BABY BEHAVIORS. HAPP-E, OUR STORIES!

Netherlands.1

NETHERLANDS

Preterm Birth Rates – Netherlands

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

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

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

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

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

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

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COMMUNITY

A simple solution for healthier premature babies?

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

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

 

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

Published on Jan 20, 2020

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

 

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

Published: 07 March 2019

Abstract:

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

Results

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

Conclusions

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

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

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

 

intergrowth

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

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

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

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

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

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

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INNOVATIONS

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

Posted on 04 February 2020

happe

Copyright INESC TEC and ISPUP

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

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

If you

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

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

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

 

EFONI

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

POSTED ON 20 JANUARY 2020

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

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

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

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

 

PMC

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

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

Abstract 

OBJECTIVE:

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

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

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

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

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

 

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HEALTH CARE PARTNERS

Mild maternal thyroid dysfunction increases preterm birth risk

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

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

August 20, 2019

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

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

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

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

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

Preterm birth risk

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

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

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

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

Universal screening not justified

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

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

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

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

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

Posted on 13 September 2019

Dr Sylvia van der Pal & Professor Erik Verrips

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

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

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

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

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

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

mood

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

dr.deborariAshok Deorari    Published on Dec 31, 2017

Different behavioral states and assessment by PIP score in premature baby

who

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

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

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

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

Story:

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

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

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

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

Fewer Baby Boys with Mental Stress?

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

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

Other Impacts of Stress

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

Social Support Matters

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

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

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

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

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

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

 

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PREEMIE FAMILY PARTNERS

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How to Choose the Best Pediatrician for Your Child

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

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

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

The Importance of Choosing a Pediatrician

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

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

Pediatrician Recommendations

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

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

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

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

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

Choosing a Pediatrician

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

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

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

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

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

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

Interviewing Pediatricians

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

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

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

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

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

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

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

 

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Miracle Babies | How a premature baby changes your life

WaterWipes 

 

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WARRIORS:

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

KAT’S CORNER

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

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sd

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

Date: January 31, 2020 Source: Karolinska Institutet

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

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

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

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

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

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

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

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

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

 

wves

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

epi

Jun 18, 2013

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

 

MATE, TRAUMA, WAR, CALMER

Syria.1

 

 

 

 

 

 

SYRIA

Rate: 10.9%      Rank: 76

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

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

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

health.syriaImpacts of attacks on healthcare in Syria

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NIH

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

Thursday, September 12, 2019

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

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

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

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

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

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

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

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

NIH…Turning Discovery Into Health®

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

 

 

HEALTH CARE PARTNERS

SD

New model mimics persistent interneuron loss seen in prematurity

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

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

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

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

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

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

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

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

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

Children’s National Health System. “New model mimics persistent interneuron loss seen in prematurity.” ScienceDaily. http://www.sciencedaily.com/releases/2019/02/190219131727.htm (accessed September 26, 2019).

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

 

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

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

Doctors, physicians, medics, surgeons are not supposed to get sick. But what if they do? Watch this revealing film and read the back story over on https://oc87recoverydiaries.org/physi…

 

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UWMed GME Wellness Service (SEATTLE)

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

Resources for residents and fellow wellness.

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

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

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

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

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

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

Easy online scheduling

We have made it super easy to book counseling appointments.

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

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

Referrals

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

Psychiatric consultation

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

Learning consultation

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

Community providers

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

Other wellness services and resources

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

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

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

Self-Screening Tools

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

SELF-SCREENING TOOLS: 

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

 

Forward Motion Mindfulness in the Medical Community

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

 

INNOVATIONS

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Scientists designed a robot to reduce pain for premature babies

Posted April 2, 2019  tech                                                         

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

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

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

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

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

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

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

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Source: UBC – Video –  A Robot called Calmer

 

 

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

Posted September 9, 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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PREEMIE FAMILY PARTNERS

SD

Stable home lives improve prospects for preemies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Barbara Melotto – “I JUST WAIT FOR YOUR LIFE”

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

 

 

 

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

Q: How can these difficulties be avoided?

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

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

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

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

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

 

WARRIORS:   

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

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

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

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

scotACE-Aware Scotland- Published on Jul 18, 2019

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

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

 

Kat’s Corner- 

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

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How Syrian Refugee Ali Kassem Found Solace Through Surfing

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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Scars…what do they mean?

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SCAR=Strength Courageous Actualized Resilience-Kat Campos

Born four months early my heart wasn’t fully developed. Weighing one pound 3 ounces at 3 ½ weeks old I underwent open heart surgery with no anesthesia. The surgical scars along my rib cage and across my upper back to my chest mark my beginnings and chart my growth. I cherish the artfully crafted scars (best tattoo ever) my surgeon, a medical pioneer and beautiful woman, adorned me with. To this day I am grateful for my surgical and neonatal team who were willing to take a leap of faith in providing me with the life-saving surgery.

I didn’t think much about my scars until I began surfing in Hawaii at age 11. People began to randomly ask me if I had been bitten by a shark? I would laugh and simply reply “I had heart surgery when I was a baby”. It was then I began to recognize the significance of my scars and how I cherished the story of survival they represented. I knew that for some removing the scars would have value, but my scars represented to me abiding love and immense beauty.

Over the years my wise and loving surfing teacher and spiritual guide Virgil advised me to respect and feel the water, do not hesitate to get up, hold my space, be one with the wave” and so much more. Riding out the heart surgery and choosing to stay here may have been one of the biggest waves I have surfed to date.

My scars are a story of STRENGTH and COURAGE held by my mom, my family, and my medical team. They are the ACTUALIZATION of hope and represent the RESILIANCE of all who believed.

Take a moment to breathe….. You are strong, courageous and full of actualized resilience! WE are here!

A Shout-Out this February to heart surgery Survivors, Caregivers and the Cardiac Support Resource community at large!

Do you ever think about your scars seen and unseen and what meaning those scars hold for you?