Mozambique: Moçambique, is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi and Zambia to the northwest, Zimbabwe to the west, and Eswatini and South Africa to the southwest. The sovereign state is separated from the Comoros, Mayotte and Madagascar by the Mozambique Channel to the east. The capital and largest city is Maputo.
Mozambique is endowed with rich and extensive natural resources, notwithstanding the country’s economy is based chiefly on fishery—substantially molluscs, crustaceans and echinoderms—and agriculture with a growing industry of food and beverages, chemical manufacturing, aluminium and oil. The tourism sector is expanding. South Africa remains Mozambique’s main trading partner, preserving a close relationship with Portugal with a perspective on other European markets.
Since 2001, Mozambique’s GDP growth has been thriving, but the nation is still one of the poorest and most underdeveloped countries in the world, ranking low in GDP per capita, human development, measures of inequality and average life expectancy.
The country’s population of around 30 million, as of 2022 estimates, is composed of overwhelmingly Bantu peoples. However, the only official language in Mozambique is the colonial language of Portuguese, which is spoken in urban areas as a first or second language by most, and generally as a lingua franca between younger Mozambicans with access to formal education. The most important local languages include Tsonga, Makhuwa, Sena, Chichewa, and Swahili.
- GLOBAL PRETERM BIRTH RATES – MOZAMBIQUE
- Estimated # of preterm births: 11.97 per 100 live births
- (USA 9.56-Global Average: 10.6)
- Source- WHO 2014- https://ptb.srhr.org/
MOZAMBIQUE: JAPAN Donates USD 20 Million to Improve Neonatal Care
The Japanese International Cooperation Agency (JICA) on Thursday pledged to disburse the sum of 20.1 million US dollars to finance the construction of a new neonatal care unit at the Maputo Central Hospital (HCM) in Mozambican.
To that end Minister of Foreign Affairs Veronica Macamo signed an agreement on behalf of the Mozambican Government and the Japanese Ambassador to Mozambique, Kimura Hajime.
The aim is to improve paediatric services provided by HCM the country’s largest public hospital.
Construction works are expected to start in 2024 and to be completed over a period of two years.
The new neonatal care unit building will provide for most of maternal and child care health services which are currently spread over a number of buildings such as maternity and paediatrics wards, among others. This is due to the lack of a single building to accommodate all services which will now be integrated in one single entity.
Speaking shortly after the signing ceremony, HCM’s general director Mouzinho Saide said that the new building will provide more space for incubators since one of the major cause of hospitalization in paediatrics wards was prematurity. It will also make for the installation of specialised operating theatres which will bring down waiting time.
The new infrastructure will also allow provision of accommodation for both babies and mothers in neonatology, which currently is not always possible. Furthermore, it will provide for more space for laboratories and training for health professionals.
“The unit will improve the Central Hospital’s capacity to provide for newborns and also render better services thanks to the provision of better equipment that will be installed”, he assured.
According to Saide, the donation comes on top of other ongoing projects in the health sectors in the country, also financed by the Japanese government seeking to achieve universal health coverage, with a special emphasis on the Mozambican President’s initiative: “One District, One Hospital”.
For his turn, the Japanese ambassador pointed out that the donation aims to improve paediatric services in Mozambique and reducing infant mortality through the construction of a neonatal care unit and provision of state-of-the-art hospital equipment to improve maternal and newborn health.
The diplomat also pointed out that Japan’s cooperation policy with Mozambique prioritizes human development, focused on improving public health as a condition for fighting poverty.
“We saw the need to improve the interconnection between neonatology, paediatrics and maternity services as a way to overcome obstacles in provision of neonatal care”, he said, adding that Mozambique has one of the highest birth rates in the world, hence the need to match the population growth.
New guidelines to care for premature babies
Nov,17,202022 KPIX | CBS NEWS BAY AREA
November 17th marks world prematurity day. Dr. Gary Darmstadt, professor of pediatrics and co-principal investigator of the Prematurity Research Center at Stanford Medicine, discusses the new World Health Organization’s updated guidelines for the care of premature and low birthweight babies.
WA Hospitals Close Labor and Delivery Units, Raising Fears For New Parents
May 14, 2023 at 6:00 am By Elise Takahama – Seattle Times staff reporter
Deciding where to have a baby is often intensely personal for new parents: Do you want to go to a hospital or give birth at home? Are you comfortable with the doctor? Is it close enough to make it in time if complications arise?
These choices — a decision about where and how to bring new life into the world — are dwindling for some expectant parents across Washington. Labor and delivery units, particularly in rural areas, have been among the first services to be cut as Washington hospitals face financial turmoil.
When Yakima County resident Emma Argo became pregnant with her third child last summer, she hoped to deliver at Astria Toppenish, a community hospital less than 10 minutes from her home in Zillah. She was taken aback when the hospital abruptly closed its labor and delivery unit in December, four months before her due date. After the closure, Argo said she felt an “emotional toll.”
“The time I should be spending packing a hospital bag or washing baby clothes is spent sorting this out,” she said a few weeks before giving birth. “It just feels like one more thing.”
Labor and delivery units have been on the front lines for cuts because they’re expensive for hospitals to operate. They require specialized staff, services like neonatal intensive care units are particularly costly, and government-paid insurance plans often don’t reimburse hospitals for the full cost of care.
At the same time, hospitals are desperate: Hospitals in the state had collectively lost about $2.1 billion by the end of 2022, largely due to dried-up federal pandemic relief, rising costs and low Medicaid reimbursement rates. But as labor and delivery units close, parents in those areas are left with fewer options — and the possibility that it could take them longer to access obstetric care in an emergency, when every second counts.
Reducing options for expectant parents in Southeast King County, MultiCare Covington Medical Center shuttered its birth center in September. The same happened at Forks Community Hospital on the Olympic Peninsula last December, about 60 miles from the nearest hospital birthing center in Port Angeles, though the hospital is working to restaff the unit.
Washington health care leaders have warned of hospitals’ financial problems for at least a year now, and other services have been cut in recent months: At Providence Everett, admissions to its pediatric inpatient unit have been paused since last fall. Astria Sunnyside lost its cardiology services in the winter. But the labor and delivery cuts may have sparked the most public pushback.
Some relief for pregnancy care is on its way after the state Legislature, which recently wrapped up its 2023 session, boosted Medicaid rates and funded a new doula program. At the same time, communities are scrambling to prevent these losses.
“Losing hospital services is something every Washingtonian should be concerned about,” Cassie Sauer, CEO of the Washington State Hospital Association, said in a news conference in November. “When these resources leave a community, it’s nearly impossible to get them back.”
How we got here
Apple orchards, hops farms and rolling hills stretch over more than 4,000 square miles of Central Washington. At the northeast edge of the Yakama Reservation, the town of Toppenish is home to about 9,000 people in the lower Yakima Valley, with farmland surrounding a small downtown dotted with murals. The town’s hospital, Astria Toppenish, has been a community staple for decades, and its maternity center was well-loved.
The December 2022 closure came as a shock, said Dr. Jordann Loehr, an OB-GYN who used to deliver out of Astria Toppenish.
“I still don’t understand this decision,” she said. “It’s heartbreaking to our community, many whose mothers, grandmothers and great grandmothers had their babies at Toppenish.”
According to the hospital, however, its labor and delivery unit had struggled all year. Astria Toppenish reported it brought on nearly 200% more travel nurses, contracted workers who typically move from hospital to hospital in response to demand and often get paid more than staff nurses. The hospital also saw increases in supply costs due to inflation. Efforts to hire permanent pediatricians, who also worked in the unit, were unsuccessful, the hospital said.
Astria Toppenish’s reimbursement rates for Medicaid services, temporarily boosted in 2020 thanks to a one-year budget provision, were slashed by a third the following year when lawmakers denied an extension, according to the hospital. The drop meant providers were not getting reimbursed for the complete cost of their services by federal Medicaid programs, and would ultimately lose money when treating Medicaid patients, who made up more than 75% of Astria Toppenish’s obstetrics clients.
For example, while a standard vaginal delivery, usually a one-day stay, costs about $8,000 to $10,000 per day, the hospital was only getting reimbursed about $3,765 for Medicaid patients, said Jane Winslow, an Astria Toppenish spokesperson.
A cesarean, or C-section, usually costs about $35,000 for a three-and-a-half-day stay in the hospital, while the Medicaid reimbursement amounted to about $4,933, Winslow said, using an example of a “snapshot in time” from December 2022.
By the end of the year, Toppenish’s labor and delivery services had lost $3.2 million, the hospital said.
“It is a very challenging service line to keep open when you’re facing the financial losses that many of the hospitals are right now,” said Chelene Whiteaker, senior vice president of government affairs at the Washington State Hospital Association. “You’re thinking, ‘If you keep that open, what else are you going to have to close instead?’”
Historically, obstetrics is considered a particularly resource-intensive field, said Dr. Tanya Sorensen, a maternal and fetal medicine doctor at Providence Swedish in Seattle, one of the more popular delivery units in the state.
The field requires significant hands-on nursing, Sorensen said. Labor and delivery nurses usually spend more one-on-one time with their patients compared, for example, to a nurse caring for someone gradually recovering from surgery.
Obstetrics also has become more specialized over the years, Whiteaker added: In the past, babies were commonly delivered by doctors who worked as general practitioners or family physicians. Now, it’s more typical for hospitals to employ doctors and other staff who are trained specifically in infant and pregnancy care and are prepared to address the wide variety of challenges that can arise in deliveries.
That means labor and delivery units need to have larger staffs with specialized experience — which costs more money. At the same time, hospitals, especially those in rural areas, are struggling to retain and recruit a limited number of health care workers, which means staffing costs overall have increased dramatically.
“We’re in a spot now where we’re using travel nurses, which are far more expensive, costing millions of dollars compared to our [permanent] nurses,” Sorensen said. “Swedish is able to cope with that … but if you’re a little community and trying to staff for a small labor and delivery unit, that becomes super challenging and super expensive.”
She’s particularly worried about the growing lack of obstetric care in Yakima Valley, she said, noting Swedish’s transfer rate from rural areas rose about 8% between 2021 and 2022.
“There’s a huge amount of concern about these obstetric deserts where there’s limited local care for pregnant women,” Sorensen said.
The fight back
Since several hospitals closed their labor and delivery units, few have provided updates on plans to bring services back. In the Yakima Valley, residents are determined to keep the issue from being forgotten.
At a town hall meeting in Toppenish in early January, the room was crowded with former hospital employees and patients hoping to voice their concerns about the labor and delivery closure.
“I was a senior in high school and pregnant with my first child when I suffered a miscarriage and almost died,” Semone Dittentholer, a Wapato resident and Yakama tribal member, said at the podium, recalling her experience at Astria Toppenish more than 20 years ago. She knew her community suffered disproportionately worse birth outcomes, adding to her fear.
“I was minutes from bleeding out,” she said. “There was no way I was going to make it to Yakima [Memorial],” the largest hospital in the county, about twice as far from her home as Astria Toppenish.
When Dittentholer arrived at Astria Toppenish, she couldn’t stop shaking and her skin was almost translucent. She was told she might not make it through the night.
After hours in the maternity center, Dittentholer woke up, but her baby didn’t.
“If it wasn’t for Toppenish labor and delivery, I wouldn’t have made it,” she told City Council members. “It makes me stressed and sad to think about all the women who couldn’t — and won’t be able to — make it out to Yakima.”
Since the closure of Toppenish’s maternity center, community members have continued to brainstorm ideas on how to return obstetric care to their area. They held community gatherings. They wrote to their City Council members. They advocated for new legislation.
Then, last month, a group working on maternity solutions in Washington stumbled on an old state law that mentions “maternity care distressed areas.” Ears perked up.
According to the law, enacted in 1989 and revised in 2011, the Washington state Health Care Authority would pay for contracted maternity care providers, if an area is considered to be maternity care distressed — which could mean a higher-than-average percent of people in the area received late or no prenatal care or had to travel out of the area to receive maternity care.
“We’re not sure if this is going to apply to us yet,” Loehr said, “but if this ends up working in our favor and we could get some state relief, that would be big.”
Some relief is on the way for Toppenish. Gov. Jay Inslee last week approved legislation that will raise the hospital’s Medicaid rates starting next year. In the meantime, the hospital will receive a short-term grant this summer to “bridge the gap until that reimbursement kicks in,” Winslow said.
Still, it likely won’t be enough for the hospital to reopen its maternity center, Winslow said, adding that it’s an “exceptionally expensive service” and the extra funding will likely go toward maintaining existing services, like behavioral health, instead.
Loehr is also leading efforts to introduce a public hospital district to the area, a fairly common designation in Washington. The state has 56 public hospital districts, community-created entities authorized by the state to deliver health services.
“We’re like a library district or a school district,” said Matthew Ellsworth, executive director of the Association of Washington Public Hospital Districts. “Local constituents voted to draw a circle around themselves and ultimately they can choose to tax themselves for revenue.”
Most public hospital districts in the state have hospitals, while a handful provide specific care, like emergency services, urgent care and nursing homes. Once a district is created, residents elect a board of commissioners to govern the district and decide which health-related projects to fund.
“To have health care decisions executed on a policy basis by elected officials is a big benefit,” Ellsworth said. “Ultimately, the people running your hospital are accountable to you. … But I don’t want it to be viewed as a panacea.”
For example, he said, “If you want to build a billion-dollar hospital, that’s not going to happen.” Tax revenue from public hospital district levies don’t come close to the amount needed to run a health care facility, he said.
But in places like Vashon Island, the state’s newest public hospital district, residents were able to raise enough funds to preserve some clinical services.
What’s at risk
Across the Puget Sound, similar challenges have complicated the search for pregnancy care.
As of this year, only one hospital in Kitsap County — St. Michael Medical Center in Silverdale — is staffed to deliver babies. The Naval Hospital, near a base in Bremerton, closed the doors to its labor and delivery unit in April 2022, citing staffing and resource shortages. Peninsula Community Health Services, also in Bremerton, followed suit a few months later.
Because of the growing gap in care, many patients have started to rely on local midwives, said Ashley Jones, a licensed midwife and executive director of True North Birth Center in Poulsbo, the only out-of-hospital birth center on the peninsula. The practice has seen a huge influx in patients since last July, Jones said.
“The unfortunate thing is that I know there are those who do qualify (for a low-risk birth) who may actually choose our option and just don’t know about us,” Jones said. “We’re a big military community, so some people are coming from states like Virginia and Texas, or somewhere where midwifery is not as common may not even know that we’re an option.”
She’s hoping to continue to spread the word about her practice in case St. Michael’s obstetric unit does fill up. In the last year, many of Jones’ new patients transferred to her practice after experiencing or hearing stories of long waits at St. Michael, she said.
Because of recent changes to the state’s landscape of labor and delivery care, patient numbers have fluctuated at different hospitals, making clear trends in demand difficult to identify.
While the number of MultiCare Yakima Memorial’s monthly deliveries has slowly increased since Astria Toppenish’s unit closure, signaling some absorption of patient volume, St. Michael hasn’t necessarily seen the same rise on the Kitsap Peninsula.
St. Michael’s president, Chad Melton, says its unit does have room and staffing has “stabilized” in the past four to five months, though it still does partially rely on contract travel nurses. Demand has actually dropped from an average of about 200 deliveries a month during most of the pandemic to now about 130 per month.
“It’s a service we need to provide,” Melton said.
Meanwhile, patient demand at Kitsap OB-GYN, one of the few independent practices on the peninsula, has been growing for months, said administrator Megan McDermaid.
“There’s not a lot of choice in the county,” McDermaid said.
Morgan Runge, 27, a mother of two who lives on Chinook Pass, said she’s concerned for other new parents in the Yakima area who now may be far from the nearest hospital, or may no longer have a choice in where they deliver their baby.
She said she felt fortunate to have options: She delivered her son at Astria Toppenish just days before its maternity center closed, instead of MultiCare Yakima Memorial. While Yakima was much closer to her home — about 30 minutes, compared to an hour’s drive to Toppenish — she was willing to make the hourlong trip because of a traumatic experience delivering her first child at Yakima Valley.
She was in labor the entire drive, she said.
“It’s a terrifying thought that these types of services are drying up in some parts of our state,” she said.
Messias Maricoa – Cuidar De Mim (Official Music Vídeo
Messias Maricoa #MessiasMaricoa #CuidarDeMim
MOZAMBIQUE“OUR PRIORITY IS THE HEALTH OF CHILDREN AND YOUNG PEOPLE”
CUAMM attended the Second National Paediatric Congress of Mozambique to follow the proceedings at close hand and observe the development of best practice for protecting children’s health.
In a country with only 68 paediatricians for over 12 million children, where over 90% of children never see a paediatrician, the question of children’s health is ever more pressing. The Second National Paediatric Congress of Mozambique, which took place from 25 to 28 October in the Mozambican capital Maputo, was therefore an important contribution to the national debate, which CUAMM was determined not to miss.
The event, organised by AMOPE(Associação Moçambicana de Pediatras – Mozambican Association of Paediatricians) under the heading “Our Priority is the Health of Children and Young People”, was opened by Nazira Abdula, Mozambique’s Minister of Health. CUAMM was represented by Olga Denysyuk, a neonatologist working at Beira Hospital.
It offered an opportunity to discuss integrated care as a means of controlling the main diseases causing ill health and death in Mozambique’s children. To date, premature birth, asphyxia and infections have been the main causes of death in newborns, while HIV/AIDS, malaria, TB, malnutrition, respiratory disease and diarrhoea continue to affect very young children. While there are signs of progress, there is still much to do, as Valéria Chicamba, Director of the National Paediatric Programme, explained:
CUAMM is playing its part in guaranteeing health care for Mozambican children: we are improving the facilities at Beira Central Hospital’s Neonatology Department and enlarging the “kangaroo mother” therapy unit for premature babies, as well as providing equipment and on-the-job training for local staff.
Thirteen foreign paediatricians have been brought in to strengthen the 68-strong Mozambican team, bringing the total to 81. Moreover, there is a significant geographical imbalance, with 58 of these specialists concentrated in the capital Maputo, leaving just 23 paediatricians working in the remaining 10 Provinces. This hampers the struggle to reduce infant mortality, which now stands at a rate of 64 deaths for every 1,000 live births.
PREEMIE FAMILY PARTNERS
Supporting Parents of Sick or Premature Babies
Parents of sick or premature babies go through a lot of emotional ups and downs in the early weeks and months of their babies’ lives.
When they get practical help and emotional support from family and friends, parents often cope a lot better with the experience. And when they’re managing well, they’re better able to look after their babies.
Here’s how you can help.
1. Celebrate as you usually would when a baby is born
Offer congratulations, send a card or flowers, and ring the new parents. By celebrating the birth of their baby in this way, you’re helping them celebrate as well. Give a gift if this is what you’d usually do. Small gifts for the parents can help them feel nurtured too.
If you’re thinking of giving clothes for the baby, make sure they’re very easy to put on and take off – loose necklines and armholes are good. If the baby is premature, size 00000 clothes can also be useful, because many parents won’t have bought these smaller sizes. Baby clothes for later are wonderful too, because they help the parents think about the future, when their child is at home.
Another gift could be a voucher for hospital parking. Or you could give a voucher for a restaurant close to the hospital, so that parents can have a meal and some time together but not be far away from their baby.
“A lot of people sent flowers in the first few days after the birth. Most preemies spend at least two weeks in hospital or more, so it’s nice to get flowers or a gift a bit later. It’s a nice surprise and encouraging along the long journey”.
– Mother of 35-week premature baby
2. Offer practical help
Parents will be visiting the hospital as often and for as long as they can for days, weeks or months to come. This means that everyday chores are hard to fit in or don’t get done, which can be stressful.
Here are helpful things you could offer to do:
- Mow the lawn or walk the dog.
- Prepare meals or do the weekly grocery shopping.
- Take older siblings to preschool or school or look after the other children in the evening.
- Give parents a lift to the hospital – parking and transport can be very expensive.
- Set up a messaging group or social media page, so that parents can send updates to just one source.
3. Support parents in whatever way they need
It’s OK to ask parents what they need. Some parents want to shut themselves off and cope with the situation alone or with a few close friends and family. Respect their wishes, but also let them know that you’re thinking of them. You could try to offer help at different times.
Some parents need a lot of people around for support. These parents might love having company at the hospital. You could offer to drive, have lunch or just sit with them. Some parents want to talk about things other than the baby. Parents’ needs can change as their baby grows and changes.
“I found the weeks my baby was in hospital a very lonely time. The friends who helped me most were those who offered specific things. They said things like, ‘I’ll drive you into the hospital tomorrow and stay with you for the day’, or ‘I’ll meet you there and we’ll have a bite of lunch together’. The friends who said, ‘Let me know if I can do anything’ didn’t help so much. They were just as sincere, but it was just easier if they offered something specific”.
– Mother of a 28-week premature baby
4. Stay in touch with parents
A text message, an email, a quick phone call or voice message, or even an old-fashioned card in the mail – these are simple ways to let parents know you’re thinking of them. They help parents feel supported and remembered.
Try to understand how stressed the parents are and avoid judging them if they forget a birthday, can’t get to a family gathering, or take less interest in what’s happening in your life. It’s not that they don’t care – it’s just that right now, all their energy and focus is on their baby.
“When you feel up to it, encourage loved ones to visit you at hospital. It’s good to have some time out, fresh air and different conversation, because the hospital becomes your life”.
– Mother of 27-week premature baby
5. Say positive things about the baby
You can show your support by saying positive things like ‘Your baby is growing fast already’, or ‘They’re strong just like you’.
Avoid talking about setbacks that might happen or challenges that the baby could face, unless the parents bring it up with you. Also avoid giving advice about the baby.
6. Don’t expect to cuddle the baby
Sick or premature babies are very sensitive to touch, noise, infection and other things in their environment, so cuddling or touching is often limited or not allowed. Parents can also be very protective of their babies.
You might not even be able to see the baby, because there are usually limits on the number of visitors allowed at one time. Often it’s only 2. Sometimes only family is allowed – often this is only the baby’s parents. Each hospital has its own set of rules. Instead, you could ask to see some photos of the baby (if the parent feels up to sharing them) or have a coffee with the parents at the hospital café.
Don’t be surprised if you still can’t have a good cuddle when the baby goes home. Many babies are still easily overwhelmed and might need to be protected from too much handling and too many new people.
If you’re sick, you should avoid visiting a family with a baby in the neonatal intensive care unit (NICU) or the special care nursery (SCN). Sick or premature babies can get illnesses and infections very easily.
7. Listen to parents
Parents are likely to have mixed and powerful feelings about their sick or premature baby and their experiences of the birth or hospital. These might not surface for weeks, months or even years.
Be open, let them talk and avoid giving advice unless it’s asked for. Avoid comparing them with other parents who’ve had a hard time. If you listen more than talk and follow the lead of the baby’s parents, you’re more likely to be helpful.
8. Keep offering help after the baby comes home
Your family member or friend might be tied to the house for some weeks once the baby comes home. Having someone organise shopping or preschool and school runs can really help.
What are the risk factors for preterm labor and birth?
There are several risk factors for preterm labor and premature birth, including ones that researchers have not yet identified. Some of these risk factors are “modifiable,” meaning they can be changed to help reduce the risk. Other factors cannot be changed.
Health care providers consider the following factors to put women at high risk for preterm labor or birth:
- Women who have delivered preterm before, or who have experienced preterm labor before, are considered to be at high risk for preterm labor and birth.1
- Being pregnant with twins, triplets, or more (called “multiple gestations”) or the use of assisted reproductive technology is associated with a higher risk of preterm labor and birth. One study showed that more than 50% of twin births occurred preterm, compared with only 10% of births of single infants.2
- Women with certain anomalies of the reproductive organs are at greater risk for preterm labor and birth than are women who do not have these anomalies. For instance, women who have a short cervix (the lower part of the uterus) or whose cervix shortens in the second trimester (fourth through sixth months) of pregnancy instead of the third trimester are at high risk for preterm delivery.
Certain medical conditions, including some that occur only during pregnancy, also place a woman at higher risk for preterm labor and delivery. Some of these conditions include3:
- Urinary tract infections
- Sexually transmitted infections
- Certain vaginal infections, such as bacterial vaginosis and trichomoniasis
- High blood pressure
- Bleeding from the vagina
- Certain developmental anomalies in the fetus
- Pregnancy resulting from in vitro fertilization
- Being underweight or obese before pregnancy
- Short time period between pregnancies (less than 6 months between a birth and the beginning of the next pregnancy)
- Placenta previa, a condition in which the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix
- Being at risk for rupture of the uterus (when the wall of the uterus rips open). Rupture of the uterus is more likely if you have had a prior cesarean delivery or have had a uterine fibroid removed.
- Diabetes (high blood sugar) and gestational diabetes (which occurs only during pregnancy)
- Blood clotting problems
Other factors that may increase risk for preterm labor and premature birth include:
- Ethnicity. Preterm labor and birth occur more often among certain racial and ethnic groups. For example, infants of African American mothers are more likely to be born preterm than infants of white mothers. American Indian/Alaska Native mothers are also more likely to give birth preterm than are white mothers.4
- Age of the mother.
- Women younger than age 18 are more likely to have a preterm delivery.
- Women older than age 35 are also at risk of having preterm infants because they are more likely to have other conditions (such as high blood pressure and diabetes) that can cause complications requiring preterm delivery.4
- Certain lifestyle and environmental factors, including:3
- Late or no health care during pregnancy
- Drinking alcohol
- Using illegal drugs
- Domestic violence, including physical, sexual, or emotional abuse
- Lack of social support
- Long working hours with long periods of standing
- Exposure to certain environmental pollutants
App Helps Support Parents of NICU Babies No Matter Where They Are
April 3, 2023
At 23 weeks gestation, a rare pregnancy-related complication forced Meg Hamilton to have a caesarean section to save her life and give birth to her baby Will four months early.
Weighing 1 pound at birth, Will had a 50-50 survival chance, she and her husband, Dave Hamilton, say. Doctors expected him to spend at least four months in the neonatal intensive care unit (NICU) at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois.
“It was traumatic,” recalls Meg Hamilton, who underwent in vitro fertilization to conceive the baby the Elmhurst, Illinois, couple considers a miracle.
As Will’s condition developed, updating about 70 members of the couple’s large family became overwhelming.
“There was a lot going on in a very short amount of time,” Dave Hamilton recalls. “We were looking for a way to communicate with everyone that was secure and also that we could invite people to. But there are some people that didn’t need to know the entire story. And there were some people that we did want to know the entire story.”
A smartphone app developed by a Northwestern University team offered most of the features the Hamiltons needed to track and update everyone on Will’s progress until his hospital discharge. The app, NICU2Home, provides updates on NICU newborns and allows parents to share as much information as they want and with whom.
Dr. Craig Garfield and engineer Young Seok Lee created the app to keep parents informed about their baby’s care no matter their location. Most parents don’t expect their baby to require intensive care, and they easily can become overwhelmed by the staggering amounts of information they receive during such a distressing period. So far, about 2,000 NICU parents have relied on the app for updates and information.
“What made us start to think about how we could do this was when smartphones really first came out, and I saw so many parents at the bedside with their phones while their baby was sleeping,” says Garfield, pediatrician and professor of pediatrics and medical social sciences at Northwestern University Feinberg School of Medicine. “We realized very early on that designing an app to deliver information that was personalized and specific for that particular baby in that particular situation that we could extract the exact information we wanted to send to those parents so as not to overwhelm them.”
After the app’s 2020 launch at Northwestern Medicine Prentice Women’s Hospital in Chicago, Garfield and Lee wanted to offer it at facilities with more diverse patient populations to determine whether it can help improve health outcomes and equity. They expanded their research at Central DuPage Hospital, Northwest Community Hospital in Arlington Heights, Illinois, and Rush University Medical Center in Chicago with support from Health Care Service Corporation (HCSC).
“These are our families that are generally not included in research or maybe kind of marginalized in society more generally, but they’re having babies prematurely,” Garfield says. “When HCSC was looking for solutions to help with health equity, we put in a proposal and HCSC was incredibly enthusiastic about it.”
HCSC leaders believe the NICU2Home app could help lower-income, urban and suburban NICU parents with transportation, work flexibility or child-care challenges. The app would allow parents to remain engaged and connected to their NICU baby, reducing the stress of trying to maintain a continuous beside presence.
“Part of what we’re trying to do is help support research that helps improve the care and the health outcomes for babies that are premature and also helping them in that transition to home process,” says Dr. Derek Robinson, a vice president and chief medical officer for HCSC’s Illinois plan. “We think this is a tremendous opportunity to address some of the disparities that impact the lived experience of the parents who are caring for these children.”
The app’s use could significantly enhance a parent’s ability to care for their newborn, based on a study published in the Journal of Pediatrics external link.
Garfield and Lee found that among Prentice NICU parents who used it, the app boosted their confidence in caring for their babies and continued to help them up to a month after their babies’ hospital discharges.
“Our hope is that the information that we provide in the app actually helps parents feel confident enough that they didn’t have to immediately run as soon as their babies showed one sign of something or the other into the doctor’s office,” Garfield says.
Lee, an adjunct professor at Northwestern University’s Feinberg School of Medicine with a Ph.D. in industrial engineering, wants to create apps to address other maternal infant care areas, including postpartum depression.
“I think still there are a lot of innovation we can create to address challenges,” he says, adding that he’d like to expand NICU2Home’s access nationwide.
Maintaining connection and reducing worry
Central DuPage Hospital’s NICU sometimes cares for babies from as far away as the Iowa state line. Access to the NICU2Home app may help reduce the anxiety and worry of parents who can’t always be at their baby’s side, says Dr. Jeffery Loughead, medical director for the hospital’s Lurie Children’s Program.
“Updating the families in a real-time basis is enormous,” he says. “It really allows them to touch base with their baby right away. Also, the educational features of the app allow the parents to be better informed as to what their baby is experiencing medically and what to expect developmentally at each gestational milestone.”
For the Hamiltons, having a secure place to share photos and post comments with family helped everyone stay connected during Will’s NICU stay.
“Posting and keeping track of his milestones was huge,” Meg Hamilton says. “It was great for us to have something to share with people and show how well he was doing.”
Her husband agrees.
“It was massive for our family to have that app as much as it was a convenience to us,” he says.
Supporting Robust Teamwork — Bridging Technology and Organizational Science
List of authors: Anna T. Mayo, Ph.D., Christopher G. Myers, Ph.D., John C. Bucuvalas, M.D., Sandy Feng, M.D., Ph.D., Courtney E. Juliano, M.D.
Health care organizations are meeting the demands associated with caring for patient populations with increasingly complex needs by leveraging larger teams that include clinicians with diverse and specialized expertise. Simultaneously, high turnover and labor shortages mean that facilities are often employing a more temporary and mobile workforce than in past eras. The result is that the structure of health care teams often defies decades of wisdom from team-design research about the conditions that support the best possible performance.
Rather than facilities having well-defined teams with clear boundaries dictating who is included, team boundaries are blurred, with individual clinicians having roles on multiple care teams whose compositions may evolve over time because of shift changes, the timing of rotations, and changing patient needs. Furthermore, instead of being part of stable teams with a history of working together, clinicians who share a patient often have limited, if any, history of collaboration. These features constrain coordination and communication within and across teams, hamper collective learning processes, and can result in suboptimal — and at times devastating — patient outcomes.
Recognizing the challenges posed by these conditions, many organizations have implemented costly technology to support collective work. Clinicians formerly communicated directly, but in recent years, the complexity of clinical work has increased concurrently with the adoption of various communication tools — from messaging applications to electronic medical record systems.
Although these technological solutions hold potential for facilitating communication, they often don’t address the fundamental human challenges involved in fostering effective teamwork, such as managing attention and relationships.
Implementing effective solutions for modern health care teams requires a deep understanding of human behavior, not just more advanced technologies. But the findings from decades of research in the organizational sciences and related fields (e.g., human-factors engineering and psychology), which has included rigorous studies of human behavior in health care settings, haven’t been incorporated into most health care research.1,2 We believe there are promising opportunities for integration across these fields. Recent findings from organizational science shed light on coordination and collective-learning constraints in health care. Integrating these findings with technology development could create powerful levers to support robust teamwork.
There are numerous challenges associated with promoting effective teamwork in health care. The shift toward communicating mostly asynchronously by means of notes and messaging platforms, with the occasional phone call or in-person conversation, was intended to facilitate communication among dispersed clinicians. But when someone is out of sight, they are often out of mind.
In keeping with substantial research on cross-boundary collaboration in organizations, one of us found in a recent study of medical inpatient teams at an academic medical center that teams tended to turn inward when conducting their work, excluding other clinicians who could play a critical role in delivering high-quality care, such as nurses, specialists, and pharmacists, as well as patients and their families.3 Even when information was gathered from outside the team (e.g., a consult occurred and a note was sent back), the team may not have provided other clinicians with all the relevant patient-level information, which limited the usefulness of their input. Moreover, inward-focused teams often failed to take the critical step of synthesizing the input they received from these out-of-sight people. This pattern of isolated work resulted in backtracking and delays when previously missing input from people outside the team came to light and necessitated reworking plans or when clinicians found that they had been oblivious to important decisions (e.g., when nurses were delayed in seeing electronic notices of “STAT” orders, thereby slowing medication delivery).
In the same study, however, about 25% of inpatient teams were found to dynamically integrate people with other roles into team processes as needed. To facilitate this integration, teams essentially shifted their boundaries over time: the boundary surrounding the core medical team expanded as its members gathered input from other clinicians, as well as patients and families, and met with them in real time, often in person, to collectively synthesize information and conduct complex decision making during rounds; the team boundary then contracted again when the core medical team huddled to delegate tasks internally and move on to its next patient. On the surface, these teams engaged in more time-consuming coordination-related work, but they capitalized on available expertise for each patient, and they backtracked less often and completed daily rounds faster than teams that didn’t consistently integrate people with other roles in real time. The patients assigned to these teams also had shorter lengths of stay than patients assigned to other teams.
The increasingly fluid structure of health care teams and the reliance on technology-mediated communication do not only affect the care of current patients; they can also erode opportunities for learning from others, which is a critical component of teamwork in health care and is necessary for improving care for future patients. For instance, the evolution of clinical technologies and their uses (e.g., the integration of robots in surgery) has altered trainees’ roles and professional routines, thereby reducing opportunities for trainees to learn by working with experts. Post-training learning opportunities are also being constrained by the increasingly mobile nature of the health care workforce, which undercuts the formation of key relationships that could otherwise be important sources of knowledge transfer.
Research on learning in organizations reveals the power of creating spaces for informal conversation or observing others and learning on the job, which could promote the knowledge sharing and learning necessary for collective work. For example, the constant reconfiguration of air medical transport crews restricts collaboration and interferes with traditional learning mechanisms, yet research by one of us has found that crew members use storytelling routines during downtime to learn from other crews’ experiences. This finding, along with a robust body of work on organizational learning, highlights that although didactic teaching is often emphasized in health care (particularly in academic medical centers), learning is a social process. Learning vicariously and learning by doing (together) are critical practices that organizations can support by means of dedicated efforts to bring professionals together to share experience and expertise.
Better understanding the human-focused constraints on — and opportunities for — teamwork in health care can help guide more effective technology-based interventions to track and increase coordination and learning. For instance, artificial intelligence that processes conversations in real time could support information management during team decision making, including by inviting input from people (e.g., nurses, specialists, or patients) who haven’t contributed to a discussion but probably should. Identifying patterns of clinician interactions (i.e., who is involved and when) that are associated with critical outcomes could also inform the development of better teamwork-related metrics and tools to encourage collaboration. Such tools could include algorithms that provide recommendations about interactions — prompting, for example, a primary care team to connect with a particular consultant. Similarly, scheduling technologies could draw on interaction and outcome data to create ideal care-team assignments, balancing the inclusion of members who are more familiar with each other (which could improve communication and collaboration) with those who are less familiar with each other and might provide new perspectives or stories related to their own disparate experiences (which would be in keeping with research on the potential value of working with multiple people in the same role — for example, residents working with a greater number of nurses — to enhance learning).
Of course, there are risks associated with deploying new technologies. Algorithms used to support human decision making can lack transparency, which, along with concerns about data security, can create distrust. They can also perpetuate bias, which is especially a risk when high-quality data aren’t available. These shortcomings could hamper innovation. Moreover, scaling solutions and integrating them across heterogeneous sites can be challenging. Here, too, research from organizational science and related fields could help organizations collect the right data and use meaningful metrics to identify important contextual factors that could inform modification and integration across sites and to better manage change and implement new solutions.
Calls to improve teamwork-related practices in health care aren’t new. Yet in today’s dynamic health care landscape, where team design often conflicts with best practices, we believe it’s critical that researchers, developers, and practitioners integrate insights from research in the organizational sciences with technology development to cultivate more robust teamwork.
Earlier fetal monitoring may reduce stillbirth rates without increasing neonatal morbidity
April 27, 2023
Key takeaways :
- Fetal monitoring from 39 weeks may reduce stillbirth among South Asian-born women.
- Stillbirth, early neonatal death and special care nursery admission decreased after initiation of fetal monitoring at 39 weeks.
Fetal monitoring from 39 weeks’ gestation may be an alternative to routine earlier labor induction to reduce stillbirth rates among certain women without causing increased neonatal morbidity, according to researchers.
The largest maternity service in Victoria, Australia, formerly began fetal monitoring at 41 weeks’ gestation. Because women of South Asian birth were at five times higher risk for stillbirth compared with Australian-born women by 41 weeks, the maternity service implemented a new guideline of twice weekly cardiotocography and measurement of amniotic fluid for all South Asian women in their practice at 39 weeks’ gestation.
Data were derived from Davies-Tuck ML, et al. Am J Obstet Gynecol. 2023;doi:10.1016/j.ajog.2023.02.028.
“A policy of offering fetal monitoring from 39 weeks for women of South Asian background allowed identification of fetal compromise and guided timing of birth where relevant to significantly reduce the rates of stillbirth at term. Through offering monitoring, the rates of stillbirth at term become equivalent to all other women at the service,” Miranda L. Davies-Tuck, PhD, head of the perinatal epidemiology and clinical trials at Hudson Institute of Medical Research, Clayton, Australia, told Healio. “Additionally, while the rate of induction initially increased, it did not continue to increase over the study period. Therefore, a fall in stillbirth was not achieved by continuing increases in inductions.”
This cohort study, published in the American Journal of Obstetrics and Gynecology, included 3,506 South Asian-born women who gave birth prior to these new recommendations and 8,532 who gave birth after these new recommendations were implemented. All women gave birth between 2016 and 2020. Researchers determined differences in stillbirth rates, neonatal deaths, perinatal morbidities and interventions after July 2017 and assessed changes in stillbirth rates and labor induction.
After these new recommendations were implemented, researchers observed a 64% reduction in term stillbirth among South Asian-born women, from 2.3 per 1,000 births to 0.8 per 1,000 births (P = .047). Early neonatal death rates (3.1 vs. 1.3 per 1,000; P = .03) and special care nursery admission (16.5% vs. 11.1%; P < .001) rates also decreased after these new recommendations were implemented.
Researchers observed no significant differences in admission to NICUs, Apgar score less than 7 at 5 minutes, birth weight or differences in trends of labor induction per month.
According to Davies-Tuck, future research should include qualitative work capturing the views of women themselves as well as a large, multisite randomized controlled trial of monitoring and targeted earlier birth compared with routine earlier induction of labor and to determine if this approach works for other groups experiencing high stillbirth rates at term.
“The findings of this work provide a strategy to reduce stillbirth at term for South Asian women and can represent an alternative to offering earlier induction of labor,” Davies-Tuck said.
Physical Examination of a Premature Infant
Stanford Medicine – Phillip Sunshine MD
The House is on Fire!! Responding to Unexpected Neonatal Events
Like firefighters, neonatologists must be ready to “put out a fire” anytime. While we are clinically prepared for the necessary interventions, we may feel less prepared for coding such events. Understanding what was done, what was submitted before the emergency, and which codes have procedures bundled or when 24-hour global codes apply can help.
The hospital delivery team (NICU RN and RT) attends a routine C/ Section of a term infant as per hospital policy. At 15 minutes of life, the neonatologist on call receives a call from the RN because she is not comfortable taking the baby to the NBN. The Neo rushes to the DR and finds the infant in mild respiratory distress with oxygen saturations in the mid-80s. The baby does not appear distressed, the heart rate is in the 120s, and the pulses are equal throughout. The Neo applies CPAP and asks the OB about the significant pregnancy complications. The OB states that the mother had gestational DM. The Neo then orders a CXR to evaluate heart size, shape, and lung fields, which is unremarkable. At 25 minutes of life, the infant’s oxygen saturations are above 95%, and the CPAP is removed. The infant is observed for another 10 minutes and then cleared for transport to NBN. The Neo updates the parents and documents in the chart—total time 40 minutes.
The best CPT code for this encounter is:
A. 99464 Attendance at delivery
B. 99465 Delivery room resuscitation
C. 99221 Initial hospital care
D. 99252 Inpatient consult, 35 minutes
Correct answer: D. When a consult code is used, the documentation should reflect the request for a consult and the total time spent. CPT 2023 has revised the time requirements.
CPT Code Time (minutes)
With the updated CPT, the face-to-face time with the patient does not have to be documented separately, merely the total time.
Because the resuscitation was over, neither delivery room code was appropriate.
Despite the exam and history obtained, this does not meet the requirement for H&P. Therefore; answer C cannot be used.
The neonatologist on call is requested to come to the Level II nursery. A 5-day-old 33-week infant receiving low flow oxygen via NC, approximately 100 ml/kg enteral feedings, and has a PIV for TPN running at approximately 50 ml/kg. She weighs 1750 grams today. She was seen by a member of the same physician group this morning. The nurse at the bedside tells you the baby has had increasing oxygen needs and abdominal distension throughout her shift and has passed a bloody stool. On exam, the abdomen is discolored and grossly distended, and during the exam, the infant has a significant apneic episode. The neonatologist intubates the infant, stops feeds, places a Replogle, and orders an X-ray showing diffuse pneumatosis. Labs are drawn, broad-spectrum antibiotics are
ordered, and the infant is transferred to the Level IV nursery across the hall, total time spent 75 minutes.
The best CPT code for the evening encounter is:
A. 99479 intensive care day 1500-2500 grams
B. 99468 Initial critical care < 29 days of life
C. 99469 Subsequent critical care < 29 days of life
D. 99291 Critical care time (99291), 31500 Intubation
Correct answer: B.
This infant was initially admitted to the Level II nursery. All admit codes can only be used once per admission, and since this infant has spent the entire admission in the intensive care unit, this transfer to critical care qualifies for a critical care admission code. The critical care codes are 24-hour global and bundled, meaning most procedures are included and cannot be billed separately. Since critical care had been provided (intubation, PPV,) this code could be used. However, the infant was transferred to Level IV and will be cared for there. Thus, the global code is more appropriate.
The pediatrician on call is asked to come urgently to the Emergency Department. EMS has dropped off a newly born infant from a birthing center. The infant appears term, is pale, grunting, and is lethargic. Their heart rate is 190’s. The dad had accompanied the infant and said there was “a lot of blood” when the baby came out. The pediatrician suspects a cord accident or placental abruption. She quickly places a UVC (5 minutes), gives a bolus of NS over 10 minutes, and orders emergency blood. The respiratory distress worsens, and the pediatrician intubates the infant (5 minutes). The pediatrician calls the regional NICU (covered by a different group) for transfer. The total time spent was 80 minutes.
The best CPT code for this encounter is:
A. 99291 critical care (30-74 minutes), 99292 critical care (additional 30 minutes)
B. 99291,31500 (intubation), 31560 (UVC), 96360 (administration of IVF, 31-60 min)
C. 99291, 31500, 31560
Correct answer C.
Procedures are not bundled with critical care time but must be subtracted from total critical care time. After subtracting procedural time, the critical care time does not exceed 74 minutes, and 99292 cannot be added as in answer A. If this infant had been admitted directly to NICU in this facility and the neonatologist and the pediatrician were in the same group, 99468 would be used, and separate codes from ED would not be entered. Since the infant is being transferred to a different facility and covered by a different group, the pediatrician can submit codes reflecting the work done in ED.
Unpredictability is the hallmark of Neonatology. When you think everything is under control, a fire breaks out somewhere, requiring your time and attention. Coding and documentation is the boring part of the job, but even firefighters have boring parts, too. I see them at the grocery store every time I go…
Let us be like firefighters: always look on the bright side and approach our work with a burning passion!
ADI and Infant Mortality Link Shed New Light on Maternal Health Crisis
Noting the link between neighborhood social vulnerability and NICU infant mortality gives another explanation for the nation’s maternal health crises.
By. Sarah Heath
May 15, 2023 – A new study in JAMA Network Open uncovered a link between social vulnerability and NICU morbidity and mortality, adding yet another layer to the maternal health crisis facing the United States.
Particularly, the study showed that a high score on the Area Deprivation Index (ADI) is a risk factor for NICU mortality among extremely premature infants born younger than 29 weeks gestation.
These findings come as the US continues to understand its maternal health crisis. The US has the highest maternal mortality rate of similarly developed nations and the steepest racial disparities in maternal and infant outcomes, previous research has found.
This latest study adds another foil to those figures, noting that greater neighborhood social vulnerability is a risk factor for poor NICU outcomes.
The researchers looked at four NICUs in the Midwest, Northeast, Mid-Atlantic, and South to garner insights about in-hospital morbidity and mortality for extremely premature infants staying in the NICU.
Across the nearly 3,000 infants included in the study, high ADI was linked to in-hospital mortality, the researchers found.
Particularly, ADI was higher among the 498 infants who died before NICU discharge, with the average ADI score being 71. This compares to an average ADI of 64 among infants who did not die prior to NICU discharge.
The researchers also observed a higher median ADI for those with late-onset sepsis or necrotizing enterocolitis (NEC) (68 versus 64) and those with severe intraventricular hemorrhage (IVH) (69 versus 64).
These figures were in line with the researchers’ hypothesis that higher ADI would be linked with worse NICU outcomes, likely because pregnant people from under-resourced neighborhoods may lack the prenatal care access that increases the chances of better birth outcomes.
“The mechanism by which area deprivation affects neonatal outcomes may include the effect of maternal adversity on the developing fetus,” the researchers explained. “Maternal stress and poor access to prenatal care have been linked with adverse birth outcomes. Lower maternal socioeconomic status increases the risk of preterm birth, and among those born prematurely, it increases the risk of adverse neurodevelopmental outcomes.”
These findings also add another layer to the racial health disparities evident in maternal and infant health outcomes. For one thing, Black race was linked to higher ADI; the median ADI among Black infants was 77 compared to 57 for White infants. In other words, Black infants were more likely to have a risk factor for NICU morbidity and mortality. However, Black race itself was not a predictor of NICU morbidity and mortality.
“As racial minority individuals proportionally endure more socioeconomic deprivation, it becomes essential to consider social disparities as a significant mediator of racial disparities,” the researchers offered.
The team added that it is often difficult to parse out the impacts that race and social disadvantage have on health outcomes, largely because the two pair together. That’s likely the result of institutional racism. For example, racist policies like redlining segregated racial minorities into under-resourced neighborhoods, meaning that Black people and other racial/ethnic minorities are more likely to live in places with higher ADI scores.
Generally, these findings provide an explanation for a phenomenon scientists already knew existed; Black babies have worse infant mortality rates than White babies. Per CDC figures, non-Hispanic Black babies face and infant mortality rate that is more than double that of non-Hispanic White babies, coming at 10.6 deaths per 100,000 live births and 4.5 deaths per 100,000 live births, respectively. For Hispanic babies, the infant mortality rate was 5 deaths per 100,000 live births.
Future public health investigation is necessary to determine how to mediate these barriers, the JAMA researchers indicated.
Infant Care Innovation Improves Outcomes for Preterm Infants
February 22, 2023 by Nicole Franco
A new feeding practice could become the standard of care in other neonatal ICUs.
If you visit an American neonatal intensive care unit (NICU), you will likely see a ward governed by strict routine. Nurses look after preterm babies (born at less than 37 weeks gestation) by ministering care at prescribed intervals. Even the feedings will be given, like clockwork, every three hours exactly.
However, according to Ani Jacob, DNP, clinical assistant professor in the College of Nursing and Public Health, this approach to preterm infant care does not reflect the latest research. Feeding preterm infants on a rigid schedule inevitably means babies must sometimes feed when they aren’t ready and therefore experience stress, which initial research indicates is associated with negative stress-related symptoms.
To see just how much the prevailing feeding practice was adversely affecting babies, a healthcare team including Dr. Jacob implemented a new practice at a hospital in Manhasset, New York. “Instead of feeding preterm infants at scheduled times or prescribed intervals, it’s important to feed them based on the signs and cues the infants show that indicate they’re hungry and ready to feed,” she said. She shared the benefits of this approach in an evidence-based practice project of cue-based feeding in the hospital’s NICU, published as “Implementation of Cue-Based Feeding to Improve Preterm Infant Feeding Outcomes and Promote Parents’ Involvement” (Journal of Obstetric, Gynecologic & Neonatal Nursing, May 2021).1
Preterm infants, Dr. Jacob explained, exhibit several cues that indicate they want to be fed. Some are visual: “First, the baby must be awake. Second, they should turn their head when you touch their cheek. And, third, if you put a nipple near the baby’s mouth, they should open their mouth to suck.” But vital signs are equally crucial cues, and ignoring them can have serious health consequences for a preterm infant. “If you feed babies when they aren’t ready,” she emphasized, “they may become stressed. Stress can elevate their heart rate, increase their rate of respirations and affect their level of oxygen saturation. If we continue to feed despite these stress signals, the baby may need to be rescued, which often involves more invasive—and more costly—procedures.”
When Dr. Jacob and her team implemented a cue-based feeding approach in the hospital’s NICU as part of their project, they found positive results across the board. “After changing our feeding practice, the babies exhibited fewer stress symptoms when feeding. The babies’ length of stay in the NICU also decreased because the reduction in stress led to better outcomes. So, while improving the level of care we delivered, we simultaneously lowered the average total cost of NICU care.”
The shift also led to another improvement that surprised Dr. Jacob and her team: Parents started to feel more comfortable caring for their babies. “Usually, parents are afraid of feeding preterm babies because these infants are so small and usually have compromised respiratory systems,” she said. “We taught parents to look for cues of feeding readiness by giving them handouts and encouraging them to identify when they think their baby is ready to eat. At the end of the project implementation, they were more comfortable caring for preterm babies because they felt they could interpret their baby’s cues at home.”
Now that their hospital has adopted cue-based feeding, Dr. Jacob and her team hope that the practice will become the standard of care in NICUs elsewhere. More importantly, though, the project imparted a broader lesson she believes all healthcare workers would do well to heed. “Too often in this field, we continue to provide care one way because that’s the way we were taught and know, instead of evidence-based care for better outcomes,” she concluded. “That’s a big problem. Instead, we should be looking for the best evidence that is out there, and then change our practice as we’ve done with cue-based feeding.”
© UNICEF/Raphael Pouget
‘Silent emergency’: Premature births claim a million lives yearly
9 May 2023 Health
A “silent emergency” that is claiming one million tiny lives born premature each year requires concerted action to swiftly improve children’s health and survival, according to a new report released by UN agencies and partners on Wednesday.
An estimated 13.4 million babies were born premature in 2020, with nearly a million dying from pre-term complications, according to Born too soon: Decade of action on preterm birth.
Produced by a range of agencies, including the UN Children’s Fund (UNICEF) and the World Health Organization (WHO), with its Partnership for Maternal, Newborn and Child Health (PMNCH), the report outlines a strategy forward to address this phenomenon, which has been long under-recognized in its scale and severity.
Progress is ‘flatlining’
“Progress is flatlining for maternal and newborn health, as well as the prevention of stillbirths,” PMNCH Executive Director Helga Fogstad said.
Gains made are now being pushed back further through the devastating combination of COVID-19, climate change, expanding conflicts and rising living costs, she warned.
“By working together in partnership – governments, donors, the private sector, civil society, parents, and health professionals – we can sound the alarmabout this silent emergency,” she said.
This means bringing preterm prevention and care efforts to the forefront of national health and development efforts, building human capital by supporting families, societies, and economies everywhere, she added.
Born too soon
Preterm birth rates have not changed in any region in the world in the past decade, with 152 million vulnerable babies born too soon from 2010 to 2020, the report showed.
Preterm births occur earlier than 37 weeks of an expected 40-week full-term pregnancy.
The report included updated estimates from WHO and UNICEF, prepared with the London School of Hygiene and Tropical Medicine, on the prevalence of preterm births.
Leading cause of child deaths
Steven Lauwerier, Director of Health at UNICEF, noted that every preterm death, created “a trail of loss and heartbreak”.
“Despite the many advances the world has made in the past decade, we have made no progress in reducing the number of small babies born too soon or averting the risk of their death. The toll is devasting. It’s time we improve access to care for pregnant mothers and preterm infants and ensure every child gets a healthy start and thrives in life.”
Preterm birth is now the leading cause of child deaths, accounting for more than one in five of all deaths of children occurring before their fifth birthday, the report said. Preterm survivors can face lifelong health consequences, with an increased likelihood of disability and developmental delays.
Too often, where babies are born, determines if they survive, the report found, noting that only 1 in 10 extremely preterm babies survive in low-income countries, compared to more than nine in 10 in high-income nations.
The report showed gaping inequalities related to race, ethnicity, income, and access to quality care, determine the likelihood of preterm birth, death, and disability, even in high-income countries.
Southern Asia and sub-Saharan Africa have the highest rates of preterm birth, accounting for more than 65 per cent of global cases.
Other factors are also making an impact, increasing risks for women and babies everywhere. For example, air pollution is estimated to contribute to six million preterm births each year, the report showed.
At the same time, nearly one in 10 preterm babies are born in the 10 most fragile countries affected by humanitarian crises, according to a new analysis in the report.
Across the world, groups for affected families of preterm birth have been at the forefront of advocating for access to better care and policy change and supporting other families, the report showed.
In addition, the past decade has also seen a growth of community activism on preterm birth and stillbirth prevention, driven by networks of parents, health professionals, academia, and civil society.
UN agencies, including the UN Population Fund (UNICEF), WHO, and UNICEF, are calling for a set of actions to save lives: boost investments in newborn health, accelerate implementation of national policies, integrate efforts across sectors, and support locally led innovation and research to support improvements in quality of care and equity in access.
“Ensuring quality care for these tiniest, most vulnerable babies and their families is absolutely imperative for improving child health and survival,” said Anshu Banerjee, Director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO.
Progress must also advance in prevention, which means every woman must be able to access quality health services before and during pregnancy to identify and manage risks, she said.
Top 7 Medical Innovations In 2023 – The Medical Futurist
Jan 4, 2023 The Medical Futurist
At the beginning of every year, I come up with a few medical innovations I find to be important for the year ahead.
My Early Surprise: A Bedtime Story For Preemies by Sharifa Brown | #ReadAloud
Join me as we read, “My Early Surprise: A Bedtime Story For Preemies” by Sharifa Brown. Here we see firsthand the obstacles Baby Malik and his family faced during his early entrance into the world!
How To Make A Vision Board | 2021 SIMPLE
How to make a vision board? DIY Vision Board, Vision board ideas. Watch as we show you how to make a simple vision board for 2021 that actually works. Whether it’s a digital vision board, a poster board or images on your phone; Vision boards really work. Vision boards help you identify goals and resolutions. No need to over-explain on complicate this; It’s pretty simple. Like Mateo says, it’s like a post-it note. Vision boards are great for kids. You want to gather images and phrases that will remind you of goals, dreams, and things you want to accomplish in the next year. The most important part is to place it somewhere you will see it often. The constant reminder is where the magic lies. Also, keep in mind that the more specific you can be, the more clear your action plan can be. Make sure you take steps to plan how you will achieve your goals! The vision board is just a start, HAVE A PLAN!
#visionboard #visionboards #visionboardparty
Dreamy Mozambique surf trip – surfing & diving in beautiful Tofo & Tofino – Africa Travel – Pollywog
Jun 10, 2020 Pollywog surf
Pollywog surf travel presents Mozambique.
Mozambique is a dream tropical surf destination once simply must travel to. Just one of the many places to visit and surf in Africa and one of the many reasons why you should plan a surf trip to Africa. Africa is one of the last places on earth with pristine, untouched beaches and surf breaks, which makes it one of the best places to visit for a unique surf trip experience. In this video, we head up to Tofo in the middle of Moz with South African surfers Luke Patterson and Tanika Hoffman to find untapped, rustic beauty and experience the true essence of Africa and of course to score some epic waves and see some incredible marine wildlife along the way. The roads are mainly dirt, winding through endless palm trees. Even the roads in the village of Tofo are still dirt roads. It is pretty remote, but that adds to the charm. Still, the town has a great energy, with plenty of restaurants serving fresh fish and bars serving ice cold 2M beer! Surfing in Mozambique is a throwback to the past. The waves are largely uncrowded and the ocean is teeming with wildlife. The main wave is Tofino a right had point break that cooks when the conditions are right. It is a pretty consistent wave too and its possible to surf Tofino all year round. Tofino is probably the most famed wave in Mozambique, along with Ponto do Ouro. The winter months (May, June, July) bring the bigger swells from the south, but Mozambique often receives cyclone swells in the summer (Feb, March) which can create incredible surf conditions. Many South African surfers will drive the long journey chasing cyclone swells up the coast. Tofo, closer to town is a lot more sheltered and the more mellow wave is often good for longboarding or learning to surf. Tofo is also renowned for incredible diving, especially swimming with Whale sharks and Manta Rays.