Nature, Dancing and a Cuddle!

Columbia.1

columbia.2

Preterm Birth Rates – Colombia

Rank: 114 –Rate: 8.8% Estimated # of preterm births per 100 live births (USA – 12 %)

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

Colombia, officially the Republic of Colombia  is a country largely in the north of South America, with territories in North America. Colombia is bounded on the north by the Caribbean Sea, the northwest by Panama, the south by Ecuador and Peru, the east by Venezuela, the southeast by Brazil, and the west by the Pacific Ocean. It comprises 32 departments and the Capital District of Bogotá, the country’s largest city. With an area of 1,141,748 square kilometers (440,831 square miles), Colombia is the fourth-largest country in South America, after Brazil, Argentina and Peru. It is also the 25th-largest country in the world, the fifth-largest country in Latin America, and the fourth-largest Spanish-speaking country.

The overall life expectancy in Colombia at birth is 74.8 years (71.2 years for males and 78.4 years for females). Healthcare reforms have led to massive improvements in the healthcare systems of the country, with health standards in Colombia improving very much since the 1980s. Although this new system has widened population coverage by the social and health security system from 21% (pre-1993) to 96% in 2012, health disparities persist.

Through health tourism, many people from over the world travel from their places of residence to other countries in search of medical treatment and the attractions in the countries visited. Colombia is projected as one of Latin America’s main destinations in terms of health tourism due to the quality of its health care professionals, a good number of institutions devoted to health, and an immense inventory of natural and architectural sites. Cities such as Bogotá, Cali, Medellín and Bucaramanga are the most visited in cardiology procedures, neurologydental treatmentsstem cell therapyENTophthalmology and joint replacements because of the quality of medical treatment.

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

 

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COMMUNITY

Cuddling Preemies Kangaroo Style Helps Into Adulthood

By Maggie Fox -Dec. 12, 2016

Cuddling small and premature babies in a style known as “kangaroo mother care” helps them in life decades later, researchers reported Monday.

They found that babies held upright and close to bare skin and breastfed, instead of being left in incubators, grew up with fewer social problems. They were far less likely to die young.

It’s a reassuring finding for parents who may worry that tiny and premature babies are safer in an incubator than in their arms, the team wrote in their report, published in the journal Pediatrics.

Kangaroo mother care was first described in Colombia, and the team of experts there who first showed it was safe did a 20-year follow-up to see how the babies fared as they grew up. They tracked down 494 of the original 716 children who were born prematurely from 1993 to 1996 and randomly assigned to get either kangaroo mother care or standard handling.

“The effects of kangaroo mother care at one year on IQ and home environment were still present 20 years later in the most fragile individuals, and kangaroo mother care parents were more protective and nurturing,” Dr. Nathalie Charpak and colleagues at the Kangaroo Foundation in Bogota, Colombia, wrote in their report.

“At 20 years, the young ex-kangaroo mother care participants, especially in the poorest families, had less aggressive drive and were less impulsive and hyperactive. They exhibited less antisocial behavior, which might be associated with separation from the mother at birth,” they added.

“Kangaroo mother care may change the behavior of less well-educated mothers by increasing their sensitivity to the needs of their children, thus making them equivalent to mothers in more favorable environments.”

Twenty million babies are born at a low birth weight every year around the globe, the World Health Organization reports. The U.S. has one of the highest rates of pre-term and low-weight births — about one in 12 births, according to the March of Dimes.

It defines low birthweight as being when a baby is born weighing less than 5 pounds, 8 ounces.

Most of these small babies are premature and they are at high risk of dying, of developing cerebral palsy, or having learning disabilities, and they can grow up more prone to a range of diseases.

High-tech care can help, but WHO promotes the simpler, low-tech approach alongside modern medical care — or instead of it in some poor settings.

“Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term. Its key features are: early, continuous and prolonged skin-to-skin contact between the mother and the baby; exclusive breastfeeding (ideally); it is initiated in hospital and can be continued at home; small babies can be discharged early; mothers at home require adequate support and follow-up,” WHO said.

“It is a gentle, effective method that avoids the agitation routinely experienced in a busy ward with preterm infants.”

And it’s safe, WHO added. “Almost two decades of implementation and research have made it clear that kangaroo mother care is more than an alternative to incubator care.”

Charpak’s team found the babies randomly assigned to get this treatment were 39 percent more likely to live into adulthood. They had stayed in school longer and earned more as adults.

It didn’t work miracles. Children with cerebral palsy were equally likely to have symptoms whether they had the kangaroo care or not, and more than half the people in the entire group needed glasses. The children given standard care had higher math and language scores in school, while IQ levels were about the same in both groups.

But overall, the findings support the benefits of kangaroo mother care, the team concluded.

“Our long-term findings should support the decision to introduce kangaroo mother care to reduce medical and psychological disorders attributable to prematurity and low birth weight,” they wrote.

“We suggest that both biology and environment together might modulate a powerful developmental path for these children, impacting until adult age,” they added.

“We firmly believe that this is a powerful, efficient, scientifically based health intervention that can be used in all settings.”

Source:https://www.nbcnews.com/health/health-news/cuddling-preemies-kangaroo-style-helps-adulthood-n694971

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Kat and I have danced Zumba for the past 13 years and are both certified instructors. Kat teaches several Zumba and Strong Nation (HITT) classes every week.  Zumba founders Alberto “Beto” Pérez (Colombian native), Alberto Perlman, and Alberto Aghion built a worldwide global health and fitness community (180 countries)  that we are grateful to be a part of.  Zumba in the streets? That’s what it’s all about! And our Neonatal Womb Community? We all need to do a little dancing. This pandemic has been challenging and we have a ways to go! Let’s move forward with curiosity, creativity, some crazy footwork and a focus on taking active care of ourselves and each other.

Colombia: Bogota Police help fight corona-virus isolation blues with dance classes

Apr 1, 2020

Colombian national police officers took to Bogota’s streets on Tuesday with loud speakers and dance tunes to encourage citizens to get some exercise and help them get through self-isolation with high spirits. “We are working at the moment on the idea of prevention to help people in everything that relates to tranquility in terms of their spiritual, physical and mental control in relation to the entire quarantine due to COVID-19,” said national police colonel Doris Manosalva. Footage shows police officers coordinating the dance operation before heading out to the streets to dance, calling on people to join them as well as reminding everybody the importance of staying inside. Police officers go to a different area of the city every day to reach as many citizens as possible.

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How California Became The Only State To Lower Its Infant Mortality Rate

Here’s how they’re saving the lives of more premature babies.

By Anna Almendrala08/08/2018

California was the only state to significantly reduce the rate of stillbirths and newborn deaths from 2014 to 2016.

In 2014, Dr. Elizabeth Rogers and her colleagues at the UCSF Benioff Children’s Hospital in San Francisco noticed a disturbing trend among the tiniest preemies in their neonatal intensive care unit: a high rate of brain bleeds among these babies born before 28 weeks’ gestation.

Rogers wondered if other NICUs had seen an increase as well or if there was something about her patient population that put them at particular risk.

Intracranial hemorrhages, caused by the rupture of immature blood vessels in the brain, are a major cause of death in very preterm babies, as well as a complication linked to developmental delays and cognitive deficits later in life. Driving down the rate of such complications is one way that hospitals can help reduce the number of early infant deaths.

Compared to other rich countries, the U.S. has unacceptably high rates of perinatal deaths, a category that covers stillbirths and deaths within the first week of life. And the most recent data suggest those numbers are not improving ― except in California. That state was the only one to see a decrease in perinatal deaths from 2014 to 2016, according to a report published Wednesday by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

The reason for California’s success may be a statewide data project that has been gathering information from hospitals for the past two decades. In any other state, Rogers and her colleagues would have struggled to find an answer to her initial question about the prevalence of brain bleeds. But because they were in California, Rogers was able to log into a data dashboard created by the California Perinatal Quality Care Collaborative. The easy-to-use clearinghouse of real-time information from more than 90 percent of California hospitals that treat babies in NICUs let her compare her unit’s outcomes to those at similar units.

What she found shocked her. UCSF was seeing brain bleeds in more than 15 percent of NICU babies, or nearly four times the rate at comparable hospitals of the same size and expertise.

“I was able to go to the dashboard and say, ‘Not only do we think this is a problem, but this really is a problem,’” said Rogers, who is director of the hospital’s intensive-care small-baby program.

Armed with that information, she persuaded hospital administrators to allocate resources to the issue; gathered a group of doctors, nurses, therapists, technicians, janitors and parents to consider what steps to take; and produced a training manual for staffers.

I was able to go to the dashboard and say, ‘Not only do we think this is a problem, but this really is a problem.’ Dr. Elizabeth Rogers

It isn’t clear what causes brain bleeds in premature babies, so Rogers’ group tackled the issue in multiple ways. Starting in 2014, women who went into labor preterm received a shot of steroids to strengthen their babies’ brains. Immediately after birth, the clamping of a preemie’s umbilical cord was delayed 45 seconds, which is known to decrease brain bleeds.

Everyone who interacted with the babies, from X-ray techs to sanitary workers, received training on how to create a calm environment, which included intervening as little as possible and using low voices if they had to speak.

In about three years, UCSF reduced the rate of brain bleeds to 3.8 percent, just a quarter of what it had been and on par with comparable hospitals in the state. This decrease set off a cascade of other positive outcomes. Deaths in the NICU were cut almost in half, dropping from 11.9 percent to 6.8 percent over that time period. Rates of necrotizing enterocolitis ― another common complication among premature babies ― went down as well, which Rogers attributed to the hospital’s increased attention to their littlest patients.

The speed at which Rogers and her team implemented research-based change was remarkable and unusual. It takes an average of 17 years for research data to alter standard medical practice, in part because of entrenched hospital bureaucracies that favor tradition, a systemic reluctance to spend money on monitoring and prevention, and medical staff who may feel competitive and territorial.

Without the initial comparative data, Rogers is convinced she wouldn’t have been able to revamp her NICU’s systems so fast and the rates of hemorrhage would have remained high.

Hospitals in general need to become better at rapidly adjusting and refining their care when it’s lacking or when new research points to a better way of doing things, Rogers argues.

Across the rest of the country, rates of stillbirths and deaths within a week after birth remain at a standstill. In one state, Missouri, the rate has actually gone up since 2014. California has the third-lowest rate, following Washington state and Wyoming.

“To see the results … is a huge reward,” said Rogers. “It’s a huge validation that all of this effort is worth it.”

They’ll pay thousands to monitor one baby’s heart rate, but there’s no money set aside to monitor the monitors. Dr. Jeffrey Gould, co-founder of the California Perinatal Quality Care Collaborative

While the larger issue of American infant mortality is now more widely recognized, it wasn’t in the public consciousness 21 years ago when Dr. Jeffrey Gould, then a researcher with the University of California, Berkeley, began to compile a single statewide database of numbers on newborn deaths and complications, paid for by the state.

The project grew as Gould convinced neonatologists, hospitals, insurance payers, public health experts and state agencies that it was in everyone’s interest to share NICU data in real time. With its wealth of information, the California Perinatal Quality Care Collaborative also develops best practice standards and toolkits to help hospitals implement those practices. It periodically launches initiatives aimed at improving care in one particular area, such as breastfeeding in the NICU, using antibiotics and reuniting these vulnerable newborns with their families.

The model of the California Perinatal Quality Care Collaborative has spread across the country, albeit only in recent years. Most states now have some kind of perinatal quality collaborative, but they aren’t created or funded equally. Because California was the first, none of the other state collaboratives has as much data or experience. And though some of them provide education on better practices, they don’t seek to help hospitals implement specific changes ― an aspect of California’s collaborative that makes membership so worthwhile. This means the gains California has seen are not guaranteed in other parts of the country.

Gould, now a professor of neonatal and developmental medicine at Stanford, is especially frustrated that hospitals still hesitate to invest real money in trying to improve the quality of care.

“One of the big drawbacks in this country is that quality improvement is not really seen by hospital administrators as a line item kind of thing,” Gould said. “They’ll pay thousands to monitor one baby’s heart rate, but there’s no money set aside to monitor the monitors.”

The annual cost of membership in the California Perinatal Quality Care Collaborative is $13,000 to $15,000, depending on the size of the hospital, and it gives them access to the data dashboard. Participation in each individual initiative is optional and costs an additional fee ― around $8,500 per hospital ― to defray the additional costs for data collection, training and network access.

Meanwhile, the average daily cost of one baby’s care in a NICU is more than $3,000.

More data may ultimately ease this problem too, Rogers said. Besides helping doctors make the case to administrators for more resources for the NICU, as she did, better information leads to more effective and efficient care, which can lead to cost savings.

When a state does decide to invest in improving outcomes for preemies, hospitals may not know where to start. Gould’s suggestion: Use the data to find the low-hanging fruit, and then build on those first successes.

That’s exactly what Rogers is doing. The doctor is now turning her attention to necrotizing enterocolitis, a bacterial infection in the gut that can destroy intestinal walls. As brain bleeds have continued to decrease, necrotizing enterocolitis has become the biggest contributor to preemie deaths in her unit.

Again, armed with data, Rogers convinced the hospital to free up some funding for her unit to take part in the California Perinatal Quality Care Collaborative’s current effort to improve nutrition in NICUs. For premature babies, this boils down to hospital policies that encourage and assist mothers to pump breast milk soon after the baby’s birth ― a difficult task for women who have just experienced a stressful and unexpected early delivery.

Because formula feeding is one of the only consistent risk factors for necrotizing enterocolitis, breast milk ― especially milk produced by the baby’s mother ― decreases the odds that a premature baby will develop the infection. It’s so good for NICU patients, Rogers said, that doctors look at it more like medicine than food.

Source:https://www.huffpost.com/entry/california-infant-mortality-premature-babies_n_5b6b650de4b0bdd062062348

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rio

Brazil changes maternity leave for mothers of premature babies – a step to a fairer and more humane scenario of the labour market for all women 

Brazil (2019): The maternity leave for mothers of premature babies is extended. Last month Brazil’s Supreme Federal Tribunal decided to prolong the period of maternity leave for mothers of premature infants. We talked to Denise Leao Suguitani, founder and executive director  of GLANCE partner parent organisation Brazilian Parents of Preemies’ Association (Prematuridade.com), member of the GLANCE advisory board, about this important adjustment in Brazilian law.

  1. Ms Suguitani, Brazil took another big step to strengthening maternal rights. What brought this change to come?

We, the organized civil society, were finally able to raise awareness for the Brazilian Governments about the challenges prematurity brings along. It seems they have understood the essentiality of protecting motherhood and childhood, especially for more delicate babies like the premature ones. Although the decision is valid only for mothers working on a formal contract, it is a huge step towards a fairer and more humane scenario of the labour market for all women.

  1. Ms Suguitani, your parent organisation spoke to the lawyers who placed the injunction that was eventually approved. What changes for mothers of premature babies in Brazil from now on?

Women in the workforce in Brazil have 120 days of standard maternity leave, which begins on the day of the delivery. From now on, mothers of premature babies can require a new beginning of maternity leave, if their baby needs to be in the hospital for more than two weeks. Once the baby is discharged, the maternity leave with its 120 days starts anew – regardless of how long the baby had to stay in hospital.

  1. The initial decision of Minister Fachin was valid until the Brazilian Federal Supreme Court plenary confirmed the new law, on April 3rd. How do you assess that victory in the Court?

We were really optimistic that the injunction would not be overturned since we have been working for the approval of this law for over 5 years now, dialoguing with politicians and decision makers. It is such a great achievement for the cause of prematurity in our country and a big step for our society.

Ms Suguitani, thank you so much for taking the time to speak with us.

Source: https://www.glance-network.org/news/details/brazil-extends-maternity-leave/

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INNOVATIONS

Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the USA Systematic Review

Bruce Bekkar, MD1Susan Pacheco, MD2Rupa Basu, PhD3,4; et alNathaniel DeNicola, MD, MSHP5 – June 18, 2020

Key Points:

Question  Are increases in air pollutant or heat exposure related to climate change associated with adverse pregnancy outcomes, such as preterm birth, low birth weight, and stillbirth, in the US?

Findings  In this systematic review of 57 of 68 studies including a total of 32 798 152 births, there was a statistically significant association between heat, ozone, or fine particulate matter and adverse pregnancy outcomes. Heterogeneous studies from across the US revealed positive findings in each analysis of exposure and outcome.

Meaning  The findings suggest that exacerbation of air pollution and heat exposure related to climate change may be significantly associated with risk to pregnancy outcomes in the US.

Abstract

Importance  Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country.

Objective  To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth.

Findings  Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The sub-populations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality.

Conclusions and Relevance  This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.

Introduction

The current climate crisis, also known as climate change or global warming, has been widely recognized as an environmental emergency that threatens many critical resources and protections including sustainable food and water supplies, natural disaster preparedness, and US national security. However, as the World Health Organization and The Lancet Countdown have identified, one of the greatest consequences of climate change is its association with human health.

Specific to women’s health, the American College of Obstetricians and Gynecologists position statement recognizes that “climate change is an urgent women’s health concern as well as a major public health challenge.” The associations of climate change with women’s health have been further outlined to include a wide range of undesirable outcomes, such as worsening of cardiac disease, respiratory disease, and mental health, and exposure to an increasing number of infectious diseases.

These adverse health effects are most consequential to at-risk populations, which include a high number of pregnant women and developing fetuses. The obstetrical literature has included numerous observational studies demonstrating an association between air pollution and heat and increased risk of adverse birth outcomes. Two components of air pollution that are exacerbated by climate change and continued use of fossil fuels are fine particulate matter less than 2.5 μm in diameter (PM2.5) and ozone.

In this review, we assessed the associations between exposure to PM, ozone, and heat and preterm birth, low birth weight, and stillbirth. Although these associations have largely been studied in a global setting, we focused specifically on the US population, in which these exposures are increasingly common.

Methods

Scope of Review

For this systematic review, we evaluated evidence of the association between air pollution and heat on the adverse obstetrical outcomes of preterm birth, low birth weight, and stillbirth. The Arskey O’Malley methodologic framework for a scoping review was used.18,19 This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Research Questions

The following specific key questions were addressed in this review. Is prenatal exposure to PM2.5 or ozone associated with increased risk of preterm birth? Is prenatal exposure to PM2.5 or ozone associated with increased risk of low birth weight? Is prenatal exposure to PM2.5 or ozone associated with increased risk of stillbirth? Is prenatal exposure to heat associated with increased risk of preterm birth? Is prenatal exposure to heat associated with increased risk of low birth weight? Is prenatal exposure to heat associated with increased risk of stillbirth?

Discussion

Studies across diverse US populations were identified that reported an association of PM2.5, ozone, and heat exposure with the adverse obstetrical outcomes of preterm birth, low birth weight at term, and stillbirth. More than 32 million births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. In each analysis of climate change–related exposure and adverse obstetrical outcome, most of the studies found a statistically significant increased risk (Table). The highest number of studies were found for risk of preterm birth (29 studies) and low birth weight (32 studies), whereas limited studies were identified for stillbirth (7 studies) because of the lack of available data for health studies.

Our review contributes the largest number of recent studies (2007-2019) focusing solely on US populations and is the first, to our knowledge, to combine the increasingly common exposures of air pollutants and heat associated with a series of adverse obstetrical outcomes. Our findings are consistent with other review articles that were not included in our analysis (all included non-US participants). Reviews that examined PM2.5 found consistently positive association with preterm birth and low birth weight or continuous birth weight, and 1 systematic review and meta-analysis on stillbirth risk showed elevated effect estimates for both PM2.5 and ozone, although they did not achieve significance. Five reviews that focused on heat exposure found an association with preterm birth in most studies, as did 4 that analyzed low birth weight and 2 analyzing stillbirth risk.

The adverse obstetrical outcomes examined in this study are known to be complex, heterogeneous, and multifactorial in origin; several animal studies suggested that both air pollutant and heat exposure may contribute to adverse obstetrical outcomes. Regarding preterm birth, mechanisms that implicate toxic fine particulates include maternal hematologic transport of inhaled noxious chemicals, the triggering of systemic inflammation, or alterations in function of the autonomic nervous system. Low birth weight may be associated with air pollutants by direct toxic effects from fetal exposure, altered maternal cardiac or pulmonary function, systemic inflammation from oxidative stress, placental inflammation, altered placental gene expression, or changes in blood viscosity; multiple effects may operate simultaneously. Mechanisms for the association of air pollutants with stillbirth may involve alterations in oxygen transport, DNA damage, or placental injury. The cause-specific analysis by Ebisu et al of stillbirths reinforces the apparent association of injury to the fetal-placental unit with air pollutant exposure compared with other possible causes.

Heat exposure may contribute to prematurity through labor instigation from dehydration (via prostaglandin or oxytocin release), from altered blood viscosity, and/or by leading to inefficient thermoregulation; it may also trigger preterm premature rupture of membranes and thus preterm birth during the warm season. Likewise, heat exposure may impair fetal growth by reducing uterine blood flow and altering placental-fetal exchange. Mechanisms associated with elevated temperatures and stillbirth include the initiation of premature labor (as noted above), lowering amniotic fluid volume, damaging the placenta, or causing abruption.

Biologic plausibility is further supported by other recent studies not included in this review. The study by Casey et al of preterm birth rates in California before and after coal power plant closures showed a 27% reduction during the 10-year period after closure. Currie et al found that among 1.1 million live births in Pennsylvania, the risk of low birth weight was higher within 3 km of a fracking site compared with the background risk and increased by 25% within 1 km of a site.

This review revealed a disproportionate effect on populations defined as pregnant women with certain medical conditions or specific race/ethnicities. Women with asthma may be particularly susceptible to adverse outcomes, such as preterm birth and stillbirth, in association with PM2.5 exposure during gestation. Among racial/ethnic groups, our findings suggest that black mothers are at greater risk for preterm birth and low birth weight. Social determinants of health, including residence in urban areas with higher exposure to air pollutants and long-term high levels of stress, are known to contribute to adverse obstetrical outcomes. A recent study from California suggested that PM2.5 exposure alone was associated with an equivalent amount of the racial disparity (black vs white) in preterm birth rates as did other demographic and social factors. Our research suggests that these environmental exposures further exacerbate that background risk and could be included among these social determinants.

Regarding both air pollutant and heat exposure, associations with adverse birth outcomes were found across the continental US. For example, studies on air pollution and low birth weight found an association in 19 states in the Northeast (10), Southeast (5), Midwest (2), Mountain (1), and West (1) regions. California, known for both high temperatures and unhealthy particulate and ozone levels, was included in the greatest number of studies showing a positive association (13), followed by Massachusetts (6), Georgia (5), and Florida (4). The exposures are complex; even within 1 state, the weather patterns, geography, and urbanization may create zones with widely different pollution risks, as shown by Tu et al in Georgia.

Future research is needed to further identify at-risk populations, high-exposure geographic areas, and effects of seasonality. This ongoing research may be enhanced by improved geographic information systems that can be mapped onto existing US public health data-banks such.

Conclusions

This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US. It appears that the medical community at large and women’s health clinicians in particular should take note of the emerging data and become facile in both communicating these risks with patients and integrating them into plans for care. Moreover, physicians can adopt a more active role as patient advocates to educate elected officials entrusted with public policy and insist on effective action to stop the climate crisis.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767260

hat.stop

Intensive Care Neonates and Evidence to Support the Elimination of Hats for Safe Sleep

Fulmer, Megan BSN, RN-NIC; Zachritz, Whitney MSN, CPNP-BC, RN; Posencheg, Michael A. MD

Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC, Section Editor

Advances in Neonatal Care: June 2020 – Volume 20 – Issue 3 – p 229-232

Abstract

Background: 

Although the incidence of sudden unexplained infant deaths has decreased over time with the use of safe sleep practices, one area that remains unclear is the safety of hats during infant sleep.

Purpose: 

Decrease the risk of overheating or suffocation by removing NICU infants’ hats during sleep without increasing the relative risk of hypothermia during transition to an open crib.

Methods: 

Removal of hats for routine thermoregulation, beyond the initial infant resuscitation and stabilization of NICU infant was implemented in 2015. Retrospective chart audits were conducted on all NICU infants between February 2015 and December 2016. Hypothermia (≤ 97.6°F) data during transition to an open crib was collected. Exclusion criteria included concurrent diagnosis of: sepsis, hyperbilirubinemia, congenital anomaly inhibiting infants thermoregulation and noncompliance with unit guideline for weaning infant to open crib.

Findings: 

Over 18 months, 2.7% of infants became hypothermic (≤ 97.6°F) during transition to open crib, requiring return to isolettes.

Implications for Practice: 

Hats were found to be unnecessary in maintaining thermoneutrality after weaning infants to an open crib in our NICU. By avoiding the use of hats in an open crib, it’s possible infants will avoid overheating and a risk of suffocation, creating a safer sleep environment.

Implications for Research: 

The removal of hats during sleep to promote infant health should be considered for all infants.

Source:https://journals.lww.com/advancesinneonatalcare/Abstract/2020/06000/Intensive_Care_Neonates_and_Evidence_to_Support.9.aspx

columbia.baby

PREEMIE FAMILY PARTNERS

Premature Baby Makes Full Recovery After Experimental Coronavirus Treatment | NBC News NOW

newsJun 22, 2020

Born premature at just 27 weeks, one baby is finally on his way home after battling both sepsis and COVID-19. NBC News’ Helena Humphrey spoke with the baby’s mother about his 47-day battle.

 

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Preemie Parent Perspective: Addressing Health Equity and Cultural Competency in the NICU

Jenné Johns, MPH

In 2016, I published Once Upon A Preemie, a first- of its kind children’s book written to comfort parents of premature infants during their journey through the Neonatal Intensive Care Unit (NICU). During my journey, I discovered that reading to my micropreemie was the one activity as a mother that I could offer my son that helped normalize my overwhelming and traumatic NICU experience. During our nearly three-month stay in the NICU, I read to my son every day as research studies suggest that reading stimulates healthy brain development in preemies, and also helps to form a bond between parent and baby. Many of the bedtime stories that we read ended with a parent tucking the child into bed at home with Mommy and Daddy. That wasn’t our reality for three months. There were no books about us. Little did I know that in publishing my deepest emotions carried during and post NICU would lead me to become an author and speaker, but also an advocate and advisor for the needs of preemie parents, especially African Americans. As the mother of a micro-preemie and miracle baby born at 26 weeks and weighing 1 lb 15.3 ounces, I found myself advocating for his needs as I knew his life depended on it. Despite my 10-year career working to eliminate racial and ethnic disparities in health care, nothing prepared me for the heart-wrenching experience of my son’s premature birth. “Disparity” became real for me as my son joined the ranks of the nearly 500,000 premature babies born in the United States, nearly half to African American and Hispanic mothers. It was through this dual role that I experienced the NICU, one as a vulnerable micro-preemie mother, and the other as a health equity professional.

At birth, my son required life-saving medical interventions; oxygen, photo-therapy lights, feeding tubes, a heart monitor, medication, vitamins, and even caffeine. Over our nearly three-month stay in the NICU, I traveled through snowstorms and blizzards, to parent and nurture my baby. I only missed three days (two due to inclement weather and one self-care day). A typical day in the NICU lasted from 7 am until midnight, with many breaks to pump breast milk. My lactation consultant promised that my breast milk was liquid medicine. Midway through our NICU journey, I had to return to work, unlike many of my new NICU parent friends who were Caucasian. My advocacy skills were tested daily, as his life depended on how well I could speak “neonatology” language, I had to be his voice and articulate his needs. This was challenging because, after all, “I’m just a Mom,” an African American Mom, and not a doctor.

As a mother, my NICU journey was traumatic and filled with a sea of emotions, including fear, anxiety, helplessness, and isolation. Much of which NICU parents are facing due to the current COVID-19 pandemic. Many of my fears, concerns, and feelings of isolation were due to the NICU environment, which was not as culturally friendly and supportive, as I assumed it would be. I’m being generous by saying there was little cultural diversity; it was dismal at best. There were times when the lack of cultural sensitivity and bedside manner caused more pain than my son’s actual health status, and it made me very uncomfortable because as the end of each night, I had to trust my most prized possession with nurses and doctors who I did not always trust. Another challenge I faced as an African American preemie parent, was that although our larger hospital system had active and robust NICU parent support groups, these resources were not made available at the smaller hospital where I delivered my son. This hospital served more African American and lower-income families than the other hospitals. Many of the parents I developed a relationship with, felt as if our socio and emotional needs did not matter and were oftentimes dismissed because of this missing resource.

Lastly, I experienced inconsistent positive communication and relationships with many of the NICU staff. Although I now believe that all of the members of my son’s care team, held his safety and the quality of care they delivered to him with the utmost regard, our daily communication and interaction lacked humility, respect, and sensitivity. I will admit, I was not always the easiest or most cheerful mother to deal with, I now believe, that with trauma-informed and implicit bias training among hospital staff, the professional staff would have been better equipped to communicate and support my delicate and fragile nature.

Overall, a good deal of our NICU experience was positive; some experiences left permanent and negative memories that, to this day, cannot be erased. As much as I tried checking my professional credentials at the door before entering the NICU, my interactions with the NICU staff begged, yelled, and warranted us to have those tough cultural sensitivity conversations. Not in a negative way, but as an opportunity for forming better communication, respect, and, most importantly, trust. In my professional view, the NICU is a microcosm of the larger hospital system on steroids, particularly NICU’s serving low income and racially, ethnically, and linguistically diverse populations. Health disparities impacting the NICU are also a reflection of a larger hospital ecosystem. Below are my preemie parent and professional recommendations for integrating health equity and cultural competency in the NICU:

1. Prioritize health equity and cultural competency as strategic priorities and goals. Establishing opportunities for integrating and addressing health equity in short and long terms strategies ensures layers of accountability, allocation of funding, measurement, and documentation of outcomes. One example of an important health equity priority includes staff diversity. Peer-reviewed studies have shown that cultural congruence among patients and providers yields better health outcomes, better communication, and trust.

2.Make health equity, cultural competency, and implicit bias training mandatory for all NICU Staff. Participating in an annual training program is a great start to begin addressing and delivering equitable care to all NICU families. However, one-time training is not sufficient. Integrating health equity and implicit bias content into clinical rounds, staff development, and training opportunities are critical to reducing racial and ethnic disparities in the NICU.

3.Communicating in lay terms should be standard in every NICU. Literacy and health literacy levels are important considerations for family-centered and culturally appropriate care in the NICU. Regardless of one’s educational level, the NICU terminology is overwhelming and confusing for a new parent entering the NICU. Literacy and health literacy considerations are also important factors for families who are limited or non-English speaking. Break the communication barriers by speaking the same language and utilizing interpreters even if everyone speaks English. I had a great deal of respect and appreciation for the NICU staff who used lay terms and avoided NICU jargon when communicating with me. In time, I began understanding the NICU language; however, that wasn’t my job as a preemie parent. Preemie parents should be made to feel as comfortable speaking and interacting with NICU staff regardless of their literacy and health literacy levels.

4.Partner with parents to address the cultural competency, spiritual diversity, and unconscious biases that exist in the NICU. Listen to the voices of parents with multicultural backgrounds to be more sensitive to racial, ethnic, language, income, education, transportation, and spiritual needs. Encourage preemie parents to speak up. Staff should value their input. Allow parents to give their insights on their baby’s health status, and any gut feelings they may have about a diagnosis or new development. This is extremely important for minority parents who assume their voice and parental role is undervalued.

5.Engage and establish culturally congruent NICU family supports. Many minority parents may not immediately express a need for mental or emotional help while in the NICU for fear of being labeled. Where and when possible, make culturally congruent resources available to support these parents, even if the supports are outside of the NICU.

6.Make digital technology and virtual solutions available to parents with transportation, competing work schedules, or other barriers to delivering care to their preemies. This is most critical during the current COVID season, where parental fears and social distancing may prohibit them from visiting their baby. Creating safe opportunities for parents to connect with their babies is vital bonding via smart devices or other safe technology solutions.

Source:http://www.neonatologytoday.net/newsletters/nt-jun20.pdf

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Coastal Sunrise Father dances on TikTok for his son in NICU

3waveWSAV3 – Feb 5, 2020

 

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HEALTH CARE PARTNERS

Using Neonatal Intensive Care Units More Wisely for At-Risk Newborns and Their Families

DeWayne M. Pursley, MD, MPH1,2John A. F. Zupancic, MD, ScD1,2   June 18, 2020

Escalating US health care expenditures, including estimates that 20% to almost 50% of these costs involve processes, products, and services that do not improve outcomes, have brought renewed attention to the need to improve value in health care.1 Among the 6 waste categories outlined by Berwick and Hackbarth, there has been considerable focus on opportunities to reduce overtreatment, “the waste that comes from subjecting patients to care that… cannot possibly help them… rooted in outmoded habits, supply-driven behaviors, and ignoring science.”

Neonatal intensive care unit (NICU) services are at particularly high risk of overuse. Hospital and professional services reimbursements, reflecting the acute and highly technical nature of intensive care, are favorable and remain closely linked to admission volume and patient days in most regions. Both a legacy of intervention and a fear of litigation in caring for an at-risk population can also contribute to ineffective testing and treatments. The neonatology community is, however, starting to recognize the potential for improving care and controlling resource utilization. A 2015 study describing a systematic process to identify ineffective or harmful neonatal tests and treatments yielded a “Choosing Wisely Top Five” list in part to guide these efforts. In recent years, the neonatal care value literature has evolved to also focus more broadly on trends relating to NICU utilization—specifically, increasing admission rates and longer lengths of stay.

In the study by Braun et al,3 investigators from Kaiser Permanente share a population-based study describing a decline in NICU utilization—both admission rates and patient days—during a 9-year period. This is an important study, as it describes a trend that is counter to several recent reports of unexplained increasing NICU utilization, particularly for more mature and higher birth-weight infants, using a clinical rather than administrative data set. It is also important because the results may have been associated with several intercurrent performance improvement initiatives. Kaiser Permanente is a large, integrated health care system with a diverse population and a population-based financial payment structure and is in many ways uniquely suited (and motivated) to undertake a project to identify and characterize potential approaches to safely reduce neonatal care that is costly, may be ineffective, separates families, and is potentially harmful. The authors used a risk-adjustment model to ensure that the improvements were associated with postnatal care practices and not with changes in case mix reflecting patients less in need of acute neonatal care. They were also careful to include balancing measures, such as readmission and mortality, among the outcomes. Also important is the residual practice variation, which may hint at future opportunities for reduction in NICU utilization.

In the study by Braun et al, 12% of more than 300 000 liveborn infants were admitted to the NICU. Contrary to public perceptions of NICUs as prematurity colonies, more than two-thirds of these admissions were infants born after 34 weeks gestational age with birth weights more than 2000 g. The risk-adjusted NICU admission rate, accounting for socioeconomic, prenatal, and delivery room variables to control for independent factors that might affect admission or length of stay, decreased 25% over the study period to 10.9% of births, with 92% of the decline represented by infants with greater gestational age and higher birth weights. Importantly, these changes occurred without evidence of higher 30-day readmission or mortality rates.

There are compelling reasons that these results might not have been a random occurrence, as the health care system’s clinical leadership had implemented several concurrent performance improvement initiatives associated with decreased NICU admissions. A revised policy raised the threshold for NICU admission by lowering the gestational age (<35 weeks) and birth weight (<2000 g) for which well-appearing preterm infants were routinely admitted. A decision support tool based on individual infant estimates of early onset sepsis risk was introduced to guide laboratory testing and empirical antibiotic treatment. Finally, obstetric policies to decrease the rate of nonmedically indicated deliveries before 39 weeks of gestation and to reduce nonmedically indicated nulliparous, term, singleton, and vertex cesarean births were introduced.

The findings by Braun et al3 stand in contrast to a national trend documented in a 2015 population-based study. In that study using a public data set, birth-weight–specific NICU admission rates of US neonates were examined over a 6-year period (2007-2012). During this time, despite adjustment for maternal and neonatal characteristics, NICU admissions increased by 23%. These increases were generally represented by larger and less premature infants, such that by the end of the study period, most NICU admissions were for infants with birth weight more than 2500 g.

Although not population-based, observations by NICU member collaboratives, such as the California Perinatal Quality Care Collaborative and the Vermont-Oxford Network, have documented substantial variations in NICU admission and length-of-stay profiles. One California Perinatal Quality Care Collaborative study from 2018 observed that 79% of NICU admissions in 2015 were among infants born at or after 34 weeks gestation, while 10% of infants with 34 or more weeks gestation were admitted to the NICU. Schulman et al5 documented a 40-fold variation among member hospitals in the proportion of NICU admissions meeting high acuity definitions. In a Vermont-Oxford Network6 study involving approximately 500 000 infants hospitalized for nearly 10 million days in 381 NICUs from 2014 to 2016, 74% of NICU admissions were infants at 34 or more weeks gestation and only 15% of admissions met high acuity criteria. The proportion of admissions, patient days, high acuity, and short stays varied significantly both within and between different NICU types.

The origins of NICUs go back a half century, and NICUs have contributed substantially to reductions in US infant mortality during this time, a period during which rates of prematurity and low birth weight have actually increased. In 1967, the infant mortality rate was 22.4 per 1000 live births.  Fifty years later, in 2017, the rate had declined to 5.8 per 1000 live births, a remarkable 74% reduction. Neonatal intensive care is highly effective and has achieved these outcomes and corresponding reductions in morbidity by mitigating the effects of prematurity, congenital anomalies, and pregnancy and perinatal complications. In the early days, NICUs were in short supply and public health entities mobilized to develop regionalized perinatal systems to ensure that obstetric and neonatal patients at high risk had access to specialized services when indicated. As the neonatology workforce and NICU bed capacity increased, hospitals and hospital systems, seeking to become full-service systems, contributed to deregionalization, and there was increasing reliance on economic forces to regulate growth and distribution. In some areas, infants at high risk were distributed more broadly, including to smaller, lower-level units, resulting in less favorable outcomes. Because NICUs are high-margin services, there are significant pressures to expand capacity and maintain volume. This can lead to overuse, including more frequent admission of infants at low risk or a failure to focus sufficiently on care practices that could potentially reduce demand.

There is a cost to these practices. Although NICUs are effective, they are also expensive. Health care system costs are largely borne by government and business, and unwarranted increases may potentially compromise funding of other essential services. Importantly, there may be hidden financial harms for families as well, including costs associated with transportation or lost work days. There are also risks. Short NICU stays by infants at low risk may interfere with breastfeeding, expose them to infection, or increase antibiotic exposure. Additionally, family-infant separation may contribute to emotional risk.

It is not clear that increases in short term, low acuity, and high gestational age and birth-weight NICU admissions have benefited these infants and their families. In fact, the study by Braun et al suggests that it may be possible to reverse these trends without compromising and even potentially enhancing care. Rigorous adoption of evidence-based clinical practices, such as use of early onset sepsis decision support and obstetric policies to reduce non-medically indicated early deliveries and low-risk cesarean delivery rates is a start. There is also a need to examine the opportunities demonstrated by the enormous variation in NICU utilization and in specific NICU practices. These include gestational age thresholds for NICU admission; preferred sites of clinical evaluation, intravenous placement, and antibiotic administration for well-appearing infants with sepsis risk; preferred sites for monitoring and treatment and guidance for length of treatment for opiate withdrawal; and duration of apnea monitoring of preterm infants nearing discharge.

Neonatal intensive care is one of the major achievements of the last half century, and it has resulted in substantial reductions in mortality and long-term morbidity that benefit infants at high risk, including those born to mothers at substantial social risk. If the neonatology community is to successfully achieve the Triple Aim goal for neonatal intensive care—improved neonatal health, better family experience, and reduced cost—we must intensify efforts to learn how to use NICUs more wisely.

Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.5693

Corresponding Author: DeWayne M. Pursley, MD, MPH, Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (dpursley@bidmc.harvard.edu).

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767254

welcome.home

Why The Trauma Parents Experience In The NICU Follows Them Home

By COURTNEY COLLINS  FEB 14, 2020

Parents who’ve spent time in the neonatal intensive care unit (NICU) carry anxiety with them even after their baby is released.

The NICU’s constant barrage of doctors and beeping monitors is traumatic — and that trauma lingers.

Kepley Wakefield approaches life with typical 13-month-old vigor. A lot of smiling, excellent crawling acceleration and a fair amount of shrieking.

Her parents Courtney and Hollis Wakefield cherish her. They were by her side for each of the 95 days Kepley spent in the NICU.

“I had some bleeding at 21 weeks. So at that point, they put me on bed rest and we were having really difficult conversations,” Hollis said. “Viability is considered 24, so we had like two-and-a-half or three weeks to get through — which was a really, really scary time.”

Giving Birth At 24 Weeks

Hollis knew her pregnancy was going to be high risk. She was a 39-year-old cervical cancer survivor, so she and her wife had a plan for early labor. Even they weren’t prepared for delivery at 24 weeks, five days. But that’s when Kepley arrived, at 1 lb 10 ounces. The NICU team braced the Dallas couple for a long and frustrating road.

“They told us it would be like a roller coaster,” Hollis said. “They were like it’s going to be, you know, minute-to-minute some days. It’s not a straight line at all.”

Kepley started out in the NICU at UT-Southwestern’s Clements University Hospital, but eventually moved to the higher level NICU just down the road at Children’s Medical Center in Dallas. She was on a ventilator for three months.

When she was discharged, she still was tiny not even five pounds. She still needed supplementary oxygen and had weekly doctors appointments. Courtney says the stress from the NICU followed them home.

“I’m anxious all the time,” she said. “I have said, I have not been myself since Kepley was born.”

At-Home Risks

Because Kepley was born so early, her lungs weren’t fully developed. And because a ventilator helped her breathe for so long, those tiny lungs were also damaged. So even though Kepley is now thriving, flu season is a real threat. Her parents second guess every public outing, even quick trips to the store.

“And you’re thinking, do we risk it? Are we both going to be home where one of us could stay home?” Courtney said. “Just kind having to deal with that, even just for day-to-day tasks that we might normally bring a baby to. We’re having to kind of think twice.”

That’s not an overreaction. Doctors say catching a respiratory virus like RSV or the flu might put a premature baby right back in the hospital, which could re-traumatize those parents who’ve already spent time in the NICU.

Dr. Rashmin Savani is the chief of neonatal medicine at Children’s Health and UT Southwestern. He says even just the noise of endlessly beeping NICU monitors can overwhelm parents.

“The medical team and the nursing team they’re phenomenal, they understand what all these beeps are and when to respond, when to not respond.” Savani said. “But the family is bombarded with this sort of cacophony of alarms that are all designed to say ‘hey, pay attention to me.’ But for the family, it’s really scary.”

Children’s Health has a support crew in place to handle everything but the medicine. Every family has access to a team that includes a social worker, a psychologist and a chaplain.

‘Cutting The Umbilical Cord The Second Time’

Dr. Savani says Children’s Health also has a team devoted to helping a family transition to home — learning the ins and outs of complicated equipment and medication, as well as making sure the house is set up for a preemie, without the constant surveillance of doctors and nurses.

“And I actually call it you’re cutting the umbilical cord the second time,” he said. “And it’s a very scary thing for parents to go through.”

Hollis and Courtney Wakefield have been there. And while some things about caring for a preemie are old hat by now, they say some of those visceral NICU memories will never fade. There’s a visual reminder in the house too — a strand of colorful beads, so long it could wrap around Kepley’s tiny waist a dozen times. Courtney says each bead stands for something different Kepley went through in the NICU, for example: blood draws, surgeries and overnight stays.

One day, Kepley might decide to hang these beads on the wall — a memento of her earliest triumph.

For now though, she’s happy to use them as a teething toy.

Source: https://www.keranews.org/post/why-trauma-parents-experience-nicu-follows-them-home

WARRIORS:

Cultura de surf hecho en Chocó – Surf culture made in Chocó

  Apr 10, 2017

Nestor Tello, Termales, Chocó, Colombia, 2015. Directed by Guillaume Parent y Sina Ribak Suport: masartemasaccion.org Fundación Buen Punto: clubdesurfdelchoco.com In this mini video series we meet with some persons from the Colombian Chocó region who live on the Pacific Coast, south of Nuquí. In Chocó exists a big contrast between the wealth of natural resources and the few opportunities of what we call development for its population. Same as in many rural areas in Colombia, corruption and violence are reality. Nevertheless, the visitor experiences an impression of freedom, tranquility and solidarity. Here, you (re-)connect with nature – you almost dissolve into it – and you feed on the philosophy and dreams of the Chocó people.

KAT’S CORNER

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We need these articles to inspire, guide and support our precious community

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Survival of the littlest: the long-term impacts of being born extremely early

nature

Babies born before 28 weeks of gestation are surviving into adulthood at higher rates than ever, and scientists are checking in on their health.

Amber Dance- NEWS FEATURE  – 02 JUNE 2020

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Scientists are watching out for the health of adults born extremely premature, such as these people who took part in a photography project. Credit: Red Méthot

They told Marcelle Girard her baby was dead.

Back in 1992, Girard, a dentist in Gatineau, Canada, was 26 weeks pregnant and on her honeymoon in the Dominican Republic.

When she started bleeding, physicians at the local clinic assumed the baby had died. But Girard and her husband felt a kick. Only then did the doctors check for a fetal heartbeat and realize the baby was alive.

The couple was medically evacuated by air to Montreal, Canada, then taken to the Sainte-Justine University Hospital Center. Five hours later, Camille Girard-Bock was born, weighing just 920 grams (2 pounds).

Babies born so early are fragile and underdeveloped. Their lungs are particularly delicate: the organs lack the slippery substance, called surfactant, that prevents the airways from collapsing upon exhalation. Fortunately for Girard and her family, Sainte-Justine had recently started giving surfactant, a new treatment at the time, to premature babies.

After three months of intensive care, Girard took her baby home.

Today, Camille Girard-Bock is 27 years old and studying for a PhD in biomedical sciences at the University of Montreal. Working with researchers at Sainte-Justine, she’s addressing the long-term consequences of being born extremely premature — defined, variously, as less than 25–28 weeks in gestational age.

Families often assume they will have grasped the major issues arising from a premature birth once the child reaches school age, by which time any neuro-developmental problems will have appeared, Girard-Bock says. But that’s not necessarily the case. Her PhD advisers have found that young adults of this population exhibit risk factors for cardiovascular disease — and it may be that more chronic health conditions will show up with time.

Girard-Bock doesn’t let these risks preoccupy her. “As a survivor of preterm birth, you beat so many odds,” she says. “I guess I have some kind of sense that I’m going to beat those odds also.”

She and other against-the-odds babies are part of a population which is larger now than at any time in history: young adults who are survivors of extreme prematurity. For the first time, researchers can start to understand the long-term consequences of being born so early. Results are pouring out of cohort studies that have been tracking kids since birth, providing data on possible long-term outcomes; other studies are trialing ways to minimize the consequences for health.

earl

These data can help parents make difficult decisions about whether to keep fighting for a baby’s survival. Although many extremely premature infants grow up to lead healthy lives, disability is still a major concern, particularly cognitive deficits and cerebral palsy.

Researchers are working on novel interventions to boost survival and reduce disability in extremely premature newborns. Several compounds aimed at improving lung, brain and eye function are in clinical trials, and researchers are exploring parent-support programmes, too.

Researchers are also investigating ways to help adults who were born extremely prematurely to cope with some of the long-term health impacts they might face: trialing exercise regimes to minimize the newly identified risk of cardiovascular disease, for example.

“We are really at the stage of seeing this cohort becoming older,” says neonatologist Jeanie Cheong at the Royal Women’s Hospital in Melbourne, Australia. Cheong is the director of the Victorian Infant Collaborative Study (VICS), which has been following survivors for four decades. “This is an exciting time for us to really make a difference to their health.”

The late twentieth century brought huge changes to neonatal medicine. Lex Doyle, a paediatrician and previous director of VICS, recalls that when he started caring for preterm infants in 1975, very few survived if they were born at under 1,000 grams — a birthweight that corresponds to about 28 weeks’ gestation. The introduction of ventilators, in the 1970s in Australia, helped, but also caused lung injuries, says Doyle, now associate director of research at the Royal Women’s Hospital. In the following decades, doctors began to give corticosteroids to mothers due to deliver early, to help mature the baby’s lungs just before birth. But the biggest difference to survival came in the early 1990s, with surfactant treatment.

“I remember when it arrived,” says Anne Monique Nuyt, a neonatologist at Sainte-Justine and one of Girard-Bock’s advisers. “It was a miracle.” Risk of death for premature infants dropped to 60–73% of what it was before.

Today, many hospitals regularly treat, and often save, babies born as early as 22–24 weeks. Survival rates vary depending on location and the kinds of interventions a hospital is able to provide. In the United Kingdom, for example, among babies who are alive at birth and receiving care, 35% born at 22 weeks survive, 38% at 23 weeks, and 60% at 24 weeks.

For babies who survive, the earlier they are born, the higher the risk of complications or ongoing disability (see ‘The effects of being early’). There is a long list of potential problems — including asthma, anxiety, autism spectrum disorder, cerebral palsy, epilepsy and cognitive impairment — and about one-third of children born extremely prematurely have one condition on the list, says Mike O’Shea, a neonatologist at the University of North Carolina School of Medicine in Chapel Hill, who co-runs a study tracking children born between 2002 and 2004. In this cohort, another one-third have multiple disabilities, he says, and the rest have none.

“Preterm birth should be thought of as a chronic condition that requires long-term follow-up,” says Casey Crump, a family physician and epidemiologist at the Icahn School of Medicine at Mount Sinai in New York, who notes that when these babies become older children or adults, they don’t usually get special medical attention. “Doctors are not used to seeing them, but they increasingly will.”

Outlooks for earlies

What should doctors expect? For a report in the Journal of the American Medical Association last year, Crump and his colleagues scraped data from the Swedish birth registry. They looked at more than 2.5 million people born from 1973 to 1997, and checked their records for health issues up until the end of 2015.

Of the 5,391 people born extremely preterm, 78% had at least one condition that manifested in adolescence or early adulthood, such as a psychiatric disorder, compared with 37% of those born full-term. When the researchers looked at predictors of early mortality, such as heart disease, 68% of people born extremely prematurely had at least one such predictor, compared with 18% for full-term births — although these data include people born before surfactant and corticosteroid use were widespread, so it’s unclear if these data reflect outcomes for babies born today. Researchers have found similar trends in a UK cohort study of extremely premature births. In results published earlier this year, the EPICure study team, led by neonatologist Neil Marlow at University College London, found that 60% of 19-year-olds who were extremely premature were impaired in at least one neuropsychological area, often cognition.

Such disabilities can impact education as well as quality of life. Craig Garfield, a paediatrician at the Northwestern University Feinberg School of Medicine and the Lurie Children’s Hospital of Chicago, Illinois, addressed a basic question about the first formal year of schooling in the United States: “Is your kid ready for kindergarten, or not?”

To answer it, Garfield and his colleagues analysed standardized test scores and teacher assessments on children born in Florida between 1992 and 2002. Of those born at 23 or 24 weeks, 65% were considered ready to start kindergarten at the standard age, 5–6 years old, with the age adjusted to take into account their earlier birth. In comparison, 85.3% of children born full term were kindergarten-ready.

Despite their tricky start, by the time they reach adolescence, many people born prematurely have a positive outlook. In a 2006 paper, researchers studying individuals born weighing 1,000 grams or less compared these young adults’ perceptions of their own quality of life with those of peers of normal birth-weight — and, to their surprise, found that the scores were comparable. Conversely, a 2018 study8 found that children born at less than 28 weeks did report having a significantly lower quality of life. The children, who did not have major disabilities, scored themselves 6 points lower, out of 100, than a reference population.

As Marlow spent time with his participants and their families, his worries about severe neurological issues diminished. Even when such issues are present, they don’t greatly limit most children and young adults. “They want to know that they are going to live a long life, a happy life,” he says. Most are on track to do so. “The truth is, if you survive at 22 weeks, the majority of survivors do not have a severe, life-limiting disability.”

Breathless

But scientists have only just begun to follow people born extremely prematurely into adulthood and then middle age and beyond, where health issues may yet lurk. “I’d like scientists to focus on improving the long-term outcomes as much as the short-term outcomes,” says Tala Alsadik, a 16-year-old high-school student in Jeddah, Saudi Arabia.

When Alsadik’s mother was 25 weeks pregnant and her waters broke, doctors went so far as to hand funeral paperwork to the family before consenting to perform a caesarean section. As a newborn, Alsadik spent three months in the neonatal-intensive-care unit (NICU) with kidney failure, sepsis and respiratory distress.

The complications didn’t end when she went home. The consequences of her prematurity are on display every time she speaks, her voice high and breathy because the ventilator she was put on damaged her vocal cords. When she was 15, her navel unexpectedly began leaking yellow discharge, and she required surgery. It turned out to be caused by materials leftover from when she received nutrients through a navel tube.

That certainly wasn’t something her physicians knew to check for. In fact, doctors don’t often ask if an adolescent or adult patient was born prematurely — but doing so can be revealing.

Charlotte Bolton is a respiratory physician at the University of Nottingham, UK, where she specializes in patients with chronic obstructive pulmonary disease (COPD). People coming into her practice tend to be in their 40s or older, often current or former smokers. But in around 2008, she began to notice a new type of patient being referred to her owing to breathlessness and COPD-like symptoms: 20-something non-smokers.

Quizzing them, Bolton discovered that many had been born before 32 weeks. For more insight, she got in touch with Marlow, who had also become concerned about lung function as the EPICure participants aged. Alterations in lung function are a key predictor of cardiovascular disease, the leading cause of death around the world. Clinicians already knew that after extremely premature birth, the lungs often don’t grow to full size. Ventilators, high oxygen levels, inflammation and infection can further damage the immature lungs, leading to low lung function and long-term breathing problems, as Bolton, Marlow and their colleagues showed in a study of 11-year-olds.

VICS research backs up the cardiovascular concerns: researchers have observed diminished airflow in 8-year-olds, worsening as they aged, as well as high blood pressure in young adults. “We really haven’t found the reason yet,” says Cheong. “That opens up a whole new research area.”

At Sainte-Justine, researchers have also noticed that young adults who were born at 28 weeks or less are at nearly three times the usual risk of having high blood pressure. The researchers figured they would try medications to control it. But their patient advisory board members had other ideas — they wanted to try lifestyle interventions first.

The scientists were pessimistic as they began a pilot study of a 14-week exercise programme. They thought that the cardiovascular risk factors would be unchangeable. Preliminary results indicate that they were wrong; the young adults are improving with exercise.

Girard-Bock says the data motivate her to eat healthily and stay active. “I’ve been given the chance to stay alive,” she says. “I need to be careful.”

From the start

For babies born prematurely, the first weeks and months of life are still the most treacherous. Dozens of clinical trials are in progress for prematurity and associated complications, some testing different nutritional formulas or improving parental support, and others targeting specific issues that lead to disability later on: underdeveloped lungs, brain bleeds and altered eye development.

For instance, researchers hoping to protect babies’ lungs gave a growth factor called IGF-1 — which the fetus usually gets from its mother during the first two trimesters of pregnancy — to premature babies in a phase II clinical trial reported in 2016. Rates of a chronic lung condition that often affects premature babies halved, and babies were somewhat less likely to have a severe brain hemorrhage in their earliest months.

Another concern is visual impairment.

Retina development halts prematurely when babies born early begin breathing oxygen. Later it restarts, but preterm babies might then make too much of a growth factor called VEGF, causing over-proliferation of blood vessels in the eye, a disorder known as retinopathy. In a phase III trial announced in 2018, researchers successfully treated 80% of these retinopathy cases with a VEGF-blocking drug called ranibizumab, and in 2019 the drug was approved in the European Union for use in premature babies.

Some common drugs might also be of use: paracetamol (acetaminophen), for example, lowers levels of biomolecules called prostaglandins, and this seems to encourage a key fetal vein in the lungs to close, preventing fluid from entering the lungs.

But among the most promising treatment programmes, some neonatologists say, are social interventions to help families after they leave the hospital. For parents, it can be nerve-racking to go it alone after depending on a team of specialists for months, and lack of parental confidence has been linked to parental depression and difficulties with behaviour and social development in their growing children.

At Women & Infants Hospital of Rhode Island in Providence, Betty Vohr is director of the Neonatal Follow-Up Program. There, families are placed in private rooms, instead of sharing a large bay as happens in many NICUs. Once they are ready to leave, a programme called Transition Home Plus helps them to prepare and provides assistance such as regular check-ins by phone and in person in the first few days at home, and a 24/7 helpline. For mothers with postnatal depression, the hospital offers care from psychologists and specialist nurses.

The results have been significant, says Vohr. The single-family rooms resulted in higher milk production by mothers: 30% more at four weeks than for families in more open spaces. At 2 years old, children from the single-family rooms scored higher on cognitive and language tests. After Transition Home Plus began, babies discharged from the NICU had lower health-care costs and fewer hospital visits — issues that are of great concern for premature infants. Other NICUs are developing similar programmes, Vohr says.

With these types of novel intervention, and the long-term data that continue to pour out of studies, doctors can make better predictions than ever before about how extremely premature infants will fare. Although these individuals face complications, many will thrive.

Alsadik, for one, intends to be a success story. Despite her difficult start in life, she does well academically, and plans to become a neonatologist. “I, also, want to improve the long-term outcomes of premature birth for other people.”

Source:https://www.nature.com/articles/d41586-020-01517-z

 

Cloud Surfing Roldanillo, Colombia in a Paraglider

Jan 30, 2017 Jonathan Kelley

Cloud Surfing Roldanillo, Colombia in a paraglider in January 2017

beach

 

Climate Migrants, Microfluidic Systems, GoMo

B.1

BANGLADESH

Rate: 14% Rank 24 Global Average 11.1%

Bangladesh  is the eighth-most populous country in the world, with a population exceeding 161 million people. In terms of land mass, Bangladesh ranks 92nd, spanning 147,570 square kilometres (56,980 sq mi), making it one of the most densely-populated countries in the world. Bangladesh shares land borders with India to the west, north, and east, Myanmar to the southeast, and the Bay of Bengal to the south. It is narrowly separated from Nepal and Bhutan by India’s Siliguri Corridor, and from China by the Indian state of Sikkim, in the north, respectively. Dhaka, the capital and largest city, is the nation’s economic, political and cultural hub. Chittagong, the largest sea port, is the second largest city. With numerous criss-crossing rivers and inland waterways, the dominant geographic feature of Bangladesh is the Ganges delta, which empties into the Bay of Bengal with the combined waters of several river systems, including the Brahmaputra river and the Ganges riverHighlands, with evergreen forests, cover the northeastern and southeastern regions, while the country’s biodiversity comprises a vast array of plants and wildlife, including the endangered Royal Bengal tiger, which is the national animal. The seacoast features the world’s longest natural sandy beach in Cox’s Bazar as well as the Sundarbans, which is the world’s largest mangrove forest.

Healthcare facilities in Bangladesh are considered less than adequate, although they have improved as poverty levels have decreased significantly. Findings from a recent study in Chakaria (a rural Upazila under Cox’s Bazar District) revealed that the “village doctors”, practicing allopathic medicine without formal training, were reported to have provided 65% of the healthcare sought for illness episodes occurring within 14 days prior to the survey. Formally-trained providers made up only four percent of the total health workforce. The Future Health Systems survey indicated significant deficiencies in the treatment practices of village doctors, with widespread harmful and inappropriate drug prescribing. Receiving health care from informal providers is encouraged.

Malnutrition has been a persistent problem in Bangladesh, with the World Bank ranking the country first in the number of malnourished children worldwide. More than 54% of preschool-age children are stunted, 56% are underweight and more than 17% are wasted. More than 45 percent of rural families and 76 percent of urban families were below the acceptable caloric-intake level.

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

Born on Time: Fathers Clubs in Bangladesh

planPlanCanadaVideos   Jun 4, 2019

The Born on Time project educates communities on the risk factors of preterm birth. The risk of preterm birth can be decreased by addressing unhealthy lifestyle factors and harmful gender discriminatory behaviors such as: heavy workloads for mothers, domestic violence, and child, early and forced marriage. Born on Time Fathers Clubs encourage male engagement in birth preparedness, safe pregnancy and delivery, and in preterm birth prevention. See how Born On Time supported Abdur take part in a Fathers Club in Bangladesh, transforming local gender roles and teaching dads to put family first.

 

planets

COMMUNITY

Dhaka

One-fifth of babies born premature in Bangladesh

Published at 10:47 pm November 16th, 2019
Bangladesh has managed to curb the premature deaths in recent years, according to the United Nations (UN).

Although the deaths caused by communicable diseases have decreased over the past years, the death of premature babies is still a concern for the authorities.

Even a few years ago, Bangladesh was a country where communicable diseases were responsible for the death of many newborn babies. But with the recent awareness programs by different organizations, about how to take care of neonates, mortality rate of infants from communicable diseases have decreased noticeably.

When asked, DGHS officials said more than 3 million children are born every year in Bangladesh, and very few die of communicable diseases.

Though, death from premature birth now tops the list. Out of 3 million children born every year in Bangladesh some 0.6 million are born premature, and out of that 0.6 million premature births 20,000 infants die, said UN.

According to 2018 UN estimation, the newborn mortality rate in Bangladesh is 18 per 1000 infants.

Dr Shamim Jahan, director of Health, Nutrition & HIV/AIDS, Save the Children, said the number has decreased in comparison to 2016 as 23620 infants died due to premature birth that year.

Experts opinion

The UN estimation said that complications of premature birth is the cause for it to top the list of infant deaths.

Experts opined that this situation has not been addressed for a long time, resulting in such number of deaths in the country.

Though, experts themselves are still unaware of the real reason as to why premature birth tops the list for infant mortality.

Professor Dr Begum Sharifun Nahar, head of Neonatology department of Sir Salimullah Medical College and Mitford Hospital, said “A premature child do not live for long, as most of the time the infant’s vital organs are not completely developed, and they suffer from lung problems, which leads to breathing issues. In conjunction with low birth weight, feeding disorders and hypothermia causes the death of premature infants. But she added that many of these issues can be avoided if people are more aware of the procedure, and the baby is taken care of by proper doctors, and nurses who have good knowledge about premature birth related issues, she added.

bangladesh.checklist

A miracle touch keeps child breathing without stress

When Popy (25) became pregnant for the second time, her family became very cautious, as she went through a miscarriage two years back.

She was married at the age of 20 and when she first conceived at 22. In her second pregnancy she was supposed to give birth to twins.

But her joy turned into tears, as the low birth weight caused death to one of her children ten days after their birth on October 29, following their premature birth weight of only 1500 grams. The babies had breathing difficulties along with other health hazards.

Her child was given treatment at NICU of Mitford Hospital, and later given to her as part of KMC.

“You can’t explain the feelings of its breath, when it takes its food from you. It seems like the world started living on my chest,” Popy told the reporter.

Professor Dr Begum Sharifun Nahar said KMC, a method of contacting a skin–to–skin contact between a mother and her newborn facilitating frequent or exclusive breastfeeding, and early discharge from the hospital has been effective in reducing the risk of mortality among preterm, and low birth weight infants.

“KMC helps the children to be stress free, and easiest breast feeding process. We have witnessed that the child going through KMC treatment have good growth, more sleep, less infections, and control temperature lessening chances of hypothermia,” she said.

Dr Shamim Jahan director – Health, Nutrition & HIV/AIDS, Save the Children said:  “As part of their objectives to make Bangladesh controlling deaths from premature birth, Save the Children is providing assistance in capacity building, establishing a monitoring system, and by providing technical assistance to the government for effective implement of KMC.”

Government initiatives to end premature birth

Dr Shamim Jahan said Bangladesh is at the seventh position among the top 10 countries with the largest numbers of preterm births, and deaths.

In the course of changing paradigm of diseases that are causing neonatal deaths, without controlling premature deaths, achieving SDGs new global target to end preventable newborn, and child deaths by 2030 (SDG 3.2) would never be possible, he said, adding that the theme for World Prematurity Day 2019 has put forth our course of action rightly — ‘’Born Too Soon: Providing the right care, at the right time, in the right place.”

Recognizing premature birth and death as a matter of concern, Dr Shamsul Haque, line director of Mother Neonatal Care and Adolescent Health (MNC&AH) under Directorate General of Health Services (DGHS) said, under the fourth sectoral program DGHS has established some 42 Special Care Newborn Units (SCANU) in tertiary, and district level hospitals.

Besides, as part of keeping the child alive, government has taken KMC as a trusted way, and have already established 132 centres in tertiary, district, and upazila level government hospitals. Besides, the private hospitals have also been asked to use the method.

The government started the programme (January 2017-June 2022) with an aim to reduce the newborn mortality rate to under 12 per 1,000 live births by 2030.

Directorate General of Family Planning (DGFP) and Directorate General of Health Services (DGHS) under the Ministry of Health and Family Welfare are implementing the programme at a cost of around Tk 422 crore.

To meet the manpower problem, necessary training is being provided to pediatric specialists, and nurses in the hospitals, as many as they can. So that, wherever the doctors are transferred, they could continue the process.

“The government has planned to establish SCANU in every district, and all the upazila would have the facility of KMC treatment within 2022,” the line director stressing the need for creating awareness among rural people regarding premature births.

About KMC he said it is a very low cost treatment, and costs almost nothing. Besides, it takes only Tk 85,000 to set up a two bed unit.

The early result of KMC methods has made them hopeful of the fact that it would play a key role in preventing premature birth, and infant death in the country within the timeline they targeted, he added.

Source: https://www.dhakatribune.com/bangladesh/2019/11/16/one-fifth-of-babies-born-premature-in-bangladesh

unicef

Rohingya Refugee Children Are in Desperate Need of Help

Enter here arrow

https://www.unicefusa.org/mission/emergencies/child-refugees-and-migrants/rohingya-refugee-children-are-desperate-need-help

Perinatal health of refugee and asylum-seeking women in Sweden

2014–17: a register-based cohort study

Published:  04 July 2019   Can Liu, Mia Ahlberg, Anders Hjern, Olof Stephansson

European Journal of Public Health, Volume 29, Issue 6

Source: https://doi.org/10.1093/eurpub/ckz120

Abstract

Background

An increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country.

Methods

Using the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women.

Results

Compared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22).

Conclusion

Refugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.

Source: https://academic.oup.com/eurpub/article/29/6/1048/5528507

 

Taking care of premature babies with Kangaroo Mother Care

UNICEF Bangladesh   Sep 1, 2019

Learn how to take care of premature babies with Kangaroo Mother Care

 

people

INNOVATIONS

Successfully leveraging mobile technology to reduce preterm births

A maternal population risk study

Mary E. Cramer PhD, RN, FAAN – Elizabeth K. Mollard PhD, APRN‐NP – Amy L. Ford DNP, RN –  Kevin A. Kupzyk PhD, Fernando A. Wilson PhD

In Nebraska, nearly half of the counties on average – mostly rural – have a higher percentage of preterm births than the March of Dimes national average of 8.1%. Many of these rural counties are home to 30% or more soon-to-be mothers who receive inadequate prenatal care. Access to prevention and resources are rural barriers in Nebraska that contribute to preterm births.

Through a pilot study conducted under the direction of the University of Nebraska Medical Center (UNMC) and with funding from Blue Cross Blue Shield of Nebraska, we sought to positively impact these issues within Nebraska’s prenatal patient population. GoMo Health collaborated with Dr. Amy Ford and Dr. Mary Cramer from UNMC to develop a program with specialized content to help reduce preterm births.

Abstract

Objectives: (1) Assess feasibility of a smartphone platform intervention combined with Community Health Worker (CHW) reinforcement in rural pregnant women; (2) Obtain data on the promise of the intervention on birth outcomes, patient activation, and medical care adherence; and (3) Explore financial implications of the intervention using return on investment (ROI).

Sample: A total of 98 rural pregnant women were enrolled and assigned to intervention or control groups in this two‐group experimental design.

Intervention: The intervention group received usual prenatal care plus a smartphone preloaded with a tailored prenatal platform with automated texting, chat function, and hyperlinks and weekly contact from the CHW. The control group received usual prenatal care and printed educational materials.

Measurements: Demographics, health risk data, interaction with platform, medical records, hospital billing charges, Client Satisfaction Questionnaire‐8, satisfaction comments, and the Patient Activation Measure.

Results: A total of 77 women completed the study. The intervention was well‐received, showed promise for improving birth outcomes, patient activation, and medical care adherence. Financial analysis showed a positive ROI under two scenarios.

Conclusions: Despite several practical issues, the study appears feasible. The intervention shows promise for extending prenatal care and improving birth outcomes in rural communities. Further research is needed with a larger and more at‐risk population to appreciate the impact of the intervention.

Source: https://gomohealth.com/resource/unmc/

HOPE

New preclinical study shows promise for treating necrotizing enterocolitis

Reviewed by James Ives, M.Psych. (Editor)May 6 2020

Necrotizing enterocolitis (NEC), a rare inflammatory bowel disease, primarily affects premature infants and is a leading cause of death in the smallest and sickest of these patients. The exact cause remains unclear, and there is no effective treatment.

No test can definitively diagnose the devastating condition early, so infants with suspected NEC are carefully monitored and administered supportive care, such as IV fluids and nutrition, and antibiotics to fight infection caused by bacteria invading the gut wall. Surgery must be done to excise damaged intestinal tissue if the condition worsens.

A new preclinical study by researchers at the University of South Florida Health (USF Health) Morsani College of Medicine and Johns Hopkins University School of Medicine offers promise of a specific treatment for NEC, one of the most challenging diseases confronting neonatologists and pediatric surgeons.

The team found that inhibiting the inflammatory and blood-clotting molecule thrombin with targeted nanotherapy can protect against NEC-like injury in newborn mice.

Their findings were reported May 4 in the Proceedings of the National Academy of Sciences.

Our data identified the inflammatory molecule thrombin, which plays a critical role in platelet-activated blood clotting, as a potential new therapeutic target for NEC. We showed that anti-thrombin nanoparticles can find, capture and inactivate all the active thrombin in the gut, thereby preventing or reducing the small blood vessel damage and clotting that accelerates NEC.”

Samuel Wickline, MD, Study Co-Author and Professor of Cardiovascular Sciences, Morsani College of Medicine. Dr Wickline is also the director of the USF Health Heart Institute.

PNAS paper’s senior author is Akhil Maheshwari, MD, professor of pediatrics and director of neonatology at the Johns Hopkins University School of Medicine.

Before joining Johns Hopkins Medicine (Baltimore) in 2018, Dr. Maheshwari’s group at USF Health was the first to demonstrate that platelet activation is an early, critical event in causing NEC, and therapeutic measures to block these platelets might be a new way to prevent or reduce intestinal injury in NEC.

The nanotherapy platform created by Dr. Wickline and USF Health biomedical engineer Hua Pan, PhD, delivers high drug concentrations that specifically inhibit thrombin from forming blood clots on the intestinal blood vessel wall without suppressing the (clotting) activity needed to prevent bleeding elsewhere in the body.

This localized treatment is particularly important for premature infants, Dr. Wickline said, because the underdeveloped blood vessels in their brains and other vital organs are still fragile and susceptible to rupture and bleeding.

For this study the researchers used a model they created — infant mice, or pups, induced to develop digestive tract damage resembling human NEC, including the thrombocytopenia commonly experienced by premature infants with NEC.

Thrombocytopenia is characterized by low counts of blood cell fragments known as platelets, or thrombocytes, which normally stop bleeding from a cut or wound by clumping together to plug breaks injured blood vessels.

The molecule thrombin plays a key role in the bowel inflammation driven by overactive platelets. While investigating role of platelet depletion in NEC-related thrombocytopenia, the USF-Johns Hopkins researchers were surprised to find that thrombin mediates platelet-activated blood clotting early in the pathology of NEC-like injury – before bacteria leaks from inside the gut to circulating blood or other organs.

This clotting clogs small blood vessels and restricts blood flow to the inflamed bowel. Eventually, the lining of the damaged intestinal wall can begin to die off.

The investigative therapy essentially works “like a thrombin sponge” that is exponentially more potent than current agents used to inhibit clotting, Dr. Wickline explained. “It literally puts trillions of nanoparticles at that damaged (intestinal wall) site to sponge up all the overactive thrombin, which tones down the clotting and inflammation processes promoted by thrombin.”

“We are so excited about finding this new way to attenuate intestinal injury in NEC,” Dr. Maheshwari said.

The same approach has also been shown in preclinical studies to inhibit the growth of atherosclerotic plaques and certain kidney injuries without causing systemic bleeding problems. Dr. Wickline added. “The nanoparticles can be tailored to other inflammatory diseases highly dependent on thrombin for their progression.”

The study authors conclude that their experimental targeted treatment for NEC merits further evaluation in clinical trials.

Source: University of South Florida (USF Health)

Journal reference: Namachivayam, K., et al. (2020) Targeted inhibition of thrombin attenuates murine neonatal necrotizing enterocolitis. Proceedings of National Academy of Sciences.

Source: doi.org/10.1073/pnas.1912357117.

earth

Climate change is causing an increase in preterm births: Study

first.post

Myupchar Dec 12, 2019

With the change in climate, the emergence of vector-borne diseases (insects-bearing diseases) like dengue and chikungunya, has spiked. This is subsequently leading to more than 7 lakh deaths annually.

That’s just the beginning though. The increase in temperature directly affects health by compromising the body’s ability to regulate its internal temperature. With the inability to control the internal temperature of the body, we become more prone to a cascade of illnesses like heat cramps, heat exhaustion, heatstroke, and hyperthermia during extreme heat and hypothermia and frostbite in extremely cold temperatures.

And now we find that climate change is having an insidious effect on pregnant women.

Studies have claimed that, with the rise in temperature, the cases of preterm delivery have increased. Any birth that occurs at least three weeks before the due date is considered by doctors to be a premature delivery. Some of the complications that this could lead to are slow weight gain, immature lungs, poor feeding, etc.

Heat and preterm labour

Long span research was conducted by Alan Barreca, an associate professor at UCLA’s Institute of Environmental Sustainability, and economist Jessamyn Schaller of Claremont McKenna College in a two-decade window, i.e., from 1969 to 1988, to find out the link between the change in temperature and preterm deliveries.

The researchers found that when the temperature exceeded or reached 32.2ºC (90ºF), the premature birth rate per 100,000 women increased by 0.97. It was also noted that on days when the temperature was hot but not extreme, the premature births increased by 0.57.

They further concluded that with an increase in temperature, the gestation period was decreased by two weeks. The gestation period is the time period of 40 weeks that it takes for fetal development, starting right from the conception till the day before the delivery.

Across the entire 20-year period of the study, around 25,000 infants were born prematurely every year, leading to the loss of more than 150,000 gestational days, all because of exposure to an exceptionally hot environment.

Another long span study was conducted by scientists led by Dr Lyndsay A. Avalos in Northern California for a time window of 14 years, i.e., between January 1, 1995, to December 31, 2009, to investigate the impact of apparent temperature on spontaneous preterm delivery.

Dr Lyndsay concluded the research by stating that with the increase in temperature by 10 °F (5.6 °C) during warm seasons, the cases of spontaneous preterm delivery increased by 11.6%.

All the preterm deliveries in this study took place between 28 and 37 weeks of gestational period, instead of 40.

The uncertain reason

Scientists have not been able to find the exact cause, but have laid down some possible reasons that could lead to premature labour:

  • Scientists believe that due to the increased heat, the mother could have cardiovascular stress that in turn could trigger the body to go into labour early.
  • The second theory proposed by the scientists is that the high temperatures could trigger an increase in the levels of the hormone oxytocin, which plays a role in inducing labour.
  • The third theory stated that because of the hot temperature the mother might unable to sleep properly. This could increase the chances of preterm labour and preeclampsia (complication in pregnancy marked with high BP) in the mother.

The alarming situation

It’s time to realize that climate change is real. And not only is it adversely affecting the environment but it has serious health implications as well, especially for the coming generation.

For more information, please read our article on Preterm Labour.

Source: https://www.firstpost.com/health/climate-change-is-causing-an-increase-in-preterm-births-study-7773851.html

flowers

Microfluidic Systems for Sweat Analysis and Neonatal Care

newsApr 24, 2020: In this interview, Professor John Rogers talks to News-Medical Life Sciences about his research and work in developing biocompatible electronics and microfluidic systems with skin-like properties.

Biological systems are traditionally mechanically soft however modern electronic and microfluidic technologies are rigid, meaning the layouts are completely different. Eliminating this mismatch will create huge opportunities in man-made systems that can be used for diagnostics, therapeutics and in clinical and healthcare. Can you tell us about the new opportunities these man-made systems will create?

There are all kinds of interesting and compelling opportunities that could come from thinking about how to reformulate the kinds of systems that form the core foundations of devices that you see in consumer gadgetry, so computer chips, integrated circuit chips that are flat and rigid and planar, into forms that are more naturally biocompatible – compatible with the soft surfaces of the human body.  And integrated circuits are not the only kind of man-made technology that has those kinds of physical characteristics and geometrical shapes.

You see the same type of thing in optoelectronic devices, lab-on-a-chip type technologies and microelectromechanical systems. The goal behind our research, and that of a growing community of researchers, is to create new ideas in material science and manufacturing, mechanical engineering and electrical engineering that will allow us to reformulate those sorts of technologies, without sacrificing the performance or capabilities, into platforms with geometries and mechanical properties that are inherently biocompatible and can be interfaced with soft tissue systems — the skin, the brain, the heart, the peripheral nervous system, the bladder, and the kidneys. And the idea is to develop those technologies into system that can ultimately enhance human health and extend life.

Can you tell us more about these ‘biocompatible’ electronic and microfluidic systems with skin-like physical properties?

The skin-like devices that we have developed are specifically designed to interface with the skin and to use the skin as a window for measuring clinical-grade physiological status parameters associated natural processes of the human body. For example, looking at cardiac activity, respiratory activity, flow properties associated with blood through near-surface arteries and veins; to reproduce what’s done in the hospital, but in platforms that can be worn continuously for wireless streaming of data outside of the hospital in the home setting, to develop a deep foundational basis of information on health status. This information can be used with artificial intelligence algorithms to assess a person’s well-being at any given moment and to make predictive assessments of health trajectories over time. This kind of personalized, digitally oriented model for healthcare enabled by these kinds of skin-like platforms will be a very powerful way that healthcare will evolve into the future for reduced costs and improved outcomes.

You presented the Wallace. H. Coulter Lecture this year at Pittcon 2020 in Chicago. What did you discuss in your talk?

In this talk, I will focus on skin-interfaced systems, devices that provide not only this electronic monitoring functionality but those that also embed tiny networks of microchannels. The microchannels along with very small reservoirs and valves that are designed to capture sweat that is pumped to the surface of the skin through the Eccrine glands and the connective ducts for capture and analysis of biomarkers in sweat.

Sweat is a relatively under-explored but very potentially important class of bio-fluid that could provide information content to substitute for blood draws. The idea is to use sweat and the noninvasive ability to collect sweat to do biochemical based assessments of health status to complement the sort of physics-based measurements that we can achieve with our electronic devices.

What sparked your interest in ‘soft’ materials?

My core expertise is in electronic materials, and I like to think about novel electronic materials in the context of technologies with capabilities that go beyond what is currently supported with conventional sorts of electronic materials. We got our start in this area thinking about flexible displays, so paper-like displays that could replace the kind of liquid crystal and organic light-emitting diode displays that you see in consumer devices today. So, thinking about thin paper-like systems, lightweight, mechanically rugged, capable of rolling up in storage when they’re not being used. And so that was interesting for us for a while, and it remains a major focus at most large display companies.

I happened to be giving a talk at the University of Pennsylvania on that kind of technology. It turned out that a couple of curious neuroscientists were in the audience and they came up to me after the talk and asked whether we could take those kinds of flexible electronic devices and put them on the brain to study the electrical activity of the brain. That was the first suggestion that these kinds of devices could be brought to bear to important problems in human health and in research around the fundamental mechanisms that govern the behavior of living systems. That interaction catalyzed a whole new set of research opportunities for us and it has been a sustained area of activity now in the group for the last 10 years.

What extra levels of functionality do soft electronics provide? How were they discovered?

Soft electronics allow you to intimately and persistently integrate advanced biosensors, radios, stimulators, microprocessors and digital memory technologies with the human body, in ways that go far beyond what’s possible with conventional wearable technologies that you see on the market today. Commercial devices are dominated by bulky, clunky pieces of electronics, loosely strapped to the body, typically at the wrist. That kind of technology approach can allow you to measure certain parameters, qualitative assessments of health and wellbeing, you can count steps, you can get a rough estimate of heart rate, but those are parameters that physicians can’t readily interpret and act upon.

What we’re thinking about is the next generation of wearable technology that integrates more intimately with the body, almost serving as a second skin that laminates in a physically imperceptible way on the surface of your actual skin. Almost like a temporary tattoo or a bandaid to provide ICU grade measurements of health status to allow physicians to, at a very detailed level, track health progression over time, not in an episodic way, which is currently the way that measurements are made when a patient comes to a hospital or a clinic. But now thinking about those same types of measurements performed continuously and I feel that it’s going to open up new frontiers to think about how to manage health conditions and to promote healthy living as well.

What ‘skin-like’ physical properties do biocompatible electronic and microfluidic systems have?

We target a set of physical properties that are precisely matched to the skin itself. The skin stretches somewhat, it can flex and bend and wrinkle, it has certain thermal characteristics, it has a whole set of properties, water permeability characteristics as well, thermal. And we try to embody those exact skin-like properties into electronic devices. And that’s the trick and the centroid of the research that we’ve been doing over the last decade or so. You think about a silicon-based integrated circuit, the mechanical properties are a million times different than those of the skin. So, there’s a huge chasm and a gap there. It’s perfectly flat, it really can’t conform to a natural curvature and the sort of sub-millimeter scale texture associated with the skin. So we try, to the best of our ability, to take a collection of materials and build them into an electronic system that has the same type of functionality you achieve with a silicon-based electronic platform today, but with mechanical properties, geometrical features that precisely match those of the skin.

The goal is to develop almost like a second skin that interfaces directly and naturally with your natural skin so you can wear these devices for long periods of time without even realizing they’re there because they’re matched to the skin. You don’t have a physical sensation that they’re there. And we think that that’s not just a convenience, that’s an essential characteristic of the devices because if they can’t be worn in a comfortable way that doesn’t introduce irritation at the surface of the skin, then nobody will wear the devices. The patient compliance will be unacceptably low.

That’s the goal around engineering and it turns out that with a few relatively simple ideas, we can get very close. The thickness of these devices is thinner than the epidermis, the mechanical properties almost precisely matched, the overall thermal mass is almost the same, there’s no thermal load as a result.

Could you name some of the main advantages of using soft, skin-like electronics over using conventional hospital apparatus?

What’s used in hospitals today, are primarily biosensors that are attached to the surface of the skin just with adhesive tapes. They connect via hard wires to external boxes of electronics that do all the data acquisition and storage and processing. And that works fairly well for an adult patient who’s in a hospital bed and not moving around a lot.

The wires, however, even in that kind of scenario, create a pretty serious inconvenience and in many cases, they frustrate basic operations in clinical care, surgical operations are confounded by the presence of the wires.

The idea is to go to a platform that gets rid of the wires, so it’s wireless. And the forces that are inevitably imparted through the wires to the interface between the biosensors and the skin also go away, we can get away with an adhesive that has an adhesive strength to the skin that’s a factor of 10 or a hundred times lower than that which is required for the wired based devices. And the consequence of that is that you end up with a much more comfortable interface to the skin and one that is much less prone to create skin irritation.

In the context of almost all sorts of hospital practice in terms of monitoring, these kinds of skin-like or band-aid-like devices represent an important advantage, but if you take a look at probably the most extreme scenario where those wires are problematic, it’s what you encounter in the neonatal intensive care unit.

If you consider what’s done with premature babies, they have to be monitored for all vital signs, at clinical grade quality 24/7, because they’re in a very fragile health status, but their skin is also very fragile. They don’t accommodate these strong adhesive tapes very effectively. The wires are not just a nuisance, now they frustrate the natural motions of the baby. They frustrate the ability of the parents to interact with the baby as well because you have to manage the wires.

A lot of the work that we’ve done so far is focused on that use case as the most compelling opportunity for these kinds of technologies. We’ve done a lot of work in the NICU facility at Lurie Children’s Hospital in Chicago. We tested out the devices on about a hundred neonates who’ve come through the hospital and we’ve shown equivalency in the measurements made with our wireless skin-like devices to those determined with the conventional wired based devices and external boxes of electronics.

In fact, those platforms are now deployed at scale in Africa through funding from the Gates Foundation and the Save The Children Foundation, because in the developing world there are no monitoring capabilities at all. The idea is to kind of leapfrog the old-style wired based devices, go straight to wireless and provide improved capabilities in healthcare in that context of neonatal, pediatric, maternal and fetal health.

Another application of biocompatible electronic systems is in sport and fitness research. Why is sweat an important bodily fluid to be looked at?

Sweat, in the context of athletics, athletic performance, fitness, and general well-being is sort of low hanging fruit in terms of how to think about sweat as a biofluid, that can characterize health because it’s very clear that sweat loss can lead to dehydration.

In fact, maintaining optimal sports performance requires optimal hydration management. If you go into a training scenario or you enter an athletic competition, you want to keep your body at an optimally hydrated state. So, the ability of these skin interfaced microfluidic devices to continuously monitor sweat loss locally — and that local measurement correlates to full body sweat loss — can inform an athlete precisely how much water they need to drink in order to replenish the lost water through the sweating process.

But not only that, we can also measure the electrolyte concentration in sweat – a quantity that varies depending on the individual, their genetic background, their racial background, their dietary habits, all sorts of things. So the devices measure not only sweat loss but electrolyte loss as well. In this way, they allow you to replenish not only the lost water but also the lost electrolytes so you can maintain not only perfect hydration, but you can also maintain perfect electrolyte balance as well.

For competition at the highest levels, a few percentage improvements that can result from that data-driven hydration management can be very important. We have a partnership with Gatorade, and as you might imagine that kind of capability is touching on their core product, to distribute these devices to athletes, both pro athletes and youth athletes as well, to maintain better performance and also to avoid things like cramping and injuries that can also result from poor hydration management.

Nanotechnology has become an increasingly investigated area within the science industry, also having many applications within medicine. How does nanotechnology take part in your research?

Nanotechnology is important for us, but it’s not necessarily the end goal. We’ll use nanotechnology where it makes sense. We’re focused at the system level and how you can achieve novelty in devices and construction can yield data streams that are a direct benefit for health or fitness or sports.

But nanotechnology specifically does come into play, in a pretty simple way if you think about it. A silicon wafer has a certain set of mechanical properties that are defined by the silicon itself, but also by the geometry of the wafer. It’s fairly thick, it’s about a millimeter in thickness, half a millimeter in thickness or so and it’s partly because of that thickness that the silicon wafer cannot be bent without fracturing the material. Nanotechnology comes into play then because reducing the thickness of the silicon imparts a flexibility to the silicon just due to elementary bending mechanics. So a 2 x 4 you can’t bend that. You can bend a sheet of paper. It’s the same materials just by virtue of the fact that the paper’s really thin compared to the 2 x 4 that you can bend it.

The same principles apply to silicon. We deploy silicon in nano-scale forms rather than in wafer-based forms. If you take the thickness of a wafer, half a millimeter, and you shrink that down to a hundred nanometers, the flexibility improves by a factor of 1012 or something like that. It’s absolutely transformative in terms of the way you think about the material. That’s how nanotechnology enters the systems that we’re interested in, it allows us a straightforward route to make a material like silicon flexible and skin-compatible ultimately.

If this continued research is carried out into the field of biocompatible electronic and microfluidic systems, where could this take us?

The skin interfaced devices represent the most immediate opportunity because they’re minimally invasive. It’s very easy to get approvals for using these devices on human patients. They can easily be removed if any kind of adverse effect develops, although we haven’t seen that. It’s a straightforward and natural starting point for bio-integrated electronics, as the skin as an interface, at least for use in humans. We do a lot, however, with implantable systems, primarily in animal model studies as a predicate to eventually moving into use in humans.

The frontier for us is in taking the design principles that we’ve proven out for skin interface devices and deploying the same technology on the brain or the heart to allow similar types of functionality but in the context of internal organs. Electronically enhanced organ health is the way you can think about it. So devices that wrap the outside surface of the heart have the ability to monitor basic cardiac function, but also with the capability to deliver stimulus, therapeutic stimulus, as an advanced type of pacemaker, but one that’s distributed around the outside surface of the heart. The same types of possibilities are present in the context of brain disorders as well. So I think moving these devices from the skin to internal organs in the body is a huge area of opportunity.

What is next in your research into soft, skin-like electronics?

Exploring more deeply the value and information content embedded in sweat. Sweat has not been nearly as thoroughly explored as blood or interstitial fluid as a biofluid that contains biomarkers of relevance to health status.

There’s some work to be done there, but the area is opening up because now we have microfluidic devices that allow us to capture very small, but pristine quantities of sweat that can be used for very precise chemical analysis and correlation ultimately to blood.

It’s a technology-enabled opportunity in studies of human physiology and basic biological questions around how sweat relates to blood. And if you can establish those correlations, then I think sweat becomes a compelling way to make a biochemical assessment of health that avoids the need to do a blood draw.

Can you tell us why you come to Pittcon?

There is an amazing collection of people who are interested in topics very similar to those that represent core activities in my own research group. There is a huge synergy and resonance between my interests and the topics that are covered at Pittcon. It’s also comprehensive. It’s a very large meeting with all the key experts and so it’s kind of a one-stop shop for work in this area. I think it’s a fantastic event and I’ve been to this meeting many times in the past.

What do you expect to achieve this year at Pittcon?

I’ll be delivering this special lecture at Pittcon and I expect, as occurs many times, that I’ll be able to strike up some conversations and seed some areas for collaboration. Conferences for me are successful if I make new connections and meet new people and maybe open up new opportunities for research.

Why are events like Pittcon important for your research but also important for the analytical chemistry industry?

The exchange of ideas is incredibly important as a catalyzing aspect of how science works. It’s very important to share insights and ideas. A conference of this type provides an excellent platform for doing that, and so I think it helps everyone. It helps the whole community and helps society in a sense because it just accelerates progress in research.

Source: https://www.news-medical.net/news/20200424/Microfluidic-Systems-for-Sweat-Analysis-and-Neonatal-Care.aspx

people.b

PREEMIE FAMILY PARTNERS

bama

Cuddler to the Rescue! Meet NYP’s “Grandma Cuddler”

nypNew York-Presbyterian Hospital Published on Apr 20, 2018                                      Visit https://healthmatters.nyp.org for more about ‘Grandma Cuddler’ and other inspiring stories.

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Preterm Birth a Key Risk Factor for Development of Childhood Depression

psyc.Publish Date October 4, 2018 The study investigators observed that low level of urbanization was associated with a lower risk for depression.

Children born preterm may have an increased risk for depression compared with children born full-term, according to study results published in the Journal of Affective Disorders.

Researchers analyzed data from 21,478 preterm children and 85,903 full-term children born between 2000 and 2010 who were included in the Taiwan National Health Insurance Research Database. The mean ages of the preterm children and full-term children were 9.72 and 9.88 years, respectively.

Evaluation of the study population found that preterm birth was the key risk factor for depression.

The risk of depression among preterm children was 2.75 times higher than that seen in full-term children (95% CI, 1.58–4.79; P <.001). Depression rates in full-term children were 0.37, compared with 1.01 in preterm children, per 10,000 person-years. In female preterm children, incidence of depression was 3 times higher compared with full-term children. Preterm children whose parents had blue-collar occupations had a risk for depression 3.4 times higher than full-term children in the same demographic. Preterm children whose parents had occupations other than blue-collar positions had a 6.06-fold higher risk for depression compared with full-term children in the same demographic (blue-collar occupations: 95% CI, 1.04–11.15; P <.05; other occupations: 95% CI, 1.71–

Researchers conclude that “findings of the present study suggest that preterm infants have a significantly higher risk of depression in adolescence compared with full-term infants.” They note that limitations of the study include lack of maternal demographic data and emphasize the need for healthcare providers to recognize the potential for depression in children born prematurely.

Reference

Chiu TF, Yu TM, Chuang YW. Sequential risk of depression in children born prematurely: A nationwide population-based analysis J Affect Disord. 2018; 243:42-47. doi: 10.1016/j.jad.2018.09.019

Source: https://www.psychiatryadvisor.com/home/depression-advisor/preterm-birth-a-key-risk-factor-for-development-of-childhood-depression/

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Mayo Clinic Minute: 5 signs your teenager is battling depression

mayo.clinicMay 8, 2018: It’s no secret that teenagers can be moody, but research shows that ongoing moodiness often is far more serious. Dr. Janna Gewirtz O’Brien, a Mayo Clinic pediatrician, says teen depression is much more common than most people realize.

RESOURCES For Our GRIEVING FAMILY PARTNERS:

GAPPS seeks to improve birth outcomes worldwide by reducing the burden of premature birth and stillbirths. We are working to close the knowledge gap in understanding the causes of preterm birth and stillbirth and collaborating to implement evidence based interventions to improve birth outcomes.

Parent Support

Below are some additional links to organizations with information that may be useful for those caring for preterm newborns or dealing with the loss of a baby

First Candle

First Candle is one of the nation’s leading nonprofit organizations dedicated to safe pregnancies and the survival of babies through the first years of life. Their current priority is to eliminate stillbirth, Sudden Infant Death Syndrome and other Sudden Unexpected Infant Deaths through research, education, and advocacy programs.

Source: https://firstcandle.org/

International Stillbirth Alliance

The International Stillbirth Alliance is a nonprofit coalition of organizations dedicated to understanding the causes of and working on the prevention of stillbirth. Their mission is to raise stillbirth awareness, promote global collaboration in the prevention of stillbirth, and to provide appropriate care for parents who have lost a baby to stillbirth.

Source: https://www.stillbirthalliance.org/

SANDS: Stillbirth & Neonatal Death Society (UK)

SANDS supports anyone affected by the death of a baby, works in partnership with health professionals to improve the quality of care and services offered to bereaved families, and promotes research and changes in practice that could help to reduce the loss of babies’ lives.

Source: https://www.sands.org.uk/

The Tears Foundation

The TEARS Foundation is a non-profit organization that seeks to compassionately assist bereaved parents with the financial expenses they face in making final arrangements for their baby who has died.

Source: https://thetearsfoundation.org/

March of Dimes

March of Dimes helps moms have full-term pregnancies and focuses on researching problems that threaten babies’ health.

Source: https://www.marchofdimes.org/

Hayden’s Helping Hands

Hayden’s Helping Hands is a non-profit foundation that assists Oregon and Washington families after the birth of a stillborn baby by paying for a portion or all of their hospital delivery medical expenses.

*** With our record-breaking success from very generous donors, we will continue to accept applications for financial assistance to ALL states within the United States.

Source: https://www.haydenshelpinghands.com/

peeps

HEALTH CARE PARTNERS

*** We heartthis infographic!

kid Illustrative Neonatology 

Praveen Chandrasekharan : An infographic application, this provides easy to understand illustrations on some of the common and rare pathophysiology in neonatal perinatal medicine. It is designed and made available for download at no cost in handheld devices to be used as a ready reckoner for all.

Download APP Here: https://apps.apple.com/us/app/illustrative-neonatology/id1220324936

music

Attenuated brain responses to speech sounds in moderate preterm infants at term age.

Dev Sci. 2020 May 16     François C1, Rodriguez-Fornells A2,3,4, Teixidó M3, Agut T5,6, Bosch L3,6,7.

Abstract: Recent findings have revealed that very preterm neonates already show the typical brain responses to place of articulation changes in stop consonants, but data on their sensitivity to other types of phonetic changes remains scarce. Here, we examined the impact of 7-8 weeks of extra-uterine life on the automatic processing of syllables in 20 healthy moderate preterm infants (mean gestational age at birth 33 weeks) matched in maturational age with 20 full-term neonates, thus differing in their previous auditory experience. This design allows elucidating the contribution of extra-uterine auditory experience in the immature brain on the encoding of linguistically relevant speech features. Specifically, we collected brain responses to natural CV syllables differing in three dimensions using a multi-feature mismatch paradigm, with the syllable /ba/ as the standard and three deviants: a pitch change, a vowel change to /bo/, and a consonant Voice Onset Time (VOT) change to /pa/. No significant between-group differences were found for pitch and consonant VOT deviants. However, moderate preterm infants showed attenuated responses to vowel deviants compared to full-terms. These results suggest that moderate preterm infants’ limited experience with low-pass filtered speech prenatally can hinder vowel change detection and that exposure to natural speech after birth does not seem to contribute to improve this capacity. These data are in line with recent evidence suggesting a sequential development of a hierarchical functional architecture of speech processing that is highly sensitive to early auditory experience.

Source: https://pubmed.ncbi.nlm.nih.gov/32416634/

heart

Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults

Kara N. Goss, MD1,2Kristin Haraldsdottir, PhD1,3Arij G. Beshish, PhD1; et alGregory P. Barton, PhD1,4Andrew M. Watson, MD5Mari Palta, PhD6,7Naomi C. Chesler, PhD1,6,7,8Chris J. Francois, MD8,9Oliver Wieben, PhD4,8,9Marlowe W. Eldridge, MD1,3,8

JAMA Cardiol. Published online May 20, 2020. doi:10.1001/jamacardio.2020.1511

Key Points

Question  What are the consequences of premature birth for later cardiac structure and function?

Findings  In this cardiac magnetic resonance imaging–based cross-sectional cohort study, adolescents (n = 20) and young adults (n = 38) born moderately to extremely preterm (≤32 weeks) demonstrated statistically significantly smaller biventricular cardiac chamber size and lower biventricular mass compared with 52 age-matched participants who were born at term. Cardiac function was preserved, with a hypercontractile strain pattern in adults.

Meaning  Adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size with preserved function, notably without a hypertrophic response, which may contribute to their increased lifetime cardiovascular risk.

Abstract

Importance  Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood.

Objective  To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI).

Design, Setting, and Participants  This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019.

Exposures  Premature birth (gestational age ≤32 weeks) or birth weight less than 1500 g.

Main Outcomes and Measures  Main study outcomes included MRI measures of biventricular volume, mass, and strain.

Results  Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P < .001), and the mean (SD) left ventricular end-systolic volume index was 30 (4) vs 34 (6) and 32 (7) vs 38 (8) mL/m2, respectively (P < .001). Stroke volume index was also reduced in adolescent vs adult participants in the preterm group vs age-matched participants in the term group, with a mean (SD) of 42 (7) vs 46 (7) and 48 (7) vs 54 (9) mL/m2, respectively (P < .001), although biventricular ejection fractions were preserved. Biventricular mass was statistically significantly lower in adolescents and adults born preterm: the mean (SD) left ventricular mass index was 39.6 (5.9) vs 44.4 (7.5) and 40.7 (7.3) vs 49.8 (14.0), respectively (P < .001). Cardiac strain analyses demonstrated a hypercontractile heart, primarily in the right ventricle, in adults born prematurely.

Conclusions and Relevance  In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.

Source: https://jamanetwork.com/journals/jamacardiology/article-abstract/2766286

nurse

Our Feelings are Valid, Too: How Emotional Labor Affects the NICU Nurse

By Victoria Lemme, BSN RN

NANN Footprints: Stories from the NICU April 2020

To many, I have the best job in the world. I see babies take their first breaths, first baths, first bottles; but I also see the lasts for some. I am a Neonatal Intensive Care Unit nurse and yes, I have the best and worst job all wrapped up into one. I may appear put together on the outside, but on the inside, there are emotions begging to be recognized because my feelings are valid, too.

When I chose to become a nurse, I knew that I would have to contend with extenuating circumstances that often led to death. What I did not know but have come to realize is that behind the calm and collected persona of a nurse is someone who has feelings, too. Although the physical labor of working with infants is significantly less than that of working with adults, the emotional labor of building unforgettable relationships with families and babies, regardless of whether I’ve met them for a moment or had the opportunity to spend months with them, is everlasting.

Emotional labor has been defined as “the labor that requires one to induce or suppress feeling in order to sustain the outward countenance that produces the proper state of mind in others- in this case the sense of being cared for in a convivial and safe place” (Cricco-Lizza, 2014). For those unfamiliar with the NICU environment, I encourage you to look up what the typical bedside of a neonate looks like. From ventilators and IV poles to alarming monitors, the NICU is anything but calming to new parents. This is where we as nurses come into play. We are the calm in the storm, or so we think we must be.

I vividly remember the night I lost my first patient. I walked into the unit at the start of my shift expecting my usual assignment to see that I was assigned to one baby. I walked over to the bedside to see two parents staring in at their little girl while her day nurse stared at her monitor as the baby’s oxygen saturations were in the 60s. My immediate thought was, “Why is nobody doing anything?” As I received report, I came to realize that there was not much more humanly possible to do to help this tiny girl. I felt broken for this family knowing that they would not be able to take their baby girl home but despite my feelings, I had to be the calm in the storm for them.

Right before the shift was over, I handed the precious baby girl to her mother as support was withdrawn. I fought back my tears in front of the family because I felt selfish making this moment about my emotions. When the day nurse arrived, we walked the family to a private room to spend their lasts moments with their baby. As the door shut, I began to break down.

There are still days that I believe that I am not entitled to my feelings. I’ve been asked “Are you sure this is the right job for you?” and for a moment I actually question it. I stumbled upon the article, “The Need to Nurse the Nurse: Emotional Labor in the Neonatal Intensive Care” by Roberta Cricco- Lizza and for once I felt my emotions were validated. It’s okay to be sad and angry. It’s okay not to bottle those feelings up. The emotional burden of working in the NICU is one that can no longer be ignored.

Here are a handful of quotes from fellow nurses, from the article and in my workplace, that resonated with me:

“We are always on stage in the unit…the nurse had to expend considerable emotional labor to maintain a ‘happy face’ persona, but they believed that this helped the families feel safe and calm.” (Cricco-Lizza, 2014)

“There are days your heartstrings are pulled to the point of breaking. Tears flow for babies and moms and families who don’t get a chance to feel the love a child can help grow. Sometimes I feel angry, too, for an innocent baby who wasn’t given a fair chance at life.” (M. Ouellette, 2020)

“Sometimes leaving work at work can be difficult, but realizing you did everything you could during your shift for the baby and the family is all you can do.” (S. Kaminski, 2020)

If there’s any one thing a nurse can take away from this, I want it to be that you don’t always have to put on your brave face to mask your emotions. Speak out, tell your truth and you will find that you are not alone in how you feel. Before we are healthcare professionals, we are human, and our feelings are valid too.

References: Cricco-Lizza, R. (2014). The Need to Nurse the Nurse. Qualitative Health Research24(5), 615–628. doi: 10.1177/1049732314528810- Kaminski, S (2020). Personal Interview – Ouellette, M (2020). Personal Interview

Source: http://nann.org/publications/april-2020-footprints

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WARRIORS:

Helping a friend struggling with depression: Tips from

Dr. Randy Auerbach

Dr. Randy Auerbach, Associate Professor at Columbia Psychiatry, gives some tips on how to help a friend struggling with depression. Break the silence and be the one to prevent suicide. The National Suicide Prevention Lifeline (1-800-273-8355) provides 24/7, free and confidential support and prevention and crisis resources for people in distress.

 

kats.korner (2)

KAT’S CORNER

Blue economies or water-friendly urban planning in Bangladesh, perhaps soil improvement and water management in Ethiopia? So many possibilities… I wonder what kinds of innovations we Warriors may generate as we face the challenges calling us into action.

Climate change drastically effects our global preterm birth community. In the video below Dr. Oppenheimer shares interesting perspectives of the why and how we may choose to prepare locally and globally in order to proactively respond as climate change rearranges our world. While progressive communities committed to protecting our planet and humanity take scientifically supported measures to reduce the effects of climate change we question if anything can be done to create sustainable economies to support and harness the capacities migrant/refugee populations have to share.

SBEC-Infographic

Refugees Are Fleeing Climate Change

yearsJan 31, 2020   The YEARS Project

Tens of millions of people could be displaced by climate change by the end of this century. Climate scientist Michael Oppenheimer explains why that matters, why he supports the right to migrate, and what governments need to do to prepare.

SURFING BANGLADESH | 2019

Dennis Sundström   Aug 6, 2019 : A short movie from my trip to Cox’s Bazar, Bangladesh. Thanks to everyone that made the trip unforgettable!

Covid-19, a collective technological journey

Iceland.

ICELAND

Preterm Birth Rates – Iceland

Rank: 167–Rate: 6.5% Estimated # of preterm births per 100 live births (USA – 12 %)

Iceland is a Nordic island country in the North Atlantic, with a population of 364,134 and an area of 103,000 km (40,000 sq mi), making it the most sparsely populated country in Europe. The capital and largest city is Reykjavík. Reykjavik and the surrounding areas in the southwest of the country are home to over two-thirds of the population. Iceland is volcanically and geologically active. The interior consists of a plateau characterised by sand and lava fieldsmountains, and glaciers, and many glacial rivers flow to the sea through the lowlands. Iceland is warmed by the Gulf Stream and has a temperate climate, despite a high latitude just outside the Arctic Circle. Its high latitude and marine influence keep summers chilly, with most of the archipelago having a polar climate.

Health: Iceland has a universal health care system that is administered by its Ministry of Welfare paid for mostly by taxes (85%) and to a lesser extent by service fees (15%). Unlike most countries, there are no private hospitals, and private insurance is practically nonexistent. A considerable portion of the government budget is assigned to health care,  and Iceland ranks 11th in health care expenditures as a percentage of GDP and 14th in spending per capita. Overall, the country’s health care system is one of the best performing in the world, ranked 15th by the World Health Organization. According to an OECD report, Iceland devotes far more resources to healthcare than most industrialised nations. As of 2009, Iceland had 3.7 doctors per 1,000 people (compared with an average of 3.1 in OECD countries) and 15.3 nurses per 1,000 people (compared with an OECD average of 8.4). Icelanders are among the world’s healthiest people, with 81% reporting they are in good health, according to an OECD survey.

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COMMUNITY

Our focus in this month’s blog will highlight some of the unique challenges our preterm birth community faces during the current Covid-19 pandemic.

Big  THANKS  to our essential workers and community members who are respecting and following local Covid-19 protocols/orders. Together we are saving lives.  Here in Seattle, WA. King 5 News staff working from their homes remind us that although times are tough, together we can get through this. Through their Neighbors Helping Neighbors virtual stories King 5 staff show us that it is heroic to not only care about others but to act accordingly. You are likely sharing similar do-good stories within your local communities.  People everywhere are connecting with respect and kindness while offering diverse and creative ways to pitch in for our mutual good. We see through responsible media-sharing that as a community we are resilient and adaptable as we quickly learn to educate ourselves and our children using  our in-home technology and resources. We have immersed ourselves in creating home offices, learning new software programs, and changing the ways we work in order provide meaningful services and goods.  We are learning to cook and bake at home, and we have had time to garden, read, make home improvements and opportunity to ponder things that have special personal meaning in our lives! We will look back at this time with sorrow, gratitude, joy and relief.  We may be thinking about how we can use this time to manifest our dreams moving forward. We will be stronger, more educated, with renewed clarity about the power of human kindness and our global and local reliance on each other.

i.5From our third floor window, while a very inspired woodpecker hammers our wood/concrete siding in order to mark his territory, we greet you with our love, gratitude, and very best wishes!

Mothers and Fathers kept from seeing their premature babies due to Covid-19 – ITV News

ITV News

The Covid-19 pandemic has led to time between babies and parents being rationed. In some cases, this means new mothers and fathers are having to wait days – and in some cases weeks – to see their newborns on the neonatal ward. Health officials say the strict measures are in place to protect babies born prematurely from the risk of infection. ITV News spoke to some of the parents who were forced to stay away from their ill newborns.

An Iceland Preemie Innovation

The company name Róró originates from the Icelandic word “ró” which means calmness and comfort. Róró is dedicated to helping babies and their caregivers feel better. It was founded in 2011 around a single idea: to make a product for babies that imitated closeness when their parents needed to be away. Indeed, the idea of the Lulla doll was born when our friend had her baby girl prematurely and had to leave her alone in the hospital every night for two weeks.

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Lulla doll is a soother and sleep companion for preemies, babies, toddlers and beyond. It imitates closeness to a caregiver at rest with its soft feel and soothing sounds of real-life breathing and heartbeat. Lulla plays for 12 hours to provide comfort all night long. The doll is machine washable and comes with 2 AA batteries.

Watch How the Lulla Doll Works

 

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COVID-19 and the NICU Balancing Safety and Care

I dedicate this column to the late Dr. Andrew (Andy) Shennan, the founder of the perinatal program at Women’s College Hospital (now at Sunnybrook Health Sciences Centre). To my teacher, my mentor and the man I owe my career as it is to, thank you. You have earned your place where there are no hospitals and no NICUs, where all the babies do is laugh and giggle and sleep.

“There is no evidence of vertical transmission of novel coronavirus between mother and baby at this time. Infants born to COVID-19 infected mothers have not tested positive for the disease, nor has novel coronavirus been found in amniotic fluid or breast milk.”  Rob Graham, R.R.T./N.R.C.P.

One cannot watch television or pick up a newspaper without being bombarded with COVID-19 stories and information. In our lifetimes, we haven’t seen anything like this; while the adult world is the focus of this pandemic, we in the NICU must contend with the risks associated with parental involvement in the care of their babies.

There is no evidence of vertical transmission of novel coronavirus between mother and baby at this time. Infants born to COVID-19 infected mothers have not tested positive for the disease, nor has novel coronavirus been found in amniotic fluid or breast milk. While this is ostensibly good news, it must be tempered with the fact that this is a hitherto unknown pathogen and that while our knowledge base is growing daily, there is still much we don’t know. It is my opinion that one cannot be too cautious dealing with COVID-19; better to modify the policy as evidence becomes available than to wait for evidence to form policy. Unfortunately, the latter approach has been most common and has likely led to the explosion in cases outside the Wuhan epicentre.

Many hospitals have prohibited visitors during this crisis. This approach is certainly prudent given the increasing evidence of asymptomatic transmission but may not be in the best interests of the neonatal population. Regardless, in Toronto, there are discrepancies between institutions. (A copy of Toronto’s guideline is attached. NOTE: this is an example and not intended as medical advice or protocol). A previous column (December 2019) discussed the relationship between respiratory care and neurodevelopmental outcome, including the benefits of direct parental involvement and kangaroo care. The clear benefits of parental contact must be weighed against the risks to the baby and those who care for it. The unit in which I am employed has limited visitation to one parent at a time. Overnight stays are permitted, parents are forbidden to leave the NICU area until leaving the hospital, and face masks must be worn at all times.

The major concern when breastfeeding an infant of a COVID-19 infected mother or symptomatic parent under investigation is twofold: prevention of transmission to the infant and protection of those charged with the infant’s care. It is not breastmilk that is of concern, rather the potential infection of others via droplet. The safest approach here is to have parents wear masks to reduce the chance of droplet exposure during breastfeeding; however, the utility of regular surgical masks in preventing transmission of COVID-19 is questionable. The same applies to kangaroo care since exposure is identical. During skin to skin contact, consideration may be given to having the involved parent thoroughly clean the area of contact in addition to routine hygiene. Ideally those entering the room of a COVID-19 infected patient should wear a properly fitted N-95 mask,  but the international breakdown of our supply chain has resulted in an acute shortage of PPE; thus surgical masks are being used as a substitute. There is much debate over the utility of these masks to protect caregivers but increasing evidence in their ability to reduce transmission.

The best way to contain an outbreak like this is to test and isolate. China and South Korea have amply demonstrated the efficacy of this approach. However, a combination of reagent supply shortage and a concurrent shortage of swabs (ironically mostly manufactured in Italy) have made this impossible as the pandemic spread to the rest of the world, and the fact that the number of infections outside the epicentre now greatly outnumber those within is a testament to the necessity of testing. Given the possibility of asymptomatic transmission, it would behoove us to assume infection in all until proven otherwise and act accordingly. This is a case of what we don’t know can indeed hurt us.

The risks associated with aerosol-generating medical procedures are well known, particularly in the adult population. It stands to reason that a premature infant generates less aerosol than an adult; however current guidelines call for the infant of a confirmed or suspected parent to be treated in the same manner as an adult patient. Compounding this is the unusually high viral titre with COVID-19 infection, potentially making droplets more likely to lead to infection.

In the adult population, when mechanical ventilation is required, lower tidal volumes (3-6mls/kg) and higher PEEP has been recommended, although recent anecdotal reports from the front lines are less clear. (These anecdotal reports are coming from Twitter® posts from ER physicians on the front line and as such do not constitute evidence). A letter to the editor of The American Journal of Respiratory and Critical Care Medicine, March 2020, suggests a different approach. One that is echoed by other anecdotal reports and describes an atypical ARDS picture associated with COVID-19. In this case, it is not a lack of recruitment that is the problem but rather uneven ventilation/perfusion matching. (10) HFO is potentially more prone to aerosol generation, and if used, airborne precautions are advised. (11) (This is an excellent reference for the management of all COVID-19 patients.) A filter on the expiratory limb of any ventilated patient may be considered provided it does not interfere with the normal operation of the machine and are changed in accordance with the manufacturer’s recommendations.

It is perhaps fortunate we have little data regarding neonatal infection with COVID-19. It seems that mechanical ventilation for symptomatic positive infants may only be required for other reasons (i.e., extreme prematurity as the limited number of cases seen thus far have not required intubation) and that neonates exhibit the same relatively mild symptoms of older children.(12) Recent reports of 2 infants succumbing to COVID-19 in the U.S. may be a harbinger of things to come.(13) It is my sincere hope this is not the case. Perhaps the most significant risk NICU staff face for infection are each other. Given the increasing rate of community-acquired infection and asymptomatic transmission, we are at the same or greater risk than the general population. Fomites are a known source of transmission (particularly plastic and stainless steel). (14) We are all potentially exposed this way, particularly when using public transit as grab bars, and handles are all made of plastic and stainless steel. The importance of meticulous, regular hand hygiene, and avoidance of touching the face cannot be emphasised enough.

The concept of social distancing is difficult to achieve in the NICU environment due to the necessity of close contact during procedures and the proximity of workstations. Staff are well-advised to wear face masks at all times as a matter of policy to mitigate the risk of infection. Patient assignments should be such that staff can be stationed as far away from each other as is practically possible. COVID-19 doesn’t discriminate based on credentials!

This pandemic will affect all of us one way or another. As NICU caregivers, we may be at reduced risk relative to our adult colleagues; however, as the crisis worsens, some of us may be seconded to adult areas. Now would be a good time for those assigned exclusively to the NICU to brush up on adult ventilation protocols. The Toronto Centre for Excellence in Mechanical Ventilation provides an excellent resource.

As evidence is gathered, the guidelines and recommendations we practice under are subject to change. Given limited numbers (although still increasing exponentially), the fact that there is presently no evidence to suggest vertical transmission or risks associated with breastmilk, for example, doesn’t necessarily mean risks do not exist. Healthy, younger patients are dying from COVID-19. While the mean age of infection is 45 years, the mortality rate for those <60 is approximately 0.32% compared to 6.4% in those >60 and 13.4% in those >80. (16) 0.32% seems pretty small, but this represents a 3-fold increase over that of seasonal flu in the general population.(17) We’re all playing Russian roulette; the only difference is the number of bullets in the gun. I, for one, prefer not to play.

Finally, while high-frequency jet ventilation (HFJV) is commonly used in the NICU setting, there is currently no commercially available adult jet ventilator in North America. There are a few machines available in Toronto cobbled together in labs at the University of Toronto years ago. These have been used as a last-ditch effort when other modes have failed. The Oscillate study of conventional (CV) vs. high-frequency oscillation (HFO) ventilation in adult respiratory distress syndrome (ARDS) found HFO detrimental, but similar research on HFJV has not been performed.(18) The benefits of HFJV in the neonatal population may well apply to the adult population; the high mortality rate from ARDS surely should provide an incentive to its study in this population. Now seems to be a good time.

I have been asked to explore the possibility of using the LifePulse HFJV machine in larger patients. I shall keep readers apprised of any progress in that regard. We are facing the challenge of our careers and, indeed, our lives. The world is counting on us. Please, everyone, take care of yourselves and each other. While always important, it is now more so than ever. References: 1. https://www.frontiersin.org/articles/10.3389/ fped.2020.00104/full 2

Source: https://www.cdc.gov/coronavirus/2019-ncov/

 

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A digital response to help ensure safer childbirths during COVID-19

A new initiative launched today by Maternity Foundation, University of Copenhagen and Laerdal Global Health in collaboration with International Confederation of Midwives (ICM) and UNFPA, the UN sexual and reproductive health agency, uses a digital tool to equip midwives in low-resource settings to protect themselves, mothers and newborns from the Coronavirus and to ensure that women continue to receive respectful quality of care during pregnancy and childbirth. During the current COVID-19 pandemic, women everywhere will continue to get pregnant and give birth. In low-resource countries and in humanitarian settings affected by conflict, pregnant women, new mothers, newborns and the health personnel providing them care face great risks in the new reality brought by the virus. Health systems are facing enormous pressure with lack of staff, resources and training to take necessary preventative measures against the virus. Midwives and other skilled health personnel providing care during childbirth need immediate support and tools to be able to still provide quality maternal care in the light of the pandemic. A new digital tool launched today aims to do just that.

In response to the global COVID-19 pandemic, Maternity Foundation, University of Copenhagen, and Laerdal Global Health in collaboration with International Confederation of Midwives (ICM) and UNFPA have partnered up to develop and disseminate an immediate and digital response for healthcare personnel – particularly midwives – to protect themselves, women and newborns from COVID-19.

The coalition is launching tools for capacity building and training for midwives through the Safe Delivery App, a mobile application developed by Maternity Foundation and University of Copenhagen, which provides visual, clinical and practical guidance on how to handle the most common childbirth complications. Through the Safe Delivery App, midwives can now get key information, animated video instructions, and check lists as well as guided training to support them to limit the spread of COVID-19 in the health facilities, including information on infection prevention, breastfeeding and vertical transmission.

The Safe Delivery App is a free application that is already being used by midwives and other skilled health personnel providing care during childbirth in over 40 countries worldwide. Thereby, the partners are leveraging an existing platform that is already reaching thousands of frontline health workers. All current users of the App will receive a pop-up message creating awareness about the new module and the importance of taking pre-cautions during COVID-19. It works offline once downloaded, making it easy to use in remote settings without a stable internet connection. The new COVID-19 content in the App is available in English as of today and will be available in French in a near future. The content of the Safe Delivery App is updated according to WHO standards and guidelines.

Laerdal Global Health has 10 years of experience of simulation-based training for midwives and other health care providers in low resource settings through the Helping Mothers Survive and Helping Babies Survive training programmes, implemented in over 80 countries. The current collaboration on merging scenarios for simulation into the Safe Delivery App will expand use of the App and support training in an efficient way, supporting the midwives where they are working.

In Moshi in northern Tanzania, senior nurse midwife at Mawenzi Regional Hospital Anne Shuma and her colleagues have just been introduced to the new COVID-19 module in the Safe Delivery App. The hospital is one of the hospitals in the country selected for receiving COVID-19 patients, and preparations are in full motion to prepare isolation centers, so they are ready when the first cases arrive. In the first week of April alone, they had 50 deliveries in the hospital.

“Going through the Safe Delivery App and the COVID-19 module made us realise that we were not prepared to receive pregnant women with suspected COVID-19. Immediately, we prepared a delivery kit and brought it to the isolation center and prepared a cube where suspected cases can give birth. We have now developed checklists based on the content in the App, so we are ready for when suspected cases come. It’s a very helpful tool for us midwives in an outbreak like this. It takes a concrete case and gives guidelines that are aligned with our national guidelines; procedures for handwashing and how to handle personal protective equipment. The App has opened our minds, we’re prepared now”, says Anne Shuma, who will spend the next weeks training fellow midwives and nurses in nearby clinics and hospitals to use the Safe Delivery App in their preparations for the COVID-19 response.

Dr. Natalia Kanem, Executive Director UNFPA: “The enormity of the COVID-19 crisis and its consequences is testing us all. As essential frontline health care workers, midwives must be protected and prioritized so that they can continue providing quality care to women and their newborns during the pandemic. UNFPA is pleased to collaborate with the Maternity Foundation, Laerdal, ICM and the Government of Denmark in developing innovative online resources to support midwives and other maternity care providers working in the field. These new digital tools will enable them to access the latest evidence-based approaches to care delivery in the context of COVID-19.”

Dr. Sally Pairman, CEO of the International Confederation of Midwives: “Midwives everywhere are frontline health care professionals in the face of the coronavirus, providing essential care to pregnant women and their babies during the childbirth continuum, despite the risk this presents to their own health. Many midwives have never had to work in pandemic situations before, and for everyone the coronavirus is new. In speaking with our Midwives’ Association members, we’ve been saddened by news of midwives dying from Covid19, simply because they were not adequately protected from the virus or did not have proper information on how to protect themselves. It’s essential that midwives and all other health professionals providing maternity care can access up-to-date and evidence-based advice on the changes they need to incorporate into their practice to keep women and their babies, and themselves, as safe as possible. The new modules in the Safe Delivery App will help guide midwives everywhere with advice they can count on.”

Chairman of Laerdal Global Health Tore Laerdal: “Our mission has always been helping save lives and now it has come even closer. During these extraordinary days, we work even harder towards our mission. There are hundreds of thousands of health workers who heroically continue to work through challenging situations and are in need of all the support we can offer. We hope our manikins and simulation solutions will be the helping hand that will support them in providing safe and respectful care.”CEO of Maternity Foundation, Anna Frellsen: “The direct and indirect consequences caused by the covid-19 pandemic can be fatal for mothers and newborns in many parts of the world. The Ebola outbreak in West Africa in 2013-16 showed a dramatic increase in maternal deaths because the health system was under too much pressure to fight the pandemic to also provide quality care. In a situation like this we need to respond fast and we need to do it together. By building on an existing digital platform and our global partners’ strong channels, we are now availing essential clinical guidelines instantly to midwives, even in some of the most vulnerable settings.”

How to download the Safe Delivery App

  • Search for Safe Delivery App in Google Play or App store
  • Click Download – the App is free of charge
  • Open the App and select language version – the COVID-19 content is in the global English version
  • If you already have the Safe Delivery App on your phone, update it and the COVID-19 module will appear in the global English version

The full Infection Prevention video can be found here.

Source: https://www.healthynewbornnetwork.org/news-item/a-digital-response-to-help-ensure-safer-childbirths-during-covid-19/

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PREEMIE FAMILY PARTNERS

Vulnerable babies are being separated from their families because of corona virus

i.10Published on Apr 19, 2020

Babies born sick and premature are being separated from their families because of hospital restrictions put in place during the corona-virus outbreak. Some hospitals are only allowing one parent to visit at a time and it’s even more difficult for siblings to meet their new relative.

 

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Doctors are pessimistic about premature babies. Despite the evidence, we all are.

We tend to view them as “miracle babies,” or as the result of medical hubris.

By Sarah DiGregorio – Sarah DiGregorio is the author of “Early: An Intimate History of Premature Birth and What it Teaches Us About Being Human.” Feb. 21, 2020

In 2014, I was 28 weeks pregnant and sitting in a hospital bed, my husband beside me. My placenta was failing; to survive, our daughter would need to be delivered soon. She was smaller than average for this stage, an estimated 1.75 pounds.

The neonatal intensive-care unit (NICU) dispatched a neonatology fellow to help us understand what this meant. He started with our baby’s brain. When she was born, it might bleed, putting her at risk of death or cerebral palsy. Her lungs: They would certainly be immature, and she would probably have some degree of respiratory distress syndrome. Her heart might have a hole in it that would fail to close. Her intestines might develop an infection, possibly fatal, in which lengths of the bowel die. In the long term, premature babies are much more likely to experience developmental delays — the doctor guessed that our daughter had about a 50 percent chance of having a disability of some kind. She might lose some IQ points as a result of being premature, he added. The message was clear: Being born early was very, very bad, and our baby was likely to be fundamentally damaged, even in ways we would never definitively know.

It’s important that parents have the facts, and our doctor wanted us to know something true: Being born prematurely can affect a child’s health in many ways, and some of those complications can be fatal. The information he recited was medically accurate, though he probably inflated the likelihood of disability. (One benchmark is that, among babies born at 25 weeks, 13 percent develop a profound neurodevelopmental disability, and 29 percent develop a moderate one, according to data from the National Institute of Child Health and Human Development.)

The doctor’s laundry list also missed something important, something we really needed to hear at the time: The majority of babies born early, even very early, survive in good health. Their weeks, months and years ahead will not be easy. But there is also plenty of evidence for optimism.

Health-care providers have a well-documented and surprisingly durable pessimism about preemies. A 1994 survey in the American Journal of Obstetrics and Gynecology showed that doctors significantly underestimated their survival rates and overestimated their long-term disability rates. More than a decade later, a Pediatrics study of physicians, nurses and nurse practitioners echoed those findings, and showed that learning the true rates made doctors more likely to recommend resuscitation in theoretical borderline cases. Doctors are much sunnier about other patients: Research shows that internists and intensive-care unit physicians accurately assess the survival chances of adult patients admitted to the ICU.

This professional pessimism is matched by a broader cultural ambivalence. Our feelings about preterm infants are powerfully fraught. They suggest the thinness of the line between life and death; they symbolize the heights of human capability and the perils of going too far. We have two common narratives about premature infants: inspirational “miracle baby” stories and warnings of medical hubris. Record-setting “micro-preemies” who “defy the odds” and “fight for their lives” are regularly featured in tabloids and local TV broadcasts. Meanwhile, a 2017 Maclean’s article wondered, in the case of a very early birth, “to what extent should we intervene to prevent nature from taking that life before it becomes fully viable and conscious?” A Bloomberg Businessweek article, “Million-Dollar Babies,” asked, “Is there such a thing as too young?” Perhaps the general hand-wringing over such efforts made AOL’s chief executive blame the expensive medical care of “distressed babies” when he cut employee retirement benefits in 2014.

Our fascination with premature infants has always contained starry-eyed optimism about what could be done for them, along with uncertainty about whether the results were “worth” those efforts. That conflict goes back to the invention of the incubator in the 1880s, as Jeffrey Baker writes in “The Machine in the Nursery.” The medical establishment was slow to adopt the technology: The machine was expensive, and the value of the lives saved was seen as dubious. At the time, “Better Baby” contests were wildly popular, grading children on pseudoscientific traits like head measurements and awarding prizes to the “fittest” (i.e. large, able-bodied babies of white European heritage). Eugenicists argued that premature babies weren’t meant to survive; they would become a drain on society. The Buffalo Medical Journal wondered “whether the race as a whole does not suffer from the preservation of these weaklings to perpetuate their kind.” As a result, incubators remained a curiosity, touring world’s fairs and popping up in Coney Island as a boardwalk sideshow. People paid to gawk at preemies in their warm, glass-fronted boxes — they were objects of voyeuristic amazement, inspiring both hope and horror.

Even as cultural attitudes have progressed, some anxiety remains, often rooted in fears of disability. The 1985 book “Playing God in the Nursery” warned of “the dismal fate of a disturbing number of ‘salvaged’ babies’ ” who go on to lead “pathetic lives.” Two neonatologists called on fellow physicians to reexamine these beliefs in the Journal of Perinatology in 2013: “For the case of the preterm newborn, in particular, there may also be a sense that she is still ‘not meant to be here,’ ” they wrote. “If she survives with significant disability, the physicians might perceive that: But for our actions, there would be no disabled child.” The worry about gratuitous intervention, present in many medical decisions, seems especially acute when it comes to these patients.

All preterm babies are at increased risk for neurodevelopmental and learning disabilities when compared with term babies; the earlier the birth, the higher and more severe the risk. But these blanket assessments elide the fact that “disability” includes a whole range of experiences. Rigorous quality-of-life studies have found that as extremely premature babies grow into young adults, they rate their own health-related quality of life just as highly as a control group born at term. That includes former preemies who have a significant disability, such as cerebral palsy, vision problems or hydrocephalus — outcomes that providers seem to view more negatively than parents do. Neonatal providers often think that serious disabilities following from premature birth are worse than death, one study published in the Journal of the American Medical Association found. Most parents of babies born under 2.2 pounds feel differently — as do the grown ex-preemies themselves.

The truth is that the successful treatment of premature babies is one of the great triumphs of modern medicine. Before the widespread adoption of the incubator (and back when babies were usually studied by weight rather than gestational age), an 1883 study found, only about 35 percent of babies born under 4.4 pounds survived. But it isn’t just the incubator: With the subsequent development of respiratory support, intravenous nutrition and a host of other treatments, outcomes have improved dramatically. Infants born at the edge of viability, between 22 and 25 weeks, do, unfortunately, face substantial risk of death. But the vast majority of premature babies — more than 80 percent — are born after 32 weeks, and those born at 26 weeks and above are now quite likely to survive. According to the most recent available data from the Centers for Disease Control and Prevention, 87 percent of infants born at 26 weeks survive, and outcomes improve with each week of development.

Health-care providers are uniquely positioned to reframe our understanding of premature birth. They can answer parents’ questions, rather than leading with negative (and often hypothetical) predictions, and they can ground the discussion in the latest research. That evidence-based optimism might seep into the wider conversation. At the very least, it would make a difference to families, whose numbers are growing: More than 1,000 babies are born prematurely in the United States every day, and that figure has been rising for the past four years.

Families of premature babies are often deeply grateful to the providers who saved their children’s lives, and I am no exception. The doctor who recited that laundry list may have just been following hospital protocol. He probably had the best intentions; he may have been trying to manage his own emotions and expectations. But our counseling session hit me so hard not just because it laid out all the worst-case scenarios: It also seemed to say that my daughter would not have a wide-open future. She would forever be measured against an ideal that she was born short of and could never grow into.

And yet, in the time since, I have never wished my daughter, now age 5, were different. I speak from a position of tremendous luck: Her IQ is “normal,” whatever that means; she has a pulmonologist monitoring her persistent asthma and receives physical and occupational therapies for minor motor delay. Some of her fellow former preemies have fewer challenges; others have far more. But I don’t contemplate who she may have been, and I can’t wish away those difficulties without, in some real sense, wishing her away, exactly as she is.

We have a powerful collective fantasy of newborn perfection. We associate babies with possibility; we believe they could grow up to be anything, do anything. The truth is that no one, anywhere, has unlimited potential, not even at the very start of their life. But that fantasy can lend early births an unnecessarily tragic aspect — a sense of brokenness, of damage, even before parents have a chance to hold their infants. And often, we have plenty of reason to hope.

Source: https://www.washingtonpost.com/outlook/doctors-are-pessimistic-about-premature-babies-despite-the-evidence-we-all-are/2020/02/20/c4cefe50-4c44-11ea-9b5c-eac5b16dafaa_story.html

 

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Does COVID-19 affect pregnancies?

UW Medicine – Mar 24, 2020

Much is still unknown about the virus that causes COVID-19. Dr. Kristina Adams Waldorf, professor of obstetrics and gynecology at University of Washington School of Medicine, shifted her lab’s focus to research what effects the virus may have on a pregnancy or a newborn. Scientists are investigating such questions as whether the infection can affect a fetus’ growth or whether it heightens the risk for preterm birth, stillbirth, and other conditions. This kind of research can help determine clinicians’ responses to pregnancies that also involve COVID-19.

 

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INNOVATIONS

Will Simplifying the Finnegan Neonatal Abstinence Scoring Tool Improve Outcomes for Infants With Opioid Exposure?

Ju Lee Oei, MD1,2; Trecia Wouldes, PhD3

It has been known for decades that opioid withdrawal in neonates has the potential to be fatal. Unfortunately, newborn withdrawal symptoms can be nonspecific, and identifying and differentiating infants with drug withdrawal from those with other illnesses, such as infection or neurologic problems, can be difficult, especially when maternal history is not forthcoming. Loretta Finnegan and colleagues devised the 21-point Finnegan Neonatal Abstinence Scoring Tool (FNAST) in 1975 based on observations of 55 full-term infants with narcotic exposure who were born at the Philadelphia General Hospital. The neonates were all admitted to a nursery and scored every hour for the first 24 hours, then every 2 hours on day 2, and then every 4 hours after that. They were formula fed and treated with a repertoire of agents that are no longer used as first-line treatments, including phenobarbital, paregoric, chlorpromazine, and diazepam. The FNAST is now the most widely used tool to screen, assess, and treat infants suspected of having drug withdrawal, but it is notoriously difficult to administer and is fraught with subjective differences.

In the study by Devlin et al, the authors attempted to shorten and simplify the FNAST by incorporating observational data from several infant cohorts (N = 424), including infants who did not require medications for neonatal abstinence syndrome (NAS). They dichotomized items that were previously expressed in grades of severity and removed items that were not observed frequently or were extremely heterogeneous, including convulsions, high-pitched crying, and hyperactive reflexes. The result was an assessment scale made up of 8 items, from which scores of 4 and 5 yielded closest agreement with FNAST treatment thresholds of 8 and 12, respectively (weight κ = 0.55; 95% CI, 0.48-0.61).

The simplicity of this tool is attractive. However, before it can be embraced in clinical care, several questions remain to be answered. First, only 1 score was used to determine treatment. Withdrawal symptoms typically evolve as the infant ages, and whether the associations between the 8 chosen items and NAS remain consistent with time needs to be assessed. The rare or uncommon items, such as seizures, were removed, but this may have limited the ability of the scale to detect severe but rare manifestations of withdrawal that require urgent treatment rather than continued observation. Critical events, such as seizures, may not have been common in the cohort studied by Devlin et al4 because the infants, unlike historical examples, were already monitored and treated preemptively with supportive care.

Nevertheless, the most significant knowledge gaps with the use of this and other scales is the lack of information regarding long-term outcomes. No prospective, well-controlled longitudinal studies have been conducted to associate prenatal drug exposure as well as assessment and treatment for NAS with later neurodevelopmental outcomes. Every single drug that causes NAS and every single medication that is used to treat withdrawal is neurotoxic. For example, opioids interfere with neurotransmitter homeostasis, promote cell death by apoptosis, and reduce brain growth and neuronal differentiation.5 Conversely, without treatment, severe withdrawal could lead to serious complications, such as dehydration, malnutrition, seizures, and even death.

Certainly, the work of Devlin et al highlights that much more needs to be known about how an infant responds postnatally to intrauterine drug exposure and the optimum screening, diagnostic, and treatment strategies. Perhaps the ultimate goal should not be to decide whether to treat an infant with medication but to prevent poor outcomes, including neurologic harm and death. Adopting simple measures will only be effective if they are systematically accepted by clinicians, parents, guardians, and caretakers, which is often not the case. For example, standardized protocols for identifying and treating women with opioid use disorder and for assessing and treating infants at risk of NAS have been shown to be beneficial in reducing length of hospitalization and rates of NAS treatment even without changing assessment scales.

Finally, we need to acknowledge that infants, especially those affected by multiple drugs, may need more than 1 type of assessment. The FNAST was based on infants withdrawing from narcotics, most notably heroin and methadone. Today, pregnant women with a drug use disorder usually use multiple drugs, which may obfuscate the clinical presentation of the infant. Incorporating items from other scales, such as the NICU Network Neurobehavioral Scale, which incorporates physiological parameters with interactive capabilities in an assessment method, may provide useful diagnostic information even for infants without opioid exposure and may even prognosticate not only for the short term but also, importantly, for longer-term outcomes.

Published: April 8, 2020. doi:10.1001/jamanetworkopen.2020.2271

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2764194

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Advanced Wireless Neonatal Body Monitors to Improve Outcomes

Babies that end up in the neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) are monitored via a complex collection of sensors, each of which has a wire connected to a patient monitor. While necessary, all this technology makes it difficult for parents to bond with their children and for clinicians to access their patients.

Northwestern University engineers have developed flexible, wireless sensor patches that are able to collect the same vital signs as wired devices while offering an entire set of additional capabilities that existing commercial devices lack.

The new sensors are able to track the heart rate, respiration rate, temperature, and blood oxygenation as well as conventional sensors, and they also allow for monitoring of body movement and orientation, recording heart sounds, crying, and other audio biomarkers, and even provide a pretty accurate estimate of systolic blood pressure.

The sensors are powered by internal batteries and are pretty cheap to manufacture, and so should be applicable for use in low resource areas and varying clinical settings. Additionally, the same sensors can be used to monitor pregnant women and potentially hospitalized adults as well.

Following comprehensive testing at two hospitals in Chicago, the results of which have just been published in journal Nature Medicine, the sensors are already being evaluated for use on newborns in a hospital in Kenya and one in Zambia.

Source: https://www.medgadget.com/2020/03/advanced-wireless-neonatal-body-monitors-to-improve-outcomes.html

 

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HEALTH CARE PARTNERS

At Mayo Clinic, Bringing Neonatologists to the Point of Care with Telemedicine

The health system has co-developed a tele-neonatology program designed to close a gap in care that has existed when neonatologists aren’t physically available.

Rajiv Leventhal– Oct 29th, 2019

According to researchers at the Rochester, Minn.-based Mayo Clinic, 10 percent of all newborn infants will require assistance at birth, while approximately 1 in 1,000 newborns will require advanced resuscitation after delivery—an intervention after a baby is born to help it breathe and to help its heart beat.

When these high-risk deliveries occur in a local referral center, such as the aforementioned Mayo Clinic, newborn outcomes can be optimized under the care of a multidisciplinary team that has frequent experience with neonatal resuscitation.

Conversely, if a similar high-risk delivery occurs in a community hospital, the local providers may face unique challenges when responding to delivery room emergencies, Mayo Clinic researchers pointed out. As such, the health system recently co-developed a Newborn Resuscitation Telemedicine Program (NRTP) in collaboration with telehealth solutions company InTouch Health.

At Mayo Clinic, the organization’s main hub in Rochester has Level III and Level IV regional NICUs (neonatal intensive care units)—Level IV being the highest level of neonatal care—but there are also 10 Mayo Clinic health system sites that range from having just Level 1 well baby nurseries up to Level II intermediate specialty care nurseries. On top of that, Mayo Clinic has eight emergency departments (EDs) that are a part of either critical access hospitals or standalone EDs where there are no labor or delivery services, explains Beth Kreofsky, operations manager for the new tele-neonatology program at Mayo Clinic.

“So when mothers present to these sites, they may not always have access to a neonatologist. Six years ago, our team identified—with the assistants of our Mayo Clinic health system pediatric teams and family medicine providers—that there was a need to have a neonatologist available for assistance at the bedside in critical care situations where newborn resuscitation was needed,” Kreofsky recalls.

This disparity based on birth location was what motivated Christopher E. Colby, M.D., chair of neonatal medicine at Mayo Clinic’s Rochester campus to explore the use of telemedicine for newborn resuscitation, according to health system officials who noted that Dr. Colby’s first consultation was for an extremely preterm baby with an unknown gestational age due to limited prenatal care.

In this scenario, the local physician was unsure if the newborn was viable and if resuscitation was indicated. After examining the baby via video, Dr. Colby determined the neonate was likely 26 to 28 weeks gestation and proceeded to guide the resuscitation and stabilization. After a short time in the Mayo Clinic NICU, the baby was transferred back to the local Level II nursery. From there, the healthy infant was discharged home, health system officials explained.

The telemedicine program that has now been established enables nine board certified Rochester-based neonatologists to consult with local care teams in 10 health system sites. Prior to using telemedicine, only 43 percent of newborns in Mayo Clinic health system sites had access to a neonatologist if they required advanced resuscitation, officials pointed out, and as Kreofsky explains it, in these situations, local care teams would activate Mayo Clinic’s transport services and be asked to connect by phone to a neonatologist to assist in the service.

“Now we have added the video component onto that workflow so our neonatologists can see what the infants look like and what the physician at the local hospital is seeing, and can then provide appropriate recommendations. This is [compared with the prior approach of] not being able to see what’s going on and conducting what essentially [amounted] to a phone consult,” Kreofsky says.

This can be especially beneficial in rural settings where neonatal resuscitations are typically attended by general pediatricians or family practitioners. “While clinicians may have completed Neonatal Resuscitation Program training, knowledge and technical skills decline within four to six months, if not used regularly. Maintaining high proficiency in the face of low volumes presents inevitable challenges for rural providers. Telemedicine serves as a mechanism to address barriers in access to subspecialty care, support neonatal resuscitation in remote sites, and improve care for critically ill outborn neonates,” Kreofsky and her Mayo Clinic colleagues wrote in a study that evaluated the tele-neonatology program.

The study also examined the effectiveness of two telemedicine technologies used to provide NRTP consults: the InTouch Health Lite device compared with a wired telemedicine cart. As Kreofsky explains, if a mother needs to be moved to a different room, say for a C-section, the wired cart solution requires unplugging the device and removing it from the wall to a place where a network jack could be found. And if the physician gets disconnected during that transition, he or she would have to reconnect once the network is reestablished on that device.

But the InTouch technology, on the other hand, allows the physician to stay connected as the patient is being transitioned, meaning the transition is “more seamless and you don’t have to worry about unplugging anything or reestablishing connections in this scenario,” says Kreofsky.

Kreofsky also clarifies that when a tele-neonatology  service does occur, neonatologists are able to partner with the local family medicine physician and pediatrician to assist with guidance and recommendations, but it’s the bedside physician who is still in control of all the care that’s happening on site. “So while a neonatologist cannot physically get their hands on a patient, he or she can assist with recommendations on how neonatal resuscitation program standards are followed throughout a resuscitation,” Kreofsky explains.

During the 20-month study period, 118 NRTP consultations were performed across Mayo Clinic sites, resulting in:

  • 96 percent first connection attempt rate—the ability of the device to connect to the network on the first try.
  • 93 percent incident resolve rate—the ability of the provider to easily resolve any issues with the device before patient care is impacted.
  • Results of the NRTP device can be compared to a traditional wired cart, which saw a 73 percent connection attempt rate and a 68 percent incident resolve rate.

Kreofsky also notes that more recent satisfaction survey results found that 99 percent of the local care teams who have been surveyed agreed that they would use tele-neonatology again and would recommend  it to others. Further, 100 percent of Mayo Clinic’s local care teams surveyed agreed that the consulting neonatologist provided, brief, clear, and specific information for the team, and worked collaboratively with them locally via telemedicine.

According to Jennifer L. Fang, M.D., with neonatal medicine at Mayo Clinic in Minnesota, the next step is to study the impact telemedicine has on the quality of newborn resuscitations. “While we and our colleagues in the health system believe telemedicine is improving delivery room care, we need to design a study to better answer that question,” she said.

Source: https://www.hcinnovationgroup.com/population-health-management/telehealth/article/21112281/at-mayo-clinic-bringing-neonatologists-to-the-point-of-care-with-telemedicine

 

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A simple solution for healthier premature babies?

bCBC 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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Kat has been teaching virtual fitness classes from home during Covid-19 Stay at Home restrictions. Kat’s voice was significantly impacted from long term intubation as a 24 week micro-preemie. Back in 1991 the intubation equipment was quite large and the roof of her mouth is a deep cavern. Her voice is smokey in her normal tone and she is often asked if she is a smoker (she is not). Kat has always had difficulty talking loudly and she will not be pursuing a singing career. I stay upstairs while she teaches her classes and have had the opportunity to re-notice how challenging it is for her to shout out directions and encouragement while teaching HITT fitness (Strong Nation) classes throughout each 60 minute session. This is not a big problem that needs fixing, just an interesting preemie outcome. I wish I would have been more aware of this impairment issue when Kat was a kid and her coaches yelled at her to yell louder!

Voice Abnormalities and Laryngeal Pathology in Preterm Children

Anne Hseu  1 Nohamin Ayele  1 Kosuke Kawai  1 Geralyn Woodnorth  1 Roger Nuss  1

PMID: 29962214 DOI: 10.1177/0003489418776987

Abstract

Introduction: The prevalence of voice abnormalities in children born prematurely has been reported to be as high as 58%. Few studies have examined these abnormalities with laryngoscopic or videostroboscopic findings and characterized their laryngeal pathologies.

Objective: To review voice abnormalities in patients with a history of prematurity and characterize the etiology of their voice problems. A secondary objective is to see if there is a correlation between the findings and the patient’s intubation and surgical history.

Methods: A retrospective chart review was conducted of all preterm patients seen in voice clinic at a tertiary pediatric hospital. Demographic data, diagnoses, and office laryngoscopies were reviewed as well as any speech therapy evaluations and/or medical and surgical treatments.

Results: Fifty-seven patients were included. Mean age at presentation was 5.1 (±4.3) years. Mean gestational age was 27.8 (±3.7) weeks. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) perceptual evaluations included a mean overall dysphonia severity of 46.6 (±24.2). Patients who had undergone prolonged intubation (⩾28 days) in the NICU or had prolonged NICU stays (>12 weeks) had significantly higher overall dysphonia severity scores. Thirty-three patients with vocal fold hypo- or immobility had significantly greater voice deviance in breathiness, loudness, and overall severity compared to those without vocal fold immobility. Of all patients, 35% were recommended surgical intervention and 49% voice therapy.

Conclusion: Intubation greater than 28 days and prolonged NICU stays are associated with more severe dysphonia in premature patients. There should be a low threshold for clinical evaluation of dysphonia in this unique patient population. ***Dysphonia= impairment of the voice

Source: https://pubmed.ncbi.nlm.nih.gov/29962214/

 

WARRIORS:

Covid-19: A Collective Hero’s Journey Dr. Arielle Schwartz

Posted on March 28, 2020 by Arielle Schwartz

“Covid-19 has led many of us around the world to experience feelings of shock and confusion. This collective crisis has disrupted our orientation to the world as we have known it. We have been thrust into a process of self-discovery and a requisite redefining of our lives. It is impossible to go back to the old ways of living.” ~Dr. Arielle Schwartz

American mythologist, Joseph Campbell (2008), describes personal transformation as a hero’s journey. The hero must enter the darkness, face challenges, slay the dragon, retrieve the treasure, and emerge stronger. Here, we understand that challenging life events can serve as a call to enter the hero’s journey. You may feel as though you have been thrown into an abyss. The dragons you must slay are the inner demons. You walk into the darkness in order retrieve the treasures that exist within you, such as inner strength, wisdom, and hope. You emerge with an enhanced sense of meaning and purpose, which become the gifts that you have to offer to the world.

A Collective Hero’s Journey

Campbell described the hero’s journey as a “monomyth,” which serves as a blueprint for many of our fairytales, books, and movies. The monomyth is described as a cycle that begins with a phase of freedom and innocence. This period of ease is tragically disrupted by a crisis that sends the hero into exile.

Here we are. There is no turning back. Covid-19 has changed our world. But, we are in this together. To overcome the challenges that are set before us, we must seek out resources needed to face our fears and inner demons. We must go within to gather our strength and to rise up in the midst of crisis. We are being asked to become the best version of ourselves.

This doesn’t mean that we won’t feel pain. Attending to our sadness, anger, fear is the path forward. Attend with love. Reach out…we are not meant to move through this alone. Perhaps, that is part of the lesson. We are a collective. We are deeply connected to each other. We are here to give and receive from each other.

Crisis as Catalyst

Perhaps our current world crisis has been the catalyst. Or, maybe your hero’s journey began long ago as a result of childhood trauma. No matter the origin, a hero’s journey can guide our process by encouraging us to transform our pain into a source of wisdom.

You might have uncomfortable places that you don’t like to acknowledge or feel. As a result, you might want to reject the call to enter the hero’s journey. The desire to avoid peering into the darkness is normal. It is human instinct to move away from pain. However, learning to turn toward discomfort is necessary and important. Even though you might want to run away, explore the resources that help you to step forward toward the discomfort. Remote psychotherapy, online support groups, journaling, time in nature, or mindful embodiment practices can all help you lean into discomfort at a pace that is right for you.

Living in Two Worlds

The challenge set before us is to learn to live in two worlds—that is, to maintain a connection to our inner, spiritual self while simultaneously living in the outer world. This dual connection helps us learn to live on a threshold where we can acknowledge our pain as a source of compassion.

At times, we might wonder how to live in a world that has betrayed us and that could betray us again. We grow by increasing our ability to hold the complexity of the human experience. This world contains experiences of harm and loss; however, this is also a world of love and care.

Transformed by a hero’s journey, we have an opportunity to grow ourselves into mature adults, capable of holding complex feelings and ideas in a world that can cause harm. There is a great maturity in being able to hold the truth that hurtfulness and happiness can coexist around and within you. We can learn to hold dichotomies, polarities, and contradictions. Experiences of pain are an inevitable part of life; opening our hearts involves the risk of pain. However, life can have excruciatingly painful moments and still be magnificently beautiful. Living on the threshold allows us to walk through the world with an effortless grace that emanates from within.

Emerging into Wholeness

Walk slowly and gently as you face your fears.

In time, we can all learn to trust our capacity to enter the darkness and return to the light. Successfully navigating the hero’s journey gives us the opportunity to discover that we are more powerful than we previously realized.

As a result, the here’s journey allows us to feel more grounded, real, and whole because – in truth – this transformation is about revealing who we truly are.

Together, let us remember that there is an inseparable relationship between our own personal happiness and the wellbeing of others.

Source: https://drarielleschwartz.com/covid-19-a-collective-heros-journey/#.XpjBAEBFxhE

(Kathy) I spent time with Joseph Campbell at Esalen Institute (late 1970’s/early 1980’s). His informal meal gatherings were enlightening and soul-challenging. He was an understated yet powerful speaker who mastered the dynamics of human behavior, subconscious motivations and pathways to transformation. Who in your life inspires transformation?

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KAT’S CORNER

Covid-19 requires that we look beyond our preterm birth community this month into our broader communities so we can all be empowered through our shared resources and information. How Covid-19 will affect maternal outcomes and our preterm birth communities will be somewhat identified over time. Please reach out to your local healthcare providers for guidance and support and consider reviewing fluid resources such as WHO regarding Covid-19 pregnancy and childbirth information:                   Source: https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-and-pregnancy-and-childbirth

Communities worldwide are navigating with limited resources the creation/expansion of medical, social, economic, governing, inter-governmental, technological, educational, interpersonal and personal best practices to maximize the health and wellness of their community members, patients, essential workforce and healthcare/wellness providers. The global health care provider shortage crisis is now critically exacerbated by our global pandemic experience.

Providing communities with factual, science-based information and resources is a critical component in building trust and reducing fear during crisis in a society that has access to multiple “news” resources at their fingertips. Addressing and advancing mental health holistically in our communities strengthens our ability to save lives, limit loss, and prevents fear-based violence. Media that offers not only factual information but also provides a community with guidelines for engaging in meaningful action supports mental wellness during times of crisis.

THANK YOU to the media members who have reached out to challenge us, give our actions meaning and power, who have focused on what good we can accomplish together while building hope and expressing our fears and gratitude.

As time transpires and we are able to review pertinent essential data including community engagement strategies, socioeconomic factors, local and global resources we will have an opportunity to build better societal strategies to serve our diverse communities. Borders do not exist for climate change and environmental disasters or for pandemic types of     human-centric challenges. Technology has the capacity to collect, provide, analyze, and disperse critical data that through collaboration and intent will allow all of us to respond to our personal, community, and global health care challenges with effective, fluid, time-sensitive, immediate and long-term action based planning.

It is essential that we work together in order to support and empower a healthy and sustainable planet. Covid-19 offers, and in some ways forces us to see in action the possibilities positive collaborative engagement provides. Our thanks to all of you who are choosing to stay informed, conduct your lives with intelligence and humane purpose, who live with integrity and a vision of good. Together we can create a safer, life affirming, dynamic and responsible global/local community for all.

Under An Arctic Sky – Official Trailer #1

Jan 17, 2017

With three hours of light each day, brutal winter storms and freezing temperatures, Iceland is far from the ideal surf trip. However, this didn’t stop photographer Chris Burkard and filmmaker Ben Weiland from rounding up a crew of surfers to seek out unknown waves in the islands remote north… all during the worst storm to hit Iceland’s shores in 25 years.

 

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GLOBAL/LOCAL EMPOWERMENT THROUGH COLLABORATION

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NICARAGUA

Preterm Birth Rates – Nicaragua

Rank: 105 –Rate: 9.3% Estimated # of preterm births per 100 live births (USA – 12 %)

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

The Nicaraguan government guarantees universal free health care for its citizens. However, limitations of current delivery models and unequal distribution of resources and medical personnel contribute to the persistent lack of quality care in more remote areas of Nicaragua, especially amongst rural communities in the Central and Atlantic region. To respond to the dynamic needs of localities, the government has adopted a decentralized model that emphasizes community-based preventive and primary medical care.

Source: https://en.wikipedia.org/wiki/Nicaragua#Healthcare

COMMUNITY

Nicaragua is a country in crisis, and the press has been diminished by the current government.  We were not able to access current news related to our preterm birth community in Nicaragua.  To our brothers and sisters in Nicaragua we send our Love N.heartand Respect for our Neonatal Womb/preterm birth community members and hold your well-being and health in our collective consciousness.

Our goal this month is to provide time sensitive information relevant to our Global/local preterm birth community focused on supporting our preterm birth families, health care providers and community members. Wishing us all health, wellness, hope and love.

 

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Pregnant and worried about the new corona virus

Home » Harvard Health Blog » Pregnant and worried about the new coronavirus?Harvard Health Blog Posted March 16, 2020, 2:30 pm , Updated March 18, 2020, 10:14  Huma Farid, MD – Contributor   Babar Memon, MD, MSc – Contributor

COVID-19, the disease caused by a new coronavirus, has rapidly spread globally. The World Health Organization recently labeled COVID-19 a pandemic. Many of my pregnant patients have expressed concerns, both for themselves and their babies, about the impact of COVID-19 on their health. To answer often-asked questions about pregnancy and the new coronavirus, I’ve teamed up with my husband, an infectious disease specialist and internist. Together, we reviewed the extremely limited data available to provide evidence-based responses below.

Pregnancy and the new coronavirus

As you probably know, the virus spreads through respiratory droplets sent into the air when a person who has COVID-19 coughs or sneezes. It may also spread when someone touches a surface infected by a person who has the virus.

What can I do to protect myself against catching the new coronavirus?

The most important step is to practice excellent hand hygiene by frequently washing hands with soap and water for 20 seconds. Avoid touching your eyes, mouth, and nose. You should also avoid large gatherings. Social distancing is important to limit the spread of the virus. If you have a mild cough or cold, stay at home and limit exposures to other people. Sneeze and cough into a tissue that you discard immediately, or into your elbow, to avoid making others sick. Hydration and adequate rest also are important in maintaining the health of your immune system.

As a pregnant woman, what is my risk of becoming very ill from COVID-19?

Given that this is a novel virus, little is known about its impact on pregnant women. At this point, experts think that pregnant women are just as likely, or possibly more likely, than the general public to develop symptoms if infected with the new coronavirus. Current information suggests symptoms are likely to be mild to moderate, as is true for women (and men) in this age range who are not pregnant.

If I am pregnant and have COVID-19, does this increase the risk of miscarriage or other complications?

There does not appear to be any increased risk of miscarriage or other complications such as fetal malformations for pregnant women who are infected with COVID-19, according to the Centers for Disease Control and Prevention (CDC). Based on data from other coronaviruses, such as SARS and MERS, the American College of Obstetricians and Gynecologists notes that pregnant women who get COVID-19 may have a higher risk for some complications, such as preterm birth, but the data are extremely limited and the infection may not be the direct cause of preterm birth.

If I get sick from the new coronavirus, what is the risk of passing the virus onto my fetus or newborn?

A study of nine pregnant women who were infected with COVID-19 and had symptoms showed that none of their babies were affected by the virus. The virus was not present in amniotic fluid, the babies’ throats, or in breast milk. The risk of passing the infection to the fetus appears to be very low, and there is no evidence of any fetal malformations or effects due to maternal infection with COVID-19.

I tested positive for COVID-19. Can I breastfeed my baby?

Currently, there is no evidence of the virus in breast milk. Given that the virus is spread through respiratory droplets, mothers should wash their hands and consider wearing a face mask to minimize infants’ exposure to the virus.

Can I travel for my baby-moon?

We recommend avoiding all travel at this time, given the concerns that the virus could be widespread, and the uncertainty for travel restrictions (see CDC travel advisories).

Should I reschedule my baby shower because of the new coronavirus?

While a baby shower is a joyous and important occasion, public health agencies such as the CDC recommend social distancing to limit the spread of the virus. Particularly in large gatherings, the risk of possible exposure and infection is quite high. We recommend limiting social gatherings at this time.

What should I do if I have a fever or cough, have traveled from a country in which the virus is widespread, or have been in contact with a person confirmed to have COVID-19?

Every hospital has specific rules for the best way to handle these situations. The first step is to call your doctor’s office to inform them of your symptoms, travel, or contact with someone who has a confirmed case of COVID-19. Do not simply go to your doctor’s office. It is very important to limit the spread of the virus. Particularly if you have symptoms, it is best to call your doctor first to determine whether you need testing and/or to come in for evaluation.

I am worried that doctors, even obstetricians, will be diverted in an emergency setting and may not be available when I am delivering. Will that be the case?

At this time, there is no plan for any other doctors to be pulled from their regular duties to staff other parts of the hospital. Obstetrics is an essential component of health, and it is unlikely that an ob/gyn will not be present at the time of your baby’s birth. Ask your health care team about this.

For more information about the new coronavirus and COVID-19, please see Harvard Health Publishing’s Coronavirus Resource Center.

Source: https://www.health.harvard.edu/blog/pregnant-and-worried-about-the-new-coronavirus-2020031619212?utm_campaign=shareaholic&utm_medium=email_this&utm_source=email]

Is it ethical to recruit doctors from countries with physician shortages?

cjWendy Glauser  2019 May 6; 191(18): E512–E513.

To help address its physician shortage, Nova Scotia is recruiting doctors in the UK.

As Nova Scotia looks to the United Kingdom for doctors, and Britain comes under fire for importing more doctors than it trains, health human resource experts are calling for ethical and local solutions to Canada’s physician shortage.

Staff from the Nova Scotia Office of Immigration, the Nova Scotia Health Authority and the College of Physicians and Surgeons of Nova Scotia recently traveled to four cities in England and Scotland to meet with 36 doctors interested in working in the province. The Nova Scotia Office of Immigration launched a fast-track immigration stream for recruiting and processing doctors last year, according to Lynette MacLeod, a media relations adviser for the office.

Meanwhile, the UK is facing its own physician shortage. According to data from the General Medical Council, 53% of new physician hires at the National Health Service (NHS) come from another country, up from 39% in 2015. Simon Stevens, head of the NHS, called on Britain to stop “denuding low-income countries of health professionals they need.” Most of the recruits come from eastern Europe and India.

Ivy Bourgeault, who holds the Canadian Institutes of Health Research Chair in Gender, Work and Health Human Resources, says it is “not ethical” to recruit from the UK. “They have incredible shortages of GPs … this is being exacerbated by Brexit,” she says.

In Nova Scotia, however, the focus is on the shortage at home. Grayson Fulmer, senior director of medical affairs for the Nova Scotia Health Authority, pointed out that 5% of Nova Scotians are in need of a family doctor. “Just as Nova Scotian physicians are lured to other work environments for competitive offerings, we have a duty to our population to provide access to health care wherever possible,” Fulmer wrote in a statement. “This is a timely and complex issue.”

With 25% of its doctors educated abroad, Nova Scotia’s foreign-trained doctor ratio is in line with Ontario and other provinces. (In Saskatchewan, meanwhile, 50% of doctors are foreign-trained). Overall, data from the Canadian Medical Association show that, in 2018, around 26% of doctors working in Canada were trained abroad. That percentage has held steady over the last decade. Many come from low- and middle-income countries.

“Our dependency ratio on foreign-trained doctors hasn’t really shifted. It’s built into the body and soul of the Canadian health system,” says Ronald Labonté, a Canada Research Chair in Contemporary Globalization and Health Equity. “Under that sort of circumstance, I think Canada has a larger moral obligation to … make sure there are adequate resource transfers to lower- or middle-income countries.”

Numerous suggestions have been floated about how high-income countries could compensate lower-income countries for the brain drain, such as increasing foreign aid, but none have been adopted. Labonté proposes that income tax gathered from doctors from nations with severe physician shortages could be funnelled back to their home countries. No matter how compensation is structured, it should be invested in these countries’ health systems, Labonté argues, to address the common “push factors” that cause doctors to leave — namely, that they are underpaid and working in under-resourced health systems.

Bourgeault says Canada should be taking steps internally to solve its physician distribution and supply issues. “We need to be doing better at health workforce planning, which we are pathetic at,” she says. “It’s inexcusable, that as a high-income country that has invested millions in data on the patient side, we don’t invest the money [to gather and analyze] the data on the health workforce side.”

In addition to better health workforce planning, Canada should focus on increasing rural training opportunities, streamlining processes for licensure in multiple provinces, exploring how to “bring Canadian physicians back” if they are practising abroad, and better utilizing nurse practitioners and physician assistants, Bourgeault suggests.

She adds that recruiting abroad is typically not an effective measure to fill needs in rural areas in the long term. A 2012 study found that a majority of international medical graduates practising in Newfoundland left the province after gaining full licensure. “You have to look at the broader ethics of recruiting, and most people don’t,” says Bourgeault, who estimates that Canada saves about $1 million in training costs for each foreign-trained physician hired.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509029/

 

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Heatwaves Linked to Greater Risk of Preterm Births

By Traci Pedersen  Associate News Editor   Last updated: 26 Feb 2020

A new study reveals that heatwave exposure during the week before birth is strongly linked to an increased risk of preterm delivery — the hotter the temperature or the longer the heatwave, the greater the risk. In particular, longer duration heatwaves are associated with the highest risk of a preterm birth.

“We looked at acute exposure to extreme heat during the week before birth, to see if it triggered an earlier delivery,” said first author Sindana Ilango, a Ph.D. student in the Joint Doctoral Program in Public Health at the University of California (UC) San Diego and San Diego State University. “We found a consistent pattern: exposure to extreme heat does increase risk. And, importantly, we found that this was true for several definitions of “heatwave”. The findings are published in the journal Environment International.

“We knew from previous studies that exposure to extreme heat during the last week of pregnancy can accelerate labor,” said senior author Tarik Benmarhnia, Ph.D., assistant professor of epidemiology at UC San Diego School of Medicine and Scripps Institution of Oceanography.

“But no one had tried to figure out exactly what kinds of conditions could trigger preterm births. Is it the temperature? Is it the combination of the temperature and the humidity? Is it the duration of the heatwave? It’s important to ask these questions to know when we need to intervene and inform pregnant people to stay inside and stay cool.”

Preterm birth is defined as birth before 37 weeks of pregnancy, which typically lasts at least 40 weeks. Early birth can cause a variety of health problems in infants, from respiratory and cardiac ailments and difficulty controlling body temperature to increased risk for brain hemorrhages and long-term health concerns such as cerebral palsy, mental health issues, learning difficulties, and vision and hearing problems.

“Identifying risk factors that can contribute to increased preterm birth rates is an important piece of improving birth outcomes,” Ilango said. While previous studies of this kind have been conducted in other countries, including Canada, China, and Australia, this is the first of its kind to be completed in the United States.

The new study also incorporated information about ambient humidity into the data, which affects the “feels like” temperature in a region.

“In coastal California, due to climate change, we’re seeing more humid heat waves,” said Benmarhnia. “Humid air holds heat longer, which can keep temperatures high overnight, contributing to longer heatwaves. This could be important for the recommendations given to pregnant people — it might not be enough to stay inside just during the day, we might have to think about what to do for night temperatures, too.”

The research team used data collected by the California Department of Public Health that included information about every single birth in the state of California between 2005 and 2013, comprising nearly 2 million live births during the summer months. Then they categorized individuals based on their zip code and compared the birth outcome data to environmental records for that area at the time the woman went into labor.

“California is an interesting region for this study because it has a very diverse population spread across a wide variety of microclimates, providing a lot of variation in the data to help us tease apart the relationship between high temperatures and preterm birth rates,” said Benmarhnia.

The researchers found that while the baseline rate of preterm birth was around 7 percent of all pregnancies, under the most conservative definition classifying a heatwave (an average maximum temperature equal to or greater than the 98th percentile, averaging 98.11 degrees and lasting at least four days), the risk of preterm birth was increased by 13 percent.

While the results were in line with the researchers’ hypothesis, “it was surprising how strong the trend was,” said Ilango. “It was so clear that as temperature and duration of a heatwave went up, so did the risk of preterm birth.”

“We were also surprised to note that the duration of the heatwave seems to be more important than the temperature threshold,” added Benmarhnia. “We thought that temperature would matter the most, but it turns out that it has more to do with how long you’re stuck with the high temperatures rather than how hot it is outside.”

These findings could be used for directly informing recommendations for families faced with high temperatures in their region, as communities use regional weather trends to determine how they define a heatwave and when to issue warnings for pregnant people to stay in air conditioned spaces.

Source: University of California- San Diego https://psychcentral.com/news/2020/02/26/heatwaves-linked-to-greater-risk-of-preterm-births/154502.html

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How to protect your family’s mental health in the face of corona virus disease (COVID-19)

A conversation with adolescent psychology expert Dr. Lisa Damour.

By UNICEF

Parents and children are facing major life disruptions with the outbreak of coronavirus disease (COVID-19). School closures, physical distancing, it’s a lot to take in and it’s difficult for everyone in the family. We sat down with expert adolescent psychologist, best-selling author, monthly New York Times columnist and mother of two Dr. Lisa Damour to learn more about how families can support each other and make the most of this new (temporary) normal.

UNICEF: How can teenagers and parents take care of their mental health during the coronavirus disease (COVID-19) outbreak?

Dr. Damour: The first thing that parents can do is actually to normalize the fact that they [teenagers] are feeling anxious. Many teenagers have the misunderstanding that anxiety is always a sign of mental illness when in fact, psychologists have long recognized that anxiety is a normal and healthy function that alerts us to threats and helps us take measures to protect ourselves. So it’s very helpful for teenagers if you say, “You’re having the right reaction. Some anxiety right now makes sense, you’re supposed to feel that way. And that anxiety is going to help you make the decisions that you need to be making right now.” Practicing social distancing, washing your hands often and not touching your face — your anxiety will help you do what needs to be done right now, so that you can feel better. So that’s one thing we can do.

Another thing we can do is actually help them look outward. Say to them, “Listen, I know you’re feeling really anxious about catching coronavirus, but part of why we’re asking you to do all these things  — to wash your face, to stay close to home — is that that’s also how we take care of members of our community. We think about the people around us.” And then give them further things to do that may be of help: perhaps dropping off food to people in need or going shopping for them or figuring out what areas of our community need support and doing things to support the people around them while maintaining social distance. Finding ways to care for others will help young people feel better themselves. And then the third thing to help with anxiety is to help young people find distractions. What psychologists know is that when we are under chronically difficult conditions — and this is certainly a chronically difficult condition that’s going to go on for a while — it’s very helpful to divide the problem into two categories: things I can do something about, and then things I can do nothing about. There’s going to be a lot in that second category right now, where kids are going to have to live with a pretty difficult situation for a while. Researchers have found that finding positive distractions can help us deal with that second category: we do our homework, we watch our favourite movies, we get in bed with a novel. That is a very appropriate strategy right now. There’s probably a lot to be said for talking about coronavirus and anxiety as a way to seek relief, and there is also a lot to be said about not talking about it as a way to seek relief. Helping kids find that right balance will make a big difference.

UNICEF: On distractions, it’s going to be tempting for a lot of teenagers to bury themselves in screens right now. How can parents and teenagers best handle that?

Dr. Damour: I would be very up front with a teenager and say, “Okay, you and I both know you’ve got a heck of a lot of time on your hands, but you and I both know that it’s not going to be a good idea to have unfettered access to screens and/or social media. That’s not healthy, that’s not smart and it may amplify your anxiety. We really don’t think you having a social media free-for-all is a good idea under any condition. So the fact that you’re not in school and your time isn’t being taken up by classes doesn’t necessarily mean that all of that time should be replaced with social media.” But I think you just say that in a very up-front way which acknowledges that, naturally, there’s no way that the time spent in school will be entirely replaced with being online. And then ask the teenager, “How should we handle this? What should our plans be? What do you propose in this new normal or new short-term normal. Your time is no longer structured in the ways you’re accustomed to, come up with a structure and show me the structure that you have in mind, and then we can think it through together.”

UNICEF: Is structure key to maintaining a sense of normalcy?

Dr. Damour: Kids need structure. Full stop. And what we’re all having to do, very quickly, is invent entirely new structures to get every one of us through our days. And so I would strongly recommend that parents make sure that there’s a schedule for the day, that there’s a plan for how time will be spent — and that can include playtime where kids can get on their phones and connect with their friends, which of course they’re going to want to do. But it also should have technology-free time, time set aside to help with making dinner, time to go outside. If you can be outside you should. We need to think about what we value and we need to build a structure that reflects that, and it will be a great relief to our kids to have a sense of a predictable day and a sense of when they’re supposed to be working and when they get to play. I would say for kids under the age of 10 or 11, the parent should come up with a structure and then negotiate from there with their child and see if there’s any feedback that makes good sense. For children 10 and 11 or older, I would ask the child to design it — and give them a sense of the kinds of things that should be part of that structure, and then work with what they create.

UNICEF: What tips would you give parents who are building a structure for younger children?

Dr. Damour: I think we have to recognize that younger kids actually do sit in class for periods of the day and tolerate the interruptions and annoyances of a lot of kids around them, and they won’t have to tolerate those when they’re at home. Which is to say that I don’t think we should underestimate their ability to work in a focused way from home. That said, every family knows their child best and it may be ideal, depending on who is supervising them (I realize that not every parent is going to be home to do this), to structure their day so that all of those things that need to get done get done before anything else happens: All of their schoolwork, all of their chores, all of their have-to-do activities versus get-to-do activities. For some families, doing that at the start of the day will work best for kids. Other families may find that it works well to start the day a little bit later, to sleep in, to enjoy a longer breakfast together, and then get rolling at 10 or 11 in the morning. Every family gets to do it their own way. I also want to add something that some people may be reluctant to voice: We’re stuck with this, so to the degree you can enjoy it — you should. If this means you’re making pancakes as a family for breakfast and that is something that was never a possibility on a normal school day and that’s something that makes everybody happy, enjoy that.

Here’s the bottom line: Kids need predictability — as much predictability as you can offer in a situation like this. So don’t wake up every day and figure out the schedule. Try a schedule, or maybe try a provisional one for a week as a family and then review it at the end of the week.

We should remember that they are the passengers in this and we are driving the car.”

UNICEF: How important is a parent’s own behaviour in a time of crisis?

Dr. Damour: Parents, of course, are anxious too and our kids know us better than we know ourselves. They will take emotional cues from us. I would ask parents to do what they can to manage their anxiety on their own time – to not overshare their fears with their children. That may mean containing emotions, which may be hard for parents at times especially if they’re feeling those emotions pretty intensely. I would want for parents to find an outlet for their anxiety that’s not their children. We should remember that they are the passengers in this and we are driving the car. And so even if we’re feeling anxious, which of course we will be, we can’t let that get in the way of them feeling like safe passengers in our car.

UNICEF: Should parents ask their children how they’re feeling on a regular basis or does that bring up more feelings of anxiety?

Dr. Damour: I think it depends on the kid. Some kids really keep to themselves and so it may be valuable for a parent to say, “How are you doing?” or “What are you hearing?” Other kids are going to be talking and talking and talking about it. The way we want to approach these things is to find a good balance between expression and containment. You want some expression and feeling, especially at a time when we should expect kids to have some pretty intense feelings, but you also want those emotions to feel contained. So if your kid is high on expression, you’re going to work on containment, if your kid is high on containment you’re going to help them with a little bit of expression.

UNICEF: Children may worry about catching the virus, but not feel comfortable speaking to their parents about it. How should parents approach the topic with them?

Dr. Damour: Parents should have a calm, proactive conversation with their children about the coronavirus disease (COVID-19), and the important role children can play in keeping themselves healthy. Let them know that it is possible that [you or your children] might start to feel symptoms at some point, which are often very similar to the common cold or flu, and that they do not need to feel unduly frightened of this possibility. Parents should encourage their kids to let them know if they’re not feeling well, or if they are feeling worried about the virus so that the parents can be of help. Adults can empathize with the fact that children are feeling understandably nervous and worried about COVID-19. Reassure your children that illness due to COVID-19 infection is generally mild, especially for children and young adults. It’s also important to remember that many of the symptoms of COVID-19 can be treated. From there, we can remind them that there are many effective things we can do to keep ourselves and others safe and to feel in better control of our circumstances: frequently wash our hands, don’t touch our faces and engage in social distancing.

UNICEF: There’s a lot of inaccurate information about corona virus disease (COVID-19) out there. What can parents do to help counter this misinformation?

Dr. Damour: Start by finding out what they are hearing or what they think is true. It’s not enough to just give your kid facts. If your child has picked up something that is inaccurate or picked up news that is not correct they will combine the new information you give them with the old information they have into a sort of Frankenstein understanding of what’s going on.  So ask them, “What are you hearing? When you see kids on social media or when you were last at the playground, what was being said?” Find out what they already know and start from there in terms of getting them on the right track. From there, adults should strongly encourage kids to trust and use reliable sources [such as UNICEF and the World Health Organization’s websites] to get information, or to check any information they might be getting through less reliable channels.

>> Get the latest information and tips to protect you and your family against the virus.

When it comes to having a painful feeling, the only way out is through.”

UNICEF: How can parents support their children who are experiencing disappointment due to cancelled events and activities?

Dr. Damour: Let them be sad and don’t try to guilt them out of it. Don’t say, “Other people have this worse than you.” Now your kid feels sad and guilty! That doesn’t make it better. Say to them, “You are having the right reaction. This really stinks. You’re not going to get to be with your friends. You’re not going to get to spend spring on college campus. You’re not going to get to go to this convention that you spent six months preparing for.” In the scope of an adolescent’s life these are major losses. And the other thing adults have to remember is we’ve never seen anything like this, and we’ve been around for a long time. They’ve never seen anything like this and they’re much younger. The disruption of four months in the life of a 14-year-old is a very great percentage of their time they remember being alive. This is bigger for them than it is for us.

A year in a teenager’s life is like seven years in an adult’s life. So, we have to have really high empathy for how big these losses feel. This is their one high school graduation for their whole life, this was their one sophomore spring on campus for their whole life. These are large-scale losses. Even if they’re not catastrophic, they’re really upsetting and rightly so to teenagers. So I would ask parents to expect and normalize that teenagers are very sad and very frustrated about the losses they are mourning and all kids are mourning losses right now. I happened to be around six teenagers yesterday who were leaving school who were deeply sad, and I said, “Go be sad. This is really yucky and this stinks, and you have every right to be sad.” When it comes to having a painful feeling, the only way out is through. When we allow people to feel sad, they usually feel better faster. So, empathy, empathy, support, support. Our kids deserve it. Our job as adults is to provide it. They’re having the right reaction. This is not what any of us would want.

UNICEF: What recommendations do you have for teenagers who are feeling lonely and disconnected from friends and activities?

Dr. Damour: This is where we now may appreciate social media in a whole new way! While adults can have such a jaundiced view of adolescents and social media, teenagers want to be with their friends. Under social distancing conditions: tada! They can be with their friends! Further, I would never underestimate the creativity of teenagers. My hunch is that they will find ways to play with one another online that are different from how they’ve been doing it before. And so I would not hold a dim view of all social media right now. I would just make sure that it’s not a wall-to-wall experience for kids because that’s not good for anybody.

UNICEF: What are some of the outlets teenagers can use to work through these difficult feelings and take care of their mental health?

Dr. Damour: I think every kid is going to do this in a different way. Some kids are going to make art, some kids are going to want to talk to their friends and use their shared sadness as a way to feel connected in a time when they can’t be together in person. Some kids are going to want to find ways to get food to food banks. I would just say know your kid, take your cues from your teenager, and really think a lot about balancing talking about feelings with finding distractions and allow distractions when kids need a relief from feeling very upset.

UNICEF: Some children are facing abuse at school or online around the coronavirus outbreak. What should a child do if they are experiencing bullying?

Dr. Damour: Activating bystanders is the best way to address any kind of bullying. Along these lines, all parents should tell their children that if they witness bullying, they should reach out to the victim or find an adult who can help.

UNICEF: How can parents make the most of the situation?  If you’re able to be with your kids, how can you have fun together while you’re stuck at home?

Dr. Damour: In our house — I have two daughters — we’ve decided that we are going to have a dinner team every night. We’re going to create a schedule of who’s in charge of dinner and sometimes it’ll be me and my spouse and sometimes it’ll be me and one of my daughters. We’ll mix it up in pairs, and my older daughter is a teen and my younger daughter is elementary-school age, so there will be nights where the two girls are in charge of things. And so, we rotate who is in charge of making dinner for the family. We often don’t get the time to make dinner as a family. We don’t usually have the time in the day to enjoy cooking together, so we’re doing that.

I have been making a list of all of the things I want to do with myself: the books I want to read and the things that I’ve been meaning to do — I’ve been meaning to teach my younger daughter how to knit and she’s been asking, so if she’s still interested we’ll be knitting! We’re thinking about having a movie night every three or four nights and we were thinking that the dinner team gets to choose the movie. Every family has their own rhythm and culture and the challenge right now is to invent structures — to pluck them out of thin air. But we can do that, and it’s what our kids need.

Source: https://www.unicef.org/coronavirus/how-protect-your-familys-mental-health-face-coronavirus-disease-covid-19

 

family

PREEMIE FAMILY PARTNERS

efoni

Coronavirus – Risks for preterm born infants: An interview with Professor Doctor Christoph Bührer

Posted on 09 March 2020

The Coronavirus disease (COVID-19) and its distribution is on everyone‘s lips and speculations run high. Especially older people and persons with a pre-existing medical condition appear to be develop a serious illness more often than others (WHO). This might leave parents-to-be, parents of preterm born infants and former preterms worrying. We talked to Professor Doctor Christoph Bührer, Medical Director Department of Neonatology, Charité Berlin about the risks he sees for unborn babies, preterm born infants and preterm born adults.

Professor Bührer, can corona virus pass from pregnant woman to her unborn infant?
At present, the most likely mode of transmission in all newborn infants with COVID-19 infection analysed so far is postnatal transmission. No case of intrauterine transmission has been documented. This do not exclude the possibility that transmission before birth may happen, but it is very unlikely.

What kind of risk of corona infection do you see for preterm born infants?
Infants, as compared to adults, have a much lower risk of getting infected with the new corona virus. Moreover, they are also less likely to develop symptoms. In China, only 9 infants less than 1 year of age were identified by early February 2020, at a time when the total number of infected people had already risen to more than 50,000. None of the infants with a positive test result was seriously ill, none of them was admitted to an intensive care unit. At present, there is no specific data for preterm infants available. As manuscripts on the epidemiology of COVID-19 are published at high speed, there is reason to assume that infants, both term and preterm, are just not the prime target of this virus. If a COVID-19 infection turns into pneumonia, preterm infants with bronchopulmonary dysplasia should be expected develop more serious symptoms (such as shortness of breath, increased rates of breathing, or poor oxygenation) than those with healthy lungs, so they would be more likely to be tested for COVID-19. However, there is lack of reports on COVID-19 ravaging preterm infants which is rather reassuring.

Is the risk of an infection higher for a preterm born adult?
If a COVID-19 infection turns into pneumonia, anybody with a chronic lung condition (such asthma, cystic fibrosis, or former preterm infants who had bronchopulmonary dysplasia) will have more trouble coping with the disease. These people may need more medical help than somebody who is completely healthy. As COVID-19 and flu (notably H1N1) have a similar attack rates, adults and adolescents born very preterm are advised to get vaccinated against influenza.

We would like to thank Prof Bührer for taking time to give this interview.

Note: To avoid infection with COVID-19 it is advisable to frequently wash your hands. If you want to promote handwashing in your organisation, find useful materials such as posters, flyers and colouring pictures at: www.efcni.org/activities/campaigns/wash-your-hands/

Source: https://www.efcni.org/news/coronavirus-risks-for-preterm-born-infants-an-interview-with-professor-doctor-christoph-buhrer/

 

dad.hat

World Prematurity Day 2019: How Fathers Can Take Care of Wife and Preemie

You need to comfort and support your baby and your partner and realize that you’re making a difference. Remember, the father can connect with the newborn from the very beginning.

News18.com  Updated: November 17, 2019, 11:20 AM IST

As a father, you are the first point of contact for the doctors after the birth of your baby. You are the first to learn about your premature baby’s condition and inform your partner, friends and family about the same.

The father can connect with the newborn from the very beginning. It has been found that men experience a surge in “bonding” hormones around the time their children are born. The earlier you hold your premature baby and engage in her care, the more likely you’re to feel satisfaction, affection and love for your baby. No wonder why they say, it’s an evolutionary response to turn men into dads!

You’re a vital member of the team at the Neonatal, Intensive Care Unit, that’s working to make your baby stronger. Being a NICU dad can be difficult but that’s when you need to step up and do all the things proactively. You need to comfort and support your baby and your partner and realize that you’re making a difference. The more time you spend in the NICU, the better it is for your child’s development.

Remember to take kangaroo care which is a simple act of spending a lot of time with your baby, wherein you maintain a constant skin to skin contact and constant communication with them. It is important to talk to the preemie as it aids in the development of their cognitive faculties. Know that your baby recognizes your voice and touch. According to American Academy of Pediatrics, skin-to-skin or kangaroo contact improves infant’s respiratory patterns and increases the rate of infant’s ideal weight gain.

It is important to being hands on with the daily care. You want to be involved in feeding, changing nappies or settling your baby which helps create one-on-one time with your baby.

Premature babies can get stressed easily and signs such as heart rate and oxygen levels are an indication of the same. You can always check with the nurse on what you can do.

Amidst all this, it’s normal and understandable to feel lost or stretched between responsibilities at home which includes looking after other children, hospital and work. Your needs can sometimes get forgotten too, with family and hospital staff focusing on your premature baby and your partner.

You may be undergoing a plethora of emotions; sometimes anxiety and fear and other times overwhelming love and pride. You and your partner may experience the same feelings but not always at the same time. Key is to be patient and to reassure her, help with the demand of pumping milk and praise her for her efforts.

It therefore becomes important to take some time out to spend with your partner. Couples therapy is a way to go about it. Couples should make it a point to spend time with each other as it not only strengthens their bond but also helps the baby to become accustomed to both the parents. If you’re in the NICU, it can also help your partner feel more confident about the situation. Your support can be of encouragement to her, for her well-being and mental health.

(Dr Preeti Gangan, IBCLC certified consultant, Pediatrician)

Source:https://www.news18.com/news/lifestyle/dad-step-in-how-to-take-care-of-your-wife-and-preemie-2389711.html

 

run.free

Preterm babies are more likely to be diagnosed with reactive attachment disorder

Date: March 12, 2020 Source: University of Turku

Summary:

Premature birth, low birth weight, and neonatal intensive care are associated with the risk of being diagnosed with reactive attachment disorder (RAD). The disorder causes problems in emotional bonding, social interaction, and expression of emotions, and it can lead to severe and expensive consequences later in life. The disorder will impair child’s social interactions and it is connected with later child protection issues, psychiatric and substance use disorders, and social exclusion.

A new study by the Research Centre for Child Psychiatry of the University of Turku, Finland, suggests that premature babies have the risk of reactive attachment disorder that can impair child’s ability to function in normal situations and their social interactions and it is connected with later child protection issues, psychiatric and substance use disorders, and social exclusion.

“The study showed that children’s risk of being diagnosed with reactive attachment disorder increases by three times if their gestational age at birth is less than 32 weeks. The risk was twofold if the birth weight was less than 2.5 kilos, or if the newborn required monitoring in a Neonatal Intensive Care Unit, says lead author,” researcher Subina Upadhyaya.

The results acknowledged parental age and psychiatric and substance abuse diagnoses, and mother’s socioeconomic status and smoking. Therefore, the association between attachment disorder and early preterm birth is not due to differences in these parental background or lifestyle differences between the diagnosed and the control group.

This is the first population study to report perinatal and obstetric risk factors for RAD. Previously, the research group discovered an association between parental mental health diagnosis, parental substance abuse and RAD.

Results support family-centered treatment

According to Professor in Child Psychiatry Andre Sourander from the University of Turku, the results benefit the planning of preventive and early mental health services.

“The fact that premature birth is so strongly associated with reactive attachment disorder is an important finding. It indicates that family-centered support of early parent-infant interactions and need for care should be taken into account when treating premature babies, says Sourander,” who led the study.

Sourander says that most of the children in the study were born in the 1990s and early 2000s. Treatment practices have changed since then in many countries.

“The management of premature infants should be multidisciplinary and personalised. Parent-infant interaction and family-centered care have recently received attention, and the care of premature infants has become increasingly comprehensive. The practice of skin-to-skin care is increasingly becoming popular worldwide. Early parental-infant closeness should be encouraged in centers that care for preterm infants.

“In the future, it is important to determine whether the independent relationship of prematurity to RAD has decreased as treatment practices have changed,” Professor Sourander concludes.

All the children who were born in Finland between 1991-2012 and diagnosed with RAD were included in the study. There were a total of 614 cases and 2423 controls. The study was part of Inequalities, Interventions, and New Welfare State research flagship funded by Academy of Finland.

Source: https://www.sciencedaily.com/releases/2020/03/200312101031.htm

 

peeps.provide

HEALTHCARE PARTNERS

news.med

More internationally educated nurses in hospitals may result in a stable nursing workforce

Having more nurses trained outside of the United States working on a hospital unit does not hurt collaboration among healthcare professionals and may result in a more educated and stable nursing workforce, finds a new study by researchers at NYU Rory Meyers College of Nursing published in the journal Nursing Economic$.

Internationally educated nurses–who receive their primary nursing education outside of the country where they currently work–have become an important part of the nursing workforce in many countries. In the U.S., recruiting internationally educated nurses has been used to address nursing shortages. While the true number of internationally educated nurses in the U.S. is difficult to capture, it is estimated that 5.6 to 16 percent–or 168,000 to 480,000–of the country’s more than 3 million nurses were educated in another country.

Internationally educated nurses often face challenges when transitioning to practice in the U.S. because of cultural, language, and healthcare system differences. While internationally educated nurses can help mitigate nursing workforce shortages, there is little research on their impact on quality of care and patient outcomes, and the findings have been mixed.

In this study, the researchers looked at the proportion of internationally educated nurses on hospital units and evaluated whether this affects collaboration among health professionals and other factors of hospital units. They used 2013 survey data from the National Database of Nursing Quality Indicators, analyzing responses from 24,045 nurses (2,156 of whom were trained outside the U.S.) working on 958 units across 160 U.S. acute care hospitals. Collaboration on a unit was measured using a nurse-nurse interaction scale and a nurse-physician interaction scale.

The researchers found having more internationally educated nurses did not lead to decreased collaboration among nurses and between nurses and physicians. This is important because collaboration among healthcare professionals is a fundamental aspect of quality work environments and can result in positive patient outcomes and satisfaction.

Interestingly, units with higher proportions of internationally educated nurses had notable differences, including factors that could both help and hurt patient care. For example, units with more internationally trained nurses had nurses with higher levels of education, which may be because internationally educated nurses are more likely to have a baccalaureate degree in order to qualify for and pass the U.S. nursing licensure exam.

“Research shows that having more nurses with bachelor degrees improves patient safety, so it is possible that internationally educated nurses are contributing to improved health outcomes,” said Ma.

Units with more internationally trained nurses also had less turnover, as these nurses are likely to stay in a job longer than their U.S.-educated peers.

“In other words, units with more internationally educated nurses have a more stable nursing workforce. Not only can lower turnover rates reduce recruiting and hiring expenses, but they are also linked to fostering collaborative environments among nurses,” said Ma.

In contrast, units with more internationally trained nurses had worse nurse staffing levels or higher patient-to-nurse ratios, despite these nurses being recruited to address shortages. Worse staffing levels have been shown to hurt collaboration and could potentially worsen patient outcomes.

The researchers note that hospitals and nurse recruitment agencies can play important roles helping to integrate internationally educated nurses into the U.S. workforce–for instance, providing training on the basics of the U.S. healthcare system, creating peer mentoring programs, and running workshops on culture, communication, and teamwork.

“Given the ongoing nursing workforce shortage, especially in rural areas, nurse managers and hospital administrators should not be reluctant to hire qualified internationally educated nurses to fill vacancies,” said Ma. “In addition, nurse managers and peer nurses should recognize the contributions of their internationally educated colleagues, who are part of more stable, educated nursing teams. Recognizing the value of individual nurses can lead to a healthy work environment and workforce, which contributes to high quality patient care and outcomes.”

Source: https://www.news-medical.net/news/20200218/More-internationally-educated-nurses-in-hospitals-may-result-in-a-stable-nursing-workforce.aspx?utm_source=news_medical_newsletter&utm_medium=email&utm_campaign=nursing_newsletter_9_march_2020

 

nationwide

Severe BPD Ventilator Strategies: A Quick Guide

Prevention of bronchopulmonary dysplasia (BPD) is a primary focus of treatment when an infant is born preterm. An infant who needs ventilator support does best with low tidal volumes and short inspiratory times to try and prevent lung injury during the acute course of lung disease.

However, once lung injury has occurred and the patient is diagnosed with BPD, some patients are still taken care of as if they have acute lung disease, says Leif Nelin, MD, chief of the Division of Neonatology at Nationwide Children’s Hospital and a founder of the national Bronchopulmonary Dysplasia Collaborative. In fact, ventilator strategies and settings must change dramatically after severe BPD is established. The collaborative has published a review of best practices for the interdisciplinary care of children with severe BPD, and included recommendations for ventilator and gas exchange strategies. This chart provided is a guide, adapted from those recommendations and current clinical practice at Nationwide Children’s Hospital.

This chart, adapted from the Bronchopulmonary Dysplasia Collaborative, shows the differences in strategies between the first week of life, when prevention is the goal, and later, when severe BPD has been established ENTER HERE: https://www.nationwidechildrens.org/for-medical-professionals/tools-for-your-practice/connect-with-nationwide-childrens/pediatrics-online/severe-bpd-ventilator-strategies

med.press

Babies born prematurely can catch up their immune systems, study finds

by King’s College London – March 9, 2020

Researchers from King’s College London & Homerton University Hospital have found babies born before 32 weeks’ gestation can rapidly acquire some adult immune functions after birth, equivalent to that achieved by infants born at term.

In research published today in Nature Communications, the team followed babies born before 32 weeks gestation to identify different immune cell populations, the state of these populations, their ability to produce mediators, and how these features changed post-natally. They also took stool samples and analysed to see which bacteria were present.

They found that all the infants’ immune profiles progressed in a similar direction as they aged, regardless of the number of weeks of gestation at birth. Babies born at the earliest gestations—before 28 weeks—made a greater degree of movement over a similar time period to those born at later gestation. This suggests that preterm and term infants converge in a similar time frame, and immune development in all babies follows a set path after birth.

Dr. Deena Gibbons, a lecturer in Immunology in the School of Immunology & Microbial Sciences, said: “These data highlight that the majority of immune development takes place after birth and, as such, even those babies born very prematurely have the ability to develop a normal immune system.”

Infection and infection-related complications are significant causes of death following preterm birth. Despite this, there is limited understanding of the development of the immune system in babies born prematurely, and how this development can be influenced by the environment post birth.

Some preterm babies who went on to develop infection showed reduced CXCL8-producing T cells at birth. This suggests that infants at risk of infection and complications in the first few months of their life could be identified shortly after birth, which may lead to improved outcomes.

There were limited differences driven by sex which suggests that the few identified may play a role in the observations that preterm male infants often experience poorer outcomes.

The findings build on previous findings studying the infant immune system.

Dr. Deena Gibbons: “We are continuing to study the role of the CXCL8-producing T cell and how it can be activated to help babies fight infection. We also want to take a closer look at other immune functions that change during infection to help improve outcomes for this vulnerable group.”

Source: https://medicalxpress.com/news/2020-03-babies-born-prematurely-immune.html

 

central

Emotional First Aid for Those on the Front Lines of COVID-19

By Nicholette Leanza, MEd, LPCC-S    Last updated: 31 Mar 2020

The stress that COVID-19 has placed on our health care workers is immense. Exhaustion, frustration and feeling overwhelmed has become a daily norm for many of our beloved medical professionals who are on the frontlines fighting COVID-19. Hospitals struggle to find space to help those with the virus while at the same time continuing to care for all their other patients too. “All hands on deck” is not just a term used for a crew of a ship but can now also be used for a crew of a hospital.

During this very difficult time, it’s more important than ever that we take care of our doctors, nurses and other health care professionals as we battle this pandemic. Since these are unprecedented times, typical stress management techniques are not enough to help these caring professionals deal with their stressful jobs. They need an emotional first aid kit to promote a resilient mindset as they battle this devastating virus.

Here are some emotional first aid tips to help those on the front-lines battling COVID-19:

You are not alone.

At times, it can feel like a lonely and uphill battle fighting COVID-19, especially after a long and grueling shift. Remember you are not alone; you are part of a medical team and system fighting this pandemic and can also feel confident that your loved ones and your community are behind you in this fight. The duty to care and to protect others is probably part of what drives you to get up and go to work every day, but just remember you are not doing it alone. You are part of a band of brothers and sisters combatting this virus. We are truly all in this together.

Compassion for Yourself

It’s more important than ever to remember to be kind to yourself during this challenging time. You are dealing with frustration and grief everyday especially as we continue to understand and get ahead of this virus.

You are probably surrounded by the virus every moment of your day as you care for your patients at work and then come home where your loved ones are talking about it as well. You may not even be able to escape it as the media inundates us with information about COVID-19 throughout the day. The ultimate compassion you can show yourself is to soothe your stress in whatever way that works best for you.

Find moments throughout your day where you take a mental break and decompress. Self-care is key! Sleep, hydrate, exercise, connect with family/friends, play video games, watch Netflix. Pamper yourself. Don’t forget to enjoy your pets, they miss and love you too.

Know Your Worth

You may already know that you do a very important job but now more than ever, you will be a part of history as we battle this epic virus. You are brave and courageous. You persevere even when you’re so exhausted both mentally and physically. Be proud of the work you do each day and who you are. Society salutes you and stands behind you and let this be the motivation that helps keep you going.

Know that this is not going to last forever.

There are so many unknowns related to COVID-19 which is what instills a lot of collective anxiety but do know that this pandemic will end. There will be a point when we will be able to breathe easier and slow down. We will have learned so much not just about COVID-19 but about ourselves and our resilience as a species on this planet. We may only initially remember the dire effects of the pandemic, such as the grief and loss it brought to us, the loss life as well as the limits to our freedom as we abided by the safety measures to contain the virus. But do believe that ultimately, we will prevail as we always do to overcome hardship as a collective human spirit.

Please use this emotional first aid kit as a tool for yourself as you care for those with COVID-19. Please remember to be grateful for your team as you are not alone in this fight, to be compassionate and gentle with yourself as you are such an important soldier in this battle that will not last forever because we will win the war. Thank you for all that you do

Source: https://psychcentral.com/blog/emotional-first-aid-for-those-on-the-front-lines-of-covid-19/

bridge

5 ways to bridge the global health worker shortage

world.econ

A shortage of health workers is pervasive across most countries – and the most worrying aspect is that this gap is increasing. Aggravating the issue is the unmet need for upskilling and reskilling that new disease patterns and emerging technology in healthcare continuously demand.

This shortfall is captured by the following statistics:

Add to this the rising incidence of non-communicable diseases (NCDs) and growing geriatric population – these will generate a demand for 40 million additional health workers globally by 2030. This would require doubling our current global health workforce.

This is a formidable target, unless steps to correct the situation are implemented with a sense of urgency. Without timely action, a shortfall of 18 million workers is predicted by 2030, along with a resultant annual cost to healthcare of $500 billion, due to health workforce inefficiency.

It is therefore imperative to address the shortage of healthcare workforce across the gamut – doctors, nurses, allied health professionals, community outreach workers. We must be on a war footing if we are to meet the UHC targets within set timelines.

There is no alternative to investing in human resources for health; sustainable funding models have to be a critical part of the strategy. A report by the High-Level Commission on Health Employment and Economic Growth reveals return on investment in health at a ratio of 9:1. A further one extra year of average life expectancy has been shown to raise GDP per capita by about 4%.

Addressing the global health workforce shortage has to be a key priority area in national development agendas. Useful steps in a multi-stakeholder participation would include:

  1. Strengthening governance frameworks

Setting up strong governance frameworks to guide medical education, health employment, international exchange of medical services, migration of health workers, and innovative partnership models is crucial. Fostering sustainable PPPs would require strengthening of institutional models with high-quality and accessible cross-sectoral inputs, such as finance, education, training, among others.

  1. Harnessing technology

The healthcare industry is fast-tracking use of e-health and e-learning techniques, AI, VR simulation and the internet of things to train, upskill and empower health workers. From personalized wearable devices for home-based care, to point of care, drone technology and telemedicine strategies for outreach remote healthcare, all are revolutionizing healthcare delivery. The scaling-up is rapid, based on big data and analytics, and these emerging technologies are also generating more demand for new skills, increasing the potential to employ more in digital healthcare delivery.

A clear roadmap to align technology and the workforce is critical. In India, for instance, the thinktank NITI Aayog, in the National Strategy for Artificial Intelligence and Strategy for New India @75, has already set out plans to bring technology and innovation at the core of healthcare & related policy formations, a crucial step for augmenting healthcare resources.

  1. Rebalancing healthcare tasks

As per an OECD global survey, 79% of nurses and 76% of doctors were found to be performing tasks for which they were over-qualified. Given the global evidence for the poor distribution of skills, we must rationally re-organize our workforce for effective management of high-burden diseases, particularly NCDs, which are responsible for 71% of the global mortality and, unless addressed, could cost the world $30 trillion by 2030.

Nurses and GPs can be trained with the essential skill set that enables them to perform select live-saving procedures, recognize acute conditions in time, and make referrals to relevant specialists. This will not only reduce high dependency on limited specialists available worldwide, but also reduce cost and time needed to scale up additional workforce.

  1. Developing new care models

Health systems designed around hospitals and clinics need to shift focus towards preventive care, and encourage a holistic health approach encompassing all socio-economic determinants of health. New care models should be created, with a “hub and spoke” arrangement of assets, and workforce trained to provide high-quality, community-based, integrated healthcare, focused on disease surveillance, prevention & ambulatory care. This will not just help avoid unnecessary in-patient and emergency room visits, but will also result in better health outcomes for the community at large.

  1. Creating a sustainable and gender-balanced workforce

Evidence points towards gender imbalance and disparities in health employment and the medical education system. According to the WHO, globally only 30% of doctors are females and more than 70% of nurses are females. A similar trend is seen in India, where the majority of the nursing workforce is comprised of women, but only 16.8% of allopathic doctors are females. As per ILO data, gender wage gaps are also a cause for concern. We need pro-active steps to create a balanced healthcare workforce that addresses the issue of gender inequity and ensure equal pay for work of equal value, a favorable working environment, and targets investments towards training the female workforce.

Globally, too there needs to be better mapping of healthcare resources to facilitate collaborations in medical education and exchange programs between countries. For instance, several countries have similar course curriculums for nursing; however, cultural aspects sometimes pose problems. For instance, Sweden and India have a similar nursing curriculum, and there is great potential to encourage exchange of nurses, but the potential for exchange is restricted due to linguistic barriers. This can be easily overcome, and more conducive arrangements put in place to facilitate exchange of healthcare workers.

It is time for all stakeholders in healthcare, be it in the domains of policy, medical education, training or financing, to align with each other on specific issues and targets, and implement steps to augment healthcare workforce productivity towards creating a population-centric workforce.

Source: https://www.weforum.org/agenda/2019/07/5-ways-to-bridge-the-global-health-worker-shortage/

 

INNOVATIONS

zatt

rwEXPANSION OF THE SAVING MATERNAL AND NEWBORN LIVES IN REFUGE SETTINGS (CAMAROON- NIGER- CHAD): SUMMARY OF BASELINE ASSESSMENT

Published 10 Jan 2020

Access to quality health services is essential for women and newborns in refugee contexts. In times of conflict, displacement, or humanitarian emergency, neonatal and maternal health is often compromised and the availability of maternal, newborn, and family planning services becomes even more important.

In line with UNHCR’s mandate and with support from the Bill and Melinda Gates Foundation (BMGF), UNHCR has extended the “Saving Maternal and Newborn Lives in Refugee Settings” project to three further refugee situations in Cameroon, Niger and Chad. With the aim to improve newborn and maternal health, the two-year project is focusing on low cost, high impact maternal and newborn interventions, ensuring that every refugee mother and newborn has the chance to live a healthy life.

Context

Following successful interventions to strengthen maternal and newborn health services in Jordan, South Sudan and Kenya, UNHCR has launched “Expansion of the Saving Maternal and Newborn Lives in Refugee Contexts” in selected refugee operations in Niger, Cameroon and Chad. The project aims to scale up and to consolidate lifesaving newborn, maternal, and family planning interventions. This also includes quality family planning services, recognizing the important role of family planning in reducing maternal and neonatal morbidity and mortality, preventing unwanted pregnancies, reducing rates of abortion (including unsafe abortion), and reducing the risks of adolescent pregnancy.

A baseline assessment was conducted in the targeted refugee sites, including health facility assessments; interviews of program managers and front-line health providers to gather in-depth information about their practices, needs, and perceived gaps in care; and focus group discussions with community members which provided valuable insight into community perceptions of health services as well as traditional beliefs and practices.

Chad, Cameroon and Niger were chosen for this project due to their poor reproductive health indicators as well as high burden of refugee populations in the countries. Each of the three countries are facing similar challenges, including poorly funded health systems and under resourced and under staffed health facilities, particularly at the district hospital level. Remote locations, poor roads, and regular influxes of new refugees further complicate operations. Insecurity and violent attacks limit access and care provision, particularly in the Malian camps of Niger and Sudanese camps of Eastern Chad, some of which are only accessible with a military escort.

Source: https://reliefweb.int/report/cameroon/expansion-saving-maternal-and-newborn-lives-refugee-settings-project-cameroon-niger

 

eye

A fundus image shows an eye with aggressive posterior retinopathy of prematurity (AP-ROP). The i-ROP DL deep learning system quantified the dilation and tortuosity of the retinal vessels, which both occur to a high degree in AP-ROP.

AI may help spot newborns at risk for most severe form of blinding disease

NEI-funded device under FDA review; AI-based metrics bring clarity to aggressive posterior retinopathy of prematurity diagnosis – March 4, 2020

An artificial intelligence (AI) device that has been fast-tracked for approval by the Food and Drug Administration may help identify newborns at risk for aggressive posterior retinopathy of prematurity (AP-ROP). AP-ROP is the most severe form of ROP and can be difficult to diagnose in time to save vision. The findings of the National Eye Institute-funded study published online February 7 in Ophthalmology.

“Artificial intelligence has the potential to help us recognize babies with AP-ROP earlier. But it also provides the foundation for quantitative metrics to help us better understand AP-ROP pathophysiology, which is key for improving how we manage it,” said the study’s lead investigator, J. Peter Campbell, M.D., M.P.H., Casey Eye Institute, Oregon Health and Science University in Portland.

Babies born prematurely are at risk for retinopathy. That is, they have fragile vessels in their eyes, which can leak blood and grow abnormally. If left untreated, vessel growth can worsen and cause scarring, which can pull on and cause detachment of the retina, the light-sensing tissue at the back of the eye. Retinal detachment is the main cause of vision loss from ROP. Each year, the incidence of ROP in the United States is approximately 0.17%. Most cases are mild and resolve without treatment.

Upon birth, the eyes of preemies are screened and closely watched for signs of retinopathy. But ROP-related changes occur along a spectrum of severity. AP-ROP can elude diagnosis because its features can be more subtle and harder to appreciate than typical ROP. AP-ROP was formally recognized as a diagnostic entity in 2005. Yet in everyday practice there’s significant variation in how clinicians interpret whether fundus images taken of the inside of the eye show signs of AP-ROP. “Even the most highly experienced evaluators have been known to disagree about whether fundus images indicate AP-ROP,” said Campbell.

In a previous study, deep learning, a type of AI used for image recognition, was more accurate than experts at detecting subtle patterns in fundus images and at classifying ROP. Using the automated deep learning ROP classifier, researchers devised a quantitative vascular severity score (1-9 scale) for evaluating newborns, monitoring disease progression and response to treatment. The study, however, did not specifically address AP-ROP detection.

For the current study, nine neonatal care centers used deep learning to determine how well it detected AP-ROP. The 947 newborns in the study were followed over time and fundus images from a total of 5945 eye examinations were analyzed both by the deep learning system and a team of expert fundus image graders.

Among all eyes followed, 3% developed AP-ROP.

There was a significant level of inter-reader disagreement among the expert graders, suggesting the need for objective metrics of disease severity.

Importantly, a clearer, quantifiable AP-ROP patient profile emerged, which could help identify at-risk infants earlier. Infants who developed AP-ROP tended to be more premature. Compared with infants who needed treatment but never developed AP-ROP-, AP-ROP infants were born lighter (617 g vs. 679 g) and younger (24.3 weeks vs. 25.0 weeks). No infants born after 26 weeks developed AP-ROP in this population.

AP-ROP also tended to onset rapidly and quickly grow worse. Although rapid progression of disease has always been implied in the diagnosis of AP-ROP, to date there has been no way to measure this clinical feature. Monitoring the rate of vascular severity score changes could therefore improve detection of AP-ROP risk, according to the study findings.

Infants with AP-ROP also were more likely to have comorbidities such as chronic lung disease, compared to infants without AP-ROP. The requirement for higher oxygen concentrations among infants with lung disease may have played a role in their eye disease, said Campbell. Decades ago, researchers made a connection between the routine use of high concentrations of oxygen at birth and an increase in the development of retinopathy. Oxygen is nearly always required for survival, but is titrated very carefully to maximize survival while minimizing the risk to vision. “It’s still a balancing act,” said Campbell.

“It’s important to acknowledge that there is currently no gold standard for diagnosing AP-ROP. But having objective, AI-based metrics for detecting AP-ROP is a step in the right direction for this highly vulnerable population of infants,” said Grace L. Shen, Ph.D., who manages the retinal diseases program for the Division of Extramural Science Programs at the NEI.

The deep learning system in the clinical trial, the i-ROP DL system, was recently granted breakthrough status by the FDA, which accelerates its development and FDA review. Development of the device was supported by the NEI, part of the National Institutes of Health.

Funding for the study was provided by grants R01EY19474, K12EY027720, T15LM007088, and P30EY10572

Source: https://www.nei.nih.gov/about/news-and-events/news/ai-may-help-spot-newborns-risk-most-severe-form-blinding-disease

 

preemie

Preemie for a Day

UNC Health and UNC School of Medicine / Newsroom

Article by: Diane Hudson-Barr, PhD, RN, Clinical Nurse Specialist, Neonatal Developmental Care Specialist; Sarah Kenney, March of Dimes NICU Family Support Specialist; and Jennifer Flippin, RN, BSN, RNC-NIC, Nurse Manager, Newborn Critical Care Center

 

An interactive, multisensory workshop simulating the premature birth experience from the baby’s point of view has our Newborn Critical Care Center nurses rethinking how to provide the best care to our tiniest, most fragile patients.

Info

First it’s quiet. You’re in a warm, safe, comfortable environment. Then, in an instant, you’re thrust into complete chaos. Bright lights. Loud noises. People touching you.

This is how premature babies experience birth. Nurses from the Newborn Critical Care Center (NCCC) at N.C. Children’s Hospital recently participated in a simulated premature birth experience during “Preemie for a Day,” sponsored by the March of Dimes. The four-hour workshop gave the nurses a unique opportunity: experiencing delivery from the baby’s point of view.

“The presenters, a NICU registered nurse and pediatric occupational therapist, began the program with a review of the baby’s normal development in utero and how exposure to the light, sounds, smells and healthcare provider touch can alter ongoing development of a premature baby,” explains Jennifer Flippin, RN, BSN, RNC-NIC, NCCC nurse manager. “The presenters facilitated discussion about strategies that could be used in everyday practice to promote optimal neurosensory development for the babies.”

After the introductory discussion, nurses moved to the hands-on session of the workshop. Five nurses volunteered to play the role of newborn preemies. These nurses went into a different room with dimmed lights and listened to sounds recorded from the womb. They were asked to curl up in their most comfortable position. The other participants formed five care teams. They were instructed to mimic the admission process, and dramatically interrupted the calm and quiet environment of the volunteer preemies.

The adult preemies were first restrained, their arms and legs taped to the mattress. Then came the “intubation” with straws taped to their faces. The nursing teams prepared IVs with cold alcohol wipes and “inserted” a straw IV taped to a board for securing. The preemies had their temperature taken under the arm using a cold metal rod that had not been pre-warmed. Their heartbeats were assessed using a cold stethoscope.

All every day things done for a baby admitted to an ICU.

After the hands-on activity, each of the preemies took a turn to tell the other participants how the experience felt to them. They described how startled they were, how overwhelmed they felt and how threatening the experience was to them.

“Hearing those feelings from the preemie volunteers helped the nurses to better understand how traumatic the admission process is for critically ill babies,” says Jennifer Flippin. “As participants left the workshop, you could hear them talking about ways they would change their practice to be more developmentally supportive of the babies. This is exactly the outcome that the organizers had hoped for.”

 Source: http://news.unchealthcare.org/uncchildrens/news/care-2013/issue-4/preemie-for-a-day

 

WARRIORS:

guysComfort & Reassurance: Guided Sleep Talkdown for Uncertain Times

Mar 31, 2020

The Honest Guys – Meditations – Relaxation

This guided visualization will gently take you into a place of peace and comfort. It guides you softly down into sleep with reassurances that all will be well in your life. To aid sleep, the visuals dim as the recording progresses.

 

Two Weeks in Nicaragua | SURF | Early Season

surf

Feb 3, 2015

Nicaragua is without a doubt one of the greatest places in the world to go surfing! Subscribe Here for daily XTreme surfing videos: http://goo.gl/fXjZeb Two weeks in Nicaragua during one of the beautiful swell of the year. Riders: Dimitri Ouvre David Leboulch Naum Ildefonce Edited & Filmed by: M.Darrigade

 

kat

KAT’S CORNER

Over the last month we have observed and witnessed the diverse International Community response to the Covid-19 pandemic. A number of international countries have responded strongly and urgently, employing well thought out emergency preparedness and contingency planning with the safety of their healthcare worker community and citizens/residents as a priority. In the USA we have struggled to coordinate, uphold, and prioritize the safety of citizens/residents and our healthcare community members in a timely and well-planned out manner. In short, we have much to learn, share and teach each other as a global community.

In the face of this global crisis an increased effort to serve community, care for others, and global collaboration is what is leading us to productive solution building strategies. In the USA we have a broad community of healthcare workers, providers and researchers working diligently with our global community to build ways to safely provide care, form treatment solutions and potential vaccinations. It is essential to recognize the conscious choice to connect with a global community is what will lead to the best outcomes for our local to global community. It has been inspirational to see the ways healthcare providers are courageously speaking up about the reality of their situations and their urgent needs in order to safely serve us. Our hearts soar as we witness communities like that in Italy singing in unison on their balconies in order to comfort each other. We are inspired and hopeful as nations, NGOs, and organizations come together to move beyond political agendas and send aid to our global families in places like Iran where there is extreme need. When we care for each other in times of despair, panic, greed, and suffering we foster empowerment and together we will rise out of crisis. The pandemic shows us how we can build better health and wellness, stronger economies, and a life-sustainable planet through Global/local collaboration. Whether we choose this or not, we are all in this together!

Let’s empower ourselves with the gifts we all have to share! world  

Volcano Surfing or Volcano Boarding in Cerro Negro, Nicaragua

Apr 19, 2013  rafa   Rafa Ocón

Volcano Boarding o volcano surfing en Cerro Negro, Nicaragua, el único volcán activo del mundo donde se puede hacer volcan surfing, o lo que es lo mismo bajar por pendientes de hasta el 40% de desnivel con una tabla de snowboard o un trineo diseñado para este tipo de superficie. // Volcano surfing in Cerro Negro, Nicaragua, the only active volcano in the world where you can practise volcano boarding on a snowboard. Volcano Boarding or volcano surfing in Cerro Negro, Nicaragua, the only active volcano in the world where you can surf surfing, or what is the same down slopes up to 40% uneven with a snowboard or sled designed for this type of surface.

BABY BEHAVIORS. HAPP-E, OUR STORIES!

Netherlands.1

NETHERLANDS

Preterm Birth Rates – Netherlands

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

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

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

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

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

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

N.4

COMMUNITY

A simple solution for healthier premature babies?

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

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

 

mask

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

Published on Jan 20, 2020

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

 

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

Published: 07 March 2019

Abstract:

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

Results

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

Conclusions

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

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

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

 

intergrowth

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

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

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

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

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

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

face

INNOVATIONS

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

Posted on 04 February 2020

happe

Copyright INESC TEC and ISPUP

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

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

If you

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

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

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

 

EFONI

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

POSTED ON 20 JANUARY 2020

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

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

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

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

 

PMC

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

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

Abstract 

OBJECTIVE:

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

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

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

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

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

 

docs

HEALTH CARE PARTNERS

Mild maternal thyroid dysfunction increases preterm birth risk

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

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

August 20, 2019

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

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

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

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

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

Preterm birth risk

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

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

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

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

Universal screening not justified

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

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

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

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

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

Posted on 13 September 2019

Dr Sylvia van der Pal & Professor Erik Verrips

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

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

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

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

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

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

mood

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

dr.deborariAshok Deorari    Published on Dec 31, 2017

Different behavioral states and assessment by PIP score in premature baby

who

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

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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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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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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

 

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

epi

Jun 18, 2013

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

 

Databases, Hero’s & Provider Health

Ghana.1

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Preterm Birth Rates – Ghana

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

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

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

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

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

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

 

COMMUNITY

G.4The unsung hero in breast-milk

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

 

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

Oligosaccharides

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

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

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

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

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

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

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

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

Infections

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

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

Brain development

Thirdly, HMOs are also considered nutrients for brain development.

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

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

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

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

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

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

Perfect food

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

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

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

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

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

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

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

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

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

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Israeli gov’t provides support GHS in Neonatal care

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

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

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

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

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

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

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

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

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

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

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

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

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

HEALTH CARE PARTNERS

g.7

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

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

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

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

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

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

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

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

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

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

 

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G.9

Tackling Physician Burnout and Moral Injury

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

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

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

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

Seeing the Problem

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

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

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

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

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

Understanding the Problem

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

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

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

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

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

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

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

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

Fixing the Problem

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

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

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

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

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

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

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

How to Protect Clinician Well-being

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

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

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

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

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

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

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

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

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A Randomized Trial of Erythropoietin for Neuroprotection in Preterm Infants

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

 Abstract

Background

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

Methods

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

Results

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

Conclusions

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

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

 

PREEMIE FAMILY PARTNERS

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

Picture14Alyssa Veech   Published on May 10, 2019

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

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Preterm children have similar temperament to children who were institutionally deprived

Date: November 12, 2019 Source: University of Warwick

Summary:

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

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

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

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

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

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

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

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

 

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

Picture18Preemie Graduation | Canadian Premature Babies Foundation

Canadian Premature Babies Foundation – Published on Nov 13, 2019

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

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

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

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

 

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          Picture20Simple test predicts dangerous pregnancy disorder

Date: October 23, 2019      Source: Edith Cowan University

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

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

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

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

Survey gives early warning

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

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

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

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

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

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

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

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

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

 

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NICU Technology Predicts Care

Hurley Medical Center / Hurley Children’s Hospital

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

 

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Environmental Research   Volume 176, September 2019,

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

A population-based cohort study

Abstract

Background

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

Objectives

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

Methods

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

Results

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

Discussion

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

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

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

Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial

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

Abstract

BACKGROUND:

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

OBJECTIVE:

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

METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

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

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

 

WARRIORS:

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GHANAIAN WISDOM

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Article Research Source: Finnish Institute for Health and Welfare

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

KAT’S CORNER

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“Be an opener of doors”

― Ralph Waldo Emerson

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

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

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

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Dads, Midwives & Oxytocin

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Preterm Birth Rates – Australia

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

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

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

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

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

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

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

COMMUNITY

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

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

Abstract

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

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

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

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

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

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

  • Published: February 21, 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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HEALTH CARE PARTNERS

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

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

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

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

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

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

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

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

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

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

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

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

Summary and Conclusions-

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

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

    

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Retinopathy of Prematurity (ROP) is a condition that is found in the eyes of very preterm born babies. It is characterised by changes in the developing blood vessels of the retina (the light-sensitive layer in the back of the eye that sends visual signals to the brain). If detected timely, it can usually be treated and a blindness can be prevented. Still, it is a condition of the eye that can have long-term effects. We would like to learn a bit more about these long-term effects of ROP today.

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

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

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

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

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

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

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

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

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

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

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

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

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

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PREEMIE FAMILY PARTNERS

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

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INTERNATIONAL WORKING GROUP

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

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

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

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

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

WHAT NEONATAL FATHERS SAY

These are quotations from the published research that we reviewed.

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

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

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

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

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

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

We also make 12 practical recommendations for practice:

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

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

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

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

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

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

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Historical background to maternal-neonate separation and neonatal care.

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

Abstract

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

© 2019 Wiley Periodicals, Inc.

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

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Family Support Linked to Resilience in Kindergarteners Born Preterm

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

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

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

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

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

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

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

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

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

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

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

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

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INNOVATIONS

Naturally boost Oxycontin levels for Neonatal Bonding | Living Healthy Chicago

LH.jpgLivingHealthyChicago  Published on Mar 11, 2019

Oxytocin is naturally occurring hormone that plays a role in social bonding. Today Jackie learns about scent clothes that are helping babies who spend time in the NICU bond with their parents! Find out why scent cloth hearts are making a big difference for the very youngest of patients.

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Sewing students create fabric hearts for babies in neonatal intensive care

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

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

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

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

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

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

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

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

 

WARRIORS:

KAT’S CORNER

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Redefining Happiness | Street Philosophy With Jay Shetty

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

Disabled Surfing Australia – Gerroa 2016

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

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Brains, Fatigue, and Saving Earth

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Preterm Birth Rates – Mexico

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

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

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

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

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

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

COMMUNITY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Touch shapes preterm babies’ brains

16th March 2017

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

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

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

ResearchGate: What motivated this study?

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

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

RG: Can you tell us what you found?

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

RG: How did you conduct the study?

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

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

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

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

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

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

RG: Does it matter who touches the baby?

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

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

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

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

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

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

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

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

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

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

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

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HEALTH CARE PARTNERS

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

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

Objective

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

Study design

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

Results

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

Conclusions

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

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

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Compassion Fatigue

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

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

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

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

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

Juliette Watt   Published on Nov 26, 2018

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

 

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

First published: 31 October 2019

Aim

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

Methods

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

Results

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

Conclusion

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

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

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PREEMIE FAMILY PARTNERS

How Parents Help Preemies Fight to Survive

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

Development follow up for NICU babies

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

by Diabetologia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Preterm Labor & Premature Birth

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

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

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

In This Topic

ENJOY  a cup.jpg  of  CURIOSITY

INNOVATIONS

INSIGHTS INTO LINKS BETWEEN MICROBIOLOGY AND PRETERM BIRTH

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

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

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

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

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

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

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

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Intrahealth International  VITAL – November 15, 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WARRIORS:

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

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Preterm adults have ‘older’ brains, finds study

Written by Honor Whiteman on September 27, 2017

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

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

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

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

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

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

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

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

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

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

Accelerated brain maturation identified:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Sayulita, Mexico Surfing * Lola Mignot * LA BAILARINA

wavesNobodySurf : Surfing Videos – Published on Jan 23, 2019

 

ART, November 17, and Tenderness

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THAILAND

Rate: 12%      Rank: 55

(US Rate: USA – 12% Rank: 54)

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

Thailand, officially the Kingdom of Thailand and formerly known as Siam, is a country at the centre of the Southeast Asian Indochinese peninsula composed of 76 provinces. At 513,120 km (198,120 sq mi) and over 68 million people, Thailand is the world’s 50th-largest country by total area and the 21st-most-populous country. The capital and largest city is Bangkok, a special administrative area. Thailand is bordered to the north by Myanmar and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the west by the Andaman Sea and the southern extremity of Myanmar. Its maritime boundaries include Vietnam in the Gulf of Thailand to the southeast, and Indonesia and India on the Andaman Sea to the southwest. It is a unitary state. Although nominally the country is a constitutional monarchy and parliamentary democracy, the most recent coup, in 2014, established a de facto military dictatorship under a junta.

Health and medical care is overseen by the Ministry of Public Health (MOPH), along with several other non-ministerial government agencies, with total national expenditures on health amounting to 4.3 percent of GDP in 2009. Non-communicable diseases form the major burden of morbidity and mortality, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues.

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

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COMMUNITY

The Prevention of Preterm Birth

The Prevention of Preterm Birth

thai.logoSamitivej Hospitals – Sep 27, 2017

Preterm birth is a major concern in Thailand because the rate of preterm births is about 12% of all births. Preterm babies are at increased risk of death, disability or complications. During prenatal care, the cervical length is measured by transvaginal ultrasound between 18-24 weeks of pregnancy. When the cervical length is less than 2.5 cm, women face the probability of preterm delivery. We can prevent this by giving natural progesterone to at-risk pregnant women. A follow-up examination is then made to determine any cervical length shortening and other possible complications. In the case of a short cervical length, management techniques include using a silicone pessary (made from body friendly silicone) which is placed around the cervix transvaginally, or tightening the cervix with a stitch (cervical cerclage). With the 3P Concept initiated by the Preterm Prevention Clinic, the risk of preterm birth is reduced by 50% (compared to the WHO’s target).

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The Lancet editor Richard Horton honored with Roux Prize

Dr. Richard Horton, the “activist editor” of the international medical journal The Lancet, was honored June 10 for his accomplishments as one of the world’s most “committed, articulate, and influential advocates for population health.” He received the Roux Prize, given annually to individuals on the front lines of global health innovation in data science.

 

Interview: Ryan McAdams, US

In our Interview series, we are grateful to present this interview with  @Ryan McAdams , US, a neonatologist who is also a painter. We were curious to speak with Ryan about his art work, and the intersection of neonatology, child health and arts. By Stefan Johansson – October 3, 2018:

Could you please introduce yourself and where you currently work?

I am Ryan McAdams, the Neonatology Division Chief and Neonatal-Perinatal Medicine Fellowship Program Director at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. I’m married and have two wonderful children.

How did your professional career lead you to this spot?

After my fellowship training in San Antonio, Texas, I worked on a naval base in Okinawa, Japan, as an officer and neonatologist in the United States Air Force. I was the Air Transport director responsible for orchestrating and often going on flights to transport critically ill neonates throughout the Western Pacific who required care in the NICU. I met some amazing people in the military and learned a lot about other cultures. While in Japan, I became passionate about global neonatal heal