Belarus currently has the lowest preterm birthrate of all globally ranked countries.

                           BELARUS 

Rate: 4.1%          Rank: 184

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

Belarus: officially the Republic of Belarus, formerly known by its Russian name Byelorussia or Belorussia is a landlocked country in Eastern Europe bordered by Russia to the northeast, Ukraine to the south, Poland to the west, and Lithuania and Latvia to the northwest. Its capital and most populous city is Minsk. Over 40% of its 207,600 square kilometres (80,200 sq mi) is forested. Its major economic sectors are service industries and manufacturing.

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

Healthcare- Belarus

Information available regarding healthcare in Belarus indicates that citizens have access to free medical aide and affordable medications. There may be many issues that contribute to preterm birth rates and infant mortality in any given country, or even section of a country. The US is indicated to be the wealthiest country, and yet our infant mortality and preterm birth rates are similar to or worse than many “developing” nations. It is a fact that access to healthcare in a major determinant of infant mortality and preterm birth rates, yet in my research I read articles in US publications that listed off many other potential factors related to infant mortality and preterm birth rates that did not mention access to healthcare. Interesting…..It makes sense to use our access to Global metrics and research to support and guide US research and solution-oriented efforts to reduce the high infant mortality and preterm birth rates in the USA. What can we learn from countries like Belarus to improve our efforts to prevent preterm birth?

The healthcare system in the Republic of Belarus is based on the principles of social justice and affordability. (Source: President of The Republic of Belarus)

 A kidney transplant surgery is performed at the Grodno Oblast Clinical Hospital

In line with the Belarusian legislation, all people are guaranteed:

• free medical aid in state-run healthcare institutions;
• affordability of medications;
• informed voluntary consent to medical intervention;
• the right to choose an attending doctor and a healthcare facility;
• participation in the choice of treatment methods;
• availability of information about their own health status, treatment methods, and qualifications of the attending doctor, other personnel directly involved in the treatment process;
• the right to choose people who can be informed about their health status;
• the right to deny medical treatment, including medical intervention, with the exception of the cases stipulated by the legislation;
• in-patient treatment in healthcare facilities meeting hygiene, sanitary, and anti-epidemic requirements; the right to security and protection of personal dignity;
• respectful and humane attitude of healthcare workers.

The entire healthcare system has been recently modernized in Belarus, from first-aid and obstetric stations to regional hospitals and advanced healthcare facilities.

Sixteen specialized national research centers have been set up in Belarus. These include the Cardiology Center, the Mother and Child Center, the Center for Transplantation of Organs and Tissues, the Neurology and Neurosurgery Center, the Center for Transfusion and Medical Biotechnologies, the Traumatology and Orthopedics Center, etc. Their goal is to bring together research and practice to apply state-of-the-art technologies in treatment and diagnostics.

The government has an unwavering focus on the well-being of women and children. Belarusian prenatal centers nurse newborns whose weight is below 500g. In 2008 the program of mass screening of children and newborn babies was launched in Belarus in a bid to improve medical aid to pregnant women and newborns.

Recuperation facilities are part of the medical rehabilitation network. There are 475 recuperation centers in Belarus.

It is always better to prevent a disease than to treat it. That is why Belarusian healthcare professionals invest a lot of efforts in preventing health hazards, promoting a healthy lifestyle and creating appropriate conditions for it. Belarus runs a comprehensive educational and awareness-raising system aimed to promote a healthy lifestyle.

National programs Cardiology, Oncology, Tuberculosis, Innovative Technologies and many more are implemented in the country. The National AIDS Prevention Center was established in Belarus to curb the spread of HIV.

The national healthcare system aims to make the population healthier by raising the quality of medical services and ensuring equal healthcare opportunities for all people regardless of their residence.

The Belarusian healthcare system is working to apply more high-tech projects and innovation technologies. There are plans to raise more investments, promote public-private partnership, expand the range of paid medical services, while preserving the opportunity to get free medical treatment. Belarus is also determined to increase the export of medical services fivefold by 2015 in comparison with the year 2010.

Source: http://president.gov.by/en/medicine_en/

COMMUNITY

We are packing for the annual Zumba Instructor’s Convention in Orlando, Florida where 7-8000 Global instructors will gather to learn, share, teach, and collaborate globally to build community through dance, fitness, music and, of course, having FUN! Because the global average for preterm birth is more than one in ten babies, a large portion of our global Zumba buddies are also Neonatal Womb Warriors and/or Neonatal Womb community partners.

Love /ZIN 75/OFICIAL CHOREO / ZIN MINSK

Published on Jun 21, 2018

Democracy Dies in Darkness

Our infant mortality rate is a national embarrassment–By Christopher Ingraham September 29, 2014

The United States has a higher infant mortality rate than any of the other 27 wealthy countries, according to a new report from the Centers for Disease Control. A baby born in the U.S. is nearly three times as likely to die during her first year of life as one born in Finland or Japan. That same American baby is about twice as likely to die in her first year as a Spanish or Korean one.

Despite healthcare spending levels that are significantly higher than any other country in the world, a baby born in the U.S. is less likely to see his first birthday than one born in Hungary, Poland or Slovakia. Or in Belarus. Or in Cuba, for that matter.

The U.S. rate of 6.1 infant deaths per 1,000 live births masks considerable state-level variation. If Alabama were a country, its rate of 8.7 infant deaths per 1,000 would place it slightly behind Lebanon in the world rankings. Mississippi, with its 9.6 deaths, would be somewhere between Botswana and Bahrain.

We’re the wealthiest nation in the world. How did we end up like this?

New research, in a draft paper from Alice Chen of the University of South California, Emily Oster of the University of Chicago, and Heidi Williams of MIT, offers up some clues. They note that the infant mortality gap between the U.S. and other wealthy nations has been persistent — and is poorly understood.

One factor, according to the paper: “Extremely preterm births recorded in some places may be considered a miscarriage or still birth in other countries. Since survival before 22 weeks or under 500 grams is very rare, categorizing these births as live births will inflate reported infant mortality rates (which are reported as a share of live births).”

Oster and her colleagues found that this reporting difference accounts for up to 40 percent of the U.S. infant mortality disadvantage relative to Austria and Finland. This is somewhat heartening.

But what about that other 60 percent?

“Most striking,” they write, “the US has similar neonatal mortality but a substantial disadvantage in postneonatal mortality” compared to Austria and Finland. In other words, mortality rates among infants in their first days and weeks of life are similar across all three countries. But as infants get older, a mortality gap opens between the U.S. and the other countries, and widens considerably. You can see this clearly in the chart below.

Digging deeper into these numbers, Oster and her colleagues found that the higher U.S. mortality rates are due “entirely, or almost entirely, to high mortality among less advantaged groups.” To put it bluntly, babies born to poor moms in the U.S. are significantly more likely to die in their first year than babies born to wealthier moms.

In fact, infant mortality rates among wealthy Americans are similar to the mortality rates among wealthy Fins and Austrians. The difference is that in Finland and Austria, poor babies are nearly as likely to survive their first years as wealthy ones. In the U.S. – land of opportunity – that is starkly not the case: “there is tremendous inequality in the US, with lower education groups, unmarried and African-American women having much higher infant mortality rates,” the authors conclude.

One way of understanding these numbers is by noting that most American babies, regardless of socio-economic status, are born in hospitals. And while in the hospital, American infants receive exceedingly good care – our neo-natal intensive care units are among the best in the world. This may explain why mortality rates in the first few weeks of life are similar in the U.S., Finland and Austria.

But the differences arise after infants are sent home. Poor American families have considerably less access to quality healthcare as their wealthier counterparts.

One measure of the Affordable Care Act’s success, then, will be whether it leads to improvements in the infant mortality rate. Oster and her colleagues note that Obamacare contains provisions to expand post-natal home nurse visits, which are fairly common in Europe.

Research like this drives home the notion that economic debates in this country – about inequality, poverty, healthcare – aren’t just policy abstractions. There are real lives at stake.

*** Update – Mary Katherine Wildeman – Jan 8, 2018

New data released by the Centers for Disease Control and Prevention shows there was no change in the national rate of infant mortality between 2014 and 2015, the most recent years for which it has published numbers.

Source: https://www.postandcourier.com/features/health-in-brief-cdc-publishes-updated-infant-mortality-data-national/article_ba685ecc-f17c-11e7-b7c4-eb95009f8d46.html

Kat and I were pleased to read a copy of a recent letter sent by APHA to Washington DC encouraging support of federal research and promoting known interventions and community initiatives related to preterm birth.

About APHA:

“We all deserve access to a culture of health – living as long as you can, as well as you can and having a short but glorious ending. It also means having a system in place that ensures we can all achieve it.” – APHA Executive Director Georges Benjamin, MD

APHA champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that influences federal policy, has a nearly 150-year perspective and brings together members from all fields of public health.

Please see the letter below and note all who signed it!

June 25, 2018

The Honorable Lamar Alexander   The Honorable Michael Bennet Chairman, Senate Committee on Health, 261 Russell Senate Office Building   Education, Labor and Pensions   Washington, DC 20510 428 Dirksen Senate Office Building Washington, DC 20510

Dear Chairman Alexander and Senator Bennet,

The undersigned organizations committed to the health and wellbeing of mothers, infants, children and families applaud introduction of S. 3029/H.R. 6085, the PREEMIE Reauthorization Act of 2018, and support its swift passage.

Every day, one in ten infants is born premature in our nation. Preterm delivery can happen to any pregnant woman, and often its cause is unknown. Preterm birth is the leading contributor to infant death, and those babies who survive are more likely to suffer from intellectual and physical disabilities. In addition to its human, emotional, and financial impact on families, preterm birth places a tremendous economic burden on our nation. A 2006 report by the National Academy of Medicine found the cost associated with preterm birth in the United States was $26.2 billion annually, or $51,600 per infant born preterm. Employers, private insurers and individuals bear approximately half of the costs of health care for these infants, and another 40 percent is paid by Medicaid.

The original PREEMIE Act (P.L. 109-450) brought the first-ever national focus to prematurity prevention. For several years after its passage, preterm birth rates dropped by small but significant increments. Unfortunately, for the past three years, preterm birth rates have once again risen. In particular, troubling racial disparities in preterm birth persist, with black women experiencing preterm birth rates more than 50% higher than white women. Clearly, our nation must redouble its efforts to ensuring that every pregnancy and baby is as healthy as possible.

The PREEMIE Reauthorization Act of 2018 demonstrates Congress’s continued commitment to our most vulnerable infants and their families by supporting federal research and promoting known interventions and community initiatives. We applaud your sponsorship of this critically important legislation, and we strongly support its passage. If our organizations may be of further assistance, please contact Cindy Pellegrini at March of Dimes at cpellegrini@marchofdimes.org or 202/659-1800.

1,000 Days American Academy of Pediatrics American College of Nurse-Midwives American College of Obstetricians and Gynecologists American Psychological Association American Public Health Association American Thoracic Society Association of Maternal & Child Health Programs Association of State and Territorial Health Officials Association of Women’s Health, Obstetric and Neonatal Nurses Birth Equity Collaborative California Breastfeeding Coalition Children’s Dental Health Project Children’s Hospital Association Children’s Hospital of Philadelphia Cribs for Kids Every Mother Counts Every Woman CT Family Voices Ferring Pharmaceuticals First Focus March of Dimes Moms Rising National Hispanic Medical Association National WIC Association Nurse-Family Partnership PCOS Challenge: The National Polycystic Ovary Syndrome Association Preeclampsia Foundation Preemie World, LLC Prevent Blindness Rhode Island Chapter American Academy of Pediatrics Society for Maternal-Fetal Medicine Society for Reproductive Investigation Stanford University

Source: https://www.apha.org/search-results?q=preterm birth

HEALTH CARE PARTNERS

Fetal Immune System May Trigger Premature Birth: Study

April 25, 2018, at 2:00 p.m.     Gulf News UK   By Dennis Thompson   HealthDay

WEDNESDAY, April 25, 2018 (HealthDay News) — Most potential explanations of premature birth revolve around the mother, and what might cause her body to reject her developing fetus. But what if it’s the other way around?

A new study suggests some preterm births occur because the fetus rejects the mother, after its immune system is triggered too early and senses maternal cells as foreign invaders. Researchers found that umbilical cord blood drawn from preemies contained elevated levels of immune cells generated by the fetus. Subsequent lab tests revealed that this immune response had been activated specifically to attack the mother’s cells.

The flood of inflammatory chemicals released during this fetal immune response can induce contractions in the uterus, causing preterm labor, the study concludes.

“We’re showing that in the context of maternal infection or inflammation — the most common cause of preterm labor — the naive fetal immune system wakes up, gets activated too early, and can actually identify and reject the mother’s cells,” said lead researcher Dr. Tippi MacKenzie.

More than one in 10 pregnancies are affected by preterm labor, in which a baby is born earlier than 37 weeks of gestation, said MacKenzie. She is an associate professor with the University of California, San Francisco pediatric surgery and fetal treatment center.Preterm birth is the leading cause of infant mortality in the United States and the world. Children who survive may go on to face a lifetime of health problems. Despite this, the causes of preterm labor remain “one of the big mysteries in science,” MacKenzie said.

Some recent studies have hinted that one cause might be the mother’s immune system rejecting the fetus. Much like an organ transplant, pregnancy requires the immune system of the mother to tolerate the fetus so it is not rejected. Until now, no one has considered that the fetus might play a role, because the fetal immune system is still developing when preterm birth occurs, MacKenzie said.

In their study, the researchers tested umbilical cord blood and maternal blood taken from 89 women who had healthy pregnancies and 70 who went into early labor. There were no signs of immune response in the mother’s blood. However, researchers found that the cord blood of preterm infants had higher levels of two types of immune cells: T cells, which attack foreign agents and promote immune response; and antigen-presenting cells, which guide the T cells to the foreign bodies under attack.

“Both of those cell types were quite immature in the blood of normal healthy term babies we looked at, but both of those cells were quite activated in the preterm labor blood we looked at,” MacKenzie said.Further tests showed that the fetal immune cells were attacking cells from the mother, and releasing significantly higher levels of inflammatory chemicals as part of their attack. In a laboratory model, the researchers showed these chemicals induced contractions in the uterus.

The scientists suspect the fetal immune system becomes triggered as a result of an infection in the mother, and mistakenly identifies the mother as a threat.Dr. Scott Sullivan, head of maternal-fetal medicine at the Medical University of South Carolina in Charleston, welcomed the report. “I really applaud their work, because one of the glaring holes we have with preterm labor and preterm birth is we don’t have a good understanding of the basic mechanisms and underpinning of the symptoms we see,” said Sullivan. At the same time, Sullivan and MacKenzie agreed that this is probably just one of many different ways in which preterm labor occurs.

High blood pressure, diabetes, improper fetal development, early water breaking or a short cervix are other likely risk factors for premature birth, Sullivan said. “As we understand the basic mechanisms, it helps us think of and develop treatments and preventative strategies,” Sullivan said. “Ultimately, there’s not likely to be one treatment that’s going to work for everybody. Ideally, we’re going to end up with different treatments for different mechanisms.” That said, these results might eventually help doctors detect and head off preterm delivery caused specifically by a fetal immune response, MacKenzie noted.

“We can potentially develop some biomarkers that allow us to diagnose it earlier,” MacKenzie said. “And if we know exactly which cell types and which mechanisms are involved, we can potentially develop specific medicines to treat it.” The study was published April 25 in the journal Science Translational Medicine.

Source: https://gulfnews.com/news/europe/uk/bacteria-in-placenta-responsible-for-preterm-births-study-1.2224282Reporter

Could Early Birth Hinder Adult Success?

By Alan Mozes     HealthDay Reporter   (HealthDay)

WEDNESDAY, June 6, 2018 (HealthDay News) — Babies born prematurely or very small may not fare as well in life as those born full-term, a new research review suggests.

Adults who were born tiny or early may be more likely to lag behind educationally and professionally. They’re also more likely to use social services, according to the review of 23 prior studies from eight countries.

Preterm birth occurs before the 37th week of pregnancy. The difficulties reported in the new study were greater for those born very prematurely — before 32 weeks.

Despite the findings, study lead author Dieter Wolke stressed that people born early or at a low birth weight are not destined to struggle in adulthood.

“Most preterm-born adults are in employment and live independently. Most do well according to these markers,” said Wolke, a professor of psychology at the University of Warwick in Coventry, England.

The studies involved more than 5.9 million adults in all. They were conducted across the United States, the United Kingdom, Canada, Denmark, Finland, Germany, Norway and Sweden.

Nearly 272,000 participants had been born before 37 weeks or weighed less than 5.5 pounds.

In adulthood, this group was less likely to have gone on to college, less likely to have a job, and more likely to receive social benefits, compared with their full-term peers, the study review found.

These odds tended to rise with the degree of prematurity, especially educationally.

The achievement markers were viewed as stand-ins for overall adult wealth. In other words, preemies were more likely to have financial problems as adults than babies carried to full-term.

Dr. Lisa Waddell, deputy medical officer of the March of Dimes, said these are “important” findings. “They point out a clear association between preterm birth and adverse consequences down the road,” she said. “While we know that there are clinical consequences, this points out the impacts of preterm birth may have a long-term impact on the child into adulthood,” added Waddell, who wasn’t involved with the research.

Globally, about 11 percent of children are born prematurely. And nearly 9 percent of those are born in industrialized nations, according to background notes with the study.

Wolke said prior research suggests “super-sensitive” parenting is critical for helping these early, undersized arrivals to do as well as their average full-term peers.

But he cautioned that more research is needed to pinpoint the best way to foster and maximize resilience among preemies as they develop.

The news wasn’t all troubling: No difference was seen between preemies and full-term births in the ability to live independently as an adult, though Wolke cautioned that this latter finding “requires further investigation.”

What exactly might explain the findings? Wolke said that’s difficult to say, because of differences among the studies.

He noted, for example, that not all the studies analyzed neurological deficits among preemies. That’s one possible driver, among many, behind the findings, he said.

“Neurological deficits and disability will be part of the explanation,” Wolke said. He added such deficits tend to be minor among premature babies born relatively close to full-term.

Waddell said the findings “really reinforce the urgent need to reduce the numbers of preterm births and especially those born very preterm.”

Premature birth and its consequences are the leading contributor to deaths in the first year of life, she said.

“If we are going to give every baby the best possible start in life and the opportunity to grow, live, thrive and change the world, we must support the health of women before, during and after her pregnancy,” said Waddell.

The findings appear in the June 6 online edition of Pediatrics.

Copyright © 2018 HealthDay. All rights reserved.

Source:https://journals.lww.com/advancesinneonatalcare/Fulltext/2018/06000/Noteworthy_Professional_News.2.aspx

REIKI IN THE NICU FOR OPIOID WITHDRAW?

Noteworthy Professional News

Smith, Heather, E., PhD, RN, NNP-BC, CNS Section Editor(s): Newnam, Katherine M. PhD, RN, CPNP, NNP-BC, IBCLE; ; Smith, Heather E. PhD, RN, NNP-BC, CNS; doi: 10.1097/ANC.0000000000000512

As more Americans are succumbing to opioid abuse, neonates are innocently being affected from those pregnant opioid users. Although this is not a new phenomenan¹ in history, it is estimated that today there are over 2 million people with an opioid addiction in the United States.² Regardless of gestational age beyond viability, many of these neonates end up being cared for in the neonatal intensive care unit (NICU) due to the withdrawal period postdelivery from regular fetal opioid exposure called neonatal abstinence syndrome (NAS).^{3 , 4} Assessments of neonates with NAS have been measured using several different NAS tools over time, with the Finnegan Neonatal Abstinence Scoring System getting most use.^{3 , 5} NAS symptoms include, but are not limited to, uncoordinated feeding patterns, vomiting, diarrhea, high-pitched crying, and irritability.³ In premature infants born to opioid-addicted mothers, the risk for more frequent intermittent hypoxemia is present compared with the baseline intermittent hypoxemia common among most premature infants.⁶ NAS admissions have increased significantly over the last decade, which has increased length of stay and medical interventions.⁷ Neonatal nurses will need to continue expanding their thoughts and tools to assist in caring for this growing patient population.

One nonpharmacologic option recently researched in this patient population is the use of Reiki therapy.⁸ Reiki therapy is considered complementary or an alternative medicine that uses the person’s own healing energy guided by a Reiki practitioner to restore the body and/or restore balance within the person.⁹ Thirty opioid-exposed infants underwent a 30-minute Reiki therapy session with vital signs monitored to ensure the neonate was not overstimulated. Analyses showed performing Reiki in a NAS group of neonates did not pose any adverse events and, in fact, may have caused relaxation as noted by a slight decrease in heart rate during the session.⁸ Although the sample size was small and much more research is needed to determine further benefit, Reiki may be a viable nonpharmacologic intervention to opioid-exposed neonates with NAS.

Source:https://journals.lww.com/advancesinneonatalcare/Fulltext/2018/06000/NoteworthyProfessional_News.2.aspx

PREEMIE FAMILY PARTNERS

Kat and I witness many spectacular men in our World! This article points out a special way men may excel!

At last, something men are better at than women!

Posted on 28 May 2018 by keithbarrington – Neonatal Research

Following important research in neonatology / newborn medicine from around the world

That is, giving blood for babies, at least maybe.

The introduction to this new publication notes something that I was not aware of, that plasma donated by women is associated with a substantially greater frequency of transfusion related complications than man-plasma. It is thought to be due, perhaps to the leukocyte antibodies in higher concentration in female derived plasma, and the increase in risk is particularly in TRALI (transfusion related lung injury), and was first identified by the UK surveillance program, Serious Hazards of Transfusion, which I guess has the acronym SHAT.

The new article (Murphy T, et al. Impact of Blood Donor Sex on Transfusion-Related Outcomes in Preterm Infants. The Journal of pediatrics. 2018) examined the donor sex of blood given to preterm babies. We use a lot of blood in our tiniest babies, but not that much plasma; platelet transfusions are not uncommon and they contain a lot of plasma. In this study they only included babies who had received blood, and excluded those who had also had high plasma products. They ended up with a cohort of 170 babies under 32 weeks who had received blood, and divided them into groups of female only donors, male only donors and both. Initial comparisons were between the male only and the others, and that showed that babies who were received some female donor blood had more BPD, more composite morbidity and longer hospital stay than those who received exclusively man-blood.

If you think about it, getting out of the NICU having received blood from only male donors, compared to mixed male/female donors is more likely if you only have one or two transfusion donors. So the authors found that the mixed male/female donor group were more likely to have had more transfusions than the male-donor-only group. Perhaps they were therefore were sicker and had more complications. When they corrected for numbers of transfusions there was still a difference, with male-donor-only babies having better outcomes, but with smaller Odds Ratios and confidence intervals that now included no difference.

They then also compared those that had only female donors to the male-donor-only group, to compare recipients who had the same numbers of transfusions; the numbers are now getting smaller, about 60 per group. The odds ratios for BPD and any major morbidity (1.12 and 1.75) remain in the direction of worse outcomes with female-donor blood, but the confidence intervals are now quite wide and include no effect (or even a protective impact).

The data suggest then that it is possible that there is an impact, with man-blood recipients having better outcomes. Certainly a big enough impact to be worth investigating further. Donating blood also increases your life expectancy maybe if more men donated blood we could catch up to women, and provide safer blood to babies also!

Source: https://neonatalresearch.org/2018/05/28/at-last-something-men-are-better-at-than-women/

Books for Preemie Siblings and a Guide for Grandparents

Information is Power, and we know that the preterm birth experience is a walk in the DARK for most. Here are a few resources that may help light the journeys of preterm birth siblings and Grandparents traveling the Neonatal Womb path….

Books for Siblings

Heaven’s Brightest Star- by Kara M. Glad

Evan Early by Rebecca- by Hogue Wojahn

My Baby Sister Is a Preemie (Helping Kids Heal)- by Diana M. Amadeo

(Author), Cheri Bladholm (Illustrator)      

The Ultimate Guide for New Preemie Grandparents

What to do, say, and understand when your grandchild is a preemie-By Trish Ringley, RN Updated August 15, 2017

When Your Grandbaby Is Premature

By Kimberly Tchang

When I was pregnant with my twin boys, I had visions of giving birth to two healthy, full-term babies. But things didn’t turn out that way. Instead, my sons were born prematurely, at 28 weeks, and spent two months in the Neonatal Intensive Care Unit, or NICU. During that all-consuming time, when I was at the NICU every day, and my husband joined me there after work, my mother and my in-laws rose to the occasion. They visited regularly, brought us food, and were thrilled when the nurses eventually gave them the okay to hold their tiny grandsons. Premature babies (defined as being born before the 37th week of pregnancy), make up nearly 13 percent of all U.S. births, according to the March of Dimes, so it’s likely you or someone you know could become the grandparent of a preemie. Following are some suggestions on how best to help your family if your grandchild arrives early, based on my firsthand experience, and that of others who’ve been there.

 Prepare for a Bumpy Ride People describe the NICU experience as an emotional roller-coaster ride, and with good reason. Preemies undergo frequent testing and blood transfusions, and typically experience setbacks. Their condition can change on a daily basis.

It can be a traumatic experience, and some grandparents handle the stress better than others. But while you’ll obviously be very worried about your grandchild, falling apart in the NICU is not helpful to anyone. Rebecca Herranen of San Diego knows the stress firsthand. She spent almost three months with her daughter in the NICU after her granddaughter, Ava, was born in 2003. Considered a “micro-preemie,” Ava, now 7, weighed just 1 pound, 15 ounces, when she was born at 26-and-a-half weeks. “When we realized how small Ava was, our greatest fear was that she would not survive,” says Herranen, who now runs a website, AvaBabys.com, specializing in preemie and micro-preemie clothing. “But as grandparents, you have to dig down deep and find the courage to be strong for your kids, because they’re terrified. This is their child.”

Dr. Jennifer Gunter, an OB/GYN from Mill Valley, Calif., found that her parents’ constant questioning only added to her anxiety when she gave birth to premature triplets in 2003; two of her sons survived. “My parents just kept asking me all these questions: When are you coming home? When are they going to get better?” recalls Gunter, author of The Preemie Primer (Da Capo, 2010). “There are so many unknowns — you don’t know if your baby’s coming home soon, or how long he’s going to be on a respirator. And having someone constantly ask you those questions is like reopening a wound.” Gunter recommends that grandparents acknowledge what their children are going through — and then respond proactively. She advises, “Say, This must be so hard for you. How can I help? or, That sounds very stressful. What can I do?”   

Stay Behind the Scenes Sometimes, the best thing grandparents can do is not to visit the NICU each day, but to keep things running smoothly at home. While parents juggle work responsibilities and NICU visits, there might be an older sibling to take care of, groceries to buy, or laundry to do — and that’s where you come in. Long-distance grandparents can also help out by sending gift cards to local restaurants, arranging for meal deliveries, or hiring a cleaning service for the family. “Whatever the mom and dad want, Herranen says, “if it’s in your power to help them do it or get it, then do that.”  

Spread the News Family and friends are often eager for updates on how a preemie is doing. But it can be exhausting, if not impossible, Gunter says, for parents to recount each day’s events by e-mail, much less to return endless, if solicitous, phone messages — Yes, he’s still on a G-tube; Yes, he’s still on a ventilator. Grandparents can help by keeping everyone updated on the baby’s progress. That might mean making calls or sending e-mails, starting a blog, or creating a page about your grandchild on a website like CaringBridge.com, which offers free, easy-to-use templates. Whatever you decide to report, be sure to get the parents’ okay first.
And then look forward to the day when your precious grandbaby arrives home at last!

Source: https://www.grandparents.com/family-and-relationships/family-matters/premature-grandbabies

INNOVATIONS

Embrace Neonatal MRI System – MRI for Neonates In The NICU

Guernsey’s hospital to launch maternity app to record special moments of premature babies

ITV Report 28 March 2018 at 5:50am

Here at ITV we’re proud to be the most watched, most loved and biggest commercial broadcaster in the UK.

An app which will allow nurses to record special moments missed by parents of premature babies is being launched at Guernsey’s hospital.

vCreate will help reassure parents of their child’s progress when they need to go home to get some much-needed rest, or spend time with older siblings. Nurses at the hospital will be able to record video updates from a hospital-owned tablet, and send them securely to the parent’s own smart device. The application will be free for parents to use and has been set up with the help of the Priaulx Premature Baby Foundation.

Jo Priaulx, co-founder of the PPBF, was keen to support the technology following the premature birth of both of her children. This new technology will give new parents such reassurance as well as an incredible record of how far their baby has come.

– Jo Priaulx, Co-Founder of the PPBD

Heather Renouf, Lead Nurse of the PEH Neonatal Unit has said the app will allow nurses to create video diaries for families to record their child’s development. Nursing staff will be able to record precious moments on camera, like when babies open their eyes for the first time, or comes off ventilation. These milestones are important to parents.

– Heather Renouf, Lead Nurse PEH Neonatal Unit Last updated Wed 28 Mar 2018

Source: https://www.itv.com/news/channel/2018-03-28/guernsey-hospital-to-launch-maternity-app-to-record-special-moments-of-premature-babies/

WARRIORS:

KAT CHAT

*** In our March 16, 2018 blog (South Korea) we began to write our Writing For Wellness stories. Kat’s story continues as she becomes a volunteer in the NICU…….

The next day I found myself speaking with the volunteer service managers to set up my schedule for volunteer orientation. Within the next two weeks I was signing the paperwork, getting my volunteer badge, and completing the week of volunteer orientation training. After meeting with the volunteer service manager I was given permission to waive the 6-month entry level program as patient escort and directly start my service in the NICU.

Next came a slew of shots required for the safety of the patients. Finalizing my immunization papers and obtaining my volunteer badge I found myself captured by the heart of the community that kept me alive. As I walked into the NICU for the first time what caught my eye was the private patient rooms adorned with name tags and décor personalizing the space for each family. In the center of the unit was the staff station lined with computers and headboards; its ceiling contained tiny star-like lights.

Touring the unit with the nurse manager I was mesmerized by the tiny humans contained in the glass incubators, metal beds, and wooden cribs. I had no idea what my mom must have gone through in the months I was hospitalized. A turning point in my healing journey came to light when I witnessed my first 24-weeker. Watching her tiny body hooked up to various IV’s, laying in the blue light and ventilation of the incubator, I watched as she reached out her hand touching the glass window next to me. In my heart I felt our connection; I was once where she lay. Struggling daily to survive and thrive this little being was barely “keeping her head above water” until an amazing family came into her life! The effects of the couple’s loving visits were quickly noticed in the improvement of the baby’s vitals, and overtime, in the steady advancement in the baby’s overall health. Eventually, the baby left the NICU in the arms of the loving adoptive father and mother. The baby continued to grow and I have no doubt that the adoptive parent’s touch, attention, and deep love for the baby played a crucial part in the survival and vitality of the precious child. This patient’s story of hope has impacted my life and heart in ways that allow me to embrace our global preterm birth community more fully.

During the first few weeks of volunteering I interacted with various staff members, some of whom cared for me as a patient. I was overwhelmed by the stories, questions, and newfound information presented to me by my past care-providers.

Within my second week at the NICU I was able to reconnect to the respiratory therapist that cared for me daily as a patient. Growing up I heard stories of my respiratory therapist, the man now stood before me. This man was very important in my mom’s and my NICU journey. He had taught my mom our nightly ritual of back-tapping and massage we practiced until I was 12. His smile seemed familiar and I immediate felt at home in his presence. My respiratory therapist himself was born premature. An Eritrean native, he is dedicated to providing loving care to each patient and their family. I admire his ability to connect so well with those he works alongside with each day. I believe we connect at a high capacity thru the heart, for my respiratory therapist has a very expansive and loving heart.

I am grateful for the providers like my respiratory therapist that make significant impacts on our NICU family members. I encourage us to all take a moment to reflect on who has impacted our NICU/preterm birth journey. Consider taking the time to thank them whether it be in your heart, through a note, an email or a social media message! We are powerful Neonatal Womb Community members, and as evolved human beings we know the power of gratitude!

WARRIORS! Come Journal With Me !!!!!!

TOP 3 JOURNAL APPS OF 2018

Surfing on an artificial wave Flowboarding

Published on Nov 23, 2017

Flowboarding – Surfing simulator, surfing on artificial flow or wave. May 27, young Belarusian Ruslan Sugako brought Belarus a gold medal!

Join us in England where strategic long term preemie research continues to explore and empower our Global Neonatal Womb community. Enjoy Kat’s journey back into the NICU, and watch a film that takes us through a chilling yet thought-provoking immersion into the NICU infant experience.

ENGLAND 

7.0% (48,490) of live births were low birthweight

Source:https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2016

Rate: 7.8%     Rank: 134 (United Kingdom)

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

England: Birth place of preemies Winston Churchill and Sir Isaac Newton, The Beatles and The Queen

COMMUNITY

Epicure is a fascinating endeavor that continues to improve our understanding of the preterm birth experience and a great contributor towards the development of wellness resources for all of our community members!

Epicure creates population based studies of survival and later health status in extremely premature infants. EPICure (UK, Ireland) is a series of studies of survival and later health among babies and young people who were born at extremely low gestations – from 22 to 26 weeks. The first study was published in 1995.

Publications page: http://www.epicure.ac.uk/publications/publications-by-year/

Meet the team : The biggest contributors to the EPICure study are the paediatricians and neonatal nurses from all the maternity units in the UK and Ireland who contributed to the original data collection and made the whole thing possible and of course the parents and children who have taken part in the childhood studies, giving freely of their time, to help us collect this important information.

Premature Babies – a Success Story

One of the success stories in modern medicine has been the increasing survival of very premature babies. Over the past decade survival has improved dramatically for babies born at 26 weeks of gestation and above so that now over 80% survive. Normal pregnancy lasts 40 weeks, but babies may survive from as early as 22 weeks, although at these extremely low gestations (22-24 weeks) most babies are born too immature to survive. As with all advances in care, there is a cost in terms of disability suffered by some children among those that survive. This is the whole point of EPICure, as it allows us to quantify the outcomes and shows us where we need to target our care. For parents faced with the prospect of delivering a child before 26 weeks gestation, there has been little information available which describes outcomes from large numbers of children. Thus, until we carried out the first study it had been difficult to give parents accurate information regarding the chances of survival and the possibility of disability or other long term problems amongst survivors.  Because care improves, and more babies survive, we hope outcomes also improve but we need to show this as well – hence EPICure2.

Why do we need to study extreme prematurity?

We know that disability increases as gestation at birth gets shorter. Births (and surviving children) at gestations below 27 weeks are relatively uncommon – being less than 1% of all births. Babies born this early need to stay in neonatal units for a long time and their care is very intense and costly. Because the number of extremely premature babies born is so small we need large studies to be accurate in describing their outcomes. The decision to admit a preterm baby for intensive care is made by doctors after discussion with the parents but until 2000 there were no national guidelines or data on which to build them. Data from EPICure have informed important national initiatives such as the report from the Nuffield Council on Bioethics describing many of the issues surrounding decision making in the period around birth (www.nuffieldbioethics.org). Some of these new guidelines have been based on the results of the EPICure studies (www.bapm-london.org/publications).The attitude of individual neonatologists and obstetricians may influence the management of different babies. The information on which that management is based needs to be impartial as possible as, on the basis of such decisions, treatments that are thought to be effective may be withheld. Clinicians, healthcare planners and parents need population based data relevant to modern intensive care practices for informed decision making. EPICure has given them this nationally based information, which can be used to help this process.

What are we up to now?

We have several major EPICure projects on the go at present:

Analysis of EPICure2 data – here we are studying the effects that the organisation of neonatal care has on outcomes – size of neonatal services that babies are born in, their staffing and the effects of transfers – all things important to parents and their babies.  In this the premature babies charity Bliss are helping us.  We have the data but need to reanalyse it in new ways.

EPICure@16 – in this project we are writing to all the 16 year olds and asking their permission to contact them personally in a few years to ask if they continue to help us with our studies as they are such an important group.

EPICure@19 – we are currently planning another assessment at 19 years and are currently applying for funding from the Medical Research Council to do this.

Parents and decisions – we are aware that the one area of the family we know little about is the effect that a birth so early has on the family and we are designing some new studies to start to tease out this important area.

SOURCE: http://www.epicure.ac.uk/

Experience this Docu-fiction feature that allows us to experience a preterm birth infant’s point of view.

MOVIE PREEMIE PERSPECTIVE:

SOURCE:http://sales.arte.tv/fiche/6377/LA_VIE_A_VENIR_360___VR____Dans_la_peau_d_un_premature

PREEMIE FAMILY PARTNERS

Perhaps the hardest lesson in life is the art of letting go; of control, expectations, patterns and predictability, and of having to know why and what is next. The preterm birth experience provides an opportunity to let go and love at levels we may never have anticipated we could choose. Resilience is strength. Flexibility and an open mind and heart promote growth and well-being. We have choices…

What Makes Us Resilient?

New research explores the psychology of resilience

Posted Apr 10, 2018

Resilience is all about being able to overcome the unexpected. Sustainability is about survival. The goal of resilience is to thrive. —Jamais Cascio

Mental health professionals working with trauma victims have long recognized that many people exposed to horrific experiences often seem able to cope successfully and even thrive afterward. Whether those experiences occur due to an abusive childhood, dealing with the traumatic aftermath of physical or sexual assault, or recovering from a disaster (man-made or natural), many survivors are still able to move on with the lives without developing the mental health problems often faced by others.

This ability to cope with adversity, often referred to as psychological resilience, has been examined in hundreds of research studies though we still have a limited understanding of what makes some people more resilient than others. Even identifying resilient people can be a problem since they often don’t develop the mental health problems that might otherwise bring them to the attention of health professionals. But is there more to resilience than simply not developing mental health problems? What about the people who are able to grow and flourish because of their ability to cope effectively with what they have experienced?

According to the resilience portfolio model proposed by John Grych of Marquette University, resilience has three primary components:

• Self-regulation, or the ability to control impulses, manage difficult emotions, and being able to carry on despite setbacks. As one example of this, research looking at children with a history of domestic violence has shown better outcomes in children depending on their capacity for emotional self-regulation. Self-regulation also seems related to personality factors such as perseverance or grit.
• Interpersonal relationships, particularly the supportive relationships that can come from family or friends. This also includes those qualities that help people maintain these relationships, even during times of personal crisis. Social support has long been recognized as an important protective factor for people dealing with traumatic life events or emotional distress. For people without this kind of support, loneliness can often contribute to the emotional aftermath of trauma and make recovery that much more difficult. Interpersonal support can also come from being part of a caring community.
• Meaning-making, or the ability to understand and to explain what someone is experiencing, no matter how traumatic. For people who are spiritual or religious, the meaning they find often reflects their beliefs about religion or a higher power but can also involve finding new purpose or hope as part of the process of recovery.

In the same way that a traumatic event is not going to affect everyone equally, people are going to differ in terms of the qualities that make them resilient. According to the resilience portfolio model, people need a range of different strengths to survive and prosper after adversity. Referred to by researchers as poly-strengths, it is the total number of different strengths in anyone’s resilience portfolio that makes survival possible. This is in contrast to “poly-victimizations” or the number of different adverse experiences a person might have which can make them increasingly vulnerable to psychological problems.

But what are the kind of poly-strengths that can protect against traumatic experiences? And why do similar traumas affect people in different ways? A new research study published in the journal Psychology of Violence explores these questions through a unique test of the resilience portfolio model.

A team of researchers led by Sherry Hamby of the Life Paths Appalachian Research Center in Monteagle, Tennessee recruited 2565 participants from the Appalachian region of three U.S. states to take part in the study. The participants had an average age of 30 (65.3 percent female) and included adolescents aged twelve or older. They were recruited through mass advertising and at local community events such as country fairs. This allowed the researchers to bring in people who might not ordinarily participate in psychological studies. Along with providing demographic information, all participants completed questionnaires asking about their history of adversity, their individual strengths as reflected by the resilience portfolio model, their current psychological functioning, and how effectively they were able to cope with their experiences. Posttraumatic growth, mental health, and psychological endurance were measured using standardized inventories.

Given that the participants were recruited from one of the most poverty-stricken areas of the country, it’s hardly surprising that over 98 percent of the participants in the study reported at least one form of adversity. This included physical intimidation or abuse, exposure to family violence or emotional abuse, neglect, or bullying. Other stressful events that were reported included unemployment, poverty, natural disasters, or the death of a family member. Many participants reported multiple traumatic experiences in their lives. Despite this history of adversity, however, most participants endorsed items such as “I discovered that I am stronger than I thought I was” and “I changed my priorities about what is important in life.” Less than half of the participants in the sample reported mental health problems resulting from what they experienced.

Overall, individuals reporting a strong sense of purpose reported greater subjective well-being, posttraumatic growth, and fewer mental health symptoms. Other protective factors that contributed to positive outcomes included optimism, emotional regulation and awareness, and psychological endurance. As the resilience portfolio model predicted, the more of these individual protective factors an individual had, the more successful they were at coping with adversity. This suggests that it is the total number of poly-strengths that is important in resilience rather than individual factors alone.

So, what can be learned from this research? Even though more research is needed,  these results do highlight the importance of a strengths-based approach in helping people recover from trauma and learn to move on with their lives. While there are already treatment programs aimed at helping trauma victims, they are usually aimed at people already dealing with posttraumatic symptoms rather than helping people become more resilient. Programs teaching conflict negotiation and emotional learning are also available though they tend to ignore other sources of strength such as optimism or meaning-making.

Unfortunately, for most people, the only way to build up resilience is to experience trauma and loss for themselves. To quote Elizabeth Hardwicke, “Adversity is a great teacher, but this teacher makes us pay dearly for its instruction; and often the profit we derive, is not worth the price we paid.”   While it might be possible someday to develop programs that can teach the different strengths which promote resilience, we don’t seem to be there yet.

Still, the lessons learned from people able to grow and prosper following trauma may provide vital clues that can help others do the same.

SOURCE: https://www.psychologytoday.com/us/blog/media-spotlight/201804/what-makes-us-resilient

Ted Talk

Psychologist Susan David shares how the way we deal with our emotions shapes everything that matters: our actions, careers, relationships, health and happiness. In this deeply moving, humorous and potentially life-changing talk, she challenges a culture that prizes positivity over emotional truth and discusses the powerful strategies of emotional agility. A talk to share.

Susan David, a Harvard Medical School psychologist, studies emotional agility: the psychology of how we can use emotion to bring forward our best selves in all aspects of how we love, live, parent and lead.

SOURCE:https://www.ted.com/talks/susan_david_the_gift_and_power_of_emotional_courage

INNOVATIONS

Interesting ventilator options from the UK and Tasmania, and the development of blood testing to predict preterm births follow…

Infant news – Draeger launches VentStar Helix heated hose system for high frequency ventilation

 May 18, 2018 – The VentStar Helix heated hose system for high frequency ventilation.

The VentStar Helix heated (N) plus has been specifically developed for high frequency ventilation and for interaction with ventilators that have a high frequency ventilation function.It uses hoses that only expand slightly so that the ventilation pressure in the system is maintained, and small volumes of breathing gas can pass through the ventilation hose to the patient.A helical heating wire, which winds around the hose system as a double-helix, is designed to evenly heat the breathing gas from the outside. This means that the inside of the hose is free of heating wires, which allows the breathing gas to flow through the hose into the neonatal patient’s airway with low resistance.

SOURCE:http://www.infantjournal.co.uk/news_detail.html?id=289

Infant news – SLE and the University of Tasmania announce license of technology designed to reduce infant mortality

The OxyGenie technology will be incorporated into the SLE6000 ventilator

March 20, 2018

SLE Ltd and the University of Tasmania have announced that they have concluded a commercial licence that will see SLE begin incorporating the university’s patented algorithm (using a closed-loop control for optimised oxygen concentration in the blood circulation of infants) into the SLE6000 neonatal ventilator.

Branded OxyGenie, the technology has been developed over the last nine years by a team of scientists led by Professor Peter Dargaville of the Tasmanian Health Service and Dr Tim Gale of the School of Engineering and ICT at the University of Tasmania and is now being integrated into the SLE6000 in collaboration with the SLE engineering department.

Past multi-centre studies have shown that vulnerable infants are very susceptible to changes in the oxygen in their circulation. Maintenance of this blood oxygen in a narrow but critical band may reduce mortality, retinal damage and other long-term effects. OxyGenie technology, which is currently only licensed to SLE, will keep infants within the target range without the intervention of clinical staff.

Findings of a clinical study of the algorithm that reinforce its capacity to control oxygen delivery in tiny preterm infants under challenging clinical conditions will be presented at the Society for Paediatric Research meeting in Toronto in May this year.

SOURCE: http://www.infantjournal.co.uk/news_detail.html?id=272

Premature birth test being trialed

08Jun18 – BBC News

Scientists are trialling a blood test that may predict whether a pregnant woman will give birth prematurely.

Preliminary results, published in the journal Science, suggest it is accurate in up to 80% of high-risk women.

The team, at Stanford University, in the US, say it is also as accurate as ultra-sound scans at predicting due dates.

However, there is still far more work to do before it could be used clinically.

• Every year 15 million babies are born too early (before 37 weeks gestation) around the world
• Preterm birth is linked to a million deaths a year
• It is the leading cause of deaths among children under the age of five

The test measures the activity of genetic material, called RNA, coming from the foetus, placenta and mother that ends up in the bloodstream. The researchers started by taking blood samples from pregnant women every week to see how levels of different RNAs changed during pregnancy and which could be used to predict gestational age or a premature birth. The blood test was accurate 45% of the time at predicting gestational age in experiments involving 38 women, compared with 48% for ultrasounds, the researchers say. The test was also used to predict preterm birth up to two months ahead of labour starting. It was used in two separate groups of women – in one it was right six times out of eight, in the other it worked four times out of five. Mira Moufarrej, one of the researchers, told the BBC: “I’m really excited about the potential of all this. “If we can use a mother’s blood to make healthcare more accessible and affordable to people that don’t have access to ultrasounds, then hopefully that means healthier babies and healthier pregnancies.” However, she emphasised this was still only a pilot study and the results needed to be confirmed in much larger trials. Prof Basky Thilaganathan, a Royal College of Obstetricians and Gynaecologists spokesman, said: “Complications from premature birth are a leading cause of infant mortality and affect 7-8% of all births in the UK.

“However, the number of cases in the study were small and the accuracy of prediction was poor for premature birth. More research is needed to confirm the findings before it can be considered in clinical settings.”

SOURCE: https://www.bbc.com/news/health-44386367

HEALTH CARE PARTNERS

Enjoy this recent research regarding Reducing Alarm Fatigue in the NICU, Team Coaching/Rounding and the significant and selective effects preterm birth has on the functional networks of a child’s brain.

Reducing Alarm Fatigue in Two Neonatal Intensive Care Units through a Quality Improvement Collaboration

Author information: Johnson KR^1,2, Hagadorn JI^1,2, Sink DW^1,2.

Division of Neonatology, Connecticut Children’s Medical Center, Hartford, Connecticut. Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.

Abstract

OBJECTIVE:

To reduce nonactionable oximeter alarms by 80% without increasing time infants were hypoxemic (oxygen saturation [SpO₂] ≤ 80%) or hyperoxemic (SpO₂ > 95% while on supplemental oxygen).

STUDY DESIGN:

In 2015, a multidisciplinary team at Connecticut Children’s Medical Center initiated a quality improvement project to reduce nonactionable oximeter alarms in two referral neonatal intensive care units (NICUs). Changes made through improvement cycles included reduction of the low oximeter alarm limit for specific populations, increased low alarm delay, development of postmenstrual age-based alarm profiles, and updated bedside visual reminders. Manual alarm tallies and electronic SpO₂ data were collected throughout the project.

RESULTS:

Alarm tallies were collected for 158 patient care hours with SpO₂ data available for 138 of those hours. Mean number of total nonactionable alarms per patient per hour decreased from 9 to 2 (78% decrease) and the mean number of nonactionable low alarms per patient per hour decreased from 5 to 1 (80% decrease). No change was noted in the balancing measures of percentage time with SpO₂ ≤ 80% (mean 4.3%) or SpO₂ > 95% (mean 23.7%).

CONCLUSION:

Through small changes in oximeter alarm settings, including revision of alarm limits, alarm delays, and age-specific alarm profiles, our NICUs significantly reduced nonactionable alarms without increasing hypoxemia.

Am J Perinatol. 2018 May 21. doi: 10.1055/s-0038-1653945. [Epub ahead of print]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

SOURCE: https://www.ncbi.nlm.nih.gov/pubmed/29783270

Team coaching and rounding as a framework to enhance organizational wellbeing, & team performance

Becoming an effective front-line nurse manager is a complex and dynamic process, particularly when nurses progress to these roles within their own unit when multifaceted interpersonal factors may feature. This article reports on a project referred to as, ‘Coaching and Rounding’ in the neonatal intensive care unit of the Women’s Hospital in Qatar. This project integrated leadership coaching activities with staff rounding on nurses they supervised using a structured framework. This project was designed to equip front-line nurse leaders with enhanced skills and techniques to promote a framework for developing relational leadership styles. Evaluation involved the charge nurses and staff under their supervision. Results suggested that there was improved supervisor-supervisee relationships, increased motivation and more frequent constructive feedback. The challenges to sustain these initial gains are the focus of ongoing initiatives. Full Article:

SOURCE:https://www.journalofneonatalnursing.com/article/S1355-1841(17)30074-1/fulltext

Preterm birth leaves its mark in the functional networks of the brain

Date: February 26, 2018 Source: University of Helsinki

Summary:

Researchers have demonstrated that premature birth has a significant and, at the same time, a very selective effect on the functional networks of a child’s brain. The effects can primarily be seen in the frontal lobe, which is significant for cognitive functions.

Premature birth is globally the most important risk factor for life-time disorders and defects in neurocognitive functions. However, current methods have not shed much light on how premature birth affects the early activity of neurons in the frontal lobe, significant specifically to cognitive functions.

A study involving 46 infants exposed to very early prematurity and nearly 70 healthy and mature control infants was recently conducted at the University of Helsinki and the Helsinki University Hospital. Brain function in the infants was monitored and measured with the help of an EEG cap, developed earlier at the clinic, revealing new information on the subject.

“In this study, a new ‘source analysis’ method was used for the first time to measure functional networks in the infant brain: with the help of a computer model, the measured EEG signals were interpreted as activity in the infant cortex, which enabled the evaluation of the functional networking of neurons in a very versatile manner on the cortical level,” says Sampsa Vanhatalo, a professor in clinical neurophysiology and the head of the study.

It was found that there are several overlapping functional neural networks in the cortex of a newborn. Another finding was that premature birth has a significant, but also a very selective effect on these networks. The clearest effect can be seen in the functional networks of the frontal lobe, especially significant to cognitive functions.

“We were able to demonstrate how the strength of synapses in the frontal lobe is linked with the neurological abilities of infants. This provides an extremely interesting opportunity to use the functional networking of the brain as an early indicator in, for example, clinical trials that compare the effects of different treatments on brain development. The selective changes found in the study also provide a potential explanation for attention deficit and other cognitive issues often found in children who are prematurely born.”

Vanhatalo points out that functional MRI imaging does not show the functional coupling of an infant’s neurons, even though the method is still widely used all over the world for studying this very phenomenon.

“Therefore, our EEG findings are the first results that actually provide information on cortical functional networks in preterm infants.”

University of Helsinki. “Preterm birth leaves its mark in the functional networks of the brain.” ScienceDaily. ScienceDaily, 26 February 2018. <www.sciencedaily.com/releases/2018/02/180226090303.htm>.

SOURCE: https://www.sciencedaily.com/releases/2018/02/180226090303.htm

WARRIORS:

KAT: Returning  to my NICU Home – Day 1

It was a beautiful sunny Spring day in Washington State. The cherry blossoms were beginning to peek through the tree tops, painting the outside entrance of the Medical Center in bursts of soft pinks and deep reds. My stomach felt as if it was going to burst as I put the car in park and gathered myself for the meeting about to transpire. I was a 21 year old woman taking footsteps back into the starting place of my life journey.

I arrived with sweaty palms to the hospital lobby and asked the volunteer at the check-in station directions to the Neonatal ICU Unit. Little did I know this station would soon become a familiar and frequent destination. Rounding the corner of the tiny café, I wound myself around a crowd of crisp lab coats, colorful scrubs, and anxious community members. Pressing the button of the Mountlake elevator I pondered what would take place. The elevator doors opened revealing a bright neon green sign  that read “Neonatal Intensive Care Unit”. As a walked along the hallway, my eyes embraced a collage of beautiful portraits containing the short stories of various NICU Grads.

Enclosed behind sliding glass windows was the receptionist, who greeted me warmly. I told her my name and that I was meeting with the Medical Director. The kind receptionist escorted me to the unit lobby;  a new glass enclosed structure that provided me with an outstanding view of South Lake Union. In nervous anticipation I sat admiring the ducks as I awaited the Director.

Soon, a nurse arrived and  introduced me to a sturdy man with white hair, a perfectly trimmed beard, and twinkly blue eyes. Shaking hands with the physician I felt a wave of emotion come over me. Before me stood a renowned health-care provider who had helped save my life. As we spoke, I watched tears glisten in his eyes as the doctor shared with me that he had never met an adult NICU survivor that he had treated. I was shocked to learn that care providers like him so often never got the opportunity to be personally thanked by the tiny patients they served.  In that moment I realized our meeting was not only meant for my own healing but for his as well.  I realized that a gesture of gratitude may provide validation for the services health care providers contribute to their patients each day. I felt comforted hearing  his condolences for the loss of my brother and he asked me about my mother. I learned about his passion for neonatal care and love for his family. He shared with me some of my medical history including my habit of pulling the oxygen tube out of my throat, setting off alarms. Our shared laughter sent us into a place of radiant joy.  I expressed my interest in volunteering in the NICU and told him of my interest in medicine. With a hug we ended our meeting and I provided my contact information. While parting, he told me he would have the nurse manager contact me regarding volunteering. And so my journey back into the NICU began…..

*** In our March 16, 2018 blog (South Korea) we began to write our Writing For Wellness stories. Kat’s story continues in our next global adventure…….

Tandem Surfing UK

Published on Oct 10, 2016

What these people can do on a surfboard is incredible!

BRASIL/BRAZIL 

the LARGEST country in South America, and fifth largest country in the world…

COMMUNITY

Healthcare in Brazil is a constitutional right. It is provided by both private and government institutions. The Health Minister administers national health policy. Primary healthcare remains the responsibility of the federal government, elements of which (such as the operation of hospitals) are overseen by individual states. Public healthcare is provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Healthcare System, known as the Unified Health System (Portuguese: Sistema Único de Saúde, SUS). The SUS is universal and free for everyone.

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

Country/Brazil (Global Average – 11.1%)   Rate: 9.2%  Rank: 107

Source: http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

Kathy: I recently met a young mother of a late term preemie who shared a NICU experience that was intellectually, emotionally and financially challenging. Resources to guide her through this experience were few and far between.  Current research indicates that even late preterm birth babies experience a variety of significant physical, neurological, medical and related challenges and needs. Although this group of preterm birth survivors may experience less complications than their micro-preemie brothers and sisters, late preterm birth preemies present unique needs/complications that we must continue to explore and understand. One issue that concerns me is the increase in non-emergency C-Section deliveries and the potential associated effects of this medical practice on our preterm birth community at large.

Brazil’s Women Are Pushing Back Against Rampant C-Sections

MOTHERBOARD   –    Marina Lopez – 12/07/16

Brazil has become a C-section capital of the world—a lucrative trend for doctors. But women are demanding the right to vaginal births.

Suzana Silva de Sousa was just three months pregnant when her doctor tried to schedule a cesarean section. De Sousa, 29, asked about a natural birth, but he pushed her towards the C-section surgery.

“I had a natural birth in mind, but I had no idea how hard it would be [to find a doctor],” de Sousa told me in Sao Paulo. “The easiest path was surgery, and that’s not normal,” she said.

De Sousa is one of thousands of Brazilian women fighting for greater access to natural births in what has become the C-section capital of the world. Here 80-90 percent of women in private hospitals, and 40 percent of women in public hospitals opt for the surgery, versus 32 percent in the United States and 9 percent in England. Compare that to the World Health Organization recommendation of 15 percent. The WHO warns that unnecessary C-sections can harm both the mother and baby. Not to mention they can rack up unnecessary health bills.

But that trend may finally be starting to change. Doulas and home births are becoming increasingly trendy and the Brazilian government has been pushing hospitals to increase their natural birth rates.

Despite a decreasing mortality rate, Brazil ranks alongside Congo and Nigeria as producing the largest number of premature babies in the world. The number of babies born prematurely in Brazil has nearly doubled over the last decade, to 11 percent of all births, according to a 2012 study by the World Health Organization. Researchers see a link between c-section rate and the rise in premature births.

In a country where women regularly undergo plastic surgery, C-sections have become a commonplace status symbol. Luxury hospitals offer everything from manicures to massages and happy hours following the surgery. But while many mothers have been taught to prefer C-sections, the health system does too. Doctors favor the procedure, which is more profitable and allows them to schedule back to back deliveries. Vaginal births cost on average $300 in Brazil, while C-sections can go for as much as $5,000, according to the Brazilian Medical Association.

Low-income mothers like de Sousa have even fewer options when it comes to delivery without surgery. In public hospitals, queues of women waiting to give birth can drive doctors to medically speed up deliveries and rush the process. The popularity of C-sections has also meant that fewer doctors have experience delivering children in any other way. Meanwhile, home births and doulas, increasingly popular options, are expensive and not covered by insurance.

So when de Sousa came across Casa Angela, a natural birth clinic on the outskirts of a favela in Sao Paulo, she knew it was the right place for her. The non-profit clinic, which caters to low-income women, emphasizes minimal interference from doctors. Each room comes equipped with bathtubs, yoga balls and monkey bars to help speed up delivery. The center also offers workshops on breastfeeding, prenatal yoga and welfare referral services.

“Low-income women going through a natural birth in a Brazilian hospital can be emotionally, culturally and physically isolated,” said Anke Riedel, a coordinator at the center. “They often have less self esteem and don’t know their rights when it comes to births.”

Casa Angela is the only clinic of its kind in Sao Paulo, a city of 20 million people. Its services proved so popular that Brazil’s upper class women showed up at the center a few years ago, asking to deliver their babies there as well. Today, half of the 400 women who deliver at Casa Angela every year are low-income and pay nothing for their deliveries. The rest pay on a sliding rate with prices up to $2000—the full cost of a birth for the clinic. The clinic is funded partially by the government and partially through private donations.

Brazil’s government has now decided to support this shift. It is trying to expand the number of women following de Sousa’s path. In an effort to curb what it called a “C-section epidemic” and prevent premature births, Brazil passed a law in June requiring women to sign consent forms acknowledging the risks of a C-section before going into surgery. The government also launched a partnership with 26 hospitals called to promote vaginal births. Since the start of the project one year ago, vaginal births increased by 76 percent and complications during birth in three of the hospitals fell by half. The project is now expanding to 150 hospitals around the country. But critics say outspoken mothers and government pressure hinder doctors’ abilities to use their expertise to decide what’s best for the patient.

“It puts the doctor in a difficult situation and interferes in the process of delivery,”said Dr. Gutemberg Fialho, president of the Medical Union of Brasilia. “The government wants us to push for natural birth, but what ends up happening is that if you avoid interfering until the last minute, it can lead to complications or even death for the baby.”

Last year a baby died in central Brazil because the mother insisted on a natural birth despite the doctor’s objections. Following the incident, a court ruled that doctors were responsible for deciding on the final birthing plan. “It reinforces a doctor’s autonomy. Even if the parents want a natural birth, the doctor is not bound by their decision,” the Governor Valadares Association, one of the country’s oldest doctor’s unions, said in a statement.

But more Brazilians are still starting to believe that women should have more control over how they give birth, even if it’s inconvenient for their doctors.

“This has really been a movement started by mothers,” said Jose Moacir, a doctor at the clinic. “Women are taking the issue into their own hands and demanding that doctors rethink their practice.”

Source: https://motherboard.vice.com/en_us/article/9a38g8/brazil-c-sections-natural-births

INNOVATIONS

Imaging technology, safer transport for critically ill preemies, modified CPAP/ventilators for Neonatal Rescues are innovations that will positively impact our community!

Early Life Research- Posted on Tuesday 27th June 2017

University of Nottingham

Best paper prize at 12th IEEE Conference on Automatic Face and Gesture Recognition

Researchers from the Division of Child Health, Obstetrics and Gynaecology and the School of Computer Science have won the Best Conference Paper at the prestigious 12th IEEE Conference on Automatic Face and Gesture Recognition (FG2017) in Washington DC.

Submitted papers were reviewed by over 250 experts to decide on the winner. The paper, presented orally by Dr Mercedes Torres-Torres, described the clinical trial, GestATion, undertaken in Nottingham aiming to use machine learning to estimate gestation age in newborn babies using still images of the babies foot, face and ear.  The method could be used in low-middle income countries where antenatal care is poor and many babies are born prematurely with no record of this or unable to decide on the care they require.

Dr Don Sharkey, Associate Professor of Neonatal Medicine and chief investigator, Dr Caz Henry, Carole Ward (all from Academic Child Health) and Dr Michel Valstar (Lecturer in Computer Science) were also authors of the paper.  The study was funded by the Bill and Melinda Gates Foundation.

Source: https://www.nottingham.ac.uk/research/groups/earlyliferesearch/news/2017-best-paper-prize-at-12th-ieee-conference.aspx

Saving newborns with the NeoLife Ventilator, created by BYU alums and students

 Centre for Healthcare Technologies: World first for premature newborn research-

Although neonatal intensive care has advanced hugely in recent years with many more premature babies surviving, very preterm babies are still at risk of developing disabilities or neurological conditions. Many premature babies need to be taken some distance for specialist treatment within a few hours of birth. In the UK there are currently more than 16,000 neonatal inter-hospital transfers which is on the increase.

In a few years, premature babies could benefit from new safer systems for transporting them between hospitals thanks to pioneering research underway in Nottingham.

Clinicians, scientists and engineers at The University of Nottingham have studied the effects of noise, vibration and stress on premature babies in order to develop a safer, better transport incubator for use during transfers between hospitals for specialist care.

The initial work, led by Associate Professor of Neonatal Medicine Dr Don Sharkey, has recently been published and provides the most detailed assessment of vibration exposure in newborn babies to date.  Very premature babies who need to be transported between hospitals for life saving care are more likely to develop brain injury. This can lead to life-long disabilities and neurological conditions such as cerebral palsy. This type of brain injury is most likely to happen in the first few days of life when many of these babies are transferred. The team speculate that the significant vibration and noise the babies are exposed to could be a major contributing factor in the stress and brain injury observed.

Working with Professor Donal McNally, and others at the Centre for Healthcare Technologies, the team have also crash tested current newborn restraint systems used during the transport and believe they can be significantly improved.

The team are now undertaking a 3 year project to develop the next generation of neonatal transport system that aims to reduce the vibration and noise, whilst improving the comfort and safety, to reduce the stress for the baby and hopefully improve neurological outcomes.

The research is large collaborative effort with Industrial partners including ParAid Medical. The team has been awarded £872,000 by the NIHR to support this project, in addition to over £300,000 already awarded, and hope to have the new system available in 3-4 years that will improve the care of babies for years to come.

Source: http://www.healthcaretechnologies.ac.uk/news.aspx

HEALTH CARE PARTNERS

We are experiencing a global and local health care provider shortage. This shortage will increase over time, We are facing a health care shortage crisis. The Neonatal Womb/Preterm Birth community must support the development, retention, viability, and well-being of our health care partners. Globally, our Warriors themselves represent 11.1% of the global population. Our preterm birth family of parents, scientists, family members, friends, health care providers, scientists, researchers, innovators, financial support investors, teachers, funding sources, etc.  touch the majority of our human population at large. We all need each other in order to survive, thrive, and live fulfilling lives with joy, in health and wellness.

New Research Shows Increasing Physician Shortages in Both Primary and Specialty Care

Wednesday, April 11, 2018

The United States could see a shortage of up to 120,000 physicians by 2030, impacting patient care across the nation, according to new data published today by the AAMC (Association of American Medical Colleges). The report, The Complexities of Physician Supply and Demand: Projections from 2016-2030, updates and aligns with estimates conducted in 2015, 2016, and 2017, and shows a projected shortage of between 42,600 and 121,300 physicians by the end of the next decade.

“This year’s analysis reinforces the serious threat posed by a real and significant doctor shortage,” said AAMC President and CEO Darrell G. Kirch, MD. “With the additional demand from a population that will not only continue to grow but also age considerably over the next 12 years, we must start training more doctors now to meet the needs of our patients in the future.”

The Life Science division of IHS Markit, a global information company, conducted this fourth annual study of physician supply and demand on behalf of the AAMC. The study modeled a wide range of health care and policy scenarios, such as payment and delivery reform, increased use of advanced practice nurses and physician assistants, and delays in physician retirements.

The report aggregates the shortages in four broad categories: primary care, medical specialties, surgical specialties, and other specialties. By 2030, the study estimates a shortfall of between 14,800 and 49,300 primary care physicians. At the same time, there will be a shortage in non-primary care specialties of between 33,800 and 72,700 physicians. These findings are consistent with previous reports and persist despite modeling that takes into account the use of other health professions and changes in care delivery.

As in prior projections, much of the increased demand comes from a growing, aging population. The U.S. population is estimated to grow by nearly 11%, with those over age 65 increasing by 50% by 2030. Additionally, the aging population will affect physician supply, since one-third of all currently active doctors will be older than 65 in the next decade. When these physicians decide to retire could have the greatest impact on supply.

This year’s report also repeated an analysis first conducted in 2017, which examined physician workforce demand if underserved populations had care utilization patterns similar to groups with fewer barriers to health care and physician access. According to the data, if people living in non-metropolitan areas and people without insurance used care the same way as insured individuals in metropolitan areas, the nation would have needed an additional 31,600 physicians in 2016, with nearly half of those needed in the South. If all Americans had utilization patterns similar to non-Hispanic white populations with insurance in metropolitan areas, the U.S. would need an additional 95,100 doctors immediately.

In addition to training more physicians, the AAMC believes that a multi-pronged approach is necessary to ease the physician shortage. Medical schools and teaching hospitals are educating future physicians in team-based, interprofessional care, developing innovative care delivery and payment models, and integrating cutting-edge technology and research into the patient care environment. The AAMC also supports legislation that would increase federal support for an additional 3,000 new residency positions each year over the next five years. These additional slots are crucial since every medical school graduate needs to complete training after medical school to practice independently.

In addition, the AAMC supports federal incentives and programs such as the National Health Service Corps, Public Service Loan Forgiveness, the Conrad 30 Waiver Program, and Title VII/VIII workforce development and diversity pipeline programs, all designed to recruit a diverse workforce and encourage physicians to enter shortage specialties and to practice in underserved communities.

“Medical schools and teaching hospitals are working to ensure that the supply of physicians is sufficient to meet demand and that those physicians are ready to practice in the health care system of future,” Kirch said. “To address the doctor shortage, medical schools have increased class sizes by nearly 30% since 2002. Now it’s time for Congress to do its part. Funding for residency training has been frozen since 1997 and without an increase in federal support, there simply won’t be enough doctors to provide the care Americans need.”

Source: https://news.aamc.org/press releases/article/workforce_report_shortage_04112018/

Limiting Resident Hours Ups Satisfaction, No Effect on Education

Veronica Hackethal, MD March 28, 2018

Residents with limited work hours report more satisfaction with their training and work–life balance than those with flexible hours and longer shifts, according to results from the Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial.

The study, published online March 20 in the New England Journal of Medicine, also shows that limiting residents’ work hours does not appear to affect educational outcomes. “Many educators have worried that the shift work created by limited duty hours will undermine the training and socialization of young physicians,” principal investigator David Asch, MD, from the University of Pennsylvania in Philadelphia, said in a press release. “Educating young physicians is critically important to health care, but it isn’t the only thing that matters. We didn’t find important differences in education outcomes, but we still await results about the sleep interns receive and the safety of patients under their care,” he added.

The issue goes back at least to 2003, when the Accreditation Council of Graduate Medical Education (ACGME) limited resident work hours to 30-hour shifts and 80-hour work weeks. In 2011, the ACGME further limited shifts to 16 hours for first-year residents (interns). Before these changes, resident hours were generally unrestricted. Ninety-plus hour work weeks and 36-hour shifts were often the norm. Program directors often justified these long hours by saying they contributed to continuity of care and helped train physicians to function successfully while sleep-deprived and under pressure.

Early evaluations showed that the restriction in work hours did not significantly affect patient outcomes. Yet program directors still reported that the quality of training and professional development of residents may be suffering. And they continued to voice concerns about the safety and quality of patient care. To find out what is really going on, researchers conducted a randomized trial at 63 internal medicine residency programs across the United States between July 2015 and June 2016.

They assigned 31 programs to standard work hours with limited work hours according to the 2011 ACGME policies: maximum 16-hour shifts for interns, maximum 28-hour shifts for more senior residents, at least 8 hours off between shifts, maximum 80-hour work weeks, and at least 1 day off every 7 days. The other 32 programs were assigned to use flexible work hours, with maximum 80-hour work weeks and 1 day off every 7 days, but no restrictions on shift length or mandatory time off between shifts.

For the current analysis, 23 trained observers followed the daily shifts of 80 interns (44 in flexible programs, 36 in standard programs) to evaluate activities and time spent in patient care vs education. The researchers also assessed medical knowledge by comparing scores on the American College of Physicians second-year in-training exam, and they surveyed trainees and program directors to assess their perceptions about satisfaction, education, burnout, work intensity, and continuity of care.

Results showed no significant differences in time spent on direct patient care for trainees in flexible programs (13.0%) vs standard programs (11.8%; P = .21). Residents in both types of programs also spent the same amount of time on education: 7.3 hours per shift for both (P > .99). Likewise, residents in flexible and standard programs had similar scores on in-training exams, even after adjusting for baseline scores that varied largely across programs (P < .001 for non-inferiority). In 2016, second-year residents in flexible programs had average scores of 68.9%, and those in standard programs had scores of 69.4%.

However, differences emerged when it came to satisfaction with work–life balance and education.Compared with interns in standard programs, those in flexible programs were almost 2.5 times more likely to report dissatisfaction with their overall well-being (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.67 – 3.65) and were more than six times more likely to report dissatisfaction with how the program affects their personal lives with friends and family (OR, 6.11; 95% CI, 3.76 – 9.91). They also reported more than 1.5 times more dissatisfaction with the overall quality of education (OR, 1.67; 95% CI, 1.02 – 2.73). Yet both groups reported similarly high rates of burnout: 79% for flexible programs and 72% for standard programs.

In contrast, program directors of standard programs were more likely than those of flexible programs to report dissatisfaction with various aspects of training. For example, directors of standard programs reported more dissatisfaction with the quality and frequency of patient handoffs and the adequacy of bedside teaching, as well as the ability of interns to manage patients they admit and effectively perform their clinical duties.

“The takeaway is that interns were overall less satisfied with the flexible policies and the program directors were less satisfied with the standard approach,” senior author Judy Shea, PhD, from the University of Pennsylvania said in a press release. Principal investigator Asch added: “The residents are telling us something and program directors should listen carefully.”

Source: https://www.medscape.com/viewarticle/894509

Researchers Find Genes Linked to Preterm Birth

By Robert Preidt, HealthDay Reporter

WEDNESDAY, Sept. 6, 2017 (HealthDay News) — Researchers say they’ve pinpointed gene areas linked with preterm birth — and they said this could pave new ways to prevent the leading cause of death among children under age 5 worldwide.

The team looked at DNA and other data from more than 50,000 women from the United States and northern European countries. The researchers identified six gene regions that influence the length of pregnancy and the timing of birth.

“These are exciting findings that could play a key role in reducing newborn deaths and giving every child the chance to grow up smart and strong,” said Trevor Mundel, president of the Global Health Division at the Bill & Melinda Gates Foundation.

Source: https://health.usnews.com/health-care/articles/2017-09-06/researchers-find-genes-linked-to-preterm-birth

Taking Care of the NICU Graduate: A Team Approach

Bree Andrews, MD, MPH; Colleen Peyton, PT, DPT, PCS

• Pediatric Annals. 2018;47(4):e140-e141- Healio – Posted April 18, 2018

• There are three general types of neonatal intensive care unit (NICU) graduates with overlap in diagnosis and needs in infancy and early childhood: premature infants, infants with congenital malformations or anomalies requiring surgical and subspecialty follow up, and term infants with distress after birth.
• Most infants who stay in the NICU for more than 2 weeks require extensive follow-up care. These infants are often more medically complex and have increased risk of long-term neurodevelopmental impairments. Although NICU graduates are often medically managed by pediatricians in the community, a multidisciplinary approach can help to optimize neurodevelopmental trajectories. In this issue of Pediatric Annals, we are pleased to present the perspectives of professionals from various backgrounds, reflecting the multifaceted care that is often required in these high-risk NICU graduates.
• As clinicians, we are obliged to set the tempo throughout the NICU period regarding medical needs and clinical expectations at the time of discharge. We should also be mindful that parents will look to us for guidance about early childhood as well. Introductions to subspecialty teams and the interventions that take place in the NICU are crucial to long-term comfort and ease of the parents facing a different experience from some families after the birth of a child. A methodical approach to discharging an infant from the NICU can aid families and their physicians considerably in the months and years to come.
• In the case of the preterm infant, a pathway to discharge in the arenas of breathing, temperature control, feeding, and sleep should be explained as the child matures. Parents should be informed that growth and development of NICU graduates are typically “adjusted” back to take account of their prematurity. Parents should be provided with resources to understand medical problems, developmental milestones, feeding guidelines, overall safety, and specialized processes for making sure premature infants thrive after discharge.
• In the first article, “Follow-Up Care for High-Risk Preterm Infants,” Dr. Stephannie M. B. Voller overviews the medical issues and developmental concerns that a pediatrician should consider when caring for a high-risk preterm infant. In the second article, “Common Queries About Immunizations in Preterm Infants,” Dr. Ansul Asad provides answers to commonly asked questions about immunizations specific to infants born preterm. Next, Taylor Peters and Cecelia Pompeii-Wolfe in their article, “Nutrition Considerations After NICU Discharge,” highlight the nutritional concerns and provide feeding resources for clinicians and families of preterm infants.
• For children with congenital anomalies, especially where surgical intervention is needed, families can be taught about overarching clinical or genetic conditions while surgical procedures and planning ensue. Many centers have multidisciplinary groups for unique diagnoses such as cleft lip and palate, Prader-Willi syndrome, hyperinsulinism, neural tube defects, and others. Many conditions have support groups online for parents to unite and find novel evaluations or treatments.
• Infants facing distress after birth are unique and often need tertiary care. The most common reasons for a term infant to need NICU care are infection, respiratory distress, perinatal depression, and seizures. These conditions often require a set of interventions unique to the infant’s presentation. Although many patients will have short treatment courses for these illnesses, some will be protracted after long-term ventilation or extracorporeal membrane oxygenation.
• As patients in the NICU become more stable and approach graduation, the NICU team should build on the inpatient processes for outpatient care and care coordination. The specialized processes can include the use of durable medical equipment and specialized pharmacies for supplies and medications, respectively.
• Each medical problem should be detailed with the parents of NICU graduates; the importance of follow-up care should be emphasized, with the intent of having an ongoing discussion that imprints the parents with the education and capacity to seek that follow-up care. NICU graduates, including those with congenital anomalies, who are in distress after term birth or those born preterm are all at risk of having adverse neurodevelopmental outcome. In the article, “General Movements: A Behavioral Biomarker of Later Motor and Cognitive Dysfunction in NICU Graduates,” Drs. Colleen Peyton and Christa Einspieler provide an overview of a clinical tool that can be used in infants younger than age 5 months to predict neurodevelopmental outcome in high-risk infants. In the final article, “NICU Graduates: The Role of the Allied Health Team in Follow-Up,” Dr. Jane L. Orton and colleagues offer a comprehensive overview about the role of the allied health team in the care of infants at-risk or with known developmental issues.
• This issue is dedicated to exploring mechanisms of enhancing clinician and parent capacity to care for these patients after NICU discharge. Graduations come with hopes and dreams, but also concerns and uncertainties.

Source: https://doi.org/10.3928/19382359-20180320-03

PREEMIE FAMILY PARTNERS

Dads are more stressed than moms after bringing preemies home

Chicago Tribune Sunday May 06, 2018

Baby Ava weighed 2 pounds, 15 ounces when she was born 10 weeks early after her mother had preeclampsia. When she was born in 2014, she didn’t move or cry initially. Ava’s skin was too sensitive for clothing, her parents couldn’t hold her, and she was connected to all kinds of wires and monitors. After a five-week stay in the neonatal intensive care unit, where each day was a struggle, the Illinois couple got to bring their baby home — but after getting accustomed to having help from monitors, they knew the transition wouldn’t be easy.

“She wouldn’t be connected to monitors to tell us if she’s still breathing; we won’t have nurses constantly monitoring her,” said Ava’s dad, Irwin Obispo, a pharmacist manager at a local retail pharmacy. “The stress of having to take care of a preemie with all the extra monitoring and attention to care is highly overwhelming.”

There also was sleep loss paired with a day job and worries about his wife, plus the knowledge that the family had narrowly slipped through some very dangerous territory at the hospital. “I may have physically endured pain, but the emotional and mental pain of possibly losing his family is equally as hard,” said Michelle Obispo about her husband.

Contrary to popular belief, it’s the fathers whose stress levels rise when bringing premature NICU babies home from the hospital — while the mothers’ stress levels stay constant, according to a new study by researchers at Northwestern Medicine.

They found that before being discharged from the NICU, both parents had high levels of cortisol, the stress hormone. But during the two weeks after being discharged, the mothers’ stress levels returned to normal, while the fathers’ continued to rise. When the babies are in the hospital, they’re cared for by a team of nurses and physicians, said Craig Garfield, lead author of the study, and associate professor of pediatrics and medical social sciences at Northwestern University.

“When the baby comes home, suddenly baby needs care and support, mom needs care and support, and dad may still be trying to juggle work and his growing home responsibilities,” said Garfield, who also is an attending physician at Lurie Children’s Hospital. Mothers also tend to process the situation long before fathers do, which may account for their being able to adjust faster, said AnnaMarie Rodney, owner of Chicago Family Douglas. As soon as a woman gets pregnant, she begins to plan for her baby, while many men might not do as much until the baby is born.

“I talk to five to 10 moms a day, and the things I hear from them are that when they’re pregnant, their husbands don’t think their lives are going to change,” Rodney said. “When dads realize, ‘I’m a dad,’ — this changes everything — but now, if anything isn’t perfect, it’s an additional stress, and they really don’t know what to do with it.”

If the baby goes directly to the NICU, many fathers continue to feel powerless, said Jennifer Howard, a licensed professional counselor in Virginia who specializes in the treatment of perinatal mental health and is the mother of a preemie. In there, the machines, nurses and doctors take over, as the parents watch.

“When your baby is discharged from the NICU, it can feel quite overwhelming to transition to a position where you are now in charge,” Howard said. “This transition likely heightens dad’s feelings of insecurity about their ability to care for their baby.”  The partners also are faced with a unique role, as they’re supposed to be the strong ones in this situation since they didn’t give birth, so they have to care for the mother and the baby. And while postpartum depression is a much-publicized medical problem facing mothers, men’s stress and postpartum issues haven’t been studied much until now.

“It’s largely misunderstood, but fathers also experience perinatal mood and anxiety disorders,” Howard said.About 1 in 7 women will experience postpartum depression, and 1 in 10 men will also experience it. An NICU stay is one of the factors related to postpartum depression, and it could affect men and women, Howard said. Fathers often are the first to see their preemies or sick children in the NICU because the mother is still in the recovery room. Fathers also watch emergency C-sections, and they are there during the crisis, while the mother may be under anesthesia or may not be as aware of what’s happening.

“If the birth was traumatic — for instance, if the baby was resuscitated — then dads may be exposed and more aware of the baby’s health concerns,” Howard said. “This can lead dads to experience symptoms of PTSD, as well.” But postpartum depression and stress symptoms after childbirth typically manifest differently in dads than in moms. Men will often be angry, irritable, will be more likely to abuse alcohol or other substances, and will withdraw and be alone, said Crystal Clancy, executive director of community engagement at Pregnancy & Postpartum Support Minnesota.They should seek professional help immediately, as they need to be healthy to properly care for their infant.

Source:http://www.chicagotribune.com/lifestyles/health/sc-fam-dads-stress-preemie-0213-story.html

EurekAlert! is an online, global news service operated by AAAS, the science society

Public Release: 5-May-2018 – Pediatric Academic Societies

Majority of late preterm infants suffer from morbidities resulting in hospital stay

Physiological immaturity plays an important role in producing poorer outcomes

TORONTO, May 5, 2018 – A new study found the majority of late preterm infants (LPTs) suffer from morbidities resulting in hospital stay. Although factors that result in LPT births do contribute to morbidity, physiological immaturity plays an important role in producing poorer outcomes. The research will be presented during the Pediatric Academic Societies (PAS) 2018 Meeting in Toronto.

LPTs constitute 70 percent of the preterm population. Common neonatal morbidities are higher in this group compared to term infants. Although this increased risk is attributed to physiological immaturity, recent studies indicate that immaturity itself may not be the sole cause of morbidity as all premature infants experience this risk, but suffer different outcomes. Some studies demonstrate that the risk of morbidities is determined by the causes of preterm delivery with immaturity acting as modulator. The relative contribution of these factors is unclear. The objective of this study was to assess the role of indications of delivery in LPT in determination of common neonatal morbidities that result in hospital stay.

The study was conducted as a retrospective cohort study of LPTs born in a single tertiary care centre between April 2014 and February 2016. Researchers categorized indications of birth as threatened preterm labor (TPTL), preterm premature rupture of membrane (PPROM) and medically indicated deliveries, which included maternal and fetal pathologies. Risk of hypoglycemia, hyperbilirubinemia, use of CPAP, and apnea of prematurity in LPT were estimated by calculating unadjusted and adjusted for gestational age risk ratios using multiple regression analysis with PPROM as a reference category.

PPROM was responsible for 38.4 percent of deliveries, TPTL in 22.8 percent, and 39.1 percent were delivered due to various obstetric and fetal indications with pre-eclampsia and intrauterine growth restriction being the most common reason for medically indicated preterm deliveries. All morbidities were significant across gestational age, with increased risk with decreased gestational age, except hypoglycemia where the incident was highest at 36 weeks (66.7 percent), versus 28.5 percent at 35 weeks, and 22.7 percent at 34 weeks (p value=0.039).

Dr. Melissa Lorenzo will present the abstract, “Morbidity Risk Among Late Term Preterm Infants: Immaturity vs Indication of Delivery,” during the PAS 2018 Meeting on Tuesday, May 8 at 7:30 a.m. EDT.

Source: https://www.eurekalert.org/pub_releases/2018-05/pas-mol042618.php#.Wu600dAn3c0.email

WARRIORS:

As announced  in our last Blog, moving forward I (Kat) will be sharing my preterm birth survivor story through  our Writing-for- Wellness experience. I feel deeply connected to each and every one of you in my heart and soul. I have always considered myself a Global citizen. My genealogy tells me a story about the history of my body – a Global composition of DNA that looks like this:

Genealogy of my maternal and paternal strands is pictured above. My brother Seth, sister Ciara and I took our DNA tests and found out our genetic make up is as shown in the photos above. Ethnically we are Western and Eastern European, Scandinavian, North African Berber, Senegalese/Central African, South African, Middle Eastern, South and East Asian, Latin, Indigenous to the Americas, and Polynesian.

Hello World!

HUFFPOST SPORTS – 04/30/2018 – By Mary Papenfuss

Cowabunga! Brazilian Rodrigo Koxa Breaks World Record Surfing        80-Foot Wave 

“I got a present from God,” the gutsy surfer said at a World Surf League ceremony.

Brazilian Rodrigo Koxa has broken a world record by riding the biggest wave ever surfed, according to the World Surf League.

Koxa mastered the monster 80-footer off the coast of Nazaré, Portugal, in November. His record-breaking feat only became official Saturday, when it was recognized with the Quiksilver XXL Biggest Wave Award at a World Surf League ceremony in Los Angeles.

“The award goes to the surfer who, by any means available, catches the biggest wave of the year,” the league said in a statement. “Not only did Koxa win this year’s honor, but he now holds the Guinness World Record for the biggest wave surfed.”

NEPAL

Nepal, officially the Federal Democratic Republic of Nepal  is a landlocked country in South Asia located in the Himalaya. With an estimated population of 26.4 million, it is 48th largest country by population and 93rd largest country by area. Public health and health care services in Nepal are provided by both the public and private sectors and fare poorly by international standards.
Source:https://en.wikipedia.org/wiki/Nepal
In Nepal, 81,000 babies are born too soon each year and 3,980 children under five die due to direct preterm complications (May 2017)

• March of Dimes Ranking – 20
• Preterm birth rate – 14%
• Global Average (current) – 11.1

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

COMMUNITY

• Free NICU service in Bharatpur Hospital   
• Published: March 25, 2017  Rastriya Samachar Samiti

CHITWAN: The Bharatpur Hospital is set to offer the Neonatal Intensive Care Unit (NICU) service for free of charge from Sunday. The NICU service which is already in operation will be offered free coinciding with 54th anniversary of the hospital, said the chairman of the hospital management committee Raj Kumar Rajbhandari. There are 12 beds in the NICU that started a year ago and eight will be added, he said. Earlier, only the charges for beds were free. Other expenditure cost were borne by the hospital itself, Rajbhandari said. All services in the NICU and infant wards are provided for free, said the hospital medical superintendent Dr. Rudra Prasad Marasini. In general, private hospitals charge the amount of mooney between Rs 5,000 to Rs 7,000 *** per day for using NICU. The free service provided by the hospital has helped poor people visiting the hospital with the need to admit their ailing children to the NICU in many ways.

Full Article: https://thehimalayantimes.com/nepal/neonatal-intensive-care-unit-service-bharatpur-hospital-provided-free/

• Average NICU costs daily in Nepal –  $77.10 – $107.94 (article above)
• Average annual wage Nepal – $ 9,024 (http://www.averagesalarysurvey.com/nepal) 04/02/18
• Glassdoor’s – median salary for U.S. employees – $51,272 (2017)
• Full Article: https://www.fool.com/investing/2017/03/24/whats-the-average-income-in-the-united-states.aspx
• Medela Neonatal Perspectives estimates NICU costs daily average $2369 per day (note – great variance)
• Full Article: http://blog.neonatalperspectives.com/2015/08/07/unraveling-the-cost-of-very-low-birth-weight-infants/

New Wrap Is the Future of Care for Low-Birthweight Babies in Nepal

When a mother gives birth to a low-birthweight baby in Nepal, she is advised by the health care provider to use a “wrap” to carry the baby for skin-to-skin care. This practice is a key feature of kangaroo mother care (KMC)—a proven intervention to help small babies survive by increasing the baby’s weight and regulating the baby’s body temperature. However, the traditional cloth that is commonly used to wrap the baby poses challenges, making it difficult for mothers and families to practice KMC.

As one mother stated, “The family member trained in the hospital for tying the traditional wrap is not always available at home, and when we seek help from other untrained relatives or neighbors, they cannot tie the wrap securely.”

Globally, 60%–80% of newborn deaths are low-birthweight babies. In Nepal, there are 81,000 premature/low-birthweight babies born annually, with approximately 10,400 infant deaths due to premature/low-birthweight complications. KMC can prevent many of these deaths, but it is not widely used in Nepal. Nepal has worked to reduce newborn mortality, but knows there is still more to do.

A recent Jhpiego study in Nepal, which aims to increase the use of KMC, offers hope for families to more easily practice this lifesaving intervention for their babies. Funded by Laerdal Global Health, the study trained nurse-midwives in KMC at two Nepalese hospitals using a Jhpiego-developed training package. After nurse-midwives were equipped with the necessary skills, they counseled, trained, supported and provided follow-up to families with stable, low-birthweight babies. Families were offered a choice between taking home a traditional wrap or a new wrap known as CarePlus and designed by Laerdal Global Health.

Over a period of five months, nurse-midwives enrolled 96 women with low-birthweight babies. Of those, 82 women chose the CarePlus wrap and 14 women chose the traditional wrap. Results showed that mothers who selected the CarePlus wrap performed skin-to-skin contact for about 77 hours more than traditional wrap users.

In focus group discussions and in-depth interviews, mothers who selected the CarePlus wrap said it was easy to tie and could be tied without the help of another person. They found the wrap secure for the baby, more comfortable, easy to carry and rest with the baby, and family members preferred the new wrap.

 Mothers who chose the traditional wrap reported challenges, such as having difficulty tying the wrap, being fearful that the baby would fall and be injured, and feeling uncomfortable. Fathers were also more reluctant to practice KMC with the traditional wrap because it is a cloth worn by women.

“My husband … had carried the baby during hospital stay, but as I chose the traditional wrap, he avoided carrying the baby in the traditional wrap at home,” reported one mother who did not practice KMC at home.

All of the mothers who chose the CarePlus wrap performed household chores while practicing KMC with the baby; however, none of the mothers who chose the traditional wrap performed household chores while practicing KMC.

The results of this study offer promise for Nepal to increase utilization of KMC and prevent more newborn deaths. The study found that building capacity of nurse-midwives and providing the CarePlus wrap resulted in increased KMC practice. Scale-up of the intervention, including the preferred CarePlus wrap, by the Ministry of Health could help Nepal advance its efforts to decrease newborn deaths.

Full Article: https://www.jhpiego.org/success-story/new-wrap-future-care-low-birthweight-babies-nepal/

Helping Small Babies Grow: Scaling Up the CarePlus Wrap

Provider Site (Trainers): https://laerdalglobalhealth.com/products/careplus/

HEALTH CARE PARTNERS

Complications at birth associated with lasting chemical changes in the brain

Date: November 28, 2017 Source: King’s College London

Summary:

New research shows that adults born prematurely — who also suffered small brain injuries around the time of birth — have lower levels of dopamine in the brain.

New King’s College London research, published today (28 November) in eLife, shows that adults born prematurely — who also suffered small brain injuries around the time of birth — have lower levels of dopamine in the brain.

This chemical change has been linked to lack of motivation and enjoyment in normal life, and changes to attention and concentration, which could all be early signs of more serious mental health issues such as substance dependence and depression.

The study, which is a collaboration between researchers from King’s, Imperial College London and the Icahn School of Medicine at Mount Sinai in New York, also shows that most people born prematurely have completely normal dopamine levels.

Mental health problems often arise from a complex mix of genetic factors which make people more vulnerable, and negative or stressful life-experiences. Difficulties at birth can be among the most dangerous and dramatic of those life experiences.

Around one in 10 people are born prematurely and most experience no major complications around the time of birth. However in 15-20 per cent of babies born before 32 weeks of pregnancy, bleeding happens in the first week of life in fluid-filled spaces called ventricles, which are contained in the brain. If bleeding is significant, it can cause long-term problems.

The biological link between birth complications and greater risk of mental health issues is unclear, but one theory is that the stress of a complicated birth could lead to increased levels of dopamine, which is also increased in people with schizophrenia.

The researchers used a combination of positron emission tomography (PET) scans and magnetic resonance imaging (MRI) scans of the brain with a range of psychological tests in order to identify the precise changes to chemistry and structure of the brain following early brain damage. They compared three groups of people: adults who were born very preterm who sustained early brain damage, adults who were born very preterm who did not sustain brain damage and controls born at term.

Dr Sean Froudist-Walsh, the study’s first author, who carried out the study at King’s College London, said: ‘People have hypothesised for over 100 years that certain mental illnesses could be related to problems in early brain development. Studies using animal models have shown us how early brain damage and mental illness could be linked, but these theories had not been tested in experiments with humans.

‘We found that dopamine, a chemical that’s important for learning and enjoyment, is affected in people who had early brain injury, but not in the way a lot of people would have thought — dopamine levels were actually lower in these individuals. This could be important to how we think about treating people who suffered early brain damage and develop mental illness. I hope this will motivate scientists, doctors and policymakers to pay more attention to problems around birth, and how they can affect the brain in the long-term.’

Dr Chiara Nosarti, the study’s joint senior author from King’s College London, said ‘The discovery of a potential mechanism linking early life risk factors to adult mental illness could one day lead to more targeted and effective treatments of psychiatric problems in people who experienced complications at birth.’

Professor Oliver Howes, the study’s other joint senior author, also from King’s, said: ‘These findings could help develop approaches to prevent the development of problems in people who were born early.’

The study was funded by the March of Dimes and the Medical Research Council, and was supported by the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre.

Full Article:https://www.sciencedaily.com/releases/2017/11/171128090957.htm

Observational study found that even small variations in light can wake up very preterm infants in a neonatal intensive care unit

Abstract

Aim-This prospective observational study evaluated the behavioural responses of very preterm infants to spontaneous light variations.

Methods-We measured spontaneous light variations in the incubators of 27 very preterm infants, with a median gestational age of 28 weeks (range 26–31 weeks), over 10 hours. All of them had been admitted to the neonatal care unit of the Strasbourg University Hospital, France, between April 2008 and July 2009. Two independent raters examined changes in the infants’ behavioural states using video recordings. The percentage of awakenings was recorded when there were light variations and during control periods with no changes.

Results-We analysed 275 periods following light variations and 275 control periods. The overall percentage of awakenings was greater during periods following a change in light than during control periods (16.3% vs 11%, p = 0.03). The extent of light protection affected the percentage of awakenings. In mild light protection, there were more awakenings following changes in light than in control periods (25.6% vs 6.7%, p = 0.01). This difference was not found in high light protection.

Conclusion-Very preterm infants can be woken up by small variations in light, when the light protection in their incubator is insufficient.

Full Article: https://onlinelibrary.wiley.com/doi/abs/10.1111/apa.14261

Science News

Rapid whole-genome sequencing of neonatal ICU patients is useful and cost-effective

Date: October 19, 2017 Source: American Society of Human Genetics

Rapid whole-genome sequencing (WGS) of acutely ill neonatal intensive care unit (NICU) patients in the first few days of life yields clinically useful diagnoses in many cases, and results in lower aggregate costs than the current standard of care, according to findings presented at the American Society of Human Genetics (ASHG) 2017 Annual Meeting in Orlando, Fla.

Shimul Chowdhury, PhD, FACMG, Clinical Laboratory Director at the Rady Children’s Institute for Genomic Medicine, and his colleagues focused their analysis on a broad swath of NICU patients for whom a genetic diagnosis might help inform treatment decisions and disease management. They studied the clinical utility and cost-effectiveness of sequencing infants and their parents.

“Newborns often don’t fit traditional methods of diagnosis, as they may present with non-specific symptoms or display different signs from older children,” said Dr. Chowdhury. In many such cases, he explained, sequencing can pinpoint the cause of illness, yielding a diagnosis that allows doctors to modify inpatient treatment and resulting in dramatically improved medical outcomes in both the short and long term.

Because of the potential for early intervention and immediate adjustment in care, the researchers used a rapid WGS procedure that took three to seven days from sample collection to delivering results to patients’ families. The process can be further accelerated if medically necessary. In contrast, most clinical diagnostic tests take four to six weeks.

In 34 (35%) of the 98 patients enrolled in the study, WGS yielded a genetic diagnosis, and in 28 (80%) of those patients, that diagnosis led to changes in medical management, such as the use of medications targeted to the underlying disease, avoidance of unnecessary surgery, and guidance about palliative care. Cost-effectiveness analyses are ongoing, but among the first 42 infants sequenced, the researchers calculated a $1.3 million net cost savings for that hospitalization versus the current standard of care.

“The cost savings were especially striking, given that sequencing costs are still high — even with those costs, we found that rapid WGS was not just clinically useful but economically prudent,” Dr. Chowdhury said. “Given these benefits, we’d eventually like to see rapid WGS as a reimbursable first-tier test for a proportion of infants in the NICU.”

Currently, the researchers are looking to expand their study and assess the effectiveness of their approach across health systems and populations. This summer, they launched partnerships with children’s hospitals in California and Minnesota, an effort that will involve scaling up the rapid WGS process to meet demand and yield new insights about its clinical utility, cost-effectiveness, and ease of implementation in different environments.

Dr. Chowdhury noted the important contribution of genetics research to their progress so far. “Translational research leading to improvements in the speed and accuracy of sequencing tests is so important to our work and has a real impact on patients and their families,” he said.

Full Article: https://www.sciencedaily.com/releases/2017/10/171019110855.htm

INNOVATIONS

Tracking preemies’ blood flow to monitor brain maturation

December 11, 2017Share List

Blood is the conduit through which our cells receive much of what they need to grow and thrive. The nutrients and oxygen that cells require are transported by this liquid messenger. Getting adequate blood flow is especially important during the rapid growth of gestation and early childhood – particularly for the brain, the weight of which roughly triples during the last 13 weeks of a typical pregnancy. Any disruption to blood flow during this time could dramatically affect the development of this critical organ.

Now, a new study by Children’s National Health System researchers finds that blood flow to key regions of very premature infants’ brains is altered, providing an early warning sign of disturbed brain maturation well before such injury is visible on conventional imaging. The prospective, observational study was published online Dec. 4, 2017 by The Journal of Pediatrics.

“During the third trimester of pregnancy, the fetal brain undergoes an unprecedented growth spurt. To power that growth, cerebral blood flow increases and delivers the extra oxygen and nutrients needed to nurture normal brain development,” says Catherine Limperopoulos, Ph.D., director of the Developing Brain Research Laboratory at Children’s National and senior author of the study. “In full-term pregnancies, these critical brain structures mature inside the protective womb where the fetus can hear the mother and her heartbeat, which stimulates additional brain maturation. For infants born preterm, however, this essential maturation process happens in settings often stripped of such stimuli.”

The challenge: How to capture what goes right or wrong in the developing brains of these very fragile newborns? The researchers relied on arterial spin labeling (ASL) magnetic resonance (MR) imaging, a noninvasive technique that labels the water portion of blood to map how blood flows through infants’ brains in order to describe which regions do or do not receive adequate blood supply. The imaging work can be done without a contrast agent since water from arterial blood itself illuminates the path traveled by cerebral blood.

“In our study, very preterm infants had greater absolute cortical cerebral blood flow compared with full-term infants. Within regions, however, the insula (a region critical to experiencing emotion), anterior cingulate cortex (a region involved in cognitive processes) and auditory cortex (a region involved in processing sound) for preterm infants received a significantly decreased volume of blood, compared with full-term infants. For preterm infants, parenchymal brain injury and the need for cardiac vasopressor support both were correlated with decreased regional CBF,” Limperopoulos adds.

The team studied 98 preterm infants who were born June 2012 to December 2015, were younger than 32 gestational weeks at birth and who weighed less than 1,500 grams. They matched those preemies by gestational age with 104 infants who had been carried to term. The brain MRIs were performed as the infants slept.

Blood flows where it is needed most with areas of the brain that are used more heavily commandeering more oxygen and nutrients. Thus, during brain development, CBF is a good indicator of functional brain maturation since brain areas that are the most metabolically active need more blood.

“The ongoing maturation of the newborn’s brain can be seen in the distribution pattern of cerebral blood flow, with the greatest volume of blood traveling to the brainstem and deep grey matter,” says Marine Bouyssi-Kobar, M.S., the study’s lead author. “Because of the sharp resolution provided by ASL-MR images, our study finds that in addition to the brainstem and deep grey matter, the insula and the areas of the brain responsible for sensory and motor functions are also among the most oxygenated regions. This underscores the critical importance of these brain regions in early brain development. In preterm infants, the insula may be particularly vulnerable to the added stresses of life outside the womb.”

Of note, compromised regional brain structures in adults are implicated in multiple neurodevelopmental disorders. “Altered development of the insula and anterior cingulate cortex in newborns may represent early warning signs of preterm infants at greater risk for long-term neurodevelopmental impairments,” Limperopoulos says.

Research reported in this post was supported by the Canadian Institutes of Health Research, MOP-81116; the SickKids Foundation, XG 06-069; and the National Institutes of Health under award number R01 HL116585-01.

Hydrotherapy in the Sharp Mary Birch NICU

Published on Jan 2, 2018  Youtube-Sharp Mary Birch Hospital for Women & Newborns is one of only a few hospitals to offer hydrotherapy, a unique form of developmental care that helps strengthen the bodies of premature babies.

APP: Zero Mothers Die Application

The Zero Mothers Die App (ZMD App) is a source of essential maternal, newborn and child health information for pregnant women, new mothers and health workers providing care to their community.

As a unique mobile health app, the ZMD App delivers crucial information on healthy pregnancy and taking care of newborns for both the general public (women and their families) as well as frontline health workers, to help bridge the knowledge and skills gap as well as reduce maternal and newborn mortality across the globe.

The ZMD App has been launched for Android devices and is available in English, French, Spanish and Oromo.

Published on Sep 18, 2014-Zero Mothers Die is a global partnership initiative to reduce maternal mortality through the use of mobile technologies and cross-sector partnerships. Our aim is to support pregnant women, new mothers and local health workers to overcome barriers to maternal, newborn and child health using accessible mobile technology.

PREEMIE FAMILY PARTNERS

Premature babies healthier when parents help with hospital care, study shows Babies in trial put on more weight in first three weeks and parents were less stressed

Sarah Boseley – Health editor – 7 Feb 2018

Premature babies do better if their parents are allowed to help care for them in hospital alongside the nurses, rather than being treated as visitors and left on the sidelines, a new study shows.

Many parents feel acutely anxious, stressed and out of control when their child is in a newborn intensive care unit and there seems to be nothing they can do for her. Inspired by the example of a hospital in Estonia that brings in parents to help with basic care of their baby, doctors in Canada organized a major study in three countries – Canada, Australia and New Zealand – to see what the effect is on the baby.

Mothers in early 30s have lowest premature birth risk, study finds.

In their paper in the Lancet Child and Adolescent Health journal, they say that feeling excluded in the premature baby unit could have long-term consequences for the parents. “These feelings of helplessness, anxiety, depression, and fear might contribute to their inability to assume normal parenting roles,” they write.

The study involved 26 hospitals and nearly 1,800 babies, half of whom had basic care from their parents alongside the nursing staff, while the other half did not. Parents had to commit to spending six hours a day, five days a week, in the unit and were trained to help. They bathed, fed and dressed their babies, changed nappies, gave oral medication and took temperatures. They were encouraged to take part in decisions about the baby’s treatment, join ward rounds and chart their infant’s growth and progress.

The babies on what was called FiCare – family integrated care – had put on more weight by 21 days, their parents were less stressed and once the baby went home, the mothers were more likely to breastfeed frequently than mothers who had been less involved in the hospital.

“How care is provided to the family, not just the infant, has a positive effect on the wellbeing of both infant and family,” says Dr. Karel O’Brien, of the department of paediatrics, Sinai Health System, Toronto, Canada. “Weight gain, breastfeeding and reduced parental stress and anxiety are all associated with positive neurodevelopmental outcomes, suggesting that integrating parents into the care of infants at this early stage could potentially have longer-term benefits.”

Full Article:https://www.theguardian.com/society/2018/feb/07/premature-babies-healthier-when-parents-help-with-hospital-care-study-shows

Can you reduce your risk for preterm labor and premature birth?

Yes, you may be able to reduce your risk for early labor and birth. Some risk factors are things you can’t change, like having a premature birth in a previous pregnancy. Others are things you can do something about, like quitting smoking. Here’s what you can do to reduce your risk for preterm labor and premature birth:

• Get to a healthy weight before pregnancy and gain the right amount of weight during pregnancy. Talk to your provider about the right amount of weight for you before and during pregnancy.
• Don’t smoke, drink alcohol use street drugs or abuse prescription drugs. Ask your provider about programs that can help you quit.
• Go to your first prenatal care checkup as soon as you think you’re pregnant. During pregnancy, go to all your prenatal care checkups, even if you’re feeling fine. Prenatal care helps your provider make sure you and your baby are healthy.
• Get treated for chronic health conditions, like high blood pressure, diabetes, depression and thyroid problems. Depression is a medical condition in which strong feelings of sadness last for a long time and interfere with your daily life. It needs treatment to get better. The thyroid is a gland in your neck that makes hormones that help your body store and use energy from food.
• Protect yourself from infections. Talk to your provider about vaccinations that can help protect you from certain infections. Wash your hands with soap and water after using the bathroom or blowing your nose. Don’t eat raw meat, fish or eggs. Have safe sex. Don’t touch cat poop.
• Reduce your stress. Eat healthy foods and do something active every day. Ask family and friends for help around the house or taking care of other children. Get help if your partner abuses you. Talk to your boss about how to lower your stress at work.
• Wait at least 18 months between giving birth and getting pregnant again. Use birth control until you’re ready to get pregnant again. If you’re older than 35 or you’ve had a miscarriage or stillbirth, talk to your provider about how long to wait between pregnancies. Miscarriage is the death of a baby in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy.

Full Article: https://www.marchofdimes.org/complications/preterm-labor-and-premature-birth-are-you-at-risk.aspx

 WARRIORS:

Our next blog will begin to integrate Kat’s story as a preterm birth survivor into our Writing-for- Wellness experience. Please share her journey and reflect on your unique life adventures. In doing so, you will empower your-SELF!

Our (Kathy) Story Continues –Writing for Wellness:

After Kathryn’s distance healing at about age one, the ER visits ended and a new-normal developed. I nursed Kat until she was a bit over three years of age, believing with conviction that breast milk was crucial for her survival. I continued to provide Kat with the back and chest massage and tapping that the Respiratory Therapist/healer had empowered me with. In prayer and meditation daily I saw Kathryn and her siblings healthy and happy. Playing biddy sports and taking swimming lessons starting at the age of 3 yrs. Kathryn seemed different from the other kids in that she was so small and so affectionately distracted by her fellow classmates and team members. Playing tee ball, Kat would stop and hug each player as she ran the bases. The deep grove the intubation tube had created in Kathryn’s mouth generated a series of very displaced and disorganized teeth, requiring braces starting at age eight (an eight-year process). Around the time the braces were applied, Kathryn came home from school and announced that she wanted to be called Kat and then she said “I want to be a humanitarian when I grow up”. I stared at her and thought “you have got to be **** kidding me!”, and in that moment my role in her life changed and my parental responsibilities were dramatically redirected.

Entering the pre-teen years Kat’s height surpassed the estimated maximum height of 4’10” the medical professionals had anticipated. At age 17 yrs. Kathryn underwent a hymenectomy, and we were told that it was not uncommon for female preemies to require the surgery. Kat played various school and private league sports, usually in a leadership capacity. She was strong willed and often chose to do things her own way, creating conflict with authority figures. Kathryn determined she wanted to attend the most culturally diverse high school in Washington State at that time in order to globalize her worldview, and Mariner High School in Everett, WA. was the perfect place to accomplish that objective. Over time, Kathryn exhibited unexpected skills such as the ability to Latin dance, Krump and perform dissections in science classes with ease. Attending college in Missouri, Kat made friends with students from all across the globe and in the process developed intermediate Portuguese language skills. I wonder what effects the 60 plus transfusions Kathryn received while in the NICU played in the development of her global attraction and development of unanticipated talents. Did her emergent connection with her heart surgeon transfer to Kathryn, whose current intent is to become a trauma surgeon, influence her path forward?

It is the universal lesson of being present and letting go that our children, no matter how long or short their journey, presents to us. Following Kathryn’s announcement that she wanted to be a humanitarian, I exposed her to many great minds and healers through the process of attending book signings and lectures. Kathryn would carry the books through the lines for a handshake and a signing by the likes of Dr. Larry Dossey, Dr. Bernie Siegal, Bruce Lipton Ph.D., Marianne Williamson, and Dr. Deepak Chopra. I recall Deepak’s surprised look at seeing a child so small asking for her book to be signed. He said to her, “Where is your mother?” Kathryn’s spirituality and healing abilities developed over time. She sought shamanism training through Bastyr University, attended lectures by Dr. Mehmet and Lisa Oz, and participated in a non-traditional volunteer experience and medical shadow with John of God in Brazil. Kathryn nourished a loving connection with our beloved minister and teacher Imam Jamal Rahman (The Three Amigos), his dear friend, Rabbi Falcon, and she shared a hug and prayer with the beautiful and generous Amma. I was gladdened as Kathryn connected with the amazing health care providers and staff, magnificent doctors, NICU babies and family members at the University of Washington and Harborview Medical Centers as her mentoring process was thus enhanced and my responsibilities shared.

At times I think about the lyrics of the song “The Dance” (lyrics by Garth Brooks) and wonder if I would have agreed to this dance with Cruz and Kat knowing the challenges I encountered? In reflection, I so appreciate the surrender that not knowing presents, the richness and power that faith reveals.  Out of such pain and chaos, unimaginable beauty and exquisite love prevail.

One in every 10 babies born in the U.S. is admitted to a neonatal intensive care unit, according to the March of Dimes. Statistically NICU parents encounter a very high level of divorce and often experience the effects of post-traumatic stress disorder. PTSD in NICU parents is socially unrecognized and is often undiagnosed and untreated. The constant exposure to death, the breath by breath effort to sustain life, a myriad of medical complications due to preterm birth, interacting with a womb so different than the natural womb, overwhelming financial challenges, the unexpected and permanent disruption and reorganization of so many lives and immediate need to create balance within chaos produces untold stress for NICU/preterm birth journeyers. As preterm birth parents, we have the longing and potential for healing. So often, the one-foot-in-front-of-the-other rhythm that carries us through the NICU orientation becomes a life pattern, and the needs of our feeling bodies are never heard or healed.

At 27 years of age, Kathryn stands tall at 5 ft. 5 inches. Proudly wearing her surgical scars as her Zumba Instructor shirt whirls around her, Kathryn dances to the music of the global community she embraces. Knowing she has much to experience as a preterm birth survivor Kathryn’s life journey continues to expose itself, seeking to be heard and healed. Despite the common thought that a NICU survivor cannot remember the early trauma of their human beginnings, nothing could be further from the truth. The body and brain are one, and although a preterm infant is without language skills, the body has memory, feeling, and knowledge stored within the vast energetic system that contains the human experience. Epigenetic and super gene sciences continue to expand our understanding of the wildly complex, beautifully sensitive nature of a life journey.

As Kathryn continues to understand, explore, recognize and empower her healing potentials, both self and other oriented, my hope is that she will continue to heal, grow and engage with other NICU/preterm birth survivors. Perhaps through connection they will shed light into the mysteries of life for a preterm being nurtured and supported within the Neonatal Womb, and their companionship will deepen their breathe, open their hearts, inspire them, and carry them forward with courage and resolve.

KAT’S CORNER

May the Gratitude in My Heart Kiss all the Universe – Hafiz

In the writing above we identified some critical events that lead me to my current path in life. Warriors, if you were to list the important events in your life and connect the dots what kind of picture would it create and would it reflect where you are at in your journey?

White Water Surf Racing in Nepal

Published on Aug 16, 2016 – 2017 will ca 4 Event White Water Surfing Race Series in Nepal.Hosted by the Nepal National Surfing Association and organized by Surfing Nepal.

MALI

Exploring our preterm birth community in Mali where the preterm birth rate is one of the highest in the World has been unsettling. The health care provider shortage in Mali is severe. The country remains in political turmoil and according to Daily Mail.com in an article dated 2 March 2018 “Across the country an estimated 4.1 million people are in need of humanitarian assistance.” In this environment, general health care and security issues for the population as a whole are needed in order to provide a basis for caring for the preterm birth community. The need for safe drinking water remains a crisis Mali faces.

Source: http://www.dailymail.co.uk/wires/afp/article-5456863/Mali-insecurity-continues-migrating-countrys-center-UN.html

Preterm birth rate (births <37 weeks per 100 live births) – 12

Leading causes of neonatal deaths in Mali (2015) – 29% Preterm birth complications

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

Mali, officially the Republic of Mali (French: République du Mali), is a landlocked country in West Africa, a region geologically identified with the West African Craton. Mali is the eighth-largest country in Africa, with an area of just over 1,240,000 square kilometres (480,000 sq. mi). The population of Mali is 18 million. Its capital is Bamako. Mali consists of eight regions and its borders on the north reach deep into the middle of the Sahara Desert, while the country’s southern part, where the majority of inhabitants live, features the Niger and Senegal rivers. The country’s economy centers on agriculture and fishing. Some of Mali’s prominent natural resources include gold, being the third largest producer of gold in the African continent, and salt. About half the population lives below the international poverty line of $1.25 (U.S.) a day.

Mali faces numerous health challenges related to poverty, malnutrition, and inadequate hygiene and sanitation. Mali’s health and development indicators rank among the worst in the world.  Life expectancy at birth is estimated to be 53.06 years in 2012. In 2000, 62–65 percent of the population was estimated to have access to safe drinking water and only 69 percent to sanitation services of some kind.

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

COMMUNITY

Born On Time

We have mentioned Born on Time in prior blogs. Several organizations provide humanitarian assistance in Mali. Our challenge is to identify sources that we can research and recommend with some reliability. Born on Time work in Mali is ongoing and focused, and their efforts may profoundly affect our Mali preterm birth community.

Born On Time is a Public-Private Partnership to Prevent Preterm Birth. This bold new initiative brings together expertise and resources from World Vision Canada, Plan Canada, Save the Children, the Government of Canada and Johnson & Johnson. Working closely with local governments and stakeholders, the partners are working to improve newborn survival, with a focus on preventing preterm birth in high-burden areas of Bangladesh, Ethiopia and Mali over five years (2015-20).

 Save the Children’s participation in Born On Time will focus on Mali:                          In Mali men, as the primary decision makers, generally do not see maternal and newborn health and nutrition as their priority and women’s and girl’s voice are often excluded from community-level health services, which can mean decisions around healthcare do not reflect a focus on maternal and child health and needs. As such women are often hindered in their ability to seek healthcare for themselves and their children, and are limited in their ability to adopt preventive health measures such as family planning. Other important factors contributing to the high prevalence of preterm births in Mali include child, early, and forced marriage (CEFM) – in Mali, 55% of women aged 20 – 24 were married by 18 – and the high prevalence of violence against women and girls in the country.

Save the Children will work to conduct capacity-building activities on the gender equality dimensions of MNH to support the delivery of quality, gender-responsive reproductive health services. We will seek to empower girls and women by engaging them in health centre management boards and community health action groups in Mali, encouraging them to play a role as decision-makers in the community and at home. We will work to increase women’s and girls’ access to information and knowledge through a wide range of actions, such as the provision of information on healthy behaviors and care seeking through community awareness sessions. We will also engage the community, including traditional and religious leaders, older female decision-makers and especially men, as active partners of change through awareness-raising and social and behaviour change communication activities.

Source: https://www.savethechildren.ca/what-we-do/health-and-nutrition/born-on-time/

You can give a single gift, become a monthly donor, provide emergency relief, host an event and much more. Join us today in changing children’s lives!

Donate/participate in Mali heath here: https://www.savethechildren.ca/what-you-can-do/donate/

PREEMIE FAMILY PARTNERS

Kat: My life was deeply enriched when I witnessed the overwhelming changes that adoptable NICU babies experienced on special occasions when a preemie baby and an adoptive family were united. I have no doubt that lives are saved and/or transformed through the love and attention, touch and emotional connection of a family and infant.

Adoptive Families:             February 26, 2018

Adopting a Premature Infant-

If you’re adopting a premature baby, our expert has all of the information you need to understand development, hospital stay, and feeding to better care for your little one. by Dana E. Johnson, M.D., Ph.D. and Judith K. Eckerle, M.D.

In the United States, 8 to 10 percent of infants are born prematurely, and the figure is likely higher in adoptees, due to the prevalence of factors that lead to prematurity, such as lack of prenatal care and poor nutrition. Adoptive parents whose child was born prematurely, or at a low birth weight (LBW), are justifiably concerned about the medical conditions the child may face immediately after delivery, and medical and/or developmental problems in the future. While they appear tiny and fragile, preemies are surprisingly resilient. Most overcome their initial medical problems and enter their adoptive families with few lingering concerns.

Very low birth weight (VLBW) or very preterm infants have the highest risk of adverse outcomes. An analysis of multiple outcome studies, published in Pediatrics, in 2009, concluded that these children were at risk for moderate to severe deficits in academic achievement (math, reading, and spelling), and at a higher risk for attention problems, internalizing behavior problems (depression, anxiety), as well as deficits in executive function. Additional problems can include cerebral palsy or persistent lung problems, such as asthma, as well as hearing or vision loss.

For late preterm infants, which make up the majority of premature births (75 percent), outcomes are usually quite good. However, work published in Child’s Nervous System, in 2010, has identified a slightly increased risk over full-term infants for many of the long-term issues that affect very low birth weight/very preterm infants.

Some correction for prematurity is commonly used up to 24 months, to determine adjusted growth and development. Thus, the younger the baby, the more difficult it is to predict outcome. If a child is making good progress in developmental milestones during the first 12-24 months, growth is normal and hearing and vision unimpaired, we can be fairly optimistic that outcome will be favorable. However, we must often wait until school age to detect more subtle problems in learning, cognition, attention, and behavior. Preemies will be monitored through life for growth (shorter stature as an adult), subtle abnormalities in lung function, and a possibly higher risk of chronic diseases, such as hypertension.

Parenting a Preemie-

The environment in which a preemie develops is enormously important. Studies have found that parent education, child rearing by two parents (regardless of marital status), and stability in geographic residence and family composition over a 10-year-period positively impact school outcome in preemies. The Minnesota International Adoption Project surveyed more than 1,800 families whose children had been living with them for an average of seven years. When asked how the child’s medical and/or behavioral problems affected the family, parents of low birth weight infants were no more likely than parents of other children to report they were struggling to adjust.

While there are risks of ongoing medical, developmental, and behavioral problems, particularly for the smallest preemies, most of them experience normal growth and development during infancy and childhood. If a family sets appropriate expectations, knows their own abilities and the resources available, seeks appropriate consultation, and is cognizant of a premature child’s potential challenges, they can experience all the joys of parenting.

Full Article: https://www.adoptivefamilies.com/adoption-process/adopting-a-premature-baby/

 Spirituality, Health and Medicine

Kat’s Survival as a micro-preemie was supported, enabled, empowered by a gifted Neonatal Womb Community of Healers from Western, Eastern, and globally indigenous (originating or occurring naturally in a particular place) backgrounds.  I cannot express the anguish I felt as the mother of a child on the brink of death, moment to moment, hour to hour, day to day, week to week for the first year of Kathryn’s life. I am endlessly grateful for the guidance that led me to all of the healers that kept my daughter alive and created a foundation for her health. This Mali blog was a tough one for me, but there are healers in Mali, and a complex and challenging foundation to approach. We human beings are a tenacious species….

Our (Kathy) Story Continues –Writing for Wellness:

The label on the isolette said “Baby B, Kathryn”. My intention was to call the infant by her middle name, Keeley, but by the end of her 4 month stay, the NICU that saved her had formalized her name; Kathryn. Who is this tiny brown being covered in hair fighting to survive, I wondered? Standing in the NICU for the first time, the resounding question for me was “what do I do now, and how can I breathe without screaming”?

Every NICU family arrives with its own particular luggage and life that is left behind, forever transformed by the evolving NICU journey. NICU families have deeply held stories to tell. We too traveled from an origin that was both unique and complex. Our NICU story will focus on the NICU journey itself in order to attempt to connect with the NICU community, which we call The Neonatal Womb, through aspects that may reflect the collective experience.

On March 19, 1991, the day the twins were born, the NICU’s only available information for NICU families was a pamphlet for families whose child had died and while this was useful for entering the dark, it provided no direction towards the light. There were no books, publications, resources or technology available to guide the NICU family journey. My experience was one of navigation without compass or illuminated pathways.

Kathryn’s brain bleeds and declining weight (from 1 lb. 8 oz. to 1 lb. 3 oz.) culminated in a lifesaving heart surgery at a mere 3 and ½ weeks of age. The surgery, performed without anesthesia (due to medical standards at that time) was provided by a pioneer in cardiac surgery, and supported by a staff that trusted the renown and very brave surgeon. My spiritual self kept the rest of me present at a time when so much of me wanted to disconnect. My older twins, Seth and Ciara, played quietly in the designated family waiting room while we waited; me not knowing if I wanted the wait to end. Eventually, a staff member came to inform me Kathryn had survived the surgery, but her condition was critical.  I never met the surgeon, a very private person I am told, whom I deeply love and appreciate.  Over time I learned about her dynamic and impressive accomplishments and esteemed career.

During her NICU stay we visited Kathryn multiple times daily. The steroids she was given provided her with chubby cheeks in two localities. Over time the precious and anticipated “peanut” shaped head formed giving her a cartoonish appearance. Kathryn recognized the music I had played to her when she and Cruz resided within the confines of my womb. We watched her ears form, her eyes open, and were terrorized and yet proud of her ability to remove her intubation equipment, setting off all kinds of frightening alarms, forcing the World to acknowledge that she was a force to be reckoned with. Two months after Kathryn was born she experienced her first bath. The nurse placed Kathryn in a very small metal bowl and Kathryn, a Pisces, clearly expressed her love of water. Following this immersion, a milestone occurred, and I held Kathryn in my arms for the very first time, a fragile yet tender encounter.

One particular member of our NICU staff did advance my desire to participate in the healing and well-being of my child. A respiratory therapist, a preemie himself, born in Africa, who clearly had healing capacities beyond his job title taught me under his supervision and guidance to massage and “tap” Kathryn’s spine in order to support her very weak respiratory functioning. We both understood the healing potential touch bestows, and I provided this treatment to Kathryn for several years following her hospitalization. This healer empowered me, a gift I desperately desired at that time when I felt I had so little to offer.

During our NICU journey, NICU staff was fully and appropriately immersed in providing care to the premature infants and clearly the medical focus was directed toward the neonate patient. Families were unattended for the most part, not seen as participant team members and not provided with resources to empower their abilities to positively participate in and support the NICU and their journey. On our NICU journey we were allowed to observe the Neonatal Womb, but in general were not educated to appropriately and powerfully engage.  Moms that choose to provide breast milk for the neonate (requiring consistent and arduous pumping several times daily) did have a visceral opportunity to contribute to their child’s health and survival, while other family members were left with little if any ability to meaningfully contribute, engage, empower their roles within the Neonatal Womb. The impact on the NICU fathers/other parent was often devastating especially given the general action-oriented nature of men in their roles as protector/provider. In this regard the NICU journey, even now, can devastate a family unit.

Two months after Kathryn was born, our insurance carrier required a transfer to an alternative Medical Center that was not as well certified as our prior provider. In order to ensure Kathryn was not put through unadvised medical procedures that had already been performed by the initial NICU provider, I was guided at times to intervene, educate and monitor the staff. The drop off in care was clearly evident, and but for a knowledgeable traveling NICU Nurse the staff was clearly less qualified to provide quality care and treatment. When Kathryn left the NICU following an additional two month stay (4 months total) she wore a white 18-inch doll dress with a matching bonnet. Only a few hours prior to discharge were Kathryn’s oxygen ensuring nasal prongs removed. Our family was not prepared by staff to confidently care for the still tiny infant weighing barely 4 pounds.  Kathryn terrified us for months as we took turns watching her chest move up and down, ensuring her breath and vitality.

NICU babies are fragile in many ways.  Underdeveloped and compromised immune systems, complicated by the use of steroids to support the development of the infant’s lungs and physical growth, and numerous other medical conditions, render exposure to people in general, well dangerous! In the NICU and following discharge exposure to people outside of the caregivers and immediate family may be significantly restricted, sometimes for many months. The separation and limited exposure available to children and other family members limits bonding opportunities with NICU infant. Technology, now expanded, offers current NICU travelers enhanced opportunity to build connection with family members in a safe, progressive, interactive fashion. The issue of limiting infant exposure becomes especially difficult once the baby leaves the NICU and goes home. Well-meaning family members want to see, touch, connect with the infant and may not understand the danger to the infant created through exposure to airborne and contact pathogens. Lack of resources to educate family/friends, who are also a part of the Neonatal Womb, and conflicting emotions of the parents/caretakers as they care for the infant may create stress, separation and conflict within the extended family unit. While the NICU parents/caregivers seek to protect the NICU infant, family members may feel rejected, useless, and denied the roles they imagined for themselves in the premature infant’s life. Currently, the availability of technology has the potential to educate, include, and connect the extended family throughout the NICU journey while supporting the infant’s health and reducing stress for family members.

When Kathryn was about five months old a group of family members arrived unannounced at the house to meet the surviving twin. Although asked not to visit and provided with the associated medical recommendations and precautions they pushed through the door into the room where Kathryn abided in her little red crib. My heart sunk knowing the meeting was a dangerous one.  Feeling angry and powerless to protect her in that moment I was aware of the visiting family members determination to stake a claim in Kathryn’s life, and their total dismissal of the precautions related to Kathryn’s well-being. The situation was difficult, and Kathryn ended up in the ER shortly following the family exposure, critically ill, unable to breath. The ER visit was one of many that occurred following graduation from the NICU unit.

Long before Kathryn’s birth I had observed through my professional career the harmful and sometimes deadly effects of long term steroid use. Reaching her first birthday, Kathryn remained under treatment for her chronic lung disease and I perceived myself as slowly killing her as I blew the steroid towards her face three times daily. ER visits for treatment related to Kathryn’s chronic lung disease were frequent and profoundly disturbing. The Universe answered my constant prayers for guidance at 5:30 AM one morning when the local news program ran a one-time only report citing research confirming the dangers of long term steroid use. I did not hear the report ever broadcasted publicly again, but once was enough to confirm the “Truth” I had long acknowledged deeply within.

In 1992 the late renown Sylvia Browne was a locally known psychic residing in the Federal Way area south of Seattle, WA. Guided to seek alternative healing for my daughter, I met with Sylvia Browne who listened to my needs and referred me to a well-known horse healer who lived in Oklahoma. The healer, who preferred to work with horses, not humans, agreed to provide distance healing to Kathryn via surrogate (Kathryn was too ill to travel). Within a week of the healing session, Kathryn was successfully weaned from steroids completely, and she has not since been to an ER, emergency walk-in or general medical clinic for medical treatment for her lungs.

To be continued…

HEALTH CARE PARTNERS

Premature birth associated with increased risk of heart disease in mothers-January 24, 2018- Source: Keele University – Summary: A study has found the risk of death in later life due to coronary heart disease doubles in women who give birth prematurely.

A study led by researchers at Keele University has found the risk of death in later life due to coronary heart disease doubles in women who give birth prematurely.

Researchers from Keele University’s Research Institute for Primary Care and Health Sciences, together with colleagues at the University Hospital of North Midlands Trust (UHNM), the University of Arizona, and the University of Leicester, analyzed 21 studies and over five million women, with the findings published in the Journal of the American Heart Association.

Premature birth (delivery before 37 gestational weeks) affects 10% of all pregnancies, and is linked to poor health in premature babies. However, the study found that there are also long-term implications for the mother’s health. The study shows women who give birth before 37 weeks are 1.4 — 1.6 times more likely to experience cardiovascular disease, stroke, and coronary heart disease than mothers who give birth at full term (39 weeks), and also have double the risk of death caused by coronary heart disease.

The study promotes the importance of cardiovascular risk assessments in women who give birth prematurely, in order to identify high-risk individuals. These individuals can be targeted to reduce the risk of future cardiovascular events by encouraging a healthy lifestyle and behavioural changes, and prescribing drug therapies which will help reduce their risks.

Lead author Dr. Pensee Wu, Keele University lecturer and Honorary Consultant Obstetrician at the University Hospital of North Midlands NHS Trust, commented: “Doctors need to be aware that women who have had premature births are at higher risk of cardiovascular disease, and should be considering obstetric history during a woman’s cardiovascular risk assessment.

“I hope this work will raise awareness amongst hospitals and primary care doctors of the lifestyle advice that they can give women who have had a preterm birth in the past. With funding from the National Institute for Health Research (NIHR) we are conducting further research to understand the causes of increased cardiovascular risk in women who have premature births.”

Mamas Mamas, senior author of the study and Professor of Cardiology at Keele University, added: “Obstetricians and cardiologists need to work closer together in treating these patients identified as high risk, with the development of shared treatment pathways that cross medical specialties and target interventions to this high-risk group.”

Dr. Wu has also been awarded a  NIHR fellowship to examine pregnancy complications and long-term cardiovascular outcomes.

Eye On Traditional Medicine In Mali

Posted by THE BODY TEMPLE INSTITUTE on January 27, 2014 at 7:30pm

• Traditional Medicine Men Being Certified By The Government
• Pregnant women in Mali are dependent on medicine men and women, also called traditional practitioners (TPs) of folk medicine. Researchers are now collaborating with these healers to help improve their practice.
• Approximately 75 percent of the population of West African countries rely on traditional plant medicines when they fall ill.
• Healers, or TPs, play a key role in the primary health system of Mali’s 14 million inhabitants, including caring for women who are pregnant, giving birth or lactating.
• Mali has only one doctor per 20,000 inhabitants. The risk of women dying during pregnancy or during the delivery of an infant is 100 times higher than in Norway.
• What happens when TPs and healers have responsibility for treating pregnant women?
• Master’s degree students at the University of Oslo (UiO) and the Norwegian Institute of Public Health have joined the University of Bamako in interviewing 72 TPs or “medicine men” [although 64 percent of these healers were women] in Mali.

·      Treating 13 pregnancies per month

• The researchers calculated that each TP or healer treated an average of 13 pregnant women per month. The ages of the TPs interviewed ranged from 34 to 90.
• “Our study indicates that healers and TPs play an important part in the health care of pregnant women in Mali,” says Pharmacology Professor Hedvig Nordeng of UiO.
• The researchers found that TPs in Mali know quite a bit about pregnancies and deliveries. They treat common maladies associated with pregnancy as well as diseases such as malaria.

·       Nausea and births

• Many of the pregnant women who seek help from PTs have problems with morning sickness ― nausea. The TPs generally agree on which plants should be used to treat nausea and dermatitis among pregnant women, Nordeng says.
• The researchers also observed that pregnant women with malaria were generally treated with fever-reducing plant medicines.
• They catalogued more than 40 different medical plants that were used, and also found that traditional practitioners in Mali know very little about the mental problems that can plague pregnant women.
• “We asked the healers specifically if they knew of any treatment for depression in connection with a pregnancy or birth,” says Nordeng.
• This was a difficult subject. Most of the healers did not know about any medicinal plants that could be used for these kinds of ailments.
• The researchers attribute this to the fact that it is taboo to talk about depression in many African cultures. The professor in pharmacology thinks mental health ought to get more attention in Mali.

·       Safer use of plants

• Many TPs use the plant Cola cordifolia in difficult deliveries, because it is believed to help ease the birth.
• “The healers often take special precautions when treating pregnant women. They said they refrain from using the strongest parts of certain plants. They also avoided the use of plant parts that taste bitter, because they thought this could lead to uterus contractions and a spontaneous abortion.”
• Nordeng says that pharmacological studies have documented that many bitter plants contain high concentrations of alkaloids. Thus, there is scientific support for avoiding these compounds during pregnancy.
• Now the researchers want to interview women in Mali about their attitudes and habits regarding plant medicines and pregnancies. The researchers hope to contribute to the safe use of medicinal plants during the birthing process, or afterwards, when women are breastfeeding.

·       The healers have main responsibility

• Professor Berit Smestad Paulsen of UiO’s Department of Pharmaceutical Chemistry was the first to initiate contact with Mali’s health officials and has played a key role in the project.
• Paulsen says healers definitely have the main responsibility for health in countries like Mali.
• “This is simply because there are no doctors available for most people.”
• “The Mali authorities have created an official quality control system for healers, and are the first country in Africa to do so. Healers cannot be issued a certificate without demonstrating their ability to heal a certain number of people.”
• Paulsen thinks this system could serve as a model for other African countries. She has received an EU research grant to continue collaboration with Mali health officials and will initiate similar projects in Uganda and South Africa.

·       Cheaper medicines

• The National Institute of Public Health in Mali has opened a department of traditional medicine. One of the major priorities of the authorities is to bolster knowledge of folk medicine.
• They want to ensure the public gets the best traditional medicines available.
• “Traditional medicines are also cheaper than Western medicines,” Paulsen points out.
• She has worked with her colleagues in Norway and Mali on laboratory studies to determine the chemical effects of the plants that are used.
• Researchers and other partners from Mali will use this information to develop local medicinal products, which will then be made available in the country’s pharmacies.
• Four students from Mali have earned their doctorates in pharmacology at the University of Oslo. They are now involved in the study of traditional medicinal plants in their home country.

Full Article- http://thebodytemple.ning.com/profiles/blogs/eye-on-traditional-medicine-in-mali

NICUniversity Mission Statement

The NICUniversity mission is to be an educational and informational resource for neonatologists and other members of the neonatology health care team. We deliver the highest quality information designed to stimulate critical thinking and analysis of the current issues and trends in neonatology.

NICUniversity delivers:

• Access to lectures by internationally recognized expert faculty.
• CME/CE on topics that can improve patient management and outcomes.
• Timely and relevant, unbiased, and balanced educational information critical to the care of neonatal patients.

NICUniversity is a Web-based medical education center for Physicians, Nurse Practitioners, Nurses, Respiratory Therapists, and Pharmacists. We offer continuing education credits through the Accreditation Council for Continuing Medical Education (ACCME).

At NICUniversity, we are dedicated to the continuing education of the neonatology community, where neonatal professionals can explore the latest issues and findings in neonatology

Source: http://www.nicuniversity.org/Home.aspx

Reducing Invasive Procedures in Preterm Infants

Neil Finer, MD, discusses reducing invasive procedures and finding alternatives with surfactants in preterm infants.

Full Article- http://www.nemourseducation.org/Video/TabId/61/VideoId/890/Reducing-Invasive-Procedures-In-Preterm-Infants.aspx

INNOVATIONS

Neonatal outlier is training for a better tomorrow – CNN Video

Simple innovations that are transforming neonatal care in Africa.

Source- https://www.cnn.com/videos/world/2018/01/01/inside-africa-neonatal-outlier-is-training-for-a-better-tomorrow-c.cnn

The only neonatal doctor in Zambia’s public sector empowers future pediatric healthcare workers to make a difference in Africa‘s healthcare industry.

WARRIORS:

Mali is a land-locked country, surrounded by countries that touch the ocean. The rain that falls upon our pre-term birth community brothers and sisters in Mali slaps the Elliot Bay seawall in Seattle. Days and hours of researching surfing in Mali (the Niger River does cross through Mali) we finally stumbled upon a true gem in the documentary below, a West Africa Surf trip, including travel through Mali. The 29 minute, 12 second film overwhelmed us with beauty, fragility, strength, diversity, heart and humility that we share throughout our human experiences. This blog challenged us to find that Ray of hope and inspiration required to transform the hopelessness we sometimes feel when we feel disempowered. The film, through great music, vivid and spectacular videography, touching humanity will touch your soul. We could not take our eyes away from this gift! Enjoy the adventure …..

West Africa Surf Trip | I’M AFRICAN

XTreme Video (29.12) – Published on Aug 23, 2017

“I’m Moroccan and Africa is my continent, a continent where happiness is epidemic. I travelled 8 countries in 5 months with a mission, bringing clean water to peoples in need, and a dream crossing a continent with local transport”.

Filed by Ismail Benlamlih – Dji by Mark Leonard
Additional footage by Mehdi Boutaleb
Music by Ballaké Sissoko and Toumani Diabaté

Celebrating  : the 2018 Winter Olympics in South Korea; our approaching Valentine’s Day ; and the forthcoming second anniversary on The Neonatal Womb Warriors Blog. This year, Kat and I plan to share a bit more of our personal adventures, we continue to explore, cherish, honor and celebrate the amazing and inspiring partnership with our extensive Global community. Thank you, each and every one, for your strength, courage, hope, resilience and creativity.

SOUTH KOREA     

Republic of Korea

The 2018 Winter Olympics will take place in Pyeongchang, South Korea, from Friday, February 9, 2018 to Sunday, February 25, 2018. Welcome! 

COMMUNITY

South Koreans have the right to universal healthcare, ranking first in the OECD for healthcare access. Satisfaction of healthcare has been consistently among the highest in the world – South Korea ranked as having the world’s second best healthcare system in 2017 by Numbeo and was rated as the fourth most efficient healthcare system by Bloomberg.

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

   Preterm Birth in Republic of Korea: Rate: 9.2%     Rank: 108

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

HEALTH CARE PARTNERS

For providers that want to access some basic information regarding Late Preterm Birth we discovered a free and accessible website offering pre/post testing and information that may be of value to physicians, residents, nurses, medical students, community health care and other health care providers. The site was created by Elizabeth McIntosh Chawla of Georgetown University School of Medicine. Please visit Physician Classroom @
http://www.physicianclassroom.org/index.html

Nurses are the heart and foundation of preterm birth care in many communities. See these Nurses seamlessly take action to protect the lives of their precious patients!

NICU unit nurses in South Korea reaction when the earthquake hit the hospital

Adult Survivors of Preterm Birth Have Smaller Airways

By Anne Harding – December 26, 2017

NEW YORK (Reuters Health) – The airways of adult survivors of preterm birth are smaller than those of their peers born full-term, which may help to explain their worse lung function, according to findings published online November 29 in Experimental Physiology.

Airway obstruction at rest is a “hallmark finding” in adults who had been born prematurely, Dr. Joseph W. Duke of Northern Arizona University in Flagstaff, who helped conduct the study, noted in a telephone interview with Reuters Health. On average, he added, premature birth is associated with a 20% to 30% reduction in lung function, with expiratory flow limitation (EFL) and reduced inspiratory volume during exercise.

Dr. Duke and his team used dysanapsis ratio (DR), an indirect measure that accounts for maximal flow, static recoil and vital capacity, to compare airway size in three groups of adults (mean age, 22 years): 14 who had been born at least eight weeks premature and had bronchopulmonary dysplasia (BPD), 21 born at least 8 weeks premature without BPD, and 24 term-born controls matched by age, sex and height.

DR was 0.16 for the preterm adults without BPD, 0.10 for the BPD group, and 0.22 for the controls. DR correlated significantly with both peak expiratory airflow at rest (r=0.42) and expiratory flow limitation during exercise (r=0.60).

The researchers used two different equations to measure DR, with consistent results: DR was significantly smaller for the preterm adults with or without BPD than for the controls, and those with BPD had significantly smaller DR than those without BPD.

Given the findings, standard treatments for asthma and chronic obstructive pulmonary disease, which work by dilating the airways, may not be effective in these patients, Dr. Duke noted. “We need to do some studies looking at these traditional medicines to reverse airflow obstruction and see what effect, if any, they have on adult survivors of preterm birth,” he said.

He and his colleagues conclude: “The data in the present study suggest that smaller than normal airways explain, at least in part, the lower expiratory airflow rate in PRE (i.e., without BPD) and BPD. The present findings add important information to our understanding of the cardiopulmonary physiology of PRE and BPD.”

Source: https://www.medscape.com/viewarticle/890555

Listed in the Top 25 physician writers globally, Nawal El Saadawi is a leading Egyptian feminist, sociologist, medical doctor (psychiatry) and writer.

Writing and Trauma – 2 Minute Insights

Want to expand your toolkit with the curative potentialities expressive writing can offer? Pick up a notepad and pen and step into Dr. Pennebaker’s informative Ted Talk:

The Secret Life of Pronouns: James Pennebaker at TEDxAustin-
Chair of the Department of Psychology at one of the largest universities in the country, Jamie delves into our use of language and how it can reflect — and reshape — our understanding of ourselves, our interactions with others and our underlying feelings of strength and empowerment.

PREEMIE FAMILY PARTNERS

Writing for wellness is basically a cost -free modality for healing from post-verbal trauma that most of our global community can access. Story telling and art journaling are other expressive ways to recognize, move and transition stagnant energies.

Center for Integrative Medicine -Writing for Wellness

WRITING IS A HEALING TOOL

More than 30 years of research have demonstrated that writing is an effective way to release stress and improve health and wellbeing. Through writing, you can activate your body’s innate healing potential and be an active participant in your own wellness and healing process. For those who have experienced trauma, illness, or other life stressors, you know the negative effect these can have on your body, your mind, and your spirit, not to mention your relationships, job, and priorities. Writing is a tool that can help us move through suffering by first exploring it. Indeed, Psychiatrist Viktor Frankl, a Holocaust survivor, asserted that “suffering ceases to be suffering … at the moment it finds a meaning.” Writing is a healing modality that helps us let go of painful emotions and memories. It is also a wonderful way to search for meaning and explore new identities and pathways to wholeness.

EMPIRICAL BENEFITS OF WRITING-

Many empirical studies have examined the effect of writing on health, revealing a host of benefits for the writer:

• Better physical health
• Fewer doctor visits
• Improved sleep
• Less pain
• Positive mood
• Stronger immune system
• Lower blood pressure and heart rate
• Lower stress hormone levels
• Physical and mental relaxation
• And much more!

Additionally, research has also found that those who wrote about emotional topics experienced better grades, found jobs more quickly, and were absent from work less often compared to those who wrote about superficial topics, or just about the facts of the crisis. In each of the studies, those who wrote about superficial topics, without addressing their feelings, did not experience health benefits. This makes sense because when we suppress our emotions we intensify the experience of pain, setting ourselves up for illness and a difficult recovery. For many, the lasting improvement in their well-being far outweighs any temporary distress from writing about painful topics.

NARRATIVE MEDICINE-

In addition to writing, we will be reading and discussing some select pieces of literature, such as poems and short stories. Reading these pieces will enrich your understanding of your own illness or trauma and provide new perspectives for your recovery process. In fact, these types of exercises have been called Narrative Medicine. Reading other’s writing is also a wonderful catalyst for your own writing.

When everything in your life feels out of control, including your own body, writing can help. It is one thing you still have control over. It is something you can do anytime, anywhere. It is a safe and private outlet.

No writing experience is necessary to experience the benefits.

Source-http://cim.umaryland.edu/Events–Trainings/Writing-for-Wellness/

This year Kat and I plan to share some of our personal perspectives as our global journey within the Neonatal Womb (Preterm Birth) Community progresses. Within the preterm birth community, each of our experiences are unique and unparalleled. We encourage you to share your story with compassion and sensitivity, even if only and most importantly with yourself!

Kat and I have both noted and at times we discuss an interesting reaction that preterm birth moms, from various economic and global communities, often exhibit when asked how the preterm birth parent experience was for them. In most cases we see their Soul (light in their eyes) make a lightening retreat, they visibly swallow a few times, and lower their eyes before speaking. When they do speak, their voices seem distant, and guardedly softer.  These are reactions perhaps a neuroscientist would be able to explain. My personal experience and research tells me that the journey of preterm birth for parents is often a very isolating experience, hidden for a multitude of reasons.

Our (Kathy) Story Begins–Writing for Wellness:

The snow had barely melted off the long steeply inclined driveway as I pushed the gas pedal, propelling me to the house where three of my children were waiting. Relieved and happy to arrive home safely, I anticipated the hot bath I prepared after dinner would feel so good to my cold feet. Almost six months pregnant with my second set of twins my body was swollen, sore and naked. Preparing to step into the tub my eyes were drawn to the floor beneath me. Frozen with horror upon seeing my mucus plug lying there, my heart dropped, breath stopped, and my labor pains began to play their dreadful rhythm. Unwilling and unprepared, my NICU journey began. 

Checked into the hospital that would serve to station the next three days of labor, I was told by hospital staff that the twins would not survive birth at 24 weeks gestation. Even so, medications to delay the birthing process were provided. For three days I researched funeral homes that would be willing to cremate the ever-small twin bodies. I washed my face compulsively in an attempt to keep my soul present through the tortuous process that possessed me.

On the fourth day of labor I was transported by ambulance to an alternative hospital that had a high level NICU (Neonatal Intensive Care Unit). There I was told by a Labor and Delivery resident that there was a slight chance the babies may survive. The young doctor asked what my feelings were regarding life-saving efforts in relationship to the very early birth of the twins? I had been exploring this issue deeply for days.  Looking directly into the resident’s questioning eyes I responded “I do not want to imprison a soul in a body that has no ability to function”.

Hours later the birth process reached its climax. Alone on the hospital gurney in the delivery room my son was born. The attending resident was in another room having a party with a beautiful woman, a Victoria’s Secret model per staff conversations, who had come into my room earlier appearing as an Angel of Death. As the party continued, I screamed for help, but it was several minutes before anyone from the Labor and Delivery team came to assist and provide care. My son, partially birthed, was unattended and I felt helpless. When the medical team arrived, Cruz was removed from my body, dying in the process or very shortly after. As Cruz transitioned, and to my complete surprise, his twin sister Kathryn arrived, her tiny voice shattering the silence. The NICU staff, arriving swiftly, surrounded Kathryn, taking over her care and much of her life for the next several months.

Eventually Cruz was brought to me for a brief encounter. Although grateful for the opportunity to hold him, I regret not being more present in those elusive moments. Over time, I have come to recognize the precious potential for healing that time spent with the deceased child may hold for the parents, and the emergent need for guidance and support the unprepared and overwhelmed travelers experience is those critical moments of the preterm birth journey.

Seeing Kathryn, a few hours older, all 1 lb. 8 oz. of her, I first witnessed “BIG” technology on a tiny baby. Covered with fine black hair, sporting a body with no butt, unformed ears, and fused eyes the infant proclaimed her presence. Encased in glass and metal, bejeweled with IV’s, a large intubation tube, and attached to all sorts of strange medical life support equipment, Kathryn was exquisitely beautiful.

Following his brief journey into life, Cruz disappeared for a week into the mystery of death and hospital convention. My questions regarding his whereabouts were only vaguely addressed. Due to his small size Cruz journeyed with a larger, unknown body through the cremation process. Within the tiny bag of ashes a perfectly shaped hip bone confirmed his existence.

And so our NICU journey continued…

INNOVATIONS

Effects of Kangaroo Care on Neonatal Pain in South Korea

Journal of Tropical Pediatrics, Volume 62, Issue 3, 1 June 2016, Pages 246–249,             Young Sun Seo Department of Nursing, Eulji University Hospital, Daejeon, 302-799   South Korea

Abstract-

Blood sampling for a newborn screening test is necessary for all neonates in South Korea. During the heel stick, an appropriate intervention should be implemented to reduce neonatal pain. This study was conducted to identify the effectiveness of kangaroo care (KC), skin contact with the mother, on pain relief during the neonatal heel stick. Twenty-six neonates undergoing KC and 30 control neonates at a university hospital participated in this study. Physiological responses of neonates, including heart rate, oxygen saturation, duration of crying and Premature Infant Pain Profile (PIPP) scores were measured and compared before, during and 1 min and 2 min after heel sticks. The heart rate of KC neonates was lower at both 1 and 2 min after sampling than those of the control group. Also, PIPP scores of KC neonates were significantly lower both during and after sampling. The duration of crying for KC neonates was around 10% of the duration of the control group. In conclusion, KC might be an effective intervention in a full-term nursery for neonatal pain management.

Source: https://academic.oup.com/tropej/article/62/3/246/2363022

WARRIORS:

Our Warriors are competing in the Olympics!

The SUN – By MARTIN PHILLIPS, Senior Features Writer- Updated: 11th July 2017

‘the toughest fighter’

Wayde van Niekerk was fast from the start … he was born 11 weeks early, says gold medalists’ mum.

The sprint sensation was born three months premature and on Sunday, 24 years on, secured his 400m crown with a world-record time

SPRINT sensation Wayde van Niekerk always was keen to get over the finish line fastest. The Olympic champion was born three months premature and on Sunday, 24 years on, secured his 400m crown with a world-record time.

Wayde was born three months early but fought through. His mum Odessa Swarts was in Rio to see her boy storm home in 43.03 seconds — a feat not lost on someone whose own record-breaking athletics career was stifled by South Africa’s apartheid system. But from the moment Wayde joined Bellville Primary School in Cape Town, Odessa knew she had a future champion on her hands. At a school whose motto is “where children become winners”, Wayde hit the ground running. Van Niekerk says he’s blessed to be Olympic champion.

Source: https://www.thesun.co.uk/sport/1617149/wayde-van-niekerk-was-fast-from-the-start-he-was-born-11-weeks-early-says-gold-medallists-mum/

Wayde Van Niekerk’s Story

Published on Aug 17, 2016- After winning Gold at the Rio Olympics in the 400m race, and breaking a 17-year world record, Wayde has become a beacon for inspiration in South Africa. Check out his story of triumph as he thanks God, his mom, dad and coach for helping him reach this pinnacle.

KAT’S CORNER

Exploring “writing for wellness” as shared in our blog this month has had a positive impact on my personal journey. Seeking to express my internal feelings regarding my early birth in addition to my experiences volunteering/working in the neonatal care environment as an adult has produced an outcome of greater self-awareness. Experiential journaling has allowed me to gain physical and visceral release through the action of placing what is held internally on an external source.

Warriors, please consider using the tool of journaling to identify whatever questions and concerns that surface for you in relation to your birth and life journey. Expressive writing may assist you in gaining new-found insight into who you are or connect you in new ways with your family. Expressive writing may bring clarity to your understanding of your personal experience as a neonate, separate from the stories you have been told. Parents, family members, providers, and friends all have deeply personal stories to share in relation to the preterm birth experience. We all move through the trauma of the preterm birth journey together yet independently. The walk may be lonely and difficult, and putting one foot in front of the other may be a miraculous demonstration of choosing to love over fear. Journaling may provide us with an opportunity to be fully present for ourselves. Whether sharing something painful, joyful or routine, writing provides an opportunity to create space that is uniquely ours.

Surfing Haeundae in Busan / 부산, 해운대에서 서핑을~!

Dynamic Busan (부산/부산시/부산광역시/Busan City Official)-Published on Jul 3, 2013

            CANADA EH!

Canadians are present, engaged, and innovative in their approach to the exploration, understanding, treatment/preventative developments and care delivery within the Neonatal Womb/Preterm Birth community!

Two of our FAVORITE Canadian Neonatal Womb resources for information, innovations and progressive collaborations are the The Canadian Neonatal Network and Canadian Institutes of Health Research.  About 8% of Canada’s babies are born preterm.  

  Full Source-https://www.canada.ca/en/institutes-healthresearch/news/2017/05/preterm_birth_researchinitiative.html 

The Canadian Neonatal Network™ is a group of Canadian researchers who collaborate on research issues relating to neonatal care. The Network was founded in 1995 by Shoo Lee, MBBS, FRCPC, PhD and now includes members from 30 hospitals and 17 universities across Canada. The Network maintains a standardized neonatal intensive care unit (NICU) database and provides a unique opportunity for researchers to participate in collaborative projects on a national and international scale. Health care professionals, health services researchers and health administrators participate actively in clinical, epidemiologic, outcomes, health services, health policy and informatics research aimed at improving efficacy and efficiency of neonatal care. Research results are published in Network reports and in peer-reviewed journals.                                                                      Full Source: http://www.canadianneonatalnetwork.org/portal/Default.aspx

Canadian Institutes of Health Research

CIHR’s Institute of Human Development, Child and Youth Health has established a Preterm Birth Initiative to support new and innovative research ideas as well as improvements in the perinatal health care system and patient outcomes.

• The Institute has invested $6.45 million to support three elements under its initiative:
• A pan-Canadian collaborative preterm birth research network
• A research team focusing on improving the perinatal health care system in Canada
• Annual reports provide interesting/important on-going data and findings.

Full Source: https://www.canada.ca/en/institutes-health-research/news/2017/05/preterm_birth_researchinitiative.html

 COMMUNITY        

Our Canadian Family is investing in our Future. What they learn, they share with the Neonatal Womb community at large! Note that the individual providers in charge of each research project are listed below. Our Community will certainly benefit from their efforts!

Preterm Birth Research Initiative-

Backgrounder- From Canadian Institutes of Health Research

An estimated 390,000 babies are born each year in Canada. Of these, nearly 8 percent are born prematurely – at less than 37 weeks of gestation. The cause of the majority of preterm births is unknown.

Preterm birth may result in serious health complications for the baby and increase the risk of developing chronic health conditions later in the life; it also accounts for nearly two thirds of infant deaths in Canada. In addition, preterm birth has social and financial impacts on families and additional costs for society in terms of healthcare and education.

CIHR’s Institute of Human Development, Child and Youth Health has established a Preterm Birth Initiative to support new and innovative research ideas as well as improvements in the perinatal health care system and patient outcomes.

• The Institute has invested $6.45 million to support three elements under its initiative:
• A pan-Canadian collaborative preterm birth research network.
• A research team focusing on improving the perinatal health care system in Canada
• Six research projects focused on catalyzing new research approaches to preventing preterm birth and improving outcomes for babies born preterm

Preterm Birth Network-

The Improving Outcomes for Preterm Infants and their Families: A Canadian Collaborative Network led by Dr. Prakeshkumar Shah at Toronto’s Sinai Health System will bring together researchers, doctors, nurses, and families from coast-to-coast to improve the delivery of care and consequently the outcomes of preterm birth. The network will conduct research across the continuum of care for extremely preterm infants. Over the next 5 years, the network aims to increase the rate of preterm infant survival without complications by 30%.

Perinatal Health Care System Improvement-

Overall Canadians benefit from excellent perinatal health care. However, the regionalization of care throughout Canada results in significant variability in maternal and infant outcomes, perinatal care practices, and health care system performance between provinces and territories.

A research team led by Dr. K.S. Joseph at the University of British Columba and the BC Children’s Hospital will analyze the perinatal health care system in Canada to determine the impact of regionalization on hospital services, emergency transport, access to care, and health outcomes from mothers and babies. The results will be used to formulate and implement recommendations for optimizing care in collaboration with provincial and territorial health ministries and perinatal care programs.

Catalyzing Innovation in Preterm Birth Research-

Six research projects were funded on health issues commonly affecting premature babies and their mothers.

• Dr. Karen Benzies at the University of Calgary will study the effect of a family integrated model of care on child development, maternal mental health, and health care costs.
• Dr. Lawrence McCandless at Simon Fraser University will estimate the cumulative impact of a mother’s exposure to environmental contaminants on preterm birth.
• Dr. Silvia Pagliardini at the University of Alberta will study the control of expiration – or breathing out – in preterm newborns as a way of treating irregular breathing during sleep.
• Dr. Katherine Ryan at the University of British Columbia will identify the factors in the gut bacteria that protect infants from necrotizing enterocolitis, a serious disease affecting premature babies.
• Dr. Oksana Shynlova at Toronto’s Sinai Health System will study magnetic resonance imaging of a mother’s cervix and blood markers as a tool to predict preterm birth.
• Dr. Graeme Smith at Queen’s University will develop new therapeutics for the treatment of pre-eclampsia – or high blood pressure – in pregnant women.

Together these projects will advance our knowledge and understanding of the causes and mechanisms of preterm birth and guide new approaches to prevent preterm birth and improve health outcomes for premature babies.

INNOVATIONS

Sleep Disorders, Genetic Discoveries, and Emotional Analytics …

*** New developments in identifying factors that may impact preterm birth, and empowering our Community through expanded communication resources…

• Sleep Disorders Linked to Preterm Birth in Large California Study – Aug 8, 2017
• Insomnia, Sleep Apnea Nearly Double the Risk of a Preterm Delivery Before 34 Weeks By Laura Kurtzman

Pregnant women who are diagnosed with sleep disorders such as sleep apnea and insomnia appear to be at risk of delivering their babies before reaching full term, according to an analysis of California births by researchers at UC San Francisco. The study found the prevalence of preterm birth—defined as delivery before 37 weeks’ gestation—was 14.6 percent for women diagnosed with a sleep disorder during pregnancy, compared to 10.9 percent for women who were not. The odds of early preterm birth—before 34 weeks—was more than double for women with sleep apnea and nearly double for women with insomnia. Complications are more severe among early preterm births, which makes this latter finding particularly important, the authors said.

In contrast to the normal sleep changes that typically occur during pregnancy, the new study focused on major disruptions likely to result in impairment. The true prevalence of these disorders is unknown because pregnant women often go undiagnosed. Treating sleep disorders during pregnancy could be a way to reduce the preterm rate, which is about 10 percent in the United States, more than most other highly developed countries. The study, published Aug. 8, 2017 in Obstetrics & Gynecology, is the first to examine the effects of insomnia during pregnancy. Because of a large sample size, the authors were able to examine the relationship between different types of sleep disorders and subtypes of preterm birth (for example, early vs. late preterm birth, or spontaneous preterm labor vs. early deliveries that were initiated by providers due to mothers’ health issues).

To separate the effects of poor sleep from other factors that also contribute to a risk of preterm birth, the researchers used a case-control design: 2,265 women with a sleep disorder diagnosis during pregnancy were matched to controls who did not have such a diagnosis, but had identical maternal risk factors for preterm birth, such as a previous preterm birth, smoking during pregnancy, or hypertension. “This gave us more confidence that our finding of an earlier delivery among women with disordered sleep was truly attributable to the sleep disorder, and not to other differences between women with and without these disorders,” said Jennifer Felder, PhD, a postdoctoral fellow in the UCSF Department of Psychiatry and the lead author of the study. The researchers were surprised by how few women in the dataset—well below 1 percent—had a sleep disorder diagnosis, and suspect that only the most serious cases were identified. “The women who had a diagnosis of a sleep disorder recorded in their medical record most likely had more severe presentations,” said Aric Prather, PhD, assistant professor of psychiatry at UCSF and senior author of the study. “It’s likely that the prevalence would be much higher if more women were screened for sleep disorders during pregnancy.” Cognitive behavioral therapy has been shown to be effective in the general population and does not require taking medications that many pregnant women prefer to avoid. To find out if this therapy is effective among pregnant women with insomnia, and ultimately whether it may improve birth outcomes, Felder and colleagues are recruiting participants for the UCSF Research on Expecting Moms and Sleep Therapy (REST) Study.“What’s so exciting about this study is that a sleep disorder is a potentially modifiable risk factor,” said Felder, who was trained in clinical psychology. Other authors of the study include Rebecca Baer, MPH, of the Department of Pediatrics at UC San Diego; Larry Rand, MD, of the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences; and Laura Jelliffe-Pawlowski, PhD, of the UCSF Department of Epidemiology and Biostatistics.The study was supported by the California Preterm Birth Initiative (PTBi-CA) at UCSF and funded by Marc and Lynne Benioff.

Full Source-http://pretermbirth.ucsf.edu/news/sleep-disorders-linked-preterm-birth-large-california-study

                        New Genetic Discovery May Someday End Premature Birth

Published on Sep 7, 2017-An international team of researchers has identified — for the first time — six genes that determine the length of pregnancy and whether a baby is born preterm. Preterm birth is a major cause of infant death and disability. Now, as VOA’s Carol Pearson reports, scientists may have clues about preventing prematurity.

Please enjoy this informative video!   

Beyond Verbal – Emotional Analytics

Emotional Intelligence (EI) is a key factor in effective communication, and EI can improve with skill development and through the use of Artificial Emotional Intelligence Technology. Innovations in technology allow us the opportunity to increase our emotional intelligence in diverse ways using resources that compliment individual learning and communication styles! A key issue that led Kat and I to explore emotional intelligence, analytics, and artificial emotional intelligence is the indication that preterm birth survivors may be somewhat more likely to be on the autism disorder spectrum (ASD) combined with the seemingly increasing number of gifted scientists and health care providers on the ASD spectrum providing services within our community. I recommend that anyone interested in ASD consider reading Neuro Tribes, The Legacy of Autism and the Future of Neurodiversity by Steve Silberman

Beyond Verbal – Emotional Analytics – A technology resource for emotional analytics. Emotions Analytics change the way we interact with our machines and ourselves – forever. By decoding human vocal intonations into their underlying emotions in real-time, Emotions Analytics enables voice-powered devices, apps and solutions to interact with us on an emotional level, just as humans do. Entre!

PREEMIE FAMILY PARTNERS

* Exciting news from the UK and Canada where progression in preterm birth care compliments advances in family-centered care. I certainly did not have this kind of support 26 years ago when Kat was born, which enables me to see the value in moving towards family-centered preterm birth care globally.

The hospital where parents care for premature babies-By Nicola Rees & Andy Smythe Victoria Derbyshire programme – 4 April 2017

On a hospital ward in Leeds, parents of premature babies are encouraged to help care for their newborns – from taking temperatures to the delicate task of inserting feeding tubes. So how does the approach benefit families?

“It is just nice to feel like a mum, rather than just somebody watching,” Anna Cox tells the Victoria Derbyshire programme, as she takes the temperature of her baby. Lola was born at just 23 weeks. She had a twin brother who sadly did not survive and she was given little hope of survival.

“During labour, one of the neo-natal consultants came to see us and painted a really bad picture that she could have all sorts of problems,” Anna says.Lola was cared for at St James’s University Hospital in Leeds -the first in the UK to implement a family integrated care system. ‘Pretty simple’ It put parents – not nurses – in charge of everything other than the most complicated medical treatments for their premature babies while they were in hospital. “One of the jobs we have to do is take her temperature, maybe every three or four hours,” Anna says. “It is a pretty simple procedure really.” However, parents also perform more complicated tasks, including inserting a tube into their baby’s nose to allow them to feed. “There are certain things they [nurses] obviously watch over you quite a bit to begin with because it needs to be done right,” she says. “They do like to make sure you know what you’re doing, they wouldn’t just leave you to it.”                     Full Source: http://www.bbc.com/news/uk-39444127

Family Integrated Care- Improving Care for Premature Babies

St James’s University Hospital in Leeds * Enjoy this personal story of Integrated care “Family Integrated Care’ is dramatically improving outcomes for premature babies in Leeds. Nicola Rees reports from St James’ Hospital neonatal unit for the BBC Victoria Derbyshire programme.”

Vancouver hospital launches new kind of Neonatal Intensive Care Unit-Premature or sick babies will be cared for right next to their mothers– CBC News –               Posted: Sep 28, 2017

The new Teck Acute Care Centre on the campus of BC Children’s Hospital has 70 separate single-family rooms, designed to care for premature babies and their mothers, together. (CBC News)

BC Children’s Hospital in Vancouver is rolling out a whole new way to care for newborns with serious medical problems. Once fully operational, the Teck Acute Care Centre will house North America’s first Neonatal Intensive Care Unit (NICU) where mother and child will receive medical care in the same room, from the same nurse.

It’s a stark contrast to the traditional NICU model where incubators are lined up in rows in one room. The new Teck Acute Care Centre will contain 70 separate single-patient rooms.

In a release, the hospital said this new model will “help parents bond with their new baby from day one.” Low-risk mothers will receive their postpartum care alongside their premature or sick baby by nurses trained to care for both. A Mom’s perspective is shared in the short yet exciting article: http://www.cbc.ca/news/canada/british-columbia/neonatal-intensive-care-unit-1.4310322

HEALTH CARE PARTNERS

So, you know you are smart, but are you emotionally intelligent?

Emotional intelligence helps make better doctors

Study finds physicians in training have high level of emotional intelligence – March 14, 2017 – Loyola University Health System- Summary:

A study found that pediatric residents had a median score of 110 on an emotional intelligence survey, compared to an average score of 100 in the general population. The physicians scored highest in impulse control, empathy and social responsibility and lowest in assertiveness, flexibility and independence.

Among the qualities that go into making an excellent physician is                  emotional intelligence.

Emotional intelligence is the ability to recognize and understand emotions in yourself and others and to use this awareness to manage your behavior and relationships. Emotional intelligence plays a big role in determining a physician’s bedside manner. It helps make patients more trusting, which in turn leads to better doctor-patient relationships, increased patient satisfaction and better patient compliance. Emotional intelligence also can help make physicians more resilient to the stresses of the profession and less likely to experience burnout.

Loyola University Medical Center is among the centers that are studying emotional intelligence in physicians as a way to improve patient care and physicians’ well-being. In a new study for example, Loyola researchers report that physicians-in-training scored in the high range of emotional intelligence.

The young physicians as a group had a median score of 110 on an emotional intelligence survey, which is considered in the high range. (The average score for the general population is 100.) The physicians scored the highest in the subcategories of impulse control (114), empathy (113) and social responsibility (112) and lowest in assertiveness (102), flexibility (102) and independence (101).

The study by Ramzan Shahid, MD, Jerold Stirling, MD, and William Adams, MA, is published in the Journal of Contemporary Medical Education. Dr. Shahid is an associate professor and director of the pediatric residency program. Dr. Stirling is professor and chair of Loyola’s department of pediatrics. Mr. Adams is a biostatistician in the health sciences division of Loyola University Chicago.

There have been previous studies of emotional intelligence among physicians, but most studies have not included pediatric residents. To address this need, the Loyola study enrolled 31 pediatric and 16 med-peds residents at Loyola. (A resident is a physician who, following medical school, practices in a hospital under the supervision of an attending physician. A pediatric residency lasts three years. A med-peds residency, which combines pediatrics and internal medicine, lasts four years.) The residents completed the Bar-On Emotional Quotient Inventory 2.0, a validated 133-item online survey that assesses emotional intelligence skills.

Residents in their third and fourth years of training scored higher in assertiveness (109) than residents in their first and second years (100). This could be related to the acquisition of new knowledge and skills and increased self-confidence as residents progress in their training.

But first- and second-year residents scored higher in empathy (115.5) than third- and fourth-year senior residents (110). “One could hypothesize: Does a resident’s level of assertiveness increase at the cost of losing empathy?” the authors wrote. There were no differences in emotional intelligence composite scores between males and females or between pediatric and med-peds residents.

The study is titled, “Assessment of emotional intelligence in pediatric and med-peds residents.” Unlike IQ, emotional intelligence can be taught. “Educational interventions to improve resident emotional intelligence scores should focus on the areas of independence, assertiveness and empathy,” the authors wrote. “These interventions should help them become assertive but should ensure they do not lose empathy.”

The Loyola pediatrics and med-peds residents recently went through an emotional intelligence educational program that consisted of four hours of workshops. Initial data show the intervention has increased residents’ emotional intelligence scores, including the subcomponents related to stress management and wellness.

Full Source: https://www.sciencedaily.com/releases/2017/03/170314190224.htm

CURIOUS ABOUT YOUR EMOTIONAL IQ?

Emotional IQ Assessment -Two Interesting Options: 

Psychology Today: Emotional Intelligence Test – 45 minutes-  https://www.psychologytoday.com/tests/personality/emotional-intelligence-test *** After finishing this test you will receive a FREE snapshot report with a summary evaluation and graph. You will then have the option to purchase the full results for $9.95

                                                        AND

 Emotional Intelligence Test (Free, approximately 10 Minutes)-The Global Emotional Intelligence Test – GEIT,  uses 40 questions which are derived from, the Global EI Capability Assessment instrument, which contains 158 items. These are based on Goleman’s four quadrant Emotional Intelligence Competency Model (2002). Click here for more details.  Short EI quizzes such as the GEIT are meant to be fun, and to give you a guide to which EI areas you are doing well in and those which perhaps you need to focus on for development.                   Test 10 Minutes- http://globalleadershipfoundation.com/geit/eitest.htm

Mothers’ Challenges after Infants’ Discharge from Neonatal Intensive Care Unit: A Qualitative Study

 Iranian Journal of Neonatology 2017; 8(1)- Zeinab Hemati1, Mahboobeh Namnabati2*, Fariba Taleghani3, Alireza Sadeghnia4-

Abstract: Background: Mothers with premature infants face certain challenges such as uncertainty on how to deal with their infant’s condition and care for it after discharge from neonatal intensive care unit (NICU).  Methods: A qualitative design was used to explain mothers’ challenges after their infant’s discharge from NICUs in Isfahan, Iran, 2015. Purposive sampling was adopted to interview the mothers who could provide us information about the challenges after their infant’s discharge. Data collection was performed by interviewing mothers. Data saturation was reached after conducting 23 in-depth, semi-structured interviews. All the data was analyzed by qualitative content analysis.  Results: Four themes and nine categories were identified. The themes were incompetence in breastfeeding, dependence on hospital and nurses, feeding tube as a reason for stress, and constantly worried mothers.  : Mothers have difficulty in meeting their infants’ basic needs after discharge. Supporting these mothers can enable them promote their infant’s health

Conclusion: Regarding the findings of this study, we can argue that mothers’ presence in NICU to engage in infant care and healthcare team’s support for these mothers after discharge might lower their stress and promote their self-confidence and care abilities, which in turn, lead to infants’ growth and development, as well as reduction in their NICU readmission.

Full Source: http://ijn.mums.ac.ir/article_8520_7fe55687c5964fa0107bbc4074f00267.pdf

Our Universe of Technology continues to amaze! Check out this Artificial Intelligence movement

The next big thing in AI, emotional intelligence, could give hospitals a competitive edge But some big questions need to be answered as tools like Siri and Alexa start playing a role in the patient journey, says one expert. By Mike Miliard – August 17, 2017

As Amazon’s Alexa makes “herself” comfortable in more and more homes, she and similar artificial intelligence technologies could soon be having an impact on hospitals.AI-based virtual assistants are evolving quickly, and more and more effort is being put into making them emotionally intelligent – able to pick up on subtle cues in speech, inflection or gesture to assess a person’s mood and feelings. The ways that could impact wellness and healthcare are intriguing. By reading into vocal tone, AI platforms could perhaps detect depression, or potentially even underlying chronic conditions such as heart disease. A short, action-packed article worth the read: http://www.healthcareitnews.com/news/next-big-thing-ai-emotional-intelligence-could-give-hospitals-competitive-edge

WARRIORS:

Nature: accessible, free, healing, priceless – We live here! The evolution of IT; we also live there! It’s all about –

Nature’s health benefits: Access to all

The Seattle Times – Originally published November 3, 2017 – By Letters editor

Kudos for the article on veteran Alex Seling’s Mexico border to Canada hike. Scientific evidence for a wide range of nature-related health benefits is growing, and Pacific Northwest residents are positioned to put that evidence to work.

In a classic study, patients recovering from gallbladder surgery occupying rooms with views of trees were discharged more quickly and required fewer painkillers than those with views of a brick wall. Research has shown that exposure to nature can enhance immune function and child development, and reduce depression, stress and Attention Deficit Hyperactivity Disorder symptoms

On Oct. 26, the Center for Creative Conservation at the University of Washington hosted the Northwest Nature & Health Symposium. Sponsored by the Bullitt Foundation and REI, it brought together scientists, physicians, community organizers, city planners and others to discuss the health benefits of nature. Among the many lessons learned, perhaps the most potent was the desire to improve access to nature in a fair and equitable manner. Much work is needed to make nature and the health benefits that come with it accessible to all.

Josh Lawler, Sara Jo Breslow and Ben Packard, University of Washington EarthLab’s Center for Creative Conservation-https://www.seattletimes.com/opinion/letters-to-the-editor/natures-health-benefits-access-to-all/ 

Kat’s Corner-

Acknowledging that it is sometimes beneficial to gain an outside perspective when it comes to better understanding and communicating with ourselves and others, I took the 10-minute Global Emotional Intelligence Test – GEIT, which we noted in our blog. While I scored quite high in the areas of Self and Social-Awareness, I noted room for growth in the areas of Self and Relationship Management.

Our scientific understanding of ASD is progressing as medical research expands and embraces members of our ASD community at large. There is a shift within our social perspective of ASD as more mainstream information about ASD is displayed and celebrated in our technologically driven outlets such as media, internet, college coursework, workplace education, etc.  I appreciate TV shows like The Good Doctor that provide us with insight into the lives of people living with ASD; powerfully impacting our public dialogue, general education, and constructive actions.

I believe that ASD may be part of our human evolution and that our definition of “fully abled people” will also evolve over time. In the meantime, I support the concept that we are all differently-abled and that our presence on this journey is fully-enabled as a result.  It is critical for those of us who can impact social constructs within our social structures (professional workplaces, public policy, healthcare management, law, and educational systems) do so with the intention of making such places better informed, accessible, inclusive and empowered for healthy human evolution to continue for all.

tofino ’16 | sun, sand, surf

You can easily judge the character of a man by how he treats those who can do nothing for him.” ― Johann Wolfgang von Goethe

COMMUNITY

Germany: Bundesrepublik Deutschland) is the largest country in Central Europe. Germany is a federation of 16 states, roughly corresponding to regions with their own distinct and unique cultures. Germany is one of the most influential European nations culturally, and one of the world’s main economic powers. Known around the world for its precision engineering and high-tech products, it is equally admired by visitors for its old-world charm and “Gemütlichkeit” (coziness). If you have perceptions of Germany as simply homogeneous, it will surprise you with its many historical regions and local diversity.

Germany has a universal^[1] multi-payer health care system paid for by a combination of statutory health insurance (Gesetzliche Krankenversicherung) officially called “sickness funds” (Krankenkassen) and private health insurance (Private Krankenversicherung), colloquially also called “(private) sickness funds”. According to the Euro health consumer index, which placed it in 7th position in its 2015 survey, Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it. https://en.wikipedia.org/wiki/Main_Page

Preterm Birth Rate I Germany is 9.2% (rank 106)

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

Locally:

U.S. preterm births rise for second year in a row

By Ashley Welch CBS News November 1, 2017, 2:45 PM

After nearly a decade of decline, the U.S. rate of preterm birth — the largest contributor to infant death in the country — increased again in 2016 for the second year in a row, according to a new report from the March of Dimes. More than 380,000 babies are born prematurely each year, putting them at greater risk of death before their first birthday. They’re also more likely to suffer lifelong disabilities and chronic health conditions including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays. In addition to the health toll, the National Academy of Medicine reports that preterm birth accounts for more than $26 billion each year in avoidable medical and societal costs. The “March of Dimes Premature Birth Report Card” cites data from the National Center for Health Statistics (NCHS) that found the U.S. preterm birth rate went up from 9.6 percent of births in 2015 to 9.8 percent in 2016. Some communities were hit even harder than others. “The 2017 March of Dimes Report Card demonstrates that moms and babies in this country face a higher risk of preterm birth based on race and zip code,” Stacey D. Stewart, president of the March of Dimes, said in a statement. “We see that preterm birth rates worsened in 43 states plus the District of Columbia and Puerto Rico, and among all racial/ethnic groups. This is an unacceptable trend that requires immediate attention.” The findings revealed startling racial disparities: Across the nation, African-American women are 49 percent more likely to deliver their babies preterm compared to white women, while American Indian/Alaska Native women are 18 percent more likely to deliver prematurely compared to white women. The report provides rates and grades for states and counties within all 50 states, the District of Columbia and Puerto Rico:

• 4 states — Vermont, New Hampshire, Washington, and Oregon — received “A” grades for preterm birthrates of 8.1 percent or less.
• 13 states received a “B” grade for preterm birthrates between 8.2 and 9.2 percent.
• 18 states got a “C” grade for preterm birthrates between 9.3 and 10.3 percent.
• 11 states and the District of Columbia received a “D” grade for preterm birthrates between 10.4 and 11.4 percent.
• 4 states, including West Virginia, Alabama, Louisiana, and Mississippi, as well as Puerto Rico, got an “F” for preterm birth rates of 11.5 or greater.

Full Article-https://www.cbsnews.com/news/preterm-birth-on-the-rise-second-year-in-a-row-march-of-dimes/ 

INNOVATIONS

UGANDA PREMATURE BABIES; 9PM- 19/09/2017

In Uganda’s rural environment something as simple as a foot length card saves lives. Thank you to Community Health Care Workers, local medical and scientific specialists and cooperative family members who collaborate with expertise and resources to reduce childhood mortality and increase Community wellness. See our May 20, 2016 blog for additional information regarding the progressive and resourced-based work of  Dr. Getrude Namazzi and Associates.

2017 NEONATAL & PEDIATRIC AWARD Winner- UNC Carolina Air Care Pediatric/Neonatal Transport Team

PREEMIE FAMILY PARTNERS

Science Daily – Children’s National Health System – September 15, 2017

• 45 percent of parents experience depression, anxiety and stress when newborns leave NICU
• Parents who were the most anxious also were the most depressed; older parents were less stressed

Almost half of parents whose children were admitted to Children’s National Health System’s neonatal intensive care unit (NICU) experienced postpartum depressive symptoms, anxiety and stress when their newborns were discharged from the hospital. And parents who were the most anxious also were the most depressed, according to research presented during the 2017 American Academy of Pediatrics (AAP) national conference.

The Centers for Disease Control and Prevention has found that one in 10 infants born in the United States each year is born preterm, or before 37 weeks’ gestation. Because fetuses undergo dramatic growth in the final weeks of pregnancy, readying them for life outside of the womb, tiny preemies often need help in the NICU with such essentials as breathing, eating and regulating their body temperature. Some very sick newborns die.

Because their infants’ lives hang in the balance, NICU parents are at particular risk for poor emotional function, including mood disorders, anxiety and distress. Children’s National Neonatologist Lamia Soghier, M.D., and the study team tried to determine factors closely associated with poor emotional function in order to identify at-risk parents most in need of mental health support.

The study team enrolled 300 parents and infants in a randomized controlled clinical trial that explored the impact of providing peer-to-peer support to parents after their newborns are discharged from the NICU. The researchers relied on a 10-item tool to assess depressive symptoms and a 46-question tool to describe the degree of parental stress. They used regression and partial correlation to characterize the relationship between depressive symptoms, stress, gender and educational status with such factors as the infant’s gestational age at birth, birth weight and length of stay.

Some 58 percent of the infants in the study were male; 58 percent weighed less than 2,500 grams at birth; and the average length of stay for 54 percent of infants was less than two weeks. Eighty-nine percent of parents who completed the surveys were mothers; 44 percent were African American; and 45 percent reported having attained at least a college degree. Forty-three percent were first-time parents.

About 45 percent of NICU parents had elevated Center for Epidemiological Studies Depression Scale (CES-D) scores.

“The baby’s gender, gestational age at birth and length of NICU stay were associated with the parents having more pronounced depressive symptoms,” Dr. Soghier says. “Paradoxically, parents whose newborns were close to full-term at delivery had 6.6-fold increased odds of having elevated CES-D scores compared with parents of preemies born prior to 28 weeks’ gestation. Stress levels were higher in mothers compared with fathers, but older parents had lower levels of stress than younger parents.”

Dr. Soghier says the results presented at AAP are an interim analysis. The longer-term PCORI-funded study continues and explores the impact of providing peer support for parents after NICU discharge.

Full Article- https://www.sciencedaily.com/releases/2017/09/170915095203.htm

AAP News and Journals                   Pediatrics        Accepted June 5, 2017                                       August 2017

Very Preterm Birth and Parents’ Quality of Life 27 Years Later

Dieter Wolke, Nicole Baumann, Barbara Busch, Peter Bartmann

Abstract

BACKGROUND AND OBJECTIVES: Parents of preterm children experience increased distress early in their children’s lives. Whether the quality of life of parents of preterm children is comparable to that of parents of term children by the time their offspring reach adulthood is unknown. What precursors in their offspring’s childhood predict parental quality of life?

METHODS: A prospective whole-population study in Germany followed very preterm (VP) (<32 weeks gestation) or very low birth weight (VLBW) (<1500 g) (N = 250) and term-born individuals (N = 230) and their parents (VP or VLBW: N = 219; term: N = 227) from birth to adulthood. Parental quality of life was evaluated with the World Health Organization Quality of Life assessment and the Satisfaction with Life questionnaire when their offspring were adults (mean age 27.3 years, 95% confidence interval [CI]: 27.2 to 27.3). Childhood standard assessments of VP or VLBW and term offspring included neurosensory disability, academic achievement, mental health, and parent-child and peer relationships.

RESULTS: Overall quality of life of parents of VP or VLBW adults was found to be comparable to parents of term individuals (P > .05). Parental quality of life was not predicted by their children being born VP or VLBW, experiencing disability, academic achievement, or the parent-child relationship in childhood but by their offspring’s mental health (B = 0.15, 95% CI: 0.08 to 0.22) and peer relationships (B = 0.09, 95% CI: 0.02 to 0.16) in childhood.

CONCLUSIONS: As a testament to resilience, parents of VP or VLBW adults had quality of life comparable to parents of term adults. Support and interventions to improve mental health and peer relationships in all children are likely to improve parents’ quality of life.

• Copyright © 2017 by the American Academy of Pediatrics

Full Article-http://pediatrics.aappublications.org/content/early/2017/08/08/peds.2017-1263

HEALTH CARE PARTNERS

What’s Up? Take a peek at one of the 2017 Best Anxiety APPS! Fun, Effective and Free!https://www.healthline.com/health/anxiety/top-iphone-android-apps

Physicians’ occupational stress, depressive symptoms and work ability in relation to their working environment: a cross-sectional study of differences among medical residents with various specialties working in German hospitals

Monika Bernburg,¹ Karin Vitzthum,¹ David A Groneberg,² and Stefanie Mache³

Full Article-http://creativecommons.org/licenses/by-nc/4.0/

Abstract – Published online 2016 Jun 15- PMCID: PMC491661

Objectives-This study aimed to analyze and compare differences in occupational stress, depressive symptoms, work ability and working environment among residents working in various medical specialties.

Results-Results show that up to 17% of the physicians reported high levels of occupational distress and 9% reported high levels of depressive symptoms. 11% of the hospital physicians scored low in work ability. Significant differences between medical specialties were demonstrated for occupational distress, depressive symptoms, work ability, job demands and job resources. Surgeons showed consistently the highest levels of perceived distress but also the highest levels of work ability and lowest scores for depression. Depressive symptoms were rated with the highest levels by anesthesiologists. Significant associations between physicians’ working conditions, occupational distress and mental health-related aspects are illustrated.

Conclusions-Study results demonstrated significant differences in specific job stressors, demands and resources. Relevant relations between work factors and physicians’ health and work ability are discussed. These findings should be reinvestigated in further studies, especially with a longitudinal study design. This work suggests that to ensure physicians’ health, hospital management should plan and implement suitable mental health promotion strategies. In addition, operational efficiency through resource planning optimization and work process improvements should be focused by hospital management.

Full Site: http://bmjopen.bmj.com/content/6/6/e011369

Frontiers in Immunology

Preterm Birth Affects the Risk of Developing Immune-Mediated Diseases – 09 October 2017

Sybelle Goedicke-Fritz, Christoph Härtel, Gabriela Krasteva-Christ, Matthias V. Kopp, Sascha Meyer and Michael Zemlin

Prematurity affects approximately 10% of all children, resulting in drastically altered antigen exposure due to premature confrontation with microbes, nutritional antigens, and other environmental factors. During the last trimester of pregnancy, the fetal immune system adapts to tolerate maternal and self-antigens, while also preparing for postnatal immune defense by acquiring passive immunity from the mother. Since the perinatal period is regarded as the most important “window of opportunity” for imprinting metabolism and immunity, preterm birth may have long-term consequences for the development of immune-mediated diseases. Intriguingly, preterm neonates appear to develop bronchial asthma more frequently, but atopic dermatitis less frequently in comparison to term neonates. The longitudinal study of preterm neonates could offer important insights into the process of imprinting for immune-mediated diseases. On the one hand, preterm birth may interrupt influences of the intrauterine environment on the fetus that increase or decrease the risk of later immune disease (e.g., maternal antibodies and placenta-derived factors), whereas on the other hand, it may lead to the premature exposure to protective or harmful extrauterine factors such as microbiota and nutritional antigen. Solving this puzzle may help unravel new preventive and therapeutic approaches for immune diseases.

Conclusion and Future Directions-Due to care under highly controlled conditions, preterm neonates are a distinct group of patients that can be used as a model to discern (epi-) genetic factors from environmental changes and from maturation-dependent changes in the immune system. Short-term and long-term influences of preterm birth can be measured by comparison to term born children. The influence of preterm birth on the developing immune system is poorly understood but may imprint the risk for immune-mediated diseases later in life (84). Future research should systematically address immunological pathways in the fetus (prenatal), in the preterm neonate and in the mature-born neonate to discern changes that were caused by maturational programs from those that were triggered by premature exposure to the extrauterine environment. The clinical outcome in relation to immune diseases should be assessed, furthering our understanding of the perinatal influences that have a long-term effect on the inflammatory response.

It remains unclear why preterm neonates have a reduced risk of atopic dermatitis and atopy defined as elevated serum IgE, specific IgE, and skin prick test (27). However the increased risk of asthma in preterm neonates is most likely not mediated by an atopic pathophysiology.

The following questions should be addressed in future studies:

• (1) Which factors are responsible for the epidemiological differences between asthma and atopic dermatitis in preterm children? In addition to thorough clinical phenotyping and lung function testing, it is essential to include objective analyses for sensitization such as serum IgE, specific IgE, and a skin prick test.
• (2) How are the various asthma and atopic dermatitis phenotypes distributed in preterm children?
• (3) Is the incidence of autoimmune disease altered in individuals that were born prematurely?
• (4) What effect do the microbiome, epigenetics, and other mechanisms have in imprinting the immune system of preterm neonates?

These studies could provide important insights into the mechanisms of immunological imprinting and potential therapeutic interventions to lower the risk of immune-mediated diseases not just in preterm neonates but in the wider population.

Full Article-https://www.frontiersin.org/articles/10.3389/fimmu.2017.01266/full

WARRIORS:

KAT CHAT  –   

Why We Matter – The Wisdom of Warriors– Kat Campos & Kathy Papac

Serving on a Neonatal Advisory Board exposed me (Kat) to the neonatal community on a deeper level. Members of the board included neonatologists, nurses, respiratory therapists, occupational and physical therapists, and preterm parents. I was a volunteer at the time representing Preterm Birth Survivors/NICU Grads. I enjoyed learning and working with a diverse team on various projects for our NICU unit, exploring topics that ranged from parent PTSD support to innovative areas of research such as the usage of probiotics for neonates.

When I started out on the board I did experience some adversity regarding my qualifications to actively contribute as a board member. At the time I was young and eager to learn from the healthcare providers around me. However, being questioned and told I couldn’t possibly “remember” my experience as a neonate helped me recognize the need for the preemie survivor voice and value to be acknowledged.  The denial of my worth in this situation propelled me deeper into the Neonatal Womb community that was my family.

After serving for a 2-year term on the board, a transition in leadership and new Federal regulations were implemented into the rules and regulations for advisory board councils.  I was informed that due to my status as a non-parent and non-professional care provider I would no longer qualify as a Board member. In addition, it was suggested that based on the assumption that because my experience in the NICU occurred as an infant I could not bring the same value as members working in the NICU or parents. On a deeper level both my mom and I knew that this assumption was incorrect. I realized that being told I was dismissed from serving as representative of NICU Grads I felt like I was being told the voice of the preemie survivor did not matter within the community that was built to make that voice possible. We were guided to create this blog in part to recognize and give voice to those who, like me, are preterm birth survivors.

Infant survival related to preterm birth is increasing, especially as it relates to the micro-preemie population. As we grow, thrive, experience life and face challenges, some of which will be related to being born preterm, our experiences and voices will be essential in charting our courses and the life experiences of the preterm birth brothers and sisters that follow.  We are the Future of neonatal innovation. Ongoing and new research, methods of care, technologies, diagnostics and treatments will evolve from our experiences globally.  Preterm birth survivors will be heard, we will participate, and we will demand recognition and quality healthcare.  To the providers in our community I ask, please do not discourage or discount the ability for those of us that have been born early to connect to that journey. Do not disregard the fact that we are active participants in this Preterm Birth community. We too share stories, scars, and visceral memories of the trauma we have experienced. The Neonatal Womb community has the opportunity and responsibility to collaborate and support our Family as a whole. Each Partner in our community plays a critical role in the health and well-being of all of us. We ask that rather than shutting the door when we leave the NICU that the door of collaboration is left open. We need to continue to work together, to reach out to and support one another, so that doing better is not something placed into the future but is something tangible we can work towards today.

Early Life Stress May Have Greater Impact on Extreme Preemies’ Mental Health

Family Doctor.org

PsychCentral – By Traci Pedersen -10/05/17

A new Canadian study finds that childhood stress may pose an even greater mental health risk to adults who were extremely low birth weight preemies (2.2 pounds or less) than to those born at normal weight. In particular, decreased exposure to bullying and family problems during childhood and adolescence is linked to a lower risk of adult mental illness in extreme low birth weight preemies. Early mental health support for these children and their parents could also prove beneficial.

“In terms of major stresses in childhood and adolescence, preterm survivors appear to be impacted more than those born at normal birth weight,” said Ryan J. Van Lieshout, assistant professor of psychiatry and behavioural neurosciences at McMaster University and the Albert Einstein/Irving Zucker Chair in Neuroscience.

“If we can find meaningful interventions for extremely low birth weight survivors and their parents, we can improve the lives of preterm survivors and potentially prevent the development of depression and anxiety in adulthood.

The researchers used the McMaster Extremely Low Birth Weight (ELBW) Cohort, which involves a group of 179 extremely low birth weight survivors and 145 normal birth weight controls born between 1977 and 1982, which has 40 years’ worth of data.

The findings reveal that although these preemies were not necessarily exposed to a larger number of risk factors compared to their normal birth weight counterparts, these stressors appeared to have a greater impact on their mental health as adults.

Besides bullying by peers and a small circle of friends, researchers looked at a number of other risk factors, including maternal anxiety or depression and family dysfunction.

“We believe it may be helpful to monitor and provide support for the mental health of mothers of preemies, in particular, as for the purposes of this study, they were the primary caregiver,” said Van Lieshout.

“There can also be family strain associated with raising a preemie and all the related medical care, which can lead to difficulties. Support for the family in a variety of forms might also be beneficial.

The study builds on previous research showing that extremely low birth weight survivors have an increased risk of mental illness in adulthood. 

“We are concerned that being born really small and being exposed to all the stresses associated with preterm birth can lead to an amplification of normal stresses that predispose people to develop depression and anxiety later in life,” said Van Lieshout.

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

Source: McMaster University

Full Article-https://psychcentral.com/news/2017/10/05/early-life-stress-may-have-greater-impact-on-extreme-preemies-mental-health

River Surfing in Munich, Germany

Check out Tropical Islands Resort is a tropical theme park located in the former Brand-Briesen Airfield in Halbe, municipality in the district of Dahme-Spreewald in Brandenburg, Germany, 50 kilometres from the southern boundary of Berlin.^[1] It is housed in a former airship hangar (known as the Aerium), the biggest free-standing hall in the world. 

Full Article-https://en.wikipedia.org/wiki/Tropical_Islands_Resort

COMMUNITY

Born Too Soon reports that the preterm birth rate in Chile is 7.1% live births out of 100 (Global Average 11.1, USA 12).  http://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3

What makes Chile’s preterm birth rate significantly lower than the Global average?

Chile is today one of South America’s most stable and prosperous nations. It leads Latin American nations in rankings of human development, competitiveness, income per capita, globalization, state of peace, economic freedom, and low perception of corruption. Population: 17.91 million (2016).                                                                               Full Article- https://en.wikipedia.org/wiki/Chile

Chile has maintained a dual health care system under which its citizens can voluntarily opt for coverage by either the public National Health Insurance Fund or any of the country’s private health insurance companies. Currently, 68% of the population is covered by the public fund and 18% by private companies.

INNOVATIONS 

Per Techflier, Chile has emerged as the leading producer of healthcare-related tech startups in LATAM. Due to ample support from the government and private funding sources, the country’s healthtech startups have led the charge globally in developing cutting edge products and services for the medical and healthcare industry.

Babybe–*** Neonatal Womb Partners may be drawn to innovation #9!

Source: babybemedical.com.

September 17, 2017 – 11 Healthtech Startups from Chile You Need to Know About in 2017

#9 – Babybe was designed to help premature babies transition into the world with less trauma and difficulty—the device measures the mother’s lungs and heartbeat to transform them into a sensory experience for the baby. This enables premature babies to feel the presence of their mothers, even inside an incubator.

Full Link- https://www.techflier.com/2017/09/14/11-healthtech-startups-from-chile-you-need-to-know-about-in-2017/

Curious? Check out this article in Wired and the YOUTUBE below:

BabyBe provides sensory comfort to premature babies

For the youngest and tiniest patients in hospitals across the world, the first few weeks and months of life on Earth can be a stressful experience. Kept inside incubators, premature babies are delicate and susceptible to infection. They are also separated from their mothers. Physical interaction between mother and baby during this time is very limited. Mothers too can feel frustrated by this too, or even suffer postpartum depression due to the fact they are not able to physically care for and comfort their babies. BabyBe, a company from Chile aims to help change this. It wants to shorten hospital stays for premature babies and make women feel actively like mothers from the moment their babies are born. To do this it has created a system that measures the movement of the mother’s lungs and heartbeat and transforms it into a sensory experience for the baby, reducing the stress they feel and aiding their development and early memories. “It gives premature babies the ability to feel their mothers touch from within an incubation machine,” says Raphael PM Lang from BabyBe.                                                                              Full Article- http://www.wired.co.uk/article/babybe  

Make It Wearable Finalists | Meet Team Babybe

• Hungry for more information?
• Brochure: http://www.babybemedical.com/wp-content/uploads/2017/05/BABYBE-GmbH-brochure-.pdf
• Article: http://www.wired.co.uk/article/babybe
• Clinical Validation: http://www.babybemedical.com/clinical-validation/

As the   struggles to discover, create, and provide our Neonatal Womb and National Communities with effective healthcare resources, each Country has wisdom and expertise to help us achieve our collective and individual wellness goals. The New England Journal explores Chile’s Health Care changes in the interesting article below:

The New England Journal of Medicine: January 07, 2016

Innovation and Change in the Chilean Health System

Thomas J. Bossert, Ph.D., and Thomas Leisewitz, M.D., M.P.H.                                      Although Chile produces a sufficient number of doctors to cover its population, Chilean physicians, like those elsewhere, tend to prefer to work in urban areas and, despite innovative family medicine programs in several prestigious medical schools, often seek higher-paid specialties. Moreover, the private sector’s higher salaries and better working conditions have lured physicians away from public services, causing a shortage of general practitioners and family physicians in public clinics. Many municipalities therefore hire doctors from other countries, such as Ecuador, Bolivia, and Cuba, who will accept lower pay and less advantageous working conditions.

Like other middle- and high-income countries, Chile faces growing prevalence of chronic diseases in an aging population, increasing costs, and insufficient prevention and health-promotion activities. These epidemiological changes have increased demand for care, which in turn has affected the quality of care and timely access to services, at least in the large public services. Chile is also contending with substantial inequality between high-income participants in the private system and the large majority covered by social insurance and tax-funded public health services.

With the courts and both public and private sectors acknowledging the need for reform, presidential advisory commissions have been convened to develop a consensus plan. The most recent commission recommended returning to a single-payer public insurance system somewhat similar to the Canadian system (and the recently abandoned Vermont plan. A minority report, however, proposed introducing a broader minimum health plan, at a single price, into the private system, with a compensation fund for reducing risk-selection behavior (which could also eventually be open to FONASA. The debate ongoing.  Full Link- http://www.nejm.org/doi/full/10.1056/NEJMp1514202

HEALTH CARE PARTNERS

As we face a critical and expansive global health care provider shortage we support and are committed to manifesting strong health and wellness for all Neonatal Womb Family Partners. Our healthcare providers are our heartbeat of hope and beacon of progress as we seek to prevent preterm birth and provide support to preterm birth survivors, families and our Global Neonatal Womb partners.

Just Ask – World Suicide Prevention Day 2017

This study explores the rates and causes of death (neoplastic diseases, suicide, accidents, medical and surgical diseases, accidental poisoning, homicide, etc.) for residents, and compare them with rates in the general population. In particular, researchers were interested in the number and leading causes of resident deaths; related patterns and trends as well as associations with gender, year in training, program accreditation status, and whether any patterns could offer information to reduce avoidable deaths.

Academic Medicine/AAMC:

Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment

• Yaghmour, Nicholas A. MPP; Brigham, Timothy P. MDiv, PhD; Richter, Thomas MA; Miller, Rebecca S. MS; Philibert, Ingrid PhD, MBA; Baldwin, DeWitt C. Jr MD; Nasca, Thomas J. MD
• Academic Medicine: July 2017 – Volume 92 – Issue 7 – p 976–983

Our study sought to better understand the rates and causes of death for residents, and compare them with rates in the general population. In particular, we were interested in the number and leading causes of resident deaths; their patterns and trends in occurrence; and associations with gender, year in training, program accreditation status, and whether any patterns could offer information to reduce avoidable deaths.

Limitations and strengths-

There are limitations to this study. First, despite the magnitude of the cohort, it does not represent all residents in the United States. The American Osteopathic Association accredits osteopathic programs, and a number of surgical fellowship programs are accredited by specialty societies or other entities. Also, our study did not assess the prevalence of suicide after dismissal from, or completion of, residency. Finally, the limited number of deaths from specific causes, including suicide deaths, and absence of individual resident data beyond demographic information, precluded the use of regression analysis to provide a more sophisticated assessment of risk factors. Strengths of this study include that it is the most complete study of causes of resident death to date, covering 15 academic years of ACGME-accredited programs and involving nearly 400,000 physicians in training, with the causes of death obtained through the NDI database or other public sources of information

Conclusions-

Resident death occurs significantly less frequently than in the age- and gender-matched general population. Malignancy is the most common cause, with suicide the second-most prevalent etiology and the most preventable cause of death of trainees. The data suggest a higher risk for individuals early in their training and during vulnerable periods in the first quarter of the academic year and after the winter holiday season. Strategies to reduce preventable deaths should include preventive and treatment services, emergency support for trainees in distress, and ongoing monitoring and provision of wellness services that take into account the level of training, age of the trainee, and the time of year. Future research should explore institution- and program-level approaches to increase and support help-seeking behaviors by trainees in distress.

Full.Article- http://journals.lww.com/academicmedicine/Fulltext/2017/07000/Causes_of_Death_of_Residents_in_ACGME_Accredited.41.aspx

PREEMIE FAMILY PARTNERS

Volunteer baby cuddlers bring comfort to NICU preemies and their families – YouTube

Kat, The Cuddler:

 Cuddling my first micro-preemie (also born at 24 weeks gestation) was a sweet/sad emotional moment in time. In my hands lay another human being traveling a familiar path. Holding the preemie was an eye and  opening experience. In my arms lay a 4-pound miracle surrounded by various medical wires, a feeding tube, and monitors. Nurses on staff prepared me to properly cuddle the patient, use proper transfer techniques and to adhere to cuddling protocols.  Nervous, I took a deep breath and cradled the precious and fragile infant before settling into a calm state of pure presence.

Cuddling has awakened me on many levels!  In addition to deepening my connection to my early days, the cuddling experience awakens my awareness of the countless providers, far more than I had previously recognized, that were involved in my treatment and survival. Cuddling allows me to interface intimately with patients, neonatal health care providers and families and to appreciate the value and purpose of our interconnections.

Cuddling, like Kangaroo care, is a critical part of providing holistic and comforting care to neonatal patients. For those of you that may be interested in becoming a cuddler I highly recommend considering contacting a local Neonatal ICU for information about how to apply. Your ability to impact the lives of the families and patients is of value and may bring hope to those you may meet.  The cuddler may also experience increased personal joy and wellness through partnership within the preterm birth community.

My experience as a NICU cuddler for the past 3 ½ years has empowered me with a few tips I would like to share:

1)  Before you start your shift, take some time to prepare yourself for the experience. Being present with the patient and those you may come across while cuddling may lead to important conversations and connections. For me, a few minutes of meditation enables me to center myself prior to entering the NICU.

2)  Due to high volumes of work load and staff shortages, time management and prioritizing task comes first for care providers. This impacts the ability of the staff to perform tasks such as cuddling. Assisting the team in providing care to the patient is what makes the role of a cuddler special and unique.

3)   Some babies in the NICU may not have their families available to hold them due to various circumstances while others may be up for adoption. The opportunity to provide all NICU patients with physical comfort is critical for their development.

4)  Connect from the heart and know your role matters.

5)   In addition to assisting the patients you may also have an impact on the providers, parents, and families that need support. Whether it’s helping a nurse prepare a baby for feeding, giving encouragement to the medical residents learning the craft of neonatology, or lending a compassionate ear to the stressed-out parent in need, your presence makes an important difference for our community.

6)   Enjoy the experience, open your heart, choose love, and appreciate life.

WARRIORS:

Apps may offer quick, effective, and diverse resources to help us deal with anxiety on this challenging and dynamic journey.

10 Apps To Help You Cope With Anxiety – Therachat – July 25, 2017-

Staying connected to everything and everyone during the 24 hours of our day is one of the biggest mistakes we make when it comes to avoiding anxiety and stress.

• A 2015 APA reportuncovered that adults feeling stressed in the U.S. have only slightly increased in the last year, but reports of adults describing extreme levels of stress have increased more.

There are plenty of reasons associated with why stress is on the rise; many point fingers at the increase of digital noise interrupting our daily routines, as a result people have increased anxiety to keep up with this rush.

• Over the space of 24 hours, we touch our smartphones, on average, 2,617 times. This obsessive amount of interactions with our smartphones is said to be driving some of the digital mess, combined with email pile-ups, media consumption and instant messenger, to mention a few.
• With all types of anxietyon the rise across the U.S. and other first world countries, so are the efforts to attempt to alleviate the noise with practical solutions. The likes of meditation and yoga have been on the rise, with a mainstream push to reduce stress and anxiety on a daily basis.
• Despite the noise of your smartphone, apps have also become one of the leading solutions to anxiety reduction.
• With this, we thought it’d be good to bring together a list of applications that can be used to reduce your anxiety and stress levels, wherever you may be. These hand-picked applications should provide you with some escapism from your hectic day, and recharge your batteries.

We have summarized the top ten recommended Apps below-

• 1.   Mindfulness-According to a 2014 review, 47 trials of 3,515 participants suggested that mindfulness meditation programs showed a moderate evidence of improving anxiety and depression.
• 2.Pause-Pause is very simple. Grab your earphones and place your finger on the screen. Your finger will create a ripple-like effect on the screen, pause and bring your focus and attention to this visual experience. The goal of Pause is to freeze your attention onto this and bring all of your focus on being in the present moment.
• 3.Therachat-Therachat aims to keep clients engaged in between therapy sessions by providing a seamless way to report emotions and much more. Including a secure way to self-reflect during the day to help improve the session quality between a therapist and its clients.
• 4.  Pigment-One of the most popular physical practices in the last 24 months has been coloring books for adults. This simple activity has driven a lot of attention as a way to de-stress from the business of the work day.
• 5.  Prune-Beautifully crafted,Prune provides an artistic approach to maintain your trees. This zen-like approach to stress and anxiety reduction is constructive for short-bursts of gameplay without disturbing your workflow too much.
• 6.  Calm-These soft short-burst stories can be anywhere between 3-10 minutes long and provide you with a relaxing audio experience to help induce sleep in the evenings. You’ll be asleep in no time.
• 7.  Sleep Better-Brought to you by Runtastic, the successful sport tracking application, Sleep Better provides a free way to start mapping your full sleeping pattern and give actionable feedback on how to improve it. This insight into your sleeping pattern can be incredibly useful for homing in on your anxiety and culling any bad sleeping habits.
• 8.  Happify-Daily happiness is possible. As BJ Novak quotes “Happiness is a muscle”, it requires attention and is something you can mold every day. The app Happify aims to be the science-backed solution to improving your day-to-day smiles. Happify is a combination of games and activities to help you quantify and improve your learning of how to be happy.
• 9.  Asana Rebel-According to YogaJournal, 43% of all yoga sessions occur at home, and that’s where Asana Rebel, our yoga app recommendation aims to help. With $2.5B spent on yoga classes every year in the US, Asana Rebel seeks to be a cheaper more cost-effective option for practicing yoga at home.
• 10. Stop, Breathe & Think-Breathing is one of the most underrated ways to relax.

   Full Link- https://blog.therachat.io/anxiety-apps/

 Find your Chile – Surf espera por você-

Published on Dec 7, 2016 – Você adora que a água salpique no seu rosto e o coração se acelere com cada nova onda? Percorra os mais de 4.000 quilômetros da costa chilena e deslize através dos magníficos tubos que esconde este verdadeiro paraíso para os amantes do surf.

IRAN (Persia)

COMMUNITY

Rumi, Hafez, Sahams Tabrizi; globally renown philosophers and Poets of Iran!

With over 79.92 million inhabitants (as of August 2017), Iran is the world’s 18th-most-populous country (Wikipedia).

12.94% Preterm rate (2010) Global Average 11.1% Ranking: 38   Born Too Soon/March of Dimes

This interesting Forbes Magazine article indicates that the United States may face a shortage of 46,100 to 90,400 physicians by 2025. In my (Kathy) 34 years of employment within the healthcare community, I have worked with numerous international health care providers; many from Iran.  Physicians and surgeons from Iran make up a large portion of foreign-born providers practicing in the USA.  Our global preterm birth community research has shown us that our health, well-being, medical progress, resource development and innovations are globally enhanced and dependent upon our sharing, partnership, collaboration, and universal needs. This is especially true in the preterm birth community where the global average for preterm birth is 1 out of 10, representing a significant portion of the world population.     

Forbes Magazine – 07/12/16: Currently, more than one-quarter of physicians and surgeons in the United States are foreign-born. In addition to physicians, roughly one-fifth of nurses and home health and psychiatric aides, and more than one-sixth of dentists, pharmacists and clinical technicians in the United States were foreign born in 2010. When foreign-born professionals account for 16% of all civilians employed in healthcare occupations and one-fourth of practicing physicians, the system really does depend on a functioning immigration system. There are simply not enough native-born healthcare workers to meet the growing demand–especially in the geographic areas with the greatest need.

Full Article: https://www.forbes.com/sites/nicolefisher/2016/07/12/25-of-docs-are-born-outside-of-the-u-s-can-immigration-reform-solve-our-doc-shortage/#1f0bbb6a155f

INNOVATIONS

The Iranian Journal of Neonatology explores complex relationships within our Neonatal Womb Community and how existing resources can create better health through sharing and empowerment strategies.

Mothers’ Challenges after Infants’ Discharge from Neonatal Intensive Care Unit: A Qualitative Study – Iranian Journal of Neonatology – Mar 2017; 8(1) Abstract  (Open Access – Original Article

Background: Mothers with premature infants face certain challenges such as uncertainty on how to deal with their infant’s condition and care for it after discharge from neonatal intensive care unit (NICU). Methods: A qualitative design was used to explain mothers’ challenges after their infant’s discharge from NICUs in Isfahan, Iran, 2015. Purposive sampling was adopted to interview the mothers who could provide us information about the challenges after their infant’s discharge. Data collection was performed by interviewing mothers. Data saturation was reached after conducting 23 in-depth, semi-structured interviews. All the data was analyzed by qualitative content analysis.

Results: Four themes and nine categories were identified. The themes were incompetence in breastfeeding, dependence on hospital and nurses, feeding tube as a reason for stress, and constantly worried mothers.

Conclusion: Mothers have difficulty in meeting their infants’ basic needs after discharge. Supporting these mothers can enable them promote their infant’s health

Study Conclusion: Regarding the findings of this study, we can argue that mothers’ presence in NICU to engage in infant care and healthcare team’s support for these mothers after discharge might lower their stress and promote their self-confidence and care abilities, which in turn, lead to infants’ growth and development, as well as reduction in their NICU readmission.

 Catch the wave: http://ijn.mums.ac.ir/article_8520_7fe55687c5964fa0107bbc4074f00267.pdf

We enthusiastically agree with Dr. Felder (article below) who states “What’s so exciting about the study is that a sleep disorder is a potentially modifiable risk factor”

Sleep Disorders Linked to Preterm Birth in Large California Study- Aug. 8, 2017-UCS

Insomnia, Sleep Apnea Nearly Double the Risk of a Preterm Delivery Before 34 Weeks

By Laura Kurtzman

Pregnant women who are diagnosed with sleep disorders such as sleep apnea and insomnia appear to be at risk of delivering their babies before reaching full term, according to an analysis of California births by researchers at UC San Francisco.

The study found the prevalence of preterm birth—defined as delivery before 37 weeks’ gestation—was 14.6 percent for women diagnosed with a sleep disorder during pregnancy, compared to 10.9 percent for women who were not. The odds of early preterm birth—before 34 weeks—was more than double for women with sleep apnea and nearly double for women with insomnia. Complications are more severe among early preterm births, which makes this latter finding particularly important, the authors said.

The study, published Aug. 8, 2017 in Obstetrics & Gynecology, is the first to examine the effects of insomnia during pregnancy. Because of a large sample size, the authors were able to examine the relationship between different types of sleep disorders and subtypes of preterm birth (for example, early vs. late preterm birth, or spontaneous preterm labor vs. early deliveries that were initiated by providers due to mothers’ health issues).

“The women who had a diagnosis of a sleep disorder recorded in their medical record most likely had more severe presentations,” said Aric Prather, PhD, assistant professor of psychiatry at UCSF and senior author of the study. “It’s likely that the prevalence would be much higher if more women were screened for sleep disorders during pregnancy.”

Cognitive behavioral therapy has been shown to be effective in the general population and does not require taking medications that many pregnant women prefer to avoid. To find out if this therapy is effective among pregnant women with insomnia, and ultimately whether it may improve birth outcomes, Felder and colleagues are recruiting participants for the UCSF Research on Expecting Moms and Sleep Therapy (REST) Study.

Full article @ http://pretermbirth.ucsf.edu/news/sleep-disorders-linked-preterm-birth-large-california-study 

PREEMIE FAMILY PARTNERS

In Leeds, UK our Neonatal Womb partners at St. James’s University Hospital are participating in the first NICU centered family integrated care system in the UK.  Like most innovations we find in the preterm birth community, advances and innovations in medical care and technology develop globally. In the 1970s in Tallinn, Estonia the head of a local hospital faced the problem of having too many premature babies to look after and not enough nurses. Staff integrated parent participation into the care plan and found the system of inclusiveness was helping babies, resulting in better breastfeeding rates and shorter hospital stays. The article states “It took 30 years for other hospitals to copy the system, but now the system has been introduced in Canada, Australia, New Zealand, and now Leeds”.  The article integrates informative short videos in order to share the personalized experiences of program participants.

The hospital where parents care for premature babies

By Nicola Rees & Andy Smythe Victoria Derbyshire programme – 4 April 2017 – BBC.com (Section UK)

“It is just nice to feel like a mum, rather than just somebody watching,” Anna Cox tells the Victoria Derbyshire programme, as she takes the temperature of her baby. Lola was born at just 23 weeks. She had a twin brother who sadly did not survive and she was given little hope of survival.

“During labour, one of the neo-natal consultants came to see us and painted a really bad picture that she could have all sorts of problems,” Anna says. Lola was cared for at St James’s University Hospital in Leeds -the first in the UK to implement a family integrated care system.

‘Pretty simple’ It put parents – not nurses – in charge of everything other than the most complicated medical treatments for their premature babies while they were in hospital. “One of the jobs we have to do is take her temperature, maybe every three or four hours,” Anna says. “It is a pretty simple procedure really.” However, parents also perform more complicated tasks, including inserting a tube into their baby’s nose to allow them to feed. “There are certain things they [nurses] obviously watch over you quite a bit to begin with because it needs to be done right,” she says. “They do like to make sure you know what you’re doing, they wouldn’t just leave you to it.”

Enter here: http://www.bbc.com/news/uk-39444127

Preterm birth survivors and young children experience trauma differently than people experiencing trauma later in life. Trauma expert Bessel van der Kolk offers empowering tools that may enhance our parenting abilities and family relationships. Van der Kolk also provides a free webinar that may catch your interest!

For Survivors of Preverbal Trauma

The Treatment of Trauma: How Childhood Trauma is Different from PTSD April 19, 2013: Bessel van der Kolk, MD, a world-renowned trauma therapist, explains the effects of childhood trauma. Learn why early-life trauma can have devastating consequences, and what we can do for the treatment of PTSD and trauma and the brain. Trauma therapy can be complex, but the treatment of trauma is becoming more and more important.

HEALTH CARE PARTNERS

Choosing to experience life with a Curious and Creative perspective powerfully impacts our health and the progressive evolution of our Neonatal Womb community.  In this HealthDay News article (April 24, 2017) curious and creative researchers explore and identify the factors that contribute to errors in patient orders in the NICU!

Wrong-patient orders are more likely in NICU vs non-NICU pediatric units

Clinical Advisor (HealthDay News) — The risk of wrong-patient orders is higher in the neonatal intensive care unit (NICU) vs non-NICU pediatric units, and the risk of errors can be reduced with interventions, according to a study published in Pediatrics.

Jason S. Adelman, MD, from the Columbia University Medical Center in New York City, and colleagues examined the rate of wrong-patient orders in NICU and non-NICU pediatric units before implementing interventions, with an ID reentry intervention (reentry of patient identifiers before placing orders), and with the combined intervention involving addition of a distinct naming convention for newborns. During the 7-year study period, the authors reviewed more than 850,000 NICU orders and more than 3.5 million non-NICU pediatric orders.

The researchers found that wrong-patient orders were more frequent in NICU than non-NICU pediatric units at baseline (117.2 vs 74.9 per 100,000 orders; odds ratio, 1.56). The frequency of errors in the NICU was reduced with the ID reentry intervention to 60.2 per 100,000 (48.7% reduction; P<.001). An additional decrease was seen with the combined ID reentry and distinct naming interventions to 45.6 per 100,000 (61.1% reduction from baseline; P<.001).

“The risk of wrong-patient orders in the NICU was significantly higher than in non-NICU pediatric units,” the authors write. “Implementation of a combined ID reentry intervention and distinct naming convention greatly reduced this risk.”

Full Article: http://www.clinicaladvisor.com/pediatrics-information-center/wrong-patient-orders-more-likely-in-nicu-vs-non-nicu-units/article/652100/

Trauma changes the brain. This intelligent video explores a bit of the history of Trauma therapy, the isolation trauma creates, current treatment modalities, and methods to help us feel fully alive.

Bessel van der Kolk – how to detoxify the body from trauma – May 26, 2016

In an interview with Psychotherapist Bernhard Trenkle, Professor Bessel van der Kolk illustrates the manifold consequences of traumatic experiences on body and mind, how trauma therapy can contribute to “detoxication” and which therapeutic methods are considered effective. Professor van der Kolk briefly introduces his recent research project and enlarges on the development and capabilities of the fields of neurofeedback and mindfulness.

Preterm babies experience touch differently than full term infants; due in part to painful procedures preemies encountered during care.

Infants Discharged From NICUs Have a Reduced Neurological Response to Touch–

April 2017

Touch – and the somatosensory system in general – provides the “scaffolding” for development of other sensory systems in an infant’s very early life. A recent study led by a physician-researcher at Nationwide Children’s Hospital gives new insight into how that scaffolding is altered when a baby is born preterm and experiences painful procedures in the hospital.

The research also serves to emphasize the importance of supportive touch, such as parental holding, skin-to-skin contact and physical and occupational therapy, in caring for these infants.   

The study, published in Current Biology, reveals that babies born preterm have a reduced neurological response to gentle touch compared to babies born full term. It also shows that painful procedures may negatively affect neurological processing of non-painful touch.

“There is often an assumption that we can tell what a baby is perceiving based on vital signs or facial expressions, and our team wanted to go beyond that,” said Nathalie Maitre, MD, PhD, member of the Division of Neonatology at Nationwide Children’s, principal investigator in the hospital’s Center for Perinatal Research and lead author of the study. “What we found in doing that has important clinical applications.”

Dr. Maitre and her colleagues used soft-net electroencephalography to measure event-related potentials in 55 full-term babies and 61 preterm babies (with a range of gestational ages of 24-36 weeks). Researchers used a puff of air as a stimulus. They also measured brain responses to a “sham” stimulus, or a puff of air that was directed away from the baby.

Preterm infants displayed cortical responses to gentle touch over a certain time frame that were of significantly lower amplitude than infants born full term. The decrease in touch response was proportional to the degree of prematurity at birth. There was no reduction found in response to the sham stimulus.

The researchers then examined the number of painful and supportive touches experienced by infants in a neonatal intensive care unit, and those experiences’ relationship to touch response. Noiceptive exposures – including surgeries, line insertions, injections and other experiences – were associated with decreased cortical response when controlling for gestational age and postnatal days. Supportive touches were associated with increased response to gentle touch.

“Related studies show that analgesics and sucrose do not necessarily counteract painful procedures, so it absolutely essential to minimize the exposure to them that infants experience during hospitalization,” says Dr. Maitre, who is also an associate professor of Pediatrics at The Ohio State University College of Medicine. “An emphasis on non-pharmacological treatments for pain and strategies such as kangaroo care is crucial.”

Full Article: http://www.nationwidechildrens.org/medical-professional-publications/infants-discharged-from-nicus-have-a-reduced-neurological-response-to-touch?contentId=161416&orgId=4459 

WARRIORS

Zumba Instructors Convention 2017 – 7,500 Global ZUMBA Instructors – One Family

Stress is a subjective phenomenon that we each experience differently. Stress relief can be achieved through many methods including lifestyle changes, counseling, and relaxation/stress-management techniques. Choosing to engage in regular physical exercise is a powerful wellness choice and options are diverse and magnificent! We love dance! Our Zumba family builds global community health, fitness and Joy through dance exercise and HITT fitness experiences.

Psychology Today – Ilene A. Serlin Ph.D.

The Power of Dance to Work with Trauma – Oct 17, 2016

Some events are too terrible for words. *** This is where dance comes in—an ancient and powerful way of expressing feelings. Dance is also universal and universally understood. People can communicate with each other in local communities, and across the globe. Dance organizes life in societies and cells in the body. It celebrates weddings, harvests, seasons, and can bring strength and comfort in times of grief.

In this article, Life, Death and Transformation: Keep Moving, three Turkish therapists learn how to use dance to express the affirmation of life in the face of death. – (http://www.union-street-health-associates.com/articles/life_death_transf…)

Jordan, I worked with a humanitarian organization called Common Bond Institute for a conference on intergenerational trauma, and just returned. I was worried about what I would see there and how I could help. We worked with widows and children who had basic needs met, but lacked psychosocial support. One of the most powerful moments for me was being in a women’s group and belly-dancing with them. They showed such joy and renewed energy, and no words were needed to express and understand powerful primal experiences of being women together. Several of them asked for individual sessions in which they were able to tell their stories and express difficult situations and emotions.

The medical students also understood the power of ritual for community healing. They had adapted a form of the now-popular dance called HAKA. This was originally a war dance from the Maori people of Australia. It has been used recently by soccer teams to psych themselves up for the game, and the medical students had adapted a less aggressive version for their group meetings. The leaders of that association and I collaborated on a variation of that dance as part of the opening circle for the conference. In addition, I introduced a simple circle dance step that is universal in many cultures.

The situation of the Syrian refugees can bring up strong feelings of helplessness, and the desire to do something. Finding a way to help was truly a blessing—and we all felt it.

Full Article: https://www.psychologytoday.com/blog/make-your-life-blessing/201610/the-power-dance-work-trauma

Curious about HAKA?  See: Prince Harry performs Haka in New Zealand

A TRULY ENJOYABLE AND INSPIRING TED TALK!

Easkey Britton (the First Woman to Surf Iran) shares the journey of “Pulling Back the veil of the unseen” and states “Without connection, passion is an empty vessel”.  A powerful voice for human advancement, her wisdom is a call to action! While finishing her PhD in Marine Science Easkey began to explore the transformative power of surfing and how it can create positive social in places– like the province of Baluchistan, Iran, where in 2010 Easkey became the first woman to surf there. Her surfing career has been one of many firsts: aged just 16, Easkey Britton became the first Irish person to surf the ‘hell-wave’ Teahupoo in Tahiti, and has since become a Billabong XXL Global big-wave finalist and Ireland’s 5-time surfing National Champion. Now she is sharing her passion for surfing and the ocean by bringing her pioneering approach to the more isolated regions of the world exploring how the creative expression of surfing can empower women everywhere.