aspiration during labor. They are also at higher risk for polycythemia and require special attention to prevent hypothermia [2] and hypoglycemia. The placenta should be carefully examined by pathologists. These infants are at increased risk for developing necrotizing enterocolitis (NEC). They often have higher than normal caloric requirements for growth.

Intrauterine growth retardation or restriction (IUGR) is used to describe neonates whose growth is not at the 10th percentile for their gestational age in utero or in neonates in whom the weight percentile is decreasing in relation to GA (ie, crossing the 10th percentile lines); these neonates may be SGA.

Considerable evidence has shown that IUGR and smallness for gestational age can increase the risk of non-insulin-dependent diabetes mellitus (NIDDM), coronary heart disease, hypertension, and stroke. This has led to a rapidly growing field: study of the fetal origins of adult diseases.

Large for gestational age (LGA) infants are those whose weight is greater than 90th percentile for their gestational age. These infants are at increased risk for perinatal asphyxia, birth injury, hypoglycemia, hypocalcemia, polycythemia, and thrombocytopenia. Infants of mothers with diabetes are often large for gestational age.

These classifications aid the clinician in predicting clinical courses and outcomes.

Small for gestational age (SGA) neonates are those whose BW is less than the 10th percentile for their gestational age. These infants are more prone to hypoxemia and meconium aspiration during labor. They are also at higher risk for polycythemia and require special attention to prevent hypothermia [2] and hypoglycemia. The placenta should be carefully examined by pathologists. These infants are at increased risk for developing necrotizing enterocolitis (NEC). They often have higher than normal caloric requirements for growth.

Intrauterine growth retardation or restriction (IUGR) is used to describe neonates whose growth is not at the 10th percentile for their gestational age in utero or in neonates in whom the weight percentile is decreasing in relation to GA (ie, crossing the 10th percentile lines); these neonates may be SGA.

Considerable evidence has shown that IUGR and smallness for gestational age can increase the risk of non-insulin-dependent diabetes mellitus (NIDDM), coronary heart disease, hypertension, and stroke. This has led to a rapidly growing field: study of the fetal origins of adult diseases.

Large for gestational age (LGA) infants are those whose weight is greater than 90th percentile for their gestational age. These infants are at increased risk for perinatal asphyxia, birth injury, hypoglycemia, hypocalcemia, polycythemia, and thrombocytopenia. Infants of mothers with diabetes are often large for gestational age.



New doctors’ DNA ages six times faster than normal in first year

Long work hours of intern year associated with accelerated shortening of telomere regions of chromosomes

Date: May 15, 2019 Source: Michigan Medicine – University of Michigan


Every summer, tens of thousands of newly minted doctors start the most intense year of their training: the first year of residency, also called the intern year. A new study suggests that the experience will make their DNA age six times faster than normal. And the effect will be largest among those whose training programs demand the longest hours.

In just a few short weeks, tens of thousands of newly minted doctors will start the most intense year of their training: the first year of residency, also called the intern year.

A new study suggests that between now and next summer, that experience will make their DNA age six times faster than normal. And the effect will be largest among those whose training programs demand the longest hours.

The findings about the effect of residency focus on the stretch of DNA called telomeres — which keep the ends of chromosomes intact like the plastic end of shoelaces. The discovery that telomeres shrink in an accelerated way among interns suggest the importance of ongoing efforts to reduce the strain of medical training.

But the researchers say their study also holds implications for other professions and situations that expose people to prolonged stress and months of long hours.

Published online in the journal Biological Psychiatry, the new study is the first to measure telomere length before and after individuals faced a common prolonged intense experience. It involved 250 interns from around the country who volunteered for the Intern Health Study, based at the University of Michigan, and a comparison group of college students from U-M.

“Research has implicated telomeres as an indicator of aging and disease risk, but these longitudinal findings advance the possibility that telomere length can serve as a biomarker that tracks effects of stress, and helps us understand how stress gets ‘under the skin’ and increases our risk for disease,” says Srijan Sen, M.D., Ph.D., the U-M neuroscientist and psychiatrist who is the study’s senior author and heads the Intern Health Study.

He adds, “It will be important to study how telomere changes play out in larger groups of medical trainees, and in other groups of people subjected to specific prolonged stresses such as military training, graduate studies in the sciences and law, working for startup companies, or pregnancy and the first months of parenting.”

Sen’s team worked with Kathryn Ridout, M.D., Ph.D., the new study’s first author, during the research portion of her residency at Brown University. She is now a psychiatrist at Kaiser Permanente in California as well as having an appointment at Brown.

“The current model of intern year training during residency increases trainee stress, which impacts their mental health and wellbeing. These results extend this work and are the first to show that this stress reaches down to the biological level, impacting the well accepted marker of aging and disease risk, telomere length,” says Ridout. “I was particularly surprised to see the relation of number of hours worked to telomere shortening.”

Sen notes that after the discovery that telomeres protect the DNA in chromosomes from damage — a discovery that earned the 2009 Nobel Prize — research on them in humans has focused on taking snapshots of telomere length, mainly in older adults. This has yielded important discoveries about the links between shrunken telomeres and disease.

Ridout analyzed data from dozens of telomere studies for a meta analysis published in 2016 that showed clear links between telomere length and the risk and severity of depression.

In the new study, Sen and his colleagues asked recently graduated medical students to contribute a sample of their DNA before they began their intern year, and then followed up to get another sample at the end of that year. The interns also took a lengthy questionnaire before their training began, and again at several points during and at the end of the intense year.

The results show that some new doctors went into residency with telomeres that were already shorter than their peers. This included those who said their family environment early in life was especially stressful — which echoes previous findings about the impacts of such an upbringing on telomere length.

Those who scored high on personality traits that together are classed as “neuroticism” — being quick to react and slow to relax, and a tendency to respond with negativity — also had shorter telomeres at the start of intern year.

But when the team looked at the results of the DNA tests taken after intern year ended, only one factor that they studied emerged with a clear link to telomere shrinkage: the number of hours the interns worked each week.

On average, all the interns in the study said they worked an average of 64.5 hours a week. But the more the interns worked, and therefore the more days they put in that were at or above the national limit of 16 hours in effect at the time, the faster their telomeres shrank.

“The responses given by some of the interns in these surveys indicated that some were averaging more than 80 hours of work a week, and we found that those who routinely worked that many hours had most telomere attrition,” says Sen. “Those whose hours were at the lower end of the range had less telomere attrition.”

By contrast, the comparison group of 84 first-year U-M undergraduate students experienced no telomere shrinkage, despite also being in a stressful year-long situation of coping with life at an elite institution of higher education. These students were taking part in a study led by Sen’s colleague at the U-M Molecular and Behavioral Neuroscience Institute, Huda Akil, Ph.D.

Sen’s Intern Health Study has begun collecting DNA samples from many more interns, and is now monitoring their mood, sleep and activity using smartphone apps and commercial activity trackers. He hopes to study the telomeres of future groups of interns to gather more data about how they change over the intern year and how those changes match up with their experiences during the year.

For instance, the frequent changes in shift time — from day to night and back again — during residency has already emerged in Sen’s work as an important factor in mood and circadian disruption. Future studies will explore if this sort of shiftwork increases telomere attrition.

He also hopes that researchers can evaluate whether any practices can protect telomeres from shrinkage or even spur repair and lengthening of these protective stretches of DNA. For now, he says, “Residency directors should do as much as they can to keep their interns’ work hours and workload towards the lower end of the current range.”

And as new doctors prepare to graduate and head into their intern years, he advises them to focus on their mood, sleep and stress-relieving activities as much as they can.

Ridout says she hopes the results will be heeded by the Accreditation Council for Graduate Medical Education and others. “Having completed residency myself and understanding the stress that can come with this training and extended work hours, I am hopeful these data can help inform the decisions of governing bodies that have been debating the importance of regulating resident work hours,” she says. “Our results suggest that reforms in intern training and work hours with a renewed focus on wellbeing is necessary to protect the health and viability of our physician workforce.”

Story Source: Materials provided by Michigan Medicine – University of Michigan. Note: Content may be edited for style and length. Journal Reference: Kathryn K. Ridout, Samuel J. Ridout, Constance Guille, Douglas A. Mata, Huda Akil, Srijan Sen. Physician Training Stress and Accelerated Cellular Aging. Biological Psychiatry, 2019; DOI: 10.1016/j.biopsych.2019.04.030




7 Behaviors Common Among Adults Who Went Through Trauma At A Young Age

The Minds Journal- Published on Dec 1, 2018

The intensity of a traumatic incident varies from person to person. Trauma from when one was a child can range from a crippling fear of abandonment to physical abuse and anything between the two. Many adults are forced to deal with the trauma they experienced as children throughout their lives. This article will hold true for whoever has had to face something traumatic as a child. Sometimes, we just hide things because that’s easier than actually dealing with them. We even do this unconsciously in order to protect ourselves at the time. But it is important to deal with these issues so that we can finally be free of that burden. 7 characteristics shared by people who went through trauma at a young age.





Helping Parents Chart Their Path Through Their NICU Journey:                                 

 The Peekaboo ICU Parent App Hitting It’s Mark – Deb Discenza

In just two and a half years since its official debut at the October 2018 National Neonatal Nurses Conference (NANN) in Palm Springs, CA, the Peekaboo ICU free parent app has become an essential “go-to” for preemie parents faced with navigating the uncharted journey of the Neonatal Intensive Care Unit (NICU). Available on apple and android devices, its goal is to reduce anxiety for parents by equipping them to understand, document, record, and celebrate their preemie’s story. And indeed, this comprehensive resource is working.

“The app is exceeding our expectations of growth and utility,” said Mark Dolezel, co-founder, producer, and husband of the app’s clinical author, Jodi Dolezel.  With over 13,500 downloads and 9,600-page views per month, Jodi’s dream of providing a credible one-stop resource for NICU has become a reality, primarily in the US, but is also in Canada, the United Kingdom, Australia, and South America. No Wi-Fi needed and conveniently accessed at the bedside. A tutorial is available at watch?v=2H5WsjxCjIw.

Jodi was determined to find a way to support and prepare parents to feel comfortable and confident while caring for their child as essential partners with the NICU healthcare team.  In her many years of NICU bedside practice as a nurse, she has seen this is not always the case. “Parents feel alienated,” she said, “out of control and vulnerable at a time when they themselves are physically and emotionally drained. We decided to try to change this.”

So, the app’s first feature was a tool for parents to customize and track their individual preemie’s growth and development, and to journal their preemie’s unique experience. However, because so many parents are having multiples, that additional capacity was soon added.

Next, the Dolezels researched each critical area of knowledge for preemie parents, and organized them into sequential sections.

Navigating the NICU is the essential first step in helping parents understand unfamiliar medical terminology, staff roles, medical equipment, and the intense clinical environment. The Weekly Developmental Guide provides what every parent wants to know what to expect week to week.  They want to know what is considered “normal” and how is my baby progressing towards those norms? Anatomy presents a system-by-system look at each body function relevant to pre-term infants with the option of diving deeper into content regarding complications if they should arise. Growth Tracker allows parents to record and graph ongoing progress of their baby’s head circumference, weight, and length.

This area also promotes strong interaction and discussion points between parents and the healthcare team. With Milestones, parents can capture the moments and achievements they experience with their baby throughout their journey together, all of which can be downloaded and saved as a lifelong keepsake. Steps to Discharge offers a thorough explanation of the achievements required for taking your baby home, which is always a priority for preemie parents. Feeding & Nutrition has tips for successful breastfeeding, a feeding tracker, and pumping logs are essential resources and very helpful for encouraging collaboration with staff. There is a thorough education about the options available to parents, including pasteurized human donor milk and human milk-based fortifiers to ensure optimal nutrition, according to gestational weight. Journaling allows parents to import photos and document their thoughts, experiences, and feelings as often as they’d like.  If desired, they can share these with friends and family through e-mail and social media, setting up a “caring network” while decreasing the burden of endless phone calls. And finally, the Support section provides a guide to parent support organizations all over the country that moms and dads can tap into both before and after discharge.

But Peekaboo ICU is not resting on its laurels. With the success of the app comes “an obligation to continue to find new ways of making it even better and more accessible,” said Jodi.

This will include an After the NICU Section for parents to document appointments, medications, nutrition, procedures, a daily schedule, and notes with HIPPA-compliant server integration for capturing real-time data.  Server integration will also afford synchronization between multiple apps and provide safety backups. Lastly, there will be an option to create a lasting “baby book” with the ability to download the entire content recorded in the app. “We estimate the app is now available in at least 40 hospitals and the number is growing every day,” said Mark. “The number is very likely much higher as individuals using the app are not required to register their location.”

Jodi feels gratified. She says, “We are receiving amazing feedback from nurses, lactations specialists, hospitals and, of course, parents. Nurses tell us the app makes their job easier. Lactation specialists say it encourages moms to track pumping, which often leads to better outcomes. Hospitals call it an invaluable tool they can use because it is non-branded, without advertisement. And parents simply say, ‘thank you.’ “That’s all we need!







Preemies and early arrivals have higher risk of heart disease as adults

June 3, 2019 – by admin – SOURCE: and JAMA Pediatrics, online June 3, 2019.

Babies who are born too soon may be more likely to develop heart disease as adults than full-term infants, a new study suggests.

Adults who were born before 37 weeks gestation were 53 percent more likely to develop heart disease than people who were full-term babies, researchers found. And people who’d been born just a little bit early – at 37 to 38 weeks gestation – were 19 percent more likely to develop heart disease.

Pregnancy normally lasts about 40 weeks, and babies born after 37 weeks of gestation are considered full-term. Babies born prematurely – earlier than 37 weeks – often have difficulty breathing and digesting food in the weeks after birth. Preemies can also encounter longer-term challenges such as impaired vision, hearing and cognitive skills, as well as social and behavioral problems.

Preterm birth has also been linked to an increased risk of high blood pressure and diabetes decades later. But research to date hasn’t conclusively linked an early delivery to an increased risk of so-called ischemic heart disease, which happens with the arteries narrow and limit how much blood and oxygen reach the heart.

For the current study, researchers examined data on more than 2.1 million babies born in Sweden between 1973 and 1994, following them through 2015 to see how many developed heart disease. Only 1,921 of these babies, or less than one percent, went on to be diagnosed with heart disease by ages 30 to 43.

“Preterm birth interrupts the development of the cardiovascular system and other organs, leading to abnormal structure or function of blood vessels and other disorders such as diabetes that can lead to heart disease,” said lead study author Dr. Casey Crump of the Icahn School of Medicine at Mount Sinai in New York City.

“Our findings were not explained by maternal factors that might contribute to both preterm birth and future heart disease, such as obesity, hypertension, diabetes, and smoking,” Crump said by email. “In addition, we also compared persons born preterm with their siblings who were not, which suggested that the findings were not explained by other risk factors shared within families, but were more likely from direct effects of preterm birth.”

For every 100,000 babies born at full term each year, about 5.9 would develop heart disease as adults, researchers calculated. That compares to about 6.5 of every 100,000 babies born slightly early and 8.8 of every 100,000 preemies.

One limitation of the study is that researchers lacked more detailed clinical data needed to verify the heart disease diagnoses, the study authors note. They also had too few extremely preterm babies to draw firm conclusions about the heart risks associated with delivery earlier than 34 weeks gestation.

Another drawback is that the follow-up period was too brief to detect differences in heart disease rates later in adulthood, when the condition is more commonly diagnosed.

Even so, the results suggest that adults born even a little bit early should take extra precautions to protect the heart, said Dr. Thuy Mai Luu of the University of Montreal and CHU Sainte-Justine in Canada, who co-authored an editorial published with the report.

“Some risk factors associated with cardiovascular diseases can be prevented through healthy lifestyle habits including a diet rich in fruits and vegetables, reduced sedentary time, regular physical activity and avoidance of primary and secondary smoke exposure,” Luu said by email.

“This is important to all, but maybe more so for children and adults born preterm,” Luu added. “Given that it is hard to change behaviors, adopting a healthy lifestyle early in childhood is crucial; parents are central to this.”




Study could lead to ‘cognitive therapy in your pocket’

CBM-I via smartphone app could help patients with depression, anxiety, and other mental health conditions

May 29, 2019  McLean Hospital


People living with anxiety, depression, and other mental health conditions may soon be able to use a smartphone app to deliver on-demand cognitive bias modification for interpretation (CBM-I), a way to change mental habits without visiting a therapist.

Based on a study by McLean Hospital researchers, individuals with anxiety, depression, and other mental health conditions may soon be able to use a smartphone app to deliver on-demand cognitive bias modification for interpretation (CBM-I), a way to change mental habits without visiting a therapist.

The study, “Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based Psychiatric Hospital Program,” was published in the journal Behavior Therapy. It shows the potential effectiveness of CBM-I when combined with cognitive behavior therapy (CBT) in an acute psychiatric setting. It also points the way for adapting this therapeutic approach for use outside the hospital.

The lead researcher of the study is Courtney Beard, PhD, director of McLean’s Cognition and Affect Research and Education (CARE) Laboratory.

Beard described CBM-I as a “class of interventions designed to shift people’s interpretations of ambiguous situations in either a more positive or more negative way.” She explained that “CBM-I tries to address interpretation bias, a mental habit that is implicated in many mental disorders.”

To do this, individuals undergoing CBM-I treatment can be presented with a series of word association questions that address everyday situations.

For example, the CBM-I task may show a patient a situation about a person yawning during their conversation. Then the patient is asked whether that person is “tired” or “bored.” The individual who answers “tired” is told the response is “correct,” and “bored” is incorrect. Through repetition, this type of CBM-I therapy helps the person reframe or reassess these daily ambiguous situations.

“People face countless interactions like this every day in their lives,” Beard said. “If you have a tendency to jump to a threatening or negative conclusion, it can have a huge impact on how you’re feeling and on what you do and how you react. You can get stuck in a cycle that can maintain anxiety or depression.”

For their study, Beard and her colleagues developed and implemented CBM-I to augment CBT-based treatment in a partial hospital setting. They presented patients with word-sentence associations that encouraged patients to endorse positive interpretations and reject negative interpretations.

Study results showed that CBM-I was practical and acceptable to acute psychiatric patients. Many stated that CBM-I bolstered their primary CBT-based care. The study also found that that the word association exercises were successful in helping reframe potentially negative situations.

Based on these results, Beard and her team are moving forward with a National Institute of Mental Health-backed study to develop a smartphone version of CBM-I.

“With the smartphone app, we can offer CBM-I to many more people at one time,” Beard said. “With the app, they can practice new skills, create healthy mental habits, and stop automatically jumping to negative conclusions. And they can do it on demand.”

Beard stated that the app could be particularly helpful for individuals who have just been discharged from a treatment program. “They can use it during the month transition period after they leave the hospital, which is a risky and challenging time for them,” she said.

Beard sees great promise for app-based CBM-I therapy. “It quickly shows people what their brain is doing,” she explained. “The patient sees hundreds of situations in a short amount of time. So, they see how often they jumped to a negative conclusion, and that can be very powerful. It’s kind of like cognitive therapy in your pocket — but a little different and a lot faster.”

Journal Reference: Courtney Beard, Lara S. Rifkin, Alexandra L. Silverman, Thröstur Björgvinsson. Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based Psychiatric Hospital Program. Behavior Therapy, 2019; 50 (3): 515 DOI: 10.1016/j.beth.2018.09.002 McLean Hospital. “Study could lead to ‘cognitive therapy in your pocket’: CBM-I via smartphone app could help patients with depression, anxiety, and other mental health conditions.” ScienceDaily. ScienceDaily, 29 May 2019. <>.



Elvie Pump: Silent & Wearable Breast Pump Review | Channel Mum

Channel Mum      Published on Nov 2, 2018

The Elvie Pump has completely revolutionised expressing breast milk! The pump is wireless and completely silent, the only sound you will hear is the milk trickling into the empty bottle and even that stops once the bottle starts to fill up.


Kat Chat-


A brief update on my healing journey to treat my preverbal PTSD! I have engaged in a few sessions of hypnotherapy, which I found to be a gentle start. My PTSD-related issues frankly seemed to intimidate the therapist.  I realized I wanted to go deeper in a safe environment, and decided to explore additional modalities moving forward. Hypnotherapy may be something I return to in the future as a tool for exploring my internal landscape in relationship to other issues.

Seeking talk-free therapy alternatives appropriate to treat preverbal trauma I identified options that may work well and provide a supportive safe setting for a person with preverbal PTSD. Rolfing, EMDR and Shamanism are three options I may engage in. The first will be Rolfing, and I have identified and connected with a therapist to work with. When she returns to my area, appointments will be set and the adventure will unfold.

Research related to preverbal trauma is sparse and slow to develop. This, like many medical issues for Warriors, will be impacted by the choices we make.  I suggest we explore our challenges with  Spiritual Guidance, Critical Thinking, and a commitment to Manifesting Wellness as we embrace our days, years and lifetime challenges and opportunities.  Let’s share our stories…….


Preterm Birth a Key Risk Factor for Development of Childhood Depression

October 4, 2018


The study investigators observed that low level of urbanization was associated with a lower risk for depression.

Children born preterm may have an increased risk for depression compared with children born full-term, according to study results published in the Journal of Affective Disorders.

Researchers analyzed data from 21,478 preterm children and 85,903 full-term children born between 2000 and 2010 who were included in the Taiwan National Health Insurance Research Database. The mean ages of the preterm children and full-term children were 9.72 and 9.88 years, respectively.

Evaluation of the study population found that preterm birth was the key risk factor for depression.

The risk of depression among preterm children was 2.75 times higher than that seen in full-term children (95% CI, 1.58–4.79; P <.001). Depression rates in full-term children were 0.37, compared with 1.01 in preterm children, per 10,000 person-years. In female preterm children, incidence of depression was 3 times higher compared with full-term children. Preterm children whose parents had blue-collar occupations had a risk for depression 3.4 times higher than full-term children in the same demographic. Preterm children whose parents had occupations other than blue-collar positions had a 6.06-fold higher risk for depression compared with full-term children in the same demographic (blue-collar occupations: 95% CI, 1.04–11.15; P <.05; other occupations: 95% CI, 1.71–21.49; P <.01).

Researchers conclude that “findings of the present study suggest that preterm infants have a significantly higher risk of depression in adolescence compared with full-term infants.” They note that limitations of the study include lack of maternal demographic data and emphasize the need for healthcare providers to recognize the potential for depression in children born prematurely.

Reference: Chiu TF, Yu TM, Chuang YW. Sequential risk of depression in children born prematurely: A nationwide population-based analysis J Affect Disord. 2018; 243:42-47. doi: 10.1016/j.jad.2018.09.019



Seattle’s Greenlake – an urban woodland walk paradise; a community of trees from all over the world, living together in harmonious beauty. Our spiritual retreat!

Doctors urged to prescribe

woodland-walks for mental health problems


         By Sally Robertson B. Sc. – 06/10/19 Reviewed by Kate Anderson, B.Sc. (Editor)

The Woodland Trust says the Japanese practice of “forest bathing” should be prescribed on the NHS to tackle stress and other mental health problems. According to the charity, hugging trees, listening to bird song and kicking through leaves are all activities that can boost mental health.

The Trust is urging GPs to prescribe forest bathing for mental health conditions and direct patients to their nearest woodland.

Head of innovation at the Woodland Trust, Stuart Dainton, say all family doctors should have the knowledge to point patients towards the nearest suitable woodland where they can absorb nature, informally or as part of a structured program. He is appealing to GPs to make use of the more than 1,000 sites covered by the Trust in the UK.

Stemming from the Japanese art Shinrin-yoku, the practice was devised 40 years ago by the Japanese Ministry of Agriculture, Forestry, and Fisheries as part of an initiative to tackle stress among men. The activity involves breathing deeply and absorbing the atmosphere of the forest as a way of yielding calming, rejuvenating and restorative effects.

Participants are encouraged to immerse themselves in the environment and take in the sights, sounds, touch and smells of the forest.

It’s about invigorating the senses by walking in the woods, smelling, listening to the sounds of the woods, touching the ground. We’re almost losing that as a society.” Stuart Dainton. He adds that forest bathing should also be encouraged for children to help fight the “always on” culture prompted by social media.

BBC presenter Kate Humble is calling for schools to conduct lessons outside, referring to how difficult she found education whilst surrounded by four walls: “I find it stultifying and boring and I spent probably more of my school career going ‘How can five minutes feel like five hours?’ There is no reason why math, English literature or any subject cannot be taught outside.” Kate Humble

Forest bathing is now practiced by more than five million Japanese people and has quietly been gaining popularity in the UK. The therapy, which has become a cornerstone of preventative health care in Japanese medicine, has prompted a number of scientific studies that seem to prove its beneficial effects.

Research mainly conducted in Japan and South Korea, has shown that two hours of time spent mindfully exploring a forest can lower blood pressure, reduce the stress hormone cortisol and improve memory and concentration. Studies have also found that trees release substances called phytoncides, which have anti-microbial properties and can boost the immune system.

As a result of these findings, the Japanese government decided to introduce shinrin-yoku as a national health program and now forest therapy is an established practice throughout the world.

An increasing number of companies are now offering structured forest bathing programs that last anything from between a couple of days through to week-long residential stays.

The Forestry Commission, which is the largest proprietor of wooded land, has also announced that it plans to launch nationwide programs. In addition, it provides printable recommendations on how to practice the activity, including tips on how to breathe correctly.

Health benefits of forest bathing

Beneficial effects of forest bathing (that have been scientifically proven) include:

  • Increased natural killer cell count and improved immune system function
  • Reduced blood pressure
  • Improved sleep
  • Higher energy levels
  • Improved mood
  • Increased concentration, particularly among children with ADHD
  • Faster recovery from illness or surgery
  • Decreased stress

Helen Stokes-Lampard from the Royal College of GPs advises that getting outside can have a “really positive impact” on health: We do know that patients often benefit from non-medical interventions such as an exercise class, learning a skill or joining a community group. This is now referred to as ‘social prescribing,’ and ‘forest bathing’ is one of many activities that people might find beneficial for their overall wellbeing.” Helen Stokes-Lampard

Dainton says that social prescribing through aspects of Shinrin-yoku, forest bathing, is a route to helping the nation destress: “One in four of us are potentially going to suffer from mental health problems. Part of the solution is just getting outside and enjoying nature.”

Forest bathing “practitioner” Faith Douglas points out that forest bathing has been out there for years: “This is something our ancestors did, this is something that cultures do all over the planet — it’s simply being mindful in a natural environment.”

How many people could benefit from forest bathing?

Millions of people are affected by mental health problems every year in the U.S. Statistics on the prevalence and impact of these conditions in the U.S. include the following:

  • Around one-fifth (46.6 million) of adults experience a mental health condition every year
  • Each year, an estimated one in 25 (11.2 million) adults develop a serious mental health problem that significantly limits or disrupts day-today activities
  • Around one in five (21.4%) individuals aged 13 to 18 years develop a severe mental health condition
  • Around 13% of those aged 8 to 15 years develop a severe mental health condition
  • The percentage of adults living with schizophrenia is 1.1%
  • For bipolar disorder, the figure is 2.6%
  • Almost 7% (16 million) adults experienced at least one major depressive episode in the past year
  • About 18% of adults developed an anxiety disorder such as phobia, post-traumatic stress disorder and obsessive-compulsive disorder.
  • Of 20.2 million adults who had a substance abuse problem, 10.2 million also had a mental health illness


Want to give it a go? The National Trust has put together a beginner’s guide to forest bathing: Link-


Published on Feb 17, 2018 – A 4 mints film about kamchatka – surfing in kamchatka & wildlife and adventure.




Comfort Care, Telemed, a little Deepak!



“When people look at clouds they do not see their real shape, which is no shape at all, or every shape, because they are constantly changing. They see whatever it is that their heart yearns for.” A General Theory of Oblivion, Angola’s Jose Eduardo Agualusa, the second African to win the  International Dublin Literary Award (2017).

Angola, officially the Republic of Angola, is a west-coast country of southcentral Africa. It is the seventh-largest country in Africa, bordered by Namibia to the south, the Democratic Republic of the Congo to the north, Zambia to the east, and the Atlantic Ocean to the west. Angola has an exclave province, the province of Cabinda that borders the Republic of the Congo and the Democratic Republic of the Congo. The capital and largest city of Angola is Luanda.


Estimated number of preterm births per 100 live births  

Rate: 12.5% RANK: 44 (US Rate: USA – 12% Rank: 54


The National Health Service is run by the Ministry of Health, the Provincial Governments which run Provincial Hospitals and the Municipal Administrations which run Municipal Hospitals, Health Care Units and Posts. The Municipal Administrations are leading the primary healthcare network. Services are free, but very limited in rural areas. Medicine is regulated by the General Health Inspection and the National Directorate of Health which manage the National List of Essential Medicines. Medicinal products are regulated by the National Pricing System. Tendering for medical products is run by the Centralized Medicine Purchase Authority which also distributes medicine.

USAID reported that the Angolan government has not had much success in developing an effective health care system since the end of the 27-year-long Angolan Civil War in 2002. According to USAID, during the War as many as 1 million people were killed, 4.5 million people became internally displaced, and 450,000 fled the country as refugees. Due to lack of infrastructure and rapid urbanization, the government has been unable to promote programs that effectively address some of the basic needs of the people. Health care is not available in much of the country.

Some improvements were made after the end of the Civil War. According to UNICEF reports in 2005, 2% of the nation’s public expenditures were allotted to health care. That number increased after 2005. Larger problems include the shortage of doctors, the destruction of health care facilities throughout the country, and disparities between rural and urban primary care availability. Public spending on health decreased after 2014.

Census data reported by the CIA reveals that Angola has very few physicians to attend to the medical needs of its population. It is estimated that there are about 0.08 physicians per 1,000 people in Angola.  Due to the length of the Angolan Civil War, nearly an entire generation of Angolans was not given the opportunity to receive any education. This has led to a dramatic decrease of health workers and added to the poor maternal health problem. In response to the shortage of health workers, Cuban  physicians are currently working in the country to improve health overall, as well as to focus on improving maternal health.




Collaboration is the key to healing the planet, our Neonatal Womb preterm birth community, and all who inhabit our HOME … We are presenting perspectives, experiences, hopes, barriers and innovations that may enable us to use Telemedicine to positively impact  our global health care provider shortage. 


angola.spaceAngola is solving its rural health issue with TeleMedicine

By Space in AfricaDecember 7, 2018

In November, Huambo entered the history of telemedicine in Angola, as the first region in the country to have 10 interconnected municipalities, that is, patients who are in a given rural region of the province, where there is no specialized service, may, through telemedicine, conduct medical examinations, consultations or even emergency and emergency interventions without having to travel to the main hospital in urban areas.

The service reduces the patient’s movement and allows the patient to be prepared for a possible hospital transfer, if necessary, thereby increasing the safety and trust of the clinical staff of support hospitals in rural areas. It will also allow these physicians from the peripheries to receive distance education in the most diverse medical areas.

All this, according to His Excellency. the Minister of the Ministry of Telecommunications and Information Technologies, Eng. José Carvalho da Rocha, was only possible because within the framework of the Angosat Project, which has been developed, it has already begun receiving the compensations that are given by the Russian counterpart, where it has been receiving in terms of frequency capacity 144 MHz in the C band and also 144 MHz in the Ku band.

As a result of this capacity, MTTI, through INFRASAT, and in collaboration with the Ministry of Health, decided together to carry out this social project. His Excellencies: Governor of Huambo, Dr. Joana Lina Ramos Baptista, Minister of Health, Dr. Sílvia Paula Lutucuta, Secretary of State for Information Technologies, Eng. Manuel Homem, and other representatives of the different sectors participated in the event.

The project started in Huambo and the next provinces to benefit from the Telemedicine consultations are Moxico and Lunda Sul.

The inauguration of the telemedicine services in Moxico took place following the launch of the Nascer Livre para Brilhar campaign, an initiative led by the first lady of the Republic of Angola, Ana Dias Lourenço, in solidarity with the victims of HIV / AIDS, on the 1st of December.

The inauguration also counted on the presence of His Excellency, the minister of Telecommunications and Information Technologies, Eng. José Carvalho da Rocha, and His Excellency. Minister of Health, Dr. Sílvia Lutucuta, as well as Exm. Governor of Moxico, Gonçalves Muandumba, among other governmental entities and members of civil society.

According to Angop, with the inauguration of these services in the hospital, the patient can be taken care of independently of his geographical location, by a specialist who is outside his locality, especially in the specialties of pediatrics, cardiology and surgery.


uc.davis.jpgPediatric Telemedicine – Neonatal Intensive Care

Pediatric subspecialists from the UC Davis Children’s Hospital are immediately available to remote clinicians working in other hospitals that deliver newborns with unanticipated problems.

Pediatric subspecialists, including neonatologists, cardiologists, neurologists and geneticists are available for consultation in cases where newborns are experiencing problems in hospitals that do not have these specialists.

Often, as a result of these telemedicine consultations, infants are able to remain in their local hospital, eliminating the need to transport the infant away from their mother, families and community.

Dr. Kristin Hoffman pioneered the UC Davis NICU webcam program, which provides families with a way to view their infants remotely when they are unable to be in the NICU.

In 2019, UC Davis neonatologist Dr. Kristin Hoffman received a national award for her development of a webcam program in the neonatal intensive care unit (NICU), which enables parents to see their infants remotely when they are unable to be in the NICU.

The webcam program was made possible by a Children’s Miracle Network grant in 2014, and Hoffman was able to increase the number of webcam units and their reach, as well as upgrade the software through another grant in 2018.



*** In the State of Mississippi the preterm birth rate is the highest is the US (Rate 13.6%). Could access to telemedicine change these stats? It’s complicated … in the US… but fixable

Thirty-one of Mississippi’s 64 rural hospitals, or 48 percent, are at “high financial risk,” according to a national report of rural hospitals from independent consulting firm Navigant. This is more than double the rate nationwide, where just 21 percent are listed as being in danger of closing.


Until broadband access improves, telemedicine won’t help rural communities

Health News – May 20, 2019  – Linda Carroll

(Reuters Health) – Telemedicine has been touted as a solution to the dearth of doctors in rural America. But the same places where residents must drive many miles to see a physician often also have limited broadband access, a new study suggests.

About 25 percent of Americans live in rural communities while a mere 10 percent of physicians practice there, said the study’s lead author, Coleman Drake, an assistant professor in the department of health policy and management at the University of Pittsburgh Graduate School of Public Health. And making matters worse, people who live out in the country tend to be older and sicker than their urban counterparts.

“Over the last decade especially, there has been considerable interest in the potential for telehealth to make it easier to access healthcare,” Drake said. “We wondered if telemedicine really could help bridge the gap in access to care. And we discovered that in a lot of rural areas, the lack of access to broadband is potentially limiting access to telehealth.”

To see whether telemedicine could make a difference where doctors were sparse, Drake and his colleagues first mapped out the areas where access to primary care physicians or specialists might require driving an hour or more, according to the study published in the Annals of Internal Medicine.

Then, to determine access to broadband, the researchers turned to data from the Federal Communications Commission to find out whether people who lived in counties with distant drives to doctors had a way to download data at a speed of at least 25 megabits per second, which is sufficient to support video-based telehealth visits.

Drake and his colleagues discovered that the percentage of subscribers to broadband services decreased with increasing distance from cities, with rates of 96.0 percent in urban counties, 82.7 percent in rural counties and 59.9 percent in counties with extreme access considerations. Further, in counties where there was inadequate access to primary care physicians and psychiatrists (meaning no primary care provider within a 70-minute drive, for example) the subscription rate was 38.6 percent.

Even if the broadband issue were solved, it wouldn’t mean that all barriers to telemedicine would be overcome, Drake said. Right now, “Medicare, with few exceptions, doesn’t reimburse for telemedicine visits from home,” he explained.

What’s needed is for “policy makers at the local, state and federal level who are considering the cost effectiveness of infrastructure expansions to consider that you’re not just letting people get on social media in their spare time, you could also be allowing people to access telemedicine who might otherwise not be able to,” Drake said.

People often underestimate the broadband access problem, said. Dr. Peter Fleischut, chief transformation officer at NewYork-Presbyterian in New York City.

“Technology is not value neutral,” Fleischut said. “It’s critical as each new technology emerges to make sure that it doesn’t worsen disparities. That’s a problem with telemedicine if a segment of the population can’t access it because there isn’t broadband.”

And it’s not just rural counties that have this problem, Fleischut said. Some older buildings in urban areas present challenges, too, he added.

Broadband access isn’t the only issue. “There are always challenges to any new technology,” Fleischut said. “For example, there are regulatory issues involved when you’re crossing state lines. If you see a provider and then cross a state line going home, you can’t have a video visit if the provider isn’t also licensed in your state even though you can have a phone call with that provider. And that’s true even if you’re doing something as simple as a follow-up visit.”

SOURCE: Annals of Internal Medicine, online May 20, 2019.


In a related blog post dated Wednesday, May 22, 2019 titled Telemedicine can’t help rural America very much until broadband access improves, researchers conclude”

The researchers found that, in counties with inadequate access to primary care physicians and psychiatrists, the broadband subscription rate was 38.6%. And even if the broadband problem were solved, there are other barriers to telemedicine, according to lead author Coleman Drake: Medicare, with few exceptions, doesn’t reimburse for telemedicine visits from home.”



Telemedicine – Connecting Doctors

Doctors Without Borders India / Médecins Sans Frontières



Neonatology Telehealth Helped Save Baby William’s Life | SSM Health TeleNeonatology

intouch.angola.jpgInTouch Health – Published on Aug 29, 2017

Telehealth in neonatology allows pediatric specialists to provide virtual care to newborn infants directly in neonatal intensive care units. Neonatologists are now able to get to the patient’s bedside in minutes and provide life-saving treatments, when time is of the utmost importance.



Sibling Strong!


‘Long nights on the neonatal unit’a poem by SJ Bliss Baby Charity

The Essential Checklist for Bringing Your Preemie Home

Verywell is a proud partner of The Cleveland Clinic, the #2 rated hospital in the U.S., according to U.S. News and World Report.       By Trish Ringley, RN | Medically reviewed by a board-certified physician | Updated April 12, 2019

Without a doubt, the most asked question from preemie parents in every NICU, every day, everywhere, is “When will my baby come home?” It’s the one major milestone that every parent longs for, dreams of, obsesses over, and with good reason!

So would it surprise you to find out that when the big day finally comes, when weeks or months of waiting finally come to an end and it’s time to take their sweet bundle of joy home, many parents feel utterly freaked out and totally unprepared?

  • Parenting in the NICU (see full Article)
  • Getting Your Home Ready (see full Article)
  • Getting Your Support Team Ready (see full Article)
  • Getting Yourself Ready (see below)

Here’s something you may not have thought of before: parents of healthy full-term babies try to learn about baby care by hanging out with friends who have babies, or by attending classes, maybe reading books. But they don’t have their own baby to practice with. They don’t have any idea what their baby will actually like or dislike.

So, if there’s one thing to appreciate about the NICU, it’s that you have the opportunity to learn about your baby — your actual, very own baby — before taking him or her home. Lucky you!

We can’t begin to tell you how many parents don’t take the time to really learn their baby while they’re still in the NICU, for all sorts of reasons, good and bad. Maybe it’s NICU staff who keep parents at a distance, or maybe it’s a feeling that the nurses are better at it and should be the ones doing all the cares. Maybe it’s simply impossible to spend much time at the NICU when you have other children at home.

The best way to be ready for your baby at home is to dedicate some time to care for your baby while still in the NICU. Holding your baby is great, and changing diapers is great too, but I’m going to walk you through a bunch of ways you can get to know your baby even better. Then when you go home, you’ll be confident and in charge, like the super boss parent you’ve always dreamed you would be!

You’ll want to learn the following.

  • How to change your baby’s diaper. If you let the nurses know that you want to do as many diaper changes as you can when you’re there, you’re sure to get good at it in no time. Then that’s one less thing to stress you out when you take your baby home.
  • How to feed your baby. For some preemies, this is no big deal, and for others, it is nearly impossible to get them to safely and efficiently get all the milk they need to keep growing. Whichever is the case for your baby, you should be at the NICU practicing all of the different types of feeding you’ll do—breast, bottle, syringe, supplemental nursing system, whatever. You should ask to practice as much as possible, and get all of the help you can while you’re there. See the lactation consultants if you’re breastfeeding or see the occupational therapists or speech-language pathologists if your baby has complicated feedings. And practice, practice, practice.
  • How to take your baby’s temperature, and know what is normal for your baby.
  • How to bathe your baby. Let your nurses know that you want to practice bathing, and ask them to save bath time for you so that you can get the practice you need. All nurses have different ideas about the ideal way to bathe a baby, so be willing to try lots of different ways to see just what you and your baby like best.
  • How to swaddle your baby. Again, nurses have different styles, so try learning from lots of different people and you’re sure to find a few ways that work well for you. Again, the only way to get good at it is to practice.
  • How to mix your baby’s formula or fortified milk. Many preemies need to have extra calories in their diet, and that means parents have to know how to mix up the milk that they’ll be feeding their baby. Don’t wait until the last day to learn how to do this. Ask to help out with mixing up your baby’s milk early on, and you’ll soon become comfortable with the job.
  • How to give medications. If your baby will need any medications, such as multi-vitamins or reflux meds, be sure you have the nurses show you a few different ways to give them to your baby and then practice it yourself.
  • How to soothe your baby. Sometimes it’s hard to have other people telling you what your baby likes when she’s upset because you’d probably rather be figuring that out on your own, in the comfort of your own home. But NICU nurses have tons of experience helping upset babies, and some of them are sure to have figured out some things that work well with your sweet little one. Take the suggestions and use them as needed.
  • How to massage your baby. If you are lucky enough to have someone on staff who can teach you ways to massage your preemie, do it! Parents pay big bucks sometimes to have specialists teach them this, but you may have access to great teachers in your NICU.
  • Find out if you’ll need special equipment at home, and get the training you need. Some babies need special equipment such as oxygen and feeding tubes and will have home health care providers. If your baby will need any of these, try to find out as soon as possible. And start practicing with them as soon as possible! Do not wait until the last day or two to get comfortable with the equipment. Without a doubt, there will be goofs and confusions with any kind of home equipment and it’s better to work through those while you still have the NICU staff right there to help.
  • Infant CPR. Most parents, thankfully, will never need to use CPR skills, but it is a good feeling to know that you would know what to do in the event of an emergency. If your hospital does not have any CPR training available, ask them where you could take a class. 
  • Rooming In. Some hospitals allow rooming in, which is when parents stay at the hospital overnight or for several days, practicing complete independent care of their baby while still in the safety of the hospital setting. It’s great to do if it’s available.


“Hope lies in dreams, in imagination, and in the courage of those who dare to make dreams into reality”. Jonas Salk


OP.Angola  Trailer: Rwandan Neonatal Care and the Development of the Non-electric Infant Warmer GHWSP –OPENPediatrics  –  Uploaded on Apr 18, 2019

The Embrace Care is an affordable infant warmer that uses a phase-changing material to keep premature and underweight babies warm for hours without using electricity.


One Hospital’s Success with Early Adoption of the Healthy Work Environment Assessment Tool

Authors Patricia Hickey PhD, MBA, RN, NEA-BC, FAAN, Jean Connor, Dennis Doherty MSN, RN-BC, Kierrah Leger DNP, RN, Jason Thornton – Initial publication: April 16, 2019.

In this video, panelists discuss their research on the health of the work environment. They explain how they applied the Healthy Work Environment Assessment Tool across nursing specialties, and to other healthcare professionals.


In the You Tube below we bow to the contributions of the numerous neonatologists globally who have paved the way towards the development and provision of effective treatment for preterm birth babies.  We recognize the late Dr.  Jerold Lucey, a recipient of numerous honors and awards in pediatrics including the Virginia Apgar Award in Perinatal Pediatrics, the American Academy of Pediatrics Lifetime Achievement Award, the National Academy of Medicine Gustav O. Lienhard Award for Advancement of Health Care, the Alfred I. DuPont Award for Excellence in Children’s Health Care, and the John Howland Award. The Howland Award is the highest award given by the American Pediatric Society and is specifically for those who provide distinguished service to pediatrics as a whole. Dr. Lucey, the former Editor-in-Chief of Pediatrics  died on December 10, 2017. In the video Dr. Lucey provides us with insight into the process and time, planning and patience needed to research and  create effective new treatments in medicine.


NICU.University.jpgPublished on Jan 17, 204

An interview with Dr. Jerold Lucey (Founder of Hot Topics) conducted at the Hot Topics Meeting ( in December 2011 regarding the future of brain protection in the neonate.



Heart.angola.jpg HEALTH CARE PARTNERS    seth.angola.jpg

First milk expression within 8 hours related to lactation success for very low-birth-weight infants

Reviewed by James Ives, M Psych (Editor) May 10, 2019

A study led by physician researchers at Boston Medical Center has shown that first milk expression within eight hours of giving birth is associated with the highest probability of mothers of very low-birth-weight infants being able to provide milk throughout hospitalization in the neonatal intensive care unit. The study results, published in Obstetrics and Gynecology, help better inform perinatal providers and new mothers how to prioritize the many aspects of perinatal care after delivery of a very low-birth-weight infant.

Mother’s milk has many benefits for very low-birth-rate infants, including reduction of necrotizing enterocolitis, sepsis, and chronic lung disease, and improvement in later childhood development. However, mothers of very low-birth-rate infants often have challenges making milk. They are more likely to have complications during or after delivery and comorbid health conditions that affect milk production, such as diabetes. They are also more likely to be separated from their newborn for a prolonged period of time after birth.

Because of these challenges, lactation support for mothers of very low-birth-weight infants is crucial. The World Health Organization’s Baby-Friendly Hospital Initiative suggested milk expression within six hours after birth as one strategy for support. However, evidence for this time period is limited. In addition, milk expression within six hours can be difficult due to the need for intensive monitoring of newborns and/or mothers.

Mothers who have recently delivered very low-birth-weight infants have a number of competing needs. Our data-driven approach to determining optimal time of first milk expression can help providers balance the need for safe maternal care with effective support to create long-term lactation success.”

Margaret G. Parker, MD, MPH, a neonatologist at Boston Medical Center and the study’s corresponding author

The researchers used data from 1,157 mother-baby pairs in nine Massachusetts hospitals. The infants were all very low-birth-weight infants who spent time in the neonatal intensive care unit. They found 70 percent of infants whose mothers expressed first milk within eight hours of delivery were being fed any mother’s milk at discharge or transfer, compared with 52 percent of infants whose mothers expressed first milk 9-24 hours after delivery.

The authors note that given these results, randomized control trials are needed to further establish the causal relationship between timing of first milk expression and long-term lactation success among mothers of very low-birth-weight infants.



Next-Level Perinatal/Neonatal Comfort Care Training: Creating an Interdisciplinary Palliative Care Plan for Each Baby and Their Family


Register Now! Next Comfort Care Training in NYC: June 19-21, 2019. Scholarships available.

 The Next-Level Comfort Care Training is a three-day intensive training of seminars and hands-on activity sessions to provide an overview of the methods, elements, and strategies needed to create a comprehensive palliative care plan for the entire perinatal team.


nyp.jpgNeonatal Comfort Care-

New York Presbyterian HospitalLoading....Published on Sep 2, 2015

Video about neonatal comfort care at New York-Presbyterian-Morgan Stanley Children’s Hospital.



Monthly Clinical Pearl: Prenatal Consults by Neonatologists: A Challenging Part of What We Do

Joseph R. Hageman, MD.

First, I would like to provide a bit of historical perspective for your consideration. It is 1983 and, as neonatologists, we were having more conversations with our maternal-fetal medicine colleagues about extremely premature fetuses at around 24 weeks gestation as well as fetuses with prenatally diagnosed syndromes, chromosomal abnormalities, and congenital anomalies. What seemed to be novel was, with improvements in prenatal recognition and management, and the availability of surfactants and newer modes of assisted ventilation, there seemed to be more we could do to support and potentially improve the overall survival and quality of life of these fetuses before and after they were delivered. So we thought it would be a good idea to organize a multispecialty group or committee to evaluate these maternal-infant dyads and have thoughtful conversations with the parents. We organized a group and began to involve all of the disciplines that were involved in the evaluation of this group of patients. A lot of progress has been made since that time.

A lot of what I learned about each clinical condition was initiated when I was presented with a fetus or newborn who I was going to be caring for in the delivery room and in the neonatal intensive care unit (NICU). As a medical student when I had the opportunity to care for newborns with surgical problems, I learned from my supervisory residents and attending surgeons and the neonatologists. I usually did a bedside clinical conference as well, which included the development of the fetus and the anomaly (e.g., gastroschisis), the presentation in the delivery room with appropriate stabilization, then diagnosis with confirmation if the anomaly was internal (e.g., congenital heart disease), and management. I really enjoyed this care, which included discussions with the parents. This strategy continued during my residency, fellowship and, as an attending neonatologist.

What is interesting is that I think this basic strategy still applies.

  1. Gather the clinical information from the maternal-fetal medicine specialist and discuss a strategy of potential prenatal management, intrapartum and delivery room management. For many of the prenatally diagnosed clinical problems on the list above, preparation and discussion with the  parents are key portions of the management.
  1. Once the clinical plan has been worked out with all of the specialists involved with the evaluation of the fetus’ and the mother’s status, this is reviewed with the parents to confirm they agree with the plan.
  1. Make sure that everyone who will be in the delivery room knows and understands the plan. For example, if the fetus has micrognathia and will potentially be difficult to intubate with orally or nasally, or may need a tracheostomy, it will be important to have a pediatric otolaryngologist in the delivery room to evaluate the infant. Make sure the delivery room resuscitation area in the operating room is prepared with the necessary equipment.
  1. The anticipation of potential problems and their solutions once the baby is delivered is very important. As much as you prepare and anticipate, only so much can be determined prenatally.
  1. Make sure there is an ongoing conversation with the mother-father before, during and after the delivery of the infant.
  1. Preparation for whatever will need to be done once the infant is transported from the delivery room to the NICU is of the utmost importance.
  1. Once the baby is delivered and stabilized, it is important to show her/him to the mother and father and explain what has been done. Since close contact such as skin-to-skin contact may not be possible, the chance for the Mother to touch the baby or hold their hand is important.
  1. The clinical management once the infant is admitted to the NICU can be anticipated so that, if this is a surgical anomaly, the surgeons will know ahead of time and be present for immediate evaluation.
  1. If further diagnostic studies need to be performed, the neonatology team can alert the radiologist ahead of time so things can be organized for the scan, ultrasound, contrast study, MRI, etc. can be performed in a timely fashion.
  1. The plan for postoperative management is in place with the active management team alerted in advance. If they need to be in the delivery room, that can be arranged.
  1. Ongoing communication is of the utmost importance.

This summary is what I have learned beginning about 45 years ago and is based on a fair amount of clinical experiences with about one or more of every one of the clinical problems summarized in the list above.

Once we are aware of a fetus with a clinical issue and our involvement is required, preparation should begin as soon as possible. At present, there are databases to help give us an idea of the short and long term outcomes of fetuses and newborns we will be involved with caring for and it is important to have this information before having a series of discussions with the parents and colleagues. What is also clear from my own clinical experience is that each fetus, newborn and family is unique and I think it is best to also approach each clinical situation in this way.

References: *Data provided Dr. Kelly Nelson Kelly, Attending Neonatologist, University of Chicago.

Joseph R. Hageman, MD, Senior Clinician Educator, Pritzker School of Medicine


WHO.Angola.jpgExecutive Board designates 2020 as the Year of the Nurse and Midwife

30 January 2019, Geneva – The Executive Board, today, designated the year 2020 as the “Year of the Nurse and midwife”, in honor of the 200th birth anniversary of Florence Nightingale. This proposal will now be presented to Member States of the 72nd World Health Assembly for consideration and endorsement.

The year 2020 is significant for WHO in the context of nursing and midwifery strengthening for Universal Health Coverage. WHO is leading the development of the first-ever State of the World’s Nursing report which will be launched in 2020, prior to the 73rd World Health Assembly. The report will describe the nursing workforce in WHO Member States, providing an assessment of “fitness for purpose” relative to GPW13 targets. WHO is also a partner on The State of the World’s Midwifery 2020 report, which will also be launched around the same time. The NursingNow! Campaign, a three-year effort (2018-2020) to improve health globally by raising the status of nursing will culminate in 2020 by supporting country-level dissemination and policy dialogue around the State of the World’s Nursing report.

Nurses and midwives are essential to the achievement for universal health coverage. The campaign and the two technical reports are particularly important given that nurses and midwives constitute more than 50% of the health workforce in many countries, and also more than 50% of the shortfall in the global health workforce to 2030. Strengthening nursing will have the additional benefits of promoting gender equity (SDG5), contributing to economic development (SDG8) and supporting other Sustainable Development Goals.




MedicineNet  – PTSD Quiz: Test your IQ of Posttraumatic Stress Disorder

Reviewed by John P. Cunha, DO, FACOEP on October 31, 2017




I cherish the wisdom of Deepak! He is speaking to us, Warrior Family!                Deepak Chopra: ‘Technology is unstoppable, you can use it to improve your          well-being’

Published on Apr 8, 2019: Deepak Chopra discusses using technology and apps to keep calm, meditate and de-stress.


VISITE ANGOLA | “Praia dos Surfistas – Cabo Ledo”

tv.angolaTalatona TV – Published on Apr 10, 2019-

Fala a sério, não querias estar lá neste exacto momento!?
A Praia dos Surfistas é conhecida como a “Catedral do Surf” em Angola.
A sua beleza ímpar e o seu clima atraem turistas de todas as partes do mundo

WHO, Intuition & Dual Innovations





Estimated number of preterm births per 100 live births  Rate: 5.9% RANK: 174

(US Rate: USA – 12% Rank: 54)


Sweden, officially the Kingdom of Sweden is a Scandinavian Nordic country in Northern Europe. It borders Norway to the west and north and Finland to the east, and is connected to Denmark in the southwest by a bridge-tunnel across the Öresund, a strait at the Swedish-Danish border. At 450,295 square kilometres (173,860 sq mi), Sweden is the largest country in Northern Europe, the third-largest country in the European Union and the fifth largest country in Europe by area. Sweden has a total population of 10.2 million of which 2.5 million has a foreign background. It has a low population density of 22 inhabitants per square kilometre (57/sq mi). The highest concentration is in the southern half of the country.

Sweden ranks in the top five countries with respect to low infant mortality. It also ranks high in life expectancy and in safe drinking water. A person seeking care first contacts a clinic for a doctor’s appointment, and may then be referred to a specialist by the clinic physician, who may in turn recommend either in-patient or out-patient treatment, or an elective care option. The health care is governed by the 21 landsting of Sweden and is mainly funded by taxes, with nominal fees for patients.


PREEMIE STRONGweights.sweden

New studies confirm improved survival of extremely preterm babies

MARCH 26, 2019 by Ivan Couronne

Until the 1980s, doctors estimated the earliest gestational age a baby could be considered viable outside the womb was 28 weeks, Survival rates of extremely preterm infants have improved by leaps and bounds since the 1980s, with US and Swedish studies published this week providing new data on the trend.

Doctors previously estimated the earliest gestational age a baby could be considered viable outside the womb was 28 weeks, when they weigh around 2.2 pounds (one kilogram)—about 12 weeks short of the 40-week length of a normal pregnancy. Babies are considered premature under the 37-week mark.

But over the last nearly 40 years, that 28-week limit has steadily dropped, and now some babies delivered at 24, 23 or even 22 weeks (measured from their mothers’ last menstruation) are able to survive, even as they weigh 1.1 pounds or less.

A Japanese baby who weighed only 9.44 ounces (268 grams) when he was born at 24 weeks made headlines in February: he was headed home in good health after five months in the hospital.

“I’ve been in this business for 40 years, and I’ve seen the threshold of viability move back about one week every 10 years or so in my practice,” Edward Bell, a neonatologist at the University of Iowa Children’s Hospital, told AFP.

Sweden holds the world record for earliest neonatal viability: 77 percent of babies born between 22 and 26 weeks in 2014 to 2016 survived one year, up from a 70 percent about 10 years before, according to a study published Tuesday in the Journal of the American Medical Association (JAMA).

In those 10 years, Sweden standardized its procedures for neonatal advanced life support: immediate intubation at birth, administration of drugs and a quick transfer to a neonatal intensive care unit (NICU).

Nearly 90 percent of deliveries in Sweden now occur in one of six hospitals in the country that have top-level NICUs.

“Before, for a baby born at 22 or 23 weeks, an individual doctor could say that it is not worthwhile to do anything,” said Mikael Norman, coauthor of the Swedish study and a neonatologist at Karolinska University Hospital in Stockholm.

For infants younger than 22 weeks, the survival rate has improved from 3.6 percent to 20 percent over the last decade, and for those born at 26 weeks, eight in 10 survive.

US lags behind

Since the 1990s, there have been three major medical advances in the effort to improve premature infant survival.

Artificial surfactants help keep babies’ poorly developed lungs inflated when they exhale, while maternal steroid injections right before birth can speed up fetal lung development (growing as much in one day as what might usually take a week) and improved mechanical ventilation techniques also help premature babies.

These techniques are widely available in developed countries, but significant disparities remain—from country to country and even between various hospitals.

In Britain, France and the United States, about half of extremely preterm infants (less than 26 or 27 weeks) survive, according to studies conducted in the last few years.

And the US system is not equivalent to its Swedish counterpart. American health care is rife with inequalities that can play out in the level of antenatal care pregnant women in different demographics receive.

A study in JAMA shows that geographic racial segregation in the US manifests itself in health care, as premature black infants have a greater likelihood of being born in lower-quality hospitals.

But the survival rate is still improving, even in the very rare instance of babies who are born weighing under 14 ounces, the subject of a third JAMA study—focused on US data—published Monday.

Of infants born between 22 and 26 weeks and weighing less than 14 ounces in 21 US hospitals between 2008 and 2016, 13 percent survived—one of them weighed only 11.6 ounces.

At such a low gestational age, the risk of complications is much higher, as three fourths of children born that early show developmental delays at age two.

All told, “it tells you that survival is possible,” said Bell, a coauthor of one of the US studies.

“One can’t say clearly that these babies should be always resuscitated,” Bell said, “but parents deserve to have this information and probably should have a say in whether they’re resuscitated.”




Inaugural WHO Partners Forum launches new push for collaboration on global health

9 April 2019 – News release – Stockholm

To meet the world’s most pressing health challenges, WHO, governments and global health leaders today called for improved partnerships and resourcing to support WHO’s mission to deliver care, services and protection for billions of people by 2023. The inaugural two-day WHO Partners Forum opens Tuesday (9 April) in Stockholm and will be co-hosted with the Government of Sweden.

The meeting will result in a shared understanding of how to strengthen partnerships and improve effective financing of WHO, with an emphasis on predictability and flexibility.

Global leaders in health and development, representing the public sector, health partnerships and non-State actors, will come together to launch a new era of collaboration and innovation around WHO’s resource needs. Under the Organization’s Thirteenth General Programme of Work (GPW13), WHO needs US$14.1 billion between now and 2023.

“WHO is committed to leaving no one behind as we strive for the highest attainable standard of health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is building stronger and more strategic partnerships with governments, international organizations, philanthropies and the private sector to deliver on the health-related targets in the Sustainable Development Goals (SDGs).”

At the heart of the GPW13 are the “triple billion” goals of ensuring that by 2023, 1 billion more people are benefitting from universal health coverage, 1 billion more people are better protected from health emergencies, and 1 billion more people are enjoying better health and well-being.

Peter Eriksson, Sweden’s Minister for International Development Cooperation, says: “The first WHO Partners Forum is a historic moment for honest discussions on tackling modern global health threats. If the world is to meet current and future health challenges, we need to ensure WHO is equipped and supported to be able to lead the global response.”

Sweden’s Minister for Health and Social Affairs, Lena Hallengren, says great advances have been made in global public health in recent decades, but new threats are putting communities, countries and economies at risk.

“Countries and health partners alike must collaborate even closer to respond to health challenges,” says Ms. Hallengren. “Fighting antimicrobial resistance, combating disease outbreaks and providing essential health services for all are keys not only to improving people’s wellbeing, but also to promoting growth and development. Only by coming up with a sustainable model to respond to pressing health threats in all countries will we be able to deliver on the ambition of the SDGs.”

Other participants in the Inaugural WHO Partners Forum include leadership of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill & Melinda Gates Foundation, International Federation of Red Cross and Red Crescent Societies and Gavi, the Vaccine Alliance.



We love.sweden  CUBA cuba.sweden.jpg   

Kat and I want to express our humble gratitude, appreciation, respect for the medical community in Cuba, especially ELAM, the largest medical school in the world. Thank you ELAM for educating a robust global community of health care providers around the world, including US students, at a time when we are experiencing a global health care shortage crisis. The Cuban model for training  primary care physicians is a premier model, influencing healthcare education and care on all corners of the planet. The Neonatal Womb Warriers community is significantly impacted by the Cuban approach to maternal and infant care, an approach that reduces preterm birth as reflected in Cuba’s preterm birth rate 6.4% (per 100 births), Rank: 169 (USA Rate: 12.0%, Rank: 54, Global average 11.1%).


***See our 07/04/16 blog-World Warriors-Cuba-


MEDICC supports students and graduates of Havana’s Latin American School of Medicine (ELAM), the world’s largest medical school, educating socially committed physicians from low-income families in the USA and developing countries.

 MEDICC Deplores Latest US Move Against Cuba

Posted at 10:54hin MEDICC in the Media, Press Releases by medicc2016

April 19, 2019—This week the US administration announced more sanctions against Cuba, in a cruel move that puts at risk the health of people in both our countries. Building upon two MOUs in health signed under Presidents Barack Obama and Raúl Castro, scientists and health professionals had begun stepping up cooperation to address diabetes, cancer and other diseases, and prepare to jointly confront threats from new epidemics. Much hope for these initiatives was already dashed by stepped-up hostility from Washington under the current president, who has used drastic limitations in US visas to leave the MOUs in the “dead letter” box.

However, this week US national security adviser John Bolton went further. He announced the US would allow suits in US courts against foreign investors in Cuba if their investments involve Cuban-American properties nationalized by the Cuban government; cap the dollar amounts of family remittances to Cubans on the island; and further limit already-restricted travel by Americans to Cuba.

“This is a bitter day for all of us,” noted MEDICC Executive Director Dr. C. William Keck. “Not only do the new measures hurt ordinary Cubans, they also drive a wedge in the budding and all-important cooperation between our countries begun by professionals and researchers committed to our health.”

“Much can be learned from Cuba’s universal health care, as recently noted a Lancet editorial,” Keck said. “Cuba’s infant mortality, lower and with fewer disparities than our own, is one example. And Cuban biotech innovations could become a lifeline for US patients suffering an array of conditions, from diabetic foot ulcers to lung cancer.”

But, despite clear signals that the majority of Cubans and Americans—including Cuban-Americans—favor rapprochement, this administration is bent on undoing it and demonizing Cuba and the Cuban people in the process. This must beg the question: whose interests does this policy shift serve? Certainly not those of our health, in either country.



Domestic violence and preterm birth is an issue that deserves attention. Prevention of preterm birth is our number one goal because prevention is cost effective, humane, critically necessary and achievable. Identifying the diverse causes of preterm birth creates opportunity to develop policies, resources, treatments, interventions and guidelines focused on prevention. Reducing domestic violence is an issue we CAN impact.

Understanding Abuse and Preterm Birth: What Can Be Done?

April 02, 2019

More than 1 in 4 women experience domestic abuse. When a woman becomes pregnant, the frequency and severity of this abuse may be at risk of increasing (1). Domestic abuse has also been shown to increase a woman’s risk of delivering before 37 weeks, potentially putting her child in danger of lifelong complications. On the other side, early delivery is associated with an increased risk of maltreatment for infants born prematurely. Despite this pervasive link between domestic abuse and prematurity, it is rarely acknowledged in prevention education. For our March Collaboratory, we invited researchers, neonatologists and social workers to help us confront this challenging topic and lead a discussion on how we can all come together in the name of prevention.

The event, hosted at UCSF’s Mission Hall and moderated by Laura Jelliffe-Pawlowski, began with PTBi-CA epidemiologist Rebecca Bear, who provided a brief introduction to her work analyzing California hospital records. Bear explained that through her research she saw a correlation between a woman’s history of abuse and whether or not a person had a preterm birth. The results of her research indicated that the rates of preterm birth among women who had experienced abuse were nearly double than those who had not experienced abuse. However, this rate was not found once adjusting for variables such as age. Bear explained that the study was able to shed light on how health issues such as high blood pressure may be the indicator of stress that can be traced back to the violence and the preterm birth.

Human Service Agency Social Worker, Alexis Cobbins, shared her experience working directly with families who suffer from domestic violence and preterm birth. She explained that when child protective services removed a mother’s baby at birth because of the threat of violence from her abusive partner, “the babies’ attachment and bonding were disrupted. It was almost like she was suffering twice. Once from his abuse and then from child protective services – from their lens of keeping the child safe”. Though Alexis noted through her agency’s advocacy efforts they were able to reunite baby and mother, there needs to be a better understanding of how meet the mother’s needs of safety rather than focusing solely on the child.

Hector Santamaria, a social worker at the Human Service Agency, and Artanesha Jackson, a Clinical Social Worker at UCSF Benioff Children’s Hospital Oakland, also spoke about their experiences working firsthand with survivors of domestic violence how it related to their preterm births. Hector explained that what is needed is more than a specific intervention but rather, “a change in culture. I think it starts with those difficult conversations within our own families and our own communities.”

Liz Rogers, a Neonatologist and California PTBi researcher, spoke about how babies with complex medical needs are at greater risk of experiencing abuse or neglect and that babies who are born early are at risk of having complex medical needs.  Through her research, she was able to drill down to see which complications of preterm birth increased risk for non-accidental traumas, such as fractures, which indicates abuse or neglect. Rogers noted, “really across the board [of medical complications] there remained a significantly higher risk of non-accidental traumas.”





Randomized Trial of Platelet-Transfusion Thresholds in Neonates

Anna Curley, M.D., Simon J. Stanworth, F.R.C.P., D.Phil., Karen Willoughby, B.Sc., Susanna F. Fustolo-Gunnink, M.D., Vidheya Venkatesh, M.D., Cara Hudson, M.Sc., Alison Deary, M.Sc., Renate Hodge, M.Sc., Valerie Hopkins, B.Sc., Beatriz Lopez Santamaria, M.Sc., Ana Mora, Ph.D., Charlotte Llewelyn, Ph.D., et al.,  for the PlaNeT2 MATISSE Collaborators*

January 17, 2019 N Engl J Med 2019; 380:242-251 DOI: 10.1056/NEJMoa1807320


Platelet transfusions are commonly used to prevent bleeding in preterm infants with thrombocytopenia. Data are lacking to provide guidance regarding thresholds for prophylactic platelet transfusions in preterm neonates with severe thrombocytopenia.


In this multicenter trial, we randomly assigned infants born at less than 34 weeks of gestation in whom severe thrombocytopenia developed to receive a platelet transfusion at platelet-count thresholds of 50,000 per cubic millimeter (high-threshold group) or 25,000 per cubic millimeter (low-threshold group). Bleeding was documented prospectively with the use of a validated bleeding-assessment tool. The primary outcome was death or new major bleeding within 28 days after randomization.


A total of 660 infants (median birth weight, 740 g; and median gestational age, 26.6 weeks) underwent randomization. In the high-threshold group, 90% of the infants (296 of 328 infants) received at least one platelet transfusion, as compared with 53% (177 of 331 infants) in the low-threshold group. A new major bleeding episode or death occurred in 26% of the infants (85 of 324) in the high-threshold group and in 19% (61 of 329) in the low-threshold group (odds ratio, 1.57; 95% confidence interval [CI], 1.06 to 2.32; P=0.02). There was no significant difference between the groups with respect to rates of serious adverse events (25% in the high-threshold group and 22% in the low-threshold group; odds ratio, 1.14; 95% CI, 0.78 to 1.67).


Among preterm infants with severe thrombocytopenia, those randomly assigned to receive platelet transfusions at a platelet-count threshold of 50,000 per cubic millimeter had a significantly higher rate of death or major bleeding within 28 days after randomization than those who received platelet transfusions at a platelet-count threshold of 25,000 per cubic millimeter. (Funded by the National Health Service Blood and Transplant Research and Development Committee and others; Current Controlled Trials number, ISRCTN87736839.)


*** Follow-up: April 18, 2019 – N Engl J Med 2019; 380:1584-1585 DOI: 10.1056/NEJMc1902638

Collecting quality data is key: registries of babies treated for Retinopathy of Prematurity (ROP) can improve health, care, and science


Retinopathy of Prematurity (ROP) is a disease of the eye affecting preterm born babies. It is characterised by changes in the developing blood vessels of the retina (the light-sensitive layer in the back of the eye that sends visual signals to the brain). All preterm babies born before around 31 weeks of pregnancy or having a birth weight of less than 1,250g to 1,500g need to have eye examinations by a specialised eye doctor, called ophthalmologist, to check how the vessels in the eye develop.

This ensures that the development of ROP is detected early and can be treated if needed. Since there is a lag period after birth until ROP develops, the first screening usually takes place after four to six weeks following birth. It continues until the ophthalmologist can note that the vessels have fully grown in the outer parts of the eye and any ROP has resolved. Increasingly, photographs of the retina are being taken either by NICU personnel or by staff from the ophthalmology department for the ophthalmologist to evaluate the status of the eye and to document how the vessels develop.

From the point of view of our monthly topic “Data collection and documentation” in February, we are especially interested in the question, how single hospitals can evaluate their patients with retinopathy of prematurity, as they usually have only very few cases within a year. To provide all stakeholders with reliable information and outcomes, systematic collections of reliable data of quality registries focused on ROP for clinical research are of utmost importance as they help that different hospitals can evaluate their cases together and can compare the patients within a country, but even between countries.

We thus would like to present you two national ROP registries, the ROP registry from Germany and the SWEDROP registry from Sweden and talked to the medical experts in charge, Professor Andreas Stahl ( ROP registry), Head of Ophthalmology at the Greifswald University Medical Center, Germany, and Professor Ann Hellström, Professor in Pediatric Ophthalmology, Sahlgrenska Academy, from The Queen Silvia Children´s Hospital, Göteborg, Sweden, and Professor Gerd Holmström (register holder), Department of Ophthalmology at the University Hospital Uppsala, Sweden.

The German ROP registry is a collaborative network of academic institutions in Germany. It was created as a joint effort to acquire sufficient data of treated infants in a multicentre approach to analyse typical clinical features of infants, epidemiology, and treatment patterns of severe ROP.

SWEDROP is a national quality registry to evaluate screening and treatment for ROP in Sweden and to investigate possible modifications of the present screening guidelines. Almost all infants in Sweden born before a gestational age (GA) of 31 weeks are screened for ROP until the retina is fully vascularised, approximately at 40 weeks postmenstrual age (PMA). SWEDROP is organised through a steering committee where representatives from the University Hospitals (n=7) collaborate and are responsible to capture data from their regions.



Large Shortages in Primary, Specialty Physicians Seen by 2032

Kerry Dooley Young – April 25, 2019

There could be a shortage of 46,900 to 121,900 physicians by 2032, in both primary and specialty care, with burnout potentially affecting retirement timing and a trend toward shorter working hours contributing to the wide range of estimates, a new report shows.

The Association of American Medical Colleges (AAMC) on Tuesday released its latest outlook on the supply and demand for physicians, which was conducted by IHS Markit, a data analysis and market intelligence firm based in New York and London.

AAMC said in 2015 that it made a commitment to commission annual updates of national physician workforce projections. The 2019 report shows a dearth of primary care physicians by 2032, with a shortage of 21,100 to 55,200 seen in this field.

Among specialty care, the shortage is expected to be in the range of 24,800 to 65,800, including between 1900 and 12,100 medical specialists; between 14,300 and 23,400 surgical specialists, and between 20,600 and 39,100 other specialists such as pathologists, neurologists, radiologists, and psychiatrists, the report shows.

“The United States would need an additional 95,900 doctors immediately if healthcare use patterns were equalized across race, insurance coverage, and geographic location,” the AAMC states in a news release.

Physicians’ decisions on when to retire will play a key role in determining the extent of the future shortage, AAMC said. Physicians between ages 55 and 64 make up 27% of the active workforce, with those older than age 65 accounting for another for 15% of it.

“Thus, over 40% of the physician workforce is at risk for retiring over the next decade,” the AAMC report shows.

And, the toll of burnout on physicians could lead some to accelerate retirement plans, the report authors said, citing Medscape data. The 2018 Medscape National Physician Burnout and Depression Report found 42% of physician respondents reported burnout as a result of causes such as long work hours and excess bureaucratic tasks.

AAMC said it is fielding a physician survey this year to collect data about physician retirement patterns and physician work patterns. This information is intended to address questions of whether high levels of physician burnout may accelerate retirement plans or lead to reduced work hours.

Other issues that AAMC highlighted for further research include the effects of an expected increased supply of physician assistants (PAs) and advanced practice registered nurses (APRNs). It is also still unclear how an expected rise in the number of retail health clinics may affect demand for physicians, the report authors said.

The report noted the potential impact of “a trend toward physicians of all ages working fewer hours.” It added that the decline in hours worked appears “particularly large when comparing recent hours-worked patterns of younger physicians relative to physicians of a similar age a decade ago.”





28 weeker micro preemie-Willie’s first diaper change with Mommy

Naturally boost oxytocin levels for Neonatal Bonding | Living Healthy Chicago

LHSweden.jpgLivingHealthyChicago Published on Mar 11, 2019

Oxytocin is naturally occurring hormone that plays a role in social bonding. Today Jackie learns about scent clothes that are helping babies who spend time in the NICU bond with their parents! Find out why scent cloth hearts are making a big difference for the very youngest of patients. Living Healthy Chicago is a health and wellness program that airs Saturday mornings at 9am on WGN. We aim to educate and inspire our viewers to live healthier lives.

One year update after the opening of the NICU in the Teck Acute Care Centre

October 29, 2018

One year ago today, 110 patients were moved into the new Teck Acute Care Centre (Teck ACC) in just five hours. Use this image as both the current Page Image and for News listings.

It was a truly awe-inspiring feat and an auspicious beginning for the newest health-care facility on the BC Children’s Hospital and BC Women’s Hospital + Health Centre campus on Oak Street in Vancouver.

The Singhs were one of a few families who transitioned from the old Neonatal ICU (NICU) to the new one with the opening of the Teck ACC. Baby Harmeher Singh weighed just 450 grams when he was born prematurely. Harmeher and his family experienced an immediate, positive change in both care and environment between the two vastly different spaces.

“Harmeher means God’s blessing, and he truly is God’s blessing to us,” said Harmeher’s mother, Bubblepreet Randhawa. “We’re so thankful that the NICU team saved him and to have been in this bigger private room, where my husband spent the night here and Harmeher’s big brother was able to come visit to spend more time with his baby brother and share mommy-time.”

We’re happy to announce Harmeher is a thriving 13-month old (true age); his corrected age is nine and a half months. He is very intelligent and loves to play with his brother, Gurmeher. “Again, we are so grateful he is healthy and for the care he received. Thank you!”

“The BC Women’s NICU is North America’s first purpose-built unit of its kind, where mothers receive their postpartum care in the same room, from the same NICU nurse, as their newborns who need neonatal intensive care so that these mothers and babies need not be separated after birth,” said Cheryl Davies, chief operating officer, BC Women’s Hospital + Health Centre. “New and expectant mothers and their newborns now have state-of-the-art facilities in the new Teck ACC—an environment that supports our medical care providers and staff to provide the best patient care possible.”

The Teck ACC houses a range of patient care services, including the labour and delivery unit for complex pregnancies, expanded dedicated obstetrical surgical suites, blood transfusion services, centralized medical equipment depot and sterile processing services, the Emergency Department, and more than 200 private patient rooms supporting patient- and family-centred care.

Benefits for patients and their families in the new building are more natural light and access to therapeutic outdoor spaces, and amenities like kitchenettes, laundry, family lounges and play areas.

The Teck ACC is part of the BC Children’s and BC Women’s Redevelopment Project to improve care at BC Children’s and BC Women’s hospitals.


The Teck Acute Care Centre at BC Children’s Hospital – Video Tour with Michael Bublé    

music.swedenBC Children’s Hospital Foundation Published on Oct 26, 2017

bckids.swedenTake a tour of the Teck Acute Care Centre at BC Children’s Hospital, hosted by Michael Bublé. Patients’ and their families’ entire journey—of body, mind and spirit—has been planned and designed in extraordinary detail.



EFONI.Sweden.jpgNew series on cohorts of the Research on European Children and Adults born Preterm (RECAP preterm) project


Our new series presents the cohorts of the EU-funded project „Research on European Children and Adults born Preterm“ (RECAP preterm), which aims at contributing to a better understanding on the long-term effects of preterm birth and thus to an improvement of the follow-up of these children. A research cohort is a group of people who share a defining characteristic, e.g. in the case of RECAP preterm, the cohorts consist of children (and later adults) born very preterm or with very low birth weight (VPT/ VLBW cohorts). This group is then accompanied over time to research the different consequences of preterm birth that can occur. RECAP preterm brings together Europe’s strongest pregnancy, child to adult cohorts and a highly experienced group of organisations and individual researchers.

We start with the ESTONIA I & II cohorts and are delighted to present you a guest article by the expert in charge, Dr Heili Varendi from the University of Tartu.

A guest article by Dr Heili Varendi, associate professor and neonatologist at University of Tartu

The main idea for the cohorts collected in Estonia was to fill a gap – by 2006 there was no national population-based data available about the outcome of very preterm births (VPT) after 7 postnatal days in Estonia. The aim was to collect nationwide data and create a system to assess quality of perinatal and neonatal care.

(c) Dr Heili Varendi, University of Tartu

Paediatricians from three 3rd level maternity units and two regional children hospitals in Estonia initiated a national pilot register for all sick newborns in 2007 – 2008. We also prepared national guidelines for follow-up of high-risk (incl. very preterm) infants until 2 years, that was published in 2008 and had been implemented in 2009. To prepare for these activities, our team collected good examples from Finland and Sweden.

Along with the pilot register, a prospective population-based study of very preterm infants born in 2007-2008 (n= 360) was carried out with follow-up at 2-years corrected age for all VPT (n=155) and at 5 years for a subgroup (n=49) born <1000g and <29 weeks gestational age (Estonia II). For the historical control group, retrospective national perinatal-neonatal data were collected for all very preterm births (n=264) in 2002-2003, and at 5 years assessed the health and development of the subgroup (n=61), born <1000g and <29 weeks GA (Estonia I). We have also collected data about health costs and use of health care resources for all these groups (Estonia I and II, n=624) from birth until 5 years.

Challenges in data collection were: lack of resources (e.g. Tallinn Town Government supported creation of the first database but all paediatricians collected perinatal data on voluntary basis; we applied for a research grant but only received 50% of the requested rate).

It was challenging to select tests for assessment of development; most of the available tests were not translated nor validated in Estonian and Russian.

During last 10 years we have worked to achieve a systematic data collection for high risk newborns from birth to preschool age, and finally, in 2019 we’ll get the opportunity to have a chart for very preterm infants until discharge or 44 postmenstrual weeks included in the Estonian Medical Birth Registry.

Results: With these two cohorts we could see changes in perinatal and neonatal care and outcome of very preterm infants in Estonia. We had the opportunity to compare Estonian results internationally and provide feedback to obstetricians and specialists in neonatal care. We saw positive trend in increase of survival without concomitant rise in severe neonatal morbidity and long-term disability. But we faced different unexpected problems in child development at preschool age. Based on these results we could recommend prolongation of follow-up activities and interventions to extremely preterm children beyond 2 years, until school age.

With our cohorts we hope to help the families with very preterm deliveries by demonstrating what the potential prognosis of their VPT children is to survive and develop until preschool age.






Brilliant Duo’s Affordable Innovations Are Saving Lives of ICU Patients & Preemies!

In a country where 37 per cent of patients on mechanical ventilators get pneumonia and where 50 per cent of babies are born away from well-equipped hospitals, these medical marvels are proven life-savers.

by Tanvi Patel March 1, 2019, 3:56 pm

Nitesh Jangir grew up in Shivnagar village, Rajasthan.

Nachiket Daval, a son of a now-retired naval officer, lived in many parts of India due to the nature of his father’s profession.

Despite their different backgrounds, the two friends-cum-business partners have similar experiences with regards to the prevalent healthcare system in India at both village and district levels.

Nachiket and Nitesh saw upfront how the lack of medical facilities—existing and advanced—spelled doom for the people awaiting their turn at the Primary and Secondary Healthcare Centres.

While Nitesh went on to study engineering, Nachiket pursued design. But, always present back of their minds were the patients sitting at the hospitals waiting for treatments they could neither access and frankly, nor afford.

One of Lung India’s studies found that 37.5 per cent patients on mechanical ventilators in Indian ICUs catch pneumonic infections. In a large number of cases, such infections can be life-threatening.

Another shocking find stated that out of all children born, 53 per cent die under the age of 5 years during the neonatal stage. These studies propelled Nitesh and Nachiket to search for solutions.

And COEO Labs was the result.

Nitesha and Nachiket’s company makes medical devices with the aim to meet the medical needs in critical care. Together, they designed two devices; Saans—a low-skill, low-cost, neonatal Continuous Positive Airway Pressure (CPAP) device and VAPCare– an intelligent secretion management device to prevent ventilator-associated pneumonia (VAP).



On a night shift at the hospital we saw an auto come into the emergency department. Three people came out of the auto carrying a new-born. The doctor’s started the medical procedure immediately but they couldn’t save the baby,” Nachiket tells TBI.

The friends later found out that the baby had been a premature who suffered complications due to severe lack of oxygen. Lack of appropriate medical support at the hospital where the baby had been delivered, and the time it took to transfer the baby to another hospital proved fatal for the infant.

In a country where about half of the children born are, at the most, 5-10 km away from a care centre, the number of babies who die due to lack of medical facilities is staggering.

Sometimes deliveries may not always be in a hospital with respiratory support systems for premature babies. In some cases, well-equipped ambulances may do the needful but what of those who cannot afford to wait for an ambulance or where the ambulance too, is does not have the necessary equipment?

“Currently, all neonatal CPAP machines (including bubble CPAPs) require electrical power or compressed gases to function—neither of which is easily available in primary care centres, or during transport in low-resource settings,” says the COEO team.

Saans is the world’s first neonatal CPAP device that can be powered in multiple ways – through direct source electricity (including a vehicle’s electrical supply), a rechargeable battery, compressed gas, or even manual air pumping.

When there is a power cut, as is very frequent in many parts of India and Saans can be operated manually with the help of a standard Bag Valve Mask bag (BVM) (a manual resuscitator) fixed to it. The system, patented by COEO, converts a variable flow of the BVM bag to a continuous and controlled airflow.

Saans, which took over three years testing and finalisation, has already started showing results. Nitesh shares a story which has a permanent place in the team’s heart.

“We deployed a Saans device to a low-resource hospital in Kolar, Karnataka. This hospital has a high volume of premature births but lacks infrastructure to support the existing CPAP machines. A few days after we gave them the device, we got a message from the doctor saying that there was a premature baby admitted to the hospital,” says Nitesh.

The doctor said that they had tried everything they could to save the baby. When nothing else worked, they tried Saans and the baby’s condition improved within two hours. At night, during a power cut, the device continued to work thanks to its manual settings.

“The doctor messaged saying that the baby survived because of Saans and he congratulated the whole team for developing the device.”




Some people say there’s nothing new under the sun. I still think that there’s room to create, you know. And intuition doesn’t necessarily come from under this sun. It comes from within- Pharrell Williams

KAT’S CORNER      cats.corner.swede.jpg

Intuition guided my mom, brother Seth and I to adopt our PTSD cat Gannon. We had been dealing with a rat problem in our garage which my mom, my sister Ciara and I had  passionately attempted to get rid of, but the rats out-smarted us every step of the way. None of us consider ourselves “cat people”(we love big dogs!) but my brother Seth is and had been looking for a cat after his had passed. Thinking a cat may solve the rat issue and that Seth may enjoy a new member of the family one day my mom casually looked at cat adoption information. Scanning cat pictures and bios she was completely taken by Gannon’s handsome and intelligent face, his history of rehabilitation at a local prison and his PTSD status. Gannon, a mane coon – mackerel tabby had been living in the pet store for over a year. Mom located the adoptable cat and we drove to see him late that evening. For my mom and me it was deep love at first sight. Excitedly we informed Seth about Gannon and started a plan for adoption. When we contacted management about adoption, they informed us they wanted Gannon to go to a man. Seth came up from California to finalize the adoption process. A week later we welcomed Gannon into our family and the rest is history. It has taken hard work to create an environment where Gannon (Ganzie) feels safe. His PTSD habits are very similar to our own. He shows us every day he appreciates us, and he demands to lick and clean our hands and give us love bites in exchange for our petting, massages and care. He heals us as we support his healing. Intuition at it’s best……

Nikola Tesla’s Secret of Intuition- Bright Insight

nicola.swedenPublished on Mar 11, 2017

Nikola Tesla utilized an incredibly powerful combination of Intuition and creativity to develop his inventions. Tesla spoke of the energies of the Universe, Frequency and how Intuition made his inventions possible. Tesla utilized Intuition to create his inventions, and established more than 700 patents around the world. Yet, mainstream science seems bent on suppressing this incredible knowledge.


Surf city winterjam 2012 / Varberg

Jonah Lake-Loading…Published on Dec 10, 2012

This is a short mix of a surf gathering/competition held in Varberg Sweden the 9th of December. It’s probably one of, if not, the coldest surfevent ever held in the world. In the morning the temp was below -14´C and some part of the ocean close to shore was ice. During the comp it got warmer up to -4,5´C. Surfers from Sweden, Peru, Costa Rica and Panama entered the competition.

Helsingborg Sweden