BABY BEHAVIORS. HAPP-E, OUR STORIES!

Netherlands.1

NETHERLANDS

Preterm Birth Rates – Netherlands

Rank: 127 –Rate: 8% Estimated # of preterm births per 100 live births (USA – 12%)

https://www.marchofdimes.org/mission/global-preterm.aspx

The Netherlands (Dutch: Nederland, informally Holland, is a country in Northwestern Europe with some overseas territories in the Caribbean. In Europe, it consists of 12 provinces that border Germany to the east, Belgium to the south, and the North Sea to the northwest, with maritime borders in the North Sea with those countries and the United Kingdom. Together with the Caribbean NetherlandsBonaire, Sint Eustatius and Saba—it forms a constituent country of the Kingdom of the Netherlands.

Healthcare in the Netherlands can be divided in several ways: firstly in three different echelons; secondly in somatic versus mental healthcare; and thirdly in “cure” versus “care”. Home doctors form the largest part of the first echelon. Being referred by a first echelon professional is frequently required for access to treatment by the second and third echelons, or at least to qualify for insurance coverage for that treatment. The Dutch health care system is quite effective in comparison to other western countries but is not the most cost-effective.

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

Spring Solstice is March 19th this year! Wishing you all Health, Happiness, and Great Adventures Spring 2020!

N.4

COMMUNITY

A simple solution for healthier premature babies?

       CBS    CBC News: The National    Published on Feb 12, 2018

Is there a simple solution to improve the health of premature babies? A new Canadian-led study suggests there is. The study’s results showed that by simply getting a premature baby’s parents involved in the care process sooner, the baby gained 15 per cent more weight. There was also another effect — the parents also showed less stress.

 

mask

Nine News Melbourne MCG Masquerade Ball 2020 event preview: Unmasking Preterm Birth

Published on Jan 20, 2020

Melbourne’s health, sporting, business and philanthropic community is set to usher in autumn in grand style as it unites for a highly anticipated event at the MCG to benefit mothers and babies at risk of preterm birth. WIRF provides world leading research into the prevention of pre-term birth. An issue that causes more death and disability in children than any other. With your support we can help our WIRF continue their life-saving research.

 

Psychosocial developmental trajectory of a cohort of young adults born very preterm and/or with a very low birth weight in the Netherlands

Published: 07 March 2019

Abstract:

The achievement of age-specific developmental milestones in youth is of great importance to the adjustment in adult life. Young adults who were born preterm, might go through a different developmental trajectory and transition into adulthood than their peers. This study aimed to compare the psychosocial developmental trajectory of young adults who were born preterm with peers from the general population. Young adults from the POPS (Project On Preterm and Small for gestational age infants) cohort study, born in 1983 in the Netherlands, completed online the Course of Life Questionnaire (CoLQ – achievement of psychosocial developmental milestones) at 28 years of age. Analysis of variance by group, age and gender was performed to test differences on the CoLQ scale scores between the POPS-group and 211 peers (25–30 years) from the general population (Ref-group). Differences on item level, representing the achievement of individual milestones, were analyzed with logistic regression analyses by group, age and gender.

Results

The POPS-group (n = 300, 32,3% biased response) scored significantly lower than the Ref-group on the scales Psychosexual Development (effect size − 0.26, p < 0.01), Antisocial Behavior (ES − 0.44, p < 0.001) and Substance Use & Gambling (ES − 0.35, p < .001). A further exploration on item-level revealed, among others, that the POPS-group had their first boyfriend/girlfriend at later age, were more often single, misbehaved less at school and smoked, drank and gambled less than the Ref-group. On the scales Autonomy Development and Social Development no differences were found between the POPS-group and the Ref-group.

Conclusions

A relatively less vulnerable respondent group of young adults born preterm showed some psychosocial developmental trajectory delays and might benefit from support at teenage age. Because of the non-response bias, we hypothesize that the total group of young adults born preterm will show more severe psychosocial developmental problems.

Journal of Patient-Reported Outcomes volume 3, Article number: 17 (2019)

Source: https://jpro.springeropen.com/articles/10.1186/s41687-019-0106-5

 

intergrowth

Introducing the INTERGROWTH-21st clinical tools in IBADAN, Nigeria

Following the successful visit to Oxford last year of Dr Yetunde John-Akinola (Faculty of Public Health, College of Medicine, University of Ibadan), who spent 6 weeks with the INTERGROWTH-21st team on an AfOx Visiting Fellowship, Professor Stephen Kennedy visited the University and University College Hospital, Ibadan, Nigeria, in January 2020. His visit was hosted by Dr John-Akinola and Dr Idowu Ayede (Department of Paediatrics, College of Medicine, University of Ibadan).

Professor Kennedy led a 2-day ‘training-the-trainers’ workshop attended by obstetricians, neonatologists, nurses and midwives, who completed the two INTERGROWTH-21st and three INTERPRATICE-21st online modules (participants pictured below with their certificates after successfully completing the course). These trainers will now go on to spread the use of the clinical tools further.

The University and University College Hospital have, in principle, committed to implement the INTERGROWTH-21st tools into routine obstetric and neonatal practice, with a focus on: 1) estimating gestational age accurately with ultrasound; 2) assessing size at birth, and 3) monitoring preterm postnatal growth, all with the INTERGROWTH-21st Standards, as well as 4) promoting exclusive breastfeeding because the national rate is currently only 17%. Their commitment is evidenced by allocating space in their newly built research institute to the project and funding two research nurses to support the project there.

The unmet need in Nigeria is massive: 27 newborns die every hour in the country.

https://intergrowth21.tghn.org/introducing-intergrowth-21st-clinical-tools-ibadan-nigeria/

face

INNOVATIONS

New study HAPP-e is looking for participants from all over the world

Posted on 04 February 2020

happe

Copyright INESC TEC and ISPUP

Studying the health of adults born preterm is the aim of the EU-funded study HAPP-e, which has been recently launched. Focus point of HAPP-e is an electronic cohort. Researchers will follow a group of adults born preterm over a longer period of time and study the participant’s health and life conditions.  Both recruitment and follow-up of will entirely be performed using digital tools, such as a web-platform.

This makes the study less expensive than traditional cohort studies, which rely on face-to-face interviews, and make large-scale studies possible. Moreover, this approach is more convenient, since the participants can stay at home.

If you

  • are more than 18 years old
  • were born prematurely (less than 37 weeks of gestation
  • and have an email address

please participate in this study. For more information about HAPP-e and /or registration go to: https://happ-e.inesctec.pt/

Source: https://www.efcni.org/news/new-study-happ-e-is-looking-for-participants-from-all-over-the-world/

 

EFONI

Lifeline for preterm babies – funding announced for new stem cell research

POSTED ON 20 JANUARY 2020

What role can stem cells play in regenerating a damaged brain caused by preterm birth? The new project PREMSTEM, in which EFCNI is taking part, researches if stem cells can be used to regenerate the brain damage caused by preterm birth. To ‘rebuild’ the damaged areas of the brain, scientists will use human mesenchymal stem cells (H-MSC) – those taken from umbilical cord tissue as opposed to human embryonic stem cells (hESC).

PREMSTEM, which was launched in January, consists of fifteen partners from eight countries and involves world-leading clinicians, researchers and healthcare organisations specialised in neonatology in both Europe and Australia. Together with the Cerebral Palsy Alliance from Australia EFCNI’s role is to present preterm infants and their families in this project.

PREMSTEM is funded by the European Union’s Horizon 2020 Research and Innovation program, Grant Agreement number 874721.

Source: https://www.efcni.org/news/lifeline-for-preterm-babies-funding-announced-for-new-stem-cell-research/

 

PMC

Large-for-gestational-age fetuses have an increased risk for spontaneous preterm birth.

Journal of Perinatology : Official Journal of the California Perinatal Association, 01 Apr 2019, 39(8):1050-1056

Abstract 

OBJECTIVE:

Our aim was to investigate the association between large-for-gestational-age and the risk of spontaneous preterm birth.

STUDY DESIGN: We studied nulliparous women with a singleton gestation using data from the Dutch perinatal registry from 1999 to 2010. Neonates were categorized according to the Hadlock fetal weight standard, into 10th to 90th percentile, 90th to 97th percentile, or above 97th percentile. Outcomes were preterm birth <37+0 weeks and preterm birth between 25+0-27+6 weeks, 28+0-30+6 weeks, 31+0-33+6 weeks, and 34+0-36+6 weeks.

RESULTS: We included 547,418 women. The number of spontaneous preterm births <37 weeks was significantly increased in the large-for-gestational-age group ( > p97) compared with fetuses with a normal growth (p10-p90) (11.3% vs. 7.3%, odds ratio (OR) 1.8; 95% CI 1.7-1.9). The same results were found when limiting analyses to women with certain pregnancy duration (after in vitro fertilization).

CONCLUSION: Large-for-gestational-age increases the risk of spontaneous preterm delivery from 25 weeks of gestation onwards.

Source: https://europepmc.org/article/med/30940928

 

docs

HEALTH CARE PARTNERS

Mild maternal thyroid dysfunction increases preterm birth risk

Cappola AR, et al. JAMA. 2019;doi:10.1001/jama.2019.10159.

Korevaar TIM, et al. JAMA. 2019;doi:10.1001/jama.2019.10931.

August 20, 2019

Pregnant women with mild thyroid dysfunction, such as subclinical hypothyroidism, isolated hypothyroxinemia or thyroid peroxidase antibody positivity, are more likely to deliver preterm when compared with euthyroid women, according to a meta-analysis of 19 cohort studies published in JAMA.

The analysis of individual patient data from more than 47,000 participants, conducted by the Consortium on Thyroid and Pregnancy — Study Group on Preterm Birth, is the largest study of its kind conducted to date, according to researchers, and suggests that subclinical hypothyroidism, isolated hypothyroxinemia and thyroid peroxidase antibody (TPOAb) positivity in pregnant women are risk factors for preterm birth.

“These findings validate a reflex TPOAb measurement for women with a [thyroid-stimulating hormone level] above 4 mU/L and also imply that it is important to actively plan to assess early gestational thyroid function tests in women known to be TPOAb-positive preconception,” Tim Korevaar, MD, PhD, a translational epidemiologist at the Academic Center for Thyroid Diseases at Erasmus Medical Center in Rotterdam, the Netherlands, told Endocrine Today. “Our results showing a higher risk for very preterm birth in TPOAb-positive women, especially when the TSH is above 4 mU/L, seem to echo the current American Thyroid Association guidelines. Our results showing that isolated hypothyroxinemia is a risk factor for both preterm and very preterm birth was most surprising, although further studies are needed to identify the causality of this association.”

Korevaar and colleagues analyzed data from 19 prospective cohort studies conducted through March 2018 with unselected participants with available data on thyroid hormone and TPOAb status, as well as data on gestational age at birth (n = 47,045; mean age, 29 years; median gestational age at blood sampling, 12.9 weeks). Researchers excluded studies in which participants received treatment based on abnormal thyroid function tests. Primary authors provided individual participant data that was analyzed using mixed-effects models.

Within the cohort, 1,234 women (3.1%) had subclinical hypothyroidism, 904 women (2.2%) had isolated hypothyroxinemia and 3,043 (7.5%) were TPOAb positive. The primary outcome of preterm birth, defined as delivery at less than 37 weeks’ gestational age, occurred in 2,357 women (5%). Very preterm birth occurred in 349 women (0.7%).

Preterm birth risk

In analyses adjusted for maternal age, BMI, race, smoking status, parity, gestational age at blood sampling and fetal sex, women with subclinical hypothyroidism were 29% more likely to deliver preterm vs. euthyroid women (95% CI, 1.01-1.64; absolute risk, 6.1% vs. 5%). Women with isolated hypothyroxinemia were 46% more likely to delivery preterm vs. euthyroid women (95% CI, 1.12-1.9; absolute risk, 7.1% vs. 5%) and women with TPOAb positivity were 33% more likely to deliver preterm vs. women who were TPOAb negative (95% CI, 1.15-1.56; absolute risk, 6.6% vs. 4.9%).

In prespecified sensitivity analysis, the association between subclinical hypothyroidism and preterm birth was no longer statistically significant after additional adjustment for TPOAb positivity, the researchers wrote.

The researchers noted that the association of TPOAb positivity with preterm birth did not appear to be related to differences in thyroid function, but was modified by the TSH level, exemplified by the higher risk for preterm birth in TPOAb-positive women with a TSH level above 4 mIU/L.

“This study is probably the best evidence that we will have on the association of maternal thyroid function or TPOAb positivity and very preterm birth,” Korevaar said. “This is because very preterm birth is a rare outcome, yet the consequences on child health are enormous.”

Universal screening not justified

In commentary accompanying the study, Anne R. Cappola, MD, ScM, of the division of endocrinology, diabetes and metabolism at the Perelman School of Medicine at the University of Pennsylvania, and Brian M. Casey, MD, of the division of maternal and fetal medicine at the University of Alabama at Birmingham, wrote that the study findings should not be used to justify universal screening of pregnant women.

“Assuming that residual confounding did not affect these estimates and that the links were causal and would be completely reversed by early identification and treatment, how many additional preterm births could be prevented by screening with these three blood tests?” Cappola and colleagues wrote. “Based on this analysis of 47,045 women, an estimated 17 preterm births in those with subclinical hypothyroidism, 21 preterm births in those with isolated hypothyroxinemia and 49 preterm births in [TPOAb]-positive women might have been prevented. Even under these idealized assumptions, these estimates represent a relatively small potential yield given the very large screening effort required, especially when considering contemporary advances in obstetrical and neonatal care in managing late preterm delivery and that only 15% of preterm births in this analysis occurred at less than 32 weeks’ gestational age.”

Cappola and colleagues noted that subclinical hypothyroidism identified during pregnancy may not truly represent thyroid hormone inadequacy, adding, “It is time to trust the findings of the major clinical trials, move past consideration of screening for and treatment of mild thyroid testing abnormalities detected during pregnancy, and focus instead on determining their physiological context.” – by Regina Schaffer

Source: https://www.healio.com/endocrinology/thyroid/news/online/%7B59d1641c-f392-4adb-98ae-03bde28f3783%7D/mild-maternal-thyroid-dysfunction-increases-preterm-birth-risk

Series of RECAP cohorts – part 6: Follow-up of the POPS cohort in the Netherlands

Posted on 13 September 2019

Dr Sylvia van der Pal & Professor Erik Verrips

In 1983, a unique nationwide cohort of 1.338 very preterm (below 32 weeks of gestation) or VLBW (birth weight below 1500 g) infants in the Netherlands was collected and followed at several ages; the POPS (Project On Preterm and Small for gestational age infants) cohort. The studies with the POPS cohort have provided insight into how Dutch adolescents who were born very preterm or VLBW reach adulthood.

At 19 years of age a more extensive follow-up study was done for which the POPS participants visited the academic hospital closest to their home. The 19 year examination included questionnaires, tests on a computer and a full physical exam. At 19 years, 705 POPS participants participated (74% of 959 still alive).

The POPS participants showed more impairments on most outcome measures at various ages, compared to norm data. Major handicaps remained stable as the children grew older, but minor handicaps and disabilities increased. At 19 years of age, only half (47.1%) of the survivors had no disabilities and no minor or major handicaps. Especially those born small for gestational age (SGA) seemed most vulnerable.

The POPS participants were informed about the outcomes through the “POPS-19 magazine”, a glossy which also included interviews with POPS participants and advice on what health outcomes they should regularly check. At 14 years of age the POPS participants and their parents had also received a booklet with outcomes of the POPS cohort: “Even little ones grow up”. The POPS-19 magazine can also be downloaded through the website (www.tno.nl/pops) and POPS participants can also update their contact details on the website.

These long-term cohort outcomes help to support preterm and SGA born children and adolescents in reaching independent adulthood, and stress the need for long term follow-up studies and to promote prevention of disabilities and of preterm birth itself. The RECAP ICT platform, which will combine the data of 20 European cohorts of children and adults born very preterm of very low birth, will also contribute to this.

Source: https://www.efcni.org/news/follow-up-of-the-pops-cohort-in-the-netherlands/

mood

Indicators of pain, stress & its assessment- Facility Based Care of Preterm Infant 2018

dr.deborariAshok Deorari    Published on Dec 31, 2017

Different behavioral states and assessment by PIP score in premature baby

who

Source: https://www.newbornwhocc.org/

sunset

Stress during pregnancy may affect baby’s sex, risk of preterm birth

Date: October 15, 2019 Source: Columbia University Irving Medical Center

Summary: A new study has identified markers of maternal stress – both physical and psychological that may influence a baby’s sex and the likelihood of preterm birth.

Story:

It’s becoming well established that maternal stress during pregnancy can affect fetal and child development as well as birth outcomes, and a new study from researchers at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian now identifies the types of physical and psychological stress that may matter most.

“The womb is an influential first home, as important as the one a child is raised in, if not more so,” says study leader Catherine Monk, PhD, professor of medical psychology at Columbia University Vagelos College of Physicians and Surgeons and director of Women’s Mental Health in the Department of Obstetrics & Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center.

Because stress can manifest in a variety of ways, both as a subjective experience and in physical and lifestyle measurements, Monk and her colleagues examined 27 indicators of psychosocial, physical, and lifestyle stress collected from questionnaires, diaries, and daily physical assessments of 187 otherwise healthy pregnant women, ages 18 to 45.

About 17% (32) of the women were psychologically stressed, with clinically meaningful high levels of depression, anxiety, and perceived stress. Another 16% (30) were physically stressed, with relatively higher daily blood pressure and greater caloric intake compared with other healthy pregnant women. The majority (nearly 67%, or 125) were healthy.

Fewer Baby Boys with Mental Stress?

The study suggested that pregnant women experiencing physical and psychological stress are less likely to have a boy. On average, around 105 males are born for every 100 female births. But in this study, the sex ratio in the physically and psychologically stressed groups favored girls, with male-to-female ratios of 4:9 and 2:3, respectively.

“Other researchers have seen this pattern after social upheavals, such as the 9/11 terrorist attacks in New York City, after which the relative number of male births decreased,” says Monk. “This stress in women is likely of long-standing nature; studies have shown that males are more vulnerable to adverse prenatal environments, suggesting that highly stressed women may be less likely to give birth to a male due to the loss of prior male pregnancies, often without even knowing they were pregnant.”

Other Impacts of Stress

  • Physically stressed mothers, with higher blood pressure and caloric intake, were more likely to give birth prematurely than unstressed mothers.
  • Among physically stressed mothers, fetuses had reduced heart rate-movement coupling — an indicator of slower central nervous system development — compared with unstressed mothers.
  • Psychologically stressed mothers had more birth complications than physically stressed mothers.

Social Support Matters

The researchers also found that what most differentiated the three groups was the amount of social support a mother received from friends and family. For example, the more social support a mother received, the greater the likelihood of her having a male baby.

When social support was statistically equalized across the groups, the stress effects on preterm birth disappeared. “Screening for depression and anxiety are gradually becoming a routine part of prenatal practice,” says Monk. “But while our study was small, the results suggest enhancing social support is potentially an effective target for clinical intervention.”

An estimated 30% of pregnant women report psychosocial stress from job strain or related to depression and anxiety, according to the researchers. Such stress has been associated with increased risk of premature birth, which is linked to higher rates of infant mortality and of physical and mental disorders, such as attention-deficit hyperactivity disorder and anxiety, among offspring.

How a mother’s mental state might specifically affect a fetus was not examined in the study. “We know from animal studies that exposure to high levels of stress can raise levels of stress hormones like cortisol in the uterus, which in turn can affect the fetus,” says Monk. “Stress can also affect the mother’s immune system, leading to changes that affect neurological and behavioral development in the fetus. What’s clear from our study is that maternal mental health matters, not only for the mother but also for her future child.”

Story Source: Materials provided by Columbia University Irving Medical Center.

Source: https://www.sciencedaily.com/releases/2019/10/191015171554.htm

 

peguin

PREEMIE FAMILY PARTNERS

heart

Still a Preemie

Alliance for Patient Access

 

doc.check

How to Choose the Best Pediatrician for Your Child

By Vincent Iannelli, MD  Updated on February 23, 2020 – Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.

Parents seem to go to a lot of different extremes when choosing a pediatrician. Some do almost nothing and simply choose the pediatrician on call in the hospital when their baby is born or pick a doctor randomly from a list in the phone book or their insurance directory. Others do detailed research and conduct an interview asking their potential new pediatrician everything from where they went to medical school to what their scores were on their medical boards.

When choosing a pediatrician, make sure you like your new doctor, and see if you agree on important parenting topics, such as breastfeeding, discipline, and not overusing antibiotics, etc.

The Importance of Choosing a Pediatrician

Choosing the right pediatrician is more important than most parents think. While you can simply change doctors if you don’t like the first pediatrician you see, if your newborn or older child is truly sick, the first doctor you see could be making life-changing decisions about your child. Or they could miss a potentially life-threatening problem.

So even if you have a healthy newborn or an older child with a simple cold or ear infection, you should put some thought into who cares for him, just in case his medical problems are a little more serious than you think.

Pediatrician Recommendations

A common way for parents to choose a pediatrician is to get a recommendation from their friends or family members. This is probably one of the best ways, but when someone tells you that they love going to their pediatrician, be sure to ask why before you blindly follow them to the same office.

Many parents have different needs and you may be really turned off by the reason that they like their doctor. For example, they might like that their pediatrician is really fast and they are in and out of the office quickly, while you might like someone who moves slower and spends more time during the visit, even if it means that you have to wait a little longer for your appointment. Or your friend might like that their pediatrician prescribes an antibiotic every time they walk into the office, whether or not they need one.

On the other hand, you might get a negative report on a pediatrician only to find that they don’t like the doctor because he doesn’t over-prescribe antibiotics, which is actually keeping to the guidelines of the American Academy of Pediatrics.

Always try to get the reason or an explanation behind a recommendation to make sure you understand why someone likes or dislikes their pediatrician.

Your own doctor can also be a good source for a recommendation for a pediatrician, especially if you are having a new baby.

Choosing a Pediatrician

Although we like to think that things like cost and convenience should be secondary when making such an important decision, they can be very important when choosing a pediatrician. If the pediatrician you would like to see is not on your insurance plan or is an hour away, it may not be very practical to go to her office.

Important practical matters to consider when choosing a pediatrician, most of which you can ask the office staff, include:

  • Is the pediatrician on your insurance plan? If you don’t have insurance or have a high deductible, then be sure to ask how much each visit costs and maybe compare it to other pediatric offices in the area.
  • Where are you located and do you have a satellite office?
  • Do you offer same day sick appointments?
  • Do you have any late or weekend hours?
  • What happens if I need advice after hours? Is a nurse or doctor available on-call to talk to me? Will I be charged for these calls?
  • What hospitals is the pediatrician affiliated with? This is especially important if you have a Children’s Hospital in your area and you would like a doctor that will see you if you have to go there.
  • Are there any extra charges for advice calls during the day, after hours advice calls, refilling medicines, or requests to fill out forms, etc.?
  • How many doctors are in the office? Will I always see my own doctor?
  • Are the doctors all board-certified?
  • How long is a typical appointment?
  • Are there separate sick and well waiting rooms?

Another practical matter to consider is whether you want to go with a group practice or a solo practitioner. The benefit of a solo practitioner or a pediatrician who is in an office by himself is that you can be sure that you will always see your own doctor. The biggest downside is that if your pediatrician takes some time off, either for a vacation or if he takes an afternoon off, then you may have to wait for an appointment or go to another office.

In a group practice, you usually see your own pediatrician when they are in the office and have the benefit of seeing another doctor if they are out. Larger offices often have the benefit of sharing expenses and may have more equipment in the office, such as a lab, so that you don’t have to go somewhere else to get blood work done.

Once you find a pediatrician you think you might like, consider scheduling a “new mom” consult to interview them. These appointments work for new dads, too.

Interviewing Pediatricians

Although you can typically narrow down your choice of pediatricians by figuring out who is on your insurance plan and in your area, who is accepting new patients and getting some recommendations from friends and family, the best way to find a good pediatrician is to actually set up an appointment and meet with a few.

Keep in mind that while most parents like to think that they are looking for a good pediatrician, you are mostly looking for a pediatrician who is good for you and your family. And that often comes down to how well your personalities fit together.

A couple of good questions to ask during this interview to help figure out if you have found a good fit include:

  • What are good reasons to get a second opinion from a specialist? (A good answer is because either the pediatrician or the parent wants one. A parent should be able to get a second opinion if they think it is important.)
  • How long should I breastfeed my baby?
  • What is your basic philosophy on discipline, potty training, immunizations, prescribing antibiotics, etc.?
  • What is your opinion on alternative medicine, attachment parenting, co-sleeping, etc.?

Also, setting up an appointment to interview a pediatrician is just not something you can do when you are pregnant. If you already have children and have moved to a new area or are simply changing doctors, it can still be a good idea to meet with a few doctors before choosing a new pediatrician.

Most importantly, remember that it doesn’t necessarily matter whether or not your pediatrician went to the best medical school or finished first in her class, so those aren’t very important things to ask about. You are really looking for someone who is going to care about your child, listen to and respond to your needs, and be available when you need her. And while you may have to initially trust your instincts that you found the right pediatrician, it may take several visits or even several years to know for sure.

Source: https://www.verywellfamily.com/choosing-a-pediatrician-2633444

 

flower

Miracle Babies | How a premature baby changes your life

WaterWipes 

 

kids

WARRIORS:

warriors

Dr. Gabor Maté on How to Reframe a Challenging Moment and Feel Empowered | The Tim Ferriss Show

KAT’S CORNER

Aloha Warriors! I am swimming towards Winter quarter 2020 finals, amping up my immune system, digging through global medicine data, and coming up for “AIR” to let you know that your presence in our World feeds my soul ….. and I Thank You.  This month we are re-sharing our story, and if our story is new to you, please enter the link below! Much Love!  –https://neonatalwombwarriors.blog/our-story/

breath

sd

Get easily out of breath? It may be because you were small at birth, study finds 

Date: January 31, 2020 Source: Karolinska Institutet

Babies born with low birth weights are more likely to have poor cardiorespiratory fitness later in life than their normal-weight peers. That is according to a study by researchers at Karolinska Institutet in Sweden published in the journal JAHA. The findings underscore the importance of prevention strategies to reduce low birth weights even among those carried to at term delivery.

Having a good cardiorespiratory fitness — that is ability of the body to supply oxygen to the muscles during sustained physical activity — is important for staying healthy and can reduce the risk of numerous diseases and premature death. Alarmingly, cardiorespiratory fitness is declining globally, both for youths and adults. A recent study showed that the proportion of Swedish adults with low cardiorespiratory fitness almost doubled from 27 percent in 1995 to 46 percent in 2017.

Given its implications for public health, there has been a growing interest in understanding the underlying causes of poor cardiorespiratory fitness. Researchers have identified both physical inactivity and genetic factors as important determinants. Preterm delivery, and the low birth weight associated with it, has also been linked to low cardiorespiratory fitness later in life. In this study, the researchers wanted to examine if low birth weights played a role for cardiorespiratory fitness in individuals born after pregnancy of 37-41 weeks.

They followed more than 280,000 males from birth to military conscription at age 17-24 using Swedish population-based registers. At conscription, the men underwent a physical examination that included an evaluation of their maximal aerobic performance on a bicycle ergometer. The researchers found that those born with higher birth weights performed significantly better on the cardiorespiratory fitness test. For every 450 grams of extra weight at birth, in a baby born at 40 weeks, the maximum work capacity on the bicycle increased by an average of 7.9 watts.

The association was stable across all categories of body mass index (BMI) in young adulthood and was largely similar in a subset analysis of more than 52,000 siblings, suggesting that BMI and shared genetic and environmental factors alone cannot explain the link between birth weight and cardiorespiratory fitness.

“The magnitude of the difference we observed is alarming,” says Daniel Berglind, researcher at the Department of Global Public Health at Karolinska Institutet and corresponding author. “The observed 7.9 watts increase for each 450 grams of extra weight at birth, in a baby born at 40 weeks, translates into approximately 1.34 increase in metabolic equivalent (MET) which has been associated with a 13 percent difference in the risk of premature death and a 15 percent difference in the risk of developing cardiovascular disease. Such differences in mortality are similar to the effect of a 7-centimeter reduction in waist circumference.”

The researchers believe the findings are of significance to public health, seeing as about 15 percent of babies born globally weigh less than 2.5 kilos at birth and as cardiorespiratory fitness have important implications for adult health.

“Providing adequate prenatal care may be an effective means of improving adult health not only through prevention of established harms associated with low birth weight but also via improved cardiorespiratory fitness,” says Viktor H. Ahlqvist, researcher at the Department of Global Public Health and another of the study’s authors.

Source:https://www.sciencedaily.com/releases/2020/01/200131074207.htm

 

wves

Surf Scheveningen, Den Haag, Holland: Top Surf Spots in Europe Ep. 2

epi

Jun 18, 2013

In this episode Dutch wonder kid Yannick de Jager gives us the low down of his home break called Scheveningen, located in the Hague, Holland. Although it’s not known for its surf, the travelling surfer who finds himself/herself there on a good day might be pleasantly surprised with the quality of ride they find. Athlete – Yannick de Jager Location – Scheveningen, Den Haag, Holland

 

Databases, Hero’s & Provider Health

Ghana.1

ghana.2

Preterm Birth Rates – Ghana

Rank: 14 –Rate: 14.5% Estimated # of preterm births per 100 live births (USA – 12%)

Source: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3

Ghana, officially the Republic of Ghana, is a country located along the Gulf of Guinea and Atlantic Ocean, in the subregion of West Africa. Spanning a land mass of 238,535 km2 (92,099 sq mi), Ghana is bordered by the Ivory Coast in the west, Burkina Faso in the north, Togo in the east and the Gulf of Guinea and Atlantic Ocean in the south. Ghana means “Warrior King” in the Soninke language.

Ghana’s population of approximately 30 million spans a variety of ethnic, linguistic and religious groups.

Ghana is a unitary constitutional democracy led by a president who is both head of state and head of the government. Ghana’s growing economic prosperity and democratic political system have made it a regional power in West Africa. It is a member of the Non-Aligned Movement, the African Union, the Economic Community of West African States (ECOWAS), Group of 24 (G24) and the Commonwealth of Nations.

Ghana has a universal health care system strictly designated for Ghanaian nationals, National Health Insurance Scheme (NHIS).  Health care is very variable throughout Ghana and in 2012, over 12 million Ghanaian nationals were covered by the National Health Insurance Scheme (Ghana) (NHIS). Urban centres are well served, and contain most of the hospitals, clinics, and pharmacies in Ghana. There are over 200 hospitals in Ghana and Ghana is a destination for medical tourism. In 2010, there were 0.1 physicians per 1,000 people and as of 2011[update], 0.9 hospital beds per 1,000 people.

 

COMMUNITY

G.4The unsung hero in breast-milk

Date: Jan 16 , 2020 BY: Matilda Twumasi & Dr Freda Intiful

 

Breastfeeding a child after birth can be considered exciting, fascinating, interesting and tiring for mothers who have just given birth.Human breast milk is considered the best food and the gold standard for newborns and infants. It has been well documented that breastfed infants are better protected from infectious agents than formula-fed infants.This can be attributed to various factors present in milk. Oligosaccharides are one of the important factors.

Oligosaccharides

Milk oligosaccharides (HMOs) are complex sugars which form part of the functional ingredients of human breast milk.

They are the third most important solid component of breast milk (with the first and second being lactose and lipids respectively) which has positive short-and long-term effects on infants.

HMOs levels appear to be higher in first milk (colostrum, the yellowish creamy milk) after child birth and decrease as breastfeeding continues.

They have many benefits which put breastfed children at an advantage as compared to formula-fed infants.

The first of its benefits is its function on the gastrointestinal tract (GIT).

HMOs act as feed for digestive micro-organisms. HMOs have long been thought to stimulate the colonisation of beneficial microbes in the gastrointestinal tract of the infant.

Generally, breast-fed infants seem to have a less complex, more stable microbial community than formula-fed infants.

It is now well established that HMOs can serve as substrate for intestinal microbes.

Infections

The second of its benefits is its ability to protect against infections. Studies have shown that breast-fed infants have lower incidences of infectious diseases of the intestinal, urinary and respiratory tract.

Many pathogens first need to adhere to mucosal surfaces to invade the host to cause disease or initiate infection but some HMOs inhibit adhesion and enhance pathogen clearance which reduces infection.

Brain development

Thirdly, HMOs are also considered nutrients for brain development.

Studies have shown that breastfed preterm infants have superior developmental scores at 18 months of age and higher intelligence quotients at the age of seven.

Human milk is a rich source of sialic acid, and post-mortem analysis on human neonates showed that sialic acid concentrations are significantly higher in the brains of breastfed infants than infants fed with formula that contained lower amounts of sialic acid.

This shows that sialylated HMOs contribute to the majority of sialic acid in human milk that provides the developing brain with this seemingly essential nutrient and contribute to good developmental scores and intelligence quotients in breastfed infants.

HMOs represent the next frontier in neonatal nutrition as they constitute a major component of the immune-protection conferred by breast milk upon vulnerable infants.

The addition of HMOs to infant formula is currently not feasible due to the limited availability.

Cattle-milk-based infant formula contains very low levels of complex oligosaccharides, which make it difficult to be used as a substitute for that which comes from humans.

Perfect food

In an attempt to compensate for this deficiency, infant formula manufacturers are presently fortifying their products with enzymatically produced or plant-based, non-human oligosaccharides, including galactooligosaccharides (GOS) and fructooligosaccharides (FOS).

The effects of formula oligosaccharides on intestinal epithelium and barrier functions are controversial.

Some studies have reported that FOS supplementation in neonatal rats increased bacterial translocation without affecting barrier integrity.

Whether or not this is a potential health concern to the human infant remains to be clarified.

In conclusion, HMOs seem to have a wide spectrum of benefits for the breast-fed infant that go beyond the prebiotic aspects.

Adding “the real” HMOs to infant formula in similar complexity as found in breast milk will, at least for now, remain technically unfeasible.

However, with recent advances in glycan synthesis, one or more “authentic” HMOs might soon become available for clinical studies with infant health outcomes, but also to address basic measures such as HMO metabolism, bioavailability and kinetics.

Until then, breast milk still remains the most perfect food for the baby and mothers are encouraged to choose breastmilk over formula.

Source: https://www.graphic.com.gh/news/health/the-unsung-hero-in-breastmilk.html

g.5

Israeli gov’t provides support GHS in Neonatal care

By Florence Afriyie Mensah, GNA     –     Wednesday 10th July, 2019

Kumasi, July 10, GNA – The government of Israel as part of efforts to deepen relationship with the Ghana Health Service (GHS), has inaugurated two neonatal units in two health facilities in the Kumasi Metropolis.

The beneficiary hospitals are the Kumasi South and the Suntreso Government Hospitals.

Each of the 16 bed capacity for newborns, would provide essential services such as; Kangaroo Mother Care (KMC), clinical training for medical and physician assistants, while also serving as maternal and child health research hubs.

Ms. Shani Cooper, Israeli Ambassador to Ghana, who inaugurated the facilities at separate ceremonies in Kumasi on Wednesday, said the aim was to improve performance, reduce neonatal and maternal deaths in the Mother and Baby Units (MBU).

The units were created by an Israeli Physician, Dr. Miki Karplus in 2009 for the two hospitals, under the joint MASHAV and Soroka initiative.

So far, the two units have been able to register significant achievement with the introduction of new methodologies, computerized data collection system and a sharp decrease in maternal and neonatal mortality rate.

Additionally, the units have ensured permanent distant medical consultations between the Israeli team of doctors and their counterparts in the two facilities.

Ms. Cooper said the Israeli government had also helped to install at the facilities, bubble CPAP, infusion pumps, radiant warmers, oxihoods and phototherapy equipment, all being aids that promote effective delivery of neonatal services at the facilities.

She mentioned that a delegation from the Ghana health Service was already in Israel attending a conference on health technologies, adding that, her government remained committed to partner the Ghana government to speed up socio-economic development.

Dr. Ashura Bakari, Head of the MBU of the Sunterso Government Hospital, said the Hospital had an annual admission of more than 900 babies between ages of zero to two months.

He said neonatal deaths decreased from 23 in 2017 to 16 in 2018 at the facility and commended the Israeli government for the continued support to improve neonatal services at the two facilities.

Source: https://www.ghananewsagency.org/health/israeli-gov-t-provides-support-ghs-in-neonatal-care-152930

HEALTH CARE PARTNERS

g.7

esStudy provid data-based answer for preterm baby’s discharge from the NICU

Reviewed by James Ives, M.Psych. (Editor)Jan 16 2020

“When is my baby going home?” is one of the first questions asked by families of infants admitted to the neonatal intensive care unit (NICU). Now clinicians have a data-based answer. Moderate to late preterm babies (born at gestational age of 32 to 36 weeks) who have no significant medical problems on admission are likely to be discharged at 36 weeks of postmenstrual age (gestational age plus age since birth), according to a study published in the American Journal of Perinatology. Small for gestational age infants and those with specific diagnoses may stay longer.

For the first time, practitioners have tangible data on length of stay to counsel parents at the time of their preterm baby’s admission. Our results may decrease parent stress and help families prepare for their baby’s arrival home.”

Previously, length of stay predictors were signs of the infant’s physiological maturity, which were only available near the end of the hospital stay. Infants born at less than 37 weeks of completed gestation comprise almost 10 percent of births in the United States. Most preterm infants are born between 32 and 36 weeks of gestation.

To establish a reliable length of stay estimate at the time of a preterm baby’s admission, Dr. Higgins Joyce and colleagues from Lurie Children’s conducted a retrospective chart review over six years, encompassing 3,240 moderate to late preterm infants born in a large, urban NICU. They found that the mean length of stay for these infants was 17 days, ranging from 30 days for infants born at 32 weeks of gestation to about a week for infants born at 36 weeks.

“While these results come from just our hospital, we hope other centers can confirm that many parents of premature infants can anticipate having their babies home with them earlier than previously expected,” says senior author Patrick Myers, MD, neonatologist at Lurie Children’s and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

Source: Alanna Higgins Joyce, MD, MPH, lead author, hospitalist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine

Journal reference: Joyce, A. H., et al. (2020) When is My Baby Going Home? Moderate to Late Preterm Infants are Discharged at 36 Weeks Based on Admission Data. American Journal of Perinatology. doi.org/10.1055/s-0039-3401850.

Source: https://www.news-medical.net/news/20200116/Study-provides-data-based-answer-for-preterm-babys-discharge-from-the-NICU.aspx

 

G.8

G.9

Tackling Physician Burnout and Moral Injury

January 8, 2020 Health Policy and Management, Psychology Katie Brind’Amour, PhD, MS, CHES

Across the United States, burnout and suicide rates for physicians have reached record highs, claiming the life of a doctor a day. What can be done to protect and improve the wellbeing of the people who care for everyone else?

Most doctors enter their profession knowing that it is demanding, but believing that it is also rewarding and meaningful work. “Demanding” may be putting it mildly, however. Health care providers sleep less than people in any other profession. Physician stress, depression and anxiety levels are on the rise, with more than half of clinicians reporting symptoms that qualify as emotional, physical and mental burnout. And sadly, between 300 and 400 physicians per year are lost to suicide.

But why do some physicians develop burnout, moral injury and long-term mental health conditions, while others don’t? Why is America losing a doctor every day to suicide? And what can be done about it?

Seeing the Problem

The health care system surrounding today’s clinicians encompasses much more than just providing care. Clinical work is part of a much larger picture that often includes electronic medical record management, office and insurance paperwork, highly complex regulatory requirements, satisfaction reviews, quality improvement and cost reduction responsibilities, continuing education, and multidisciplinary collaboration for complex patients. Clinicians are asked to accomplish more and more, often with no extra time or resources provided.

“Clinicians are increasingly torn by competing priorities, and they report they are constantly making trade-off decisions: having to choose between getting their administrative duties completed and providing more or better patient care,” says Brandon Kozar, PsyD, MBA, director of leadership coaching and development at Nationwide Children’s Hospital. “These are individuals who are in medicine because they want to help people, so this constant battle is demoralizing, guilt-inducing and makes them feel they aren’t in control of their professional lives. They lose the joy of practicing medicine.”

Resourcefulness and hard work cannot solve this dilemma, and their resiliency plummets. Over time, clinicians who feel that these forced trade-offs infringe on their ethical duties — that they are unable to uphold their entrenched moral desire to put patients’ wellbeing first — experience “moral injury,” a significant predictor of other serious mental health concerns, such as clinical depression, substance abuse, anxiety and suicidal ideation.

Burnout — a more common phenomenon, where emotional and physical exhaustion result from constant exposure to stressors and a decreased ability to cope with daily duties — and moral injury have important implications beyond the wellbeing of the affected individual clinicians. These problems may negatively impact patient care and outcomes. When doctors are exhausted mentally, emotionally and physically, they cannot provide optimal care. They become more likely to make mistakes. Substance abuse, sleep deprivation, anger control issues, relationship troubles and other problems arise, further increasing the risk to physicians and their patients.

Unfortunately, physicians and other health care workers often feel they have nowhere to turn for relief.

Understanding the Problem

Historically, clinicians have been known for a dogged commitment to their patients and their work, often at their own expense. Acknowledging emotions and troubles, admitting to being overwhelmed, and seeking help have been tantamount to inadequacy or unprofessionalism, and thus have carried a stigma.

Even in recent years, clinicians with depression or substance use disorders have faced loss of licensure, increased supervision, restriction of hospital privileges, and loss of privacy — making admission of difficulties a potential threat to their livelihood and status. And in part because of the profession’s reticence on the idea of mental health concerns affecting their own, suicide among physicians is believed to be underreported by pathologists trying to protect their deceased colleagues’ reputations.

To further complicate matters, many hospital program and department leaders are clinicians themselves, rather than business experts trained in human resource management and administrative processes. Running a business unit with significant fiduciary, regulatory and supervisory responsibilities may come naturally to some clinical directors, but others struggle to create environments that both support morale and enable engaged productivity. Emotional intelligence — the ability to recognize and empathetically respond to the emotions of the people around you — is perhaps under-appreciated in the selection of leadership, and clinicians and other staff pay the price.

“Some departments have greater rates of burnout and poor mental health than others, and the differences are not best predicted by workload,” says Dr. Kozar, referencing literature on emotional intelligence and clinical staff performance. “Instead, just the perception of being socially supported by peers, superiors or the organization dramatically influences how health care providers cope. Positive and supportive work environments that foster a sense of support and collegiality result in more productive work, more accurate differential diagnoses and less burnout.”

This goes beyond creating a feel-good culture to fostering an environment that systematically embraces a genuine concern for clinicians and other employees both in the adoption of workplace expectations and in the everyday manner of interpersonal interactions.

and administrative processes. Running a business unit with significant fiduciary, regulatory and supervisory responsibilities may come naturally to some clinical directors, but others struggle to create environments that both support morale and enable engaged productivity. Emotional intelligence — the ability to recognize and empathetically respond to the emotions of the people around you — is perhaps under-appreciated in the selection of leadership, and clinicians and other staff pay the price.

Some departments have greater rates of burnout and poor mental health than others, and the differences are not best predicted by workload,” says Dr. Kozar, referencing literature on emotional intelligence and clinical staff performance. “Instead, just the perception of being socially supported by peers, superiors or the organization dramatically influences how health care providers cope. Positive and supportive work environments that foster a sense of support and collegiality result in more productive work, more accurate differential diagnoses and less burnout.”

This goes beyond creating a feel-good culture to fostering an environment that systematically embraces a genuine concern for clinicians and other employees both in the adoption of workplace expectations and in the everyday manner of interpersonal interactions.

Fixing the Problem

There is no cut-and-dry solution to the problem of overwhelmed and under-supported physicians. But that has not stopped many institutions from trying to take an active step toward identifying burnout and distress, helping physicians in need, and preventing the problem in the first place.

At Nationwide Children’s, for instance, Dr. Kozar’s existence on staff is a primary example of the hospital’s intentional decision to protect its people. His role was created partly in response to the hospital’s Zero Hero program, designed to eliminate preventable harm, such as overtired staff and emotionally depleted clinicians. In addition, it was an attempt to formalize programs and a cultural shift toward de-stigmatizing mental health concerns, supporting employees and equipping them with resources and outlets to address their needs.

Dr. Kozar directs the hospital’s YOU Matter program, which offers emotional and mental health support to both clinical and non-clinical staff faced with work-related and potentially traumatic stressors, such as a patient death. The program has several components, including a peer support initiative, a critical response team, on-site Master’s-level clinical counselors exclusively for staff (focused in high-acuity settings such as the emergency department and intensive care units), and hospital rounds focused on discussing psychosocial impacts of participants’ work. In addition, hospital employees are eligible for confidential counseling sessions at no cost

(focused in high-acuity settings such as the emergency department and intensive care units), and hospital rounds focused on discussing psychosocial impacts of participants’ work. In addition, hospital employees are eligible for confidential counseling sessions at no cost.

“It might be due to the increasing visibility of mental health needs in society at large, but I think clinicians are becoming more accepting of the need to speak up and speak out about salient issues of burnout,” says Dr. Kozar. “The trick is to avoid framing all stress as evil. Stress actually can have many benefits both professionally and personally, and it isn’t realistic to totally eliminate it. Distress, however, is overwhelming and negative and needs to be reduced.”

Further efforts at Nationwide Children’s have included the implementation of business coaching for clinical department leaders to help them run better-organized programs and alleviate burnout. Stress management training for staff — in which the distinction between good and bad stress is emphasized — also reinforces the hospital’s culture of confronting the issue and treating each other with compassion. Staff trained as peer support personnel are taught to pay attention to the work experiences of their colleagues and to reach out to others on a regular basis.

“Human beings are social creatures — we do better when we work and operate in an environment where we are cared for,” says Dr. Kozar. “Instead of an environment where there’s nothing but a time crunched, task-oriented day where clinicians are drawn in every direction with no time to look out for each other, we’re focusing on building deliberate and strategic social support systems that can cultivate resiliency”.

How to Protect Clinician Well-being

The widespread problems of burnout and moral injury will not disappear overnight, but Dr. Kozar is confident that personal and institutional steps to counteract these problems can equip clinicians with the support and competencies they need in order to maintain resilience and protect their psyches.

“These are high-performing individuals,” Dr. Kozar says. “When you teach them to do something, they can implement it very effectively. You just have to make sure that you’re not training them to quash problems in one area only for them to pop up in another. The approach has to be comprehensive, which means it’s oriented at the institution’s programs and personal resiliency, not just workload.”

As many as a dozen hospitals per year come to Nationwide Children’s to learn about and implement programs similar to those managed by Dr. Kozar.

His recommended steps for physicians to take to prevent and address burnout and moral injury include:

  1. Recognize as early as possible the signs of compassion fatigue (the “empathy well” has run dry), moral injury (value conflicts between what you are doing and what you believe is the right thing to do), and burnout (loss of pleasure, increasing cynicism, mental/emotional exhaustion).
  2. Seek help early: Use your employee assistance program and/or seek counsel from a trusted colleague or supervisor.
  3. Focus on what you can control (“I can’t change the medical health system, but I can control and improve this…”).
  4. Promote and engage in social support (this is the single greatest protective factor against burnout and a primary source of life satisfaction).
  5. Continue to cultivate resilience by focusing on your interpretation or framing of events and not just the events themselves. Remember: A + B = C (Activating event + Belief about that event = Consequence: How I feel and therefore behave).

Dr. Kozar also suggests some opportunities for institutions to protect their employees from the potentially devastating problems of burnout and moral injury:

  1. Recognize that burnout and the need to support and care for staff is a critical investment for their wellbeing as well as that of patients.
  2. Assign a senior executive sponsor to support, fund and advocate for staff support programs –these initiatives deserve more than just staff-driven “culture club”-level support.
  3. Train chiefs of medicine and other leaders on the 3Rs: How to Recognize, Respond and Refer physicians struggling with socioemotional issues.
  4. Promote the purpose and joy of medicine: Have regular events in which physicians are exposed to past patients and families whom they have helped. Allow them the experience of someone expressing their gratitude and appreciation for what they did.
  5. Remember to “Acknowledge the pain yet promote the gain.”
  6. Teach leaders how to promote and support intrinsic motivation in staff: Autonomy, Mastery, and Purpose.
  7. Hire leaders with above-average emotional intelligence. Poor or ineffective leadership is one of the main drivers of work-related burnout and dissatisfaction. As the saying goes, “Most people don’t leave their jobs, they leave their bosses” — so make sure the “bosses” are good not just at medicine, but at personnel management.

Source: https://pediatricsnationwide.org/2020/01/08/tackling-physician-burnout-and-moral-injury/

G.10

A Randomized Trial of Erythropoietin for Neuroprotection in Preterm Infants

G.11

January 16, 2020  By: Sandra E. Juul, M.D., Ph.D., Bryan A. Comstock, M.S., Rajan Wadhawan, M.D., Dennis E. Mayock, M.D., Sherry E. Courtney, M.D., Tonya Robinson, M.D., Kaashif A. Ahmad, M.D., Ellen Bendel-Stenzel, M.D., Mariana Baserga, M.D., Edmund F. LaGamma, M.D., L. Corbin Downey, M.D., Raghavendra Rao, M.D.,  for the PENUT Trial Consortium*

 Abstract

Background

High-dose erythropoietin has been shown to have a neuroprotective effect in preclinical models of neonatal brain injury, and phase 2 trials have suggested possible efficacy; however, the benefits and safety of this therapy in extremely preterm infants have not been established.

Methods

In this multicenter, randomized, double-blind trial of high-dose erythropoietin, we assigned 941 infants who were born at 24 weeks 0 days to 27 weeks 6 days of gestation to receive erythropoietin or placebo within 24 hours after birth. Erythropoietin was administered intravenously at a dose of 1000 U per kilogram of body weight every 48 hours for a total of six doses, followed by a maintenance dose of 400 U per kilogram three times per week by subcutaneous injection through 32 completed weeks of postmenstrual age. Placebo was administered as intravenous saline followed by sham injections. The primary outcome was death or severe neurodevelopmental impairment at 22 to 26 months of postmenstrual age. Severe neurodevelopmental impairment was defined as severe cerebral palsy or a composite motor or composite cognitive score of less than 70 (which corresponds to 2 SD below the mean, with higher scores indicating better performance) on the Bayley Scales of Infant and Toddler Development, third edition.

Results

A total of 741 infants were included in the per-protocol efficacy analysis: 376 received erythropoietin and 365 received placebo. There was no significant difference between the erythropoietin group and the placebo group in the incidence of death or severe neurodevelopmental impairment at 2 years of age (97 children [26%] vs. 94 children [26%]; relative risk, 1.03; 95% confidence interval, 0.81 to 1.32; P=0.80). There were no significant differences between the groups in the rates of retinopathy of prematurity, intracranial hemorrhage, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, or death or in the frequency of serious adverse events.

Conclusions

High-dose erythropoietin treatment administered to extremely preterm infants from 24 hours after birth through 32 weeks of postmenstrual age did not result in a lower risk of severe neurodevelopmental impairment or death at 2 years of age. (Funded by the National Institute of Neurological Disorders and Stroke; PENUT ClinicalTrials.gov number, NCT01378273. opens in new tab.)

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1907423

 

PREEMIE FAMILY PARTNERS

Buffalo NICU Nurse Writes Book for Preemies (wgrz.com)

Picture14Alyssa Veech   Published on May 10, 2019

Sisters of Charity Hospital nurse, Alyssa Veech, wrote “Small But Mighty” to help parents on the emotional journey of having a preemie in the NICU.

Picture15

Preterm children have similar temperament to children who were institutionally deprived

Date: November 12, 2019 Source: University of Warwick

Summary:

A child’s temperament appears to be affected by the early stages of their life. Researchers have found children who were born very preterm (under 32 weeks gestation) or very low birthweight (under 1500g) had similar temperamental difficulties in controlling their impulses, to children who experienced institutional deprivation

The paper ‘A Comparison of the Effects of Preterm Birth and Institutional Deprivation on Child Temperament’, published today, 12 November in the journal Development and Psychopathology, highlights how different adverse experiences such as preterm birth and institutional deprivation affect children’s temperament in similar ways, resulting in greater risk for lower self-control.

The team of researchers, from the University of Warwick, University of Tennessee, University of Southampton and King’s College London looked at children who were born very preterm, or very low birth weight from the Bavarian Longitudinal study, and children who experienced at least six months of institutional deprivation — a lack of adequate, loving caregivers — in Romanian institutions from the English and Romanian Adoptees study, who were then compared to 311 healthy term born children and 52 non-deprived adoptees, respectively.

The researchers found that both groups of children had lower effortful control at 6 years.

This is the first study that directly compares the effects of severe preterm birth and extended institutional deprivation, and suggests that self-control interventions early in life may promote the development of children after both risk experiences.

Prof Dieter Wolke from the Department of Psychology at the University of Warwick comments: “Both, early care either in an incubator or deprivation and neglect in an orphanage lead to poor effortful control. We need to further determine how this early deprivation alters the brain.”

Lucia Miranda Reyes, from the Department of Child and Family Studies at the University of Tennessee comments: “These findings suggest that children’s poor effortful control may underlie long-term social problems associated with early adverse experiences; thus, improving their self-control may also help prevent these later problems.”

Source: https://www.sciencedaily.com/releases/2019/11/191112110211.htm

 

We are all in this together. This short video shares a powerful glimpse of our preterm birth journeys. The links below will provide families and caregivers with access to great support and the opportunity to give and give back. There are preterm birth support  groups around the world. We are listing a few that we know are fully committed to supporting the Neonatal Womb/preterm birth community world-wide.

Picture18Preemie Graduation | Canadian Premature Babies Foundation

Canadian Premature Babies Foundation – Published on Nov 13, 2019

Help premature babies and their parents reach the most important graduation of all.

Hand to Hold: https://handtohold.org/

Graham’s Foundation: https://grahamsfoundation.org/

March of Dimes: https://www.marchofdimes.org/nicufamilysupport/index.aspx

 

Picture19

          Picture20Simple test predicts dangerous pregnancy disorder

Date: October 23, 2019      Source: Edith Cowan University

  Summary: Researchers have developed a simple, low-cost way to predict preeclampsia, a potentially deadly condition that kills 76,000 mothers and 500,000 babies every year.

Australian researchers have developed a way to predict the onset of a deadly pregnancy condition that kills 76,000 women and half a million babies each year, mostly in developing countries.

Researchers from Edith Cowan University in Perth Western Australia have developed a simple, low-cost way to predict preeclampsia, one of the leading causes of maternal-fetal mortality worldwide.

Preeclampsia can cause devastating complications for women and babies, including brain and liver injury in mothers and premature birth.

Survey gives early warning

ECU researchers assessed the health status of 593 pregnant Ghanaian women using the Suboptimal Health Questionnaire.

The Suboptimal Health Questionnaire was developed in 2009 by Professor Wei Wang from ECU’s School of Health and Medical Sciences. Combining scores for fatigue, heart health, digestion, immunity and mental health, the questionnaire provides an overall ‘suboptimal health score’ that can help predict chronic diseases.

Professor Wang’s PhD candidate Enoch Anto found that 61 per cent of women who scored high on the questionnaire went on to develop preeclampsia, compared with just 17 per cent of women who scored low.

When these results were combined with blood tests that measured women’s calcium and magnesium levels, the researchers were able to accurately predict the development of preeclampsia in almost 80 per cent of cases.

Mr Anto said preeclampsia was very treatable once identified, so providing an early warning could save thousands of lives.

“In developing nations, preeclampsia is a leading cause of death for both mothers and babies. In Ghana, it’s responsible for 18 per cent of maternal deaths,” Mr Anto said.

“But it can be treated using medication that lowers blood pressure once diagnosed.

“Both blood tests for magnesium and calcium and the Suboptimal Health Questionnaire are inexpensive, making this ideally suited to the developing world where preeclampsia causes the most suffering.”

Source: www.sciencedaily.com/releases/2019/10/191023093431.htm

 

Picture21

NICU Technology Predicts Care

Hurley Medical Center / Hurley Children’s Hospital

Hurley’s NICU has been performing miracles for decades. With our growing technology, we are now able to do even more. Our doctors and nurses can now predict symptoms or problems BEFORE your baby experiences them. That gives us a jump on treating your baby. #HurleyCares #NHITweek @HIMSS

 

Picture22sd

Environmental Research   Volume 176, September 2019,

Synergistic effects of prenatal exposure to fine particulate matter (PM2.5) and ozone (O3) on the risk of preterm birth:

A population-based cohort study

Abstract

Background

There is some evidence that prenatal exposure to low-level air pollution increases the risk of preterm birth (PTB), but little is known about synergistic effects of different pollutants.

Objectives

We assessed the independent and joint effects of prenatal exposure to air pollution during the entire duration of pregnancy.

Methods

The study population consisted of the 2568 members of the Espoo Cohort Study, born between 1984 and 1990, and living in the City of Espoo, Finland. We assessed individual-level prenatal exposure to ambient air pollutants of interest at all the residential addresses from conception to birth. The pollutant concentrations were estimated both by using regional-to-city-scale dispersion modelling and land-use regression–based method. We applied Poisson regression analysis to estimate the adjusted risk ratios (RRs) with their 95% confidence intervals (CI) by comparing the risk of PTB among babies with the highest quartile (Q4) of exposure during the entire duration of pregnancy with those with the lower exposure quartiles (Q1-Q3). We adjusted for season of birth, maternal age, sex of the baby, family’s socioeconomic status, maternal smoking during pregnancy, maternal exposure to environmental tobacco smoke during pregnancy, single parenthood, and exposure to other air pollutants (only in multi-pollutant models) in the analysis.

Results

In a multi-pollutant model estimating the effects of exposure during entire pregnancy, the adjusted RR was 1.37 (95% CI: 0.85, 2.23) for PM2.5 and 1.64 (95% CI: 1.15, 2.35) for O3. The joint effect of PM2.5 and O3 was substantially higher, an adjusted RR of 3.63 (95% CI: 2.16, 6.10), than what would have been expected from their independent effects (0.99 for PM2.5 and 1.34 for O3). The relative risk due to interaction (RERI) was 2.30 (95% CI: 0.95, 4.57).

Discussion

Our results strengthen the evidence that exposure to fairly low-level air pollution during pregnancy increases the risk of PTB. We provide novel observations indicating that individual air pollutants such as PM2.5 and O3 may act synergistically potentiating each other’s adverse effects.

Source: https://www.healthynewbornnetwork.org/country/ghana/

pubmedA Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women:

Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial

JMIR Res Protoc 2018 Aug 23;7(8):e10095. Epub 2018 Aug 23. Institute of Public Health & Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.

Abstract

BACKGROUND:

Preterm birth (PTB) is a leading cause of infant morbidity and mortality worldwide. Every year, 20 million babies are born with low birthweight (LBW), about 96% of which occur in low-income countries. Despite the associated dangers, in about 40%-50% of PTB and LBW cases, the causes remain unexplained. Existing evidence is inconclusive as to whether occupational physical activities such as heavy lifting are implicated. African women bear the transport burden of accessing basic needs for their families. Ghana’s PTB rate is 14.5%, whereas the global average is 9.6%. The proposed liftless intervention aims to decrease lifting exposure during pregnancy among Ghanaian women. We hypothesize that a reduction in heavy lifting among pregnant women in Ghana will increase gestational age and birthweight.

OBJECTIVE:

To investigate the effects of the liftless intervention on the incidence of PTB and LBW among pregnant Ghanaian women.

METHODS:

A cohort stepped-wedge cluster randomized controlled trial in 10 antenatal clinics will be carried out in Ghana. A total of 1000 pregnant participants will be recruited for a 60-week period. To be eligible, the participant should have a singleton pregnancy between 12 and 16 weeks gestation, be attending any of the 10 antenatal clinics, and be exposed to heavy lifting. All participants will receive standard antenatal care within the control phase; by random allocation, two clusters will transit into the intervention phase. The midwife-led 3-component liftless intervention consists of health education, a take-home reminder card mimicking the colors of a traffic light, and a shopping voucher. The primary outcome are gestational ages of <28, 28-32, and 33-37 weeks. The secondary outcomes are LBW (preterm LBW, term but LBW, and postterm), compliance, prevalence of low back and pelvic pain, and premature uterine contractions. Study midwives and participants will not be blinded to the treatment allocation.

RESULTS:

Permission to conduct the study at all 10 antenatal clinics has been granted by the Ghana Health Service. Application for funding to begin the trial is ongoing. Findings from the main trial are expected to be published by the end of 2019.

CONCLUSIONS:

To the best of our knowledge, there has been no randomized trial of this nature in Ghana. Minimizing heavy lifting among pregnant African women can reduce the soaring rates of PTB and LBW. The findings will increase the knowledge of the prevention of PTB and LBW worldwide.

©Emma Kwegyir-Afful, Jos Verbeek, Lydia Aziato, Joseph D. Seffah, Kimmo Räsänen. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 23.08.2018.

Source: https://www.pubfacts.com/detail/30139723/A-Liftless-Intervention-to-Prevent-Preterm-Birth-and-Low-Birthweight-Among-Pregnant-Ghanaian-Women-P

 

WARRIORS:

Picture24

GHANAIAN WISDOM

Picture25

Study investigates health, well-being of adults who were born preterm at very low birth weight

Reviewed by Kate Anderton, B.Sc. (Editor)Nov 18 2019

The Finnish Institute for Health and Welfare (THL) is investigating the health and well-being of adults who were born preterm at very low birth weight in a series of studies that are unique worldwide.

The study initiated 15 years ago, will be continued when the same individuals, now aged between 35 and 40, are invited to participate.

The information obtained from the study will help with the development of the care and monitoring of premature babies and the reduction of any related health risks for adults.

The study involves the participation of those who were treated at birth between 1978 and 1985 in the infant intensive care ward at the Helsinki University Hospital and who were born either preterm at very low birth weight or, as a control group, were born at full term.

The health and well-being of these individuals as adults has been studied since 2004-2005.

The follow-up study is done in cooperation with an international partner, the Department of Medical Science at the Norwegian University of Science and Technology (NTNU). In Norway, a similar study is simultaneously being carried out using the same methodology as the Finnish study. The researchers will work together to process the data collected in the Finnish and Norwegian studies, which will improve the reliability and precision of the results.

The research includes a detailed health check-up and several questionnaire forms. The individuals’ health will be assessed using different indicators such as their body fat percentage and the results of a glucose tolerance test and a pulmonary function test.

Also, their psychological well-being will be studied using different tasks and questionnaire forms. A new component of the study is a detailed eye check-up and study of their motor skills.

In addition to NTNU, this study involves cooperation with the Helsinki and Uusimaa Hospital District’s Department of Eye Diseases, the University of Helsinki’s Department of Psychology, and the University of Oulu’s Faculty of Medicine.

“We aim to make participation in the research as easy and rewarding as possible. The participants receive for themselves the results of the measurements and check-ups, and thus acquire a broad overall picture of their state of health. The adults who were born preterm at very low birth weight have participated actively in the earlier studies, and we hope that as many as possible will participate this time as well.” Maarit Kulmala, Medical Researcher and Eye Disease Specialist

Infants with a birth weight of 1.5kg or less are classified as having very low birth weight. The systematic intensive care of preterm infants at very low birth weight began in the 1970s.

The majority of those born preterm at very low birth weight consider themselves to be healthy and live a normal life. Slightly less than 10% have some kind of illness or disability which is related to being born preterm and which affects their daily life and capacity to work.

In earlier studies, it was observed that there were health differences at young adulthood between those born full term and those born preterm at very low birth weight. Those born preterm had, for example, a higher incidence of risk factors related to cardiovascular diseases, such as high blood pressure.

They also clearly engaged less in physical exercise than those born full term. Furthermore, they experienced slightly more learning difficulties, depression and anxiety disorders. On the other hand, they fared better than those born full term in some areas, showing lower levels of allergic reactions, behavioural disorders and excessive alcohol consumption.

“We previously studied those born preterm during their young adulthood, aged around 20 to 25, at which point the body’s operating capacity is at its peak. Now we will be studying how their health and operating capacity develop with age: do the differences observed between those born preterm at very low birth weight and those born full term increase over time or even out? This follow-up study for later adulthood, those aged between 35 and 40, is the first of its kind in the world,” explains Professor Eero Kajantie, who is in charge of the study and also heads up the Adults Born Preterm International Collaboration (APIC).

Article Research Source: Finnish Institute for Health and Welfare

Source: https://www.news-medical.net/news/20191118/Study-investigates-health-well-being-of-adults-who-were-born-preterm-at-very-low-birth-weight.aspx

KAT’S CORNER

Picture26

“Be an opener of doors”

― Ralph Waldo Emerson

Valentine’s Day is approaching and I am sending you all BIG LOVE everyday and everywhere. Remember this: choose to fall in love with You!

Surfing Power – The Pulse on JoyNews (3-4-18)

Picture27Apr 3, 2018  Busua’s young surfers aim for the world stage

Picture28Picture29

Dads, Midwives & Oxytocin

Australia.Photo.jpg

Australia.Frame.jpg

Preterm Birth Rates – Australia

Rank: 139 –Rate: 7.6% Estimated # of preterm births per 100 live births (USA – 12%)

Source: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3

Australia, officially the Commonwealth of Australia, is a sovereign country comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands. It is the largest country in Oceania and the world’s sixth-largest country by total area. The neighbouring countries are Papua New Guinea, Indonesia, and East Timor to the north; the Solomon Islands and Vanuatu to the north-east; and New Zealand to the south-east. The population of 26 million[ is highly urbanised and heavily concentrated on the eastern seaboard.

Australia has a highly developed healthcare structure, though because of its vast size, services are not evenly distributed. Health care is delivered in Australia by both government and private companies which are often covered by Medicare. Health care in Australia is largely funded by the government at national, state and local governmental levels, as well as by private health insurance; but the cost of health care is also borne by not-for-profit organisations, with a significant cost being borne by individual patients or by charity. Some services are provided by volunteers, especially remote and mental health services.

The federal government-administered Medicare insurance scheme covers much of the cost of primary and allied health care services. The government provides the majority of spending (67%) through Medicare and other programs. Individuals contribute more than half of the non-government funding.

Medicare is a single-payer universal health care scheme that covers all Australian citizens and permanent residents, with other programs covering specific groups, such as veterans or Indigenous Australians, and various compulsory insurance schemes cover personal injury resulting from workplace or vehicle incidents. Medicare is funded by a Medicare levy, which currently is a 2% levy on residents’ taxable income over a certain income. Higher income earners pay an additional levy (called a Medicare Levy Surcharge) if they do not have private health insurance. Residents with certain medical conditions, foreign residents, some low-income earners, and those not eligible for Medicare benefits may apply for an exemption from paying the levy, and some low-income earners can apply for reductions to the levy.

Aussy.1.jpg

ACCESS to prenatal and maternal care is the key factor in preventing preterm birth. We have presented numerous studies and articles addressing this issue, and below are three additional articles  to reference. Access to healthcare reduces preterm birth,  maternal death, and overall health care costs. The US is lagging significantly behind other “developed” countries and many “developing” countries in preventing preterm birth, and this impacts all of us. Improving maternal health and preventing/reducing preterm birth is achievable for most of the world, so why does the US choose to be less than mediocre in this regard? We have the ability to change this,  and choosing not to change our global standing on these issues is a clear choice.

COMMUNITY

We are visiting our Neonatal Womb Warrior/Preterm Birth family in Australia this month. Our hearts feel great love for the Australian people and we know that their plight related to Global Climate Change is a real and expanding threat to all of us on this planet.  In order to support our global and local preterm birth communities we must recognize the realities and fluidity of climate change, the effects of climate change on our health and longevity, and discover and engage in activities to  support planetary well-being.

Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia

Abstract

Background-Prevention of avoidable preterm birth in Aboriginal and Torres Strait Islander (Indigenous) families is a major public health priority in Australia. Evidence about effective, scalable strategies to improve maternal and infant outcomes is urgently needed. In 2013, a multiagency partnership between two Aboriginal Community Controlled Health Organisations and a tertiary maternity hospital co-designed a new service aimed at reducing preterm birth: ‘Birthing in Our Community’.

Methods-A prospective interventional cohort study compared outcomes for women with an Indigenous baby receiving care through a new service (n = 461) to women receiving standard care (n = 563), January 2013–December 2017. The primary outcome was preterm birth (< 37 weeks gestation). One to one propensity score matching was used to select equal sized standard care and new service cohorts with similar distribution of characteristics. Conditional logistic regression calculated the odds ratio with matched samples.

Findings-Women receiving the new service were less likely to give birth to a preterm infant than women receiving standard care (6·9% compared to 11.6%). After controlling for confounders, the new service significantly reduced the odds of having a preterm birth (unmatched, n = 1024: OR = 0·57, 95% CI 0·37, 0·89; matched, n = 690: OR = 0·50, 95% CI 0·31, 0·83).

Interpretation-The short-term results of this service redesign send a strong signal that the preterm birth gap can be reduced through targeted interventions that increase Indigenous governance of, and workforce in, maternity services and provide continuity of midwifery care, an integrated approach to supportive family services and a community-based hub.

Source: https://www.sciencedirect.com/science/article/pii/S258953701930094X

midwife.science.daily

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes plos.png

  • Published: February 21, 2018

Abstract-Poor coordination of care across providers and birth settings has been associated with adverse maternal-newborn outcomes. Research suggests that integration of midwives into regional health systems is a key determinant of optimal maternal-newborn outcomes, yet, to date, the characteristics of an integrated system have not been described, nor linked to health disparities.

Methods-Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and inter-professional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the ‘on the ground’ relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race.

Results-MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state.

Conclusion-The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.

Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192523

maternity

Midwifery linked to better birth outcomes in state-by-state report cards

February 21, 2018  Source: Oregon State University-Original written by Michelle Klampe

Midwife-friendly laws and regulations tend to coincide with lower rates of premature births, cesarean deliveries and newborn deaths, according to a new US-wide ‘report card’ that ranks all 50 states on the quality of their maternity care.

The first-of-its-kind study found a strong connection between the role of midwives in the health care system — what the researchers call “midwifery integration” and birth outcomes. States with high midwifery integration, like Washington and Oregon, generally had better results, while states with the least integration, primarily in the Midwest and South, tended to do worse. The findings were published today in the journal PLOS ONE.

“Our findings suggest that in states where families have greater access to midwifery care that is well integrated into the maternity system, mothers and babies tend to experience improved outcomes. The converse was also demonstrated; where integration of midwives is poorer, so are outcomes,” said Melissa Cheyney, a licensed midwife, medical anthropologist and associate professor in Oregon State University’s College of Liberal Arts and one of the study’s co-authors.

As with most population health studies, the statistical association between the role of midwives and birth outcomes doesn’t prove a cause-and-effect relationship. Other factors, especially race, loom larger, with African-Americans experiencing a disproportionate share of negative outcomes. However, almost 12 percent of the variation in neonatal death across the U.S. is attributable solely to how much of a part midwives play in each state’s health care system.

“In communities in the U.S. that are under-served — where the health system is often stretched thin — this study suggests that expanding access to midwifery is a critical strategy for improving maternal and neonatal health outcomes,” said Saraswathi Vedam, an associate professor in the Department of Family Practice at the University of British Columbia, who led the team of U.S. epidemiology and health policy researchers responsible for the study.

About 10 percent of U.S. births involve midwives, far behind other industrialized countries, where midwives participate in half or more of all deliveries. Each state has its own laws and regulations on midwives’ credentialing, their ability to provide services at a client’s home or at birth centers, their authority to prescribe medication and the degree to which they are reimbursed by Medicaid.

“A large body of cross-cultural research has actually demonstrated similar relationships between midwifery care, systems integration and improved maternity care outcomes,” Cheyney said. “This study is important because it suggests that the same relationships hold true in the United States. There are significant policy implications stemming from this work.”

The research team created a midwifery integration score based on 50 criteria covering those and other factors that determine midwives’ availability, scope of practice and acceptance by other health care providers in each state.

Washington had the highest integration score, 61 out of a possible 100, followed by New Mexico at 59 and Oregon at 58. North Carolina had the lowest score, 17. The complete list, with links to each state’s report card, is available online at http://www.birthplacelab.org/how-does-your-state-rank/.

An interactive map created by the researchers reveals two clusters of higher midwifery integration — one swath stretching from the Pacific Northwest to the Southwest, and a cluster of Northeastern states.

Vermont, Maine, Alaska and Oregon had the highest density of midwives, as measured by the number of midwives per 1,000 births. The lowest midwifery integration was in the Midwest and Deep South.

The study used higher rates of vaginal birth and breastfeeding as positive maternity care outcomes. Higher rates of caesarean birth, premature births, low birth weight and newborn deaths were indicators of poor outcomes.

The Deep South, which not only had lower integration scores, but also higher rates of African American births, had the worst rates of premature birth, low birth weight and newborn mortality. The West Coast states of California, Oregon and Washington consistently scored well on those measures.

Source: https://www.sciencedaily.com/releases/2018/02/180221180521.htm

providers.jpg

HEALTH CARE PARTNERS

Neonatal Provider Workforce-Erin L. Keels, Jay P. Goldsmith and COMMITTEE ON FETUS AND NEWBORN-Pediatrics December 2019, 144 (6) e20193147                              DOI: https://doi.org/10.1542/peds.2019-3147-                                                                                     Lead Authors: Erin L. Keels, DNP, APRN-CNP, NNP-BC

Abstract-This technical report reviews education, training, competency requirements, and scopes of practice of the different neonatal care providers who work to meet the special needs of neonatal patients and their families in the NICU. Additionally, this report examines the current workforce issues of NICU providers, offers suggestions for establishing and monitoring quality and safety of care, and suggests potential solutions to the NICU provider workforce shortages now and in the future

*** We are sharing two IMPORTANT sections (Potential Strategies To Address Workforce Shortage of Neonatal Providers  and Summary and Conclusions). We encourage you to review the full report.

Potential Strategies To Address Workforce Shortage of Neonatal Providers-Strategies to address provider workforce shortages in the NICU can include attempting to reduce the workload (i.e., reduce the number of patients admitted to the NICU and/or shorten the length of stay) and/or increase the number of providers. In addition to declining birth rates in the United States, new care strategies may potentially change the acuity and locations where newborn infants receive their care and, over time, may lead to a redistribution and change the workloads of the NICU provider workforce. These emerging care strategies include limiting elective cesarean deliveries to 39 weeks’ gestation or greater; treating infants with neonatal abstinence syndrome outside of the NICU; reducing the need for antibiotic administration and, therefore, length of hospital stay for mothers with intraamniotic inflammation or infection; reducing NICU admissions for treatment of hypoglycemia with intravenous glucose administration by using dextrose or glucose gel; and reducing length of NICU stay through quality improvement strategies, such as decreasing the incidence of central line–associated bloodstream infections.

Strategies to increase the NICU provider workforce have mostly been concentrated on increasing the use of pediatric hospitalists, NNPs, and PAs. Workforce surveys conducted by the NANNP have delineated the existing and future NNP workforce needs. The authors noted that education, recruitment, and retention of NNPs were key areas of focus to increase supply.

Education for NNPs has evolved over 5 decades from certificate programs, to bachelor’s and master’s degrees in nursing, to the doctorate of nursing practice degree, which could slow the NNP pipeline further. Barriers to obtaining this education are lack of higher degree (i.e., doctorate of nursing) programs, funding of faculty, access to preceptors, and federal and state regulations. Regulations posed by the US Department of Education related to long-distance learning have had an effect on NNP education and have contributed to a drop in enrollment in states with significantly restrictive requirements. Collaboration among educational institutions may be a strategy to overcome restrictive regulations and minimize costs and faculty needs. Locally, neonatal programs and hospitals can increase efforts to recruit more neonatal nurses within the workplace to pursue higher education as an NNP and offer tuition reimbursement or scholarships to assist with the financial burden. This strategy capitalizes on the professional expertise of neonatal nurses, facilitating success and easing the transition into the APRN role. A shortage of university nursing faculty is another limitation of enrollment in academic programs. The NANNP has led a strategy to support NNP programs to prepare expert NNP clinicians to become educators in clinical faculties. It is hoped that this effort to increase faculty will enable an increase in the student cohort size and consequently increase the numbers of newly graduated NNPs in the workforce.

Recruitment of NNPs is vital to the NICU provider workforce. Practicing NNPs should contribute to recruitment efforts by serving as clinical preceptors for NNP students. Mentoring programs for novice NNPs have been shown to be valuable recruitment tools for NNP practices and hospitals. Offering longer orientation or residency programs is attractive to new graduates as well.

Retention of NNPs in the workforce is another important aspect of maintaining the NNP supply. With an aging workforce, any additional reduction in manpower from burnout and early retirement will compound the workforce deficit and increase demand. The scope of responsibility for NNPs includes the NICU provider role along with other roles, such as transport NNP, educator, delivery room resuscitation, cross-coverage for physician housestaff, and well-infant consultations, etc.25 Adequate staffing ratios are required to balance the needs of the unit with safe and effective care to neonates. Consideration of patient load and acuity will help reduce burnout and increase job satisfaction. In hospitals that maintain 24-hour work shifts, ensuring downtime for NNPs is critical to safe and competent care. Other strategies may include creating shorter shift lengths and devising creative scheduling techniques to offer better work-life balance in an attempt to increase longevity of the NNP role.

AC PNPs, acting within their scope of practice, can be used as NICU providers for term and older infants, such as those with surgical conditions and chronic medical conditions. PC PNPs, working within their scope of practice, could be used to perform well-newborn and other types of consultations, discharge education, care coordination, and neurodevelopmental follow-up. This team-based collaborative model capitalizes on the unique skill sets of each provider. However, the PNP workforce pipeline suffers from many of the same or similar issues as the NNP pipeline, and it is likely that applying some of the above recruitment and retention strategies may help. Additionally, some PNPs may consider achieving additional certification as an NNP through a post–master’s certification academic program.

Efforts to increase the PA workforce in the NICU have included the addition of postgraduate training programs, and more hospitals are hiring PAs and providing onboarding for those without specific NICU experience. As the total population of PAs continues to increase, offering optional rotations through the NICU during student coursework and clinical rotations, creating more postgraduate training opportunities in neonatology for PAs, and formalizing neonatal PA orientation programs may increase the numbers of these providers in neonatology. Reynolds and Bricker note that PAs “represent a historically underutilized resource to resolve neonatology’s workforce issues.”

Pediatric hospitalists have completed a formal pediatrics residency program and are licensed physicians who can be used as NICU providers within their scope of practice. Hospitalists can currently achieve board certification through the ABP in the field of general pediatrics20 and, if eligible, may also soon be able to obtain board certification in PHM. The AAP Section on Hospital Medicine and its Neonatal Hospitalists Subcommittee are developing and reviewing content on delivery room care and common neonatal conditions for PHM fellowship programs and for the PHM board certification process. Recruitment and retention of pediatric hospitalists who are focused on newborn care and work as providers in the NICU may be helpful to the overall NICU provider workforce. The scope of responsibility for pediatric and neonatal hospitalists may include clinical responsibilities for delivery room resuscitation, transport, cross-coverage for housestaff, well-newborn consultation and care, and the care of selected newborn infants in the intermediate and intensive care nurseries. In addition, many pediatric hospitalists also serve as educators, researchers, and leaders of committees and quality improvement activities. Adequate staffing ratios are important to the practice environment and are required to balance the needs of the unit with safe and effective care to neonates. Consideration of patient load, acuity, and need for academic and professional development will help reduce burnout and increase longevity and job satisfaction of pediatric and neonatal hospitalists.

In addition to the pipeline, recruitment, and retention strategies mentioned previously, efforts should also be focused on effective use and quality-outcomes metrics of all neonatal providers to improve effectiveness and efficiency issues and to improve the quality of care delivered to the neonate who is hospitalized

Summary and Conclusions-

  • The NICU provider workforce consists of a variety of professionals in varied stages of their careers with a wide range of degrees, training, experience, skills, and competencies.
  • Increasing collaboration of neonatologists with other NICU providers (pediatric hospitalists, APRNs, and PAs) and physician trainees will be necessary to meet the needs of the NICU population going forward.
  • The skill level, experience, and competency of neonatology physician trainees (residents and fellows) and NICU providers (PAs, pediatric hospitalists, and PNPs) can be variable, although the training model for NNPs is well developed and may serve as a model for other NICU providers.
  • All neonatal providers should possess a basic set of knowledge, procedural, and behavioral-based competencies to provide safe and effective care.
  • It is the responsibility of the medical and nursing leadership of the NICU, with the assistance of the hospital credentialing committee, to develop and periodically review competency criteria for all NICU providers.
  • Competency criteria, such as those developed by the AAP, ACGME, AAPA, and NONPF, can help guide the development and evaluation of NICU providers to provide high-quality, safe, and cost-effective care to the high-risk NICU population.
  • Strategies to increase the overall NICU provider workforce should be evaluated and thoughtfully employed at the national and state levels to remove barriers to education, training, and practice.
  • Ultimately, the attending neonatologist is responsible for the care given by NICU providers under his or her supervision and/or collaboration. He or she should be involved in the development and periodic review of competency criteria and should ensure that malpractice liability protection, of the institution or obtained personally, covers adverse events that may involve members of the neonatal care team.

Source: https://pediatrics.aappublications.org/content/144/6/e20193147

    

Hospital transfer of premature newborns linked to heightened risk of brain injury

Ensuring extremely premature babies are born in the right place is the best approach, say researchers -16/10/2019

Transferring extremely premature babies from a lower (“non-tertiary”) level neonatal care unit to a higher (“tertiary”) level unit in the first 48 hours after birth is associated with an increased risk of severe brain injury, finds a study published by The BMJ today.

Keeping these infants at lower level units after birth is also associated with a higher risk of death, compared with birth in a tertiary facility.

The findings are based on more than 17,000 births in England between 2008 and 2015, and suggest that neonatal services should be designed to ensure, whenever possible, that extremely preterm infants are born in a tertiary care setting.

About one in 20 premature infants in high income countries are born extremely prematurely (at less than 28 weeks of pregnancy) and are at high risk of death, severe illness, and long term disability.

Studies from the 1980s found that transporting preterm infants from non-tertiary to tertiary care shortly after birth (known as “early postnatal transfer”) was linked to worse outcomes than preterm infants born in a tertiary setting.

But results from recent studies have been inconclusive, and care for the most premature babies before and after birth has changed considerably since many of these studies were done.

In England, early postnatal transfer continues to increase since neonatal care was reorganised in 2007, so it’s important to understand any effects associated with this.

To explore this further, researchers based in Finland and the UK analysed data for 17,577 extremely premature infants (born at less than 28 gestational weeks) in NHS hospitals in England between 2008 and 2015.

Infants were grouped based on birth hospital and transfer within 48 hours. Factors that could have influenced the results, like gestational age and whether antenatal steroids were given, were also taken into account by forming matched groups of babies.

Compared with controls (tertiary birth; not transferred), infants born in a non-tertiary hospital and transferred to a tertiary hospital had no significant difference in risk of death before discharge but higher risk of severe brain injury and lower chance of survival without severe brain injury.

Infants born in a non-tertiary hospital and not transferred had higher risk of death but no difference in risk of severe brain injury or survival without severe brain injury, compared with controls.

No differences in outcomes were found for infants transferred between tertiary hospitals (for non-medical reasons, such as insufficient capacity) and controls.

All these results were largely unchanged after further sensitivity analyses, suggesting that the findings withstand scrutiny.

This is an observational study, and as such, can’t establish cause, and the authors cannot rule out the possibility that some of the outcomes may have been due to other unmeasured (confounding) factors.

Nevertheless, they say this is one of the largest and most robust studies to focus on major outcomes among the highest risk infants in the context of modern neonatal care, and the results are in line with previous work in this field.

As such, they conclude: “Extremely preterm birth in a non-tertiary setting is associated with a higher risk of death and lower survival without severe brain injury compared with infants born in a tertiary neonatal setting.” They also recommend perinatal health services “promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.”

This view is supported by US researchers in a linked editorial, who say transfer before not after birth is the best approach for women at risk of preterm labour.

Professor Colm Travers from the University of Alabama at Birmingham and colleagues point out that antenatal transfer is well established in some US states, Australia and Scandinavia, where up to 95% of at risk infants are transferred before birth.

“Improved regionalization of perinatal care, prioritizing early and clear transfer pathways for women with threatened preterm labor should increase survival and reduce major lifelong morbidities among extremely preterm infants,” they conclude.

Source: https://www.bmj.com/company/newsroom/hospital-transfer-of-premature-newborns-linked-to-heightened-risk-of-brain-injury/

eye.png

Retinopathy of prematurity – not only an acute condition? An interview with Professor Armin Wolf

POSTED ON 16 DECEMBER 2019 -Interview with Professor Armin Wolf, Deputy Hospital Director, Eye Hospital, Ludwig-Maximilians-University Munich

Retinopathy of Prematurity (ROP) is a condition that is found in the eyes of very 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). If detected timely, it can usually be treated and a blindness can be prevented. Still, it is a condition of the eye that can have long-term effects. We would like to learn a bit more about these long-term effects of ROP today.

Question: Professor Wolf , is follow-up for their eyes important for all preterm born patients, or only for a certain group (e.g. children who have been treated for ROP)? And why?

We know from various studies there are risk factors for developing ROP in a preterm infant. However, we know only little about the sequelae of this eye condition with the child growing older. Therefore, there is a screening for the child until it reaches its normal gestational age. Thereafter, controls are recommended according to findings. However, if we look at the sequelea that occur in adult age, it seems not to be dependent on whether the patient was treated during the critical time of ROP development. Nevertheless, we have to take into account that treatment of ROP has not always been the same within the last 40 years, thus we will need to continue studies on the late courses of former ROP, often referred to as adult ROP.

 Question: How long should the eyes of these babies be checked for and how often?

According to the current German guidelines for screening for ROP a continuous follow-up after reaching normal gestational age is recommended for preterm children with a birth weight of less than 1500g or a gestational age of less than 32 weeks. For children with a gestational age of 32 to 36 weeks a regular follow-up is recommended until the 6th year. Every eye – and every patient with ROP is different, therefore it has to be decided based on every case. Especially if there are additional health problems, follow-up may need to be performed at shorter periods as it is not always easy to asses retinal status.

With new medical treatment modalities, we have seen late reactivation of ROP in very few cases, however, these cases must be identified. Currently, we have very little data from long-term follow-up of ROP patients. We are aware that they are at higher risk for retinal detachment, glaucoma and other ocular pathologies, however, we have too little data to draw conclusions. It seems that an eye that has gone through the active phase of ROP during early childhood, independent from treatment, seems to be a ”special eye also in the light of future treatment. Therefore, a treating surgeon will always need to know about the patient having been a preterm infant, and it seems that the birth weight does play a role in the individual risk.

Question: What is done during an eye follow-up examination after the baby has reached its due date and does it hurt?

Basically speaking, these examinations aim at examining the same structures that are examined during the active phase of ROP after birth at the NICU. In these examinations, pupil is dilated and the fundus (the back of the eye) is examined. Most of these patients are used to ophthalmic examinations, therefore, it is usually possible in a standard examination at the ophthalmologist. Only in few cases or if there is a possibly relevant finding during a standard examination, the examination has to be performed under full anesthesia to rule out relevant findings.

Testing the visual acuity and determining the refraction (i.e. the glasses the patient needs to wear), as well as examining the need to patch one eye to assure equal bilateral development are also part of these routine examinations. Invasive examinations are usually not necessary.

Question: Who can check the eyes of these babies and later children?

In general, these examinations may be done by any ophthalmologist. However, if the ophthalmologist feels uncomfortable or if there was an ROP diagnosis, a specialised ophthalmologist for retina or a specialized center may be senseful.

Question: Regarding follow-up, what is your advice for children who developed ROP?

We tend to look at ROP patients especially in their young ages.  At this age, follow-up is mandatory. However, with children growing up, preterm birth tends to be “forgotten”, and at later age there are only few patients that have regular follow-up examinations. I recommend to stick to lifelong follow-up with intervals depending on the clinical findings to avoid complications such as retinal detachments. In an uncomplicated ROP for example I do follow-up examinations year-wise.

 Source: https://pediatrics.aappublications.org/content/144/6/e20193147

heart.jpg

PREEMIE FAMILY PARTNERS

Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father co-parenting.

baby.dad.jpg

family.initative.png

INTERNATIONAL WORKING GROUP

The Family Initiative has convened the International Neonatal Fathers Working Group, involving 11 researchers and practitioners who have championed better engagement and support for fathers whose infants are being cared for in neonatal units.

RESEARCH REVIEW-The Family Initiative has been tracking and reporting on research on fathers in neonatal care since 2015 on FamilyIncluded.com. It became apparent that some interesting and new ideas were emerging in newly published articles. In response to this, the Family Initiative approached all the authors and proposed a joint effort to report on all the new evidence.

We have since published an article in the Journal of Neonatal Nursing – Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father co-parenting.

This discusses the findings from 50 pieces of research in recent years on fathers in neonatal units.

The principle finding is that understanding and supporting father-infant attachment and supporting co-parenting improves the health of the baby and helps both parents to care for the baby and for each other.

WHAT NEONATAL FATHERS SAY

These are quotations from the published research that we reviewed.

“I did a bit of kangaroo with him and when I looked at him….wow! I’m going to be paternal, I know.”

“When I first saw M., it was magic, a miracle! I was all alone in the bloc.”

“The first time I held him skin-to-skin, it was really, like, wow! It was like a communion.”
“I looked at my son and then my daughter and then my wife and I just felt, damn I’m so happy.”
“I have never been this stressed before….I take care of the other children at home and of my job, but I also need to be here – I want to be here as well.”
“As a father, you feel left out.”
“I don’t want to be weak in front of my wife. I don’t think she knows how bad I am hurting right now.”

“I have to cheer her up, but no one helps me. It is difficult to bear. I do not show that I am burnt out; instead, I suppress my feelings.”
“I wouldn’t want my wife asking me how I feel.”
“Everybody around the situation is focused on mom/baby. Dads are left to worry about everything and everyone. As a dad, you may feel lonely.”
“It would have been helpful to have maybe more contact with NICU fathers such as men with children who were either currently or had been in the NICU at some point.”

RECOMMENDATIONS FOR PRACTICE-We make three key recommendations to improve infant health on the basis of the evidence:

  • Support the father-baby bond in the same way the mother-baby bond is supported.
  • Pay attention to the differences between mothers and fathers, both within individual families and also in relation to different gendered social expectations experienced by each.
  • Support team parenting, or co-parenting, between the mother and father.

We also make 12 practical recommendations for practice:

  • Assess the needs of mother and father individually.
  • Consider individual needs and wants in family care plans.
  • Ensure complete flexibility of access for fathers to the neonatal unit.
  • Gear parenting education towards co-parenting.
  • Actively promote father-baby bonding, particularly skin-to-skin, even in the presence of the mother.
  • Be attentive to fathers hiding their stress from both professionals and their partners.
  • Inform fathers directly not just via the mother.
  • Facilitate peer-to-peer communication for fathers.
  • Differentiate and analyse by gender in service evaluations.
  • Train staff to work with fathers and to support co-parenting.
  • Develop a father-friendly audit tool for neonatal units.
  • Organise an international consultation to update guidelines for neonatal care, including those of UNICEF.

GENDER DIFFERENCES-The research identifies three ways in which fathers start from a different place from mothers:

 Fathers are often not considered “natural” careers like mothers are, a view that is strongly challenged by biological, neurobiological and psychological evidence.

Fathers are often expected to continue working and to look after older siblings.

Fathers are under strong social pressure to appear strong and to hide their distress.
Father-baby contact, particularly skin-to-skin, stimulates strong hormonal changes in men – more oxytocin, more prolactin, less testosterone. All these are linked to caring activity (as in mothers). Neurobiological changes also take place triggering ‘emotional empathy’ and ‘socio-cognitive’ networks in the father’s brain (as in the mother’s). When these two networks are strongly activated, the baby is likely to have stronger emotion regulation and social skills four years later.

Source: https://www.familyinitiative.org.uk/neonatal-fathers

chic.jpg

Historical background to maternal-neonate separation and neonatal care.

Bergman NJ. Department of Neonatology, Karolinska Institute, Stockholm, Sweden.

Abstract

Maternal-neonate separation after birth is standard practice in the modern obstetric care. This is however a relatively new phenomenon, and its origins are described. Around 1890, two obstetricians in France expanded on a newly invented egg hatchery as a method of caring for preterm newborns. Mothers provided basic care, until incubators became part of commercial exhibitions that excluded them. After some 40 years hospitals accepted incubators, and adopted the strict separation of mothers from babies observed at the exhibitions. The introduction of artificial infant formula made the separation practical, and this also became normal practice rather than breastfeeding. Incubators and formula were unquestioned standard practices before randomized controlled trials were introduced, and therefore never subjected to such trials. The introduction of Kangaroo Care began 40 years ago in Colombia, now as a novel intervention. Recent trials do in fact show that maternal-neonate separation is detrimental to mothers and babies. Recent scientific discoveries such as the microbiome, epigenetics, and neuroimaging provide the scientific explanations that have not been available before, suggesting that skin-to-skin contact and breastfeeding are defining for the basic reproductive biology of human beings.

© 2019 Wiley Periodicals, Inc.

Source:https://www.researchgate.net/publication/333514198_Historical_background_to_maternal-neonate_separation_and_neonatal_care

freidns.jpg

Family Support Linked to Resilience in Kindergarteners Born Preterm

October 10, 2019 Center for Biobehavioral Health, Neonatology  Adelaide Feibel,

Despite known adverse outcomes associated with prematurity, a large minority of kindergarteners born preterm exhibit none of them.

For years, medical researchers have dedicated countless hours to studying the adverse outcomes of premature births.

But in their attempts to illuminate the incidence of cognitive, behavioral and learning deficits in preterm and low-birth-weight infants, researchers have failed to address an equally important question: Why do some preterm infants manage to develop normally, despite the high-risk nature of their births?

  1. Gerry Taylor, PhD, principal investigator in the Center for Biobehavioral Health in the Abigail Wexner Research Institute at Nationwide Children’s Hospital, seeks to rectify this omission from the developmental literature in a study published earlier this year in the Journal of the International Neuropsychological Society.

The study, which analyzed the development of 146 extremely low-birth-weight and preterm kindergarten children and 111 of their normal-birth-weight peers from the Cleveland, Ohio, metropolitan area, found that 45% of the children in the preterm group were “resilient” to the biological risks of being preterm, meaning they displayed age-appropriate behavior and academic learning. In comparison, 73% of the control group displayed these same characteristics.

“What about the kids that do well? How do they escape the negative consequences of this quite high-risk condition? No one has really focused on that part of the population,” Dr. Taylor says. “I see resilience as the flip side of the coin of looking at the effects of brain-related risk factors in children and their development.”

By measuring both the “proximal” family environment, such as the level of stimulation at each child’s home and the quality of the relationship between the mother and child, and more “distal” social risks such as median neighborhood income, the research team discovered that resilient preterm children were more likely to have grown up in “advantaged” family environments. Such environments are those that provide ample learning opportunities for their children, where parent-child relationships are positive and supportive, and where the parents themselves do not feel highly burdened or distressed.

According to Dr. Taylor, the development literature tends to apply the concept of “resilience” to children exposed to social risks, such as high poverty, who achieve well academically and are free of significant behavior problems. In his current position, he is interested in extending the concept of resilience to children at biological risk. Children at biological risk include not only those born preterm but also those with a broader group of neurodevelopmental conditions, such as traumatic brain injury and other acquired brain insults, congenital heart disease, epilepsy and muscular dystrophy. Dr. Taylor hopes to learn more about why many children with these conditions do well and he believes that this knowledge will help find ways to enhance the development of all at-risk children.

“This is something we need to be focusing on as much as the negative outcomes,” Dr. Taylor says. “We have different things to learn from the kids that do well.”

Reference: Taylor HG, Minich N, Schluchter M, Espy KA, Klein N. Resilience in extremely preterm/extremely low birth weight kindergarten children. Journal of the International Neuropsychology Society. 2019 Apr;25(4):362-374.

Source: https://pediatricsnationwide.org/2019/10/10/family-support-linked-to-resilience-in-kindergarteners-born-preterm/

oxy..png

INNOVATIONS

Naturally boost Oxycontin levels for Neonatal Bonding | Living Healthy Chicago

LH.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.

kiddos

Sewing students create fabric hearts for babies in neonatal intensive care

CBC News · Posted: Apr 04, 2019 2:35 PM MT | Last Updated: April 4, 2019

Junior high fashion studies students at Lakeland Ridge School in Sherwood Park hold up examples of fabric hearts they’ve sewn. (Caroline McKay)

Fashion studies students at Lakeland Ridge School have a lot of heart when it comes to helping families with newborns in hospital.

The junior high students have been sewing fabric hearts to give to the Misericordia Community Hospital for its neonatal intensive-care unit.

Source: https://www.cbc.ca/news/canada/edmonton/fabric-hearts-newborn-babies-students-sherwood-park-1.5084978

Abis.Den.jpgBonding Heart – For Neonatal Units In Hospitals

Make a heart, with tips to help you secure a lovely shape, going around curves and corners, includes pivoting. Use 100% Cotton for the babies please, and something soft that will go against a baby’s soft, delicate skin x

If you are interested in making hearts, please send them with your contact details or drop them off at Sheffield Hospitals Charity, Wycliffe House, Northern General Hospital, Sheffield, S5 7AT.

 

WARRIORS:

KAT’S CORNER

katskorner.jpg

Wishing you great Peace, Joy and Health this New Year, my Warrior family. I started the year baking a Banoffee pie, something I had never heard of, but a friend of mine had mentioned it was one of his favorites! I looked at recipes and chose one. The recipe called for a  graham cracker crust, which was not baked, only chilled. My gut said this didn’t seem right, but I choose to follow the recipe. I prepared the dolce de leche, whipped cream, and bananas to perfection. After chilling everything as directed I went to serve the pie and it was a crumbly mess! Chilled, unbaked graham cracker crust was a bust. Should have listened to my gut……

Throughout history people have sold a lot of “recipes” for life . Road signs and guidelines can be helpful. Let’s choose to listen to our guts, tap into and trust our inner wisdom, and create and enjoy unique, passionate, fulfilling lives! Cheers!

pie..jpg

Premature birth linked to increased risk of chronic kidney disease into later life

Given high levels of preterm birth, findings have important public health implications, say researchers –01/05/2019

Preterm and early term birth are strong risk factors for the development of chronic kidney disease (CKD) from childhood into mid-adulthood, suggests a study from Sweden published by The BMJ today.

Given the high levels of preterm birth (currently 10% in the US and 5-8% in Europe), and better survival into adulthood, these findings have important public health implications, say the researchers.

Preterm birth (before 37 weeks of pregnancy) interrupts kidney development and maturity during late stage pregnancy, resulting in fewer nephrons forming (filters that remove waste and toxins from the body).

Lower nephron number has been associated with the development of high blood pressure and progressive kidney disease later in life, but the long-term risks for adults who were born prematurely remain unclear.

So a team led by Professor Casey Crump at the Icahn School of Medicine at Mount Sinai in New York, set out to investigate the relation between preterm birth and risk of CKD from childhood into mid-adulthood.

Using nationwide birth records, they analysed data for over 4 million single live births in Sweden during 1973-2014. Cases of CKD were then identified from nationwide hospital and clinic records through 2015 (maximum age 43 years).

Overall, 4,305 (0.1%) of participants had a diagnosis of CKD, yielding an overall incidence rate of 4.95 per 100,000 person years across all ages (0-43 years).

After taking account of other factors that might be important, they found that preterm birth (less than 37 weeks) was associated with a nearly twofold increased risk of CKD into mid-adulthood (9.24 per 100,000 person years). Extremely preterm birth (less than 28 weeks) was associated with a threefold increased risk of CKD into mid-adulthood (13.33 per 100,000 person years).

A slightly increased risk (5.9 per 100,000 person years) was seen even among those born at early term (37-38 weeks).

The association between preterm birth and CKD was strongest up to age 9 years, then weakened but remained increased at ages 10-19 years and 20-43 years.

These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.

This is an observational study, and as such, can’t establish cause, and the researchers acknowledge some limitations, such as a lack of detailed clinical data to validate CKD diagnoses and potential misclassification of CKD, especially beyond childhood.

However, the large sample size and long-term follow up prompt the researchers to conclude that preterm and early term birth “are strong risk factors for the development of CKD from childhood into mid-adulthood.”

People born prematurely “need long term follow-up for monitoring and preventive actions to preserve renal function across the life course,” they add.

And they call for additional studies to assess these risks in later adulthood, and to further explain the underlying causes and clinical course of CKD in those born prematurely.

Source:https://www.bmj.com/company/newsroom/premature-birth-linked-to-increased-risk-of-chronic-kidney-disease-into-later-life/

Redefining Happiness | Street Philosophy With Jay Shetty

Published on Sep 15, 2016-Motivational philosopher Jay Shetty urges us to redefine happiness.

Disabled Surfing Australia – Gerroa 2016

Published on Mar 24, 2016-Filmed on the 20th March 2016, with hundreds of volunteers and officials helping dozens of surfing enthusiasts enjoy the beautiful waters of 7 Mile Beach, Gerroa.

Australia.jpg

Brains, Fatigue, and Saving Earth

Mexico.1.jpg

mex.2.jpg

Preterm Birth Rates – Mexico

Rank: 149 –Rate: 7.3% Estimated # of preterm births per 100 live births (USA – 12%)

Source: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3

Mexico, officially the United Mexican States  is a country in the southern portion of North America. It is bordered to the north by the United States; to the south and west by the Pacific Ocean; to the southeast by Guatemala, Belize, and the Caribbean Sea; and to the east by the Gulf of Mexico. Covering almost 2,000,000 square kilometers (770,000 sq mi), the nation is the fifth largest country in the Americas by total area and the 13th largest independent state in the world. With an estimated population of over 129 million people, Mexico is the tenth most populous country and the most populous Spanish-speaking country in the world, while being the second most populous nation in Latin America after Brazil.  Mexico is a federation comprising 31 states plus Mexico City (CDMX), which is the capital city and its most populous city. Other metropolises in the country include Guadalajara, Monterrey, Puebla, Toluca, Tijuana, and León.

Since the early 1990s, Mexico entered a transitional stage in the health of its population and some indicators such as mortality patterns are identical to those found in highly developed countries like Germany or Japan. Mexico’s medical infrastructure is highly rated for the most part and is usually excellent in major cities, but rural communities still lack equipment for advanced medical procedures, forcing patients in those locations to travel to the closest urban areas to get specialized medical care. Social determinants of health can be used to evaluate the state of health in Mexico.

State-funded institutions such as Mexican Social Security Institute (IMSS) and the Institute for Social Security and Services for State Workers (ISSSTE) play a major role in health and social security. Private health services are also very important and account for 13% of all medical units in the country.

Medical training is done mostly at public universities with much specializations done in vocational or internship settings. Some public universities in Mexico, such as the University of Guadalajara, have signed agreements with the U.S. to receive and train American students in Medicine. Health care costs in private institutions and prescription drugs in Mexico are on average lower than that of its North American economic partners.photos.mex.5.jpg

COMMUNITY

 2016 US election linked to increase in preterm births among US Latinas

Analysis suggests 3.5 percent more preterm births among Latinas than projected for nine months following election

Source: Johns Hopkins University Bloomberg School of Public Health – July 19, 2019

Summary: A significant jump in preterm births to Latina mothers living in the U.S. occurred in the nine months following the November 8, 2016 election of President Donald Trump, according to a new study.

The study, published July 19 in JAMA Network Open, was prompted by smaller studies that had suggested adverse, stress-related health effects among Latin Americans in the U.S. after the Trump election. The new analysis, based on U.S. government data on more than 33 million live births in the country, found an excess of 2,337 preterm births to U.S. Latinas compared to what would have been expected given trends in preterm birth in the years prior to the election. This is roughly 3.5 percent more preterm births than expected given projections from pre-election data.

Preterm birth, defined as birth before 37 weeks of gestation, is associated with a wide range of negative health consequences, from a greater risk of death in infancy to developmental problems later in life.

“The 2016 election, following campaign promises of mass deportation and the rollback of policies such as DACA, the Deferred Action for Childhood Arrivals program, may have adversely affected the health of Latinas and their newborns,” says study first author Alison Gemmill, PhD, MPH, assistant professor in the Department of Population, Family and Reproductive Health at the Bloomberg School.

Researchers know that stress in pregnant women can bring an elevated risk of preterm birth. Prior studies also suggest that anti-immigrant policies or actions can stress immigrant women and/or make them less likely to seek prenatal care. Moreover, although most Latinas living in the U.S. are citizens or otherwise documented immigrants and would not be directly threatened by tighter policies for undocumented immigrants, they are very likely to have close friends or family members who would be threatened by such policies.

The new study was prompted by a smaller study in 2018 by other researchers, who found a moderately elevated rate of preterm births to foreign-born Latina women in New York City from September 1, 2015 to July 31, 2016 compared to January 1, 2017 to August 31, 2017. Gemmill and her colleagues decided to investigate this issue on a national level, using more rigorous methodology that would account, for example, for the slow rise in the national preterm rate that has been observed since 2014.

In their analysis, Gemmill and colleagues used a database from the Centers for Disease Control and Prevention that covers essentially all live births in the U.S. First, the researchers tracked preterm births to self-identified Latina women over the previous administration, January 2009 to October 2016. They then used those data to generate an estimate of expected preterm births during the following nine months, from November 2016 to July 2017. Next, the authors compared those expected numbers to the actual numbers of preterm births to Latina women during the nine months after the election. The researchers found there were 1,342 preterm births of male infants above the expected number of 36,828, and 995 preterm births of female infants above the expected 30,687.

The analysis also revealed peaks in excess preterm births in February and July of 2017 for both male and female infants, which hints that infants conceived or in the second trimester of gestation at the time of the election may have been particularly vulnerable to maternal stress.

“We’ve known that government policies, even when they’re not health policies per se, can affect people’s health, but it’s remarkable that an election and the associated shift in presidential tone appears to have done so,” says Gemmill.

Gemmill and her colleagues suggest that future research should be done to determine more precisely the mechanisms by which policies and government messages can negatively affect population health outcomes.

This work was supported in part by the Transdisciplinary Postdoctoral Fellowship of the Preterm Birth Initiative at the University of California San Francisco and a Population Health & Health Equity Scholars award from the UCSF School of Medicine.

Source: Materials provided by Johns Hopkins University Bloomberg School of Public Health. https://www.sciencedaily.com/releases/2019/07/190719135535.htm

feets.jpg

Touch shapes preterm babies’ brains

16th March 2017

A baby’s earliest experiences of touch have lasting effects on the way it responds to touch at home.

Babies born prematurely are less likely to have the usual brain response to gentle touch. However, when given supportive touch while still in the hospital, their brain responses become more like those of full-term babies by the time they go home. Nathalie Maitre and colleagues measured the brain responses of 125 preterm and full-term babies using a soft, high-density EEG net.

We spoke with Maitre about the Current Biology study, which has care implications for the 15 million preterm babies born each year.

ResearchGate: What motivated this study?

Nathalie Maitre: Preterm infants have high rates of delays and neurodevelopmental impairments. We know from research that this can be linked to early problems reacting to sensations in daily life. Infants who have difficulties responding to touch, sound, position changes, and sights also have problems with movement, learning language, and higher cognitive skills. We wanted to study the importance of responses to touch because it is one of the earliest senses to functionally develop in human infants.

However, we did not want to assume that we could tell what babies feel, because most of our guesses would have been based on what older children showed outwardly. Our team wanted to look “inside” the infant brains to see what they actually felt in response to gentle touch. We did not want to assume that other signs, such as facial expressions or vital signs, could tell us how babies’ brains process touch.

RG: Can you tell us what you found?

Maitre: The earlier a baby is born, the more likely it is to have a smaller brain response to gentle touch when going home from the hospital. The more supportive touch preterm babies experience while still in the hospital, the more their brain responses to touch will be like term-born babies by the time they go home. Conversely, the more preterm babies experience painful procedures, the less their brain responses will be like those of term born babies, even when they receive pain medications and sucrose to try and mitigate pain. ​We were very surprised to find that if babies experience painful procedures early in life, their sense of gentle touch can be affected. Thanks to the groundbreaking work of other scientists who study the responses to pain in the baby brain, we can make sense of our findings as a kind of cross-over in the wiring of the brain between two different kinds of touch sensation. ​

RG: How did you conduct the study?

Maitre: We used a soft, high-density EEG net and repeatedly measured the baby brain’s response to a soft puff of air, comparing it to the brain’s response to a sham puff. Our analysis utilized the latest topographic analysis tools, developed by the team in Switzerland. We did this with term-born babies in the nursery and in preterm babies who were in the neonatal intensive care unit, right before they were going home. ​​

RG: Why do babies, particularly preterm babies, need touch?

Maitre: All babies need supportive touch to build essential connections in their brains. For preterm infants, providing this touch is especially important because they miss months of typical development inside the uterus of the mother, where they receive constant, non-noxious tactile feedback. This tactile feedback is essential, as it happens during a critical period of brain development. In some other sensory systems, when input does not happen during critical windows, the entire sensory system can be permanently affected. We do not know if this is the case for touch, but we certainly can see the impact of deprivation in preterm infants.

Touch is a critical building block of infant learning. It helps infants learn how to move, discover the world around them, and how to communicate. Touch allows them to learn these skills even before their vision is fully developed, and certainly before they learn verbal skills.  ​

RG: How can hospitals best integrate the results of your study into caring for preterm babies?

Maitre: Making sure that preterm babies receive positive, supportive touch, such as skin-to-skin care by parents, is essential to help their brains respond gentle touch in ways similar to those of babies who experienced an entire pregnancy inside their mother’s womb. When parents cannot do this, hospitals may want to consider occupational and physical therapists to provide a carefully planned touch experience, which is sometimes missing from a hospital setting. ​

RG: Does it matter who touches the baby?

Maitre: Our study included touch by therapists and parents, and we only counted touches when skin-to skin contact was involved. This is based on studies of skin-to-skin (kangaroo care), breastfeeding, and massage that have shown promising results in helping the maturation of the nervous system. While we know that certain types of touch appear supportive, we did not have the tools before this to study which forms may prove more beneficial than others. In general, infants benefit more from their parents’ touch for other reasons such as emotional bonding, increased opportunities for parents to practice responsivity, and in the case of breast feeding and skin-to-skin care, increased health benefits for both mom and baby.
Source: https://www.researchgate.net/blog/post/touch-shapes-preterm-babies-brains

               Michigan State University’s Sleep and Learning Lab                                           has conducted one of the largest sleep studies to date, revealing that sleep deprivation affects us much more than prior theories have suggested.

Published in the Journal of Experimental Psychology: General, the research is not only one of the largest studies, but also the first to assess how sleep deprivation impacts placekeeping — or, the ability to complete a series of steps without losing one’s place, despite potential interruptions. This study builds on prior research from MSU’s sleep scientists to quantify the effect lack of sleep has on a person’s ability to follow a procedure and maintain attention.

“Our research showed that sleep deprivation doubles the odds of making placekeeping errors and triples the number of lapses in attention, which is startling,” Fenn said. “Sleep-deprived individuals need to exercise caution in absolutely everything that they do, and simply can’t trust that they won’t make costly errors. Oftentimes — like when behind the wheel of a car — these errors can have tragic consequences.”

By sharing their findings on the separate effects sleep deprivation has on cognitive function, Fenn — and co-authors Michelle Stepan, MSU doctoral candidate and Erik Altmann, professor of psychology — hope that people will acknowledge how significantly their abilities are hindered because of a lack of sleep.

“Our findings debunk a common theory that suggests that attention is the only cognitive function affected by sleep deprivation,” Stepan said. “Some sleep-deprived people might be able to hold it together under routine tasks, like a doctor taking a patient’s vitals. But our results suggest that completing an activity that requires following multiple steps, such as a doctor completing a medical procedure, is much riskier under conditions of sleep deprivation.”

The researchers recruited 138 people to participate in the overnight sleep assessment; 77 stayed awake all night and 61 went home to sleep. All participants took two separate cognitive tasks in the evening: one that measured reaction time to a stimulus; the other measured a participant’s ability to maintain their place in a series of steps without omitting or repeating a step — even after sporadic interruptions. The participants then repeated both tasks in the morning to see how sleep-deprivation affected their performance.

“After being interrupted there was a 15% error rate in the evening and we saw that the error rate spiked to about 30% for the sleep-deprived group the following morning,” Stepan said. “The rested participants’ morning scores were similar to the night before.

“There are some tasks people can do on auto-pilot that may not be affected by a lack of sleep,” Fenn said. “However, sleep deprivation causes widespread deficits across all facets of life.”

Journal Reference: Michelle E. Stepan, Erik M. Altmann, Kimberly M. Fenn. Effects of total sleep deprivation on procedural placekeeping: More than just lapses of attention.. Journal of Experimental Psychology: General, 2019; DOI: 10.1037/xge0000717

Source: https://www.sciencedaily.com/releases/2019/11/191121183923.htm

health.care.providers

HEALTH CARE PARTNERS

jp.jpg

Predicting Long-Term Survival Without Major Disability for Infants Born Preterm

December 2019 – Volume 215, Pages 90–97.e1

Objective

To describe the long-term neurodevelopmental and cognitive outcomes for children born preterm.

Study design

In this retrospective cohort study, information on children born in Western Australia between 1983 and 2010 was obtained through linkage to population databases on births, deaths, and disabilities. For the purpose of this study, disability was defined as a diagnosis of intellectual disability, autism, or cerebral palsy. The Kaplan–Meier method was used to estimate the probability of disability-free survival up to age 25 years by gestational age. The effect of covariates and predicted survival was examined using parametric survival models.

Results

Of the 720 901 recorded live births, 12 083 children were diagnosed with disability, and 5662 died without any disability diagnosis. The estimated probability of disability-free survival to 25 years was 4.1% for those born at gestational age 22 weeks, 19.7% for those born at 23 weeks, 42.4% for those born at 24 weeks, 53.0% for those born at 25 weeks, 78.3% for those born at 28 weeks, and 97.2% for those born full term (39-41 weeks). There was substantial disparity in the predicted probability of disability-free survival for children born at all gestational ages by birth profile, with 5-year estimates of 4.9% and 10.4% among Aboriginal and Caucasian populations, respectively, born at 24-27 weeks and considered at high risk (based on low Apgar score, male sex, low sociodemographic status, and remote region of residence) and 91.2% and 93.3%, respectively, for those at low risk (ie, high Apgar score, female sex, high sociodemographic status, residence in a major city).

Conclusions

Apgar score, birth weight, sex, socioeconomic status, and maternal ethnicity, in addition to gestational age, have pronounced impacts on disability-free survival.

Source: https://www.jpeds.com/article/S0022-3476(19)30964-3/fulltext

buddah.jpg

Compassion Fatigue

Compassion fatigue, also known as secondary traumatic stress (STS), is a condition characterized by a gradual lessening of compassion over time. Scholars who study compassion fatigue note that the condition is common among workers who work directly with victims of disasters, trauma, or illness, especially in the health care industry. Professionals in other occupations are also at risk for experiencing compassion fatigue, e.g. attorneys, child protection workers and veterinarians. Other occupations include: therapists, child welfare workers, nurses, radiology technologists, teachers, journalists, psychologists, police officers, paramedics, emergency medical technicians (EMTs), firefighters, animal welfare workers, public librarians, and health unit coordinators. Non-workers, such as family members and other informal caregivers of people who are suffering from a chronic illness, may also experience compassion fatigue. It was first diagnosed in nurses in the 1950s.

People who experience compassion fatigue can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, sleeplessness or nightmares, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self-doubt.

Journalism analysts argue that news media have caused widespread compassion fatigue in society by saturating newspapers and news shows with decontextualized images and stories of tragedy and suffering. This has caused the public to become desensitized or resistant to helping people who are suffering.

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

brkheart.jpg

Compassion Fatigue: What is it and do you have it?

Juliette Watt   Published on Nov 26, 2018

In this compelling talk, Juliette introduces us to “Compassion Fatigue.” A hugely pervasive syndrome that not only affects people like professional caregivers but also most of us one way or another. Juliette herself has suffered from Compassion Fatigue first hand and she is very passionate about sharing the insidious nature of this syndrome and the devastating effects it can have on your life. Compassion Fatigue can potentially happen to any age group. From people in their twenties right up to their senior years. It is an important, critical topic that Juliette has pulled out of the shadows so that we can recognize the symptoms and develop a renewed resilience to teach ourselves how to continue to give compassion without sacrificing ourselves and our lives. Born and raised in London, England, Juliette was a stunt horse rider for MGM pictures then later a London Playboy Bunny. From 18 she spent the next 20 years performing a one woman show in cabarets world-wide. In 1971 she moved to Beirut, Lebanon where she lived for 4 years during their vicious civil war. Moving to NYC in her forties, she thrived as a soap opera scriptwriter, winning two Writers Guild Awards and a nomination for a Daytime Emmy. She then become an ATP pilot and Master Flight Instructor which led her to working for 10 years at Best Friends Animal Sanctuary in Utah, eventually flying rescue missions in New Orleans saving abused and abandoned dogs in the aftermath of Hurricane Katrina. Over 6000 animals were saved. Currently she is on a passionate mission to help and guide people who have lost themselves in who they’ve been for everyone else.

 

faces.gif

peds

Pain‐related increase in serotonin transporter gene methylation associates with emotional regulation in 4.5‐year‐old preterm‐born children

First published: 31 October 2019

Aim

The main goal of this study was to assess the association between pain‐related increase in serotonin transporter gene (SLC6A4) methylation and emotional dysregulation in 4.5‐year‐old preterm children compared with full‐term matched counterparts.

Methods

Preterm (n = 29) and full‐term (n = 26) children recruited from two Italian hospitals were followed‐up from October 2011 to December 2017. SLC6A4 methylation was assessed from cord blood at birth from both groups and peripheral blood at discharge for preterm ones. At 4.5 years, emotional regulation (ie, anger, fear and sadness) was assessed through an observational standardised procedure.

Results

Preterm children (18 females; mean age = 4.5, range = 4.3‐4.8) showed greater anger display compared with full‐term controls (14 females; mean age = 4.5, range = 4.4‐4.9) in response to emotional stress. Controlling for adverse life events occurrence from discharge to 4.5 years and SLC6A4 methylation at birth, CpG‐specific SLC6A4 methylation in the neonatal period was predictive of greater anger display in preterm children but not in full‐term ones.

Conclusion

These findings contribute to highlight how epigenetic regulation of serotonin transporter gene in response to NICU pain exposure contributes to long‐lasting programming of anger regulation in preterm children.

Source: https://onlinelibrary.wiley.com/doi/10.1111/apa.15077

marchofdimes.jpg

PREEMIE FAMILY PARTNERS

How Parents Help Preemies Fight to Survive

smart.jpg

There are a number of factors that can cause premature labor, but parents should remember that they plan an essential role in helping their preemies  become healthier during the first weeks of their lives.

Development follow up for NICU babies

people.jpg

peace.love.

med.press.pngPreterm birth linked to increased rates of diabetes in children and young adults

by Diabetologia

New research shows that preterm birth is linked to increased rates of type 1 and type 2 diabetes in children and young adults, with certain effects stronger in females. People who have been born preterm may need more intensive monitoring and prevention efforts to lower their risk of diabetes, concludes the study, published in Diabetologia.

Preterm birth (before 37 weeks of pregnancy) has been associated with early life insulin resistance, which can develop into diabetes. However, no large population-based studies have examined risks of type 1 diabetes (T1D) and type 2 diabetes (T2D) in people born preterm and potential differences between boys and girls from childhood into adulthood. “This is important because doctors will increasingly encounter adults who were born prematurely due to higher survival rates, and will need to understand their long-term risks,” say the authors who include Professor Casey Crump, Icahn School of Medicine at Mount Sinai, New York, NY, USA, and colleagues.

The authors did a national cohort study of all 4,193,069 single babies (not twins or other multiple births) born in Sweden during 1973-2014, who were followed up for T1D and T2D identified from nationwide diagnoses and pharmacy data to the end of 2015 (and thus having a maximum age 43 years; the median age of the study population was 22 years). Computer modelling was used to adjust for potential confounders that could affect the results, including maternal age at delivery, maternal education, country of maternal birth, maternal BMI, maternal smoking and presence of pre-eclampsia.

In addition, the authors performed a co-sibling analysis—an assessment of the siblings of the people in the study (83% had at least one sibling). This analysis was to provide more evidence as to whether the risk of diabetes was associated specifically with preterm birth, or associated with genetic or environmental factors shared by all siblings in a family.

Throughout the study, 27,512 (0.7%) and 5,525 (0.1%) people were identified with T1D and T2D, respectively (the lower number for T2D was because of the young age of this population; T2D is much more common in older adults). Analysis showed being born preterm (earlier than 37 weeks) was associated with a 21% increased risk of T1D and a 26% increased risk of T2D in those aged less than 18 years. In young adults aged 18-43 years, being born preterm was associated with a 24% increased risk of T1D and a 49% increased risk of T2D.

In most cases, being born extremely preterm (22-28 weeks) was associated with higher risks of diabetes than those born at term, except for T1D in those aged less than 18 years. The authors say this finding for T1D in those under 18 years was against their expectations and needs further research.

Being born male and preterm was associated with an approximately 20% increased risk of T1D at both the under 18 years group and the age 18-43 years group, while for females the increased risk was around 30% for both age groups. For T2D, being born female and preterm was associated with a 60% increased risk in those aged under 18 years, while for males aged under 18 years there was no increased risk. In those aged 18-43 years, the authors found the increased risk associated with being born preterm was much higher among women (75%) than men (28%). This is despite the fact that across all normal term births in this study, T2D incidence was slightly higher among males (5.84 per 100,000 person-years) than females (5.27).

Across all the results, shared genetic and environmental factors between siblings were not wholly responsible for differences in diabetes risk in individuals born preterm. The authors highlight specifically that the association between preterm birth and T2D in those aged 18-43 years appeared independent of shared familial factors.

The authors say a host of mechanisms could account for these observed associations, including preterm birth interrupting and limiting the production of beta cells in the pancreas which produce insulin; effects on the immune system; the impact of medications and procedures in intensive care during the birth period; and then differences in other risk factors such as diet, exercise and obesity.

The authors say: “Because of major advances in treatment, most preterm infants now survive into adulthood. As a result, clinicians will increasingly encounter adult patients who were born prematurely.Preterm birth should now be recognized as a chronic condition that predisposes to the development of diabetes across the life course.”

They add: “Doctors currently seldom seek birth histories from adult patients, and thus preterm birth may remain a ‘hidden’ risk factor. Medical records and history-taking in patients of all ages should routinely include birth history, including gestational age, birthweight and any complications during or after the birth. Such information can help identify those born prematurely and facilitate screening and early preventive actions, including patient counselling to promote lifestyle prevention of diabetes.”

They conclude: “We found that preterm and early term birth were associated with increased risk of type 1 and type 2 diabetes from childhood into early to mid-adulthood in a large population-based cohort. Children and adults who were born prematurely may need early preventive evaluation and long-term follow-up for timely detection and treatment of diabetes.”

Source: https://medicalxpress.com/news/2019-12-preterm-birth-linked-diabetes-children.html

More information: Casey Crump et al. Preterm birth and risk of type 1 and type 2 diabetes: a national cohort study, Diabetologia (2019). DOI: 10.1007/s00125-019-05044-z

Preterm Labor & Premature Birth

Even if you do everything right during pregnancy, you can still have preterm labor and premature birth. Preterm labor is labor that starts too early, before 37 weeks of pregnancy.

Premature babies may have more health problems or need to stay in the hospital longer than babies born on time. Some of these babies also face long-term health effects, like problems that affect the brain, lungs, hearing or vision.

Learn the signs and symptoms of preterm labor and what to do if they happen to you. If you do begin labor early, there are treatments that may help stop your labor.

In This Topic

ENJOY  a cup.jpg  of  CURIOSITY

INNOVATIONS

INSIGHTS INTO LINKS BETWEEN MICROBIOLOGY AND PRETERM BIRTH

One of the most promising areas of inquiry in our search for the causes of and preventions for premature birth is the interaction between the mom and her microbiome, which is the community of microorganisms in her body. We know that inflammation as a result of infection is responsible for at least 50 percent of all cases of premature birth. And typically, that infection triggers a complex series of actions and reactions. These include the activation of cells of the immune system, such as neutrophils, which can precipitate the physical transformations of collagen breakdown, cervical shortening, fetal membrane stretch, contractions and ultimately, premature labor and birth. Although we know some details about how that process works, up until now, we haven’t known why. For this reason, we’ve turned to some brilliant minds in microbiology and cell-to-cell communications for help.

That help will arrive in the form of the newly formed sixth March of Dimes Prematurity Research Center at Imperial College London. There are many reasons why Imperial College London is an ideal fit. They’ve been collaborating and sharing information with March of Dimes Prematurity Research Centers (PRCs) for a number of years. And like the other centers, they specialize in researching the causes of and preventions for premature birth. Ultimately, Imperial College was motivated to apply, and was selected, because of their global leadership, unique expertise and pioneering work in the field of glycobiology, including its links to the immune system and premature birth.

Glycobiology is the study of sugar molecules that coat all cells, both human and bacterial. In the birth canal, these molecules perform a kind of “handshake” that either activates or deactivates immune responses that can in turn, either trigger or prevent premature birth. But like everything else in the study of premature birth, this process is even more complicated than it seems. In some women, for example, certain types of bacteria like Lactobacillus in the birth canal protect against other groups of bacteria, such as Streptococcus, Staphylococcus and E. coli, entering the birth canal and infecting the mom, baby or both. But in other women, some types of Lactobacillus may perform the opposite function, triggering premature birth and putting both mom and baby at risk.

The expertise of Imperial College London in this area is unmatched by any other institution and not covered by the work of any other PRC in the March of Dimes network. It is however complementary to the research themes of other PRCs, including the microbiome (Stanford), physical changes in the structure of the birth canal and organs (University of Pennsylvania), and the genetics of premature birth (The Ohio Collaborative). Together these were the most important factors in their selection as the sixth center in our network.

Professor Phillip Bennett, M.D., Ph.D., is the center’s principal investigator and has specialized in helping to prevent premature birth his entire career. Joining him to put the center together are Dr. David MacIntyre and Dr. Lynne Sykes from the Institute of Reproductive and Developmental Biology at Imperial College. Their team includes three world renowned specialists in the glycosciences: Professor Anne Dell, Professor Ten Feizi and Dr. Stuart Haslam. Also on the team are Professor Marina Botto and Dr. Pascale Kropf, experts in inflammation and immunology, as well as some of the finest microbiologists, chemists, mathematicians, obstetricians, gynecologists and researchers anywhere in the field of reproduction. Also contributing to the work will be three hospitals affiliated with Imperial College London—Queen Charlotte’s Hospital, St. Mary’s Hospital and Chelsea and Westminster Hospital.

One of the motivating factors for Professor Bennett’s team to join March of Dimes’ PRC network was the transdisciplinary approach. “What normally happens in academia is that isolated university groups work in competition with each other. But what we found exciting was the concept of a research family,” Dr. Bennett said. “March of Dimes’ model has some of the best universities in the world using their own individual expertise and skills to work together for a common cause—we find that to be a particularly attractive way of doing research.” March of Dimes believes the transdisciplinary approach to research will be profoundly important to understanding how premature birth happens and how to prevent it. As always, we’re limited only by resources, not ideas. More funding is vital for the research to continue.

Source: https://www.marchofdimes.org/materials/ICL_theme1.pdf

rosters.jpg

Intrahealth International  VITAL – November 15, 2019

The survival rate of preterm babies improved  from 73% to 100% in 2019.

The demands from the children’s ward are overwhelming. We receive so many mothers in distress.

Katakwi district, in the eastern corner of Uganda, grapples with high disease burden. The most vulnerable are young mothers like Margret because there aren’t enough health workers to meet the high demand for services, including life-threatening childbirth emergencies. The district hospital serves 38,000 people from across eight sub-counties and is a referral point for many coming through the Karamoja region.

“The demands from the children’s ward are overwhelming,” says Dr. Opus Benjamin, acting medical superintendent at the Katakwi Hospital. “We receive so many mothers in distress and must provide quality care every day.”

The hospital needed more trained staff to provide basic quality care when and where it was needed, so that babies born too soon would have a chance to live. So, they brought in Catherine Alinga, a trained midwife. Senior Catherine, as she is fondly called by many at the maternity ward, works with the IntraHealth International-led Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) project to improve the quality of care for mothers and preterm babies.

In March 2019, Catherine began training staff at the Katakwi Hospital on helping babies breathe techniques and neonatal care. She also mentored the entire maternity staff at Katakwi and lower-level facilities on kangaroo mother care and newborn care.

Margret’s baby is alive today thanks to Catherine and the midwives she trained. Catherine’s skills and efforts showcase how hospitals in rural areas have found workable solutions to prevent newborn deaths.

Before Catherine’s training, the survival rate for preterm births was less than 10%, as many babies referred from lower facilities were at risk of dying on their way to Katakwi General Hospital. Since Catherine’s trainings, though, the unit has saved 15 premature babies, including Orisa. In the month of October alone, seven premature babies were admitted. All have been discharged alive.

To achieve this feat, the hospital developed a standard operating procedure for referrals and displayed it at facilities that were sending in most cases. Now, staff at local hospitals know when to refer mothers who are in need for care to the general hospital and staff at the general hospital are prepared to care for referred mothers when they arrive at the maternity ward.

The survival rate of preterm babies improved at Katakwi hospital from 73% in June 2019 to 80% in September 2019— and then to 100% in October 2019.

“The team here has been trained in handling premature babies, in terms of infection control, prevention of hypothermia, drug administration, dosages, frequency, and dilution,” Catherine says. “These are crucial and lifesaving steps that make a difference in the death or survival of a preterm baby.”

The maternity unit also encourages mothers to practice kangaroo mother care as one of the prevention measures to keep the baby warm and suggests that male partners participate in this care as well. The father’s participation in the baby’s post-birth care has ensured the survival of babies long after they have been discharged back into the community.

“Right now, the unit is on top of its game and the hospital administration is doing its very best to make sure equipment, drugs, and systems are in place to ensure all preterm babies survive,” says Geoffrey Orijabo, senior technical officer for maternal newborn and child health / family planning for RHITES-E .

The Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-East) program is led by IntraHealth International and funded by the US Agency for International Development.

Source: https://www.intrahealth.org/vital/right-training-has-led-100-survival-preterm-babies-ugandan-hospital

WARRIORS:

Interesting… and I am looking forward to knowing over time what the research below means for our Warrior family. My Mom and I try very hard to find new research and resources to share. We explored preemie developmental care and follow-up guidelines, have found little to share to date, but are confident the information will develop and become available over time. Our community of preterm birth survivors has grown, especially our micro-preemie brothers and sisters.  Some of our potential health care concerns are recently discovered and research is growing and vibrant. Resources are sparse in terms of medical follow-up for preemies, although some medical centers have organizational programs noted on their websites. In addition NICE has created a comprehensive site for provider reference (Developmental follow-up of children and young people born preterm: https://pathways.nice.org.uk/pathways/developmental-follow-up-of-children-and-young-people-born-preterm.

nhs.jpg

Preterm adults have ‘older’ brains, finds study

Written by Honor Whiteman on September 27, 2017

Adolescents and adults who were born very prematurely may have “older” brains than those who were born full term, a new study reveals.

Researchers identified changes in the brain structure of adults born between 28 and 32 weeks gestation that corresponded with accelerated brain aging, meaning that their brains appeared older than those of their non-preterm counterparts.

Lead study author Dr. Chiara Nosarti, of the Institute of Psychiatry, Psychology and Neuroscience at King’s College London in the United Kingdom, and colleagues recently reported their findings in the journal Neuroimage.

According to the Centers for Disease Control and Prevention (CDC), around 1 in 10 infants born in the United States in 2015 were preterm, meaning that they were born before 37 weeks of pregnancy.

A baby’s brain fully develops in the final few weeks of gestation, so being born early disrupts this process. As such, babies born preterm are at greater risk of developmental disabilities including impairments in learning, language, and behavior.

But how does preterm birth affect the brain in adulthood? This is what Dr. Nosarti and colleagues sought to find out with their new study.

According to Dr. Nosarti and team, their study is the first to investigate how preterm birth might affect this adult brain maturation process.

Using MRI, the researchers analyzed the brain structure of 328 adults who had been born before 33 weeks gestation. Subjects were assessed at two time points: adolescence (mean age 19.8 years) and adulthood (mean age 30.6 years).

The brain scans of these participants were then compared with those of 232 adults who were born full term (the controls), alongside 1,210 brain scans gathered from open-access MRI archives.

Specifically, the researchers looked at volume of gray matter in the participants’ brains, which they say can be a marker of “brain age.”

Accelerated brain maturation identified:

Compared with the controls, the team found that subjects born very preterm had a lower volume of gray matter in both adolescence and adulthood, particularly in brain regions associated with memory and emotional processing.

They also pinpointed a number of structural brain alterations that demonstrated resilience to the effects of preterm birth. For example, they identified increases in gray matter volume in regions associated with behavioral control.

The team hypothesizes that such alterations may arise to compensate for other brain functions negatively impacted by preterm birth.

“Even though one can only speculate on the functional significance of these alterations, prior studies suggested that compensatory mechanisms may support cognitive and language processing in very preterm samples,” write the authors.

Upon further investigation, the team found that the reduced gray matter volume identified in very preterm participants was associated with accelerated brain maturation. As a result, the brains of the preterm subjects appeared older than those of the controls.

First study author Dr. Vjaceslavs Karolis, also of the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, says that the team was surprised by the results.

“The finding of structural signatures of accelerated brain maturation in those born very prematurely was unexpected,” he notes, “because previous research suggested delayed brain maturation at earlier stages of development.”

Dr. Nosarti adds that they are unable to confirm how the structural brain changes identified in very preterm adolescents and adults translate to day-to-day functioning, but they believe that this is something that should be investigated in future research.

Source: https://www.medicalnewstoday.com/articles/319564.php#1

We have posted numerous articles exposing the detrimental effects of pollution and climate change on our global Neonatal Womb Warrior/preterm birth community. As Warriors, we are viscerally empowered to  understand and appreciate the healing power of  our community. Although research relating to the unique medical challenges we Warriors may face as we age is in it’s early stages, we can choose to be aware of and take actions to impact issues that seriously threaten our planet and all of our people. Our survival demands our attention, evaluation, innovative efforts, and responsive involvement in the creation and facilitation of proactive and retrospective efforts to support a healthy planet.   This is our chance to provide life support to our community. Even small steps are significant.  Let’s find our ways to make a difference.

unicef.jpg

FACT SHEET: ‘The climate crisis is a child rights crisis’

people.water

A young boy crosses a bridge near where houses were swept after Cyclone Idai hit Rusitu Valley, Chimanimani District, eastern Zimbabwe.

MADRID, 6 December 2019 – The climate crisis is threatening to roll back progress on child rights without sufficient urgent investment in solutions that benefit the most vulnerable children, UNICEF said today as the UN Climate Change Conference COP25 enters its second week.

“From hurricanes to droughts to floods to wildfires, the consequences of the climate crisis are all around us, affecting children the most and threatening their health, education, protection and very survival,” said Gautam Narasimhan, UNICEF Senior Adviser on Climate Change, Energy and Environment. “Children are essential actors in responding to the climate crisis. We owe it to them to put all our efforts behind solutions we know can make a difference, such as reducing vulnerability to disasters, improving the management of water resources, and ensuring that economic development does not happen at the expense of environmental sustainability.”

Some ways the climate crisis is affecting children, and how they can be addressed, include:

  • Around 503 million children now live in areas at extremely high risk of floods due to extreme weather events such as cyclones, hurricanes and storms, as well as rising sea levels. Investments in disaster-risk reduction, such as early warning systems can help prepare communities to protect children during extreme weather events.
  • The number of children displaced by extreme weather events in the Caribbean has increased six-fold in the past five years. From 2014 to 2018, 761,000 children were internally displaced, up from 175,000 children displaced between 2009 and 2013. Strategies that limit forced displacement and shorten rehabilitation time so that families can return home are critical.
  • Around 160 million children live in areas experiencing high levels of drought – and by 2040, 1 in 4 children will live in areas of extreme water stress. Technologies to effectively manage water exist, but greater investment to scale up techniques can help better locate, extract and sustainably manage water.
  • Weather-related disasters increase the risk for girls to drop out of school and be forced into marriages, trafficking, sexual exploitation and abuse. Educating girls increases their awareness of the climate crisis and builds their resilience and capacity to cope with these impacts.
  • Nearly 90 per cent of the burden of disease attributable to climate change is borne by children under the age of five. Changes in temperature, precipitation and humidity have a direct effect on the reproduction and survival of the mosquitoes that transmit deadly diseases. However, improved prediction capabilities complimented with support to health workers and systems on the ground, is enabling us to map disease prevalence with greater accuracy and predict – and disrupt – transition mechanisms and pathways.
  • Approximately 300 million children are breathing toxic air – 17 million of them are under 1-year-old. These children live in areas where PM2.5 levels exceed six times the international limits set by the World Health Organisation, which has an immediate and long-term detrimental effect on their health, and brain function and development. Cleaner, renewable sources of energy, affordable access to public transport, more green spaces in urban areas, and better waste management that prevents the open burning of harmful chemicals can help improve the health of millions.
  • Toxic air – caused largely by carbon emissions and other greenhouse gases – has grave consequences for young children, contributing to the deaths of around 600,000 children under-five every year due to pneumonia and other respiratory problems. Despite knowing its dangers many places with high-levels of pollution do not have ground-level monitoring systems to measure the problem regularly. Only 6 per cent of children in Africa, for example, live within 50km of a ground-level monitoring station.

Source: https://www.unicef.org/press-releases/fact-sheet-climate-crisis-child-rights-crisis

Taking Action through Unicef: https://www.unicef.org/take-action

 

Sayulita, Mexico Surfing * Lola Mignot * LA BAILARINA

wavesNobodySurf : Surfing Videos – Published on Jan 23, 2019

 

ART, November 17, and Tenderness

Thailand.one.jpg

THAILAND

Rate: 12%      Rank: 55

(US Rate: USA – 12% Rank: 54)

Source: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3

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.

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

thai.boar.jpg

COMMUNITY

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).

ribbon.thai.jpg

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.

Source: https://99nicu.org/99nicu-news/interview-ryan-mcadams-us-r95/

world.thai.jpg

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  heart.2.png  NOVEMBER 17, 2019

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.

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

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 .

Source: https://www.healthynewbornnetwork.org/resource/world-prematurity-day-2018-global-and-country-level-preterm-birth-estimates/

ribbon.jpg

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

WHY

  • 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.

HOW

  • 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

WHY

  • 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

HOW

  • 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

WHY

  • 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

HOW

  • 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

Source: https://www.healthynewbornnetwork.org/resource/world-prematurity-day-2019-message-map/

docs.jpg

HEALTH CARE PARTNERS

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.

Abstract: 

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.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0882596319300478

nicu.nurse

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.

parenting.jpg

Source: https://www.nejm.org/doi/full/10.1056/NEJMp1904721

fam.png

fam.2.jpgPREEMIE FAMILY PARTNERS

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.

Source: https://psychcentral.com/news/2011/07/06/tenderness-important-for-relationship-satisfaction/27497.html

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!”

 

sunset.jpg

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.

Abstract

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.

Source: https://jamanetwork.com/journals/jama/article-abstract/2753371?widget=personalizedcontent&previousarticle=188026

 

INNOVATIONS

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.

References:

  1. “Doctors create iPad program to get NICU babies home sooner” by Julie Mazziotta, PEOPLE Magazine, March 13, 2019.
  2. https://people.com/health/doctors-ipad-program-nicu-ba­bies-get-home-faster/
  3. “UVA’s pediatric remote monitoring program Building Hope

Source:file:///C:/Users/sacre/AppData/Local/Microsoft/Windows/INetCache/IE/4X4DWPN4/nt-oct19.pdf

tree

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

Summary:

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.

Source: https://www.sciencedaily.com/releases/2019/10/191022080736.htm

 

WARRIORS:

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

tree

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.

Source: https://www.expressiveartworkshops.com/expressive-art-resources/100-art-therapy-exercises/

 

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.

end.jpg

MATE, TRAUMA, WAR, CALMER

Syria.1

 

 

 

 

 

 

SYRIA

Rate: 10.9%      Rank: 76

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

Source: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3

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.

Source-https://reliefweb.int/report/syrian-arab-republic/impacts-attacks-healthcare-syria
Ref.camp

COMMUNITY

NIH

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 https://www.nichd.nih.gov.

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 www.nih.gov.

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.

Source-https://www.nih.gov/news-events/news-releases/nih-study-suggests-higher-air-pollution-exposure-during-second-pregnancy-may-increase-preterm-birth-risk

warzone.jpg 

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

Source-https://www.sciencedaily.com/releases/2017/11/171128190042.htm

 

 

 

 

 

 

HEALTH CARE PARTNERS

SD

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. http://www.sciencedaily.com/releases/2019/02/190219131727.htm (accessed September 26, 2019).

Source-https://www.sciencedaily.com/releases/2019/02/190219131727.html

 

med

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 https://oc87recoverydiaries.org/physi…

 

sync.jpg

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 schedulicity.com
  • 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: mindywho@uw.edu, pjwood@uw.edu., or jkocian@uw.edu. They will provide directions to their office location.

Referrals

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.

SELF-SCREENING TOOLS: 

Source-https://www.uwmedicine.org/school-of-medicine/gme/wellness-service

 

Forward Motion Mindfulness in the Medical Community

UWMaduwmadison –https://centerhealthyminds.org/The 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.

 

INNOVATIONS

people.jpg

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-https://www.technology.org/2019/04/02/scientists-designed-a-robot-to-reduce-pain-for-premature-babies/

robo.jpg

Source: UBC – Video –  A Robot called Calmer

 

 

prego

 

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-https://www.technology.org/2019/09/09/bedrest-for-high-risk-pregnancies-may-be-linked-to-premature-birth/

 

fam

PREEMIE FAMILY PARTNERS

SD

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.

Source-www.sciencedaily.com/releases/2019/08/190826104830.html

music.jpg

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

Source-https://www.efcni.org/news/parenteral-nutrition-for-sick-and-preterm-infants-meeting-nutritional-needs-in-the-nicu/

 

WARRIORS:   

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.jpg

 

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- 

thumbnail_IMG_0060

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! 💕💗

70274805_121864062195349_8775266791328905523_n

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!

Bulgaria.one.jpg

BULGARIA-

Preterm Birth

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

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

Source: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3

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.

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

COMMUNITY

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.

Source: http://www.healthdata.org/news-release/g20-leaders-achieving-universal-health-coverage-should-top-your-agenda

 

b.8.png

Four Steps Leaders Can Take to Increase Joy in Work

Jessica Perlo, MPH, Director, Institute for Healthcare Improvement

 

b.9

PREEMIE FAMILY PARTNERS

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.”

Source: https://www.huffpost.com/entry/nicu-moms-depression-help_n_5acf7e7ee4b0edca2cb74958

B.10.jpg

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.

B.12.jpg

INNOVATIONS

“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.

 

 

B.13

MEDICAL PRESSB.14.jpg

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.

Source: https://medicalxpress.com/news/2019-08-breakthrough-safely-preterm-babies.html

 

 

B.15.jpg

HEALTH CARE PARTNERS

 NEONATOLOGY TODAY
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.

B.16

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

Source: https://neonatologytoday.net/newsletters/nt-aug19.pdf

 

 

MEDSCAPE REPORTS

b.17.jpg

2019 Residents Lifestyle & Happiness Report

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

Link-https://www.medscape.com/slideshow/2019-residents-lifestyle-happiness-6011774?src=ban_reslifestyle2019_desk_mscpmrk_hp

Medscape Physician Lifestyle & Happiness Report 2019

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

Link- https://www.medscape.com/slideshow/2019-lifestyle-happiness-6011057

 

B.18.jpg

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.

Source- https://www.efcni.org/news/perinatal-palliative-care-giving-parents-support-when-a-pregnancy-goes-wrong/

 

WARRIORS:

B.20

B.21

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.

Source: https://www.sciencedaily.com/releases/2019/08/190826150700.htm

KAT’S CORNER

B.22.jpg

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.

B.23.jpg

 

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