Saudi Arabia


Estimated Number Of Preterm Birth Rates –  3.96per 100 live births

(Global Average: 10.6, USA: 9.56)

Source- WHO 2014-

Saudi Arabia, officially the Kingdom of Saudi Arabia (KSA), is a country in Western Asia. It covers the bulk of the Arabian Peninsula, and has a land area of about 150,000 km2 (830,000 sq mi), making it the fifth-largest country in Asia, the second-largest in the Arab world, and the largest in Western Asia and the Middle East. It is bordered by the Red Sea to the west; JordanIraq, and Kuwait to the north; the Persian GulfQatar and the United Arab Emirates to the east; Oman to the southeast; and Yemen to the south. Bahrain is an island country off the east coast. The Gulf of Aqaba in the northwest separates Saudi Arabia from Egypt. Saudi Arabia is the only country with a coastline along both the Red Sea and the Persian Gulf, and most of its terrain consists of arid desert, lowland, steppe, and mountains. Its capital and largest city is Riyadh. The country is home to Mecca and Medina, the two holiest cities in Islam.

Saudi Arabia is considered both a regional and middle power.[35][36] The Saudi economy is the largest in the Middle East; the world’s eighteenth-largest economy by nominal GDP and the seventeenth-largest by PPP. As a country ranks 35th, very high, in the Human Development Index, it offers a tuition-free university education, no personal income tax, and a free universal health care system. Saudi Arabia is home to the world’s third-largest immigrant population. It also has one of the world’s youngest populations, with approximately 50 per cent of its population of 34.2 million being under 25 years old.[ In addition to being a member of the Gulf Cooperation Council, Saudi Arabia is an active and founding member of the United NationsOrganisation of Islamic CooperationArab LeagueArab Air Carriers Organization and OPEC.

Health care in Saudi Arabia is a national health care system in which the government provides free health care services through a number of government agencies. Saudi Arabia has been ranked among the 26 best countries in providing high quality healthcare.


Meaningful Manifestations for 2023

As we celebrate the year of 2022 and TRANSITION into the New Year, we would like to share a few of our aspirations for advancements within our global neonatal community for 2023.  Feeling passion, we desire:

  • Enhanced efforts to drive strong and focused innovation in preterm birth technology, preterm birth research and  prevention, targeted diagnostic and treatment options, and effective healthcare  workforce development.
  • Collaborative global engagement focused towards provider/patient education and support, preemie-focused developmental and time sensitive interventional care, the development of  Preterm Birth Community lifespan wellness,  and focused health care/resource  access for our global pre-term birth survivor community (10-12% of our total global population). 
  • Comprehensive research and associated development of effective diagnostics and impactful treatment for preterm birth related preverbal PTSD effecting  preterm birth survivors of all ages.
  • Longitudinal research targeted towards investigation of the gestational neurological development of the preterm birth population, with increased identification of gestational development and advanced cohort/diagnostic classifications in order to improve diagnostics, treatment planning, and best practices supporting neonatal health outcomes. 
  • Expansion of healthcare provider specialization in medical and mental health care targeting pediatric and adult preterm birth survivor needs and resources.  
  • Advancements towards holistic, comprehensive, and accurate diagnostic care management of preemie neurological development, health and wellness conditions free from potentially harmful bias and assumptions that similar symptom presentation in preterm neonates vs. non equates  to similar  diagnoses, etiology, treatment and time sensitive interventions.  


We stand firmly in the expectation that as innovation, technology, diagnostics, research, integrated care management, and global collaboration expands within the preterm birth community we will witness improvements in the quality of life for all members of our global preterm birth family.

Kathy, Kat, and our cat Gannon anticipate that 2023 will lead to the joyful amplification and manifestation of our shared hopes, wishes, dreams and more within the Global Neonatal Womb/Preterm Birth Community! Wishing us all a Joyful, Love-filled, Healthy, Satisfying,  and Adventurous 2023!  


Lack of innovation in neonatal respiratory care is the biggest problem for both preterm and term neonates: to be remembered on World Prematurity Day

Daniele De Luca   09 NOV 2022

This is an editorial commissioned to the President of the European Society for Pediatric and Neonatal Intensive Care, on the occasion of World Prematurity Day 2022. It celebrates this important event by summarizing how the most crucial (and forgotten) problem in neonatal respiratory care is the lack of active translational research. Translational research is pivotal in this context, as it allows to understand the diseases, diagnose them, and imagine new strategic pathways. The lack of translational research means no innovation, and this is jeopardizing the possibility to improve healthcare for both preterm and term critically ill neonates. Historical and more recent examples of the problem are given, together with some basic suggestions to move forward.

On November 17 every year, many countries celebrate World Prematurity Day. Purple is the color of the initiative; thus, hospitals and monuments are highlighted, whereas gadgets and people show something with this color. Since 2011, this fruitful initiative succeeded in raising the attention on the problems related to prematurity, particularly on the care of preterm babies and the important role of parents. This is a commendable and needed initiative. In fact, neonatal care risks being perceived as something taken for granted in the Western world, where birth rates and infant mortality are low and the main current health problems, particularly in the COVID-19 era, are those of the adult age and elderly.

However, we cannot forget that preterm neonates are not the only ones at risk, and, as a matter of fact, the most crucial issue for neonatal medicine has been forgotten. In fact, although many focus on preterm developmental care and parental role, we must admit that neonatology has not meaningfully improved its global clinical results, as there have not been many relevant innovations in the last two decades.

This is particularly true for neonatal respiratory critical care which is, together with hemodynamics, the core problem to be addressed for most patients in life-threatening situations. After the introduction of prenatal steroids and surfactants, we have seen no other game changers for preemies. The situation is even worse for term neonates since the last improvement has been represented only by the introduction of whole body hypothermia for perinatal asphyxia. Thus, we still lack effective drugs and clear diagnostic-therapeutic strategies for bronchopulmonary dysplasia as well as for other disorders more typical of term neonates, such as refractory pulmonary hypertension or congenital diaphragmatic hernia and other congenital lung disorders.

The reasons behind this lack of innovation are many. The regulatory procedures are too strict, time-consuming, and do not consider the peculiarities of the newborn patient and the rarity of his diseases. They are supposed to protect the patient from “wrong” innovations, but they forgot to protect him from the lack of innovation, i.e., the unavailability of drugs or medical devices. Surfactant was intensively studied in the 1980s, following animal and bench experiments performed by Mary Allen Avery and Bengt Robertson. Most likely, this would be extremely difficult, if not impossible, with current regulations, and, if these basic experiments would have been needed today, no surfactant would be available.

The neonatal market is smaller than that represented by several adult medicine specialties, and the relatively low neonatal mortality has decreased the interest of many public grant programs; as a combination of these two factors, neonatal research often lacks specific funding and this is particularly true for respiratory research. Most of the neonatal ventilation research is done without public or industry fundings ; in other words, without the charities and the dedication of researchers, we would not have several respiratory support techniques such as the newest noninvasive ventilation modalities. Other cases are less lucky: some respiratory drugs [including potentially life-saving pulmonary vasodilators do not achieve enough clinical evidence, because they are not suitable from a marketing point of view (i.e., low price, rare use) despite strong translational and clinical data supporting them.

Nonetheless, we shall admit that, besides these problems, the difficulties in finding new solutions for neonatal respiratory care are also due to our own carelessness about what has been learned in close fields, such as anesthesiology, intensive care medicine, regenerative medicine, transplantation surgery, and other fields of adult healthcare. Neonatal respiratory care, and neonatology in general, has suffered a lack of cross-disciplinary awareness that has prevented or delayed important advancements. The reason behind this was the supposition that the neonate was completely distinct from all other patients; newborn physiology may be different in some aspects, but this cannot prevent to recognize similitudes and take advantage from experience accumulated in other fields. In 1964, Gilbert Hualt provided mechanical ventilation for the first time to a newborn infant with congenital tetanus. Without his vision, the introduction of neonatal ventilation would have been delayed; ironically, this technique is now considered the basis of intensive care. How many of us have the same vision regarding strategies, tools, and research lines investigated in adult respiratory care? I still remember a professor stating, no more than 15 years ago, that applying ECMO to neonates was technically impossible. Lung transplantation in neonates and infants is still regarded as an extreme procedure, but some centers practice it with satisfactory results. Are we enough interested in artificial organs and regenerative medicine applied to neonatal respiratory disorders?

The examples are countless and the combination of all these factors leaves many neonatal disorders without a full understanding of their pathobiology and orphan of diagnostic-therapeutic tools; this creates relevant clinical unmet needs. 

Despite all of these problems, some innovations have been achieved, such as the recognition of neonatal acute respiratory distress syndrome (an entity that was forgotten for several decades;  and the implementation of point-of-care lung ultrasound, following the adult intensive care experience (although its diffusion is still variable among countries. Nonetheless, translational research is essential if we really want to fill the many clinical unmet needs. Translational projects are important to understand the mechanisms of disease, how to “intercept” them with diagnostic tools, how to personalize the treatment as much as possible and to discover new therapeutic possibilities. Thus, neonatal translational research, particularly in the respiratory field, must receive greater attention, be facilitated in the regulatory process, and take advantage from quicker industry-academy and cross-disciplinary collaborations. The work might not be exclusively unidirectional. As neonates today are the patients of tomorrow, good results achieved by neonatal research can impact on patient health for several decades ahead. Although we celebrate World Prematurity Day, we shall remember that the actual main problem, both for preterm and for full-term neonates, is that there is no future without active research.


US gets D+ grade for rising preterm birth rates, new report finds

By Jacqueline Howard, CNN   Published 8:00 AM EST, Tue November 15, 2022

The US preterm birth rate peaked in 2006 at 12.8%, according to data from the National Center for Health Statistics.

Since then, some March of Dimes reports have found US preterm birth rates much higher than 10.5%, but those rates were based on calculations that have since been updated, according to March of Dimes.

“There are too many babies being born too soon: 1 in 10. If you were to have 10 babies in front of you and one of them is having to face the complications that comes with prematurity, that’s unacceptable, and we need to do better,” Henderson said, adding that those 1 in 10 are more likely to be Black, American Indian or Alaska Native.

March of Dimes data in the new report shows that infants born to Black and Native American mothers are 62% more likely to be born preterm than those born to White women.

States with the highest and lowest rates

The new March of Dimes report also highlighted state-by-state differences in the rate of babies born prematurely across the country.

The report grades a preterm birth rate less than or equal to 7.7% as an A and a preterm birth rate greater than or equal to 11.5% as an F.

The national preterm birth rate of 10.5% is graded as a D+.

No state has achieved an A rate, and only one has a state-level preterm birth rate that would be graded as an A-: Vermont, which has the lowest preterm birth rate in the US at 8%.

Meanwhile, nine states and one territory have preterm birth rates that received an F grade: Georgia and Oklahoma with 11.9%; Arkansas, Kentucky and Puerto Rico with 12%; South Carolina with 12.1%; West Virginia with 12.8%; Alabama with 13.1%; Louisiana with 13.5%; and Mississippi with the highest preterm birth rate of all states at 15%.

“The areas that have the worst grades are the same areas we’ve been seeing consistently for a long time, and it’s past time for us to do what we need to do to make health better and make our country a better place to give birth and be born,” Henderson said. “It’s unfortunate that we don’t have policies in place to protect the most vulnerable in our country, and without protecting our moms and babies, we can’t secure the health of everyone else.”

To address these state-by-state disparities in preterm births and help improve the national preterm birth rate as a whole, March of Dimes has been advocating for certain policies, Henderson said, including the Black Maternal Health “Momnibus” Act of 2021, a sweeping bipartisan package of bills to provide pre- and postnatal support for Black mothers – but most of the bills in the package are still making their way through Congress.

March of Dimes also has been urging more states to adopt legislation expanding access to doulas and midwives, among other maternal health care services, and reduce the prevalence of maternity care deserts across the country.

How Covid-19 plays a role

There are many potential factors contributing to the nation’s rising preterm birth rate, and Henderson said the Covid-19 pandemic remains one of the biggest.

“We cannot forget about the impact of the Covid-19 pandemic and recognize that there is likely a huge contribution of that, knowing that Covid-19 infection increases the risk of preterm birth,” she said. “But we also know that this pandemic brought many other issues to the forefront, knowing that issues around structural racism and barriers to adequate prenatal care, issues around access, were brought to the forefront during this pandemic as well.”

She added that many mothers in the United States are starting pregnancies later in life, and there has been an increase in mothers with chronic health conditions, who are at higher risk of having to give birth early due to pregnancy complications.

Pregnant women with Covid-19 may be at increased risk of preterm delivery, CDC study suggests

Henderson also said that preterm birth is one of the top causes of infant deaths and disproportionately affects babies born to women of color.

“The United States is one of the worst places to give birth and be born among industrialized countries, unfortunately. When we look at maternal deaths and infant deaths, we’re at the bottom of the pack among countries with similar profiles in terms of gross domestic product,” Henderson said. “It’s because of our disproportionate numbers of preterm births –particularly for populations that are disproportionately impacted, such as Black families and American Indian and Alaskan Native families – that our rates are so much higher than other countries.”

An ‘urgent public health issue’

Globally, about 10% of births are preterm worldwide – similar to the US preterm birth rate.

About 15 million babies are born preterm each year, amounting to more than 1 in 10 of all births around the world, according to the World Health Organization, which has called prematurity an “urgent public health issue” and “the leading cause of death of children under 5.”

Separate from the March of Dimes report, WHO released new guidelines Tuesday on how nations can improve survival and health outcomes for babies born too early, at 37 weeks of pregnancy or less, or too small, at 5½ pounds or less.

These WHO recommendations advise that skin-to-skin contact, also known as kangaroo mother care, be provided to a preterm infant immediately after birth, without any initial time spent in an incubator.

“Previously, we recommended that kangaroo mother care to only be for babies that were completely stable,” said pediatrician Dr. Karen Edmond, medical officer for newborn health at WHO, who was the lead on the new guidelines.

“But now we know that if we put babies in skin-to-skin contact, unless they are really critically ill, that this will vastly increase their chances of surviving,” she said. “So what’s new is that we now know that we should provide kangaroo mother care immediately after birth, rather than waiting until the baby’s stable.”

Edmond added that immediate kangaroo mother care can help infants better regulate their body temperature and help protect against infections, and she said that these guidelines are for on-the-ground health care providers as well as families.

The new WHO guidelines also recommend that emotional, financial and workplace support be provided for families of babies born too early or at low birth weights.

“Preterm babies can survive, thrive, and change the world – but each baby must be given that chance,” WHO Director-General Tedros Adhanom Ghebreyesus said in a news release.

“These guidelines show that improving outcomes for these tiny babies is not always about providing the most high-tech solutions,” he said, “but rather ensuring access to essential healthcare that is centered around the needs of families.”


RedOne ft. Enrique Iglesias, Aseel and Shaggy | Don’t You Need Somebody

platinumrecordsmusic  236,826,729 views Jul 27, 2016

* Aseel Omran (Arabicأسيل عمران) is a Saudi Arabian singer

Consider What Happens When We Don’t Care for NICU Parents

Here’s how hospitals can support parental mental health

by Alexa Grooms, BSN, RN December 23, 2022

Evidence shows opens in a new tab or window it is the emotional opens in a new tab or window, rather than the medical, complications of pregnancy that are most impactful on the long-term well-being of the parent and child. These emotional complications, known as perinatal mood and anxiety disorders (PMADs), may occur during pregnancy until the first few years after giving birth. PMADs include the most widely known postpartum depression, as well as the lesser-known postpartum anxiety, panic disorder, postpartum obsessive-compulsive disorder, post-traumatic stress disorder, and postpartum psychosis.

Neonatal intensive care unit (NICU) parents are particularly vulnerable to PMADs. Parents rarely expect their child to require intensive care, and the journey is emotional and unpredictable. Studies most often focus on mothers, or the birthing parent, rather than fathers or the supporting parent. However, we know that NICU parents have 28-70% higher opens in a new tab or window incidences of depression. At a minimum, being separated from your child can cause distress and impaired bonding.

As a NICU nurse, I can testify that staff know parent mental health is pervasive. So why aren’t we addressing it? Unfortunately, few of us have the tools, resources, and confidence to intervene. After all we were hired to take care of babies, and adults can be intimidating, especially on such a stigmatizing topic. However, hospitals and healthcare professionals must ask ourselves: What are we missing if we do not also care for the family? Parents are the key to their child’s emotional and cognitive wellness and the effects last a lifetime, for the positive or negative. Mood disorders can be debilitating both for the individual and the family.

This year, a cross-sectional study opens in a new tab or window by Cooper Bloyd, MD, MS, and fellow researchers surveyed which NICUs were incorporating mental health screening and treatment following the 2015 release of the National Perinatal Association guidelines. Among respondents, 44% routinely screened parents for disorders, most often depression. They also found that 47% offered mental health education to families, and between 3-11% employed some type of mental health specialist in their unit. The figures, they acknowledged, were likely high because of low study participation and the respondents wanting to advertise their practices.

As the National Perinatal Association outlines opens in a new tab or window, mental health initiatives can be implemented with families via universal distress screening; “layered levels of support” through education, especially peer support groups; and employment of mental health professionals. Here are my recommendations for how these may be best incorporated into standard care.

Incorporate Universal Screening

Screening can be integrated by making it part of the admission and discharge educational packages. For example, when parents are filling out initial admission forms or upon discharge when families either transfer to another facility or go home with their follow-up pediatrician appointments. There are also opportunities to screen families during infant care milestones, such as 100 days in the NICU. Whenever possible, screening can be placed alongside standard information such as safe sleep and feeding education to minimize stigma. The Edinburgh Postnatal Depression Scale is a validated screening tool specific to postpartum depression. Other useful screening tools may include the PHQ-2 for depression or PTSD-5 for trauma. Positive results should trigger follow up with a unit-based mental health provider such as a social worker, psychologist, psychiatrist, psychiatric nurse practitioner, or nurse with extensive perinatal mental health training.

This year, a cross-sectional study opens in a new tab or window by Cooper Bloyd, MD, MS, and fellow researchers surveyed which NICUs were incorporating mental health screening and treatment following the 2015 release of the National Perinatal Association guidelines. Among respondents, 44% routinely screened parents for disorders, most often depression. They also found that 47% offered mental health education to families, and between 3-11% employed some type of mental health specialist in their unit. The figures, they acknowledged, were likely high because of low study participation and the respondents wanting to advertise their practices.

As the National Perinatal Association outlines opens in a new tab or window, mental health initiatives can be implemented with families via universal distress screening; “layered levels of support” through education, especially peer support groups; and employment of mental health professionals. Here are my recommendations for how these may be best incorporated into standard care.

Incorporate Universal Screening

Screening can be integrated by making it part of the admission and discharge educational packages. For example, when parents are filling out initial admission forms or upon discharge when families either transfer to another facility or go home with their follow-up pediatrician appointments. There are also opportunities to screen families during infant care milestones, such as 100 days in the NICU. Whenever possible, screening can be placed alongside standard information such as safe sleep and feeding education to minimize stigma. The Edinburgh Postnatal Depression Scale is a validated screening tool specific to postpartum depression. Other useful screening tools may include the PHQ-2 for depression or PTSD-5 for trauma. Positive results should trigger follow up with a unit-based mental health provider such as a social worker, psychologist, psychiatrist, psychiatric nurse practitioner, or nurse with extensive perinatal mental health training.

Additional follow up could also take the form of obstetricians reaching out to patients prior to the 6-week postpartum follow up. Screening and support should also include pediatrics, as pediatricians are in a unique position to continuing assessing the child’s development and parent-child relationship.

Education for Parents and Staff

There are many opportunities to enhance parent and staff education. Parent support groups are especially therapeutic. Parents should be welcomed in by other parents as they go through this unexpected journey together. Veteran NICU families often play an important role in facilitating and leading these groups. Parents who pump also find exceptional reward and meaning in donating breast milk back to other NICU infants.

In terms of staff, mental health education should be ongoing, as going into pediatrics means partnering with families. Patient psychosocial history and discussion about how to support families should be incorporated into daily provider rounds.

Seeing It Through With Usable Referrals

Parents who want or require psychiatric care after discharge must be referred. Most importantly, these referrals must be usable. I will argue that hospitals must guarantee NICU parents’ appointments or spots in follow up care. We cannot build the trust of these families only to refer them to help that is a dead end. Hospitals will argue it is impossible to guarantee appointments, as demand for psychiatric care is high. However, hospitals must recognize the risk of both child and parent hospital readmission if they aren’t connected to care. There is also the added benefit of building patient loyalty. Labor and delivery are where most families first interact with medical care, and a good experience can lead them to return for future care.

Of course, adding mental health staff and resources will come at a cost. As cost is an understandable concern, the value of these services can be demonstrated first in low- to zero-cost quality improvement or nurse residency projects before investing dollars. Once value is demonstrated, hospitals can leverage funding from Magnet or Baby Friendly Hospital designation budgets. Applications for these hospital designations are lengthy but worth pursing as funds are allocated for pilot projects such as these.

Final Thoughts

It is clear NICU parents need our help. My recommendations are clear and feasible, and unit staff can help integrate them into standard care practices. Hospitals have a responsibility to be part of the solution and allocate funding from existing initiatives to offset costs. Staff must be educated to support parents, and hospitals must create systems within existing infrastructure to address mental health concerns. We can no longer omit parents’ health when we care for their child.



The NICU: The palliative care team would ask us, “How do you feel about what you just heard?”

Courageous Parents Network Nov 6, 2019

The palliative care team would ask us, “How do you feel about what you just heard?” Parents of a baby son who was born with Arteriovenous Malformation (AVM) and died at age 3 months, talk about how the palliative care team interacted with and supported them, and helped manage their son’s pain and consider the future. “They really saw us as people and as parents. It was an awesome help to have them there.”

Holding Your Baby in Intensive Care

Published on Jun 19, 2022

“Yes, your baby can be held today!”

Hearing these words can trigger strong emotions. Every parent is eager to hold their baby. But holding a baby who is very small or on a breathing machine with lots of tubes and wires can be scary (even for experienced parents). Below are some common questions parents have about holding their baby in intensive care and our recommendations.

“I know I will want to hold my baby, but isn’t it better to just let my baby rest in bed?”

Babies are born needing your touch. Your touch is very different than touch from the hospital sta­ff.

When you hold your baby, you help your baby:

  • Get to know you and develop an attachment
  • Maintain body temperature
  • Develop and grow brain connections
  • Learn language
  • Develop muscles and strength
  • Gain weight
  • Feel less pain
  • Cry less
  • Stabilize breathing and heart rate
  • Sleep better
  • Reduce stress
  • Feel safe and protected

Holding your baby also helps you:

  • Feel more confident as a parent
  • Feel connected to your baby
  • Reduce stress
  • Produce milk for your baby, if you pump

“Holding my baby for the first time feels like a big deal. How can I prepare when it is time to hold my baby?”

  • Request a comfortable chair with arms and a footrest.
  • Choose a time when you can take your time and are not rushed.
  • Go to the restroom, and make sure you eat beforehand.
  • For moms who pump, pump before holding your baby.
  • Have a water bottle nearby in case you become thirsty.

“I want to hold my baby, but I don’t know whether it is safe, and I feel nervous. What are some tips?”

  • It’s never too early to start a conversation with your nurse about when your baby will be ready to be held. If your baby is not yet ready, ask your nurse, “What are some signs that tell me my baby is ready to be held?”
  • Talk to your baby’s therapists (e.g., occupational therapists, physical therapists) about suggestions for how to hold your baby.
  • Ask your baby’s nurse for ideas about how to make your baby comfortable.
  • Remember that sometimes babies have a little stress while being moved out of bed but then become very comfortable in your arms.
  • All babies (not just premature babies) benefit from skin to skin holding, which is called kangaroo care. Kangaroo care has amazing benefits for children and parents and is encouraged whenever possible. To learn more about kangaroo care, please see the Skin to Skin Care (Kangaroo Care) handout in the patient family education manual (13:B:08).
  • Before holding your baby, take some calming deep breaths.
  • Ask the social worker or psychologist for tips on how to feel more comfortable holding your baby.
  • Remember that the more you hold your baby, the easier and more comfortable it will become!

My baby’s team says my baby is not yet ready to be held. What else can I do?”

If your baby is not ready to be held, your touch is still important!

  • “Hand hugs” are a great option when your baby is not yet ready to get out of bed. This will also support your baby’s growth and your relationship.
  • Gentle, constant touch to your baby’s head, chest or feet can have a calming effect.
  • If your baby is in a warmer bed or isolette, ask for a taller chair so you can sit comfortably next to your baby and be together.


Mom shares story of premature baby now hospitalized with RSV

CBS 8 San Diego

Nov 17, 2022 – Nov 17, 2022

On World Prematurity Day, a Southern California mom is sharing her story about having a premature baby who is now hospitalized with RSV. The three-month-old has been at Children’s Health of Orange County for more than three weeks, but his story is similar to other families whose children are being treated right here in San Diego.

Respiratory syncytial virus (RSV

Respiratory syncytial virus (RSV) What is RSV Respiratory syncytial virus (abbreviated as RSV) is a virus that can cause cold-like symptoms but can also lead to severe breathing difficulties or even a severe infection of the lung. Almost all children have already once been infected with RSV by their second birthday. Since there are a lot of different forms of RSV, one can be infected several times in life.1 At risk for an RSV infection Everybody can be infected by RSV. Usually people don’t really note this, but have a cold or sniffle and recover within a few days. But the virus can also cause a very severe infection. Certain people are at risk for a more severe infection and may require hospitalisation, need of oxygen therapy and long-term damages like asthma.

Symptoms of an infection with RSV:

 The symptoms of an infection with RSV are similar to common cold symptoms, like runny nose, coughing or wheezing (a whistling sound during breathing) and a decreased appetite. An adult infected with RSV can show symptoms, but does not have to, while children usually do show symptoms. Especially in very young children the symptoms might consist of irritability and decreased activity and appetite. Also breaks in breathing (apnoea) might occur. Fever can be a symptom, but is not always present. At the beginning, the symptoms might be relatively low pronounced, but especially in people at risk for a more severe infection it can lead to hospitalisation and severe inflammation of the small airways in the lung (bronchiolitis) and infection of the lungs (pneumonia).1 Ways of transmission of the virus The virus is mainly spread by droplets from a person who is infectious to another person. This means by sneezing or coughing of an infected person into the air. When a person inhales these droplets or when they touch the mouth, nose or eye, this can lead to an infection. Also a direct or indirect contact with nasal or oral secretions from a contagious person can lead to an infection. Be aware that also kissing can lead to a transmission of the virus. Another possible form of being infected with RSV is by touching something (surfaces, toys, doorknobs, gloves,…) that an infectious person had touched before and then rubbing eyes or nose. People who are infected with the virus, but do not show symptoms or only light symptoms can still be contagious for others.

At Risk for Severe Infection:

– preterm babies young children (particularly up to 6 months)

– children with heart or lung disease (especially up to 2 years)

– certain congenital anomalies (for example trisomy 21)

 – children with a neuromuscular disease (for example children who cannot swallow easily or have – – problems clearing mucus secretions)

– elderly people who have a weak immune system

Additional Risk Factors for the babies:

– multiple birth

– male siblings in early childhood

–  passive smoking close domestic conditions

– malnutrition

– lack of breastfeeding

– family history of allergic diseases or asthma

You can help protect your baby by taking some precautions:

 The virus is able to survive quite a long time on hands (about half an hour), tissues (up to an hour) and toys/surfaces (several hours).

 Therefore the following precautions and recommendations are very important to be followed:

 Don’t share your mug, plate or cutlery with others Avoid rubbing your nose or eyes If possible, avoid interaction with high-risk children if you have cold-like symptoms When coughing or sneezing cover your mouth and nose with a tissue and throw it away afterwards Stay at home when you have cold-like symptoms Don’t kiss high-risk children while you or they show cold-like symptoms High-risk children should spend little time in potentially infectious places (for example child-care centres) Don’t smoke near your child. Wash your hands after smoking Breastfeeding reduces the risk for an infection with RSV Wash your hands frequently and wipe hard surfaces with soap and water (15-20 seconds!) or disinfectant.

Treatment of RSV Most people who are infected with RSV only show a mild form of infection and usually do not need treatment at all. For the ones suffering from a more severe form of the disease, there is no causal therapy and only the symptoms can be treated by for example lowering fever and drinking enough. Some children may even require hospitalisation and need help with breathing.4 Vaccination against RSV At the moment there is no vaccine that can help prevent RSV infection.3 Nevertheless, there may be options to prevent contracting the virus. And of course, you can help avoid RSV infection by following the already mentioned tips for hygiene! For further questions please ask your paediatrician.

A Stay in Neonatal Care – Preparing to Take Your Baby Home

The NICU Foundation Oct 14, 2021

Funded by The NICU Foundation and created in partnership with The South West Neonatal Network, this animation was created to support parents, as they navigate their journey home following a stay in neonatal care with a premature or sick baby.

*** Ask your healthcare provider what community resources are available to support you, your family, and your baby. Knowing resources in advance will empower your ability to be proactive and prepared!


Stanford Fetal Therapy VR: An inside look at complex fetal conditions

Stanford Medicine Children’s Health Apr 29, 2022

Stanford Fetal Therapy VR gives patients and doctors an unprecedented view of two complex fetal conditions—spina bifida and twin-to-twin transfusion syndrome—and how we can treat them using cutting-edge surgical techniques.

Clinical outcomes for babies born between 27 31 weeks of gestation: Should they be regarded as a single cohort?

Abdul Qader Tahir Ismail a,b,*, Elaine M. Boyle a, Thillagavathie Pillay a,c, For the OptiPrem Study Team

Journal of Neonatal Nursing 29 (2023) 27–32

  1. Introduction

 Within the UK, babies born below 27 weeks of gestation are recommended to be born in maternity services attached to neonatal intensive care units (NICU). For those babies born between 27 and 31 weeks of gestation, care can be delivered in maternity services attached to either a NICU or a local neonatal unit (LNU). While the first recommendation is evidence based (Marlow et al., 2014; Watson et al., 2014), our systematic review found a paucity of evidence for optimal location of birth and care for babies born between 27 and 31 weeks (Ismail et al., 2020).

 This reflects a more general lack of research aimed at babies born between 27 and 31 weeks of gestation. During our systematic review we found that most of the data available for this population comes from subgroup analyses in studies of larger gestational age ranges (Ismail et al., 2020; Lasswell et al., 2010). Of these, most report outcomes for this group as a whole rather than by gestational week (Watson et al., 2014). Neonatal research is logistically difficult, especially in relation to very preterm babies, as the population size decreases with each extra gestational week of prematurity. Therefore, it is common practice to cohort babies. While not ideal, this makes more sense for certain gestational age ranges than others.

 Babies born between 27 and 31 weeks do not form a ‘natural’ cohort as do those born extremely preterm. There is a significant degree of heterogeneity in the clinical presentation between babies born at either end of this spectrum. Over this five-week period the foetus is undergoing significant growth and developmental changes in-utero. In this review we describe the limited available literature on the variation in clinical presentation and outcomes for babies born between 27 and 31 weeks of gestation in the context of fetal developmental biology and preterm birth. In doing so, we highlight the importance of future research reporting gestation specific outcomes for preterm babies in general, but especially this cohort.

  • Survival and key morbidities for babies born at 2731 weeks

Table 1 and Fig. 1 summarises outcomes for major neonatal morbidities by each week between 27 and 31 weeks of gestation. They include international mortality data from national statistical bodies. An identical trend is evident for all, demonstrating increasing incidence with decreasing gestational age and substantially different outcomes for the most preterm babies within this gestational age range compared to the most mature. There is, on average, a greater than 4-fold difference in mortality between babies born at 27 weeks of gestation compared to 31 weeks, and a 4-fold increase in rates of survival to discharge without morbidity for babies born at 30 weeks compared to 27 weeks.

  • Understanding postnatal outcomes through the lens of foetal development

 The medical and nursing care required for babies in this group is likely to be more intense for those at the lower than the higher end of the gestational age spectrum, based on their degree of immaturity, and existence of co-morbidities.

  • Respiratory system

Babies born at the lower end of this gestational age range are often first supported with non-invasive ventilation (NIV) if they display sufficient respiratory drive and have a good heart rate. Those that do not will be intubated and invasively ventilated within delivery suite, and a proportion of those who initially managed on NIV may require subsequent intubation and ventilation due to significant apnoea and/or respiratory failure. These babies may benefit from a dose of surfactant and regular caffeine, with the aim to extubate onto NIV as soon as appropriate, to minimise ventilator associated lung injury while still providing an adequate level of support, which may be required for several weeks. In contrast, the majority of babies born at the upper end of this gestational age range will only require a brief period of NIV, usually in the form of high flow nasal prong oxygen or continuous positive airway pressure (CPAP) support.

How can we understand this in the context of foetal development? In-utero breathing stimulates lung growth (Harding and Hooper, 1985). By 24–28 weeks, fetal breathing movements occur for 10–20% of the time, increasing to 30–40% by 30 weeks (Fraga and Guttentag, 2012). Correspondingly, during the saccular stage of fetal lung development (24–26 weeks to 36–38 weeks), surface area for gas exchange increases as does vascularisation and surfactant production. Following preterm birth, this immaturity of central respiratory drive manifests as periods of hypoventilation and apnoea, the incidence falling from 54% at 30–31 weeks to 7% at 34–35 weeks (Henderson-Smart, 1981). In those born at 24–27 weeks, apnoeic episodes are more likely to continue for longer compared to those born ≥28 weeks (Eichenwald et al., 1997). Therefore, respiratory compromise, the need for mechanical ventilation and intensive care support is more likely with increasing prematurity, with the incidence of RDS at 60–80% for babies born at 26–28 weeks, falling to 15–30% by 32–36 weeks [14]. The more immature the lung, the greater the risk of ventilator associated lung injury, abnormal development, and chronic lung disease (CLD) [15]. Its incidence is nine times greater in babies born at 27 weeks than at 31 weeks of gestation (Bolisetty et al., 2015; Egreteau et al., 2001).

  • Cardiovascular system

Babies born at 27 weeks of gestation who are difficult to successfully extubate will often be found to have a haemodynamically significant patent ductus arteriosus (PDA) on echocardiography (although clear evidence is lacking for a causal relationship – (El-Khuffash et al., 2019; Benitz et al., 2016)). Management protocols vary unit to unit, but many will commence pharmacological treatment with ibuprofen, or more recently paracetamol. If this is unsuccessful, and on serial echocardiograms there is evidence of developing heart failure, the baby will be referred for surgical ligation. While some babies born at 31 weeks may have clinical signs of a PDA (i.e., a murmur, easily palpable femoral pulses), it is unlikely to be haemodynamically significant and can be left to close on its own. If at the time of discharge these signs are still present, an echocardiogram can provide a definitive diagnosis to arrange appropriate follow-up.

Following preterm birth, constriction of the ductus arteriosus is less likely to occur because of reduced vessel tone and pulmonary clearance of prostaglandins, to which the ductus in preterm babies is more sensitive (Clyman, 2012). This explains the increase in incidence of patent ductus arteriosus (PDA) at day 7 of life with reducing gestation (68%, 33%, and 2% at 26–27 weeks, 28–29 weeks, and ≥30 weeks, respectively) (Clyman, 2012), and a 10-fold increase in the likelihood of requiring surgery for a clinically significant PDA in those born at 27 weeks gestation when compared to those at 31 weeks (Bolisetty et al., 2015).

  • Ocular system

 Babies born at the lower end of this gestational age range most often require supplemental oxygen as part of their respiratory support. This is recognition receptors (including toll like receptors) continue development until 33 weeks, however, for up to 28 days after preterm birth at <30 weeks, toll like receptor responses are significantly reduced (Marchant et al., 2015). Regarding the complement system, average levels of terminal pathway components, C5, C6, and C8 in preterm babies are at 60–73%, 36–39%, and 29%, respectively, compared to adult levels (McGreal et al., 2012). Considering overall functional capacity, CH50 assay results increase from 32 to 36% at 26–27 weeks, to 52–81% at term.

Physical and external contributing factors, such as skin barrier integrity, repeated invasive procedures and indwelling plastic catheters, are also related to degree of prematurity.

3.6. Renal system

 Babies born at the lower end of this gestational age range receive a significant proportion of their hydration/nutrition intravenously, while simultaneously exposed to nephrotoxic drugs, e.g., gentamicin for treatment of suspected EOS, ibuprofen for treatment of a haemodynamically significant PDA, and vancomycin for treatment of CLABSI, warranting close monitoring of their electrolytes, renal function, and fluid balance. In contrast, babies born at the upper end of this gestational age range relatively quickly establish enteral feeds and much less frequently require treatment with nephrotoxic drugs.

The incidence of renal failure is 2-fold higher for a baby born at 27 weeks compared with 30 weeks of gestation (Walker et al., 2011; Jetton et al., 2017). Two thirds of new nephrons form between 28 and 36 weeks, after which no new glomeruli develop (Stritzke et al., 2017; Hinchliffe et al., 1991). Following preterm birth, nephrogenesis can continue for up to 40 days (Rodriguez et al., 2004; Black et al., 2013), but a significant proportion of new glomeruli have cystic dilatation of the Bowman’s capsule (Sutherland et al., 2011).

3.7. Neurological system

 As routine, babies born at the lower end of this gestational age range will have a cranial ultrasound scan (CrUSS) within the first few days of life, which will be repeated two to three times within the first month. It is not uncommon to diagnose uni/bilateral grade I-II intraventricular haemorrhage (IVH) and increased echogenicity in the periventricular areas even in those babies without any discernible risk factors except prematurity. However, for the more unwell (who may have required a degree of resuscitation, intubation and invasive ventilation, periods of hypoxaemia, hyper/hypocapnia and acidosis, and hypotension requiring fluid expansion and inotropic support), more severe grades of IVH (III/IV) and cystic periventricular leukomalacia (PVL) are more common. This would necessitate increasing the frequency of scanning to monitor for complications (e.g., post-haemorrhagic hydrocephalus) and plan for longer term neurodevelopmental follow-up and support. Babies born at the upper end of this gestational age range are much less likely to experience this degree of homeostatic disturbances and so are routinely scanned once within the first week of life and may not have a second scan until term equivalent or ready for discharge.

This variation in scanning frequency is based on the inverse correlation gestational age at birth has with risk of IVH (Brouwer et al., 2008; Synnes et al., 2001). Babies born at 27–28 weeks have a 2-fold increased risk of developing intraventricular haemorrhage (IVH) of any grade, compared to those born at 31 weeks (Brouwer et al., 2008; Synnes et al., 2001). Severe IVH (stage III/IV) is three times more common in those born at 27 weeks than 31 weeks.

The germinal matrix has a dense supply of fragile blood vessels that are prone to rupture with fluctuations in cerebral blood flow, causing the bulk of what is described in the literature as IVH. The risk is increased due to immature cerebral autoregulation, in which hypoxaemia, hypercapnia, hypocapnia, and acidosis cause pressure passivity (Soul et al., 2007; Tsuji et al., 2000). This, combined with increasing severity of respiratory illness and homeostatic disturbances in the more preterm baby, may explain the inverse correlation of IVH with gestational age.

The trend is similar for periventricular leucomalacia (PVL) (Luan-ying, 2011). Non-cystic PVL is characterised by hypomyelination (Volpe, 2009). By 28–30 weeks, increasing differentiation of oligodendrocyte progenitors (pre-OL) coincides with the start of myelination (Jakovcevski et al., 2009; Tau and Peterson, 2010), stimulated by microglia that are also proliferating (Menassa and Gomez-Nicola, 2018; Gould and Howard, 1991; Billiards et al., 2006). Hypoxia, infection or inflammation cause pathogenic activation of microglia and death of pre-OL cells through release of reactive nitrogen and oxygen species (RNS/ROS) (Merrill et al., 1993; Haynes et al., 2003).

Preterm babies with severe IVH (grade III/IV) and cystic PVL are at increased risk of cerebral palsy (Himmelmann and Uvebrant, 2014). There is a nearly 2-fold increase in incidence of cerebral palsy for a baby born at 27 weeks compared with 31 weeks of gestation, but the absence of cranial ultrasound abnormalities does not always mean normal neurodevelopment for babies born preterm. In utero, cortical volume increases from 13% at 28 weeks to 53% at 34 weeks. Babies born preterm have reduced growth trajectories of their cerebrum, cerebellum, and brainstem compared to the foetus within the last trimester (Bouyssi-Kobar et al., 2016). Each extra week of maturity at birth between 27 and 32 weeks is associated with an increased IQ of 2.5 points (Johnson, 2007).

  • Implications for practice

The degree of clinical support that a preterm baby may receive is graded into intensive care, high dependency and special care (BAPM, 2011). Most babies born at the lower end of this gestational age spectrum require some degree of intensive care support, based on the clinical manifestations of their prematurity. In contrast, the majority of ‘well’ preterm babies at the upper end may never require intensive care support, but rather high dependency and special care support. This dichotomy in their clinical presentation means that grouping them into a single cohort may have the following consequences:

 a) Cohorting this group in terms of decision-making regarding place of birth and care may mean over utilisation of intensive care support for those babies at the upper end of the spectrum. This in turn may limit intensive care availability for those babies who need it, especially in resource and cost constrained environments.

 b) Grouping them as a single cohort in the literature makes it more likely significant outcomes for babies at the lower end of this spectrum will be obscured.

5. Conclusion

 This review highlights the variation and range of clinical profiles and associated outcomes for babies born between 27 and 31 weeks of gestation, and how these relate to key aspects of organ/system development occurring in-utero during this 5-week period. The data summarised in Table 1 and graphically represented in Fig. 1 consistently demonstrate a gradient of risk across multiple outcomes with rates of mortality and morbidity increasing from birth at 31 to 27 weeks. Outcomes at the two extremes of this range may differ significantly, yet babies born between 27 and 31 weeks of gestation are often regarded as a single entity with respect to place of birth and care, and for research purposes. In future studies relating to very preterm birth, understanding gestation specific morbidities and outcomes may be more informative, compared to outcomes as a single collective group. This may be a useful concept for policy makers involved in preterm health service delivery, and might allow more finely tuned, appropriate utilisation of resources for this group of babies.

Full Report, Data, Charts/References


AAP Issues Reports on Point-of-care Ultrasonography Applications in the NICU


Point-of-Care Ultrasonography (POCUS) can be performed at the bedside of patients in neonatal intensive care units (NICU). If performed in a timely fashion, POCUS has the potential for enhancing quality of care and improving outcomes. The clinical report, “Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes,” along with an accompanying technical report, are published in the December 2022 Pediatrics (published online Nov. 28). Although the performance and interpretation of ultrasonography have traditionally been limited to pediatric radiologists and pediatric cardiologists, POCUS refers to ultrasonography performed at the bedside by non-radiology and non-cardiology practitioners in the NICU for diagnostic, therapeutic, and procedural purposes. The reports, written by the Committee on Fetus and Newborn and the Section on Radiology, state that the technology is increasingly used worldwide. Yet, there are no published guidelines on implementation of point-of-care ultrasonography programs in U.S. neonatal intensive care units. The AAP suggests institutional guidelines for the use of point-of-care ultrasonography and other steps to help overcome barriers in use of the technology.



Healthcare providers should consider RSV in patients with respiratory illness, particularly during the RSV season.

Respiratory syncytial virus (RSV) was discovered in 1956 and has since been recognized as one of the most common causes of childhood illness. It causes annual outbreaks of respiratory illnesses in all age groups. In most regions of the United States, RSV circulation starts in the fall and peaks in the winter, but the timing and severity of RSV season in a given community can vary from year to year. Scientists are developing several vaccines, monoclonal antibodies, and antiviral therapies to help protect infants and young children, pregnant people (to protect their unborn babies), and older adults from severe RSV infection.

Clinical Description and Diagnosis

In Infants and Young Children

RSV infection can cause a variety of respiratory illnesses in infants and young children. It most commonly causes a cold-like illness but can also cause lower respiratory infections like bronchiolitis and pneumonia. One to two percent of children younger than 6 months of age with RSV infection may need to be hospitalized. Severe disease most commonly occurs in very young infants. Additionally, children with any of the following underlying conditions are considered at high risk:

  • Premature infants
  • Infants, especially those 6 months and younger
  • Children younger than 2 years old with chronic lung disease or congenital heart disease
  • Children with suppressed immune systems
  • Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

Infants and young children with RSV infection may have rhinorrhea and a decrease in appetite before any other symptoms appear. Cough usually develops one to three days later. Soon after the cough develops, sneezing, fever, and wheezing may occur. In very young infants, irritability, decreased activity, and/or apnea may be the only symptoms of infection.

Most otherwise healthy infants and young children who are infected with RSV do not need hospitalization. Those who are hospitalized may require oxygen, intubation, and/or mechanical ventilation. Most improve with supportive care and are discharged in a few days.

In Older Adults and Adults with Chronic Medical Conditions

Adults who get infected with RSV usually have mild or no symptoms. Symptoms are usually consistent with an upper respiratory tract infection which can include rhinorrhea, pharyngitis, cough, headache, fatigue, and fever. Disease usually lasts less than five days.

Some adults, however, may have more severe symptoms consistent with a lower respiratory tract infection, such as pneumonia. Those at high risk for severe illness from RSV include:

  • Older adults, especially those 65 years and older
  • Adults with chronic lung or heart disease
  • Adults with weakened immune systems

RSV can sometimes also lead to exacerbation of serious conditions such as:

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure

Clinical Laboratory Testing

Clinical symptoms of RSV are nonspecific and can overlap with other viral respiratory infections, as well as some bacterial infections. Several types of laboratory tests are available for confirming RSV infection. These tests may be performed on upper and lower respiratory specimens.

The most commonly used types of RSV clinical laboratory tests are

  • Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR), which is more sensitive than culture and antigen testing
  • Antigen testing, which is highly sensitive in children but not sensitive in adults

Less commonly used tests include:

  • Viral culture
  • Serology, which is usually only used for research and surveillance studies

Some tests can differentiate between RSV subtypes (A and B), but the clinical significance of these subtypes is unclear. Consult your laboratorian for information on what type of respiratory specimen is most appropriate to use.

For Infants and Young Children

Both rRT-PCR and antigen detection tests are effective methods for diagnosing RSV infection in infants and young children. The RSV sensitivity of antigen detection tests generally ranges from 80% to 90% in this age group. Healthcare providers should consult experienced laboratorians for more information on interpretation of results.

For Older Children, Adolescents, and Adults

Healthcare providers should use highly sensitive rRT-PCR assays when testing older children and adults for RSV. rRT-PCR assays are now commercially available for RSV. The sensitivity of these assays often exceeds the sensitivity of virus isolation and antigen detection methods. Antigen tests are not sensitive for older children and adults because they may have lower viral loads in their respiratory specimens. Healthcare providers should consult experienced laboratorians for more information on interpretation of results.

Prophylaxis and High-Risk Infants and Young Children

Palivizumab is a monoclonal antibody recommended by the American Academy of Pediatrics (AAP) to be administered to high-risk infants and young children likely to benefit from immunoprophylaxis based on gestational age and certain underlying medical conditions. It is given in monthly intramuscular injections during the RSV season, which generally starts in the fall and peaks in the winter in most locations in the United States.


Seattle Embraces 2018 Special Olympics USA Games With Joyous Opening Ceremony Celebrating 50 Years Of Inclusion Through Sports

“Diversity really means becoming complete as human beings – all of us. We learn from each other. If you’re missing on that stage, we learn less. We all need to be on that stage.”

Juan Felipe Herrera

Daniel Laurie from Call the Midwife | Our Voice Interviews


A Little Book About Bravery by Rick DeLucco

A Kids Co. Sep 20, 2021

A Little Book About Bravery

Kiteboarding with Jasmina: Saudi Arabia Special

Bo Van Wyk  Apr 14, 2016

Kiteboarding Saudi Arabia I had the chance to go kiting at two amazing spots in Saudi Arabia. Let me take you to this unusual place. Enjoy!

ABP, Protect, Act, Progress


Estimated # of preterm births: 5.40 per 100 live births

(USA Global Average: 9.56)

Source- WHO 2014-

Latvia, officially the Republic of Latvia, is a country in the Baltic region of Northern Europe. It is one of the Baltic states; and is bordered by Estonia to the north, Lithuania to the south, Russia to the east, Belarus to the southeast, and shares a maritime border with Sweden to the west. Latvia covers an area of 64,589 km2 (24,938 sq mi), with a population of 1.9 million. The country has a temperate seasonal climate.  Its capital and largest city is RigaLatvians belong to the ethno-linguistic group of the Balts; and speak Latvian, one of the only two surviving Baltic languagesRussians are the most prominent minority in the country, at almost a quarter of the population.

Latvia is a developed country, with a high-income advanced economy; ranking very high in the Human Development Index. It performs favorably in measurements of civil libertiespress freedominternet freedomdemocratic governanceliving standards, and peacefulness. Latvia is a member of the European UnionEurozoneNATO, the Council of Europe, the United Nations, the Council of the Baltic Sea States, the International Monetary Fund, the Nordic-Baltic Eight, the Nordic Investment Bank, the Organisation for Economic Co-operation and Development, the Organization for Security and Co-operation in Europe, and the World Trade Organization.

The Latvian healthcare system is a universal programme, largely funded through government taxation. It is among the lowest-ranked healthcare systems in Europe, due to excessive waiting times for treatment, insufficient access to the latest medicines, and other factors. There were 59 hospitals in Latvia in 2009, down from 94 in 2007 and 121 in 2006.



How to Protect Staff and Patients From Violence in the Hospital

From detection tools to staff training, children’s hospitals are upping their security measures in response to growing violence across the country. By Megan McDonnell Busenbark – Published Oct. 21, 2022

Mark Moore has spent his life in the business of protection. Since serving in the United States Marine Corps for more than a decade, he has provided security services for business leaders and world events—from Bill Gates to the Olympic Games. His first foray into the health care industry came in 2018 when he joined Dayton Children’s Hospital in Ohio as corporate director of Protective and Support Services, where he’s charged with keeping 27 locations safe—from the main campus to clinics and all other locations dedicated to care.

His first order of business: approaching senior leaders about new ways of protecting staff, patients and families from violence in the hospital—specifically, shootings. He quickly gained approval from his leadership team to make a million-dollar investment in gunshot detection technology. Since that time, the need for such measures has only grown.

“The events of the world have created a sense of urgency,” says Moore. When COVID-19 turned the world on its head, the health care setting saw increased incidents of violence brought on primarily by higher levels of patient and family stress, frustrations due to mask and visitation policies, and staffing shortages. The vulnerability of health care facilities has been coming to new light over the last year, as staff have been injured or killed in shootings in the workplace across the country. On a single day back in June, four staff members were fatally shot in two different adult hospitals—one in Dayton, Ohio, and the other in Tulsa, Oklahoma, where the shooter blamed his surgeon for his back pain.

These and other shootings have raised concerns about the health care setting becoming more of a soft target, like schools—prompting new discussion and action on security approaches to keep patients, families and staff safe in both inpatient and outpatient settings. This is coming in many forms—from increased staff training and safety officer deployment to visitor management strategies and weapon detection systems. It’s placing children’s hospitals in a delicate balancing act: deploying the most effective safety and security measures without losing the warm, welcoming environment they’ve worked for years to create.

Detection tools

In the past year, the University of Vermont Children’s Hospital in Burlington has experienced an unprecedented surge in violence in its emergency department. “The number of assaults on staff members has increased significantly,” says Stephen Leffler, M.D., president and COO at Vermont Children’s. “The number of episodes where weapons are discovered on someone who’s made it into the ED or even an inpatient floor has gone from essentially zero to happening more than occasionally—and they are very scary.”

As part of a larger hospital system, the emergency department serves both adults and children. Adding metal detectors became a necessity for staff safety, even though Leffler and his team were concerned about the effect it would have on patients’ experience and perception. “Clearly, going through metal detectors is not what you’re hoping for in the entrance of your ED. It sets a certain potential tone,” he says. “But we decided that in the interest of the safety of everyone, this was the right thing to do. And it was a tough decision.”

Since installing the detectors a couple of months ago, violence has already decreased, Leffler says. And so far, patients are more accepting of them than he anticipated. “We haven’t had many complaints, and they’re grateful to know we’re thinking about their safety,” he says. This sentiment is in line with published research showing that most patients respond favorably to the presence of metal detectors in pediatric emergency departments, feeling safer.

Metal detectors come with other challenges, however. They require enough space to install and to allow for adequate traffic flow. They require capital to purchase and maintain, as well as cash flow to keep them staffed 24 hours a day by officers who are trained in using the equipment and in responding to visitors who refuse to give up their weapon. At Vermont Children’s, two security officers operate the detectors—a job which includes searching bags and escorting contraband to secure lockers before visitors are allowed into the ED.

One potential drawback of metal detectors in emergency departments is patients having to wait in long lines, Leffler says. Even if the weather isn’t an issue, someone waiting might have an urgent medical need. To solve that, Vermont Children’s has an EMT evaluating those in line to determine if someone needs triage or prioritization. “Although these drawbacks are not ideal, this is the best thing we can do to help keep our patients, families and staff as safe as we possibly can,” Leffler says.

Many of the drawbacks and limitations of metal detectors can be circumvented with newer detection technology. Children’s National in Washington, D.C., is piloting a touchless security screening system that combines metal detection and artificial intelligence to spot concealed weapons. Unlike traditional screening systems—like those in airports—a person can walk through this unobtrusive device without stopping, without removing anything from their pockets or bags, without taking off their jewelry or belts. “You’re looking to provide care to people quickly—so you want to get them into your building in the most convenient and safest way possible,” says Paul Quigley, executive director of security, parking and transportation at Children’s National.

The system will alarm when someone brings anything that is shaped like a weapon and will show the security team exactly where the potential weapon is located on that individual. “It shows a picture of the person and a region of the body or bag or cart they’re wheeling in,” he says. “But the alarm is not alerting on keys, cell phones or change in your pocket because of the advanced analytics. So, most people walking through it don’t get detected in any way.”

In addition to keeping all patients, families and staff—including security—safer, it keeps the line moving and the visitor experience positive. During a one-day demo in June, more than 1,000 people entered the hospital through this system, and 90% of them were never stopped. The security team was able to process the other 10% within five seconds each time, once the individual opened their jacket or bag, according to Quigley—and there was never a line of people waiting to enter the building.

“During our demo, it did what it was supposed to do,” Quigley says. “That is, making the staff feel comfortable because we’re screening everybody coming through—and the patients and families loved it too, because they were able to feel like the hospital was safe.” Additionally, the screening system can be branded, making the technology fit into the environment.

In the emergency department, Quigley’s team uses metal detection wands in behavioral health cases and “if there’s a fear that some harm is going to be done toward either a provider or the patient themselves,” he says, adding that families have always understood the need for the wands in such instances. “This is to keep your family member safe and our staff safe,” he says. “That’s the thing that ends up making people feel more comfortable being in our environment.”

In addition to x-ray machines and walk-through detection systems, other detection and prevention methods children’s hospitals have implemented include K-9 security dogs, video surveillance, and weapon detection systems that integrate with security cameras. Generally, detection tools are more common in emergency departments where violence most frequently occurs and traffic is high.

These tools focus on detecting guns and weapons before they enter the building, but Dayton Children’s has also installed technology that detects guns after they are fired inside the hospital. Originally developed by the U.S. Department of Energy, the technology reads the energy instead of the sound of the gunshot, which helps reduce false alarms. The system alerts first responders in seconds—and the sensors are so specific, they can detect what caliber gun was used in the shooting. And because they look like smoke detectors, they blend right in with the hospital environment.

Moore and his team collaborated with about 10 groups across the hospital to test and implement the technology—from senior leadership and facilities to IT and systems integration. “We ran the technology in a sandbox for 30 days,” he says. “We had to make sure it played nicely with our access control system, our video management system and our mass notification system before going live.” Along with this rollout came Crisis Prevention Institute (CPI) training for staff, including active shooter response classes.

Staff training

Nick Markham, assistant vice president of facilities, has been with Cook Children’s Health Care System in Fort Worth, Texas, for 19 years. While training staff to reduce risk in the case of a shooting or other act of violence has long been a priority, the team has upped its game in the face of the events of the past year.

“We can create videos, webinars and just-in-time training for any event that takes place,” Markham says, citing a 20-minute training video that was created for staff within one week of the Tulsa shooting. Ongoing safety and security training covers situational awareness, de-escalation strategies and active criminal event response. The training, while not required, is available to all staff—and features active shooter drills where the instructor wears a body camera to simulate a shooting.

“He’s in the active shooter role, and he shows people what happens should a person enter the building and how quickly the escalation takes place,” says Markham. “So, he shows how people gain access to the back of house or the back of a clinic; how they try to get through a locked door; how easy it is to jump a reception desk—those types of things.” Then, he teaches staff about Avoid, Deny and Defend, meaning how to run, how to barricade yourself or how to fight back when faced with an incident.

Public safety officers

Both Cook Children’s and Dayton Children’s employ uniformed, armed public safety officers. Neither sees them as the traditional “officer” but rather an integral part of the hospital family and patient care.

“The officer should not be an opposing figure. This should be someone who’s protective, nurturing and offering assistance,” says Markham. Public safety officers at Cook Children’s are licensed police officers in the state of Texas, with compassion as part of their training.

“You have no idea what a person is going through—families are in a very hard place when they’re here with a sick child,” Markham says. “Our officers understand that. There’s a huge compassion component when you’re an officer.”

Another huge component is the connection with patients. The personification of that is Officer Louis White. “Everybody knows Officer Louis,” says Markham. “He is everywhere. He’s at orientation, he interacts with patients on our rehab unit—he is part of the care team that goes to that unit and does music therapy with the kids. So, we have folks ingrained into the organization in ways that go far beyond the role of a security officer.”

At Dayton Children’s, special care is taken when it comes to the role of behavioral health officers. They wear a different uniform in behavioral health units and don’t look the usual part of a public safety officer, which can help keep situations from escalating, Moore says. “They are still very clearly Dayton Children’s public safety officers, but they have none of what you would consider the tools of policing,” he says. “No handcuffs, no baton, no Taser, no pepper spray—they even have cloth Velcro badges.”

Across the board, children’s hospitals are reevaluating their approach to public safety officers, asking how many to deploy, what level of weaponry to carry, and what kind of protection to wear. Some officers carry pepper spray, others firearms; some wear ballistic vests, others plain clothes. Many hospitals, including Children’s National, hire off-duty law enforcement, who are armed, in addition to staff security. These officers enforce compliance during high-threat situations, deal with weapon-related incidents, and aid in arrests when necessary, says Quigley.

Managing visitors

While much of the work being done is focused on those who may be entering a facility with bad intent, the pressures are higher than ever to manage those who are supposed to be there—including families and other visitors. At the same time, children’s hospitals have always been built to be accessible—where staff can move patients easily and families can visit their children quickly and conveniently.

To help satisfy the need for safety and mobility, Cook Children’s uses an extensive network of cameras throughout the hospital. The cameras monitor visitors and all other activity in the hospital—as well as panic buttons in strategic places, like nurse stations and areas with a psychiatric component, to help minimize risk around potential events involving visitors.

At Children’s National, the team at the welcome desk checks all visitors against a robust database, ensuring all personnel, vendors and patient visitors are authorized to be there and pose no known threat. They also work closely with the staff upstairs in the care units to help determine which visitors—and how many—should be in a patient’s room at any time.

Because of the pandemic, Vermont Children’s reduced its number of visitor entrances to three, including the emergency department, to screen for COVID-19, and they decided to keep the limited number of entry points to better monitor visitors. Most floor entrances are locked as well, including the pediatric and mother-babies areas. They would like to implement strict visitor policies and management tools, but as with other security initiatives, staffing remains an obstacle.

Social workers

The Social Work Interventions with Families and Teams (SWIFT) program at Children’s National is designed to protect the frontline care team from incidents with patients and families inside the hospital while also ensuring those patients and families feel heard and supported. Verbal escalation, threatening behavior, physical aggression or impeding care on the part of a parent or other visitor often stem from the stress of having a sick or injured child in the hospital and being unable to communicate properly, says Brenda Shepherd-Vernon, director of the Department of Family Services at Children’s National Hospital. With SWIFT, social workers help mitigate such incidents to make staff feel safe, make families feel heard, and, ultimately, keep those families at the child’s bedside when possible.

“As social workers, we’re going to be impartial and look at what happened during the encounter—and we’ll work with the family and the team to resolve it,” Shepherd-Vernon says.

“In the past, the model dictated that security would be called if a parent was upset. Now, we’re trying to hear more about the families’ concerns and deal with those concerns in real time.”

Still, security is a close partner in SWIFT, along with a committee that reviews all cases of individuals who are asked to leave the premises due to aggressive behavior. The team also shares the expectations of conduct with the families to build a shared understanding and help prevent further incidents. There is also a huddle with the care team after an incident to discuss the concerns of the family and how to best address them going forward, as well as the resolution shared with the family and the plan to keep the staff safe.

Like none other

Leffler is part of a multi-sector collaborative that is seeking broader solutions to target the root causes of violence before it ever makes it to the children’s hospital. “What we’re seeing is just a piece of what is happening everywhere right now,” he says. “We want to come up with some recommendations to try and think about this problem in a bigger way than only once they arrive at the door of the hospital.”

For Moore’s part, protecting people, property and assets from harm has been at his core for the better part of 35 years. But he’s found that the children’s hospital setting is a world unto itself—one where keeping everyone safe physically, mentally and emotionally is paramount and constant.

“When I was running a protection team in my previous life, there were ebbs and flows,” he says. “We would ramp up to go on round-the-world trips with our protectees, working 16 to 18 hours a day—then we’d come home, catch our breath and ramp up for the next big thing. Here, the pace of the hospital is relentless. It never stops, it never closes. And everybody here wants to make the place better.”

Source:How to Protect Staff and Patients From Violence in the Hospital (

Empowering Parent and Educator resource. See the essential components as identified by this innovative resource provider!

Preterm Birth Information for Education Professionals

These five learning resources have been developed to improve your knowledge and confidence in supporting prematurely born children in the classroom.

  • What is preterm birth?
  • Educational Outcomes following preterm birth
  • Cognitive and Motor Development following Preterm Birth
  • Behavioural, social, and emotional outcomes following preterm birth
  • How can education professionals support preterm children?



This section provides advice on how education professionals can support children born preterm. You may not know if a child was born preterm. Some parents are in favour of the school knowing their child’s birth history, but others prefer not to disclose this information. Don’t assume a child was born preterm just because they fit the profile described here. There are many reasons a child may have difficulties at school.

Regardless of whether you know a child’s birth history, the advice and strategies provided in this section are likely to be beneficial to any child with the difficulties described.

Children and young adults born preterm, and their parents, were asked what they wished their teachers had known about how they think and learn, and about how their preterm birth may have affected them later in life. Select the icons to hear some of their answers.


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Ticking timebomb: Without immediate action, health and care workforce gaps in the European Region could spell disaster

40% of medical doctors are close to retirement age in one third of countries in Europe and central Asia, finds new WHO/Europe report

14 September 2022

All countries of the WHO European Region – encompassing 53 Member States across Europe and central Asia – currently face severe challenges related to the health and care workforce, according to a new report released today by WHO/Europe. An ageing workforce is chief among them. The analysis finds that 13 of the 44 countries that reported data on this issue have a workforce in which 40% of medical doctors are already aged 55 years or older. 

An ageing health and care workforce was a serious problem before the COVID-19 pandemic, but is even more concerning now, with severe burnout and demographic factors contributing to an ever-shrinking labour force. Adequately replacing retiring doctors and other health and care workers will be a significant policy concern for governments and health authorities in the coming years. WHO/Europe is urging countries to act now to train, recruit and retain the next generation of health and care workers. 

Another key finding of the report is the poor mental health of this workforce in the Region. Long working hours, inadequate professional support, serious staff shortages, and high COVID-19 infection and death rates among frontline workers – especially during the pandemic’s early stages – have left a mark. 

Health worker absences in the Region increased by 62% amid the first wave of the pandemic in March 2020, and mental health issues were reported in almost all countries in the Region. In some countries, over 80% of nurses reported some form of psychological distress caused by the pandemic. WHO/Europe received reports that as many as 9 out of 10 nurses had declared their intention to quit their jobs.  

“My own personal journey through this pandemic has been a rollercoaster,” said British nurse Ms Sarah Gazzard. “I was holding a phone next to a dying woman’s ear while her daughter said her final goodbyes. That was very, very difficult for me, so I sought out some support to help me cope.”

Mixed picture across the Region  

While the 53 countries of the Region have on average the highest availability of doctors, nurses and midwives compared to other WHO regions, European and central Asian countries still face substantial shortages and gaps, with significant subregional variations.  

Health worker availability varies 5-fold between countries. The aggregate density of doctors, nurses and midwifes ranges from 54.3 per 10 000 people in Türkiye to over 200 per 10 000 people in Iceland, Monaco, Norway and Switzerland. At the subregional level, central and western Asian countries have the lowest densities, and northern and western European countries have the highest.  

“Personnel shortages, insufficient recruitment and retention, migration of qualified workers, unattractive working conditions, and poor access to continuing professional development opportunities are blighting health systems,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. 

“These are compounded by inadequate data and limited analytical capacity, poor governance and management, lack of strategic planning, and insufficient investment in developing the workforce. Furthermore, WHO estimates that roughly 50 000 health and care workers may have lost their lives due to COVID-19 in Europe alone.”  

Dr Kluge warned, “All of these threats represent a ticking time bomb which, if not addressed, is likely to lead to poor health outcomes across the board, long waiting times for treatment, many preventable deaths, and potentially even health system collapse. The time to act on health and care workforce shortages is now. Moreover, countries are responding to the challenges at a time of acute economic crisis, which demands effective, innovative and smart approaches.”

Ms Annika Schröder is a midwife from Germany who works in a hospital where around 950 births take place every year. There, the challenges mirror those seen across the Region. “I often work shifts without even the possibility to go to the toilet, without breaks or time to eat,” she told WHO/Europe. 

“The doorbell and the phones ring while we rush from one room to the other. On average, I take care of 2 women in labour at a time. This is not how I imagined my profession or my everyday working life to be. I am often exhausted and tired. The shortage of midwives makes births unsafe. And since the pandemic, things have got even worse. It is affecting the physical and mental health of us midwives, of mothers, women in labour and babies,” Ms Schröder explained.

Based on the latest data available for 2022, the Region has on average:  

  • 80 nurses per 10 000 people 
  • 37 doctors per 10 000 people  
  • 8 physiotherapists per 10 000 people 
  • 6.9 pharmacists per 10 000 people  
  • 6.7 dentists per 10 000 people 
  • 4.1 midwives per 10 000 people.

In WHO’s 2016 Global Strategy on Human Resources for Health, the threshold for aggregate health worker density was set at 44.5 doctors, nurses and midwives per 10 000 people. All countries in the Region are therefore currently above the threshold, but this does not mean they can afford to be complacent. There are serious gaps and shortages in the health and care workforce, which will only get worse with time without policies and practices to address them. 

Rising to the challenge: country examples 

“Countries will need to rethink how they support and manage their health workforce. They will need to design strategies that reflect their own contexts and needs, because there is no one-size-fits-all approach,” said Dr Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems at WHO/Europe. 

“The Region is at a critical juncture: strategic planning and smart investment are crucial next steps to make sure our health workers have the tools and support they need to care for themselves and their patients. Society will pay a heavy price if we fail to rise to this challenge. This new report and the data it includes about each of our Member States offer solutions and opportunities we shouldn’t miss.”  

Many countries across the Region have already begun taking bold and innovative steps. In Ireland, where more people will be over the age of 65 than under the age of 14 by 2028, the Government has introduced the Enhanced Community Care programme to help the ageing population maintain independence. The programme releases pressure on the hospital system by bringing enhanced community care services to older people in towns and villages across the country. 

In Kyrgyzstan, the Government has introduced a pay-for-performance system in primary health care. The aim is to attract more doctors by increasing salaries for those who perform well in their duties. The system also includes an offer for specialists to retrain as family doctors, as 30% of family doctors were of retirement age in 2020.  

In the United Kingdom, the Government has been steadily recruiting foreign-trained nurses and midwives to replace those who are retiring or leaving the profession. At present, almost 114 000 foreign-trained nurses are registered there – a 66% increase since 2017/2018. Conversely, the number of nurses trained in the European Union (EU)/European Economic Area (EEA) dropped by nearly 18% over the same period. This is likely driven by the United Kingdom’s decision to leave the EU, and reflects a major shift from recruiting nurses from the EU/EEA to recruiting from other regions and countries, notably India, Nigeria and the Philippines.  

Despite progressive steps in many places, much more investment, innovation and partnership are needed to avert further health and care workforce shortages in the future. WHO/Europe is urging all Member States – even those that currently have above-average workforce densities – to waste no time by taking the following 10 actions to strengthen the health and care workforce:  

  1. align education with population needs and health service requirements
  2. strengthen professional development to equip the workforce with new knowledge and competencies
  3. expand the use of digital tools that support the workforce
  4. develop strategies that recruit and retain health workers in rural and remote areas
  5. create working conditions that promote a healthy work–life balance
  6. protect the health and mental well-being of the workforce  
  7. build leadership capacity for workforce governance and planning
  8. improve health information systems for better data collection and analysis
  9. increase public investment in workforce education, development and protection
  10. optimize the use of funds for innovative workforce policies.  



A new patient population for adult clinicians: Preterm born adults

Amy L. D’Agata  Carol E. Green  Mary C. Sullivan Open Access Published: January 28, 2022

What if a single event could sway health, exercise capacity, learning style, social interactions, and even personal identities–yet individuals had no memory of the event? Adults born preterm are an under-recognized and vulnerable population. Multiple studies of individuals born prematurely, including our 35-year longitudinal study, have found important health concerns that adult healthcare providers should consider in their assessments. Concerns include increased rates of cardiovascular disease, metabolic syndrome, depression, anxiety and attention problems, lower educational attainment and frequency of romantic relationships.

A Nordic study of over six million individuals found a linear relationship between gestational age and protection against early adult mortality, with preterm individuals showing 1⋅4 times increased likelihood of early mortality as full-term peers.

At the same time, surviving premature birth has become increasingly common. For the last several decades, nearly one in nine U.S. babies is born early, and now more than 95% survive.

Global prevalence and survival data indicate more than 15 million preterm birth survivors annually reach adulthood.

This suggests a new population of individuals with emerging healthcare needs for adult health providers.

Birth history should be part of every patients’ medical record.

Due to the varied risks and prevalence of premature birth, all healthcare practitioners should be aware of the potential for long-term effects. With one in ten 30-year-old patients born preterm, clinical specialists who treat long-term complications of prematurity (i.e., neurology, psychiatry, cardiology) may have more preterm-born patients. Recognizing preterm birth as a cumulative, lifelong risk factor is the first step.

As clinicians and researchers, we have observed the medical community, like society at-large, tends to view prematurity as a health event localized to infancy-something kids outgrow. Ironically, some pediatric providers report limited training and understanding of health complications for children born preterm, and little evidence exists regarding adult practitioners’ knowledge to care for these adults.

Preliminary adult primary care guidelines were recently created to screen and manage prematurity-related health complications.

Health risks from prematurity are also risks to equality and justice. Women who bear social risk factors are more likely to give birth early. This includes Black women, those living in socio-economically depressed areas, and women with two or more Adverse Childhood Experiences.

The many arms of racism and caste-based inequalities can complicate and worsen the health of people already at risk from preterm birth.

Attention also needs to be drawn to the prematurity research community. To date, research has focused on younger age groups and predominantly White populations. Future research needs to seek out ethnically diverse populations and comprehensively examine potential life course complications of early birth. This is especially important when considering how socioeconomic factors may influence the allostatic load of individuals.

For many born preterm, prematurity is not just a health concern, it’s a matter of who they are. Their perception of health over time, or health related quality of life (HRQL), is a critical outcome. To date, this evidence varies with age, degree of prematurity and reporter; clinicians and parents tend to rate HRQL more negatively than survivors.

Preterm-born individuals may not have event memories but, early birth repercussions can reverberate through family narratives and unique life experiences. Some identify as typically developed individuals who happen to have been born early, others as functional and well-adapted “preemies”, and others see prematurity as having colored their lives in negative ways.

As prematurity researchers, we aim to uncover and bring awareness to the health outcomes and risks from early birth. A critical need exists for more evidence about adult health following preterm birth and yet, how do we protect individuals with statistically increased risk without unnecessarily pathologizing them?

In clinical practice and research settings, we can take the opportunity to listen to people who were too young as patients to speak for themselves but have riveting and complex stories about preterm birth’s effects. We are aware of just one other published qualitative study about the experiences of adults born preterm.

 Because most adult healthcare providers have yet to acknowledge and factor this experience into patient care, individuals born preterm are finding alternative avenues to be seen. Adults born preterm report seeking online community and support, connecting globally with people over shared early life experiences, while simultaneously making their needs and identities known.

As a research team, we strive to avoid labels for people born early but have nonetheless found that they are, in often subtle ways, a special group. They beat the odds as infants. Their birth and subsequent survival affected their families and communities in unprecedented ways. As clinicians and researchers, we can attend to the health risks of those born premature while acknowledging and celebrating their unique strengths and perspectives, often resulting from their early life experiences.


WHO advises immediate skin to skin care for survival of small and preterm babies

15 November 2022

WHO today launched new guidelines to improve survival and health outcomes for babies born early (before 37 weeks of pregnancy) or small (under 2.5kg at birth).

The guidelines advise that skin to skin contact with a caregiver – known as kangaroo mother care – should start immediately after birth, without any initial period in an incubator. This marks a significant change from earlier guidance and common clinical practice, reflecting the immense health benefits of ensuring caregivers and their preterm babies can stay close, without being separated, after birth.

The guidelines also provide recommendations to ensure emotional, financial and workplace support for families of very small and preterm babies, who can face extraordinary stress and hardship because of intensive caregiving demands and anxieties around their babies’ health.

“Preterm babies can survive, thrive, and change the world – but each baby must be given that chance,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “These guidelines show that improving outcomes for these tiny babies is not always about providing the most high-tech solutions, but rather ensuring access to essential healthcare that is centred around the needs of families.”

Prematurity is an urgent public health issue. Every year, an estimated 15 million babies are born preterm, amounting to more than 1 in 10 of all births globally, and an even higher number – over 20 million babies – have a low birthweight. This number is rising, and prematurity is now the leading cause of death of children under 5.

Depending on where they are born, there remain significant disparities in a preterm baby’s chances of surviving. While most born at or after 28 weeks in high-income countries go on to survive, in poorer countries survival rates can be as low as 10%.

Most preterm babies can be saved through feasible, cost-effective measures including quality care before, during and after childbirth, prevention and management of common infections, and kangaroo mother care – combining skin to skin contact in a special sling or wrap for as many hours as possible with a primary caregiver, usually the mother, and exclusive breastfeeding.

Because preterm babies lack body fat, many have problems regulating their own temperature when they are born, and they often require medical assistance with breathing. For these babies, previous recommendations were for an initial period of separation from their primary caregiver, with the baby first stabilized in an incubator or warmer. This would take on average, around 3-7 days.

However, research has now shown that starting kangaroo mother care immediately after birth saves many more lives, reduces infections and hypothermia, and improves feeding. 

“The first embrace with a parent is not only emotionally important, but also absolutely critical for improving chances of survival and health outcomes for small and premature babies,” said Dr Karen Edmond, Medical Officer for Newborn Health at WHO. “Through COVID-19 times, we know that many women were unnecessarily separated from their babies, which could be catastrophic for the health of babies born early or small. These new guidelines stress the need to provide care for families and preterm babies together as a unit, and ensure parents get the best possible support through what is often a uniquely stressful and anxious time.”

While these new recommendations have particular pertinence in poorer settings that may not have access to high-tech equipment, or even reliable electricity supply, they are also relevant for high-income contexts. This calls for a rethink of how neonatal intensive care is provided, the guidelines state, to ensure parents and newborns can be together at all times.

Throughout the guidelines, breastfeeding is strongly recommended to improve health outcomes for preterm and low birthweight babies, with evidence showing it reduces infection risks compared to infant formula. Where mother’s milk is not available, donor human milk is the best alternative, though fortified ‘preterm formula’ may be used if there are no donor milk banks.

Integrating feedback from families gathered through over 200 studies, the guidelines also advocate for increased emotional and financial support for caregivers. Parental leave is needed to help families care for the infant, the guidelines state, while government and regulatory policies and entitlements should ensure families of preterm and low birthweight babies receive sufficient financial and workplace support.

Earlier this year, WHO released related recommendations onantenatal treatments for women with a high likelihood of a preterm birth. These include antenatal corticosteroids, which can prevent breathing difficulties and reduce health risks for preterm babies, as well as tocolytic treatments to delay labour and allow time for a course of corticosteroids to be completed. Together, these are the first updates to WHO’s preterm and low birth weight guidelines since 2015.

NEW Guidelines:

Neonatal Brain Protocol

Ultrasound Protocols Sonographic Tendencies  Mar 23, 2021

How I do it. Neonatal Brain Ultrasound Protocol As I’ve said before, every institution may do it a bit different but these are required views.

Blogpost:… Medical Disclaimer:

Patent to be Issued to LSU Health New Orleans for Technology to Diagnose Life-Threatening Preemie Condition

November 7, 2022

US Patent 11,493,515 will be issued to LSU Health New Orleans on November 8, 2022, for a noninvasive test that more accurately diagnoses a potentially fatal condition in premature infants. Sunyoung Kim, PhD, Professor of Biochemistry and Molecular Biology at LSU Health New Orleans Schools of Medicine and Graduate Studies, led a research team that invented a diagnostic biomarker test for necrotizing enterocolitis (NEC) called NECDetect.

According to the National Institute of Child Health and Human Development, NEC is the most common, serious gastrointestinal disease affecting newborn infants. The tissue lining the intestine becomes inflamed, dies, and can slough off. Health care providers consider this disease as a medical and surgical emergency. X-rays are now used to diagnose advanced disease, but their sensitivity can be as low as 44%. Conversely, the noninvasive NECDetect biomarker panel performed on stool samples identifies 93% true positives and 95% true negatives in diagnosing the disease.

In 2017, Dr. Kim founded Chosen Diagnostics Inc, a spinout company, to develop and commercialize the technology. An Express License for Faculty Startups (ELFS) agreement executed by LSU Health and Chosen Diagnostics Inc in 2020 grants the company the exclusive license to this portfolio of patent and patent applications.

“This patent is an important milestone in protecting the commercial potential of molecular diagnostic tools in intensive care units,” notes Dr. Kim. “Necrotizing enterocolitis continues to be a devastating disease for preemie babies who require long hospital stays. This utility patent is attractive to diagnostic companies that already provide equipment to hospital pathology labs and for drug companies interested in tackling gut disease therapies.”

The National Institute of Child Health and Human Development estimates that NEC affects about 9,000 of the 480,000 infants born preterm each year in the United States. The population most at risk for NEC is increasing because the number of very low birth weight babies who survive continues to grow due to technological advances in care. The percentage of very low birth weight infants who develop NEC remains steady, however, at about 7%. NEC continues to be one of the leading causes of illness and death among preterm infants, although it can also affect full-term babies, usually those with another serious illness or risk factor. Fifteen to forty percent of infants with NEC die from the disease. Surgical survivors require lifelong care.

Rebecca Buckley, PhD, LSU Health New Orleans Research Assistant Professor of Biochemistry (and former postdoctoral research associate), is a co-inventor and Chosen Diagnostics’ Chief Operating Officer. LSU Health inventors also included two other females — Dr. Duna Penn, a member of the Neonatology faculty at the time, and Zeromeh Gerber MD, a former LSU Health neonatology fellow, along with Carl Sabottke, a medical student at the time of the initial application.

This patent is a rarity in that the majority of the team are women,” adds Dr. Kim. “In the 2020 United States Patent and Trademark Office database of all patents issued, only four women in Orleans Parish are inventor-patentees for the whole year. This number has not changed much since 1976.”

Chosen Diagnostics Inc has been awarded $3M in SBIR and STTR grants, and NECDetect’s development was fast-tracked with a Breakthrough Device Designation by the Food and Drug Administration (FDA).

“Intellectual property is the foundation upon which successful biotech businesses are built,” says Patrick Reed, RTTP, LSU Health New Orleans Assistant Vice Chancellor, Innovation & Partnerships. “Working with external counsel, the inventors, and Chosen Diagnostics, we have ensured that this important work is adequately protected, enabling Chosen to attract investment for further R&D and commercialization.”

In addition to this US patent, patent applications are pending in Canada, Europe, Hong Kong, Australia, New Zealand, and China.



Preterm Birth – What you need to know about babies born early and a NICU hospitalization

Week 24 of pregnancy is a HUGE milestone as it means the developing baby now has greater than 50% chance of survival with medical help if born today! This week we cover the big things to know about baby’s chances if born early, what some of the concerns are for babies born early, and some tips for new parents with a baby in the neonatal intensive care unit (NICU).

Lost in Transition: Health Care Experiences of Adults Born Very Preterm—A Qualitative Approach

Front. Public Health, 30 November 2020 Anna Perez1*†, Luise Thiede1†Daniel Lüdecke2Chinedu Ulrich Ebenebe1, Olaf von dem Knesebeck2 and Dominique Singer1 Section Neonatology and Pediatric Intensive Care Medicine, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany – Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Introduction: Adults Born Very Preterm (ABP) are an underperceived but steadily increasing patient population. It has been shown that they face multiple physical, mental and emotional health problems as they age. Very little is known about their specific health care needs beyond childhood and adolescence. This article focuses on their personal perspectives: it explores how they feel embedded in established health care structures and points to health care-related barriers they face.

Methods: We conducted 20 individual in-depth interviews with adults born preterm aged 20–54 years with a gestational age (GA) below 33 weeks at birth and birth weights ranging from 870–1,950 g. Qualitative content analysis of the narrative interview data was conducted to identify themes related to self-perceived health, health care satisfaction, and social well-being.

Results: The majority (85%) of the study participants reported that their former prematurity is still of concern in their everyday lives as adults. The prevalence of self-reported physical (65%) and mental (45%) long-term sequelae of prematurity was high. Most participants expressed dissatisfaction with health care services regarding their former prematurity. Lack of consideration for their prematurity status by adult health care providers and the invisibility of the often subtle impairments they face were named as main barriers to receiving adequate health care. Age and burden of disease were important factors influencing participants’ perception of their own health and their health care satisfaction. All participants expressed great interest in the provision of specialized, custom-tailored health-care services, taking the individual history of prematurity into account.

Discussion: Adults born preterm are a patient population underperceived by the health care system. Longterm effects of very preterm birth, affecting various domains of life, may become a substantial burden of disease in a subgroup of formerly preterm individuals and should therefore be taken into consideration by adult health care providers.


Sensors are first to monitor babies in the NICU

An interdisciplinary Northwestern University team has developed a pair of soft, flexible wireless body sensors that replace the tangle of wire-based sensors that currently monitor premature babies in hospitals’ neonatal intensive care units (NICU) and pose a barrier to parent-baby cuddling and physical bonding. The team recently completed a series of first human studies on premature babies at Prentice Women’s Hospital and Ann & Robert H. Lurie Children’s Hospital of Chicago. The researchers concluded that the wireless sensors provided data as precise and accurate as that from traditional monitoring systems. The wireless patches also are gentler on a newborn’s fragile skin and allow for more skin-to-skin contact with the parent. Existing sensors must be attached with adhesives that can scar and blister premature infants’ skin.

After premature birth: your emotions

Key points

  • Mixed and powerful emotions are common after premature birth.
  • All emotions are OK. Accepting and talking about emotions can help you cope.
  • It can help to focus on your baby’s successes and milestones.
  • When you look after yourself, you’ll be in better shape to care for your baby.

Your emotions after premature birth: what to expect

It’s natural to have many mixed, powerful and conflicting emotions about premature birth.

There are positive emotions, of course, like joy and love for your newborn.

But it’s common to wonder about what happened and what caused the premature birth. You might feel helpless, sad, guilty, anxious or traumatised by the birth experience. There might also be concern, fear and confusion about seeing your premature baby in the neonatal intensive care unit (NICU) or special care nursery (SCN).

Some parents might feel angry at themselves or their doctors. Or they might feel angry at their premature baby for making them feel this bad or for being born early. This might mean they feel reluctant to hold their baby or visit the neonatal intensive care unit (NICU). This is OK too.

Many people feel like things aren’t quite real. And it’s easy to feel powerless or as if you have no control over the future. It’s common to feel lonely. Some people find it hard to see themselves as parents while their premature baby is in the NICU.

Many parents find it very hard to leave their premature baby at the hospital while they go home.

Over time, there are generally fewer challenges, and they get easier to cope with. And as your premature baby gets bigger and more medically stable, you’ll be able to hold and care for them more often. As you get to know the NICU, it will feel more comfortable too. The nursing staff and other members of your baby’s care team will help you as well as care for your baby.

All of this can help you to feel more confident, less anxious and better able to connect and bond with your premature baby.

Tips for managing emotions about premature birth

Here are some ideas that might help you manage your emotions.

Managing emotions

  • Accept your feelings, whatever they are – don’t push them away. Acknowledging and naming your emotions is a healthy thing to do.
  • Be kind to yourself, and remind yourself that you’re doing the best you can.
  • If you can, get to know other parents who are in a similar situation. It helps to hear how other parents are coping, but remember that there’s no one right way to feel or respond.
  • Accept your partner’s way of coping if it’s different from yours. Try to let your partner do things their own way, and find out how your partner is feeling by talking to each other and listening to each other.

Looking after yourself

  • Eat healthy food, do physical activity, and get as much rest as you can. It’s also a good idea to limit caffeine and alcohol and other drugs.
  • Surround yourself with people who help you to feel supported.
  • Avoid unnecessary stress, if you can. It’s OK to let some things go or not do things the way you usually do while you focus on your premature baby and your family for a while.
  • Take a day off from the NICU every now and then so you can do things for yourself as well.
  • Take time to relax and do things you enjoy each day, even for just a few minutes. For example, do breathing exercises, listen to your favourite music, or go for a walk around the block. You can also do breathing exercises or listen to music while sitting next to your baby in the hospital.

Being with your baby

  • Celebrate successes, positives and progress – yours and your premature baby’s. Your baby might be in the NICU, but they’ll be reaching their own goals and milestones.
  • Get involved in your premature baby’s day-to-day care. This can help you bond with your baby, which is good for your baby and good for you.
  • Find out how you can help your premature baby. For example, you might learn about one piece of technology or your baby’s stress signs, or about how to change a nappy gently. Just focus on one thing at a time.
  • Remember that there are things only you as a parent can do. Your touch, smell and voice are all very important for your premature baby. You’re also your baby’s most important advocate.

Seeking support

  • Talk with trusted family members or friends about your emotions. It’s OK to share negative feelings and to say what you need. This might be someone just to listen or someone who doesn’t mind if you cry.
  • Seek support only from people you feel comfortable with. It’s OK to not to seek support from people who cause you tension and stress.
  • Ask your nurse if you can speak with someone at the hospital who can help you manage your emotions.
  • Speak with your GP, who can guide you to an appropriate mental health professional.
  • Contact LifelineBeyond Blue or your state or territory parent helpline.

It’s important to look after yourself in these early days and weeks of your premature baby’s life. When you look after yourself, you’ll be in better shape to care for your baby.

More than baby blues: postnatal depression after premature birth

Mood changes are common after you’ve had a baby. They can vary from mild to severe.

Many birthing mothers experience the ‘baby blues’ – a mild depression in the days after childbirth. If it continues and becomes more severe, it could become postnatal depression (PND). Non-birthing parents can suffer from PND too.

Signs of PND include a persistent feeling of sadness, low mood, feelings of hopelessness, lack of energy, low self-esteem and sleep problems.

If you think you’re experiencing the signs of postnatal depression in birthing mothers or postnatal depression in non-birthing parents, it’s important to get professional help as soon as you can. Your GP is a good place to start. With proper diagnosis, treatment and support, you can make a full recovery.



Late-Onset Sepsis Among Very Preterm Infants

Dustin D. Flannery, DO, MSCEErika M. Edwards, PhD, MPH; Sarah A. Coggins, MD; Jeffrey D. Horbar, MD;Karen M. Puopolo, MD, PhD


To determine the epidemiology, microbiology, and associated outcomes of late-onset sepsis among very preterm infants using a large and nationally representative cohort of NICUs across the United States.


Prospective observational study of very preterm infants born 401 to 1500 g and/or 22 to 29 weeks’ gestational age (GA) from January 1, 2018, to December 31, 2020, who survived >3 days in 774 participating Vermont Oxford Network centers. Late-onset sepsis was defined as isolation of a pathogenic bacteria from blood and/or cerebrospinal fluid, or fungi from blood, obtained >3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without late-onset sepsis.


Of 118 650 infants, 10 501 (8.9%) had late-onset sepsis for an incidence rate of 88.5 per 1000 (99% confidence interval [CI] [86.4–90.7]). Incidence was highest for infants born ≤23 weeks GA (322.0 per 1000, 99% CI [306.3–338.1]). The most common pathogens were coagulase negative staphylococci (29.3%) and Staphylococcus aureus (23.0%), but 34 different pathogens were identified. Infected infants had lower survival (adjusted risk ratio [aRR] 0.89, 95% CI [0.87–0.90]) and increased risks of home oxygen (aRR 1.32, 95% CI [1.26–1.38]), tracheostomy (aRR 2.88, 95% CI [2.47–3.37]), and gastrostomy (aRR 2.09, 95% CI [1.93–2.57]) among survivors.


A substantial proportion of very preterm infants continue to suffer late-onset sepsis, particularly those born at the lowest GAs. Infected infants had higher mortality, and survivors had increased risks of technology-dependent chronic morbidities. The persistent burden and diverse microbiology of late-onset sepsis among very preterm infants underscore the need for innovative and potentially organism-specific prevention strategies.


New wireless monitors let premature babies have skin-to-skin contact even in the NICU

Premature and ill babies thrive with direct contact, but wires from traditional sensors get in the way

Parents may feel helpless when their children are in the neonatal intensive care unit (NICU), and they can develop anxiety, depression, and anger. Seeing their infants isolated and entangled in wires that tether them to massive medical devices for monitoring vital signs is gruesome and heart-wrenching.

Approximately 450,000 babies are born premature in the US every year, sometimes weighing as little as 500 grams. They need constant clinical monitoring in the NICU as they might develop complications by being born unusually early in development. An additional 480,000 children spend time in the NICU or pediatric intensive care unit annually because of a critical illness.

Biosensors indeed enhance the quality of neonatal and pediatric clinical care by allowing parents to hold their babies, feed them conveniently, and clean them in a timely manner.

Precise monitoring of NICU patients is essential but invasive, typically requiring specialized catheters inserted into the patient’s tiny veins. Wired monitoring can cause scarring and increase the risk of infections and complications, such as blood clots and blood vessel blockage. Wires also get in the way of feeding and cleaning. Above all, a major disadvantage of wired monitoring is that it impedes skin-to-skin contact between parent and newborn, which has been scientifically shown to have clinical advantages for the newborn.

New technology developed by a group of American, Chinese, and Korean researchers headed by Debra Weese-Mayer, John Yoon Lee, and John Rogers may solve many problems introduced by wired monitoring of NICU patients. The first of its kind, these non-invasive, wireless biosensors can continuously monitor vital parameters by merely attaching as a patch on a skin surface.

The wireless biosensor consists of two parts, a chest and a limb unit, both of which fit inside the palm of an adult hand. The chest unit can be gently mounted on to the infant’s chest or back, while the limb unit has can go around a foot, palm, or toe. This means that the biosensor covers a wide range of infant ages and anatomies, including interfaces such as wrist-to-hand and foot-to-toe sensing. Researchers have demonstrated its successful clinical use in extremely premature infants, as young as 27 weeks of gestational age but who have been out of the womb for 6 weeks. At that point, they are about the size of a head of lettuce.

The sensor can simultaneously monitor a range of health indicators, including breathing and blood oxygen levels, at a level that is comparable to standard FDA-approved monitoring systems. It harbors an accelerometer that measures chest vibrations to generate a seismocardiogram (SCG), which provides similar information as an electrocardiogram (EKG) that monitors cardiac muscle activity and valve motion, but is better suited for small infants because it provides a direct assessment of the mechanical activity of the heart. The device also records an infant’s cries, which can be used to analyze an infant’s pain and stress levels.

The previous prototype of biosensors created by the researchers worked wirelessly, although it lacked several features compared to the current design, such as relaying the recorded patient data to a computer system placed far from the sensor. Another challenge was fixing the fragile nature of the sensor without compensating its flexibility, which is key to recording on highly curved surfaces such as the chest, ankles, and toes.

A year later, the same researchers came up with a novel model with additional built-in features that solve many of the issues that the earlier version had. The electronic components of the device are sandwiched between waterproof silicone covers, so they sit comfortably on the sensitive skin of infants. The sensor can draw power from onboard batteries or from a nearby antenna placed 30-50 cm away from the biosensor, ensuring that it never lose’s track of it’s patient’s vital signs.

The device uses Bluetooth and can transmit data into a computer system 10 meters away, meaning they can take records within a standard-sized patient room. The sensors can be sterilized between patients, and they do not generate heat for up to 24 hours, making them reliable and safe to use.

Biosensors enhance the quality of neonatal and pediatric clinical care by allowing parents to hold their babies, feed them conveniently, and clean them in a timely manner. The design is also inexpensive, durable, cost-effective, and can even be used outside a hospital setting with the data being recorded on a tablet or a cell phone.

This simple technology can be expanded beyond infants and children. Patients who need outpatient monitoring, such as those sent home after a surgery, or those with chronic conditions, could also use the device. Sharing the monitoring data with a physician online could also cut down on non-emergency hospital visits.

Although this technology is wonderful, it will probably be some time before it can be used in hospitals. This is one of the first studies to record data in real NICU patients, so more confirmation is required to ensure the reliability of these biosensors.

A physician’s human touch gives an emotional connection, but if parents are comfortable, this biosensor technology can serve as a boon by monitoring infants continuously to watch out for anomalies.


Role of Neurosonography in Critically Ill Neonates in NICU

Rupesh Rao, Amar Taksande, Sneh Kumar+2View all authors and affiliations Volume 36, Issue 3

Journal of Neonatology



Neurosonography has been commonly used for screening in neonatal intensive care unit (NICU), for early detection of defects in the central nervous system (CNS) which include findings like intracranial hemorrhage, hydrocephalus, cerebral edema, and other structural abnormalities.


To detect the CNS abnormality in critically ill neonates by neurosonography.

Materials and Methods

This was a cross-sectional study done in the NICU of AVBR Hospital, Sawangi Meghe, Wardha. Neonates were defined as “critically ill” after taking their detailed history and performing a complete physical examination. Following this, the newborns who fulfilled the studies’ inclusion criteria were subjected to neurosonogram. The following factors were considered: gestational age, clinical examination, investigations, neurosonography findings, and outcomes.


A total of 150 critically ill newborns were subjected to neurosonography, 24 of them had abnormal findings. There was a significant correlation of gestational weeks, mode of delivery, and diagnosis of critically ill neonates with abnormal neurosonography (P = .000, P = .000, and P = .000). Prematurity was the most common diagnosis followed by meningitis. A total of 16% of the newborns had abnormal results in neurosonography. About 6.67% of these had hydrocephalus, 5.34% had an intraventricular hemorrhage (IVH), 1.34% had periventricular echogenicity, 0.66% had cerebral edema, 0.67% had germinal matrix hemorrhage, and 0.66% had brain abscess. A total of 109 (72.67%) participants in the study had a positive outcome at the time of discharge from NICU; whereas, 27 (18%) unfortunately did not survive.


Neurosonography is thus a valuable, safe, and effective diagnostic tool used for screening critically ill neonates for abnormalities of the brain.


For our little family members! A fun story…

Joy by Corrinne Averiss

Why Happiness Matters

Think how wonderful the world would be if we all did what made us happy. Wouldn’t it be amazing to live in a world where we let go of the “should” and followed our hearts to what was truly important to us?

By Nathalie Thompson, Contributor Feb 1, 2016, 04:47 PM EST|Updated Dec 6, 2017

“Happiness is the meaning and the purpose of life, the whole aim and end of human existence.” – Aristotle

Happiness matters, more than you might realize. It’s important to your physical and mental health, your resiliency in the face of obstacles and crises, and believe it or not, your happiness is important to the happiness of the world at large.

Your Happiness Matters to the Whole World

Yes, you heard me — your personal happiness is important to the happy quotient of the entire world. But somewhere along the way, we’ve picked up this horribly damaging belief that wanting to be happy is selfish and arrogant. We’ve made ourselves believe that what we want most in life is not important, and that we don’t deserve it.

We’ve somehow managed to twist ourselves so out of alignment with Who We Really Are that we’ve come to believe that suffering is expected, and even virtuous! We’ve come to believe that in pursuing our own happiness, we will somehow destroy or negate the happiness of others. And so we give up on believing that our own happiness matters and we resign ourselves to a lifetime of misery because we don’t want to hurt anyone and we don’t want anyone to think badly of us.

But here’s the thing: Being happy yourself is one of the best things you can do to help other people be happy, too! We’ve all had the experience of knowing someone who seems to light up a whole room when they enter it — the kind of person who makes other people feel happy, just be being around them. Happiness has a ripple effect far beyond a single individual — when you are happy, other people (your partner, your kids, your friends, etc.) notice and are themselves influenced by your mood.

This is not just anecdotal, there’s scientific evidence: When you are happy, you boost the moods of everyone you encounter and (here’s where it gets really cool) those people whose moods you have affected will then affect the moods of everyone they encounter, too!

The Happiness Cascade Effect

This happiness “cascade effect” was documented in a study published in 2008 in the British Medical Journal. Researchers from Harvard and the University of California, San Diego discovered that “clusters of happiness result from the spread of happiness and not just a tendency for people to associate with similar individuals” and that the happiness of single individuals affects even those they don’t know… through three degrees of separation!

That means that if you are happy, not only does it make your friends happier, it also makes their friends happier and their friends’ friends happier, too!

If one person is happy, that increases the chances of happiness in a friend living within a mile by 25 percent. The “cascade” effect, as the researchers put it, continues: a friend of the friend has almost a 10 percent higher likelihood of being happy, and a friend of that friend has a 5.6 percent increased chance.

See? Happiness is contagious! So, far from being a selfish thing, the pursuit of your own happiness can be seen as a generous public service — and perhaps even a civic duty of sorts, to increase the happiness of society as a whole!

Think how wonderful the world would be if we all did what made us happy. Wouldn’t it be amazing to live in a world where we let go of the “shoulds” and followed our hearts to what was truly important to us?

Your happiness matters — to all of us. So figure out what makes your heart sing… and then go out there and do it.


Author Sheryl Sandberg said happiness is made up of numerous small moments of joy. The more you experience joyous emotions, the happier you are. Learning to shift our perspective to a positive one can greatly impact our outlook on navigating life. Through my life experience I have learned over time that choosing happiness is a skill. Thus, making the choice to become more aware of what brings us joy in life can help us cultivate our own happiness.

There is joy in the daily things we do if we just pay attention. Discovering what brings us joy through our passions, purpose, daily activities, interest, and close relationships can drive “the happiness cascade” in how we interact with the world and others around us.

What are the small moments in your life that bring you great joy?

For me, the simplicity of enjoying my daily workout, greeting my cat after the workday, catching up with internationally located friends, cooking with my mom and going on walks throughout the city with a coffee in hand brings snippets of joy into my daily life.

As we move into the holiday season, we wish you and yours great joy and happiness in the big and small moments in life.

#News #Reuters #adventuresports

Mar 28, 2021: A group of friends in Latvia have adapted their hobby to the harsh weather conditions to create a new sport they have dubbed ‘kiteskating.’

Strategies, Shifts, NICU Blues


Rank: 183  –Rate: 5.1%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Ecuador, officially the Republic of Ecuador, is a country in northwestern South America, is bordered by Colombia on the north, Peru on the east and south, and the Pacific Ocean on the west. Ecuador also includes the Galápagos Islands in the Pacific, about 1,000 kilometers (621 mi) west of the mainland. The country’s capital and largest city is Quito.

The sovereign state of Ecuador is a middle-income representative democratic republic and a developing country[19] that is highly dependent on commodities, namely petroleum and agricultural products. It is governed as a democratic presidential republic. The country is a founding member of the United NationsOrganization of American StatesMercosurPROSUR and the Non-Aligned Movement.

Ecuador currently ranks 20, in most efficient health care countries, compared to 111 back in the year 2000.  Ecuadorians have a life expectancy of 77.1 years. The infant mortality rate is 13 per 1,000 live births,  a major improvement from approximately 76 in the early 1980s and 140 in 1950. 23% of children under five are chronically malnourished. Population in some rural areas have no access to potable water, and its supply is provided by mean of water tankers. There are 686 malaria cases per 100,000 people. Basic health care, including doctor’s visits, basic surgeries, and basic medications, has been provided free since 2008. However, some public hospitals are in poor condition and often lack necessary supplies to attend the high demand of patients. Private hospitals and clinics are well equipped but still expensive for the majority of the population.

Between 2008 and 2016, new public hospitals have been built, the number of civil servants has increased significantly and salaries have been increased. In 2008, the government introduced universal and compulsory social security coverage. In 2015, corruption remains a problem. Overbilling is recorded in 20% of public establishments and in 80% of private establishments.

Source:Ecuador – Wikipedia


New recommendations from WHO to help improve the health of preterm infants

30 September 2022            


Preterm birth is the leading cause of death in newborns less than 28 days old with more than a million preterm infants dying each year. Those that do survive risk a range of disabilities throughout their lives. Alarmingly, in almost all countries with reliable data, preterm birth rates are increasing.

In order to improve the health outcomes for these newborn babies, the World Health Organization has issued updates for two interventions. One set of recommendations focuses on the use of antenatal corticosteroids. These drugs cross the placenta and enhance the structural maturity of the fetus’ developing lungs, helping to prevent respiratory-related morbidity and mortality in preterm newborns. 

Safe and effective for use in low-income countries

This recommendation (and its nine sub-recommendations) resolves previous confusion about evidence on their use in low-resource settings. Clinical trials in high-resource settings suggested that antenatal corticosteroids were safe and beneficial to newborn outcomes. The Antenatal Corticosteroids Trial in lower-income countries however found a significant increase in the number of perinatal deaths (5 excess deaths per 1000 women exposed to the treatment) and maternal infections. A subsequent trial (WHO ACTION-1) also in lower-income countries found that under the right conditions, antenatal corticosteroids were safe and effective.

New recommendation on tocolytic drugs

Another new WHO recommendation out today, is for the use of tocolytic treatments.  Tocolytic drugs inhibit contractions of the uterus and can be used to delay preterm labour and prolong pregnancy. This has multiple benefits; giving more time for fetal development, and for administering antenatal corticosteroids. It also creates a window of time for women to be transferred to a higher level of care, if necessary. 

“These recommendations provide clear guidance to health professionals on the management of preterm birth and have the potential to improve the health of newborn babies, even in low-resource settings.” Dr Doris Chou, Medical Officer, Department of Sexual and Reproductive Health and Research.

In the 2015 WHO recommendations on interventions to improve preterm birth outcomes, tocolytic treatments (acute and maintenance treatments) were not recommended for women at risk of imminent preterm as there was insufficient evidence demonstrating substantive benefits. A review of the evidence in 2022, however, has recommended in favour of nifedipine for acute and maintenance tocolytic therapy for women with a high likelihood of preterm birth, when certain conditions are met.

In formulating these recommendations, WHO, in addition to considering the clinical evidence also considered aspects of cost-effectiveness, feasibility and resources, equity and whether the intervention was valued by and acceptable to stakeholders including clinicians as well as women and their families.

Useful links- WHO recommendations

Global trends in preterm birth from 1990-2019


In a recent study from China, data from the 2019 Global Burden of Disease study have been analysed to show trends in preterm birth. Deaths and incident cases decreased globally, but on a regional and national level, preterm birth rates also increased.

Preterm birth is a global issue. Almost 15 million infants were born too soon (preterm) in 2014, with a global incidence rate of 10.6%. Despite improvements in medical care, increases in preterm births were also observed in high-income countries, as for example in the USA. Due to the higher risk of infections and other complications, preterm birth is still the leading cause of death in children under five years.

Cao et al. have analysed global trends from 1990 to 2019 regarding the occurrence and death rate in preterm born infants. For this purpose, the researchers used data from the 2019 Global Burden of Disease study. Amongst others, the yearly rate of preterm birth cases and deaths was analysed, together with age-standardised incidence rates (ASIRs: expected disease rate in a certain time period in a reference/standard population) as well as age-standardised mortality rated (ASMRs: weighted average of the age-specific mortality rates per 100 000 persons).

Globally, the good news is that the rate of preterm birth has declined by about five percent (16.06 million in 1990) to 15.22 million in 2019. Also, fewer deaths of preterm newborns could be noted; a reduction of even 48% from 1.27 million (1990) to 0.66 million in 2019.

Interestingly, the findings were also compared according to the socio-demographic index (SDI), which shows the development status of a region and is strongly related to health. It was found that regions with a high SDI show a decrease in incident cases of preterm births by about five percent. Also, the number of deaths of preterm born newborns halved in low-, middle-, middle-high-, and high-SDI regions.

Across all global burden of disease regions, the largest decrease in incident cases and deaths could be noted in East Asia. On a national level, one third of all global incident cases, in absolute numbers, accounted for India (3.10 million) and Pakistan (1.04) in 2019. The most striking increase in preterm birth rates, however, was noted in Niger (182.10%), together with the highest increase in preterm birth related deaths (105.52%). In Greece, the highest increase of age-standardised incident rates could be observed.

Finally, the overall decrease in global incidence and mortality of preterm born children can be explained by improvements in medical care and a better general health status. However, incidence of preterm birth has increased in some countries, also high-income ones. Possible explanations could be higher rates of multiple births, delayed parenthood and other changes in clinical practices. Further research is needed to find the underlying reasons and measures to prevent preterm birth worldwide. 

Paper available at:

Paulina Aguirre – La Tierra Llora

218,265 views  #latina #mujer #musica

Let Them Be Girls, and Not Mothers Before Time


Jenny Benalcazar Mosquera, Coordinator of the delivery room of the Obstetric Gynecology Hospital Isidro Ayora de Loja (Ecuador)

The World Health Organization (WHO) defines adolescence as the period between the ages of 10 and 19 years, a time of life characterised by growth and development. In my country, Ecuador, 12% of girls in this age group have had a child or at least one pregnancy—the highest rate of adolescent pregnancy in South America. According to the statistics published by Ecuador’s National Institute of Statistics and Census (INEC), 49.3 of every 100 live births in the country involve adolescent mothers. These statistics are cause for concern.

Equally worrying is the fact that over the last decade we have seen a 78% increase in births among girls in the 10 to 14 year age group and an 11% increase in motherhood among girls aged between 15 and 19 years. According to the National Sexual and Reproductive Health Plan, Ecuador has the third highest rate of adolescent pregnancy in Latin America and the highest in the Andean region, surpassed only by Nicaragua and the Dominican Republic.

Over the last decade we have seen a 78% increase in births among girls in the 10 to 14 year age group and an 11% increase in motherhood among girls aged between 15 and 19 years.

Sexual and reproductive health rights imply guaranteeing girls and women safe and effective control of their own fertility, enabling them to decide how many children they want and when they have them, facilitating access to contraception and other family planning methods. Access to family planning has improved over the last two decades in Ecuador, but gaps still exist between different social, ethnic, and age groups.

According to research carried out for UNICEF by the Observatory for the Rights of Children, 50% of indigenous adolescents do not complete their basic education, and this figure is higher among girls who become pregnant. Consequently, these adolescent girls are less likely to be integrated into the educational system and improve their living conditions than their non-indigenous peers. From childhood, these children grow up in poverty and inequality and live in a culture of punishment, especially in the provinces of the Ecuadorian Highlands (Chimborazo, Cotopaxi and Imbabura).

Sexual and reproductive health rights imply guaranteeing girls and women safe and effective control of their own fertility, enabling them to decide how many children they want and when they have them, facilitating access to contraception and other family planning methods.

Even though they may know something about contraceptive methods, in most cases they do not use them. However, the main cause of adolescent pregnancy continues to be sexual abuse and violence, which affects 42.7% of adolescents. In more than half of all cases (55%) this sexual violence occurs within the family circle. The national survey of family relations and gender violence against women carried out by the INEC estimated that 60.6% of women in the country have experienced some kind of gender violence (physical, psychological and/or sexual).

Pregnancy in adolescence is associated with serious health effects as well as economic and social repercussions. For example, while the school dropout rate in Ecuador has fallen (and pregnancy is the cause in only 2.8% of cases), the number of pregnancy-related deaths has increased by 2.5% among adolescent girls (aged 10 to 19 years).

Pregnancy in adolescence is associated with serious health effects as well as economic and social repercussions.

The available data are essential to inform decisions on public policy relating to the present adolescent population. After two decades marked by an increase in adolescent fertility, during which profound gender gaps have persisted, the challenge for the state as well as for international and local organizations working in the field of reproductive health is to prioritise strategies aimed at avoiding or postponing motherhood in the adolescent population. Indispensable prerequisites to progress include strengthening the state and the role of public institutions, especially by way of the National Plan for the Eradication of Gender Violence Against Children, Adolescents and Women—a comprehensive plan that addresses the problem of violence—and by implementing the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030).

Among the interventions announced in July 2018, the Intersectoral Strategy for the Prevention of Pregnancy in Girls and Adolescents 2018-2025 is of particular interest. This strategy will involve the cooperation of four ministries: Health, Education, Justice, and Economic and Social Inclusion. The strategy will work towards ensuring universal access among adolescents to sexual and reproductive health information, education and services, with a view to giving young people the freedom to make their own decisions; facilitating access to contraception will also be a priority. The ultimate goal is to achieve the targets for adolescent health defined by the WHO’s Global Strategy.

To reduce adolescent pregnancy rates, Ecuador must successfully tackle major challenges. Early pregnancy is a problem with serious implications for the present and future of girls and adolescents. Beyond that, it is a problem that affects not only young mothers but also the country as a whole because it is a determining factor in the intergenerational cycle of poverty.


Hospital System Saw Fewer Attacks From Patients With New Crisis Strategies

Emergency response teams, de-escalation training likely contributed to dip in violence by Randy Dotinga, Contributing Writer, MedPage Today October 21, 2022

LONG BEACH, Calif. — A Pittsburgh-based hospital system has seen a rapid decrease in violent attacks by mental health patients against staff members, a psychiatric nurse told colleagues here.

From 2020 to 2021, reported violence at Allegheny Health Network facilities fell by 20%, and reported cases of staff being struck by combative patients dropped by 29%, reported Jamie Elyse Malone, MSN, RN, during a presentation at the American Psychiatric Nurses Association annual meeting.

These improvements are likely due to a series of strategies such as emergency response teams, the flagging of violent patients, and crisis intervention training, she noted.

“We’ve seen really positive results from all these different initiatives,” Malone said. “We can’t say there’s causation from the data, but it looks like they really work.”

Any reduction in workplace violence against healthcare workers would make Allegheny Health’s hospital system an outlier. According to a report from earlier this year by the Joint Commission, “U.S. healthcare workers in the private sector are 5 times more likely to experience nonfatal violence-related injury compared to workers in all other private industries combined.”

Violence rates at general hospitals have doubled since 2011, and “overall, nearly three-quarters of all violence-related nonfatal injuries and illnesses in 2018 were incurred by healthcare workers,” the report noted.

While data are sparse, surveys have also suggested that violence against healthcare workers has increased during the COVID-19 pandemic.

A 2018 survey of 990 Allegheny staff members found that only 24% said they reported cases of workplace violence, with 74% reporting that they were instructed to do so. Only 11% said they felt prepared to deal with aggressive/violent behavior. “We realized that we needed to change in order to better protect our team members, patients, and visitors,” Malone said.

Subsequently, the hospital system developed a centralized police force with sworn officers, and spent the next several years developing other strategies to address violence.

Crisis response teams are now in place and led by clinicians with de-escalation training. Depending on availability, the teams can include security/hospital police, behavioral health staff, physicians, and hospital managers. In addition, “crisis response bags” are available that include tools such as “hard” restraints with keys, bite sleeves, spit masks, and towels, Malone added.

However, the protocol only calls for crisis teams to respond in the most severe situations, she noted. “Sometimes somebody might be yelling, they might be acting up a little bit, so you call the whole team to help and it just escalates the situation more,” she explained. “So we have four levels in our crisis response, which helps us get the appropriate response.”

The full crisis teams only respond at the highest two of the four levels when patients actually become physical/violent. “If there’s a threatening act — somebody with an IV pole trying to break a window, somebody’s trying to strangle a nurse — our police and security are trained to get into that room as quickly as possible,” she said.

Debriefing and reporting are important parts of the protocol, Malone noted, and have led to administrative action. “Because you reported that incidences of delirium have gone up, and they’ve caused 50% of our violent offenses in the last month, we’ve set up this whole program to help prevent delirium. That is the way we get staff to actually report — by being transparent with the data and letting them know how that has driven our initiatives and our processes to make things better,” she said.

Over the last 4 years, Allegheny Health has also created councils and committees devoted to preventing workplace violence, added metal detectors to emergency department entrances, conducted simulations, and adopted a violence prediction tool that provides risk notifications.

Patients at risk of being violent are now flagged in the EPIC system, Malone noted. “We wanted to make sure we very clearly but subtly communicated with our staff when a person is likely to become violent.”

Personal panic alarms are now available for staff members, along with specially designed pens and toothbrushes that prevent injury when wielded by a violent patient.

Over 3 years, more than 3,000 staff members were trained in de-escalation techniques, Malone reported, and evidence suggests that “calls for a crisis response appeared to decrease incidents of reported injury from violence.”

What’s next? Malone said she’s working on ways to keep hospital leaders focused on preventing workplace violence instead of letting their attention wander to other projects. “I also would really like to see us do a little bit better with reporting and find out how we can do more projects to continue to prevent violence. One of the big specialty projects that we hope to work on next is alcohol withdrawal. It’s a struggle at our hospitals, and we can do a lot better.”



How the mother’s mood influences her baby’s ability to speak

OCTOBER 07, 2022

Communicating with babies in infant-directed-speech is considered an essential prerequisite for successful language development of the little ones. Researchers at the Max Planck Institute for Human Cognitive and Brain Sciences have now investigated how the mood of mothers in the postpartum period affects their child’s development. They found that even children whose mothers suffer from mild depressive mood that do not yet require medical treatment show early signs of delayed language development. The reason for this could be the way the women talk to the newborns. The findings could help prevent potential deficits early on.

Up to 70 percent of mothers develop postnatal depressive mood, also known as baby blues, after their baby is born. Analyses show that this can also affect the development of the children themselves and their speech. Until now, however, it was unclear exactly how this impairment manifests itself in early language development in infants.

In a study, scientists at the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig have now investigated how well babies can distinguish speech sounds from one another depending on their mother’s mood. This ability is considered an important prerequisite for the further steps towards a well-developed language. If sounds can be distinguished from one another, individual words can also be distinguished from one another. It became clear that if mothers indicate a more negative mood two months after birth, their children show on average a less mature processing of speech sounds at the age of six months. The infants found it particularly difficult to distinguish between syllable-pitches. Specifically, they showed that the development of their so-called Mismatch Response was delayed than in those whose mothers were in a more positive mood. This Mismatch Response in turn serves as a measure of how well someone can separate sounds from one another. If this development towards a pronounced mismatch reaction is delayed, this is considered an indication of an increased risk of suffering from a speech disorder later in life.

“We suspect that the affected mothers use less infant-directed-speech,” explains Gesa Schaadt, postdoc at MPI CBS, professor of development in childhood and adolescence at FU Berlin and first author of the study, which has now appeared in the journal JAMA Network Open. “They probably use less pitch variation when directing speech to their infants.” This also leads to a more limited perception of different pitches in the children, she said. This perception, in turn, is considered a prerequisite for further language development.

The results show how important it is that parents use infant-directed speech for the further language development of their children. Infant-directed speech that varies greatly in pitch, emphasizes certain parts of words more clearly – and thus focuses the little ones’ attention on what is being said – is considered appropriate for children. Mothers, in turn, who suffer from depressive mood, often use more monotonous, less infant-directed speech. “To ensure the proper development of young children, appropriate support is also needed for mothers who suffer from mild upsets that often do not yet require treatment,” Schaadt says. That doesn’t necessarily have to be organized intervention measures. “Sometimes it just takes the fathers to be more involved.”

The researchers investigated these relationships with the help of 46 mothers who reported different moods after giving birth. Their moods were measured using a standardized questionnaire typically used to diagnose postnatal upset. They also used electroencephalography (EEG), which helps to measure how well babies can distinguish speech sounds from one another. The so-called Mismatch Response is used for this purpose, in which a specific EEG signal shows how well the brain processes and distinguishes between different speech sounds. The researchers recorded this reaction in the babies at the ages of two and six months while they were presented with various syllables such as “ba,” “ga” and “bu.

How the mother’s mood influences her baby’s ability to speak | Max Planck Institute for Human Cognitive and Brain Sciences (

Fortifying Family Foundations:Assistant Professor Ashley Weber’s intervention empowers parents to care for their premature infants

By Evelyn Fleider – July 20, 2021

Imagine you are a new mom or dad whose baby was recently born at fewer than 32 weeks old. Your infant needs weeks-long, round-the-clock support in the hospital, but you do not have the job flexibility that allows you to spend time there, a trusted sitter to care for your other child/children or reliable transportation to get you there. You are overwhelmed, emotional and missing out on critical moments at the hospital, when you could get to know your baby and learn to manage their complex care and needs.

Each year, about 100,000 U.S. women give birth to babies considered very or extremely premature who require long-term stays in a neonatal intensive care unit (NICU) and who are at a high risk of developing chronic conditions. But not all parents get the formal training they need to keep their child healthy, which can cause mental health issues for parents. To address the critical need for an effective, streamlined model of parent-driven care, Ashley Weber, PhD, RN, a practicing NICU nurse and assistant professor at the College, is piloting PREEMIE PROGRESS, a video-based intervention that helps parents understand, monitor and manage their infant’s care while in the NICU.

With the financial backing of a National Institutes of Health (NIH) grant, Weber and the College’s Center for Academic Technologies and Educational Resources (CATER) team designed and built the intervention to deliver education to overwhelmed, high-risk parents with low literacy and education through accessible, platformagnostic videos and optional worksheets. Parents can learn by watching the videos or completing worksheets
while doing laundry or caring for other family members at home. Specifically, PREEMIE PROGRESS provides family management skills including negotiated collaboration, care systems navigation, emotion control, outcome expectancy and more.

“Our mortality rates have significantly gone down over the decades, but long-term complications from prematurity have not changed,” Weber says.
“We need to decrease the stress and sensory stimulation that babies experience throughout their NICU stay. Also, research shows that babies do best when they’re with their parents.”

Although parent education interventions exist, socioeconomic barriers, such as the lack of mandated paid family leave in the U.S., often prevent parents from participating in these opportunities and learning about their baby’s complex care during their NICU stay. The need to return to work shortly after birth or lack of transportation to the NICU are some of the various obstacles that prevent parents from being able to focus on their baby’s health and deliver the majority of care in the NICU.

“If you can spend large amounts of time in the NICU, you get to learn; nurses educate you on the plan of care and you participate in rounds, getting to know your baby,” Weber says.

“I wanted to build an intervention that could help disadvantaged families learn outside of the NICU, so that when they are able to be in the NICU, they maximize that time and spend it caring for their baby as opposed to playing catch-up.”

Currently, Weber and her team are refining PREEMIE PROGRESS through iterative usability and acceptability testing. In October, they will start testing feasibility and acceptability of the refined intervention and study procedures in a pilot randomized controlled trial with 60 families over the course of two years. They anticipate the intervention will decrease parent depression and anxiety, increase infant weight gain and receipt of mother’s milk and reduce neonatal health care utilization. Weber then plans to submit a competitive R01 for additional funding to conduct an even larger trial.

PREEEMIE PROGRESS has been years in the making for Weber, who in 2018 worked with the College of Nursing’s instructional designers, technology specialists, videographers and graphic designers to create the first prototype. She hopes the project will eventually evolve into a collaborative partnership among NICUs in Cincinnati, Columbus and Cleveland to conduct research trials centered on improving family care.

Weber’s long-term goal is to become a leader in designing, disseminating and implementing sustainable family management programs to improve health outcomes in the NICU. Regardless of her success, she recognizes that the best thing she can do for her patients is to advocate for universal paid family leave, better childcare and transportation infrastructures.

“We can come up with all sorts of interventions for reducing parent and infant stress and changing the way providers deliver care in the NICU, but if a mom doesn’t have the money to pay for a babysitter so she can get to the NICU or doesn’t have paid leave and has to go back to work a week or two after birth, the chances of parent engagement in care are extremely low,” Weber says. “I hope that PREEMIE PROGRESS empowers families who are at a disadvantage through no fault of their own. We want to give NICU families skills they can use for a lifetime, but these broader public health policies to support the social determinants of family success are really needed in order to move family research forward in the NICU.”


Late Preterm Infants in the NICU – Tala Talks NICU

NICU Tala Talks

Welcome to Tala Talks NICU! In this video, we talk about late preterm infants (those born between 34 and 37 weeks gestation) and the 8 main reasons a late preterm infant would need admission to the NICU.

Joe’s Legacy: The Family Making A Difference For NICU Babies

#TheProjectTV #NICU #Fundraising  The Project

Three years ago, we introduced you to baby Joe Blackwell. Now, Joe’s legacy lives on with an annual spinathon to raise money for the Royal Hospital For Women’s newborn intensive care unit.


“NICU Blues”:A Novel Term for Common Parental Experiences

Beth Buckingham, Ph.D., HSPP, Grace LeMasters, Ph.D., MSN

Approximately one in ten babies will spend time in a newborn intensive care unit (NICU).  Studies indicate that preterm birth significantly contributes to infant morbidity and mortality. Though mortality rates have been declining for preterm infants, there remains a significant percentage of infants born at the earliest gestational age who die in the NICU. Regardless of gestational age or medical diagnosis, NICU parents often fear their baby’s neonatal death or severe morbidity. There commonly exists some level of acute disorienting parental distress.

A single definition of parental distress in the NICU does not exist.  A novel non-pathological term, “NICU blues,” is proposed to identify common parental experiences specific to the newborn intensive care unit. Giving a name to “NICU blues” for parents provides optimal understanding, relief, and meaning for parents and caregivers moving through a unique NICU journey. Over several years, confidential comments were collected by the principal author from parents with newborns in a Level III family-centered care NICU. These condensed comments, shown in quotes, are many shared voices of pain, including reflecting parental narratives used in developing the term “NICU blues” Parents in the NICU described numerous symptoms of psychological distress not fully meeting specific pathological psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). However, the clinical reflection of these vulnerable expressions of NICU parental distress helped us formulate the proposed conceptualized term “NICU blues” to shape those collective narrative stories.

Parental “NICU blues” are defined by the intersection of four factors in figure 1: NICU trauma, baby blues, postpartum mood and anxiety disorders (5), and NICU grief. NICU blues may contain varying levels of these four factors. Both parents are included in this biopsychosocial, transitory, and non-pathological model of predicted cogent symptoms in the NICU. NICU blues normalize feelings of being out of control emotionally and behaviorally with responses and experiences for any parent in the NICU. The concept of NICU blues sets an initiative-taking stage for the healthcare professional to offer adaptive coping responses and interventions within the NICU setting. Parents were suffering from extreme emotional pain, a sense of hopelessness, and despair in response to a potential NICU death or long-term morbidity of their newborn we view as an expected and understandable transitory state of parental functioning. The proposed term “NICU blues” gives voice to the logical collective voices of “feeling like I am crazy and losing my mind.” Hence, we define “NICU blues” as a condition unique to the NICU setting that includes common emotional and behavioral responses to a succession of abnormal parenting events and experiences. These responses include parental guilt, specifically maternal guilt as it relates to pregnancy loss and the baby’s NICU admission, father’s guilt as it relates to not protecting his family from the NICU stay, negative cognition and mood, decreased interest, anger, concentration problems, sleep disturbances, and struggles to experience positive emotions.

NICU blues provides a paradigm for validating parental adaptation experiences within a NICU setting and is viewed similarly to the transitory phenomena of matrescence described by anthropologist Dana Raphael.  Maltrescence is a typical physical, emotional, hormonal, and social process of transitioning into motherhood. In this sense, NICU blues is a typical process of psychosocial adjustment into parenthood occurring within the NICU. The term NICU blues normalizes perceived “out of control and helplessness emotions,” but with awareness and interventions, these emotions can transition to periods of adaptation.

Parents in the NICU need a meaningful relationship with their baby to establish a sense of parenthood, and their baby needs parental contact for optimal physiologic and psychoemotional development. Parents in the NICU often feel an additional layer of angst and guilt with physical separation from their baby. Research documents the interrelationships between NICU parents’ mental health on the functioning of their infants’ physical and psychological development.

Postpartum mothers in the NICU may try to numb the intense emotional pain of “not wanting to deal with the possible mortality of their precious long, imagined baby.” Fathers in the NICU may experience a sense of panic and doom with potential mortality for their partner and his baby, “I’m going to lose my entire family.” Parents often spend infinite initial hours in the NICU without regard for their own needs, “wanting a parent to be with the baby if they die.” This perception, real or imagined, adds to the NICU blues. Often, the father may undertake to stay in the NICU as the mother cannot leave the postpartum floor until physically mobile. The father may or may not be able to express feeling alone and isolated without his partner.

Most research on NICU parents has focused on the high prevalence rates of postpartum mood and anxiety disorders (5) and post-traumatic stress disorder (PTSD). We strongly support the National Perinatal Association (NPA) 2015 recommendations for universal screening and treatment protocols for both parents in the NICU to identify mental health challenges. Studies reveal elevated levels of depression, anxiety, and trauma symptoms shortly after their baby’s birth. Without screening and identification of common parental distress, we will be unable to support the mental health needs of our parents in the NICU as partners in their newborn care. 

We propose a novel term, NICU blues, for consideration by the NICU team within an ongoing supportive relationship with our parents. Identifying and treating complex emotional and mental health needs, such as NICU blues, provides parents in the NICU with additional consideration for robust universal standards of family-centered care. Figure 1 captures the interrelationship of clinical factors, including NICU trauma, baby blues, postpartum mood and anxiety disorders , and NICU grief, to identify a theoretical construct of a transitional, typical, and expected “NICU blues” paradigm.

NICU Trauma:

Considerable evidence exists that both parents in the NICU are at risk for psychological symptoms from traumatic birth events, including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). We suggest that NICU psychological trauma symptoms may overlap with clinical symptoms in addition to and separate from NICU blues in Figure 1. There exists an intersection of NICU trauma symptoms, including actual or threatened mortality and morbidity for the baby or mother, with symptoms of NICU blues. Parents in the NICU may have the perception and experiences birth trauma events without meeting DSM-5 diagnostic criteria. In this sense, our psychological approach is expanded beyond the narrow psychiatric diagnosis focused solely on ASD or PTSD. In our clinical experience, NICU blues symptoms for parents include attributions of self-blame for their baby’s NICU admission, guilt, fear/horror, feeling detached from self and others, avoidance behaviors from the NICU, decreased parental involvement with their baby, struggles to focus while in the NICU and sleep disturbance.

A parent in the NICU needs a meaningful, loving, and nurturing relationship with their baby. In Ainsworth and colleagues’ classic maternal attachment studies,(10) maternal attachment involves physical and psychological accessibility. Parents of babies in the NICU are largely limited from these crucial parental attachment behaviors. Bonding may be at risk. As mothers may be recovering from a traumatic delivery, fathers may typically be the first visitor to the NICU.

Qualitative research identifies themes for fathers in the NICU. . Fathers may believe they need to be stoic for their family, often hiding feelings of anxiety, fear, helplessness, disconnection, powerlessness, and being out of control. They encompass charting unfamiliar waters, including being the backbone of the family, shouldering heavy responsibilities alone, being torn between his partner and baby in the NICU, and the unexpected journey as an active and possibly only participant.  Parents may question how their involvement and participation in the NICU is important in seeing nurses and others fulfill their caregiving roles.

Trauma during a newborn’s medical stay is now considered an adverse childhood experience (ACE). Toxic stresses or adverse childhood experiences are strongly linked to poor health outcomes. For optimal physiologic and psychoemotional development, a baby may need buffering protection from a lack of parentally connected caregiving. The dearth of physical and emotional closeness between infants and their parents and parental distress can negatively affect the relationship and the infant’s developmental outcomes. Research links possible long-term protective factors for parents who participate in NICU infant care.

Psychosocial education and intervention using the paradigm of the NICU blues are paramount at these initial stages for normalization and validation that these distressing thoughts and feelings are common for most parents in a NICU setting. Unique clinical themes and identification of NICU blues provide parents with alternative schemas for assimilation and adaptation.

Discussion of NICU blues normalizes parents’ turmoil as understandable and predictable within the NICU. Early attunement and co-regulatory caregiving are the foundation for attachment and bonding. We provide a new lens of parenting in the NICU with these caregiving-bonding discussions. In highlighting NICU blues, parents are more apt to discover “what’s lovely about their baby at this moment” apart from the barrage of NICU equipment and stressful environment. Normalization of NICU blues promotes parental discovery of their baby’s physical and emotional nuances.

Parents often need a pause for adaptation from the many successive invasive medical procedures with their babies. With this conversation of NICU blues, parents have reported a much greater understanding of commonly shared universal NICU trauma reactions. With ongoing discussions by the staff of NICU blues, parents gain some psychological distance from their trauma symptoms, reporting greater acceptance, psychological flexibility, and adaptation for continued engagement in the NICU. In our clinical experience, identification of NICU blues sets a family-centered stage for later engagement with parents for other bedside compassionate family-centered interventions and connection between staff and parents in the NICU.

Baby Blues and Postpartum Mood and Anxiety Disorders: Baby blues, also known in the literature as postpartum blues or postnatal blues (with these latter terms excluding the father), is a mild transient disruption of mood occurring several days following delivery. It is imperative for NICU psychologists and medical and nursing staff to help parents make sense and meaning of their initial distress specific to identifiable physical changes, situational stressors, and loss . Parents often express relief in knowing that predictable NICU blues may be additive to or better explained to both parents than the term baby blues in addition to hormonal changes.

Parents in the NCIU report that discussion of possible NICU blues around admission to the NICU gives them a sense of hope and being understood. Our clinical impression is that this initial connection with parents in the NICU gives clarity to an internal disruption not fully understood. Perhaps with this safe therapeutic, nourishing NICU staff-parent connection, parents may be better able to bond with their babies. In our discussion of NICU blues with parents, relationship building for parent-child bonding and meaningful parent-NICU staff communication begins another positive launch for family-centered care.

Baby blues is identified as one potential risk factor for postpartum depression. These authors posit that the risks of developing perinatal mood and anxiety disorder (PMAD) may be lessened or eliminated when identifying NICU blues or baby blues. Early parental psychological identification and intervention by the psychological, medical, and nursing staff is key. Research studies indicate that both parents of babies in the NICU are at risk for postpartum depression and anxiety. There currently does not exist a DSM-5 diagnosis specific to postpartum depression. There is a specifier of “with peripartum onset” with symptom onset during pregnancy or in the four weeks following delivery, with the focus generally on the mother.

PMAD symptoms fail to voice the entire story of NICU parents. Underlying parental NICU distress reveals clinical themes. Using a 4-stage model by Beck, research authors identify maternal loss of control as the underlying problem with a NICU postpartum depressive experience. Beck identified a 4-stage process termed “teetering on the edge” between sanity and insanity with stages of encountering terror, dying of self,  struggling to survive, and regaining control. The author described stages with four identifying themes: incongruity between expectations and the reality of new motherhood, a spiraling downward process, pervasive loss, and making gains. Like Beck’s proposed process of “teetering on the edge of insanity,” parents in the NICU express “a sigh of relief knowing sanity exits and feelings expected within the term NICU blues.” 

A Father’s expectations of ideal fatherhood may, too, be affected by the fears and challenges of parenting a medically fragile baby in the NICU and supporting a mother who is not coping well. (20) Themes of loss fill the NICU room with both parents experiencing the loss of the “perfect” birth to the shocking experiences of seeing their fragile baby for the first time, often with tubes that may affect parental identity and self-esteem. Paternal feelings of helplessness may be incredibly overwhelming.

Parental suffering is often silent. NICU parents may encounter various symptoms, including NICU blues, baby blues, or PMADs. In our clinical experience, parents present with some level of emotional and behavioral NICU distress. They commonly experience an intrusive cognitive disruption to their expected and perceived positive parental role. 

Parents often experience elevated levels of negative self-blaming and misattributions for the baby’s NICU admission exacerbating parental guilt. Dreams of completing a term pregnancy, of expecting a typical delivery complete with physically holding your baby in the delivery room, are abruptly crushed. Multiple losses for any NICU parent are monumental. Parents do not dream of finding themselves as a family in a NICU. As staff present to parents the clinical term NICU blues as a common reaction to their loss of anormal newborn experience, they often feel understood and comforted. In ruling out psychiatric pathology, NICU blues provides an intersecting paradigm of composite reactions, including baby blues and postpartum mood disorder, guilt, sadness, and feelings of parental worthlessness.

NICU Grief:

Parents in the NICU may experience an avalanche of immense losses accompanied by grief associated with those losses. Significant losses for parents may include sudden pregnancy termination, medical complications, loss of anticipated motherhood and fatherhood roles, and loss of hopes and dreams of a highly anticipated future with a healthy full-term baby coming home shortly after delivery.

Symptoms of NICU blues for parents may be further conceptualized within Kubler-Ross’s model of grief and loss. Those stages include shock/denial, anger, bargaining and self-blaming, depression, and acceptance with the recent inclusion of an additional newly defined stage, meaning. Overlap of NICU blues symptoms with stages of Kubler-Ross’s model of grief exists. As Kubler-Ross’s model reflects, these symptoms of grief are experienced in stages without the nuance of diagnostic pathology. Considerations for different cultural, ethnic, and races may also affect expressions of grief and stressors within the NICU setting.

These disorienting grief responses may disrupt parental NICU involvement in baby care bonding behaviors. Parents may further isolate themselves from family and peers, intensifying experiences of NICU blues. This withdrawal from meaningful social support fuels feelings of helplessness and shame with possible stigma adding to their secret “of being different” from other parents leaving the hospital with healthy newborn babies.


Life in the NICU does not make sense. Many parents express negative self-blaming attributions for “causing” their baby’s NICU admission and stay. These parental experiences seem to coincide with feelings and thoughts of NICU blues. We suggest that parental expressions of grief, loss, and shame are strong predictive variables contributing to NICU blues. There is no clear clinical definition for the array of parental psychological distress unique to the NICU. Identifying the NICU blues seeks to add to the understanding of psychological distress as a common contextual response. Thus, parental adaptation to the NICU is viewed as adaptive versus non-adaptive. Awareness of these parental responses by NICU staff and early intervention can ease the experience of NICU blues, foster increased bonding between parent and baby, increase interactions among NICU staff and between staff and parents, and promote an overall more positive parental NICU experience. However, this new paradigm and theoretical concept “NICU blues” for parental distress, needs further empirical qualitative and quantitative evaluation to determine its efficacy and effectiveness for NICU family-centered clinical standards of care.


The Impact of Advanced Practice Registered Nurses’ Shift Length and Fatigue on Patient Safety

Position Statement #3076 – NANNP Council September 2022-  NANN Board of Directors September 2022

The National Association of Neonatal Nurse Practitioners (NANNP) and its members are committed to providing safe, ethical, and professionally accountable care. All healthcare professionals are affected by the challenges associated with role expectations and human performance factors. NANNP recognizes that fatigue, sleep deprivation, and the extended shift lengths or hours that neonatal nurse practitioners (NNPs) often work present potential safety risks for patients, providers, and employers.

As the professional voice of neonatal nurse practitioners, NANNP recommends that, regardless of work setting and patient acuity, NNPs’ maximum shift length in house be 24 hours, that a period of protected sleep time be provided following 16 consecutive hours of working, and that the maximum number of working hours per week be 60 hours. In addition, it is recommended that NNPs, their employers, and institutions collaborate to implement supportive risk-reduction strategies based on current evidence. This is in the best interest of patient safety and NNP health.

 Association Position:  Research addressing sleep deprivation, fatigue, and patient outcomes as related to nurses, and specifically NNPs, is limited. In addition, the uniqueness of the patient population and NNP responsibilities further complicate the delineation of strict scheduling limitations. Based on current evidence, regardless of work setting and patient acuity, (1) NNPs’ maximum in house shift length should be limited to 24 hours, (2) a period of protected sleep time should be provided to NNPs following 16 consecutive hours of working, and (3) the maximum number of working hours per week for NNPs should be 60 hours.

Furthermore, although healthcare providers are susceptible to the negative effects of fatigue and sleep deprivation, NNPs are professionally accountable and, as such, are responsible for minimizing any patient and personal safety risk.

Background and Significance: A number of healthcare organizations, both nursing and other disciplines, have adopted strategies to address concerns related to shift lengths and fatigue as well as the connection with risks to patients and care providers. Although no data exist to support an optimal shift length for the NNP, the safety of extended provider work hours for both the patient and the provider has been questioned in light of concerns raised by healthcare organizations and regulatory bodies (e.g., American Nurses Association [ANA], 2014; Texas Nurse Practitioners, n.d.; New York State Education Department Office of the Professions, 2021). NNPs have workflow patterns analogous to those of medical residents or fellows, flight nurses, and air medical staff (LoSasso, 2011). These healthcare providers are involved in direct patient care but not necessarily during their entire shift. Therefore, it is acceptable to examine published data from both nursing practice and other healthcare disciplines to provide a foundation upon which to form recommendations for shift length for NNPs.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) began limiting shift length and duty hours of residents and fellows, with revisions in 2011 and 2017. The most recent ACGME program revision took effect in 2017 and was based on stronger evidence than the earlier versions. The revision incorporated new language: “clinical and educational work hours” in place of “duty hours.” The limitation of no more than 80 hours per week, averaged over four weeks, was unchanged but clinical hour limits for first-year residents increased from 16 to 24 hours (ACGME, 2011 & 2017). The National Academy of Medicine (NAM), formerly known as the Institute of Medicine (IOM), has published guidelines and recommendations regarding nurses’ roles in the protection of patient safety and improved patient outcomes (IOM, 2004). The Agency for Healthcare Research and Quality (AHRQ) contracted with the IOM to study key aspects of the work environment of nurses as it relates to patient safety. Some of the pertinent issues that have risen to the federal and state policy arenas are extended work hours, fatigue, and mandatory overtime (Page, 2008).

The nursing practice of the certified registered nurse anesthetist (CRNA) has some general similarities to that of the NNP. Professionals in the two groups share the 3 hospital work setting, the need for immediate response time when on call, and long shift lengths. The American Association of Nurse Anesthesiology (AANA) is responsible for protecting and facilitating CRNA professional practice and patient safety. Anesthesia care requires continuous services and at times involves high acuity and intensity of care, which are known contributors to provider fatigue. AANA recommends shift-length guidelines based on variable settings, caseloads, and patient acuity (AANA, 2015). Included in a 2015 AANA document on the topic are considerations regarding minimum required sleep (7–9 hours), effect of circadian rhythm, scheduling in compliance with state and federal statutes and regulations, and the importance of monitoring safety recommendations from relevant organizations such as AANA, AHRQ, Institute for Healthcare Improvement, and NAM.

In the American College of Obstetricians and Gynecologists (ACOG) Committee Opinion “Fatigue and Patient Safety” (2018), a minimum of 5 hours of sleep per night was recommended to help physicians communicate effectively (e.g., during handoffs, to patients). Additional recommendations included training faculty and providers to recognize signs of fatigue and sleep deprivation and the importance of balancing continuity of care and the need for rest.

Another professional organization that has addressed the issues of fatigue and shift length is the American Nurses Association (ANA). In its 2014 position statement on the topic, ANA recommends that registered nurses in all care settings perform no more than 40 hours of professional nursing work (paid or unpaid) in a 7-day period. In addition, employers should limit shifts (including mandatory training and meetings) to a maximum of 12 hours in a 24-hour period, including both on-call hours worked and actual work hours. The ANA document was written for registered nurses and employers but states that it is relevant to other healthcare providers who collaborate to create and sustain a healthy interprofessional work environment. The American Academy of Nursing on Policy described health and safety risks related to shift work, long hours, and worker fatigue in a 2017 position statement.

NANNP conducted neonatal nurse practitioner workforce surveys in 2011, 2014, 2016, and 2020. The most recent data (2020) revealed that most NNPs still work either 24- hour shifts (41%) or 12-hour shifts with day-night rotation (37%), but these numbers decreased from the 2014 data: when 50% of NNPs worked 24-hour shifts and 46% worked 12-hours shifts with day-night rotation. Although the 2020 survey data reflected that NNPs prefer the 24-hour shift, 77% of those responding do not have protected downtime during those 24 hours. The average age of the NNP workforce is unchanged from 2014 data, with more than 50% older than 50 years of age.

The most recent NNP workforce survey also revealed that 63% of respondents worked more than their scheduled hours (up from 33% in the 2014 survey) and that most NNPs have other duties in addition to those related to patient load during their night shifts. These other duties include delivery-room coverage (77%), ER emergencies (47%), Level I consultations (37%), maternal health consultations (36%), and transports (26%). Few NNPs who work night shifts get guaranteed downtime. For those who do, the 4 downtime averaged 3 hours per shift in 2014 (Kaminski et al., 2015). Less downtime was reported in Level IV neonatal intensive care units (NICUs). Forty-seven percent of NNPs report that their practice does not have enough staff. Ninety percent of NNPs spend more than 75% of their clinical practice time in the NICU, and the average work week is 37 hours (this number is higher in Level IV practices) (Snapp et al., 2021).

 The NNP role is a mainstay staffing option for many NICUs. Shift lengths for NNPs vary and are uniquely related to the dynamics of each NICU. Actual time spent providing patient care during prolonged shifts may vary, as do anticipated periods of rest (Snapp & Reyna, 2019). In addition, NNPs may be directed to work beyond their scheduled shift lengths to meet unexpected patient care needs or to satisfy organizational or practice expectations. There is limited data examining mandatory overtime, but it is clear that mandatory overtime presents a higher risk for work-related injury (e.g., needlesticks), illness, and missed shifts (Caruso, 2014). Only 18 of 50 states have legislation against mandatory overtime for registered nurses (WorkforceHub, 2018).

In December 2011, The Joint Commission (TJC) published a Sentinel Event Alert on the connection between healthcare workers’ fatigue and patient safety. It acknowledged research linking extended-duration shifts, fatigue, and impaired performance and safety. TJC suggested evidence-based actions to help mitigate the risks of fatigue resulting from extended work hours (2011), including:

● assessing the organization for fatigue-related risks, especially during patient handoff

● inviting staff input into designing work schedules to minimize potential for fatigue

● implementing a fatigue management plan that includes scientific strategies for fighting fatigue.

● educating staff about sleep hygiene and the effects of fatigue on patient safety

● providing opportunities for staff members to express concern about fatigue and taking actions to   

     address those concerns

● encouraging teamwork as a strategy to support staff who work extended shifts or hours and to

     protect patients from potential harm

● considering fatigue as a potential contributing factor when reviewing adverse events

● assessing the environment provided for sleep breaks to ensure it fully protects sleep.

In 2018, TJC issued an addendum to the 2011 document that adds a new resource, Fatigue and Patient Safety from American College of Obstetricians and Gynecologists (ACOG), and the 2017 ACGME updated program requirements. Some of the updated TJC suggestion actions were assessment of off-shift hours, handoffs, and staffing (2018).

The IOM (now NAM) has published papers on patient and personal safety as they relate to resident duty hours. In Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, the IOM cites prolonged wakefulness, shifts longer than 16 consecutive hours, the variability of shifts, and the volume and acuity of patient load as factors that increase 5 the risk of harm to patients (IOM, 2009). Additionally, prolonged work hours may result in harm to the provider and others. The risks of being involved in a motor vehicle accident after working more than 24 hours were explored by Johnson (2011). Residents who worked more than 24 hours had a 16% higher risk of having a motor vehicle accident post-call.

It is known that sleep deprivation slows reaction time and decreases the ability to concentrate, retain, and learn (Caruso, 2014). Another example is found in a New Jersey law that imposes penalties for reckless driving if the driver is experiencing sleep deprivation (LoSasso, 2011). The Centers for Disease Control and Prevention (CDC) reports that shift work is a cause of drowsy driving and that “being awake for at least 18 hours is the same as someone having a blood alcohol content (BAC) of 0.05%. Being awake for at least 24 hours is equal to having a BAC of 0.10%. This is higher than the legal limit (0.08% BAC) in all states” (CDC National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 2017).

 Nursing research suggests that shift length affects vigilance and safety. Scott, Rogers, Hwang, & Zhang (2006) and Rogers, Hwang, Scott, Aiken, and Dinges (2004) conducted descriptive self-report studies and found statistically significant increases in errors and near errors when staff nurses worked shifts of 12.5 hours or longer. Caruso (2014) found that risks are 15% higher for evening shifts and 28% higher for night shifts when compared to day shifts. When compared with 8-hour shifts, 10-hour shifts increased the risk by 13% and 12-hour shifts increased the risk by 28%. Risk increased by 17% for the third consecutive night shift and 26% for the fourth. In 2011, Trinkoff et al. found a significant relationship between nurse work schedules and patient mortality. Scott et al. (2007) found a relationship between nurses’ work schedules, sleep duration, and drowsy driving that raised concerns for the safety of the nurses and the public.

Insufficient sleep is the critical link between work and fatigue (Akerstedt et al., 2004). Sleep deprivation, resultant fatigue, and interruptions in circadian rhythm are commonly experienced by nurses performing shift work (Peate, 2007); NNPs commonly do shift work (LoSasso, 2011). Variable working shift patterns have been suggested to affect performance, learning, and memory function (Peate, 2007). Fatigue can be predicted by several additional factors, including high work demands, female sex, the supervisor role, and advanced age (Akerstedt et al., 2004).

Circadian rhythm disruptions, fatigue, and sleep deprivation may affect the NNP’s clinical performance during night and extended shifts, with specific impact on levels of alertness (Lee et al., 2003). Additional fatigue factors include time awake, health factors (i.e., sleep disorders, medications), environmental issues (i.e., light, noise), and workload (Lerman et al., 2012). The potential consequences of altered alertness may include delayed identification or lack of identification of critical markers of clinical deterioration. Effects of fatigue on patient safety include delayed reaction time, delayed processing of information, diminished memory, failure to respond at the appropriate time, impaired efficiency, and inappropriate responses (Dingley, 1996; Caruso, 2014). These alterations in functioning have been summarized as “increased errors of 6 omission and commission” (Lim & Dinges, 2008). Patient safety is threatened when nurses work long and unpredictable hours, especially when the duration of prior awake time increases beyond 17 hours (Berger & Hobbs, 2006). Errors are increased with long shifts; in one study, the number of errors was three times higher with more than 12.5 consecutive hours of nursing practice, and the majority of errors were medication errors (Phillips & Moffett, 2013).

The relevance of these findings should be considered in relation to work hours and executive functioning necessary for the role and responsibilities of NNPs. Reduction in the occurrence of adverse events among patients requires NNPs to recognize important information from a variety of sources, to integrate complex processes and signs into a sensible thought and decision-making process, and to formulate an accurate, appropriate set of actions or reactions. Extended work shifts for nurses in critical-care settings have been associated with decreased levels of alertness and vigilance (Scott, et al., 2006).

In addition to compromising patient safety, sleep deprivation jeopardizes the well-being of providers who work extended hours. Extended workdays can have significant effects on homeostatic balance and circadian rhythm (Johnson, 2011). An increased prevalence of physical and psychiatric disorders—including but not limited to cardiovascular and gastrointestinal disturbances, diminished immunological response, infertility, spontaneous abortions, the birth of premature and low-birth-weight infants, sleep apnea, obesity, miscarriage, mood disorders, and depression—have been reported (Caruso, 2014; National Sleep Foundation, 2008; Peate, 2007). Cognitive difficulties have been cited, as well as long-term consequences of fatigue for nurses (Phillips & Moffett, 2013). Increasing age compounds the physiological and cognitive effects of fatigue (Dean, Scott, & Rogers, 2006). Older individuals are also more likely to experience sleep problems (33% of women aged 18-24 vs. 48% of women aged 55-64; Caruso, 2014).

Research specific to the NNP role in relation to fatigue and shift length is needed. However, a foundation for the following recommendations is provided by current knowledge of the science of sleep deprivation and fatigue, research from nursing and medicine, and outcome data related to shift length and patient safety. It is important to note the discrepancy in the literature regarding the definition of extended hours. The most common definitions of extended hours are shifts longer than 12, 16, or 24 hours.

Recommendations; Existing literature supports the concern that healthcare provider fatigue has a negative impact on both healthcare recipients and providers. NNPs are affected by fatigue the same way other healthcare providers are affected. Therefore, while acknowledging the lack of data clarifying the impact of fatigue on NNPs specifically and recognizing that these professionals are subject to some degree of fatigue-related sequelae, NANNP 7 provides the following recommendations in the areas of education, fatigue management, and system management.


1. NNP program education should include the recognition and management of fatigue regardless of shift length (AANA, 2015). Study areas should include sleep physiology and sleep inertia (grogginess upon awakening), personal and professional performance limitations, and identification of fatigue and fatigue mitigating strategies.

2. NNP employer education should be aimed at recognition of the relationship between extended working hours and fatigue and burnout. The unique critical care working environment, workload, and scheduling of NNPs should be included in this discussion. Education of the entire healthcare team, hospital administration, and private employers is essential to fatigue management. Workload has been identified by NNPs as a key factor in fatigue on the job (Welch-Carre, 2018; Dye, 2017).

3. NNP self and continuing education should address the individual’s responsibility to be adequately rested and fit to deliver optimal patient care. Most employment contracts state that the NNP’s responsibility is to come to work “rested and ready for work.”

 Fatigue Management

4. Fatigue-related risks should be alleviated by research-based strategies. One important aspect of fatigue management is observance of good sleep habits and routines. Sleep-hygiene measures should include monitoring sleep hours on both working and nonworking days and nights (Dean et al., 2006). To avoid chronic sleep deprivation, healthy adults should obtain approximately 8 hours of sleep per day (Dean et al., 2006).

5. Disruption of the circadian rhythm should be reduced by providing the NNP with an opportunity or designated time to sleep in the afternoon before working overnight (Landrigan et al., 2004). Working long, irregular hours, particularly at night, can disrupt the circadian rhythm even when an individual is adequately rested (Rogers, 2019). Additional fatigue mitigation strategies include minimizing shift rotations and optimizing rest time between scheduled shifts.

6. NNPs who are older than 40 years of age should be aware that they are at increased risk of experiencing fatigue and related physiological and cognitive effects that may affect performance (Reid & Dawson, 2001). Because the average NNP age is reported as 51 years old (Snapp et al., 2021), this increased risk is highly relevant to NNPs. For NNPs older than 50, night-shift hours should be optional (NANN, 2018). NNPs who have worked extended shifts for more than 20 years have an increased risk of health problems and illness (Clendon & 8 Walker, 2013) and should have the opportunity to work 8-12-hour shifts at their current position and institution.

7. Opportunities for rest should be incorporated as required by the work environment. Tools for tracking and reporting rest should be utilized. Fatigue can occur anytime in a 24-hour period. Napping is an effective non-pharmacological technique for sustaining alertness (Caldwell, Caldwell, & Schmidt, 2008). Strategic naps of 10–60 minutes have been shown to decrease fatigue and sustain performance (Arora et al., 2006; Rosekind et al., 1995). To maximize the benefit of naps, it is important to provide protected, uninterrupted time so that naps are of adequate length (Caldwell, 2001). The environment must be quiet, secluded (away from the work area), and dimly lit (Phillips & Moffett, 2013). Any on-call communication device should be handed off with sign-out to a colleague during this protected rest time. Personal phones should be put in Do Not Disturb mode.

8. Individuals should be cautious about consuming caffeine, especially 4–7 hours prior to planned sleep time (AANA, 2015). The use of stimulants, most commonly caffeine, is a fatigue management strategy often used by clinicians to temporarily improve alertness. Its effectiveness as a stimulant to temporarily improve alertness varies according to individual tolerance (Dean et al., 2006). Increased consumption of caffeine can interrupt restorative sleep. Various pharmacologic stimulants are available, but information regarding long-term side effects, tolerance, and potential for abuse is very limited (Caldwell, 2001). Behavioral and system counter-fatigue strategies are preferred over drug-based measures.  

9. Education is essential and should cover the dangers of fatigue, the causes of drowsiness on the job, and the importance of sleep and proper sleep hygiene. NNPs should assume personal responsibility to avoid excessive fatigue and use fatigue-mitigating strategies whenever possible. NNPs have a responsibility to recognize and address their fatigue before it becomes a safety concern (Salmon, 2013). Moonlighting (i.e., working a second job) and overtime hours are the responsibility of the employer and employee and need to be tracked and reported. Primary and secondary employers should be informed of any moonlighting hours by the employee.

10. Nutrition and adequate meal breaks are needed, along with respite time, to reduce fatigue (AANA, 2015).

11. Sleep applications for smartphones should be considered to facilitate better sleep practices. Applications can assist with difficulty falling asleep or staying asleep, relaxation, and best awakening time based on sleep-wake cycles (Phillips & Moffett, 2013). However, electronic sleep-tracking tools rely on Internet data tracking, so security risks must be kept in mind. Screen time on electronic devices during rest times is discouraged and use prior to sleep likely decreases ability to fall asleep, further contributing to fatigue (AANA, 2015). 9

System Management

12. Systems or processes should be designed to prevent errors associated with fatigue in the clinical setting. Collaborative efforts should be made among NNPs, their employers (including hospital risk management departments), and institutions to enhance health, safety, and productivity through the development of a fatigue risk management system with periodic review (Lerman et al., 2012). Individual practices and settings should have a written, practice-specific guideline that includes maximum hours worked per week, maximum hours worked per month, maximum number of consecutive shifts, and guidelines and monitoring of moonlighting hours (Blum et al., 2011).

13. Scheduling is vitally important. Optimal scheduling patterns may vary depending on the setting; however, the following recommendations are offered with the goal of providing safe, effective patient care and protecting the wellbeing of NNPs: a. Maximum shift lengths should be 24 hours, in-house, regardless of work setting and patient acuity. b. A relief-call system should be developed to provide coverage for NNPs who feel impaired by fatigue. c. A period of protected sleep time following 16 consecutive hours of working should be provided. d. A work assignment that compromises the availability of sufficient time for sleep and recovery from work should be negotiated or rejected (ANA, 2014). NNPs must be vigilant in pacing their own schedules to avoid fatigue by overscheduling with overtime and moonlighting hours. NNPs must be aware of the consequences of overwork (work hours and patterns) and fatigue-related errors (AANA, 2015). Avoidance of day and night shift swings is important in scheduling of 8–16 hour shifts to avoid drastic changes to sleep patterns. If alternating day/night rotations, consider 1 month on days, then 1 month on nights.

14. Team-based care models (Van Eaton et al., 2005) should be used to manage fatigue. Key aspects of this model include timely and accurate communication of information among team members, appropriate workload distribution, and use of information and documentation systems. Rather than having a single NNP responsible for patient care, team-based models make patient care a shared responsibility. Checks of medications, doses, and procedures should be requested as necessary (ENA, 2013).

15. An inherent value of team-based care is greater conciseness and accuracy in communicating information from one clinician to another, thus ensuring safer hand-offs at the end of shifts. McAllister (2006) proposed that continuity of care is a “process that optimizes our use of people, information, and management strategies.”

16. Employers and institutions should prioritize the education of NNPs and all other caregivers to ensure their understanding of the responsibility to be adequately rested and fit to deliver optimal patient care; the effects of fatigue and sleep deprivation; and strategies to mitigate fatigue and maintain alertness. Employers should conduct regular audits to ensure that scheduling policies are maintained and that meal and rest breaks are taken during work shifts (ANA, 2014). They must promote a work culture that allows the employee to express concern of fatigue (TJC, 2018).

17. Employers should provide fair and sufficient compensation and appropriate staffing to foster a safe and healthful environment (Phillips & Moffett, 2013). Employers are responsible for using scheduling practices that align with research and evidence-based recommendations. Every nurse should be able to decline extra working hours or overtime without being penalized (ANA, 2014). Mandatory overtime or on-call time as a staffing strategy should be eliminated (ANA, 2014).

18. Extended commutes after long shifts should be discouraged or the NNP should be provided with an opportunity to rest prior to leaving the institution (ANA, 2012). Transportation should be offered to fatigued employees who have completed an extended work shift. Blum et al., (2011). recommend transportation after 24-hour shifts, but we suggest it after 16-hours or longer.

19. Employers must provide safe staffing patterns and patient loads consistently for safe patient care and to provide healthy work environments (Snapp et al., 2021; ANA, 2014).

 20. Recruitment and retention of NNPs is dependent on the promotion of healthy work-life balance and on safe staffing patterns and workload. Providing an environment that attracts and retains the NNP workforce is a responsibility of employers and reduces fatigue that is caused by overwork, frequent new hire orientations, and burnout by seasoned NNPs (NANN, 2018).

21. Provider-to-provider handoff is a critical time for error after a long shift. Employers should have standardized electronic health records (EMR) with integrated patient information for the handoff process (Blum et al., 2011).

22. “Home call” should be incorporated into the overall hours worked at each institution and established guidelines for maximum hours worked with a work relief system built in (Blum et al., 2011).

 Future Recommendations

 Future study and research areas identified in this position statement are directly related to NANNP’s mission to provide recommendations for patient safety and promote NNP health and wellness. There is a lack of evidence in the literature to answer critical questions about shift length for NNPs (i.e., 12- versus 24-hour schedules) and fatigue, burnout, and job satisfaction were identified as critical areas of question that were 11 lacking in evidence in the literature. Because the NICU is evolving with increased patient complexity, workload, and NNP responsibilities, research must be conducted to determine whether all healthcare organizations should consider limiting shift length to 12 hours in Level IV units or all practice level nurseries and NICUs by 2030. There is limited evidence regarding patient safety and overall NNP health, so it is recommended that future research grants or areas of study address these questions.


Workplace fatigue remains a critical issue in healthcare and patient safety. NNPs are professionally accountable for ensuring that they are fit to provide patient care, and they should be proactive in minimizing risks to patient and personal safety. NNPs are encouraged to collaborate with colleagues and employers to create responsible staffing patterns and work models that reduce the risk of threats to patient and personal safety caused by fatigue. Employers have a responsibility to limit NNP workloads and schedules to reasonable levels

Source:Impact_of_Advanced_Practice _Shift Length_and_Fatigue_2022.pdf (

The Future Looks Bleak for Surgical Residents Like Me

Looming Medicare cuts will force surgeons to do more with less, undermining trainee succes

by Erfan Faridmoayer, MD September 28, 2022

“But you’re walking away from your dream!”

“Think about all of the years of hard work you have invested.”

“What will you do instead?”

These are common reactions people have when they hear about a surgeon walking away from medicine. It’s hard to imagine a surgeon would ever do such a thing. But the past few years may have changed that commitment to medicine for many.

My peers and I have invested nearly a decade to become surgeons. We’ve spent years in the classroom and hospital rotations, taking various standardized tests, and interviewing for competitive training positions around the country for the privilege of standing in the operating room — a humbling opportunity to serve patients from all walks of life. This is why it’s so disheartening to witness healthcare workers across the country, including residents, walk away from medicine. They are just too frustrated by the challenges of a healthcare system that is crippling surgeons and other doctors from providing effective care.

Now, a looming 8.5% cut in Medicare payments to surgical care threatens to make matters worse.

My Experience in Surgical Training

I went into medicine because I wanted to have a positive impact on people’s lives, and I chose to pursue a career in surgery because I loved the immediacy of improving patients’ health in critical situations.

These are common reactions people have when they hear about a surgeon walking away from medicine. It’s hard to imagine a surgeon would ever do such a thing. But the past few years may have changed that commitment to medicine for many.

My peers and I have invested nearly a decade to become surgeons. We’ve spent years in the classroom and hospital rotations, taking various standardized tests, and interviewing for competitive training positions around the country for the privilege of standing in the operating room — a humbling opportunity to serve patients from all walks of life. This is why it’s so disheartening to witness healthcare workers across the country, including residents, walk away from medicine. They are just too frustrated by the challenges of a healthcare system that is crippling surgeons and other doctors from providing effective care.

Now, a looming 8.5% cut in Medicare payments to surgical care threatens to make matters worse.

My Experience in Surgical Training

I went into medicine because I wanted to have a positive impact on people’s lives, and I chose to pursue a career in surgery because I loved the immediacy of improving patients’ health in critical situations.

I distinctly remember the first time I witnessed a patient wake up from a kidney transplant. The patient, a mother in her sixties, had been on dialysis for years. When I told her that her kidneys were functioning again — that she would no longer need to travel every other day to the hospital for dialysis — her expression was priceless. “I have my life back,” she said, with gratitude for the chance of an improved quality of life. That encounter, and many more, inspired me to become a surgeon.

Medicine is by no means a conventional field. While many of my college classmates are now 5 or 6 years into their careers, my decade-long training after school has just begun. Stepping foot into the hospital as newly minted physicians in 2020 was a rocky start. My co-residents and I began our program just months into the pandemic when elective surgical practice was nearly halted. The vast majority of admissions to the hospital were from complications of COVID-19, impacting our ability to gain the broad knowledge classically acquired in the junior years of surgical training.

On top of this, we’ve continuously faced staffing and equipment and drug shortages, along with pressures from the staggering rise in medical inflation.

The Impact of Looming Medicare Cuts

The challenges that impact patients and their care just keep coming. The latest? The impending sky-high Medicare cuts for the surgical field.

While I’m pleased to see that Congress recently passed legislation aimed at lowering the cost of prescription drugs for seniors, there is much more that needs to be done. It’s alarming to hear that CMS is planning to make significant cuts to Medicare payments for surgical care starting January 1, 2023.

These misguided cuts will force surgeons to do more with less, promising a bleaker future for myself and my peers.

With fewer resources, more senior surgeons will have less time to spend with residents like me. I’ve had amazing role models during my training so far. But these cuts threaten future surgeons’ access to the sound mentorship and necessary resources needed to adequately build the next generation of healthcare providers.

On top of this, these cuts will exacerbate the burnout that surgeons across the country already face, leading more surgeons to close their practices and walk away from medicine toward an early retirement. Put simply, there will be fewer surgeons to care for patients. We will be left with a vicious spiral that jeopardizes the stability of our healthcare system.

I am particularly concerned about the consequences of physician shortages on patients living in underserved areas, where there is already a scarcity of surgeons, anesthesiologists, and operating room staff. I can speak to that by the virtue of my training at the highest volume safety-net hospitals in Brooklyn. Additional cuts to the bedrock — Medicare — on which such systems rely will lead to delays in care, worsening patient outcomes, and eventually, increasing the cost of care with patients walking through our doors with more advanced disease down the road.

Year-after-year proposed cuts by CMS underscore the need for long-term reform to the broader Medicare payment system.

Without congressional action, the cuts to surgical budgets, staffing, and services will hit seniors in my area and many other regions harshly. Now, more than ever, we must support the type of thoughtful, responsible healthcare policies that ensure capable, wide-ranging surgical options for patients and their families across New York and the rest of the country.

Erfan Faridmoayer, MD, is a surgical resident at Downstate Health Sciences University in Brooklyn, New York. He is in his third year of a seven-year program.



Practice of Cuff Blood Pressure Measurements

Cistone, Nicole MSN, RN, RNC-NIC; Erlenwein, Danielle MSN, RN; Bapat, Roopali MD, FAAP; Ryshen, Greg MS, MBA, CSSGB, QIS; Thomas, Leslie MSN, APRN, NNP-BC; Haghnazari, Maria S. MSN, RN; Thomas, Roberta MPT, PT; Foor, Nicholas BS; Fathi, Omid MD Advances in Neonatal Care: August 2022 – Volume 22 – Issue 4 – p 291-299 doi: 10.1097/ANC.0000000000000947



Extreme preterm infants face lengthy hospitalizations and are often subjected to painful stimuli. These stimuli may be related to routine caregiving that may negatively impact long-term developmental outcomes. Frequently obtained cuff blood pressure (BP) measurements are an example of a potentially noxious stimulus to preterm infants that may have a cumulating impact on development.


The primary aim was to explore the frequency of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the neonatal intensive care unit (NICU). Our secondary aim was to reduce the number of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the NICU.


Quality improvement methodologies per the Institute for Healthcare Improvement were used combined with a multidisciplinary approach. Participants were infants born less than 27 weeks of gestation and discharged home. The baseline period was 2015 through Q2-2018 and the intervention period was Q3-2018 through Q1-2020. The electronic medical record was used to collect data and Minitab Statistical Software was used for data analysis.


A baseline of 5.0% of eligible patients received the desired number of cuff BP measurements and increased to 63.2% after the intervention period.

Implications for Practice: 

Findings demonstrate that using quality improvement methodology can improve clinical care. Findings suggest the feasibility and safety of reducing the number of cuff BP measurements obtained on hemodynamically stable infants in the NICU.

Implications for Research: 

Future endeavors should aim to reduce the quantity of painful stimuli in the NICU. Long-term developmental outcomes should be correlated in these patients.

Association of Neonatal Pain-Related Stress and Parent Interaction With Internalizing Behaviors Across 1.5, 3.0, 4.5, and 8.0 Years in Children Born Very Preterm

October 21, 2022

Mia A. McLean, PhD1,2Olivia C. Scoten, Bsc, Hons1Cecil M. Y. Chau, Msc1,2; et alAnne Synnes, MDCM, MHSc1,2,3Steven P. Miller, MDCM, MAS4,5Ruth E. Grunau, PhD1,2,3 JAMA Netw Open. 2022;5(10):e2238088. doi:10.1001/jamanetworkopen.2022.38088

Key Points:

Question  Does supportive parenting ameliorate the association between neonatal pain-related stress and child internalizing behaviors in children born very preterm?

Findings  In this cohort study of 186 children born very preterm, internalizing behaviors increased across ages 1.5, 3.0, 4.5, and 8.0 years, and more neonatal pain-related stress was associated with greater internalizing behaviors across ages. At 1.5 years, parenting stress was associated with more internalizing behaviors, whereas at age 3.0 years, a more supportive parenting environment was associated with fewer internalizing behaviors across development.

Meaning  These findings suggest that supportive parenting is associated with reduced child anxiety and depressive behaviors from toddlerhood through school-age in children born very preterm.


Importance  Internalizing (anxiety and/or depressive) behaviors are prevalent in children born very preterm (24-32 weeks’ gestation). Procedural pain-related stress in the neonatal intensive care unit (NICU) is associated with long-term internalizing problems in this population; however, whether positive parenting during toddlerhood attenuates development of internalizing behaviors across childhood is unknown.

Objective  To investigate whether neonatal pain-related stress is associated with trajectories of internalizing behaviors across 1.5, 3.0, 4.5, and 8.0 years, and whether supportive parenting behaviors and lower parenting stress at 1.5 and 3.0 years attenuate this association.

Design, Setting, and Participants  In this prospective longitudinal cohort study, preterm neonates (born at 24-32 weeks’ gestation) were recruited from August 16, 2006, to September 9, 2013, with follow-up visits at ages 1.5, 3.0, 4.5, and 8.0 years. The study was conducted at BC Women’s Hospital, Vancouver, Canada, with recruitment from a level III neonatal intensive care unit and sequential developmental assessments performed in a Neonatal Follow-up Program. Data analysis was performed from August to December 2021.

Main Outcomes and Measures  Parental report of child internalizing behaviors on the Child Behavior Checklist at 1.5, 3.0, 4.5, and 8.0 years.

Results  A total of 234 neonates were recruited, and 186 children (101 boys [54%]) were included in the current study across ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years. After accounting for clinical factors associated with prematurity, greater neonatal pain-related stress was associated with more internalizing behaviors across ages (B = 4.95; 95% CI, 0.76 to 9.14). Higher parenting stress at age 1.5 years (B = 0.17; 95% CI, 0.11 to 0.23) and a less supportive parent environment (less sensitivity, structure, nonintrusiveness, nonhostility, and higher parenting stress; B = −5.47; 95% CI, −9.44 to −1.51) at 3.0 years were associated with greater internalizing problems across development to age 8.0 years.

Conclusions and Relevance  In this cohort study of children born very preterm, exposure to repetitive neonatal pain-related stress was associated with persistent internalizing behavior problems across toddlerhood to age 8.0 years. Supportive parenting behaviors during early childhood were associated with better long-term behavioral outcomes, whereas elevated parenting stress was associated with more child anxiety and/or depressive behaviors in this population. These findings reinforce the need to prevent pain in preterm neonates and inform future development of targeted parent-led behavioral interventions.


Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years

List of authors: Jacqueline F. Gould, Ph.D., Maria Makrides, Ph.D., Robert A. Gibson, Ph.D., Thomas R. Sullivan, Ph.D., Andrew J. McPhee, M.B., B.S., Peter J. Anderson, Ph.D., Karen P. Best, Ph.D., Mary Sharp, M.B., B.S., Jeanie L.Y. Cheong, M.D., Gillian F. Opie, M.B., B.S., Javeed Travadi, D.M., Jana M. Bednarz, G.Dip



Docosahexaenoic acid (DHA) is a component of neural tissue. Because its accretion into the brain is greatest during the final trimester of pregnancy, infants born before 29 weeks’ gestation do not receive the normal supply of DHA. The effect of this deficiency on subsequent cognitive development is not well understood.


We assessed general intelligence at 5 years in children who had been enrolled in a trial of neonatal DHA supplementation to prevent bronchopulmonary dysplasia. In the previous trial, infants born before 29 weeks’ gestation had been randomly assigned in a 1:1 ratio to receive an enteral emulsion that provided 60 mg of DHA per kilogram of body weight per day or a control emulsion from the first 3 days of enteral feeds until 36 weeks of postmenstrual age or discharge home, whichever occurred first. Children from 5 of the 13 centers in the original trial were invited to undergo assessment with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at 5 years of corrected age. The primary outcome was the full-scale intelligence quotient (FSIQ) score. Secondary outcomes included the components of WPPSI.


A total of 1273 infants underwent randomization in the original trial; of the 656 surviving children who had undergone randomization at the centers included in this follow-up study, 480 (73%) had an FSIQ score available — 241 in the DHA group and 239 in the control group. After imputation of missing data, the mean (±SD) FSIQ scores were 95.4±17.3 in the DHA group and 91.9±19.1 in the control group (adjusted difference, 3.45; 95% confidence interval, 0.38 to 6.53; P=0.03). The results for secondary outcomes generally did not support that obtained for the primary outcome. Adverse events were similar in the two groups.


In infants born before 29 weeks’ gestation who had been enrolled in a trial to assess the effect of DHA supplementation on bronchopulmonary dysplasia, the use of an enteral DHA emulsion until 36 weeks of postmenstrual age was associated with modestly higher FSIQ scores at 5 years of age than control feeding.

Source:Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years | NEJM

Animated 🐾Where Does Kitty Go in the Rain?

133,247 views – Apr 7, 2022  #readaloud #storytime #kidsbooksonline

Toadstools and Fairy Dust

🍄We all want to know, where do the animals go…during the rain? 🌧️Do they even like the rain? Come find out and learn a few science facts along the way by joining us for a kid’s book read aloud, “Where does Kitty go in the rain” created by Vooks. Watch even more stories like this on the Vooks app today!

9 reasons why you shouldn’t let a rainy day derail your walk (or run)

No rain, no gain!

Shona Hendley  – MAY 25, 2022 9:30AM

Thanks to La Nina we’ve all be dealing with the effects of wet weather more than we’d like; umbrellas, sodden shoes, and probably cancelling more than a few of your regular ‘mental health walks’ or runs. Shona Hendley explains why the latter should never come at the expense of a bit of harmless precipitation.

For decades, musicians like Gene Kelly, the Ronettes and even Rihanna have been merrily singing and dancing in the rain; while over the past couple of months many Sydneysiders have probably inadvertently and maybe not so happily found themselves walking in it.

No, perhaps not ideal for the unprepared but for those who are equipped with an umbrella or raincoat, there are actually some pretty impressive benefits of walking or running in the rain which may have even the most reluctant soon singing along too.

Dr Vivienne Lewis, a clinical psychologist at the University of Canberra says walking in the rain is actually great for our mental health for “a range of reasons.”

1. It’s a sensory experience

“Human beings need touch. It is an essential need and rain can provide this,” she tells Body+Soul.

“When we walk (or run) in the rain it provides a sensory experience completely different to non-rain. We can feel it on our face and body and this sensory experience can feel lovely on our skin and fresh on our face.”

2. It is freeing and endorphin releasing!

“Have you ever run in the rain and just felt so free? It gets our adrenalin pumping, and this releases stress,” Lewis says.

She also says that when we walk endorphins, the feel-good chemicals are released, and this also makes us feel good.

“In the rain, the release of endorphins can be enhanced especially if we are raising our heart rate to get out of the rain!”

3. It gives us time to think

“A walk in the rain can give us time to think. To be alone with our thoughts. To feel connected to nature. It can clear our head,” explains Lewis.

4. The sound and smell are calming

Because rain is a type of white noise, it can be soothing, meaning you can get your steps up, while taking in natures calming soundtrack at the same time.

Sydneysider and regular rain walker, Leanne Lusher agrees and identifies this as one of her favourite things about walking in the rain.

“I find walking in the rain so refreshing! I love the sounds and smell it creates,” she says.

The distinctive smell that soothes your mind and body even has its own name– Petrichor which was coined in the 1960s by two Australian scientists.

5. There are less people

Lusher says another great benefit to walking in the rain, especially for those who don’t like crowds is that there are usually less people which can make it a more relaxing experience.

“I like that hardly anyone else is out walking as they are hiding from the rain,” she explains.

6. It metaphorically washes the day away

Rain can also be a metaphor for washing the day away or washing our troubles away says Lewis.

“Think of the rain running down your body as a way to release negative emotions. A bit like we might do in the shower after a hard day. It’s that sense of just letting go. Just enjoying what nature has provided. Letting go of all your cares. Allowing yourself to just be in the moment and get soaked.”

7. The air is cleaner

An MIT study published in the journal of Atmospheric Chemistry and Physics showed that the air is actually cleaner during and after heavy rainfall.

Dr Lewis adds that this freshness can make the “smell and touch of fresh water feel exhilarating.”

If the mental health benefits aren’t enough to sell the experience to you, there are also some pretty impressive physical health benefit that may just get it across the line.

8. It’s good for your skin and hair

A 2016 study found that the rain plays a pivotal role in skin health driving humidity which helps freshen and moisturise our skin and hair. Ah, yes please.

9. Walking or running in the cold can burn more fat

And if burning fat is your goal, walking or running in the rain maybe exactly what you need to do.

Japanese scientists have carried out research on the effects of rain on energy metabolism while running in cold weather which showed that “energy demand increases when running in cold conditions.”

In other words, you burn more calories walking or running in the wet and cold than in a dry and warm environment.

So, if you haven’t already, it’s time to invest in a good set of water-resistant shoes, quality raincoat and start walking around those muddy puddles.

Dr Vivienne Lewis is a clinical psychologist at the University of Canberra. She treats people with anxiety and depression.


Taking advantage of the gifts that nature provides within our environment creates opportunities for us to connect, reflect, and reset ourselves in the midst of our daily lives. 

What gifts in nature bring you a sense of joy in life and help you feel present in the world? 

For me, walking in the rain is invigorating, providing a sense of calm tranquility. I love the fresh scent of the earth, the positive ion exchange within the air and calming sounds of the pitter-pattering rain drops. The rain is representative of a new beginning, a simple reset during the day. It reminds me of the joy of being alive and present with the world around me. This Fall season in Seattle, I look forward to basking in the seasonal downpour and crunching leaves as nature transitions into its winter hibernation before the spring re-awakening. 

Wishing you all joyful wonders and rejuvenating adventures in nature’s bounty this Fall season! 

        Dec 30, 2017     Wandering_higher

Coastal towns, national parks, chill vibes, and sick waves! Stayed in Montanita and Ayampe. The people are awesome, the parties are fun, and it’s not overrun with tourists or too Americanized. First time in South America but will be back!

Law, Virtual Health, History


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

(USA – 12 %, Global Average: 11.1%)

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

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



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

Feb 28, 2022 

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


A training program for nurses in North-Eastern Greece

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


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



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

Design and methods

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


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


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

Practice implications

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


Expanding International Access to Children’s Mental Health Care

April 7, 2021

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

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

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

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

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

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

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

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

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

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


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

1,263,884 views     Jul 8, 2022     wrs

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

Pages 3631-3632 | Published online: 27 Sep 2020

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

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

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

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

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

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

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

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

May she rest in peace!


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

Apr 8, 2022    CBC News

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

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


New Guidance Encourages Moms to Nurse for Two Years

Michelle Winokur, DrPH    

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

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

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

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

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

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

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

Source:nt-aug22.pdf (

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Managing relationships after premature birth

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

How premature birth may affect the parents

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

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

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

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

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

How premature birth can affect siblings

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

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

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

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

How premature birth can affect grandparents

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

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

Managing competing demands after premature birth

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

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

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

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

How others can help

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

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

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

Celebrating your premature baby’s breakthroughs

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

Sharing good news

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

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

Tommys: Our Story

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



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

March 18, 2022

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

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

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

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

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

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

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

Health care worker stats 

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


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

    September 01, 2022

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

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

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

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

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

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

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

The Technology Behind Virtual Nursing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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


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

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

   Washington, DC June 28, 2022

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

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

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

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

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

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

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

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

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


Osteopathic Manipulative Treatment in Neonatal Intensive Care Units

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


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



Using AI to save the lives of mothers and Babies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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


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

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


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

A Systematic Review


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


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

Data Sources:

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

Study Selection:

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

Data Extraction:

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

Data Synthesis:

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


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


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


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

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

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

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

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

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

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

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

Country        Dessert            Fall 2022 Fashion                      

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

Christmas surf with friends, last waves of 2019 Greece!

Dec 28, 2019         Αγγελος Περαθωρακης

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



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

(USA – 12 %, Global Average: 11.1%)

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

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

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

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


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

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


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

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

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

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

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

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

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

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

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

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

Source:nt-jul22.pdf (

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

12,357,089 views – Nov 26, 2020

رؤى محمد نعيم – اسياد اللواري – جديد الكليبات السودانية

Patterns and outcome of neonatal surgery in Sudan

Enas IsmailA. ElnaeemaI. Salih   Published 2019

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


Using technology to promote safe maternal health practices in Nigeria

Using technology to promote safe maternal health practices in Nigeria


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


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

Description of study

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

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

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

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

Study outcomes

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

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

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


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


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

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


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

Published: February 9, 2022


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

Full Article:

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

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

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


Midwives save lives in Sudan

02 July 2021- Anna Sambrook


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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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



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


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


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


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


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


What’s New in Practice Improvements in Neonatal Care?

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

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

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

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

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

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

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

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

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

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

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


Less Invasive Surfactant Delivery Works for Tiniest Newborns

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Less Invasive Surfactant Delivery Works for Tiniest Newborns | MedPage Today

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

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


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

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

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

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

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


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

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

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

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

Tips for Parents on Building Caregiving Skills With a NICU Baby

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

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

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

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

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

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

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


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

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

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

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


Support Resources for NICU Parents and Loved Ones


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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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


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

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

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

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

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


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

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

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

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

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


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

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

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

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


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

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

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

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

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

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

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

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

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


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

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

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

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

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

Resources for Friends and Family

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

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

Last Updated: December 2020


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

    Jul 19, 2020     Science and Nonduality

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

Watch the movie at The film is available by donation.


Welcoming a new life – Physical therapies for premature baby

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

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

5 Tips to Support you Dad, in the NICU

Jun 15, 2022   CanadianPreemies


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

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

Key Points

Question  Is phthalate exposure during pregnancy associated with preterm birth?

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

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


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

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

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

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

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

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

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


New target for therapies to treat preterm labour

August 9, 2022

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

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

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

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

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

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

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

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

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

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

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

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

These 14 innovations are enabling young people to address their mental health needs

May 23, 2022 World Economic Forum

The World Economic Forum is the International Organization for Public-Private Cooperation. The Forum engages the foremost political, business, cultural and other leaders of society to shape global, regional and industry agendas. We believe that progress happens by bringing together people from all walks of life who have the drive and the influence to make positive change

Fun for the little ones!

African Animals for Children with pronunciation (and videos)

English Paradise Kids

Welcome to the world of African animals! Learn with your children and students the names of African animals. Children will travel through this virtual safari by discovering Savannah African animals in English in a playful and entertaining way while seen moving, listening to the name in English with pronunciation and reading how to write.

Diving Sudan

This video was made during a live aboard in the Red Sea of Sudan with Red Sea Explorers. During the nine days of diving we visited the following dive site’s: – Shaab Ambar – Protector Reef – Karam Masamirit – Ed Domesh – Habili gab Miyum 1 – Dahrat Abid – Habili gab Miyum 2 – Dahrat Qab – Tamarsha – Pinnacolo – Shaab Jumna – Saganeb – Shaab Rumi – Umbria




Rank: 12  –Rate: 14.9%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

The Philippines is an archipelagic country in Southeast Asia. It is situated in the western Pacific Ocean and consists of around 7,641 islands that are broadly categorized under three main geographical divisions from north to south: LuzonVisayas, and Mindanao. The Philippines is bounded by the South China Sea to the west, the Philippine Sea to the east, and the Celebes Sea to the southwest. It shares maritime borders with Taiwan to the north, Japan to the northeast, Palau to the east and southeast, Indonesia to the south, Malaysia to the southwest, Vietnam to the west, and China to the northwest. The Philippines covers an area of 300,000 km2 (120,000 sq mi) and, as of 2021, it had a population of around 109 million people, making it the world’s thirteenth-most populous country. The Philippines has diverse ethnicities and cultures throughout its islands. Manila is the country’s capital, while the largest city is Quezon City; both lie within the urban area of Metro Manila.

The Philippines is an emerging market and a newly industrialized country whose economy is transitioning from being agriculture-centered to services- and manufacturing-centered. It is a founding member of the United NationsWorld Trade OrganizationAssociation of Southeast Asian Nations, the Asia-Pacific Economic Cooperation forum, the East Asia Summit and a member of the Non-Aligned Movement since 1993. The Philippines’s position as an island country on the Pacific Ring of Fire that is close to the equator makes it prone to earthquakes and typhoons. The country has a variety of natural resources and is home to a globally significant level of biodiversity.

There were 101,688 hospital beds in the country in 2016, with government hospital beds accounting for 47% and private hospital beds for 53%. In 2009, there were an estimated 90,370 physicians or 1 per every 833 people, 480,910 nurses and 43,220 dentists. Retention of skilled practitioners is a problem. Seventy percent of nursing graduates go overseas to work. As of 2007, the Philippines was the largest supplier of nurses for export. The Philippines suffers a triple burden of high levels of communicable diseases, high levels of non-communicable diseases, and high exposure to natural disasters.

There is improvement in patients access to medicines due to Filipinos’ growing acceptance of generic drugs, with 6 out of 10 Filipinos already using generics. While the country’s universal healthcare implementation is underway as spearheaded by the state-owned Philippine Health Insurance Corporation, most healthcare-related expenses are either borne out of pocket or through health maintenance organization (HMO)-provided health plans. As of April 2020, there are only about 7 million individuals covered by these plans.


This month’s blog embraces the Philippines, our 71st country-focused blog. Throughout our journey you have inspired and amazed us, touched our hearts and fueled our imaginations. We have explored the breadth of our associations, witnessed the global diversities, similarities, needs, barriers, challenges and resources present within our Preterm Birth community. Kat and I began our journey with eyes wide open, minds full of curiosity, hearts wary yet open, following an unseen but deeply compelling call to serve the Community in some guided capacity.  We always knew we would receive more than we could ever give. We appreciate and thank you for who you are and your presence in our lives. Within your eternal perfection, such goodness, strength and love abide.


Socioeconomic Disparities in Adverse Birth Outcomes in The Philippines

Ryan C.V. Lintao Erlidia F. Llamas-Clark Ourlad Alzeus G. Tantengco Open Access Published: April 10, 2022DOI:

Kaforau et al. reported the burden of adverse birth outcomes and their risk factors in the Pacific Islands region. Preterm birth prevalence was 13.0%, while low birth weight was 12.0%. Malaria, substance use, obesity, and poor antenatal care were the most significant risk factors associated with adverse birth outcomes.

 The Philippines, a lower-middle-income country in the Asia Pacific, continues to experience challenges in addressing adverse birth outcomes. We share the status and the socioeconomic disparities in adverse birth outcomes in the Philippines.

The latest health survey in 2017 showed a 3.0% preterm birth rate in the Philippines.

 Low birth weight (LBW) incidence was 11.9% in 2020.

 Moreover, in a newborn screening cohort from 2015 to 2016, 13.6% were small-for-gestational age.

 Increased antenatal care utilization, essential newborn care, and kangaroo mother care have decreased adverse birth outcomes and neonatal mortality.

 However, health inequalities prevail in the Philippines.

Despite no difference in LBW incidence between urban and rural areas, regional disparities exist. The national capital region, Metro Manila, had the lowest LBW rate (9.0%), while two regions in the southern Philippines had the highest LBW rates (Davao at 20.0%, and Zamboanga at 21.0%).

 Smokers were more likely to have LBW newborns (21.0%) than nonsmokers (14.0%), agreeing with Kaforau and colleagues findings. A cohort study examining maternal second-hand smoke (SHS) exposure showed significantly lower birth weight in the SHS-exposed group.

Pregnant women exposed to SHS had higher parity, lower educational attainment, and lower monthly household income.

Socioeconomic status and its proxy variables (e.g., educational attainment, household income, and occupation) were shown to affect birth outcomes in the Philippines. LBW incidence decreased with higher maternal educational attainment, with 17.7% of mothers who reached primary school level and 12.5% of mothers who reached college level having LBW newborns. Household wealth was a significant determinant of LBW: mothers in the lowest wealth quintile had higher LBW incidence (16.0%) than mothers in the highest quintile (12.5%).

With increasing socioeconomic inequality exacerbated by the ongoing pandemic, underlying social determinants must be recognized and addressed. We call for more research to investigate the country’s social determinants of adverse birth outcomes, which can be used as the basis for evidence-based policies and health services to improve maternal and neonatal outcomes. We also emphasize the need for good governance, gender equality, and equitable access to women’s and reproductive health services (antenatal care, basic emergency obstetric and neonatal care, and family planning) to reduce widening disparities in adverse birth outcomes.

Source:Socioeconomic disparities in adverse birth outcomes in the Philippines – The Lancet Regional Health – Western Pacific

Magnus Haven – Oh, Jo (Official Music Video)

Premiered Jun 26, 2022  Magnus Haven

Jo is a term of endearment among Kapampangans, which means special someone. So the love song pays tribute to that “Jo” or special someone. A statement of love echoing the romantic joy that that “Jo” brings to her partner’s life.

Pregnancy becomes a more vulnerable time with climate change

Wildfires, natural disasters, rising heat can lead to poor health outcomes for the expectant and their babies – By Katherine Kam – April 11, 2022

In the western United States, where massive wildfires have fouled the air with smoke and hazardous levels of pollutants, Santosh Pandipati, an obstetrician in California, counsels pregnant patients to always check air quality before they venture outside to exercise. “You need to plan your outdoor activities when the air quality is better,” he tells them.

In other parts of the country, where hurricanes and floods have displaced pregnant residents, obstetrician Nathaniel DeNicola has advised patients, including those he saw in New Orleans, to pack a preparedness kit.

In case of evacuation, “they might be away from home for a long time,” he said. DeNicola encourages people to include emergency drinking water, extra supplies of medications and a paper copy of their medical records. “If the power’s out, that’s not typically available” now that most records are electronic, he said.

As scientists study how climate change is affecting human health, pregnant people and their unborn babies are emerging as a vulnerable group.

Those who must evacuate during natural disasters are often extremely distressed and might find their pregnancy health care interrupted. “If you have to flee, how do you make sure you continue to have access to your OB/GYN or to the hospital you plan to deliver in?” said Pandipati, who has seen patients who have escaped wildfires. “If you end up needing to go live with family an hour or two hours away, you have a disruption in care.”

Pregnancy & Parenthood

It doesn’t take a catastrophe to create problems. Ongoing exposure to hot temperatures and air pollution might raise the risk of adverse pregnancy outcomes, such as preterm birth and low birth weight.

About 7,000 California preterm births linked to wildfire smoke risks, study says

Spurred by growing evidence on climate-related effects, Pandipati and DeNicola have tailored their medical advice, not to alarm people, but to prepare them. “The reality is that we need to start telling our patients right now that the climate is changing,” Pandipati said. “We need to empower patients.”

In 2016, the American College of Obstetricians and Gynecologists issued a position statement on climate change, calling it “an urgent women’s health concern and a major public health challenge.

Air pollution and heat exposure

Amid widespread changes wrought in the environment, air pollution and heat exposure have been significantly associated with preterm birth, low birth weight and stillbirth in the United States, according to a 2020 review published in JAMA Network Open. Such exposures are becoming increasingly common, according to the paper.

DeNicola, an obstetrician at the Johns Hopkins Health System in Washington, was one of the review’s co-authors.

Exposure to high temperatures can cause dehydration. During pregnancy, dehydration can lead to the release of oxytocin, a hormone that contributes to labor contractions, he said. “The extreme heat could very well be causing an increase in that mechanism,” DeNicola said. “It’s revved up.”

If labor occurs and a baby is born before 37 weeks, it’s a preterm birth, compared with a normal pregnancy of 40 weeks. Some of these newborns may have immature organ systems and experience trouble with breathing, feeding and regulating body temperature. Long term, premature babies might develop other problems, including learning disabilities and hearing or vision problems. The more premature the baby, the more serious the health risks.

Racial disparities in exposure

In the JAMA study, women of all races were at increased risk for poor pregnancy outcomes when exposed to heat and air pollution, but disparities emerged. Black women consistently had the highest risks of preterm birth and low birth weight, said Rupa Basu, an epidemiologist who also co-wrote the JAMA study. She is chief of the air and climate epidemiology section at the California Office of Environmental Health Hazard Assessment.

Because of historical redlining, higher-risk communities might be exposed to more pollution from sources such as freeways, she said. Residents may also dwell within “heat islands,” urban locations that have higher temperatures than outlying areas. “There’s less green space and more buildings and cement and blacktops to really absorb and retain the heat,” Basu said.

Anecdotally, Pandipati said he has seen the effects of heat waves on his patients, some of whom work in agriculture. He consults on high-risk pregnancies as a maternal and fetal medicine specialist with Obstetrix of San Jose. Some women travel to the Bay Area clinic from as far away as California’s Central Valley.

During one record-breaking heat wave before the pandemic, Pandipati noticed many ultrasounds with low levels of amniotic fluid in the womb — a situation that might require doctors to deliver a baby early. “These were moms who were saying that they don’t always have access to air conditioning, they’re often working more manually, either in agriculture or manual labor-type jobs, not always able to stay hydrated adequately,” he said. “I was starting to wonder, wow, I think this is really from the heat waves that we’re experiencing.”

“We just kept monitoring these pregnancies and then things just turned around and the fluid improved. They turned around as the heat wave dissipated,” he said. “We didn’t have to end up delivering them early.”

Air pollution and poor pregnancies

Air pollution, whether from urban pollutants or wildfires, has also been linked to poor pregnancy outcomes.

Air pollution affects preterm birthrates globally, study finds Wildfire pollution may have contributed to as many as 7,000 additional preterm births in California between 2007 and 2012, according to a study that Stanford researchers published in 2021. Wildfire smoke contains fine particulate matter called PM 2.5, which can enter the lungs and bloodstream to create serious health problems. The researchers hypothesized that wildfire pollution might have triggered an inflammatory response that led to preterm delivery.

Weather disasters and mental health

There’s debate about whether human-caused climate change is producing stronger or more frequent hurricanes. But Hurricane Sandy, which struck New York and New Jersey particularly hard in 2012, offered a glimpse into how such devastating superstorms can place severe stress on pregnant people.

In a 2019 study that looked at pregnancy complications in New York after Sandy, researchers found a heightened risk of problems such as early delivery and mental illness. The latter peaked about eight months after the hurricane. In the aftermath of community disasters, post-traumatic stress disorder, depression and anxiety can develop.

Natural disasters trigger a cascade of health consequences, DeNicola said. While there may not be direct cause and effect on birth outcomes, “a lot of it is considered to be because of the stress of the event, either the stress of evacuation or the stress of difficulty getting potable water, the stress of maybe not having the typical indoor living conditions that you’re expecting,” DeNicola said. “You’re not having heat or not having air conditioning.”

“There are a number of physical stressors and psychosocial stressors that come with bracing for a natural disaster like a hurricane and an evacuation,” he said. “People posit, and I think it’s a reasonable concern, that that all prompts some kind of cascade in pregnancy that creates things like preterm contractions.”

A safer pregnancy

Both obstetricians routinely talk to their patients about air and water.

“You need more hydration in pregnancy in general. A woman’s blood volume will increase roughly 50 percent during pregnancy,” DeNicola said. “That’s a lot of extra volume to maintain, so hydration’s really important anyway. I make the extra point that as the seasons get hotter, which happens more often now, you’ll need even more hydration and you need to be aware of things like preterm contractions that are prompted by extreme heat and dehydration.”

Pandipati said he warns patients to watch out for heat waves and to keep an eye on the air quality index, too.

“Ideally, 1 to 50 is good air quality. If you’re starting to get up into the 50 to 100 range, you need to start modifying your activities, doing less outdoor exercise, not as long, not as hard,” he said. “If you’re already not feeling well, you’re coughing, you already have respiratory illness, you shouldn’t be out there.”

Such illnesses include asthma, respiratory allergies and other chronic lung conditions, Pandipati said.

“By the time the AQI is 100, you need to just exercise indoors,” he said. “You need to plan your outdoor activities when the air quality is better, so usually, very early in the morning.” Air quality over 100 begins to enter the unhealthy range.

During wildfires, those who are pregnant must be especially careful about spending time outside, DeNicola said. “During covid, we all wear masks for everything, so it’s kind of redundant,” he said, “but I do mention that wearing a mask is advised and to really limit outdoor activity.”

Basu, the epidemiologist, has advocated for pregnant people to be included in heat advisories. “There are still a lot of heat advisories that don’t include pregnant women, but include other groups, such as the elderly,” she said. Many heat advisories also mention children, people with illnesses, even pets, but not pregnant people.

A natural experiment

A few pregnant patients have asked DeNicola about environmental concerns, but that small number is increasing, he said.

“I have had patients ask about where they should buy their new home because they heard that if you live near coal power plants, that could create worse air quality,” he said. “I’ve had them say similar things related to homes near a highway.”

Pandipati talks to fellow doctors about slipping climate change into the conversation naturally, for instance, while talking about outdoor exercise or staying hydrated during pregnancy. He tells doctors, “You don’t need to be an expert on climate emissions,” he said. “What you need to understand is that those emissions are leading to environmental changes that are now measurably increasing risks to the patients you care for.”

When DeNicola speaks to health-care professionals, he often mentions “a really strong natural experiment,” he said.

Researchers studied preterm birthrates before and after eight coal and oil power plants in California were retired. When the plants shuttered, pollution levels fell. In the 10 years following the closures, the rate of preterm births in the neighboring communities dropped 27 percent, a larger-than-expected reduction.

“When you knock out air pollution over a good 10-year period, the preterm birthrate dropped in a way that no other intervention can achieve,” DeNicola said. “It gives us a bit of hope.”

Doctors can start discussing climate change with pregnant patients, but in the long run, the solutions are much bigger, Pandipati said. “We need to be ensuring that we are enacting policies that stabilize or improve the environment, that really don’t neglect the science.”

“We’ve got to address the problem at the source,” he said. “That’s the real, ultimate preventive care.”


Chemicals Found in Cosmetics, Plastics Linked to Preterm Delivery

July 14, 2022

THURSDAY, July 14, 2022 (HealthDay News) – Phthalates, chemicals that are typically used to strengthen plastics, are in millions of products people use every day, but a new analysis confirms their link to a higher risk for preterm births.

The largest study to date on the topic analyzed data from over 6,000 pregnant women in the United States to better understand the link between phthalate exposure and pregnancy. It found that women with higher concentrations of phthalates in their urine were more likely to deliver preterm babies. Preterm babies, by definition, are delivered three or more weeks before their due date.

“Having a preterm birth can be dangerous for both baby and mom, so it is important to identify risk factors that could prevent it,” said senior study author Kelly Ferguson, an epidemiologist at the U.S. National Institute of Environmental Health Sciences (NIEHS).

For the study, the researchers pooled statistics from 16 studies conducted across the United States that included data on individual phthalate levels as well as the timing of the mothers’ deliveries, with the data spanning from 1983 to 2018. Approximately 9% (or 539) of the women delivered premature babies, with phthalate byproducts detected in over 96% of those urine samples.

The study, published online July 11 in JAMA Pediatrics, examined 11 different phthalates found in the pregnant women, and discovered that four of them were associated with a 14% to 16% greater probability of having a premature baby. The most consistent exposure was linked to a phthalate found commonly in nail polishes and other cosmetics.

“It is difficult for people to completely eliminate exposure to these chemicals in everyday life, but our results show that even small reductions within a large population could have positive impacts on both mothers and their children,” first study author Barrett Welch, a postdoctoral fellow at NIEHS, said in an institute news release.

The effort could be worth it: Reducing the level of phthalates exposure by 50% could prevent preterm births by 12%, on average, the researchers said. The interventions focused on specific changes, such as choosing phthalate-free personal care products, companies reducing the number of phthalates in their products on their own or changing regulations that would reduce exposure to these chemicals.

In the meantime, the researchers suggested avoiding processed food or food wrapped in plastic, instead opting for fresh, home-cooked meals. They also recommended choosing fragrance-free products, which are lower in phthalates. Limiting the amount of product used can also lower exposure.   More information:

Visit the U.S. Centers for Disease Control and Prevention for more on phthalate exposure.

SOURCE: NIH/National Institute of Environmental Health Sciences, news release, July 11, 2022


Forced Retirement Spotlighted as Risk Factor for Physician Suicide

Also time to do away with the “myth of the never-ill physician,”study author says by Shannon Firth, Washington Correspondent, MedPage Today July 5, 2022

Systemic support systems need to be implemented for physicians to prevent work-related stressors that could lead to suicide, a thematic analysis of 200 physician deaths suggested.

Among physician suicides included in the National Violent Death Reporting System database from 2003 to 2018, six themes were found to precede such deaths, including inability to work due to physical health, substance use, mental health issues, relationship conflicts, legal problems, and increased financial stress, all leading to work-related stress, reported Kristen Kim, MD, of the University of California San Diego, and colleagues.

The results further suggested that suicide risk is associated with premature retirement due to health issues that affect employment, they noted in Suicide and Life-Threatening Behavior.

Among 200 physician death narratives, nearly all that reported earlier-than-expected retirement were linked to a physical ailment, Kim told MedPage Today, including a surgeon with a tremor, a physician with dementia, and a physician with alcohol and prescription drug use problems who had lost hospital privileges.

Investigations by state medical boards, employers, and law enforcement were also common in the narratives, and a re-examination of the data found that a majority of the physicians who died by suicide during the study period were unemployed or “pending job loss and typically not by choice,” the authors noted.

While interpersonal conflicts, including those occurring at work, were common, “strained relationships with family members,” often in the context of a divorce or extramarital affair, were even more common, they added.

The study showed “substantial overlap” with a prior study on job-related problems preceding nurse suicides, with a few exceptions. While nurses experienced difficulty accessing mental health supports and medications following job loss, physicians did not. Furthermore, legal issues were a factor in the physician suicide data but not in the nurse data.

Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.

“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” they wrote.

Kim said that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”

To that end, Kim and team offered some anonymous screening tools and “confidential pathways” to treatment, including UC San Diego’s Healer Education Assessment and Referral Program, which links physicians to counseling and outpatient treatment.

In addition, the “Dr. Lorna Breen Health Care Provider Protection Act,” which was signed into law in March, includes funding for hospitals to implement suicide prevention initiatives and to promote help-seeking.

Kim also stressed the urgent need to reform the licensure application process to eliminate “invasive” questions about physicians’ mental health and substance use history, which serve to discourage help-seeking and have unintended consequences for patient care.

For this study, Kim and colleagues used a mixed methods approach combining thematic analysis and natural language processing to develop themes representing narratives of 200 physician suicides included in the National Violent Death Reporting System database from 2003 to 2018.

Of the 200 physicians, mean age was 53, 83.5% were men, 89.5% were white, and 62.5% were married. Over half had mental health problems, 16% had problems with alcohol, 14.5% had other substance use problems, and 22% had physical health problems.

Using natural language processing, the authors confirmed five of the six identified themes — except “incapacity to work due to deterioration of physical health” — which “was likely not identified by natural language processing because physical health issues were described as the various, specific conditions affecting work performance (e.g., back pain, tremor), which were not grouped as a common theme.”

Limitations to the study included the fact that the evaluations were conducted postmortem based on short narratives — usually two paragraphs long — developed following interviews with loved ones.

“We’re using the best available data that we have on the reasons for why they decided to do what they did,” Kim said, but most of the data, with the exception of quotes from suicide notes in the narratives, were not first-hand accounts.

In addition, because most of the physicians in the study were men and white, the results may not be reflective of the work-related stressors of underrepresented minorities.

Furthermore, the database used in the study is voluntary. While the number of states participating rose from six in 2003 to 42 in 2018, including the District of Columbia and Puerto Rico, 10 states still do not report these data.

If you or anyone you know is struggling with a mental health concern or having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).


Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care

Front. Pediatr., 23 March 2022

Gabriel Fernando Todeschi Variane1,2,3*, João Paulo Vasques Camargo2,4, Daniela Pereira Rodrigues2,5, Maurício Magalhães1,2,6 and Marcelo Jenné Mimica7,8

Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

FULL ARTICLE:Frontiers | Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care (

Karen M. Puopolo, MD, PhD

CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference

Published on Mar 21, 2022 in CHOP News

Children’s Hospital of Philadelphia (CHOP) is proud to announce that Karen M. Puopolo, MD, PhD, a national leader in the field of neonatology, has received the prestigious Pennsylvania Pediatrician of the Year Award from the American Academy of Pediatrics (AAP) after a unanimous selection by the Pennsylvania AAP Governance Committee and Board of Directors. Each year, this prestigious award is granted to a Pennsylvania pediatrician who exemplifies the ideals of the pediatric profession and participates in activities that reflect the foundation of the chapter.

As an attending neonatologist at CHOP and Chief of the Section on Newborn Medicine at Pennsylvania Hospital, Dr. Puopolo has dedicated her career to quantifying the risk for neonatal infection. She developed a clinical tool known as a sepsis calculator to estimate risk at the individual infant level to avoid unnecessary antibiotic use in neonates. This research has drastically changed newborn care in birth hospitals throughout the U.S. and world. 

Most recently, Dr. Puopolo conducted important research related to the COVID-19 pandemic. Dr. Puopolo led efforts of the national AAP Section on Neonatal Perinatal Medicine (SONPM) to draft clinical guidance on the screening and care of COVID-19-exposed and COVID-19-positive newborns.

“The naming of Dr. Puopolo as the PA AAP Pediatrician of the Year highlights her enormous contributions to perinatal health,” said Eric Eichenwald, MD, Chief of the Division of Neonatology at CHOP. “She embodies the AAP’s commitment to recognize women leaders who go above and beyond to provide excellent, evidenced-based care of newborns. What’s more, Dr. Puopolo’s unwavering dedication to advance the care of neonates during the COVID-19 pandemic has been unsurpassed.”

In addition to her clinical work, Dr. Puopolo serves as Associate Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She has authored hundreds of peer-reviewed publications, scientific abstracts, chapters, and editorials. A member of AAP since 1993, Dr. Puopolo has served many roles within the organization, including as a member of the Committee on Fetus and Newborn and on the Editorial Board of NeoReviews and Pediatrics.

Currently, Dr. Puopolo serves as chair for the AAP Southeastern Central Conference on Perinatal Research, where perinatal trainees can present their research and receive high-quality feedback.

CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference | Children’s Hospital of Philadelphia

Providing A Potential Treatment Option To Infants Where There Is None

Celia Spell   April 21, 2022

A little over 1% of babies born in the U.S. in 2020 fell under the category of very low birthweight, meaning they weighed less than 1,500 grams at birth or 3 pounds, 4 ounces. And considering that the Centers for Disease Control and Prevention says more than 3.5 million babies were born that year, almost 48,500 were considered to be at very low birthweight.

Many of these babies are born premature, at 30 weeks or less, and they have a high chance of having a hemorrhage in their brains shortly after birth, known as a germinal matrix hemorrhage (GMH). Bleeding like this within the substance of the brain is a form of stroke that can lead to a buildup of fluid in the brain known as hydrocephalus – both of which put babies at an increased risk of neurodevelopmental disability, and many don’t survive.

There is currently no medical treatment for GMH, and since these blood vessels are even more delicate when a baby is born prematurely, there is no way to predict or prevent bleeding in the brain after birth.

When Ramin Eskandari, M.D., a pediatric neurosurgeon at MUSC Children’s Health, read about the work that Stephen Tomlinson, Ph.D., vice chair of the Department of Microbiology and Immunology at MUSC, was conducting related to a specific part of the immune system known as the complement system, he thought it might have applications to infants as well.

“We were just having to wait for bad things to happen,” Eskandari said. “And then we had to react to them. We have no treatment for the actual hemorrhage or for preventing the stroke or hydrocephalus that comes after. Tomlinson was looking at adult pathologies in the brain, and we thought it would be a great opportunity to apply his methods to an animal model for premature infants.”

As joint principal investigators for their recent paper in the International Journal of Molecular Sciences, Tomlinson and Eskandari created a mouse model to represent premature infants of very low birthweight and to find treatment options for GMH. Mohammed Alshareef, M.D., a senior neurosurgery resident at MUSC and member of the collaborative lab, discovered that by inhibiting the complement system at a specific site within the brain immediately after a hemorrhage, they could prevent many of the permanent and temporary deficits that accompany hydrocephalus and stroke.

By treating GMH mouse models with the complement inhibitor known as CR2Crry, Tomlinson and Eskandari found improved survival and weight gain, reduced brain injury and incidence of hydrocephalus, and improved motor and cognitive performances in adolescence.

As part of the immune system, the complement system helps antibodies and phagocytic cells activate inflammation and remove microbes and damaged cells from the body, labeling and attacking them. But inflammation activation also leads to the detrimental effects of GMH, and while there is still no way to prevent the initial hemorrhage, Tomlinson and Eskandari are excited about the potential opportunity to prevent the events that occur after the brain bleed.

Cases of GMH are on the rise, and according to Eskandari, this rise is actually due to better care and clinical advancements. With improved prenatal care and better treatment options for premature infants, more babies are surviving being born early. But with more survival, comes higher chances of GMH.

“We’re seeing younger and younger babies viable,” Eskandari said. “I remember when a 23-week-old baby wasn’t viable, and even in the last eight years since my residency, we’re now seeing babies at 20 weeks not only be viable but live full lives and attend school.” It’s these medical advancements that show Eskandari just how important the findings of this study are. And treatment of GMH has the potential to alter an infant’s life course.

Success in inhibiting the complement system has led to a recent boom in research, with over 100 clinical trials currently ongoing, according to Tomlinson. But CR2Crry inhibitor has its own niche. By targeting the therapeutic specifically to the point where the pathology begins, physicians don’t need to knock out the complement system in the entire body, which can lead to increased risk of infections and other immune disorders. They can use less of the inhibitor and target it to a local site, which is safer for patients.

“It’s because this is targeted,” Tomlinson said. “We can actually inject fairly small concentrations directly into the bloodstream to target the injured brain.”

In addition to using the CR2Crry inhibitor to develop a novel therapeutic for premature babies, Eskandari and Tomlinson think it has promise for treating other forms of brain injuries too. “These babies are a really good overall model of how all brain injury could potentially be helped,” Eskandari said. “Having a hemorrhage that leads to stroke and hydrocephalus checks a lot of boxes that we see in many patients.”

Tomlinson’s future research plans include looking at the complement system at different points following an injury in an effort to understand more fully the point at which it becomes part of an injury’s pathology rather than part of its healing process.

Eskandari hopes to host human clinical trials with the human equivalent of the CR2Crry inhibitor at MUSC next. He wants to help his premature patients to live the fullest lives possible. “We want to allow these babies to reach their full potential,” he said.

Source:Providing a potential treatment option to infants where there is none | MUSC | Charleston, SC


It takes a village: NICU parents share their experience as reminder that partners need support, too

Apr 5, 2022

Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner


Some preterm neonatal patients can be discharged from the hospital sooner through the unique Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota.

This one-of-its-kind program in Minnesota allows infants that qualify to receive expert care and monitoring at home through the use of an app on a tablet and a scale. The parent caregiver inputs the baby’s vitals daily, which are then shared and monitored by the baby’s neonatal care team.

The Children’s Minnesota Neonatal Intensive Care Unit (NICU) in St. Paul conducted a pilot study with 20 patients during a one-year period to evaluate how at-home care impacts babies’ ability to learn to feed, rates of breastfeeding and overall patient-family satisfaction. The results of the pilot were overwhelmingly positive and, for one family, meant that a father could spend precious time with his newborn while battling his own illness.

A challenging time

The year of 2021 was a time of mixed emotions for Amanda and Rob Calvin. They were excited to be welcoming their first baby, but Rob was also battling pancreatic cancer. “When we found out about Rob’s diagnosis, he was given one year to live, so we decided to have a child,” Amanda recalled.

The Calvins expected their baby to arrive in early April, but around mid-February, Amanda started having complications from a bleeding disorder she’s had since birth. “My condition had been flaring up with my pregnancy and getting worse to the point where I had to be admitted to the hospital,” Amanda said.

With the pandemic still at its height – and in light of her illness and her husband’s cancer – Amanda had a virtual baby shower from her Minneapolis hospital room. There, she also dealt with another serious health concern called preeclampsia, a severe high blood pressure condition in pregnant women. Amanda had a C-section procedure the day after her baby shower at The Mother Baby Center, a partnership between Allina Health and Children’s Minnesota.

Baby Finn arrived early

On Valentine’s Day 2021, baby Finn entered the world nearly eight weeks early – weighing just 3 pounds and 13 ounces. Finn’s care team rushed the newborn to the NICU at Children’s Minnesota and placed the tiny infant on a breathing machine. Finn spent the next month splitting time between the NICU and the special care nursery.

“I remember all of his caregivers being the most compassionate people and they made sure I knew what was going on,” recalled Amanda, a physician specializing in pulmonary and critical care medicine with HealthPartners Park Nicollet. “I’m an ICU provider and my son was in the ICU. Vital signs for infants are completely different than vital signs for adults. I tried to shut out paying attention to that stuff. There was too much for me to process.”

Time was of the essence

As Finn and Amanda navigated the NICU, Rob continued his fight with pancreatic cancer. “Rob no longer responded to chemo and was about to transition to hospice,” said Amanda. “He was so sick he couldn’t make it to the hospital.”

Preterm babies usually stay in the hospital with their care team until when they would have been full-term to grow, learn how to eat and breathe on their own. But CHAMP allowed Finn to go home a month early. Amanda used the app to stay connected with his care team and took over feeding using a nasogastric (NG) feeding tube that was inserted before heading home.

“It ended up being a major blessing,” Amanda said. “We were stretched thin going back and forth to the hospital. We were making it work. Without this program, we would not have had time together as a family at home in the place where we wanted to be.”

Finn graduated from CHAMP after a week on the special care program. Rob passed away soon after his infant’s graduation. “Rob died six days before Finn’s original due date. Finn got to be home with his dad before he died. I can’t quantify the value of that,” Amanda said while reflecting on her late husband.

Today, Finn is a healthy 1-year-old and meeting or exceeding all of his physical and developmental milestones. “Everybody at Children’s Minnesota went out of their way to make sure Finn was cared for – that we were heard, and they knew what we needed more than we did,” Amanda said while holding back tears. “I can’t thank those people enough. They gave us time we would have never had.”

About CHAMP at Children’s Minnesota

Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota is the only program of its kind in Minnesota. Before heading home, babies have a nasogastric tube (NG) inserted. Families are provided with a scale and a tablet equipped with a program called Locus, which allows parents to input vitals that are shared with their neonatal team. Families are also trained by the team on proper NG and oral feeding techniques as well as CPR.

To qualify for CHAMP, a newborn must be a current Children’s Minnesota NICU patient, be able to breathe without any respiratory or oxygen support, weigh more than four pounds and consistently gain around 30 grams of bodyweight per day.

“Children’s Minnesota will always strive to pioneer cutting-edge programs that continue to put our patients first and keep families as part of their care team – CHAMP accomplishes all of these goals,” explained Dr. Cristina Miller, medical director of the NICU follow-up clinic at Children’s Minnesota, and founder and director of CHAMP. “Even though the babies who qualify for CHAMP are home, their clinical care team still remains at their bedside virtually to ensure they are growing, healthy and thriving.”

“The first question any parent asks when their child is admitted to the NICU is, ‘When can we go home?’ We’re hoping that this method helps families return to their normal daily lives faster, especially with the additional COVID-19 pandemic restrictions that have been in place,” said Dr. Miller. “But even after the pandemic is over eventually, this could be a game changer.”

Source:Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner | Children’s Minnesota (

Importance The Of Support For NICU Families

Mar 7, 2020      LivingHealthyChicago

A health complication involving kids can really rock a family’s world- especially when it involves the very youngest in our families. This mother is sharing her family’s story in hopes of raising awareness about the importance of support for NICU families. Plus, we learn about an innovative treatment being utilized to help with a heart health issue that’s more common in premature babies.

Chatting to your premature baby

Talking and listening to children from the moment they are born helps them develop. This is especially true for babies who are born prematurely.

When a child is born prematurely, they might spend some time in the neonatal unit at hospital. Talking to your baby from day one will help the two of you get to know each other. The stimulation of your voice will help your baby develop and bond with you in the early days.

Premature babies will get tired more quickly and sleep more, but there are lots of ways to communicate with your baby such as touch, eye contact and facial expressions are all ways of communicating.

Babies can communicate before they start talking. As soon as your baby is born, they can recognise the sound of your voice.

Tips for talking to your premature baby

  • Kangaroo Care is when your baby is placed skin-to-skin on your chest. The contact will help to form a bond between you. Talk quietly and take time to listen to them – if they make noises try to respond.
  • When you are ready, care staff will support you to do some routine tasks such as nappy changing, tube feeding, or bath time. This is a great time to talk to your baby about what you are doing or sing to them as you are doing it.
  • When your baby is very small, they will like to grasp your finger and enjoy the feeling of your hands on their body.
  • Call them by their name. The sound of your voice will help relax and soothe them.
  • As the weeks go by, your baby will look at you for longer and see your face more clearly. Smile and respond to your baby.
  • It’s never too early to read a story! Choose a baby book and read. Your voice will help your baby relax and fall asleep.
  • Like adults, babies don’t always feel like being sociable. If your baby starts to hiccough, look away or yawn, these are signs they need to rest.


Innovative Music Therapy for the Brain Development of Premature Babies

Apr 3, 2022    HEC Science & Technology

It only takes a few chords to capture Ayla Campbell’s attention. She arrived 16 weeks early, weighing less than two pounds. While staying in MU Health Care’s neonatal intensive care unit, or NICU, Ayla received her first visit from a music therapist Emily Pivovarnik. “Her heart rate would just go down, and her oxygen was going up,” said Angel Campbell, Ayla’s mom. “If someone had told me that this could happen just from singing, I wouldn’t have believed it.” Pivovarnik is a trained music therapist who helps babies eat better, regulate their stress levels and adjust to stimulation. Pivovarnik is part of a team starting a research project to look at the long-term effects of a specific music therapy intervention called multimodal neurological enhancement, or MNE. This therapy combines music, gentle touch and rocking to help a baby’s brain develop. About 135 babies will be involved in the research project. After leaving the hospital, they’ll receive neurodevelopment testing.

Innovative Music Therapy for the Brain Development of Premature Babies – YouTube

Joel Mackenzie used ‘kangaroo care’ to help daughter Lucy, born prematurely. Photo: U. South Australia

Snuggling With Dad: Fathers’ Contact Can Help Preemies Thrive

Ellie Quinlan Houghtaling

THURSDAY, July 14, 2022 (HealthDay News) — Decades of research have shown the power of skin-to-skin contact between preemies and their moms, but would the same technique, dubbed “kangaroo care,” work with fathers?

Yes, claims a new Australian study that found when dads held their premature babies close to their bare chest, they reported feeling a “silent language of love and connection.”

“It’s like when your finger touches a fire, there are receptors there letting you know that it’s hot,” said study author Qiuxia Dong, a nurse and master’s candidate at the University of South Australia. “It’s the same thing [in kangaroo care], when the attachment happens between father and baby or mother and baby, it’s just another reaction.”

First-time father Joel Mackenzie experienced it with his tiny daughter, Lucy, when he was first able to hold her, two weeks into her time in the neonatal intensive care unit (NICU). Mackenzie explained that the NICU experience can be a really isolating one for parents, especially dads who are not often considered by the health care system when it comes to reconnecting with their child after a medical intervention.

“I felt like I was actively fostering her survival and her development by giving her a cuddle,” said Mackenzie, who was one of 10 dads followed in the study.

The findings were published online recently in the Journal of Clinical Nursing.

One expert in neonatal care described how the bonding process works.

“There are biologic phenomenon that exist that allow babies and their parents to bond, and there are hormones that get released that allow you to fall in love,” explained Dr. Robert Angert, a neonatologist at NYU Langone in New York City. “Those are stimulated by all your senses — your sight, but also your smell and touch. If you cut out some of those senses, you’re going to miss out on those opportunities,” he said.

“On the other side, you have anxiety and stress, and those make it harder to fall in love. As they describe in the article, a lot of parents, particularly non-birthing parents, are stressed and anxious and worried about the well-being of their child, especially a baby who’s in the ICU,” Angert added. “Bringing them together safely and in a way that’s helpful to the baby reduces that anxiety to the parent.”

Research has shown that during kangaroo care, the close contact activates nerve receptors in mammals that increase the production of hormones that lower pain and stress for both babies and parents.

The latest study illustrated that: Many of the fathers described the NICU environment as “overwhelming,” but the ability to hold their children next to their skin fostered strong bonds and relaxed them, which helped build confidence and made them very happy.

“It was palpable how much of an impact it had on her,” Mackenzie said. “Of course, it helped me in bonding with her and helping me understand her and what was good for her as a child, but also as well you could almost tell that she almost drew energy from us. She started to move better, she started to develop faster. I’d see her move better on a day-to-day basis. Eat more, be more responsive. Her eyes would open and move and engage more each time we took her out of the crib.”

Having to separate a newborn from its parent for medical reasons isn’t just traumatic for parents, it can have emotional and developmental impacts on the infant as well.

Angert said that “separation is an incredibly traumatic event in the life of a newborn, and I think we underestimate the impact that that event has on a baby. So we have an opportunity here to restore some of that togetherness, and it’s not without good reason that we’re taking the baby away. We’re saving their life. But it’s also good to think about when we can reestablish contact and allow them to give kangaroo care to their babies.”

Parents who go through the NICU process have no doubts about the efficacy of staying by their child’s side when they’re sick. Mackenzie, whose child will celebrate her first birthday next week, said the bonding made all the difference.

“She still has mild lung disease and chronic cerebral palsy, but [the kangaroo care] part of her NICU experience was definitely a contributing factor to where she is now, I have no doubt about it,” Mackenzie said. “Children who’ve gone through this experience definitely have a better chance of survival in my opinion.”

More information: To learn more about skin-to-skin contact benefits between parents and newborns, visit the Cleveland Clinic.


Occupational Therapy and Infancy: Supporting Families During the Earliest Occupations

Alexis Ferko, B.A., OTS

Occupational Therapy and Infancy: Occupational therapy (OT) is a holistic, client-centered, occupation-based profession focused on assisting individuals to independently participate in daily activities to the best of their ability . Occupational therapy practitioners (OTP) are board certified, have extensive academic training and clinical experience and treat individuals across the lifespan in various settings  while considering the “biological, developmental, and social-emotional aspects of human function in the context of daily occupations”. OTPs utilize the power of occupation to support families and infants in achieving positive outcomes . The first year of an infant’s life is a rapid period of growth; infants are learning how to actively interact with their environment and family system. Occupations of infancy are defined as “any activity or task of value in which the family or setting expects the infant to engage”  including activities of daily living (ADL) like feeding and bathing, health management including social and emotional health promotion and maintenance, rest and sleep, play and social participation . Infants also participate in co-occupations, meaning infants share an occupation with their caregiver; examples such as play and breastfeeding . OTPs also assist families with adapting to new performance patterns including habits, roles, routines, and client factors. OTPs treat infants in settings including hospitals or NICU’s, early intervention (EI), outpatient, and community-based settings. Infants may be referred to OT for concerns with maintaining homeostasis or bonding in the NICU, feeding or sensory concerns, physical development, social-emotional skills, and sleep .

OT in the NICU: Many infants and families have their first experience with OT in the NICU setting. NICU OTPs have extensive knowledge in neonatal medical conditions, development and understand the complex medical needs of infants in this setting . OTPs are members of an interdisciplinary team of professionals including pediatricians, physical therapists (PT), speech-language pathologists (SLP), lactation consultants, respiratory therapists, nurses, midwives, neonatologists, among others. OTPs administer assessments related to sensory processing, motor function, social-emotional development, pain, activities of daily living (ADL), neurobehavioral organization, and environmental screenings to identify and create an appropriate infant and family-centered intervention plan. The primary functions of an OT in the NICU is to focus on developmentally appropriate occupations, maintaining homeostasis (stable vitals, feeding, breathing), self-regulation, sensory development, feeding, motor function, coping and attachment skills, bathing and dressing, and nurturing interactions with caregivers including skin to-skin contact. OTPs utilize various interventions including sensory integration, neurodevelopmental techniques, positioning/handling, infant massage, feeding, bonding, and environmental modifications to minimize stress and overstimulation while in this setting. Therapists must also address the family system by forming a therapeutic relationship with the family. The NICU can cause separation between infant and caregivers especially if there are maternal complications after delivery which can increase stress and instability within the family system . Parent-infant attachments and occupations must be prioritized, including bonding such as skin-to-skin contact, or kangaroo care. Kangaroo care is an essential intervention to support infants in the NICU by having the infant lay on the caregiver’s bare skin. Benefits to this intervention include more stable heart rate, breathing patterns and temperatures, faster weight gain, more successful feeding, and increased bonding. OTPs also consider the Neonatal Integrative Developmental Care Model, meaning therapists are fostering a healing environment in the NICU setting – a setting known to be stressful and overstimulating for infants and their families. Core measures of this model include skin protection, optimizing nutrition, positioning/handling to promote breathing and stability, safeguarding sleep, optimizing nutrition, minimizing stress and pain through environmental and sensory modifications, and partnering with families . Research shows that interventionists who follow this model have better growth development outcomes.

Breastfeeding and Feeding: As of 2020, over 83% of infants are breastfed at some point in their young life. 60% of mothers stop breastfeeding before they intend to stop due to various reasons including latching difficulties, infant weight concerns, lack of work and family support, and concerns with medication while breastfeeding. OT can assist with facilitating breastfeeding which improves parent-infant attachment and bonding and can also reduce postpartum depression . OTPs must consider various aspects of the infant caregiver dyad during breastfeeding including infant arousal state, respiratory ability, overall stability, oral reflexes, oral strength and endurance and caregiver arousal, attention, posture and upper extremity strength, cognition, and cultural values/beliefs related to feeding . It is also important to consider sensory and environmental stimulation, social supports, and bottle/nipple type if the infant is not being breastfed. OTPs can assist breastfeeding caregivers with developing routines and habits to promote breastfeeding and education related to their infant’s hunger and stress cues, positioning, ergonomics, self-regulation, and environmental modifications . Infant interventions include suck training, positioning, and various sensory strategies to promote arousal levels. Environmental and activity modifications include changing the position of feeds, adapting the lighting, touch, sound and using supportive equipment during feeding and adapting the type, thickness or volume of milk and feeding schedule . Feeding is a very important occupation for an infant as it takes up much of their early life and helps facilitate secure attachments to their caregiver as well as promoting self-regulation .

 OT’s Role in Transitioning Home: OT also plays a role in assisting families with the transition from NICU to home. Transition planning begins at NICU admission with OTPs educating families on various interventions and considerations for the infant’s unique medical needs. Upon discharge from the NICU, OTPs may recommend follow-up with EI, outpatient OT or PT, or a feeding clinic to address various concerns including feeding, global developmental delay, ROM or joint limitations, tone management, among others . OTPs also educate families on general infant care like signs of stress and how to relax or calm an infant, feeding strategies, home environment set-up and safe sleep strategies. OTPs also work with lactation consultants to address any concerns or strategies related to breastfeeding.

Early Intervention and Infancy: Infant occupations vary based on family, contextual and cultural factors. OT is a primary service under IDEA Part C and delivers services related to the infant’s individualized family service plan (IFSP) outcomes . Gorga (1989) identified seven areas of occupational therapy treatment practices for infants in EI including motor control, sensory modulation, adaptive coping, sensorimotor development, social-emotional development, daily living skills and play . OT interventions include handling, positioning, adapting the environment, sensory registration, arousal, attention, emotional regulation, cognition, feeding and play activities like reach and grasp. The American Occupational Therapy Association (AOTA) elaborated on various interventions in early intervention including promoting healthy bonding and attachment, family education and training, adapting tasks and the environment, participation in ADLs, rest and sleep and play related to the infant’s IFSP outcomes.

Conclusion: Occupational therapy practitioners are client-centered, occupation-based and address the infant and their family holistically. Various occupations OTPs can address include feeding, bathing, rest and sleep, health management, play and social participation, among others. Breastfeeding is also an important co-occupation OTPs can address in this setting. OT can also work with the family to promote carryover of strategies, encourage developmental care, and optimize infant well-being in the NICU, EI and home setting. Various professions work with occupational therapists on multidisciplinary, transdisciplinary, and interdisciplinary teams including PT,  SLP, pediatricians, lactation consultants, nursing, midwives, neonatologists, and other specialists. These professions would benefit from working with OT to help increase independence, improve overall well-being and participation in infant and family occupations all of which leads to a greater quality of life for both the infant and family.  Occupational therapists serve a unique role in the neonatal intensive care setting by identifying, promoting, and advocating for developmental care practices that aim to support families in participating in these early occupations.



A Wearable for Monitoring Prenatal Health at Home

An estimated 15 million babies are born prematurely every year, posing a significant risk to both maternal and neonatal health. The EU funded WISH project promotes a novel tool for monitoring the risk of preterm labour at home.

Preterm birth is defined as any live birth before the 37th week of pregnancy and is associated with complications that lead to neonatal and infant mortality. Additionally, premature babies are prone to serious long-term illnesses, lifelong disabilities such as cerebral palsy and respiratory illnesses as well as poor quality of life. Consequently, preterm birth is the cause of great suffering and psychological stress to parents. For further information see the IDTechEx report on Wearable Sensors 2021-2031.

Machine learning to predict preterm birth

Currently, regular medical check-ups and clinical examinations in a hospital setting are the only available solution for expectant women to diagnose preterm labour. However, expecting couples often mistake Braxton Hicks contractions, which occur normally during a healthy pregnancy, as preterm labour contractions. This increases hospital visits and concomitant healthcare costs. To address this issue, the EU-funded WISH project has developed an innovative platform for antepartum maternal and foetal monitoring. “WISH integrates seamlessly into the daily activities of expectant women in a way that will enable remote antepartum monitoring at home,” explains Julien Penders, co-founder and COO of Bloomlife. The WISH system consists of a specifically designed electrode patch, a consumer app, a web-based dashboard and a secure cloud data platform. It measures maternal and foetal health parameters, such as heart rate and uterine activity, through a specific sensor. This real time information is processed using advanced algorithms and machine learning to provide the probability of a woman being in labour.

Clinical validation and prospects

The WISH solution was tested and validated during the project in a two-centre, interventional study on 150 pregnant women. Study participants received a WISH system and were asked to use it at least three nights per week until they gave birth. Results demonstrated that the WISH system had similar accuracy in labour detection with current diagnostic methods used in hospital. “This clearly illustrated the feasibility of applying non-invasive wearable technology at home as an alternative labour management strategy,” emphasises Penders.

Preterm birth is a global health problem and one of the EU healthcare priority areas. The high socioeconomic impact of preterm birth necessitates novel solutions for predicting and prolonging the gestational age at delivery. The WISH project laid the foundation for a new non-invasive approach for preterm labour detection and a much needed tool for high-risk pregnancies. Implementation of WISH is expected to provide essential data for both expectant women and healthcare providers, facilitating more efficient prenatal care across Europe. Importantly, WISH will offer reassurance to women throughout the last stages of pregnancy through the provision of trustworthy information. Future efforts will focus on how to exploit the WISH solution to improve doctor-patient communication, implement preventive actions and timely interventions to reduce preterm births and radically change prenatal care across Europe. Penders envisions pivotal clinical trials will support the CE marking of WISH as a medical device and render it ready for commercialisation.