ABP, Protect, Act, Progress

GLOBAL PRETERM BIRTH RATES – Latvia

Estimated # of preterm births: 5.40 per 100 live births

(USA Global Average: 9.56)

Source- WHO 2014- https://ptb.srhr.org/

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

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

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

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

COMMUNITY

How to Protect Staff and Patients From Violence in the Hospital

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

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

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

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

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

Detection tools

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

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

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

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

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

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

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

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

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

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

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

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

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

Staff training

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

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

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

Public safety officers

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

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

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

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

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

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

Managing visitors

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

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

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

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

Social workers

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

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

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

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

Like none other

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

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

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

Source:How to Protect Staff and Patients From Violence in the Hospital (childrenshospitals.org)

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

Preterm Birth Information for Education Professionals

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

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

EXAMPLE:

Introduction

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

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

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

Source:https://www.nottingham.ac.uk/helm/dev/prism/rlo5/1.html#

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

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

14 September 2022

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

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

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

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

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

Mixed picture across the Region  

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

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

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

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

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

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

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

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

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

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

Rising to the challenge: country examples 

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

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

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

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

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

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

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

Source:https://www.who.int/europe/news/item/14-09-2022-ticking-timebomb–without-immediate-action–health-and-care-workforce-gaps-in-the-european-region-could-spell-disaster

HEALTHCARE PARTNERS

A new patient population for adult clinicians: Preterm born adults

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00005-9/fulltext

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

15 November 2022

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NEW Guidelines: https://www.who.int/publications/i/item/9789240058262https://www.who.int/news/item/15-11-2022-who-advises-immediate-skin-to-skin-care-for-survival-of-small-and-preterm-babies

Neonatal Brain Protocol

Ultrasound Protocols Sonographic Tendencies  Mar 23, 2021

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

Blogpost: https://sonographictendencies.com/201… Medical Disclaimer: https://sonographictendencies.com/about/

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

November 7, 2022

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

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

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

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

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

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

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

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

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

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

Source:https://www.lsuhsc.edu/newsroom/Patent%20to%20be%20Issued%20to%20LSU%20Health%20New%20Orleans%20for%20Technology%20to%20Diagnose%20Life-Threatening%20Preemie%20Condition.html

PREEMIE FAMILY PARTNERS

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

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

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

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

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

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

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

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

Source:https://www.frontiersin.org/articles/10.3389/fpubh.2020.605149/full#:~:text=Introduction%3A%20Adults%20Born%20Very%20Preterm,needs%20beyond%20childhood%20and%20adolescence.

Sensors are first to monitor babies in the NICU

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

After premature birth: your emotions

Key points

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

Your emotions after premature birth: what to expect

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

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

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

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

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

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

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

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

Tips for managing emotions about premature birth

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

Managing emotions

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

Looking after yourself

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

Being with your baby

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

Seeking support

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

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

More than baby blues: postnatal depression after premature birth

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

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

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

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

Source:https://raisingchildren.net.au/newborns/premature-babies-sick-babies/premature-birth/premature-birth-feelings

INNOVATIONS

Late-Onset Sepsis Among Very Preterm Infants

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

OBJECTIVES:

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

METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

Source:https://publications.aap.org/pediatrics/article-abstract/doi/10.1542/peds.2022-058813/189935/Late-Onset-Sepsis-Among-Very-Preterm-Infants?redirectedFrom=fulltext

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source:https://massivesci.com/articles/nicu-premature-baby-illness-medical-care-wireless-biosensor-monitor/

Role of Neurosonography in Critically Ill Neonates in NICU

Rupesh Rao, Amar Taksande, Sneh Kumar+2View all authors and affiliations Volume 36, Issue 3https://doi.org/10.1177/09732179221113674

Journal of Neonatology

Abstract

Background

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

Aim

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

Materials and Methods

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

Results

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

Conclusion

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

Source:https://journals.sagepub.com/doi/abs/10.1177/09732179221113674

For our little family members! A fun story…

Joy by Corrinne Averiss

Why Happiness Matters

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

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

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

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

Your Happiness Matters to the Whole World

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

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

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

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

The Happiness Cascade Effect

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

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

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

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

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

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

Source:https://www.huffpost.com/entry/why-happiness-matters_b_9126862

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

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

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

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

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

#News #Reuters #adventuresports

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

Strategies, Shifts, NICU Blues

PRETERM BIRTH RATES – ECUADOR

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

(USA – 12 %, Global Average: 11.1%)

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

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

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

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

Source:Ecuador – Wikipedia

COMMUNITY

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

30 September 2022            

       

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

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

Safe and effective for use in low-income countries

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

New recommendation on tocolytic drugs

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

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

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

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

Useful links- WHO recommendations

Global trends in preterm birth from 1990-2019

 POSTED ON 22 SEPTEMBER 2022

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

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

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

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

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

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

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

Paper available at:  https://jamanetwork.com/journals/jamapediatrics/article-abstract/2792732

Paulina Aguirre – La Tierra Llora

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Let Them Be Girls, and Not Mothers Before Time

27.3.2019

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

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

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

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

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

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

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

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

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

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

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

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

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

Source:https://www.isglobal.org/en/healthisglobal/-/custom-blog-portlet/ser-madre-adolescente-en-ecuador/5083982/9801

Hospital System Saw Fewer Attacks From Patients With New Crisis Strategies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source:https://www.medpagetoday.com/meetingcoverage/apna/101343

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

OCTOBER 07, 2022

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

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

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

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

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

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

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

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

By Evelyn Fleider – July 20, 2021

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

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

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

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

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

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

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

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

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

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

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

Source: https://www.uc.edu/news/articles/2021/07/fortifying-family-foundations.html

Late Preterm Infants in the NICU – Tala Talks NICU

NICU Tala Talks

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

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

#TheProjectTV #NICU #Fundraising  The Project

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

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

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

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

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

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

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

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

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

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

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

NICU Trauma:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NICU Grief:

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

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

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

Discussion:

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

Source:http://neonatologytoday.net/newsletters/nt-oct22.pdf

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

     address those concerns

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

     protect patients from potential harm

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

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

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

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

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

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

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

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

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

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

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

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

Education

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

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

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

 Fatigue Management

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

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

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

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

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

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

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

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

System Management

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

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

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

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

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

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

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

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

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

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

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

 Future Recommendations

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

Conclusions

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

Source:Impact_of_Advanced_Practice _Shift Length_and_Fatigue_2022.pdf (nann.org)

The Future Looks Bleak for Surgical Residents Like Me

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

by Erfan Faridmoayer, MD September 28, 2022

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

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

“What will you do instead?”

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

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

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

My Experience in Surgical Training

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

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

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

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

My Experience in Surgical Training

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

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

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

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

The Impact of Looming Medicare Cuts

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

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

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

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

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

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

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

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

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

Source:https://www.medpagetoday.com/opinion/second-opinions/100952

INNOVATIONS

Practice of Cuff Blood Pressure Measurements

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

Abstract

Background: 

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

Purpose: 

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

Methods: 

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

Findings/Results: 

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

Implications for Practice: 

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

Implications for Research: 

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

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

October 21, 2022

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

Key Points:

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

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

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

Abstract

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

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

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

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

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

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

Source:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797545

Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years

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

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

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

Animated 🐾Where Does Kitty Go in the Rain?

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

Toadstools and Fairy Dust

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

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

No rain, no gain!

Shona Hendley  – MAY 25, 2022 9:30AM

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

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

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

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

1. It’s a sensory experience

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

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

2. It is freeing and endorphin releasing!

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

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

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

3. It gives us time to think

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

4. The sound and smell are calming

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

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

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

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

5. There are less people

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

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

6. It metaphorically washes the day away

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

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

7. The air is cleaner

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

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

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

8. It’s good for your skin and hair

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

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

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

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

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

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

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

Source:https://www.bodyandsoul.com.au/fitness/9-reasons-why-you-shouldnt-let-a-rainy-day-derail-your-walk-or-run/news-story/4defdb7243f69f13270a41de4af0760e

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

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

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

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

        Dec 30, 2017     Wandering_higher

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

Law, Virtual Health, History

PRETERM BIRTH RATES – GREECE

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

(USA – 12 %, Global Average: 11.1%)

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

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

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

COMMUNITY

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

Feb 28, 2022 

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

NEONATAL INTENSIVE CARE UNIT NURSE TRAINING IN IDENTIFYING ULTRASOUND LANDMARKS IN THE NEONATAL MEDIASTINUM.

A training program for nurses in North-Eastern Greece

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

Highlights

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

Abstract

Purpose

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

Design and methods

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

Results

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

Conclusions

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

Practice implications

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

Source:https://www.pediatricnursing.org/article/S0882-5963(22)00161-0/fulltext

Expanding International Access to Children’s Mental Health Care

April 7, 2021

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

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

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

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

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

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

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

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

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

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

Source:https://childmind.org/blog/expanding-international-access-to-childrens-mental-health-care/

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

1,263,884 views     Jul 8, 2022     wrs

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

Pages 3631-3632 | Published online: 27 Sep 2020

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

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

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

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

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

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

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

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

May she rest in peace!

Source:https://www.tandfonline.com/doi/full/10.1080/14767058.2020.1826134

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

Apr 8, 2022    CBC News

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

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

PREEMIE FAMILY PARTNERS

New Guidance Encourages Moms to Nurse for Two Years

Michelle Winokur, DrPH    

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

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

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

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

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

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

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

Source:nt-aug22.pdf (neonatologytoday.net)

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Managing relationships after premature birth

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

How premature birth may affect the parents

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

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

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

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

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

How premature birth can affect siblings

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

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

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

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

How premature birth can affect grandparents

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

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

Managing competing demands after premature birth

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

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

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

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

How others can help

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

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

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

Celebrating your premature baby’s breakthroughs

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

Sharing good news

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

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

Tommys: Our Story

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

Source:https://www.tommys.org/pregnancy-information/premature-birth/coping-with-premature-birth/managing-relationships-after-premature-birth

HEALTH CARE PARTNERS

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

March 18, 2022

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

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

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

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

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

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

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

Health care worker stats 

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

Source:https://www.cuimc.columbia.edu/news/lorna-breen-health-care-provider-act-signed-law

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

    September 01, 2022

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

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

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

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

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

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

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

The Technology Behind Virtual Nursing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

STEPS TO VIRTUAL NURSING SUCCESS

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

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

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

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

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

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

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

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

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

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

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

Source:https://healthtechmagazine.net/article/2022/09/rise-virtual-nurse

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

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


   Washington, DC June 28, 2022

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

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

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

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

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

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

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

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

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

Source:https://www.elsevier.com/about/press-releases/research-and-journals/how-do-children-develop-after-being-born-very-preterm-four-likely-outcomes

Osteopathic Manipulative Treatment in Neonatal Intensive Care Units

Cicchitti, L.; Di Lelio, A.; Barlafante, G.; Cozzolino, V.; Di Valerio, S.; Fusilli, P.; Lucisano, G.; Renzetti, C.; Verzella, M.; Rossi, M.C. Osteopathic Manipulative Treatment in Neonatal Intensive Care Units. Med. Sci. 20208, 24. https://doi.org/10.3390/medsci8020024

Abstract

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

Source:https://www.mdpi.com/2076-3271/8/2/24/htm

INNOVATIONS

Using AI to save the lives of mothers and Babies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source:https://www.news-medical.net/news/20220624/Using-AI-to-save-the-lives-of-mothers-and-babies.aspx

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

Abstract

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

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

Source:https://connect.springerpub.com/content/sgrnn/41/5/281

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

A Systematic Review

Abstract:
Background:

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

Purpose:

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

Data Sources:

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

Study Selection:

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

Data Extraction:

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

Data Synthesis:

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

Limitation:

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

Conclusion:

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

Source:https://www.acpjournals.org/doi/10.7326/M22-0604

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

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

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

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

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

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

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

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

Country        Dessert            Fall 2022 Fashion                      

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

Christmas surf with friends, last waves of 2019 Greece!

Dec 28, 2019         Αγγελος Περαθωρακης

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

PREDICTIONS, PATTERNS , PT

PRETERM BIRTH RATES – SUDAN

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

(USA – 12 %, Global Average: 11.1%)

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

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

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

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

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

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

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

COMMUNITY

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

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

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

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

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

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

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

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

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

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

Source:nt-jul22.pdf (neonatologytoday.net)

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

12,357,089 views – Nov 26, 2020

رؤى محمد نعيم – اسياد اللواري – جديد الكليبات السودانية

Patterns and outcome of neonatal surgery in Sudan

Enas IsmailA. ElnaeemaI. Salih   Published 2019

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

Source:https://www.semanticscholar.org/paper/Patterns-and-outcome-of-neonatal-surgery-in-Sudan-Ismail-Elnaeema/7cb8b50db5a3fcb04979523979a0a08caa3e2af8

Using technology to promote safe maternal health practices in Nigeria

Using technology to promote safe maternal health practices in Nigeria

Summary

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

Background

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

Description of study

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

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

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

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

Study outcomes

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

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

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

Lessons 

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

 Impact 

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

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

HEALTHCARE PARTNERS

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

Published: February 9, 2022  https://doi.org/10.1371/journal.pone.0262107

Abstract

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

Full Article:   https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262107

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

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

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

Source:https://pubmed.ncbi.nlm.nih.gov/35894731/

Midwives save lives in Sudan

02 July 2021- Anna Sambrook

Abstract

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source:https://www.britishjournalofmidwifery.com/content/charity-spotlight/midwives-save-lives-in-sudan/

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

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

Abstract

Background: 

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

Purpose: 

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

Methodology/Approach: 

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

Results: 

Our analyses show that the extent to which nurse–physician co-leaders share goals covaries with safety climate in NICUs. This relationship is partially mediated by norms of interprofessional cooperation among NICU team members. Our final model accounts for 54% of the variability in safety climate of NICUs.

Conclusion: 

Increasing the extent to which co-leaders share goals is an effective lever to strengthen interprofessional cooperation and foster a safety climate among nursing and physician team members of hospital units.

Source:https://journals.lww.com/hcmrjournal/fulltext/2020/07000/the_benefits_of_agreeing_on_what_matters_most_.5.aspx

What’s New in Practice Improvements in Neonatal Care?

Harris-Haman, Pamela DNP, APRN, NNP-BC; Section Editor Advances in Neonatal Care: August 2022 – Volume 22 – Issue 4 – p 281-282 doi: 10.1097/ANC.0000000000001025

In the Practice Improvements in Neonatal Care section of Advances in Neonatal Care (ANC), we encourage authors, novice as well as experienced, to share manuscripts that are fundamental to neonatal nursing practice. Let’s start with what is fundamental. What you do daily is fundamental to the care you provide to your patients?

Practice improvement and quality improvement are the “combined and unceasing efforts of everyone in the caregiving setting to make changes that will lead to better patient outcomes, better system performance, and better professional learning.1,2 This is the responsibility of all healthcare providers. One of which is you, each one of you.

Quality improvement can be related to new caregiving protocols you have learned or experienced. Questions you can ask your team are as follows: “What evidence has shaped the way you provide care?” “Have you made a recent change to your policies?” “What is your unit implementing that has benefited patients?” “What is your unit implementing that is unique, or not so unique, but has had a positive impact or unpredicted outcome?” “What is a concept or disease process that you have difficulty grasping?” “What better way to gain further understanding of that disease process than to write about it?” Educating each other is a fantastic way to learn ourselves, actually one of the best. This means content within this section is not limited to what is defined as solely a quality improvement initiative. Any topic that is fundamental to neonatal intensive caregiving is suitable for this section of the journal.

As nurses we are constantly mindful of safety risks, how to minimize these risks, and prevent errors or events from occurring. Nurses are uniquely positioned to anticipate potential events1 (you know that gut feeling). Who better to provide information to our profession than the nursing providers at the bedside? We need to ask whether this is the best we can do? Is this practice or caregiving protocol in the context of person-centered care and are the experiences of the neonates and their parents used to guide how the practice is implemented. It is important to remember that real outcome measures in healthcare are not what immediately happens but what the neonates and their family experiences over the course of their life because of their time spent in the neonatal intensive care unit (NICU).

Numerous quality improvement initiatives have been developed in the NICU setting. Some of these topics are as follows:

  • Pain assessment
  • Reduction of central line–associated bloodstream infections (CLABSIs)
  • Prevention of sepsis
  • Prevention of necrotizing enterocolitis (NEC)
  • Hand hygiene
  • Mother–infant interactions
  • Human milk nutrition
  • Prevention of unplanned extubations
  • Management of bronchopulmonary dysplasia (BPD)
  • Prevention and management of hypothermia
  • Magnetic resonance imaging without sedation
  • Use of music therapy3

In addition, there are many processes that take place on an hourly, daily, and weekly basis that require standardization, care bundles, checklists, or even pathophysiological explanations relating to their use and development.1 There are diverse topics that you can share your learned experiences on:

  • Improving our practice, by providing general information updates, reviews of the pathophysiology of a disease process, pharmacology principles of a specific medication, or pathophysiology of a certain disease process.
  • Concept analysis of ideas central to neonatal nursing. You may have written one of these during your educational endeavors. To be publishable, you need to make sure the concept analysis is applicable in the real world.
  • Clinical excellence related to specific problems. What has your unit been doing well that had had a positive effect on patient outcomes or that has positively affected parental satisfaction or participation.
  • Descriptions of essential nursing care strategies for specific diagnosis.
  • Neonatal concepts that pertain to all levels of nursing from the novice to the expert or targeted to a specific audience such as the new staff nurse or the advanced practice nurse.
  • Quality improvement projects that promote practice and process improvement.
  • Neonatal assessment processes.

Consider your own units. What is occurring that concerns you? What has been helpful? Look at the effects of the implementation of new care bundles, new equipment, new staffing models, or environmental issues. Work with the unit leadership when something new is implemented in your unit, equipment, practice bundle, or medication. Have you initiated a new task force? Document the effects of this practice. As NICU care provider, you are uniquely positioned to have a positive and lasting effect on the care provided in your institution. Share this with your colleagues. Pat yourselves on the back for the outstanding work you do and care you provide to our tiny patients and their families.

We want to use this section of ANC to capture the excellence of neonatal care that you are providing. Your unique educational and experiential viewpoints and your lived experiences are valuable. We look forward to reading your manuscripts. Many resources are available to assist you on this quest. These are in your units, hospitals, national associations, and this editorial board. Share your knowledge with our readers so that they may gain new knowledge that will enrich and expand their clinical knowledge and continue to improve the care we provide for our tiny precious patients.

Source:https://journals.lww.com/advancesinneonatalcare/Fulltext/2022/08000/What_s_New_in_Practice_Improvements_in_Neonatal.1.aspx

Less Invasive Surfactant Delivery Works for Tiniest Newborns

Less requirement for mechanical ventilation adverse in very preterm infants by James Lopilato, Staff Writer, MedPage Today August 9, 2022

For extremely preterm infants with potential respiratory distress syndrome, less invasive surfactant administration (LISA) was associated with a significant decrease in the risk of adverse outcomes, a cohort study found.

There was a drop in requirement for invasive mechanical ventilation between those infants receiving LISA within the first 72 hours of life and those who didn’t (53.6% vs 8.3%), according to the study of over 6,500 infants in Germany.

Often performed early in the delivery room, LISA was safe and associated with decreased risks during the child’s primary stay in hospital:

  • All-cause death (adjusted OR 0.74, 95% CI 0.61-0.90)
  • Bronchopulmonary dysplasia (BPD; adjusted OR 0.69, 95% CI 0.62-0.78, P<0.001)
  • BPD or death (adjusted OR 0.64, 95% CI 0.57-0.72, P<0.001)

Babies undergoing LISA also showed reductions in pneumothorax and retinopathy of prematurity, Christoph Härtel, MD, from University Hospital of Würzburg in Germany, and colleagues reported in JAMA Network Open.

LISA comprises less invasive delivery of surfactant to babies in respiratory distress. Important concepts of LISA include delayed cord clamping, facilitated fetal transition, initial continuous positive airway pressure support, maintenance of spontaneous breathing, caffeine administration, and early skin-to-skin contact, according to Härtel’s team.

The authors noted that LISA had been found to be beneficial for respiratory outcomes in earlier studies. Theirs may be the first large-scale report in “the most vulnerable preterm population,” however.

Last year’s OPTIMIST-A trial showed a nonsignificant trend of better survival in infants born at 25 to 28 weeks who received surfactant treatment.

Härtel and colleagues based their observational cohort study on the German Neonatal Network of 68 tertiary level neonatal ICUs. Infants born from 22 weeks 0 days to 26 weeks 6 days of gestation between April 2009 and December 2020 were eligible.

Data were collected from 6,542 infants (mean gestational age 25.3 weeks, 53.7% boys). Of these newborns, 38.7% received LISA.

Outcomes were adjusted for gestational age, small-for-gestational-age status, sex, multiple birth, inborn status, antenatal steroid use, and maximum fraction of inspired oxygen in the first 12 hours.

Nevertheless, some potential confounders may have been missed by the study authors.

They also acknowledged the potential for indication bias and selection bias, as well as the possibility that LISA does not avoid mechanical ventilation in some babies. “There is still an urgent need to better define those babies at high risk for failing a treatment strategy that includes LISA.”

Randomized clinical trials are needed to assess the effects of prophylactic LISA on vulnerable preterm infants, Härtel’s team suggested.

Less Invasive Surfactant Delivery Works for Tiniest Newborns | MedPage Today

Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks

2022 – Ohnstad MO, Stensvold HJ, Pripp AH On behalf of the Norwegian Neonatal Network, et al, Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks; Correspondence to Dr Mari Oma Ohnstad; mari.oma.ohnstad@ldh.no  On behalf of the Norwegian Neonatal Network

Abstract

Objective The aim of the study was to investigate first extubation attempts among extremely premature (EP) infants and to explore factors that may increase the quality of clinical judgement of extubation readiness.

Design and method A population-based study was conducted to explore first extubation attempts for EP infants born before a gestational age (GA) of 26 weeks in Norway between 1 January 2013 and 31 December 2018. Eligible infants were identified via the Norwegian Neonatal Network database. The primary outcome was successful extubation, defined as no reintubation within 72 hours after extubation.

Results Among 482 eligible infants, 316 first extubation attempts were identified. Overall, 173 (55%) infants were successfully extubated, whereas the first attempt failed in 143 (45%) infants. A total of 261 (83%) infants were extubated from conventional ventilation (CV), and 55 (17%) infants were extubated from high-frequency oscillatory ventilation (HFOV). In extubation from CV, pre-extubation fraction of inspired oxygen (FiO2) ≤0.35, higher Apgar score, higher GA, female sex and higher postnatal age were important predictors of successful extubation. In extubation from HFOV, a pre-extubation FiO2 level ≤0.35 was a relevant predictor of successful extubation.

Conclusions The correct timing of extubation in EP infants is important. In this national cohort, 55% of the first extubation attempts were successful. Our results suggest that additional emphasis on oxygen requirement, sex and general condition at birth may further increase extubation success when clinicians are about to extubate EP infants for the first time.

Full Study: Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks | BMJ Paediatrics Op

PREEMIE FAMILY PARTNERS

Building Confidence and Parenting Skills When Your Baby Is in the NICU

Nursing License Map / Building Confidence and Parenting Skills When Your Baby Is in the NICU November 23, 2020

Having a child in the neonatal intensive care unit (NICU) can be a frightening or overwhelming experience for parents. As your newborn receives lifegiving support from NICU equipment and trained professionals, you may struggle to step into your role as parent or feel fearful, helpless or uncertain.

Understanding the inner workings of the NICU and connecting with the support available to families can help you gain confidence, find ways to participate and become an advocate for yourself and your baby. Learn more through the resources below. 

Tips for Parents on Building Caregiving Skills With a NICU Baby

Understand your rights as the parent, including what you can ask for and expect during your baby’s stay; the NICU Baby’s Bill of Rights can be a useful resource.

Practice providing routine care for your baby, including changing clothes and giving baths; let your neonatal nurse practitioner or other provider know if and when you are ready to learn these skills.

Take care of your baby’s laundry if time allows; some parents say taking their baby’s clothes home to wash and bring back to the NICU helps them feel more involved.

Be present for feeding and bath times when possible, and collaborate with your nurse on participating.

Reach out to the lactation consultant if available at your hospital to create a plan for feeding your baby at home.

Choose the pediatrician who will help care for your baby after the NICU.

Notify your insurance provider to add your baby onto your policy.

COMMON TERMS TO KNOW IN THE NICU

Common Terms | Nationwide Children’s: Glossary of NICU-related terms organized alphabetically covering NICU equipment, procedures and health indicators.

Glossary of NICU Terms for Parents | National Perinatal Association (PDF, 568.65 KB): Glossary of neonatal terms organized by category, including the NICU team and medications used in the NICU.

Premature Birth: Diagnosis & Treatment | Mayo Clinic: An explanation of tests given to premature babies and treatment options available, including surgery, medication and specialized supportive care.

NICU Staff | March of Dimes: Descriptions of 29 types of staff members who may work in your hospital’s NICU and their roles.

GAINING CONFIDENCE IN THE NICU

Support Resources for NICU Parents and Loved Ones

FEEDING (NICU AND BREASTFEEDING, BOTTLE FEEDING AND FORMULA)

Breastfeeding | Office on Women’s Health: A landing page for information on breastfeeding, including breastfeeding positions and guidance on pumping and storing milk.

Breastfeeding in the NICU: Advice from a Lactation Consultant | Hand to Hold: Practical advice for women breastfeeding premature babies and suggestions for loved ones to offer support.

Feeding Difficulties & Your Preemie | Hand to Hold: Information on feeding disorders and feeding therapy that a premature baby may need in their first days and months.

Feeding Your Baby After the NICU | March of Dimes: Answers to commonly asked questions about feeding preemies after a NICU stay, such as how to know when your baby is full and where to find support.

Feeding Your Baby in the NICU | March of Dimes: Description of feeding options for babies in the NICU, including breastfeeding, bottle, a feeding tube or intravenous line (IV).

Find a Lactation Consultant Directory | International Lactation Consultant Association: Online listings of board-certified lactation consultants and services offered, fees and medical coverage information.

How to Bottle Feed a Preemie | Verywell Family: Six tips for bottle feeding a premature baby, offered by a registered nurse in a tertiary-level NICU.

La Leche League Online Support Resources | LLLI: A landing page of breastfeeding resources available online for families around the world, including virtual support groups, publications and printable toolkits.

Nourishing Your Premature Baby in the NICU | Hand to Hold: An article from a neonatal registered dietitian on the feeding and growing processes unique to premature infants.   

Practical Bottle Feeding Tips | American Academy of Pediatrics: Eight tips for safely and successfully bottle feeding an infant. 

FINDING COMMUNITY AND SUPPORT

Blogs for NICU Parents | National Perinatal Association: List of blogs written by and for parents in the NICU.

For Our Families | Hand to Hold: A landing page of resources for families in the NICU that includes private Facebook communities, counseling services, bereavement support and information on requesting a peer mentor.

Four Ways Preemie Moms Can Say “No Thanks” to Visitors | Preemie Mom Camp: A blog post with advice on declining visitors in the NICU or at home, including sample scripts.

Get Help | La Leche League International (LLLI): Searchable map for finding a local support group with La Leche League, an international organization supporting breastfeeding mothers.

The MyPreemie App for Preemie Parents | Graham’s Foundation: A free app to help parents organize their calendar, track their baby’s progress and create a virtual baby book; available on the App Store and Google Play.

Where to Find Peer-to-Peer Support | National Perinatal Association: A list of organizations that connect families in the NICU or transitioning home with peers who can offer support.

AFTER THE NICU: GOING HOME

Home After the NICU | March of Dimes: Guidance for parents on the emotional experience of transitioning home, sleep safety, childcare and vaccinations.

Parents Corner: Information That Gives the Support You Need in the NICU | Baby First: Parents’ stories on transitioning home from the NICU and information on what to expect after discharge.

Resources at Home | Nationwide Children’s: A collection of articles on caring for your infant at home and knowing when to call a provider; topics range from burn prevention and infant cardiopulmonary resuscitation (CPR) to fever and fussiness.

Taking Your Preemie Home | KidsHealth: Advice for parents on preparing for discharge from the NICU, safety precautions to take once home and suggestions for self-care.

Transitioning Newborns from NICU to Home | Agency for Healthcare Research and Quality: Collection of fact sheets for families bringing a NICU baby home; topics covered include signs of illness, managing breathing problems, medication safety, immunization schedule and many more.

NICU AND INSURANCE

Affording the NICU: 6 Ways to Reduce the Cost | Hand to Hold: Description of financial safety nets available to help parents of premature babies pay for a NICU stay.

Get Help Paying Your Baby’s Hospital Bills | Verywell Family: Information about the possible costs of a NICU visit for families with and without insurance.

Health Insurance for Your Family | March of Dimes: A guide to understanding health insurance coverage for children under the Affordable Care Act (ACA).  

Insurance for Newborns: Four Lessons From $27,000 Bill | CoPatient: An article about one family’s story with medical bills in the NICU and their suggestions for new parents navigating the NICU experience.

Paying for Your Baby’s NICU Stay | March of Dimes: Guidance for parents on the NICU and insurance coverage and questions to ask your health insurance representative to learn more.

NICU CLOTHES FOR BABIES, SUPPLIES AND BLANKETS

The Best Preemie Clothes for Extra Tiny Babies | What to Expect: Suggestions for where to buy premature baby clothes and accessories that are both comfortable and affordable.

Knitting Tips and Patterns for Preemies | The Spruce Crafts: Guidelines for knitting items for NICU babies, including patterns for socks, caps and baby blankets.

Knots of Love NICU Blanket Patterns | Knots of Love: Crochet and knit patterns for baby blankets specially made for neonatal babies.

Navigating the NICU: What to Bring to the NICU (Printable Checklist) | UnityPoint Health: A packing list for the NICU including clothes for both parents and babies, bedding, toiletries, entertainment and other essentials.

NICU PARENTS’ WELL-BEING

One in 10 New Dads Gets Postpartum Depression. Here’s How to Spot It (and Stop It). | Men’s Journal: An article on postpartum depression presenting in fathers and ways to offer support.

Postpartum Depression | Office on Women’s Health: Resources on postpartum depression in mothers and common types of treatment.

Postpartum Skincare | Lucie’s List: Recommendations for skincare after pregnancy and while breastfeeding, plus nursing-safe options.

Postpartum Support: Your New Life as a Parent | Lucie’s List: Encouragement for new mothers in managing the transition into parenthood and finding professional support when needed.

Self-Care for Parents | Program for Early Parent Support: A list of ideas for parents to meet their own physical, emotional, social and intellectual needs.

Share Your Story | March of Dimes: A landing page for March of Dimes’ blogs, forums and member groups that help parents make connections and find support.

Straight Talk | Lucie’s List: A collection of articles on the challenges of parenting babies and young children, from breastfeeding and sleep regression to tantrums and going back to work.

Taking Care of You: Support for Caregivers | KidsHealth: Tips on recharging and reaching out for help for parents of children with a serious illness.

Your Mental Health and Well-Being Are Important! | National Perinatal Association: A screening questionnaire for postpartum mental health conditions and resources for help with anxiety, depression and post-traumatic stress disorder (PTSD), among others.

RETURNING TO WORK AND CHILDCARE

Daycare and the Prematurity Factor | Hand to Hold: A discussion of the benefits and drawbacks of different childcare options specifically for preemies.

Finding Child Care for Your Premature Baby | Verywell Family: A consideration of care options for premature babies, including a stay-at-home parent, family caregivers, nannies and au pairs, home childcare and daycare.

Finding Childcare for Your Preemie | Graham’s Foundation: Advice for making childcare arrangements for preemies and their unique needs.

Going Back to Work After a Loss | Share: Ten practical suggestions to help grieving parents ease back into the workplace.

Going Back to Work After a Pregnancy Loss | Harvard Business Review: An article on the challenges that bereaved parents face in returning to work, with self-care strategies and advice for managers and colleagues.  

Resources for Friends and Family

Loved ones can play an important role in helping NICU parents transition into their new roles. Read more in the resources below about supporting parents of neonatal infants during and after a NICU stay.

The resources in this article are for informational purposes only; individuals should consult with a licensed health care provider before taking action.

Last Updated: December 2020

Source:https://nursinglicensemap.com/blog/parents-of-baby-in-nicu/

The Wisdom of Trauma, Official Trailer with Dr. Gabor Maté

    Jul 19, 2020     Science and Nonduality

This website has been translated in the following languages: عربىБългарияčeštinaDeutschFrançaisעִברִיתItalianoLietuviškaiMagyarPolskiePortuguêsTürkçe and subtitled in 27 languages.

Watch the movie at https://thewisdomoftrauma.com/ The film is available by donation.

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Welcoming a new life – Physical therapies for premature baby


KK Women’s and Children’s Hospital
– Jun 23, 2020

When a baby is born more than three weeks earlier than the expected delivery date, the baby is referred to as ‘premature’ or “preemie”. Premature babies are at risk of developmental delay as their brains and bodies have to continue to grow rapidly in an external environment, outside of the mother’s womb. The Physiotherapist will assess and review your child regularly to ensure that your baby is developing appropriately for his/her age. Physiotherapists will also be available to assist you with learning how to handle and interact with your baby. Upon discharge, Physiotherapists will continue to monitor your child’s neurological and developmental progress until at least 18 months corrected age when he/she may then continue with therapy or be discharged, depending on his/her needs at that stage.

5 Tips to Support you Dad, in the NICU

Jun 15, 2022   CanadianPreemies

INNOVATIONS

Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth A Pooled Study of 16 US Cohorts

Barrett M. Welch, PhD1Alexander P. Keil, PhD2Jessie P. Buckley, PhD3; et alAntonia M. Calafat, PhD4Kate E. Christenbury, MBA5Stephanie M. Engel, PhD2Katie M. O’Brien, PhD1Emma M. Rosen, MSPH2Tamarra James-Todd, PhD6Ami R. Zota, ScD7Kelly K. Ferguson, PhD1; and the Pooled Phthalate Exposure and Preterm Birth Study Group           JAMA Pediatr. Published online July 11, 2022. doi:10.1001/jamapediatrics.2022.2252

Key Points

Question  Is phthalate exposure during pregnancy associated with preterm birth?

Findings  In this pooled analysis of 16 studies in the US including 6045 pregnant individuals, phthalate metabolites were quantified in urine samples collected during pregnancy. Higher urinary metabolite concentrations for several prevalent phthalates were associated with greater odds of delivering preterm, and hypothetical interventions to reduce phthalate exposure levels were associated with fewer preterm births.

Meaning  In this large observational study, urinary biomarkers of common phthalates used in consumer products were a risk factor for preterm birth.

Abstract

Importance  Phthalate exposure is widespread among pregnant women and may be a risk factor for preterm birth.

Objective  To investigate the prospective association between urinary biomarkers of phthalates in pregnancy and preterm birth among individuals living in the US.

Design, Setting, and Participants  Individual-level data were pooled from 16 preconception and pregnancy studies conducted in the US. Pregnant individuals who delivered between 1983 and 2018 and provided 1 or more urine samples during pregnancy were included.

Exposures  Urinary phthalate metabolites were quantified as biomarkers of phthalate exposure. Concentrations of 11 phthalate metabolites were standardized for urine dilution and mean repeated measurements across pregnancy were calculated.

Main Outcomes and Measures  Logistic regression models were used to examine the association between each phthalate metabolite with the odds of preterm birth, defined as less than 37 weeks of gestation at delivery (n = 539). Models pooled data using fixed effects and adjusted for maternal age, race and ethnicity, education, and prepregnancy body mass index. The association between the overall mixture of phthalate metabolites and preterm birth was also examined with logistic regression. G-computation, which requires certain assumptions to be considered causal, was used to estimate the association with hypothetical interventions to reduce the mixture concentrations on preterm birth.

Results  The final analytic sample included 6045 participants (mean [SD] age, 29.1 [6.1] years). Overall, 802 individuals (13.3%) were Black, 2323 (38.4%) were Hispanic/Latina, 2576 (42.6%) were White, and 328 (5.4%) had other race and ethnicity (including American Indian/Alaskan Native, Native Hawaiian, >1 racial identity, or reported as other). Most phthalate metabolites were detected in more than 96% of participants. Higher odds of preterm birth, ranging from 12% to 16%, were observed in association with an interquartile range increase in urinary concentrations of mono-n-butyl phthalate (odds ratio [OR], 1.12 [95% CI, 0.98-1.27]), mono-isobutyl phthalate (OR, 1.16 [95% CI, 1.00-1.34]), mono(2-ethyl-5-carboxypentyl) phthalate (OR, 1.16 [95% CI, 1.00-1.34]), and mono(3-carboxypropyl) phthalate (OR, 1.14 [95% CI, 1.01-1.29]). Among approximately 90 preterm births per 1000 live births in this study population, hypothetical interventions to reduce the mixture of phthalate metabolite levels by 10%, 30%, and 50% were estimated to prevent 1.8 (95% CI, 0.5-3.1), 5.9 (95% CI, 1.7-9.9), and 11.1 (95% CI, 3.6-18.3) preterm births, respectively.

Conclusions and Relevance  Results from this large US study population suggest that phthalate exposure during pregnancy may be a preventable risk factor for preterm delivery.

Source: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2794076

New target for therapies to treat preterm labour

August 9, 2022

Researchers have identified a cause of premature (preterm) labour, an enigma that has long challenged researchers. New research published in The Journal of Physiology suggests a protein, called Piezo1, is responsible for regulating the behaviour of the uterus. Piezo1 keeps the uterus relaxed ensuring that it continues to stretch and expand during the 40 weeks it takes a foetus to grow.

Preterm birth is the single biggest cause of neonatal mortality and morbidity in the UK. Every year around 60,000 babies are born prematurely in the UK. The identification of Piezo1 in the uterus, and its role to maintain relaxation of uterus through stretch-activation during pregnancy, paves the way for drugs and therapies to be developed that could one day treat or delay preterm labour.

The muscular outer layer of the uterus is peculiar because it is the only muscle that it is not regulated by nerves and it must remain dormant for the 40 weeks despite significant expansion and stretch as the foetus develops into a baby. The researchers from University of Nevada USA studied tissue samples of the smooth muscle of the uterus to explore the mechanistic pathways to better understand the dynamics controlling the uterus, how pregnancy is maintained and what maintains quiescence until labour.

Stretching the uterus tissue, to mimic what happens during pregnancy, activates Piezo1 channels. This drives the flow of calcium molecules generating a signalling cascade that activates the enzyme nitric oxide synthase to produce the molecule nitric oxide. This Piezo1 cascade promotes and maintains the dormant state of the uterus.

Piezo1 controls the uterus by working in a dose-dependent manner, where channel activity is stimulated by the chemical Yoda1 and inhibited by a chemical called Dooku1. When Piezo1 is upregulated, the uterus remains in a relaxed state. However, in preterm tissue, the expression of Piezo1 is significantly decreased (downregulated), which ‘switches off’ the dormant signalling to the muscle, so the uterus contracts and initiates labour.

Professor Iain Buxton, Myometrial Research Group at the University of Nevada USA said,

“Pregnancy is the most impressive example of a human muscle enduring mechanical stress for a prolonged period. Finding Piezo1 in the muscular layer of the uterus means the uterus is controlled locally and is coordinated by a stretch-activated mechanism rather than hormonal influence from the ovaries or the placenta, which has been the assumption.

“It is troubling that there are still no drugs available to stop preterm labour. Thanks to the Nobel Prize winning discovery of Piezo proteins, which are responsible for how the body responds to mechanical force, and our investigation we are now closer to developing a treatment. Piezo1 and its relaxation mechanism provide a target for us which we could potentially activate with drugs. We need to test this with further studies and we hope to carry out clinical trials in the future.”

Contraction and relaxation were assessed in tissue samples compared for the following gestational periods: non-pregnant, term non-labouring, term labouring, preterm non-labouring and preterm labouring. The presence of Piezo1 channels was discovered using molecular tools while pregnant tissues contracting in a muscle bath were stimulated with Piezo1 channel activator and inhibitor to characterize the regulation of quiescence.

More research is needed to improve our understanding of how all the molecular signals and steps involved in the Piezo1 channel regulate the relaxation of the uterus and whether more chemicals are working together with Piezo1.  

Full paper title: Novel Identification and Modulation of the Mechanosensitive Piezo1 Channel in Human Myometrium. Link to paper https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP283299

New target for therapies to treat preterm labour – The Physiological Society (physoc.org)

These 14 innovations are enabling young people to address their mental health needs

May 23, 2022 World Economic Forum

The World Economic Forum is the International Organization for Public-Private Cooperation. The Forum engages the foremost political, business, cultural and other leaders of society to shape global, regional and industry agendas. We believe that progress happens by bringing together people from all walks of life who have the drive and the influence to make positive change

Fun for the little ones!

African Animals for Children with pronunciation (and videos)

English Paradise Kids

Welcome to the world of African animals! Learn with your children and students the names of African animals. Children will travel through this virtual safari by discovering Savannah African animals in English in a playful and entertaining way while seen moving, listening to the name in English with pronunciation and reading how to write.

Diving Sudan

This video was made during a live aboard in the Red Sea of Sudan with Red Sea Explorers. During the nine days of diving we visited the following dive site’s: – Shaab Ambar – Protector Reef – Karam Masamirit – Ed Domesh – Habili gab Miyum 1 – Dahrat Abid – Habili gab Miyum 2 – Dahrat Qab – Tamarsha – Pinnacolo – Shaab Jumna – Saganeb – Shaab Rumi – Umbria

WEARABLES,  CLIMATE, SNUGGLES, OT

PHILIPINNES

PRETERM BIRTH RATES – PHILLIPINES

Rank: 12  –Rate: 14.9%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

The Philippines is an archipelagic country in Southeast Asia. It is situated in the western Pacific Ocean and consists of around 7,641 islands that are broadly categorized under three main geographical divisions from north to south: LuzonVisayas, and Mindanao. The Philippines is bounded by the South China Sea to the west, the Philippine Sea to the east, and the Celebes Sea to the southwest. It shares maritime borders with Taiwan to the north, Japan to the northeast, Palau to the east and southeast, Indonesia to the south, Malaysia to the southwest, Vietnam to the west, and China to the northwest. The Philippines covers an area of 300,000 km2 (120,000 sq mi) and, as of 2021, it had a population of around 109 million people, making it the world’s thirteenth-most populous country. The Philippines has diverse ethnicities and cultures throughout its islands. Manila is the country’s capital, while the largest city is Quezon City; both lie within the urban area of Metro Manila.

The Philippines is an emerging market and a newly industrialized country whose economy is transitioning from being agriculture-centered to services- and manufacturing-centered. It is a founding member of the United NationsWorld Trade OrganizationAssociation of Southeast Asian Nations, the Asia-Pacific Economic Cooperation forum, the East Asia Summit and a member of the Non-Aligned Movement since 1993. The Philippines’s position as an island country on the Pacific Ring of Fire that is close to the equator makes it prone to earthquakes and typhoons. The country has a variety of natural resources and is home to a globally significant level of biodiversity.

There were 101,688 hospital beds in the country in 2016, with government hospital beds accounting for 47% and private hospital beds for 53%. In 2009, there were an estimated 90,370 physicians or 1 per every 833 people, 480,910 nurses and 43,220 dentists. Retention of skilled practitioners is a problem. Seventy percent of nursing graduates go overseas to work. As of 2007, the Philippines was the largest supplier of nurses for export. The Philippines suffers a triple burden of high levels of communicable diseases, high levels of non-communicable diseases, and high exposure to natural disasters.

There is improvement in patients access to medicines due to Filipinos’ growing acceptance of generic drugs, with 6 out of 10 Filipinos already using generics. While the country’s universal healthcare implementation is underway as spearheaded by the state-owned Philippine Health Insurance Corporation, most healthcare-related expenses are either borne out of pocket or through health maintenance organization (HMO)-provided health plans. As of April 2020, there are only about 7 million individuals covered by these plans.

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

This month’s blog embraces the Philippines, our 71st country-focused blog. Throughout our journey you have inspired and amazed us, touched our hearts and fueled our imaginations. We have explored the breadth of our associations, witnessed the global diversities, similarities, needs, barriers, challenges and resources present within our Preterm Birth community. Kat and I began our journey with eyes wide open, minds full of curiosity, hearts wary yet open, following an unseen but deeply compelling call to serve the Community in some guided capacity.  We always knew we would receive more than we could ever give. We appreciate and thank you for who you are and your presence in our lives. Within your eternal perfection, such goodness, strength and love abide.

COMMUNITY

Socioeconomic Disparities in Adverse Birth Outcomes in The Philippines

Ryan C.V. Lintao Erlidia F. Llamas-Clark Ourlad Alzeus G. Tantengco Open Access Published: April 10, 2022DOI:https://doi.org/10.1016/j.lanwpc.2022.100453

Kaforau et al. reported the burden of adverse birth outcomes and their risk factors in the Pacific Islands region. Preterm birth prevalence was 13.0%, while low birth weight was 12.0%. Malaria, substance use, obesity, and poor antenatal care were the most significant risk factors associated with adverse birth outcomes.

 The Philippines, a lower-middle-income country in the Asia Pacific, continues to experience challenges in addressing adverse birth outcomes. We share the status and the socioeconomic disparities in adverse birth outcomes in the Philippines.

The latest health survey in 2017 showed a 3.0% preterm birth rate in the Philippines.

 Low birth weight (LBW) incidence was 11.9% in 2020.

 Moreover, in a newborn screening cohort from 2015 to 2016, 13.6% were small-for-gestational age.

 Increased antenatal care utilization, essential newborn care, and kangaroo mother care have decreased adverse birth outcomes and neonatal mortality.

 However, health inequalities prevail in the Philippines.

Despite no difference in LBW incidence between urban and rural areas, regional disparities exist. The national capital region, Metro Manila, had the lowest LBW rate (9.0%), while two regions in the southern Philippines had the highest LBW rates (Davao at 20.0%, and Zamboanga at 21.0%).

 Smokers were more likely to have LBW newborns (21.0%) than nonsmokers (14.0%), agreeing with Kaforau and colleagues findings. A cohort study examining maternal second-hand smoke (SHS) exposure showed significantly lower birth weight in the SHS-exposed group.

Pregnant women exposed to SHS had higher parity, lower educational attainment, and lower monthly household income.

Socioeconomic status and its proxy variables (e.g., educational attainment, household income, and occupation) were shown to affect birth outcomes in the Philippines. LBW incidence decreased with higher maternal educational attainment, with 17.7% of mothers who reached primary school level and 12.5% of mothers who reached college level having LBW newborns. Household wealth was a significant determinant of LBW: mothers in the lowest wealth quintile had higher LBW incidence (16.0%) than mothers in the highest quintile (12.5%).

With increasing socioeconomic inequality exacerbated by the ongoing pandemic, underlying social determinants must be recognized and addressed. We call for more research to investigate the country’s social determinants of adverse birth outcomes, which can be used as the basis for evidence-based policies and health services to improve maternal and neonatal outcomes. We also emphasize the need for good governance, gender equality, and equitable access to women’s and reproductive health services (antenatal care, basic emergency obstetric and neonatal care, and family planning) to reduce widening disparities in adverse birth outcomes.

Source:Socioeconomic disparities in adverse birth outcomes in the Philippines – The Lancet Regional Health – Western Pacific

Magnus Haven – Oh, Jo (Official Music Video)

Premiered Jun 26, 2022  Magnus Haven

Jo is a term of endearment among Kapampangans, which means special someone. So the love song pays tribute to that “Jo” or special someone. A statement of love echoing the romantic joy that that “Jo” brings to her partner’s life.

Pregnancy becomes a more vulnerable time with climate change

Wildfires, natural disasters, rising heat can lead to poor health outcomes for the expectant and their babies – By Katherine Kam – April 11, 2022

In the western United States, where massive wildfires have fouled the air with smoke and hazardous levels of pollutants, Santosh Pandipati, an obstetrician in California, counsels pregnant patients to always check air quality before they venture outside to exercise. “You need to plan your outdoor activities when the air quality is better,” he tells them.

In other parts of the country, where hurricanes and floods have displaced pregnant residents, obstetrician Nathaniel DeNicola has advised patients, including those he saw in New Orleans, to pack a preparedness kit.

In case of evacuation, “they might be away from home for a long time,” he said. DeNicola encourages people to include emergency drinking water, extra supplies of medications and a paper copy of their medical records. “If the power’s out, that’s not typically available” now that most records are electronic, he said.

As scientists study how climate change is affecting human health, pregnant people and their unborn babies are emerging as a vulnerable group.

Those who must evacuate during natural disasters are often extremely distressed and might find their pregnancy health care interrupted. “If you have to flee, how do you make sure you continue to have access to your OB/GYN or to the hospital you plan to deliver in?” said Pandipati, who has seen patients who have escaped wildfires. “If you end up needing to go live with family an hour or two hours away, you have a disruption in care.”

Pregnancy & Parenthood

It doesn’t take a catastrophe to create problems. Ongoing exposure to hot temperatures and air pollution might raise the risk of adverse pregnancy outcomes, such as preterm birth and low birth weight.

About 7,000 California preterm births linked to wildfire smoke risks, study says

Spurred by growing evidence on climate-related effects, Pandipati and DeNicola have tailored their medical advice, not to alarm people, but to prepare them. “The reality is that we need to start telling our patients right now that the climate is changing,” Pandipati said. “We need to empower patients.”

In 2016, the American College of Obstetricians and Gynecologists issued a position statement on climate change, calling it “an urgent women’s health concern and a major public health challenge.

Air pollution and heat exposure

Amid widespread changes wrought in the environment, air pollution and heat exposure have been significantly associated with preterm birth, low birth weight and stillbirth in the United States, according to a 2020 review published in JAMA Network Open. Such exposures are becoming increasingly common, according to the paper.

DeNicola, an obstetrician at the Johns Hopkins Health System in Washington, was one of the review’s co-authors.

Exposure to high temperatures can cause dehydration. During pregnancy, dehydration can lead to the release of oxytocin, a hormone that contributes to labor contractions, he said. “The extreme heat could very well be causing an increase in that mechanism,” DeNicola said. “It’s revved up.”

If labor occurs and a baby is born before 37 weeks, it’s a preterm birth, compared with a normal pregnancy of 40 weeks. Some of these newborns may have immature organ systems and experience trouble with breathing, feeding and regulating body temperature. Long term, premature babies might develop other problems, including learning disabilities and hearing or vision problems. The more premature the baby, the more serious the health risks.

Racial disparities in exposure

In the JAMA study, women of all races were at increased risk for poor pregnancy outcomes when exposed to heat and air pollution, but disparities emerged. Black women consistently had the highest risks of preterm birth and low birth weight, said Rupa Basu, an epidemiologist who also co-wrote the JAMA study. She is chief of the air and climate epidemiology section at the California Office of Environmental Health Hazard Assessment.

Because of historical redlining, higher-risk communities might be exposed to more pollution from sources such as freeways, she said. Residents may also dwell within “heat islands,” urban locations that have higher temperatures than outlying areas. “There’s less green space and more buildings and cement and blacktops to really absorb and retain the heat,” Basu said.

Anecdotally, Pandipati said he has seen the effects of heat waves on his patients, some of whom work in agriculture. He consults on high-risk pregnancies as a maternal and fetal medicine specialist with Obstetrix of San Jose. Some women travel to the Bay Area clinic from as far away as California’s Central Valley.

During one record-breaking heat wave before the pandemic, Pandipati noticed many ultrasounds with low levels of amniotic fluid in the womb — a situation that might require doctors to deliver a baby early. “These were moms who were saying that they don’t always have access to air conditioning, they’re often working more manually, either in agriculture or manual labor-type jobs, not always able to stay hydrated adequately,” he said. “I was starting to wonder, wow, I think this is really from the heat waves that we’re experiencing.”

“We just kept monitoring these pregnancies and then things just turned around and the fluid improved. They turned around as the heat wave dissipated,” he said. “We didn’t have to end up delivering them early.”

Air pollution and poor pregnancies

Air pollution, whether from urban pollutants or wildfires, has also been linked to poor pregnancy outcomes.

Air pollution affects preterm birthrates globally, study finds Wildfire pollution may have contributed to as many as 7,000 additional preterm births in California between 2007 and 2012, according to a study that Stanford researchers published in 2021. Wildfire smoke contains fine particulate matter called PM 2.5, which can enter the lungs and bloodstream to create serious health problems. The researchers hypothesized that wildfire pollution might have triggered an inflammatory response that led to preterm delivery.

Weather disasters and mental health

There’s debate about whether human-caused climate change is producing stronger or more frequent hurricanes. But Hurricane Sandy, which struck New York and New Jersey particularly hard in 2012, offered a glimpse into how such devastating superstorms can place severe stress on pregnant people.

In a 2019 study that looked at pregnancy complications in New York after Sandy, researchers found a heightened risk of problems such as early delivery and mental illness. The latter peaked about eight months after the hurricane. In the aftermath of community disasters, post-traumatic stress disorder, depression and anxiety can develop.

Natural disasters trigger a cascade of health consequences, DeNicola said. While there may not be direct cause and effect on birth outcomes, “a lot of it is considered to be because of the stress of the event, either the stress of evacuation or the stress of difficulty getting potable water, the stress of maybe not having the typical indoor living conditions that you’re expecting,” DeNicola said. “You’re not having heat or not having air conditioning.”

“There are a number of physical stressors and psychosocial stressors that come with bracing for a natural disaster like a hurricane and an evacuation,” he said. “People posit, and I think it’s a reasonable concern, that that all prompts some kind of cascade in pregnancy that creates things like preterm contractions.”

A safer pregnancy

Both obstetricians routinely talk to their patients about air and water.

“You need more hydration in pregnancy in general. A woman’s blood volume will increase roughly 50 percent during pregnancy,” DeNicola said. “That’s a lot of extra volume to maintain, so hydration’s really important anyway. I make the extra point that as the seasons get hotter, which happens more often now, you’ll need even more hydration and you need to be aware of things like preterm contractions that are prompted by extreme heat and dehydration.”

Pandipati said he warns patients to watch out for heat waves and to keep an eye on the air quality index, too.

“Ideally, 1 to 50 is good air quality. If you’re starting to get up into the 50 to 100 range, you need to start modifying your activities, doing less outdoor exercise, not as long, not as hard,” he said. “If you’re already not feeling well, you’re coughing, you already have respiratory illness, you shouldn’t be out there.”

Such illnesses include asthma, respiratory allergies and other chronic lung conditions, Pandipati said.

“By the time the AQI is 100, you need to just exercise indoors,” he said. “You need to plan your outdoor activities when the air quality is better, so usually, very early in the morning.” Air quality over 100 begins to enter the unhealthy range.

During wildfires, those who are pregnant must be especially careful about spending time outside, DeNicola said. “During covid, we all wear masks for everything, so it’s kind of redundant,” he said, “but I do mention that wearing a mask is advised and to really limit outdoor activity.”

Basu, the epidemiologist, has advocated for pregnant people to be included in heat advisories. “There are still a lot of heat advisories that don’t include pregnant women, but include other groups, such as the elderly,” she said. Many heat advisories also mention children, people with illnesses, even pets, but not pregnant people.

A natural experiment

A few pregnant patients have asked DeNicola about environmental concerns, but that small number is increasing, he said.

“I have had patients ask about where they should buy their new home because they heard that if you live near coal power plants, that could create worse air quality,” he said. “I’ve had them say similar things related to homes near a highway.”

Pandipati talks to fellow doctors about slipping climate change into the conversation naturally, for instance, while talking about outdoor exercise or staying hydrated during pregnancy. He tells doctors, “You don’t need to be an expert on climate emissions,” he said. “What you need to understand is that those emissions are leading to environmental changes that are now measurably increasing risks to the patients you care for.”

When DeNicola speaks to health-care professionals, he often mentions “a really strong natural experiment,” he said.

Researchers studied preterm birthrates before and after eight coal and oil power plants in California were retired. When the plants shuttered, pollution levels fell. In the 10 years following the closures, the rate of preterm births in the neighboring communities dropped 27 percent, a larger-than-expected reduction.

“When you knock out air pollution over a good 10-year period, the preterm birthrate dropped in a way that no other intervention can achieve,” DeNicola said. “It gives us a bit of hope.”

Doctors can start discussing climate change with pregnant patients, but in the long run, the solutions are much bigger, Pandipati said. “We need to be ensuring that we are enacting policies that stabilize or improve the environment, that really don’t neglect the science.”

“We’ve got to address the problem at the source,” he said. “That’s the real, ultimate preventive care.”

Source:https://www.washingtonpost.com/health/2022/04/11/climate-change-pregnancy-health-babies/

Chemicals Found in Cosmetics, Plastics Linked to Preterm Delivery

July 14, 2022

THURSDAY, July 14, 2022 (HealthDay News) – Phthalates, chemicals that are typically used to strengthen plastics, are in millions of products people use every day, but a new analysis confirms their link to a higher risk for preterm births.

The largest study to date on the topic analyzed data from over 6,000 pregnant women in the United States to better understand the link between phthalate exposure and pregnancy. It found that women with higher concentrations of phthalates in their urine were more likely to deliver preterm babies. Preterm babies, by definition, are delivered three or more weeks before their due date.

“Having a preterm birth can be dangerous for both baby and mom, so it is important to identify risk factors that could prevent it,” said senior study author Kelly Ferguson, an epidemiologist at the U.S. National Institute of Environmental Health Sciences (NIEHS).

For the study, the researchers pooled statistics from 16 studies conducted across the United States that included data on individual phthalate levels as well as the timing of the mothers’ deliveries, with the data spanning from 1983 to 2018. Approximately 9% (or 539) of the women delivered premature babies, with phthalate byproducts detected in over 96% of those urine samples.

The study, published online July 11 in JAMA Pediatrics, examined 11 different phthalates found in the pregnant women, and discovered that four of them were associated with a 14% to 16% greater probability of having a premature baby. The most consistent exposure was linked to a phthalate found commonly in nail polishes and other cosmetics.

“It is difficult for people to completely eliminate exposure to these chemicals in everyday life, but our results show that even small reductions within a large population could have positive impacts on both mothers and their children,” first study author Barrett Welch, a postdoctoral fellow at NIEHS, said in an institute news release.

The effort could be worth it: Reducing the level of phthalates exposure by 50% could prevent preterm births by 12%, on average, the researchers said. The interventions focused on specific changes, such as choosing phthalate-free personal care products, companies reducing the number of phthalates in their products on their own or changing regulations that would reduce exposure to these chemicals.

In the meantime, the researchers suggested avoiding processed food or food wrapped in plastic, instead opting for fresh, home-cooked meals. They also recommended choosing fragrance-free products, which are lower in phthalates. Limiting the amount of product used can also lower exposure.   More information:

Visit the U.S. Centers for Disease Control and Prevention for more on phthalate exposure.

SOURCE: NIH/National Institute of Environmental Health Sciences, news release, July 11, 2022 https://consumer.healthday.com/b-7-14-chemicals-found-in-cosmetics-plastics-linked-to-preterm-delivery-2657652790.html

HEALTHCARE PARTNERS

Forced Retirement Spotlighted as Risk Factor for Physician Suicide

Also time to do away with the “myth of the never-ill physician,”study author says by Shannon Firth, Washington Correspondent, MedPage Today July 5, 2022

Systemic support systems need to be implemented for physicians to prevent work-related stressors that could lead to suicide, a thematic analysis of 200 physician deaths suggested.

Among physician suicides included in the National Violent Death Reporting System database from 2003 to 2018, six themes were found to precede such deaths, including inability to work due to physical health, substance use, mental health issues, relationship conflicts, legal problems, and increased financial stress, all leading to work-related stress, reported Kristen Kim, MD, of the University of California San Diego, and colleagues.

The results further suggested that suicide risk is associated with premature retirement due to health issues that affect employment, they noted in Suicide and Life-Threatening Behavior.

Among 200 physician death narratives, nearly all that reported earlier-than-expected retirement were linked to a physical ailment, Kim told MedPage Today, including a surgeon with a tremor, a physician with dementia, and a physician with alcohol and prescription drug use problems who had lost hospital privileges.

Investigations by state medical boards, employers, and law enforcement were also common in the narratives, and a re-examination of the data found that a majority of the physicians who died by suicide during the study period were unemployed or “pending job loss and typically not by choice,” the authors noted.

While interpersonal conflicts, including those occurring at work, were common, “strained relationships with family members,” often in the context of a divorce or extramarital affair, were even more common, they added.

The study showed “substantial overlap” with a prior study on job-related problems preceding nurse suicides, with a few exceptions. While nurses experienced difficulty accessing mental health supports and medications following job loss, physicians did not. Furthermore, legal issues were a factor in the physician suicide data but not in the nurse data.

Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.

“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” they wrote.

Kim said that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”

To that end, Kim and team offered some anonymous screening tools and “confidential pathways” to treatment, including UC San Diego’s Healer Education Assessment and Referral Program, which links physicians to counseling and outpatient treatment.

In addition, the “Dr. Lorna Breen Health Care Provider Protection Act,” which was signed into law in March, includes funding for hospitals to implement suicide prevention initiatives and to promote help-seeking.

Kim also stressed the urgent need to reform the licensure application process to eliminate “invasive” questions about physicians’ mental health and substance use history, which serve to discourage help-seeking and have unintended consequences for patient care.

For this study, Kim and colleagues used a mixed methods approach combining thematic analysis and natural language processing to develop themes representing narratives of 200 physician suicides included in the National Violent Death Reporting System database from 2003 to 2018.

Of the 200 physicians, mean age was 53, 83.5% were men, 89.5% were white, and 62.5% were married. Over half had mental health problems, 16% had problems with alcohol, 14.5% had other substance use problems, and 22% had physical health problems.

Using natural language processing, the authors confirmed five of the six identified themes — except “incapacity to work due to deterioration of physical health” — which “was likely not identified by natural language processing because physical health issues were described as the various, specific conditions affecting work performance (e.g., back pain, tremor), which were not grouped as a common theme.”

Limitations to the study included the fact that the evaluations were conducted postmortem based on short narratives — usually two paragraphs long — developed following interviews with loved ones.

“We’re using the best available data that we have on the reasons for why they decided to do what they did,” Kim said, but most of the data, with the exception of quotes from suicide notes in the narratives, were not first-hand accounts.

In addition, because most of the physicians in the study were men and white, the results may not be reflective of the work-related stressors of underrepresented minorities.

Furthermore, the database used in the study is voluntary. While the number of states participating rose from six in 2003 to 42 in 2018, including the District of Columbia and Puerto Rico, 10 states still do not report these data.

If you or anyone you know is struggling with a mental health concern or having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Source:https://www.medpagetoday.com/psychiatry/generalpsychiatry/99571

Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care

Front. Pediatr., 23 March 2022
Sec.Neonatology

Gabriel Fernando Todeschi Variane1,2,3*, João Paulo Vasques Camargo2,4, Daniela Pereira Rodrigues2,5, Maurício Magalhães1,2,6 and Marcelo Jenné Mimica7,8

Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

FULL ARTICLE:Frontiers | Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care (frontiersin.org)

Karen M. Puopolo, MD, PhD

CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference

Published on Mar 21, 2022 in CHOP News

Children’s Hospital of Philadelphia (CHOP) is proud to announce that Karen M. Puopolo, MD, PhD, a national leader in the field of neonatology, has received the prestigious Pennsylvania Pediatrician of the Year Award from the American Academy of Pediatrics (AAP) after a unanimous selection by the Pennsylvania AAP Governance Committee and Board of Directors. Each year, this prestigious award is granted to a Pennsylvania pediatrician who exemplifies the ideals of the pediatric profession and participates in activities that reflect the foundation of the chapter.

As an attending neonatologist at CHOP and Chief of the Section on Newborn Medicine at Pennsylvania Hospital, Dr. Puopolo has dedicated her career to quantifying the risk for neonatal infection. She developed a clinical tool known as a sepsis calculator to estimate risk at the individual infant level to avoid unnecessary antibiotic use in neonates. This research has drastically changed newborn care in birth hospitals throughout the U.S. and world. 

Most recently, Dr. Puopolo conducted important research related to the COVID-19 pandemic. Dr. Puopolo led efforts of the national AAP Section on Neonatal Perinatal Medicine (SONPM) to draft clinical guidance on the screening and care of COVID-19-exposed and COVID-19-positive newborns.

“The naming of Dr. Puopolo as the PA AAP Pediatrician of the Year highlights her enormous contributions to perinatal health,” said Eric Eichenwald, MD, Chief of the Division of Neonatology at CHOP. “She embodies the AAP’s commitment to recognize women leaders who go above and beyond to provide excellent, evidenced-based care of newborns. What’s more, Dr. Puopolo’s unwavering dedication to advance the care of neonates during the COVID-19 pandemic has been unsurpassed.”

In addition to her clinical work, Dr. Puopolo serves as Associate Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She has authored hundreds of peer-reviewed publications, scientific abstracts, chapters, and editorials. A member of AAP since 1993, Dr. Puopolo has served many roles within the organization, including as a member of the Committee on Fetus and Newborn and on the Editorial Board of NeoReviews and Pediatrics.

Currently, Dr. Puopolo serves as chair for the AAP Southeastern Central Conference on Perinatal Research, where perinatal trainees can present their research and receive high-quality feedback.

CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference | Children’s Hospital of Philadelphia

Providing A Potential Treatment Option To Infants Where There Is None

Celia Spell   April 21, 2022

A little over 1% of babies born in the U.S. in 2020 fell under the category of very low birthweight, meaning they weighed less than 1,500 grams at birth or 3 pounds, 4 ounces. And considering that the Centers for Disease Control and Prevention says more than 3.5 million babies were born that year, almost 48,500 were considered to be at very low birthweight.

Many of these babies are born premature, at 30 weeks or less, and they have a high chance of having a hemorrhage in their brains shortly after birth, known as a germinal matrix hemorrhage (GMH). Bleeding like this within the substance of the brain is a form of stroke that can lead to a buildup of fluid in the brain known as hydrocephalus – both of which put babies at an increased risk of neurodevelopmental disability, and many don’t survive.

There is currently no medical treatment for GMH, and since these blood vessels are even more delicate when a baby is born prematurely, there is no way to predict or prevent bleeding in the brain after birth.

When Ramin Eskandari, M.D., a pediatric neurosurgeon at MUSC Children’s Health, read about the work that Stephen Tomlinson, Ph.D., vice chair of the Department of Microbiology and Immunology at MUSC, was conducting related to a specific part of the immune system known as the complement system, he thought it might have applications to infants as well.

“We were just having to wait for bad things to happen,” Eskandari said. “And then we had to react to them. We have no treatment for the actual hemorrhage or for preventing the stroke or hydrocephalus that comes after. Tomlinson was looking at adult pathologies in the brain, and we thought it would be a great opportunity to apply his methods to an animal model for premature infants.”

As joint principal investigators for their recent paper in the International Journal of Molecular Sciences, Tomlinson and Eskandari created a mouse model to represent premature infants of very low birthweight and to find treatment options for GMH. Mohammed Alshareef, M.D., a senior neurosurgery resident at MUSC and member of the collaborative lab, discovered that by inhibiting the complement system at a specific site within the brain immediately after a hemorrhage, they could prevent many of the permanent and temporary deficits that accompany hydrocephalus and stroke.

By treating GMH mouse models with the complement inhibitor known as CR2Crry, Tomlinson and Eskandari found improved survival and weight gain, reduced brain injury and incidence of hydrocephalus, and improved motor and cognitive performances in adolescence.

As part of the immune system, the complement system helps antibodies and phagocytic cells activate inflammation and remove microbes and damaged cells from the body, labeling and attacking them. But inflammation activation also leads to the detrimental effects of GMH, and while there is still no way to prevent the initial hemorrhage, Tomlinson and Eskandari are excited about the potential opportunity to prevent the events that occur after the brain bleed.

Cases of GMH are on the rise, and according to Eskandari, this rise is actually due to better care and clinical advancements. With improved prenatal care and better treatment options for premature infants, more babies are surviving being born early. But with more survival, comes higher chances of GMH.

“We’re seeing younger and younger babies viable,” Eskandari said. “I remember when a 23-week-old baby wasn’t viable, and even in the last eight years since my residency, we’re now seeing babies at 20 weeks not only be viable but live full lives and attend school.” It’s these medical advancements that show Eskandari just how important the findings of this study are. And treatment of GMH has the potential to alter an infant’s life course.

Success in inhibiting the complement system has led to a recent boom in research, with over 100 clinical trials currently ongoing, according to Tomlinson. But CR2Crry inhibitor has its own niche. By targeting the therapeutic specifically to the point where the pathology begins, physicians don’t need to knock out the complement system in the entire body, which can lead to increased risk of infections and other immune disorders. They can use less of the inhibitor and target it to a local site, which is safer for patients.

“It’s because this is targeted,” Tomlinson said. “We can actually inject fairly small concentrations directly into the bloodstream to target the injured brain.”

In addition to using the CR2Crry inhibitor to develop a novel therapeutic for premature babies, Eskandari and Tomlinson think it has promise for treating other forms of brain injuries too. “These babies are a really good overall model of how all brain injury could potentially be helped,” Eskandari said. “Having a hemorrhage that leads to stroke and hydrocephalus checks a lot of boxes that we see in many patients.”

Tomlinson’s future research plans include looking at the complement system at different points following an injury in an effort to understand more fully the point at which it becomes part of an injury’s pathology rather than part of its healing process.

Eskandari hopes to host human clinical trials with the human equivalent of the CR2Crry inhibitor at MUSC next. He wants to help his premature patients to live the fullest lives possible. “We want to allow these babies to reach their full potential,” he said.

Source:Providing a potential treatment option to infants where there is none | MUSC | Charleston, SC

PREEMIE FAMILY PARTNERS

It takes a village: NICU parents share their experience as reminder that partners need support, too

Apr 5, 2022

Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner

ALEXANDRA ROTHSTEINJUNE 7, 2022

Some preterm neonatal patients can be discharged from the hospital sooner through the unique Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota.

This one-of-its-kind program in Minnesota allows infants that qualify to receive expert care and monitoring at home through the use of an app on a tablet and a scale. The parent caregiver inputs the baby’s vitals daily, which are then shared and monitored by the baby’s neonatal care team.

The Children’s Minnesota Neonatal Intensive Care Unit (NICU) in St. Paul conducted a pilot study with 20 patients during a one-year period to evaluate how at-home care impacts babies’ ability to learn to feed, rates of breastfeeding and overall patient-family satisfaction. The results of the pilot were overwhelmingly positive and, for one family, meant that a father could spend precious time with his newborn while battling his own illness.

A challenging time

The year of 2021 was a time of mixed emotions for Amanda and Rob Calvin. They were excited to be welcoming their first baby, but Rob was also battling pancreatic cancer. “When we found out about Rob’s diagnosis, he was given one year to live, so we decided to have a child,” Amanda recalled.

The Calvins expected their baby to arrive in early April, but around mid-February, Amanda started having complications from a bleeding disorder she’s had since birth. “My condition had been flaring up with my pregnancy and getting worse to the point where I had to be admitted to the hospital,” Amanda said.

With the pandemic still at its height – and in light of her illness and her husband’s cancer – Amanda had a virtual baby shower from her Minneapolis hospital room. There, she also dealt with another serious health concern called preeclampsia, a severe high blood pressure condition in pregnant women. Amanda had a C-section procedure the day after her baby shower at The Mother Baby Center, a partnership between Allina Health and Children’s Minnesota.

Baby Finn arrived early

On Valentine’s Day 2021, baby Finn entered the world nearly eight weeks early – weighing just 3 pounds and 13 ounces. Finn’s care team rushed the newborn to the NICU at Children’s Minnesota and placed the tiny infant on a breathing machine. Finn spent the next month splitting time between the NICU and the special care nursery.

“I remember all of his caregivers being the most compassionate people and they made sure I knew what was going on,” recalled Amanda, a physician specializing in pulmonary and critical care medicine with HealthPartners Park Nicollet. “I’m an ICU provider and my son was in the ICU. Vital signs for infants are completely different than vital signs for adults. I tried to shut out paying attention to that stuff. There was too much for me to process.”

Time was of the essence

As Finn and Amanda navigated the NICU, Rob continued his fight with pancreatic cancer. “Rob no longer responded to chemo and was about to transition to hospice,” said Amanda. “He was so sick he couldn’t make it to the hospital.”

Preterm babies usually stay in the hospital with their care team until when they would have been full-term to grow, learn how to eat and breathe on their own. But CHAMP allowed Finn to go home a month early. Amanda used the app to stay connected with his care team and took over feeding using a nasogastric (NG) feeding tube that was inserted before heading home.

“It ended up being a major blessing,” Amanda said. “We were stretched thin going back and forth to the hospital. We were making it work. Without this program, we would not have had time together as a family at home in the place where we wanted to be.”

Finn graduated from CHAMP after a week on the special care program. Rob passed away soon after his infant’s graduation. “Rob died six days before Finn’s original due date. Finn got to be home with his dad before he died. I can’t quantify the value of that,” Amanda said while reflecting on her late husband.

Today, Finn is a healthy 1-year-old and meeting or exceeding all of his physical and developmental milestones. “Everybody at Children’s Minnesota went out of their way to make sure Finn was cared for – that we were heard, and they knew what we needed more than we did,” Amanda said while holding back tears. “I can’t thank those people enough. They gave us time we would have never had.”

About CHAMP at Children’s Minnesota

Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota is the only program of its kind in Minnesota. Before heading home, babies have a nasogastric tube (NG) inserted. Families are provided with a scale and a tablet equipped with a program called Locus, which allows parents to input vitals that are shared with their neonatal team. Families are also trained by the team on proper NG and oral feeding techniques as well as CPR.

To qualify for CHAMP, a newborn must be a current Children’s Minnesota NICU patient, be able to breathe without any respiratory or oxygen support, weigh more than four pounds and consistently gain around 30 grams of bodyweight per day.

“Children’s Minnesota will always strive to pioneer cutting-edge programs that continue to put our patients first and keep families as part of their care team – CHAMP accomplishes all of these goals,” explained Dr. Cristina Miller, medical director of the NICU follow-up clinic at Children’s Minnesota, and founder and director of CHAMP. “Even though the babies who qualify for CHAMP are home, their clinical care team still remains at their bedside virtually to ensure they are growing, healthy and thriving.”

“The first question any parent asks when their child is admitted to the NICU is, ‘When can we go home?’ We’re hoping that this method helps families return to their normal daily lives faster, especially with the additional COVID-19 pandemic restrictions that have been in place,” said Dr. Miller. “But even after the pandemic is over eventually, this could be a game changer.”

Source:Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner | Children’s Minnesota (childrensmn.org)

Importance The Of Support For NICU Families

Mar 7, 2020      LivingHealthyChicago

A health complication involving kids can really rock a family’s world- especially when it involves the very youngest in our families. This mother is sharing her family’s story in hopes of raising awareness about the importance of support for NICU families. Plus, we learn about an innovative treatment being utilized to help with a heart health issue that’s more common in premature babies.

Chatting to your premature baby

Talking and listening to children from the moment they are born helps them develop. This is especially true for babies who are born prematurely.

When a child is born prematurely, they might spend some time in the neonatal unit at hospital. Talking to your baby from day one will help the two of you get to know each other. The stimulation of your voice will help your baby develop and bond with you in the early days.

Premature babies will get tired more quickly and sleep more, but there are lots of ways to communicate with your baby such as touch, eye contact and facial expressions are all ways of communicating.

Babies can communicate before they start talking. As soon as your baby is born, they can recognise the sound of your voice.

Tips for talking to your premature baby

  • Kangaroo Care is when your baby is placed skin-to-skin on your chest. The contact will help to form a bond between you. Talk quietly and take time to listen to them – if they make noises try to respond.
  • When you are ready, care staff will support you to do some routine tasks such as nappy changing, tube feeding, or bath time. This is a great time to talk to your baby about what you are doing or sing to them as you are doing it.
  • When your baby is very small, they will like to grasp your finger and enjoy the feeling of your hands on their body.
  • Call them by their name. The sound of your voice will help relax and soothe them.
  • As the weeks go by, your baby will look at you for longer and see your face more clearly. Smile and respond to your baby.
  • It’s never too early to read a story! Choose a baby book and read. Your voice will help your baby relax and fall asleep.
  • Like adults, babies don’t always feel like being sociable. If your baby starts to hiccough, look away or yawn, these are signs they need to rest.

Source:https://wordsforlife.org.uk/activities/chatting-your-premature-baby/?gclid=Cj0KCQjwuO6WBhDLARIsAIdeyDJc64LX9OgyPDeVIz0axNq9FLp1owC2SrE11_QKvuLH9IwTO8A9Q-MaAnkoEALw_wcB

Innovative Music Therapy for the Brain Development of Premature Babies

Apr 3, 2022    HEC Science & Technology

It only takes a few chords to capture Ayla Campbell’s attention. She arrived 16 weeks early, weighing less than two pounds. While staying in MU Health Care’s neonatal intensive care unit, or NICU, Ayla received her first visit from a music therapist Emily Pivovarnik. “Her heart rate would just go down, and her oxygen was going up,” said Angel Campbell, Ayla’s mom. “If someone had told me that this could happen just from singing, I wouldn’t have believed it.” Pivovarnik is a trained music therapist who helps babies eat better, regulate their stress levels and adjust to stimulation. Pivovarnik is part of a team starting a research project to look at the long-term effects of a specific music therapy intervention called multimodal neurological enhancement, or MNE. This therapy combines music, gentle touch and rocking to help a baby’s brain develop. About 135 babies will be involved in the research project. After leaving the hospital, they’ll receive neurodevelopment testing.

Innovative Music Therapy for the Brain Development of Premature Babies – YouTube

Joel Mackenzie used ‘kangaroo care’ to help daughter Lucy, born prematurely. Photo: U. South Australia

Snuggling With Dad: Fathers’ Contact Can Help Preemies Thrive

Ellie Quinlan Houghtaling

THURSDAY, July 14, 2022 (HealthDay News) — Decades of research have shown the power of skin-to-skin contact between preemies and their moms, but would the same technique, dubbed “kangaroo care,” work with fathers?

Yes, claims a new Australian study that found when dads held their premature babies close to their bare chest, they reported feeling a “silent language of love and connection.”

“It’s like when your finger touches a fire, there are receptors there letting you know that it’s hot,” said study author Qiuxia Dong, a nurse and master’s candidate at the University of South Australia. “It’s the same thing [in kangaroo care], when the attachment happens between father and baby or mother and baby, it’s just another reaction.”

First-time father Joel Mackenzie experienced it with his tiny daughter, Lucy, when he was first able to hold her, two weeks into her time in the neonatal intensive care unit (NICU). Mackenzie explained that the NICU experience can be a really isolating one for parents, especially dads who are not often considered by the health care system when it comes to reconnecting with their child after a medical intervention.

“I felt like I was actively fostering her survival and her development by giving her a cuddle,” said Mackenzie, who was one of 10 dads followed in the study.

The findings were published online recently in the Journal of Clinical Nursing.

One expert in neonatal care described how the bonding process works.

“There are biologic phenomenon that exist that allow babies and their parents to bond, and there are hormones that get released that allow you to fall in love,” explained Dr. Robert Angert, a neonatologist at NYU Langone in New York City. “Those are stimulated by all your senses — your sight, but also your smell and touch. If you cut out some of those senses, you’re going to miss out on those opportunities,” he said.

“On the other side, you have anxiety and stress, and those make it harder to fall in love. As they describe in the article, a lot of parents, particularly non-birthing parents, are stressed and anxious and worried about the well-being of their child, especially a baby who’s in the ICU,” Angert added. “Bringing them together safely and in a way that’s helpful to the baby reduces that anxiety to the parent.”

Research has shown that during kangaroo care, the close contact activates nerve receptors in mammals that increase the production of hormones that lower pain and stress for both babies and parents.

The latest study illustrated that: Many of the fathers described the NICU environment as “overwhelming,” but the ability to hold their children next to their skin fostered strong bonds and relaxed them, which helped build confidence and made them very happy.

“It was palpable how much of an impact it had on her,” Mackenzie said. “Of course, it helped me in bonding with her and helping me understand her and what was good for her as a child, but also as well you could almost tell that she almost drew energy from us. She started to move better, she started to develop faster. I’d see her move better on a day-to-day basis. Eat more, be more responsive. Her eyes would open and move and engage more each time we took her out of the crib.”

Having to separate a newborn from its parent for medical reasons isn’t just traumatic for parents, it can have emotional and developmental impacts on the infant as well.

Angert said that “separation is an incredibly traumatic event in the life of a newborn, and I think we underestimate the impact that that event has on a baby. So we have an opportunity here to restore some of that togetherness, and it’s not without good reason that we’re taking the baby away. We’re saving their life. But it’s also good to think about when we can reestablish contact and allow them to give kangaroo care to their babies.”

Parents who go through the NICU process have no doubts about the efficacy of staying by their child’s side when they’re sick. Mackenzie, whose child will celebrate her first birthday next week, said the bonding made all the difference.

“She still has mild lung disease and chronic cerebral palsy, but [the kangaroo care] part of her NICU experience was definitely a contributing factor to where she is now, I have no doubt about it,” Mackenzie said. “Children who’ve gone through this experience definitely have a better chance of survival in my opinion.”

More information: To learn more about skin-to-skin contact benefits between parents and newborns, visit the Cleveland Clinic.

Source:https://consumer.healthday.com/7-14-snuggling-with-dad-fathers-contact-can-help-preemie-baies-thrive-2657647641.html

Occupational Therapy and Infancy: Supporting Families During the Earliest Occupations

Alexis Ferko, B.A., OTS

Occupational Therapy and Infancy: Occupational therapy (OT) is a holistic, client-centered, occupation-based profession focused on assisting individuals to independently participate in daily activities to the best of their ability . Occupational therapy practitioners (OTP) are board certified, have extensive academic training and clinical experience and treat individuals across the lifespan in various settings  while considering the “biological, developmental, and social-emotional aspects of human function in the context of daily occupations”. OTPs utilize the power of occupation to support families and infants in achieving positive outcomes . The first year of an infant’s life is a rapid period of growth; infants are learning how to actively interact with their environment and family system. Occupations of infancy are defined as “any activity or task of value in which the family or setting expects the infant to engage”  including activities of daily living (ADL) like feeding and bathing, health management including social and emotional health promotion and maintenance, rest and sleep, play and social participation . Infants also participate in co-occupations, meaning infants share an occupation with their caregiver; examples such as play and breastfeeding . OTPs also assist families with adapting to new performance patterns including habits, roles, routines, and client factors. OTPs treat infants in settings including hospitals or NICU’s, early intervention (EI), outpatient, and community-based settings. Infants may be referred to OT for concerns with maintaining homeostasis or bonding in the NICU, feeding or sensory concerns, physical development, social-emotional skills, and sleep .

OT in the NICU: Many infants and families have their first experience with OT in the NICU setting. NICU OTPs have extensive knowledge in neonatal medical conditions, development and understand the complex medical needs of infants in this setting . OTPs are members of an interdisciplinary team of professionals including pediatricians, physical therapists (PT), speech-language pathologists (SLP), lactation consultants, respiratory therapists, nurses, midwives, neonatologists, among others. OTPs administer assessments related to sensory processing, motor function, social-emotional development, pain, activities of daily living (ADL), neurobehavioral organization, and environmental screenings to identify and create an appropriate infant and family-centered intervention plan. The primary functions of an OT in the NICU is to focus on developmentally appropriate occupations, maintaining homeostasis (stable vitals, feeding, breathing), self-regulation, sensory development, feeding, motor function, coping and attachment skills, bathing and dressing, and nurturing interactions with caregivers including skin to-skin contact. OTPs utilize various interventions including sensory integration, neurodevelopmental techniques, positioning/handling, infant massage, feeding, bonding, and environmental modifications to minimize stress and overstimulation while in this setting. Therapists must also address the family system by forming a therapeutic relationship with the family. The NICU can cause separation between infant and caregivers especially if there are maternal complications after delivery which can increase stress and instability within the family system . Parent-infant attachments and occupations must be prioritized, including bonding such as skin-to-skin contact, or kangaroo care. Kangaroo care is an essential intervention to support infants in the NICU by having the infant lay on the caregiver’s bare skin. Benefits to this intervention include more stable heart rate, breathing patterns and temperatures, faster weight gain, more successful feeding, and increased bonding. OTPs also consider the Neonatal Integrative Developmental Care Model, meaning therapists are fostering a healing environment in the NICU setting – a setting known to be stressful and overstimulating for infants and their families. Core measures of this model include skin protection, optimizing nutrition, positioning/handling to promote breathing and stability, safeguarding sleep, optimizing nutrition, minimizing stress and pain through environmental and sensory modifications, and partnering with families . Research shows that interventionists who follow this model have better growth development outcomes.

Breastfeeding and Feeding: As of 2020, over 83% of infants are breastfed at some point in their young life. 60% of mothers stop breastfeeding before they intend to stop due to various reasons including latching difficulties, infant weight concerns, lack of work and family support, and concerns with medication while breastfeeding. OT can assist with facilitating breastfeeding which improves parent-infant attachment and bonding and can also reduce postpartum depression . OTPs must consider various aspects of the infant caregiver dyad during breastfeeding including infant arousal state, respiratory ability, overall stability, oral reflexes, oral strength and endurance and caregiver arousal, attention, posture and upper extremity strength, cognition, and cultural values/beliefs related to feeding . It is also important to consider sensory and environmental stimulation, social supports, and bottle/nipple type if the infant is not being breastfed. OTPs can assist breastfeeding caregivers with developing routines and habits to promote breastfeeding and education related to their infant’s hunger and stress cues, positioning, ergonomics, self-regulation, and environmental modifications . Infant interventions include suck training, positioning, and various sensory strategies to promote arousal levels. Environmental and activity modifications include changing the position of feeds, adapting the lighting, touch, sound and using supportive equipment during feeding and adapting the type, thickness or volume of milk and feeding schedule . Feeding is a very important occupation for an infant as it takes up much of their early life and helps facilitate secure attachments to their caregiver as well as promoting self-regulation .

 OT’s Role in Transitioning Home: OT also plays a role in assisting families with the transition from NICU to home. Transition planning begins at NICU admission with OTPs educating families on various interventions and considerations for the infant’s unique medical needs. Upon discharge from the NICU, OTPs may recommend follow-up with EI, outpatient OT or PT, or a feeding clinic to address various concerns including feeding, global developmental delay, ROM or joint limitations, tone management, among others . OTPs also educate families on general infant care like signs of stress and how to relax or calm an infant, feeding strategies, home environment set-up and safe sleep strategies. OTPs also work with lactation consultants to address any concerns or strategies related to breastfeeding.

Early Intervention and Infancy: Infant occupations vary based on family, contextual and cultural factors. OT is a primary service under IDEA Part C and delivers services related to the infant’s individualized family service plan (IFSP) outcomes . Gorga (1989) identified seven areas of occupational therapy treatment practices for infants in EI including motor control, sensory modulation, adaptive coping, sensorimotor development, social-emotional development, daily living skills and play . OT interventions include handling, positioning, adapting the environment, sensory registration, arousal, attention, emotional regulation, cognition, feeding and play activities like reach and grasp. The American Occupational Therapy Association (AOTA) elaborated on various interventions in early intervention including promoting healthy bonding and attachment, family education and training, adapting tasks and the environment, participation in ADLs, rest and sleep and play related to the infant’s IFSP outcomes.

Conclusion: Occupational therapy practitioners are client-centered, occupation-based and address the infant and their family holistically. Various occupations OTPs can address include feeding, bathing, rest and sleep, health management, play and social participation, among others. Breastfeeding is also an important co-occupation OTPs can address in this setting. OT can also work with the family to promote carryover of strategies, encourage developmental care, and optimize infant well-being in the NICU, EI and home setting. Various professions work with occupational therapists on multidisciplinary, transdisciplinary, and interdisciplinary teams including PT,  SLP, pediatricians, lactation consultants, nursing, midwives, neonatologists, and other specialists. These professions would benefit from working with OT to help increase independence, improve overall well-being and participation in infant and family occupations all of which leads to a greater quality of life for both the infant and family.  Occupational therapists serve a unique role in the neonatal intensive care setting by identifying, promoting, and advocating for developmental care practices that aim to support families in participating in these early occupations.

Source:http://neonatologytoday.net/newsletters/nt-jul22.pdf

INNOVATIONS

A Wearable for Monitoring Prenatal Health at Home

An estimated 15 million babies are born prematurely every year, posing a significant risk to both maternal and neonatal health. The EU funded WISH project promotes a novel tool for monitoring the risk of preterm labour at home.

Preterm birth is defined as any live birth before the 37th week of pregnancy and is associated with complications that lead to neonatal and infant mortality. Additionally, premature babies are prone to serious long-term illnesses, lifelong disabilities such as cerebral palsy and respiratory illnesses as well as poor quality of life. Consequently, preterm birth is the cause of great suffering and psychological stress to parents. For further information see the IDTechEx report on Wearable Sensors 2021-2031.

Machine learning to predict preterm birth

Currently, regular medical check-ups and clinical examinations in a hospital setting are the only available solution for expectant women to diagnose preterm labour. However, expecting couples often mistake Braxton Hicks contractions, which occur normally during a healthy pregnancy, as preterm labour contractions. This increases hospital visits and concomitant healthcare costs. To address this issue, the EU-funded WISH project has developed an innovative platform for antepartum maternal and foetal monitoring. “WISH integrates seamlessly into the daily activities of expectant women in a way that will enable remote antepartum monitoring at home,” explains Julien Penders, co-founder and COO of Bloomlife. The WISH system consists of a specifically designed electrode patch, a consumer app, a web-based dashboard and a secure cloud data platform. It measures maternal and foetal health parameters, such as heart rate and uterine activity, through a specific sensor. This real time information is processed using advanced algorithms and machine learning to provide the probability of a woman being in labour.

Clinical validation and prospects

The WISH solution was tested and validated during the project in a two-centre, interventional study on 150 pregnant women. Study participants received a WISH system and were asked to use it at least three nights per week until they gave birth. Results demonstrated that the WISH system had similar accuracy in labour detection with current diagnostic methods used in hospital. “This clearly illustrated the feasibility of applying non-invasive wearable technology at home as an alternative labour management strategy,” emphasises Penders.

Preterm birth is a global health problem and one of the EU healthcare priority areas. The high socioeconomic impact of preterm birth necessitates novel solutions for predicting and prolonging the gestational age at delivery. The WISH project laid the foundation for a new non-invasive approach for preterm labour detection and a much needed tool for high-risk pregnancies. Implementation of WISH is expected to provide essential data for both expectant women and healthcare providers, facilitating more efficient prenatal care across Europe. Importantly, WISH will offer reassurance to women throughout the last stages of pregnancy through the provision of trustworthy information. Future efforts will focus on how to exploit the WISH solution to improve doctor-patient communication, implement preventive actions and timely interventions to reduce preterm births and radically change prenatal care across Europe. Penders envisions pivotal clinical trials will support the CE marking of WISH as a medical device and render it ready for commercialisation.

Source:A Wearable for Monitoring Prenatal Health at Home | Wearable Technology Insights

CDC: Infant outcomes vary by maternal place of birth

JUNE 29, 2022

Maternal characteristics and infant outcomes vary by maternal place of birth, according to a report published in the June issue of Vital and Health Statistics, a publication of the U.S. Centers for Disease Control and Prevention National Center for Health Statistics.

Anne K. Driscoll, Ph.D., and Claudia P. Valenzuela, M.P.H., from the National Center for Health Statistics in Hyattsville, Maryland, describe and compare maternal characteristics and infant outcomes by maternal place of birth among births occurring in 2020.

The researchers found that 21.9 percent of women who gave birth in the United States in 2020 were born outside of the United States. Women born in Latin America accounted for 12.0 and 54.9 percent of all women giving birth and those born outside of the United States, respectively, while women born in Asia accounted for 5.9 and 27.2 percent, respectively. Maternal characteristics varied by region, subregion, and country of birth, with the percentage of women giving birth under age 20 higher for women born in the United States (5.0 percent) than for those born in other regions, and obesity rates varying from 10.7 percent for women born in Asia to 38.1 percent for women born in Oceania. Infant outcomes varied by mother’s place of birth, with preterm birth rates varying from 6.90 to 11.43 percent of infants of women born in Canada and Oceania, respectively. Similar variation was seen for low birthweight and neonatal intensive care unit admission rates.

“The characteristics, residence patterns, and infant outcomes of women born outside the United States vary considerably,” the authors write.

Full Article: https://www.cdc.gov/nchs/data/series/sr_03/sr3-048.pdf https://medicalxpress.com/news/2022-06-cdc-infant-outcomes-vary-maternal.html

NICU Lighting Tech Licensed to NASA Spinoff

Post Date: April 11, 2022

Cincinnati Children’s has licensed technology that mimics sunlight in the NICU of the new Critical Care Building to a NASA spinoff, which is marketing a consumer product called the SkyView Wellness Table Lamp.

California-based Biological Innovations and Optimization Systems LLC, or BIOS, focuses on the biological application of LED lighting for people and plants. 

BIOS announced it has licensed the exclusive rights to the violet light technology invented and developed at Cincinnati Children’s, which optimizes light exposures and can influence circadian rhythms, eye development and metabolism.

The violet light technology is a component in the world’s first full-spectrum, tunable lighting system in a neonatal intensive care unit, which was installed in the Critical Care Building that opened on the Burnet Campus of Cincinnati Children’s in November 2021.

Richard Lang, PhD, director of the Visual Systems Group at Cincinnati Children’s, has worked with colleagues for more than a decade to better understand the role that sunlight plays in fetal development. Their discoveries, coupled with growing scientific knowledge about the importance of circadian rhythms to human health, sparked the idea to install lights in the NICU that could provide the full range of wavelengths found in sunlight.

“Our recent discoveries showed that violet light plays a crucial role in normal human physiology,” Lang said. “This prompted us to work with BIOS lighting to deploy a new human-centric lighting technology in our neonatal intensive care unit. We believe everyone can benefit from human-centric lighting.”

The licensing agreement comes in the wake of global studies by researchers into sleep complaints and circadian disturbances observed during the COVID-19 pandemic, BIOS stated. The science behind the company’s biological lighting expertise was first developed for the International Space Station.

“BIOS is committed to creating human-centric lighting designed to promote health and wellbeing,” Robert Soler, a former NASA engineer who is vice president of biological research and technology for Bios, said in a news release. “When the opportunity arose, we were excited to work with Cincinnati Children’s and co-develop new human-centric lighting technology. We now offer this technology in our SkyView Wellness Table Lamp.”

Source:NICU Lighting Tech Licensed to NASA Spinoff | Research Horizons (cincinnatichildrens.org)

Over the past few weeks extreme heat waves have resulted in record breaking temperatures worldwide. Living in London, I witnessed the impact of the 105-degree temperature on the local community, nature parks,  infrastructure, and public transportation. With tube station, railway, and plane shutdowns due to fires and melting roadways it was clear that this was an event that would mark an obvious need to shift towards increased climate action both within the UK and Worldwide. Millions of residents were encouraged to stay home, avoid attending events and work outside of the home and were provided emergency warning resources and information about ways to stay safe. The impact of this recent climate event has now moved along to the Pacific Northwest Region where many of my family members and friends have reported similar disruptions in their communities as consecutive high temperatures throughout the last week of July into August will reach an all-time high.

Climate change has and will continue to impact every community in a variety of anticipated and unexpected ways. Amongst our global neonatal community studies have shown a direct correlation between the effects of rising temperatures and increased risk for preterm labour. For example, a recent 2020 BMJ meta-analysis study found that “the odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. “ (Cherish et al,2020)

Increased research efforts to investigate the impact of climate change on preterm birth rates and outcomes will be instrumental in addressing collaborative solutions to implement preventative interventions and improved care to those negatively impacted as a result of climate change on maternal and neonatal health. As an active community we can do our part to enhance our knowledge and find creative ways to be a part of the solution towards helping to improve our carbon footprint within our communities and homes.

Personally, I believe our global youth have in many ways led the forefront towards addressing climate change. We have included a few engaging videos discussing ways we can help to address climate change and the experiences of young climate activists like Greta and friends who may inspire us to pick up some new habits and get involved in doing our part to bring about the prioritization of climate action to improve the health of our planet and our livelihood now and in the future.

KAT’S CORNER

Climate Change for Kids | A fun engaging introduction to climate change for kids

Hey Teachers and Parents! In this video we explore climate change for kids. We learn all about the causes of climate change like the greenhouse effect, fossil fuel burning, farming, and even deforestation and why these are big dilemmas in today’s world. We also cover ways that we can help prevent climate change and be friendlier to our environment including: walking, planting trees, using less electricity and other fun ways. We hope you and your students have fun as they learn about climate change and what we can each do to help planet earth. We also invite you to download our FREE climate change lesson plan (for grades 4-6) that is complete with more content, worksheets, activities for kids, and more!

Greta and eight young activists reveal how the climate crisis is shaping their lives | UNICEF

Nine young activists explain how climate change is affecting their lives and who inspires their efforts to make our planet a better place. Greta Thunberg (Sweden) is joined by Alexandria Villasenor (USA), Catarina Lorenzo (Brazil), Carlos Manuel (Palau), Timoci Naulusala (Fiji), Iris Duquesn (France), Raina Ivanova (Germany), Raslene Jbali (Tunisia) and Ridhima Pandey (India).

SURFING In PHILIPPINES BRITISH Mum So HAPPY To Do This

Oct 22, 2020

Surfing in the Philippines was not something that we thought about when planning our holiday. Usually you think of Hawaii’s waves and the surf vibe and culture. So when we realized we’d stumbled into Siargao Island the little Hawaii of the Philippines, we knew one of us had to take to the water and try out a surf lesson. As a British family, most of us didn’t grow up around surf culture because of the cold water and weather so we were so happy to do this here in the bath warm pacific ocean. We booked a private lesson with Racel from Makulay Resort Santa Fe in General Luna. It cost 1400 pesos or around £21 for a two hour teaching session, and Racel is actually a professional competing surfer so it felt even better to get our first experience of surfing in the Philippines with him. I stood up multiple times on the board and I highly recommend lessons with Racel if you find yourself on Siargao Island wanting to learn to surf. If this mum can do it, anyone can!

CDC: Infant outcomes vary by maternal place of birth

 

Tech Emerging, Mortality, FC Care

NORWAY

PRETERM BIRTH RATES – NORWAY

Rank: 172  –Rate: 6.0%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Norway, officially the Kingdom of Norway, is a Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of Jan Mayen and the archipelago of Svalbard also form part of Norway. Bouvet Island, located in the Subantarctic, is a dependency of Norway; it also lays claims to the Antarctic territories of Peter I Island and Queen Maud Land. The capital and largest city in Norway is Oslo.

Norway has a total area of 385,207 square kilometres (148,729 sq mi) and had a population of 5,425,270 in January 2022.[14] The country shares a long eastern border with Sweden at a length of 1,619 km (1,006 mi). It is bordered by Finland and Russia to the northeast and the Skagerrak strait to the south, on the other side of which are Denmark and the United Kingdom. Norway has an extensive coastline, facing the North Atlantic Ocean and the Barents Sea. The maritime influence dominates Norway’s climate, with mild lowland temperatures on the sea coasts; the interior, while colder, is also a lot milder than areas elsewhere in the world on such northerly latitudes. Even during polar night in the north, temperatures above freezing are commonplace on the coastline. The maritime influence brings high rainfall and snowfall to some areas of the country.

Health

Norway was awarded first place according to the UN’s Human Development Index (HDI) for 2013. In the 1800s, by contrast, poverty and communicable diseases dominated in Norway together with famines and epidemics. From the 1900s, improvements in public health occurred as a result of development in several areas such as social and living conditions, changes in disease and medical outbreaks, establishment of the health care system, and emphasis on public health matters. Vaccination and increased treatment opportunities with antibiotics resulted in great improvements within the Norwegian population. Improved hygiene and better nutrition were factors that contributed to improved health.

The disease pattern in Norway changed from communicable diseases to non-communicable diseases and chronic diseases as cardiovascular disease. Inequalities and social differences are still present in public health in Norway today.

In 2013 the infant mortality rate was 2.5 per 1,000 live births among children under the age of one. For girls it was 2.7 and for boys 2.3, which is the lowest infant mortality rate for boys ever recorded in Norway.

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

COMMUNITY

Ten Years of Neonatal Intensive Care Adaption to the Infants’ Needs: Implementation of a Family-Centered Care Model with Single-Family Rooms in Norway

Lene Tandle Lyngstad 1Flore Le Marechal 1Birgitte Lenes Ekeberg1Krzysztof Hochnowski 1Mariann Hval 1Bente Silnes Tandberg1

International Journal of Environmental Research and Public Health  13 May 2022, 19(10):5917
DOI: 10.3390/ijerph19105917 PMID: 35627454 PMCID: PMC9140644

Abstract

Ten years ago, the Neonatal intensive care unit in Drammen, Norway, implemented Single-Family Rooms (SFR), replacing the traditional open bay (OB) unit. Welcoming parents to stay together with their infant 24 h per day, seven days per week, was both challenging and inspiring. The aim of this paper is to describe the implementation of SFR and how they have contributed to a cultural change among the interprofessional staff. Parents want to participate in infant care, but to do so, they need information and supervision from nurses, as well as emotional support. Although SFR protect infants and provide private accommodation for parents, nurses may feel isolated and lack peer support.

Our paper describes how we managed to systematically reorganize the nurse’s workflow by using a Plan-Do-Study-Act (PDSA) cycle approach. Significant milestones are identified, and the implementation processes are displayed. The continuous parental presence has changed the way we perceive the family as a care recipient and how we involve the parents in daily care. We provide visions for the future with further developments of care adapted to infants’ needs by providing neonatal intensive care with parents as equal partners.

FULL ARTICLE:    http://europepmc.org/article/MED/35627454

Sigrid, Bring Me The Horizon – Bad Life

Sigrid

The RHODĒ Study

Rhode Island Cohort Of Adults Born Prematurely

The Rhode Island Cohort Of Adults Born Prematurely — or “RHODĒ” Study — is a longitudinal study following a group of 215 infants born between 1985-1989 in Rhode Island. The study was previously known as the Infant Development Study. Prior waves of data collection occurred at birth, 1 month, 18 months, 30 months, 4 years, 8 years, 12 years, 17 years, and 23 years of age. The 215 originally enrolled infants represent a wide range of gestational ages, birth weights, and illness severity, and includes both preterm and full-term participants.

In response to an Institute of Medicine recommendation for long-term outcome studies for premature infants into young adulthood, we are currently conducting the tenth wave of the study, with participants aged 30-35 years old.

We are fortunate to have retained 96% of the participant sample between ages 17 and 23 years, and 85% since birth. To our knowledge, this is the only U.S. based study to follow preterm and full-term participants from birth into age 30.

Source: https://www.rhodestudy.com/

INNOVATIONS

‘Smart pacifier’ in development with help from WSU Vancouver researchers:2701:45

Clinical trials are still to come, but the academic group hopes the small medical device eventually replaces blood draws, and a lot of wires and electrodes.

Author: kgw.com  Published: 5:43 PM PDT June 11, 2022 Updated: 5:43 PM PDT June 11, 2022

Comparison of the effect of two methods of sucking on pacifier and mother’s finger on oral feeding behavior in preterm infants: a randomized clinical trial

Abstract

Background

Oral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother’s finger on oral feeding behavior in preterm infants.

Methods

This single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother’s finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother’s finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used.

Results

The mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05).

Conclusion

Considering the positive effect of these two methods, especially non-nutritive sucking on mother’s finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit.

Source:https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03352-9

EFCNI involved in new study on blood transfusions in preterm babies

POSTED ON 11 MAY 2022

Most preterm babies admitted to a Neonatal Intensive Care Unit (NICU) receive blood transfusions. Some neonates, however, receive blood transfusions even though these transfusions may not be necessary, cause side effects or even harm. Therefore, the International Neonatal tranSfusion PoInt pREvalence study (INSPIRE) aims to describe the current state and indications for blood transfusions among preterm babies in Europe.

Although most preterm babies receive blood transfusions in the NICU, there are no international guidelines that have been incorporated into clinical practice, and there is significant variation in blood transfusion practice within Europe. Additionally, high-quality data on neonatal transfusion practice in Europe is lacking. The INSPIRE-study will describe current neonatal transfusion practices within Europe. These results will help to improve practice, develop future clinical studies, and inform guideline writing. Additionally, the results may help to reduce unnecessary transfusions through increased awareness of the proper use of transfusions in this vulnerable patient group.

In collaboration with the Neonatal Transfusion Network (NTN), EFCNI coordinates an international parental advisory board (PAB). The PAB is chaired by EFCNI and meets on a regular basis throughout the duration of the project. Furthermore, EFCNI gives advice and provides input on topics related to ethics and patient information throughout the project.

Ongoing updates on the project can also be found on our project page.

Source:https://www.efcni.org/news/efcni-involved-in-new-study-on-blood-transfusions-in-preterm-babies/

Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care

Gabriel Fernando Todeschi Variane1,2,3*, João Paulo Vasques Camargo2,4, Daniela Pereira Rodrigues2,5, Maurício Magalhães1,2,6 and Marcelo Jenné Mimica7,8

Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

Full Article: https://www.frontiersin.org/articles/10.3389/fped.2021.755144/full

Accuracy and Completeness of Intermediate-Level Nursery Descriptions on Hospital Websites

David C. Goodman, MD, MS1,2,3,4Timothy J. Price, MS1David Braun, MD5,6

JAMA Netw Open. 2022;5(6):e2215596. doi:10.1001/jamanetworkopen.2022.15596

Key Points

Question  How completely and accurately do hospital websites describe their level II special care (ie, intermediate care) nurseries?

Findings  In this cross-sectional study of hospital nurseries (including 1.99 million live births and 268 level II units) in 10 large US states that regulate nursery levels of care, state-designated intermediate (ie, level II) units were inaccurately or incompletely described in 39% and 25% of the hospital websites, respectively. There was substantial and statistically significant variation in rates of incompleteness and inaccuracy across states.

Meaning  These results suggest that hospital websites, often the only source of publicly available information describing a hospital’s neonatal unit, do not provide reliable information for prospective parents, referring physicians, and the public to assess the capacity to care for ill newborns.

Abstract

Importance  Birth at hospitals with an appropriate level of neonatal intensive care units is associated with better neonatal outcomes. The primary sources for information about hospital neonatal unit levels for prospective parents, referring physicians, and the public are hospital websites, but the accuracy of neonatal unit capacity is unclear.

Objective  To determine if hospital websites accurately report the capabilities of intermediate (ie, level II) units, which are intended for care of newborns with low to moderate illness levels or the stabilization of newborns prior to transfer.

Design, Setting, and Participants  This cross-sectional study compared descriptions of level II unit capabilities on hospital web pages in 10 large states with their respective state-level designation. Analyzed units were located in the 10 states with the highest number of live births in 2019 (excluding states with no level II regulations) and had active websites as of May 2021.

Main Outcomes and Measures  Hospital websites were assessed for whether there was any mention of the unit, the description of the unit was provided, the unit was identified as a level III or both levels II and III, the terms “neonatal intensive care unit” or “NICU” were used without indicating limits in care available or newborn acuity, or the unit was claimed to provide the most advanced level of care.

Results  A total 28 states had no regulation of nursery unit levels; in the 10 large, regulated states, web descriptions of level II units were incomplete for 39.2% of hospitals (95% CI, 33.3%-45.3%) and inaccurate for 24.6% (95% CI, 19.6%-30.2%). Within incomplete descriptions, 2.6% (95% CI, 1.1%-5.3%) of hospitals did not mention an advanced care unit and 22.0% (95% CI, 17.2%-27.5%) identified a level II unit without providing further description. Within inaccurate descriptions, 25.4% (95% CI, 20.3%-31.0%) of hospitals described the unit as a “neonatal intensive care unit” or “NICU” without any qualification and 9.3% (95% CI, 6.3%-13.5%) claimed that the unit provided the most advanced neonatal care or care to the sickest newborns; 3.0% of hospitals (95% CI, 1.3%-6.0%) stated that their unit was level III and 1.5% (95% CI, 0.4%-3.8%) as level II and III. Across states there was substantial variation in rates of incompleteness and inaccuracy.

Conclusions and Relevance  Incomplete and inaccurate hospital web descriptions of intermediate newborn care units are common. These deficits can mislead parents, clinicians, and the public about the appropriateness of a hospital for sick newborns, which raises important ethical questions.

Source:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793015

PREEMIE FAMILY PARTNERS

Turns out not where but who you’re with that really matters

Terrie Eleanor Inder   Pediatric Research volume 88, pages533–534 (2020)

An understanding of the impact of the environment, including the new enhanced single-family room (SFR) structure, on outcomes in the preterm infant is critical. The study by van Veenendaal et al. in this edition of Pediatric Research expands on others’ work by analyzing a level II neonatal facility SFR setting and concludes that the SFR environment was associated with lower rates of late onset sepsis, mediated by the lower use of intravenous and central venous catheters. The authors hypothesized that the presence of parents, who know their infants well, may have resulted in less antibiotic treatment for symptoms and signs that were interpreted by less familiar medical caregivers as concerning for late onset sepsis. It is important to note that the definition of “sepsis” included any culture positive infant, independent of treatment, and infants treated for ≥7 days with antibiotics after clinical signs of concern for sepsis with negative cultures.

This study compared two epochs from 2012−2014 and 2017−2018 with 1046 infants who were predominantly level II late preterm infants (<37 weeks’ gestation and hospital stay ≥3 days) with average gestational age of 34−35 weeks. During this time of change to SFR environment, Family Integrated Care (FICare) was also introduced with parents being present to provide most of the care for their infants. Their SFR included a full parent bed for the parent to live and sleep in the room with their infant. The major mediator of the reduction in late onset sepsis, from 9.3% in the open bay to 5.3% in the SFR, was an approximately 50% reduction in vascular lines (peripheral and central) and use of parenteral nutrition. Although the reasons for the reduction in line use remain unclear, the authors hypothesized that the presence of the parents resulted in joint decision making and avoidance of painful procedures—both leading to reduced lines and parenteral nutrition. The authors also report a trend toward higher exclusive breastfeeding at discharge and a shorter length of stay.

Although infection rates in the neonatal intensive care unit have been consistently falling over the last two decades, this study informs us that in a less intensively sick population of infants, the SFR environment may reduce the risk of late onset sepsis. Importantly, they define that the association is mediated by invasive vascular access, which may be avoided with parental engagement. This study did not evaluate early breast milk supply in the new SFR setting, but others have noted in a similarly designed study a significant increase in the availability of human milk in the SFR environment being a key driver of SFR-associated improved neurodevelopmental outcomes.

 In contrast to the current study, a study from a typical larger neonatal intensive care unit setting in Texas, USA, found an increased rate of sepsis documented following their renovation to SFR environment in 2015. They analyzed 9995 encounters in their 90-bed unit, with a trend toward increased sepsis rates in the SFR in the moderately preterm infant (OR 1.33, 95% CI 0.7−3.3) that reached significance in the term/post-term infant (OR 1.79, 95% CI 1.2−3.3). It was noted that the trend was reversed toward lower infection rates in the preterm infants <32 weeks. Their definition of sepsis was based on medical records alone and not as carefully curated as the current study.

Single-family room environments have been noted to have numerous advantages, including enhancing parent−infant closeness and engagement in infant care and improved parental psychological wellbeing with reductions in maternal depression and parental stress in both parents. In these studies, based in Scandinavia, parents in the SFR were present 21 h/day compared with 7 h/day previously in the open bay unit. The SFR environment has also been associated with improved neurodevelopmental outcomes following discharge, with an approximate 3-point advantage in cognitive and language scores on Bayley III at 18−24 months. However, in our own neonatal intensive care unit setting in St. Louis, we documented a negative impact of SFR with lower language scores (−8.3 (95% CI −2.4 to 14.2), p = 0.006) and a strong trend toward worsening motor scores at 24 months follow-up. We attributed this to the sensory isolation within the SFR environment if the parental presence and engagement was low. A subsequent study in the same unit in St. Louis by Dr. Pineda’s team demonstrated that the average presence of parents was higher in the SFR environment at 3.6 h/day compared to 2.4 h/day in the open bay environment. Notably, mothers reported more NICU stress in the SFR environment.

A recent meta-analysis of 13 study populations (n = 4793) concluded that there was no clear difference between room environments in cognitive neurodevelopment on the Bayley Scales of Infant and Toddler Development-III at 18–24 months (680 infants analyzed; mean difference 1.04 [95% CI −3.45 to 5.52], p = 0·65; I2 = 42%). However, the authors did note a lower incidence of sepsis (4165 infants analyzed; 108,035 days in hospital [hospitalization days]; risk ratio 0.63 [95% CI 0.50−0.78], p < 0·0001; I2 = 0%) and higher rates of exclusive breastfeeding at discharge (484 infants analyzed; 1.31 [1.07−1.61], p = 0.01; I2 = 0%) in SFRs than in open bay units. No other differences in neonatal outcomes were noted. This meta-analysis combined Scandinavian, Australian, and USA studies.

Differences in these studies point to a clear explanation—it is “not where but who you’re with that really matters” (the lyrics from “The Best of What’s Around” by the Dave Mathews Band). In the studies documenting benefit from the SFR environment, parental presence is almost universal and routinely >12 h in duration with shared decision making. The current study adds to this literature by documenting that such parental engagement may assist in both prevention of invasive vascular devices, that are associated with increased sepsis, and more informed interpretation of their infant’s clinical signs to better define the risk of sepsis. In the current study, it is not possible to untangle the effects of the SFR from the FICare model, with both promoting the presence and engagement of the family in care decisions. It appears that it is this critical combination that renders the benefits seen in this and other studies of the SFR, predominantly reported from Scandinavia.

In contrast, the studies documenting the adverse effects from the SFR environment, typically studies in the settings of large urban NICUs within the USA, parental presence averaged <4 h/day. Although this was increased compared to the open bay environment, it appeared associated with greater NICU stress in the mothers with both greater adult and infant isolation. Thus, without a structured program of parental support and engagement with their infant and shared decision making, this modest increase in parental presence may not offset the deficit in human language exposure which appears critical during the third trimester for language development.

In conclusion, although much effort has been focused on the room type, it appears more pertinent to ask what is happening in any space in which an infant is being cared for in the neonatal intensive care unit. This appears just as relevant for shorter lengths of stay, as shown by the current study. It is worthy of note that it is common for medical rounds or records to lack any systematic documentation or summary review of the nature of the parent’s presence or engagement, other than to discuss in a socially cursory manner. The SFR encourages greater presence of the parents to be “living” with their infant, enabling a family-centered model of care, with the combination in many studies resulting in reduced sepsis, enhanced human milk production, improved parental mental health and attachment and improved infant neurodevelopmental outcomes. To achieve the presence of parents for >12 h, and ideally 24 h/day, in the setting of the USA will require firm advocacy from the neonatal community as a fundamentally important facet of care. It is no longer “nice to have” but a “necessary element of care” for optimal outcomes. The provision of paid parental leave during the time of an infant’s neonatal intensive care course for both parents should be federally mandated as medically necessary, and we must fight for our infants’ right to their parent’s presence. The SFR environment greatly assists parents and staff with such a model of family-centered care but it is only a facilitator of the true key—the parents.

Source:https://www.nature.com/articles/s41390-020-1040-1

Preemies at greater risk for mortality in adulthood

By Svein Inge Meland – Published 23.03.2021

*** It’s important to remember that most people who are born prematurely do well, and that treatment and follow-up are constantly improving, says Professor Kari Risnes at NTNU.

The risk of dying from heart disease, chronic lung disease or diabetes in adulthood is twice as high for preemies —premature infants — as for the general population. Even those who were born just two to three weeks before term have a slightly increased risk.

A new study of mortality among young adults who were premature infants includes 6.3 million adults under the age of 50 in Norway, Sweden, Finland and Denmark. Among this group, 5.4 per cent were preemies, or born before term, according to Professor Kari Risnes at NTNU’s Department of Clinical and Molecular Medicine and St. Olavs Hospital.

Researchers used the national birth registers and compared them with the cause of death registers that all Scandinavian countries have.

“We already know that preemies have increased mortality in childhood and early adulthood. Now we’ve confirmed the risk of death from chronic diseases such as heart disease, lung disease and diabetes before the age of 50,” says Risnes.

Normal cancer and stroke risk

The study shows that the risk of preemies dying before the age of 50 is 40 per cent higher than for the population as a whole. Researchers found that the risk of dying for individuals born before full gestation and who have chronic heart disease, lung disease or diabetes is twice that of the population as a whole. However, this group has no increased risk of death from cancer and stroke.

“We were surprised to see that the risk of death was higher even in people who were born as late as weeks 37 and 38, only a few weeks before full gestation. Although the extra risk was only about 10 per cent, this group makes up about 15 per cent of all births, and we have to try to map the causal relationships here,” says the paediatrician.

Findings should be factored in

Risnes believes that the results from the study should be factored in when doctors assess the patient’s risk of disease and their preventive advice for the patient.

“Our idea is that we should increase awareness in both the general population and among doctors so that the risk can be reduced. We need to recognize that prematurity is a factor to take into account when assessing risk, just like we do with a family history of heart disease, obesity or smoking,” says Risnes.

“It’s important to be aware of additional factors that increase the risk of cardiovascular disease and diabetes, like high blood pressure, obesity, inactivity and high blood sugar, plus the high levels of all these additional factors that we see more of in premature births,” she says.

Early prevention important

“These diseases are often preventable. Good treatment is important and can often be longterm to maintain a good quality of life and avoid illness and death. We should be identifying lifestyle changes from an early age that reduce the risks, like more physical activity and avoiding obesity and smoking,” says Risnes.

One question still to be answered is whether more premature than full-term infants develop these chronic diseases, or if they are just generally less well equipped to survive the diseases.

“We need to try to address this question in the next round of research. It may be that the diseases crop up earlier in premature babies. We don’t have data on this yet,” Risnes says.

In the 1960s and 1970s, only 20 to 30 per cent of the most premature infants reached 15 years of age. Today, their survival rate is over 90 per cent. This means that the strong ones, the survivors, were preemies in Risne’s study of adults.

“With better neonatal medicine, the proportion of the population born prematurely is growing,” says Risne. She believes it will be important to follow this population closely in terms of risk. In the study, individuals born prematurely around 1980 had a slightly higher risk of cardiovascular disease than those born around 1970.

Not genetics or environment

The study doesn’t indicate that the social status of the mother or conditions of upbringing explain the increased risk of mortality. The researchers compared siblings to find out if the excess mortality was due to genetics or socioeconomic conditions.

“We found that risk of death for these diseases was higher for people born prematurely — preemies — than for their full-term siblings. We concluded that the increased risk can’t be fully explained by genes, which siblings have in common, or by socio-economic conditions and living conditions in childhood,” says Risnes.

Most common diseases

Dying in the first 50 years of life is rare. For 30-year-olds, the risk of dying is one in 1 000 per year, for 50-year-olds the risk rises to two in 1 000. Chronic diseases make up a minor percentage of these deaths. The researchers in the EU study chose to look at cancer, heart disease, stroke, chronic lung disease and diabetes because these are the most common chronic diseases that can be fatal.

In the past, it has been difficult to access other nations’ health databases. Risnes is very happy that such access was possible for this study. Robust results are easier to attain with such a large volume of health data. The findings of the study are consistent between countries.

Source:https://norwegianscitechnews.com/2021/03/study-shows-preemies-at-greater-risk-for-disease-mortality-in-adulthood/

Recognising a Grandparent’s Journey

FRIDAY, MAY 22, 2020

When a family travels the difficult journey of welcoming a premature or sick baby into the world, it isn’t just the parents or carers who are impacted.

The whole family feels the reality and shares in the emotions of the experience. None more so than grandparents. Grandparents are often an invisible casualty when a birth does not go to plan and ends in an emergency delivery and admission to the NICU. Grandparents are part of a common phenomenon where there’s a double concern for both the newborn grandchild, and their adult child who is managing this stressful event physically, mentally, and emotionally.

While Grandparents are the most common support system for new parents, the hospital restrictions and fragile health of an NICU baby can create an imbalance of involvement and un-involvement, which is often difficult to avoid. Hence, grandparents may require great flexibility to help in other ways.

One common way to help is in the home, attending to the needs of the siblings, and supporting the family’s routine which is a huge and much-needed help. During this time grandparents provide new parents the opportunity to be with their baby and to also be part of the healthcare team. In a way, they become the scaffolding for parents to be in this very important position for the best outcome for their grandchild.

It’s important to also acknowledge the challenges for grandparents of babies in the hospital during COVID-19 who would have no involvement in the NICU and for some, possibly meeting this new baby for the first-time months later, once discharged. The restrictions that are put into place are there to protect the fragile health of the baby as well as protecting this particular age group from entering a building where patients are being treated for the COVID-19 virus. All of those feelings of fear, worry, and uncertainty are shared by the new parents and extended family, however grandparents are unique and medical staff should understand and welcome them in their supportive presence. They are the unsung heroes of this life-changing event.

We are looking for stories from a grandparents perspective, sharing your experience of having a grandchild in NICU or SCN and watching your own child navigate the challenges of such a journey. If you would like to share your story click HERE.

Source:https://www.miraclebabies.org.au/content/recognising-a-grandparents-journey/gjj5f6

She Had a Preemie — and Then She Started to Ask Important Questions

By Randi Hutter Epstein  & Sarah DiGregorio – Jan. 28, 2020

EARLY:  An Intimate History of Premature Birth and What It Teaches Us About Being Human

Sarah DiGregorio was 28 weeks pregnant when she found out that her baby had stopped growing. Two days later, her daughter, Mira, was delivered via an emergency cesarean section. She weighed 1 pound 13 ounces.

“My body had been trying to kill her,” DiGregorio writes.

“Early” opens like a medical thriller. Newborn Mira is whisked away to a neonatal intensive care unit while her parents are bombarded with statistics, terrified about her future. It closes with Mira, a robust toddler, diving into a pit of foam blocks. This isn’t a spoiler — but the heart of DiGregorio’s illuminating book isn’t just about her family’s journey; it’s an expansive examination of the history and ethics of neonatology.

For most of human history, babies born months too soon were left to die. They were considered less than full-fledged beings, not quite living and therefore not worth saving. Plus, there wasn’t much to be done.

The field of neonatology took off in the second half of the 20th century when a few pediatricians, often against the advice of colleagues, dared to save newborns.

In 1961, Dr. Mildred Stahlman, a Vanderbilt University pediatrician, fitted a premature baby into a miniature iron lung machine. These machines, originally for polio patients, used negative pressure to pull open weak chest muscles to draw air into the lungs. The baby survived. Stahlman then created one of the first neonatal units and trained a cadre of disciples.

By the 1970s, negative pressure machines were replaced with positive pressure ones that worked by inflating the lungs. It was a tricky technique that required threading the tiniest of tubes through the trachea and into the lungs. Dr. Maria Delivoria-Papadopoulos, then a pediatrician at Toronto’s Hospital for Sick Children, was one of the first to try. Seventeen attempts were unsuccessful. Then she saved one baby girl. Her tenacity paved the way for half a million people born prematurely living today.

And yet, DiGregorio reminds us, every advance — every attempt at every advance — brings with it new dilemmas. Such innovations may save a child’s life but can leave them with significant disabilities. A doctor cannot predict how a particular premature baby will fare. Complicating the matter, who’s to say what kind of life is worth fighting for and how much treatment is too much?

In “Early,” we read about neonatologists, bioethicists and parents grappling with the toughest decisions. We meet pediatric palliative care specialists and parents who forgo further treatment and embrace their babies as they die. DiGregorio covers other factors that influence prematurity, such as poverty and racism.

DiGregorio, a food editor and writer, is such a beautiful storyteller, I found myself underlining passages, turning corners of pages and keeping track of the page numbers at the back of the book until I had a hodgepodge of numbers scribbled on top of each other.

She imagines her nonfunctioning placenta as “a beat-up old car, chugging along, belching smoke”; after her emergency C-section, she writes, her body “felt like an empty house that had been vacated in a rush, leaving dirty dishes in the sink.” And later, DiGregorio refers to a 1-year-old as “that sweet spot between baby and toddler.”

By the epilogue, when the narrative returns to DiGregorio’s personal story, readers will appreciate how medicine lurches forward with leaps and mishaps along with the inevitably tense discussions about which path to take and when. All doctors wrestle with these issues, yet they seem particularly poignant when we are dealing with tiny babies. That’s because, as DiGregorio puts it, the field of neonatology has “changed the way we understand what it means to be alive, what it means to be human, and what constitutes a life worth living.”

Randi Hutter Epstein is the writer in residence at the Yale School of Medicine and author of “Aroused: The History of Hormones and How They Control Just About Everything.”

EARLY
An Intimate History of Premature Birth and What It Teaches Us About Being Human

By Sarah DiGregorio
A version of this article appears in print on Feb. 9, 2020, Page 17 of the Sunday Book Review with the headline: Born Too Soon.

Source:https://www.nytimes.com/2020/01/28/books/review/early-sarah-digregorio.html

© Provided by The Boston Globe – Brian and Kristen Sardini with Aila at the Brigham and Women’s Hospital.

NEW FATHER TO CELEBRATE FIRST FATHER”S DAY IN HOSPITAL WITH PREEMIE BORN AT 25 WEEKS

Laura Crimaldi – The Boston Globe

Brian and Kristen Sardini didn’t expect to become parents in time to mark Mother’s Day and Father’s Day this year. Their first baby was due on July 4.

But little Aila had different plans.

The baby girl was born March 26 during her mother’s 25th week of pregnancy. She weighed just over a pound.

On Sunday, the family will mark Brian Sardini’s first Father’s Day with Aila in the Newborn Intensive Care Unit, or NICU, at Brigham and Women’s Hospital.

“It’s the best Father’s Day gift in the world,” he said Saturday. “I’ve always wanted to be a dad and wouldn’t change anything because Aila’s perfect.”

During her three months in the unit, Aila has made tremendous strides, her parents said. The ventilator and continuous positive airway pressure or CPAP machine that Aila once used for breathing are history. A crib has replaced the isolette where she once spent most of her time. She’s tried out breastfeeding and started wearing clothes from the Preemie Store, which sells “micro” sizes for babies who weigh between 1 and 3 pounds.

On Friday night, Aila tipped the scales at just over 4 pounds. She has a collection of colorful, hand-knitted octopuses, which are used in hospitals to comfort premature babies.

What’s more, her parents have already read her the first four books in the “Harry Potter” series and are now halfway through reading her the fifth book, “Harry Potter and the Order of the Phoenix.”

“We started reading her ‘Harry Potter’ when she was, I think, 3 days old,” said Kristen.

Dr. Elisa Abdulhayoglu, the NICU’s medical director, said she was in the room when Aila was born and watched Brian meet his daughter.

“He bent down, looked at his beautiful little girl, and he said, ‘Yup. I’m a daddy’s girl for sure,’” she said. “It was an absolutely beautiful, beautiful moment.”

Good thing beautiful moments don’t require planning. Four days before Aila was born, Kristen said she had an uneventful appointment with her obstetrician. On the following day, the couple, both 27, planned to go to work and turn in a down payment for their new home in Medway.

But that day, they also went to an ultrasound appointment, and got some troubling news. Kristen had pre-eclampsia and needed to be admitted to the hospital for monitoring. Her routine checkup from the day before was suddenly ancient history.

“I had a totally normal OB appointment. My blood pressure was like 112 over 79. Completely normal. No red flags. Nothing wrong,” she said. “Within 24 hours, I was being sent to the Brigham. That’s how quickly this stuff can happen. And it’s really crazy.”

Kristen credits her husband with getting her through the Cesarean section birth.

“He just really helped me stay calm, and just like he said, focus on the task at hand and just take one thing at a time, and not let myself get lost in in mumbo jumbo of everything,” she said.

Before the birth, the couple said they were warned that their daughter wasn’t likely to cry or move when she was born and they wouldn’t have a chance to cut her umbilical cord.

Once again, Aila had something else in mind. She entered the world kicking, waving, and “crying at the top of her lungs,” her parents said. Brian also got to cut the umbilical cord.

“People say that when you see your child for the first time, it’s just an instant, instant bond and your whole life kind of changes,” Brian said. “As cliché as it sounds, it really is what happens.”

At a gestational age of 25 weeks, Abdulhayoglu said Aila is considered young by preterm standards. The majority of preterm babies born in the United States have reached a gestational age of at least 32 weeks, she said. The Brigham’s NICU cares for preterm babies as young as 22 weeks gestation, though, according to Abdulhayoglu.

In the long-term, she said outcomes are “excellent” for babies born at 25 weeks gestation.

“Parents are the true champions for these tiny, preterm babies, and her parents are amazing,” Abdulhayoglu said. “They’re there every day.”

The couple said they don’t know when Aila will be ready to leave the hospital, but they hope to take her home next month.

On Sunday, the couple said they plan to spend most of the day at the hospital with Aila, reading and snuggling. They heaped praise on the nurses, doctors, social workers, and other Brigham employees who have assisted them during Aila’s hospitalization.

Aila shares a room overlooking a courtyard with six other babies and decorated by her nurses with photographs of her and prints of her feet positioned to look like butterfly wings.

On Mother’s Day, Kristen said her daughter’s nurses gave her a mug that read, “Mom,” with Aila’s handprint in the spot for the letter O.

Kristen said she wants her husband to enjoy his first Father’s Day with their daughter.

“I hope that he just has the best day possible,” she said. “He has 100 percent earned it.”

Source:https://www.msn.com/en-us/news/us/new-father-to-celebrate-first-father-e2-80-99s-day-in-hospital-with-preemie-born-at-25-weeks/ar-AAYBZNW?ocid=uxbndlbing

HEALTH CARE PARTNERS

MRI Detects Atypical Brain Development in Premature Babies By News Release – School of Medicine in Boston

Subtle differences in brain structure can be detected by quantitative MRI (qMRI) in premature babies who later develop abnormalities such as autism or cerebral palsy. The study, published in Radiology, demonstrates the potential for qMRI, which obtains numerical measurements, to help improve outcomes for the growing numbers of people born preterm.

Advances in neonatal care have boosted survival rates for children born extremely preterm, defined as fewer than 28 weeks of gestation. With so many preterm infants surviving, there is interest in understanding the effects of preterm birth on brain development. Research has shown that extremely preterm babies face higher risks of brain abnormalities.

“So much of the maturation of brain occurs during the third trimester when the fetus is in the womb’s nourishing environment,” said study co-author Thomas M. O’Shea, MD, from the University of North Carolina in Chapel Hill. “These preterm babies don’t experience that, so it seems likely that there are alterations in the brain maturation during that interval.”

Dr. O’Shea and colleagues at 14 academic medical centers in the US launched a study 20 years ago to better understand the effects of preterm birth. The study, known as the Extremely Low Gestational Age Newborn-Environmental Influences on Child Health Outcomes (ELGAN-ECHO), evolved over the years to include experts in medical imaging like medical physicist Hernán Jara, PhD, professor of radiology at Boston University School of Medicine in Boston.

For the new study, Dr. Jara, Dr. O’Shea, and other ELGAN-ECHO researchers used qMRI. The noninvasive technique generates rich information on the brain without radiation. The researchers used it to assess the brains of adolescents who had been born extremely preterm.

“Quantitative MRI in a large dataset allows you to identify small differences between populations that may reflect microstructural tissue abnormalities not visually observable from imaging,” Dr. Jara said.

The researchers collected data from MRI scanners at 12 different centers on females and males, ages 14 to 16 years. They compared the qMRI results between atypically versus neurotypically developing adolescents. They also compared females versus males. The comparison included common MRI parameters, or measurements, like brain volume. It looked at less commonly used parameters too. One such example was proton density, a measurement related to the amount of water in the brain’s gray and white matter.

“What we aimed to do with qMRI was establish a biological marker that could help us discern these preterm children who had a diagnosis of disorder from those who didn’t,” said study lead author Ryan McNaughton, MS, a PhD student in mechanical engineering at Boston University.

There was no control group of people born after the typical nine months of gestation. Instead, the researchers used the neurotypically developed children for comparison.

Of the 368 adolescents in the study, 252 developed neurotypically while 116 had atypical development. The atypically developing participants had differences in brain structure visible on qMRI. For instance, there were subtle differences in white matter related to proton density that corresponded with less free water.

“This might be the tip of the iceberg since the amount of free water is highly regulated in the brain,” Dr. Jara said. “The fact that this difference was observed more in females than males may also be related to the known comparative resilience of females as demonstrated in findings from earlier ELGAN-ECHO and other studies.”

The researchers collected umbilical cord and blood samples at the beginning of the study. They plan to use them to look for correlations between qMRI findings and the presence of toxic elements like cadmium, arsenic, and other metals. The power of qMRI will allow them to study both the quantity and quality of myelin, the protective covering of nerves that is important in cognitive development. They also want to bring in psychiatrists and psychologists to relate qMRI findings to intelligence, social cognition and other outcomes.

“This project shows how researchers with different expertise can work together to use qMRI as a predictor of psychiatric and neurocognitive outcome,” McNaughton said.

“The teamwork required to get where we are now is pretty astounding,” Dr. O’Shea added. “I’m really grateful for the families, the nursing coordinators, and everyone else who made this possible.”

Source:https://appliedradiology.com/communities/Pediatric-Imaging/mri-detects-atypical-brain-development-in-premature-babies

Dr. Philip Sunshine, founding father of Neonatology, is turning 90!

Jun 12, 2020

Our beloved Dr. Philip Sunshine, one of the founding fathers of Neonatology, is turning 90 years young! His only birthday wish? To help save more babies.

Fascinated? Learn more about Dr. Sunshine here: https://www.youtube.com/watch?v=h4ZjVfN3u0g

Policy Strategies for Addressing Current Threats to the U.S. Nursing Workforce

List of authors. Deena Kelly Costa, Ph.D., R.N., and Christopher R. Friese, Ph.D., R.N.

The Covid-19 pandemic has made it clear that without enough registered nurses, physicians, respiratory therapists, pharmacists, and other clinicians, the U.S. health care system cannot function. Weaknesses in health care staffing are of particular concern when it comes to the workforce of registered nurses, which could well see a mass exodus as the Covid-19 pandemic eases in the United States and the economy recovers. In a 2021 national survey conducted by the American Association of Critical-Care Nurses, 66% of respondents reported having considered leaving the profession, a percentage that is much higher than previously reported rates. Unsafe work environments — which predated the pandemic — are a key contributor to intentions to leave. Clinicians, health system executives, and policymakers have issued calls to address this crisis, but there has been little in the way of tangible federal or state policy action to prevent workforce losses or to build capacity.

Although it may comfort hospital executives to imagine a post-Covid future in which nurses are again willing to accept positions at local pay scales, such a scenario is unlikely to come about anytime soon. Historically, nurses have reduced their working hours or left the workforce during economic growth periods and returned during recessions, when family incomes fall.1 Nurses may again choose reduced employment as Covid-19 pressures ease and economic conditions improve. Moreover, nurses reported pervasive unsafe working conditions before the pandemic, and during Covid, they have cited a range of stressors and traumatic experiences, including furloughs, a lack of adequate protective equipment, increased violence, excessive workloads, and reduced support services. Pressures on the nursing workforce may therefore only worsen as Covid-19 subsides.

Federal and State Policy Approaches to Supporting Nurse Staffing in the United States.

State and federal policy solutions could prevent workforce losses and increase the supply of nurses (see table). Although there are challenges and opportunities for the nursing workforce throughout health care settings, hospitals are a particularly important area of focus.

Preventing the loss of current nurses is an essential component of shoring up the hospital nursing workforce. We contend that there isn’t a shortage of nurses, but a shortage of hospitals that provide nurses with safe work environments and adequate pay and benefits. At the federal level, the Centers for Medicare and Medicaid Services (CMS) could publish regulations, similar to recently announced policies governing skilled nursing facilities, that specify standards (including maximum patient-to-nurse ratios) for ensuring safe nursing care — and could establish financial penalties for hospitals that violate these regulations. Data supporting increased nurse staffing have been available for decades.2

Another federal strategy centers on investing in reimagined, safer health care systems. Congress could appropriate funds to the Agency for Healthcare Research and Quality to support investigator-initiated grants focused on developing new, scalable care-delivery models that are designed to improve outcomes for patients and clinicians. The National Institute for Occupational Safety and Health could expand testing of protective equipment and strategies for improving health care workers’ well-being. Data are needed on care-delivery models that keep patients safe and on approaches for promoting joy and safety in clinical work.

Regulatory bodies, including CMS and CMS-approved accreditors, such as the Joint Commission, could scale back regulations and standards that add to nursing workloads. Although some regulations were temporarily eased during the pandemic, new rulemaking could eliminate especially burdensome provisions that aren’t essential to patient safety. For example, clinical-documentation burden is a frequently cited source of job dissatisfaction and burnout. Documentation requirements, which are interpreted in various ways by different hospitals, could be minimized to reduce burnout and attrition.

States have more flexibility than the federal government when it comes to enacting legislative and regulatory changes to improve work environments and prevent losses in the nursing workforce. In the absence of federal action in this area, state legislation promoting safer nurse-staffing practices — such as laws establishing mandatory patient-to-nurse ratios — is an evidence-based intervention to support patient safety and reduce the likelihood of nurse departures. Studies have reported improved nurse staffing, improved job satisfaction among nurses, and improved patient outcomes in California after the state enacted legislation prohibiting mandatory overtime for nurses and establishing maximum patient-to-nurse ratios.3 Many U.S. hospitals continue to require nurses to work overtime hours, however, and few have mandated staffing ratios. Legislatures in some states have introduced bipartisan bills similar to California’s law that would restrict mandated overtime and implement maximum staffing ratios. When considered at a national scale, mandated staffing ratios face implementation hurdles, since coordination would be required to distribute the nursing workforce equitably throughout the country. But such policies would most likely prevent workforce losses and boost the number of entrants into the profession.

Policies could also support career development among nurses. Studies have documented the negative effects of Covid-19 on the careers of women in particular. Approximately 90% of U.S. nurses are women, and many of them have faced pressures related to family care during the pandemic, amid school and child-care facility closures. To ease nurses’ household burdens, states could offer loan-repayment programs and offset nursing school tuition debt. They could also provide grants or tax benefits to hospitals offering on-site child care, after-school care, or comprehensive dependent-care programs. Finally, states could offer innovation grants to hospitals to develop safer, more supportive workplaces or fund new initiatives to support on-site graduate-school and professional-development programs designed to retain experienced nurses.

Preventing workforce losses is important, but so is increasing the supply of nurses. The United States lacks access to real-time workforce data and expert guidance for evaluating those data and for advising policymakers on workforce shortages. The National Health Care Workforce Commission was authorized as part of the Affordable Care Act, but Congress never funded it. Appropriating funds for this commission would strengthen the country’s ability to respond to the current threat to nurse staffing and prepare for future ones.

A key factor constraining the supply of nurses derives from structural barriers within nursing education. Being hired as a nursing school faculty member requires having an advanced degree, but expert nurses rarely accept faculty positions because salaries are higher for practice roles. Faculty shortages, among other factors, limit nursing school enrollments; over the past decade, schools turned away between 47,000 and 68,000 qualified applicants annually.4 Federal policies could loosen the nursing bottleneck. For example, policymakers could increase financial incentives to recruit nurse educators, expand nursing school loan-forgiveness programs, fund grants for hospitals and nursing schools to share expert nurses as clinician-educators, and develop a nurse faculty corps program to raise salaries in regions with shortages of nurses. Creative financial incentives, such as tuition-remission programs or programs that provide loans at low interest rates, could encourage prospective students to choose nursing careers. Pipeline programs and partnerships among high schools, technical schools, and universities could permit emergency medical technicians, certified nursing assistants, and armed forces corpsmen or medics to apply clinical work hours toward nursing degrees and qualify for targeted scholarships supported by state or federal funds. Expansion of the CMS Graduate Nurse Education demonstration project could substantially increase the number of qualified nurse practitioners, who could also serve as clinical nursing faculty.

State legislation that eliminates onerous scope-of-practice regulations for advanced practice providers would enable nurse practitioners, including midwives, to practice independently and could increase access to health care. In Michigan, Senate Bill 680 would implement these reforms, thereby allowing nurse practitioners to prescribe tests, medications, and services. This bill could increase the state’s supply of clinicians and potentially attract nurses planning to pursue advanced degrees.

Threats to the nursing workforce aren’t new, and neither are proposals to address them.5 Although policies aimed at individual components of this problem could be helpful, a comprehensive package of federal, state, and local efforts would probably be the most effective approach for averting health care system dysfunction and adverse outcomes. We believe federal and state policies should both prevent the loss of current nurses and increase the supply of nurses. Without timely investments in the nursing workforce, the United States may have enough hospital beds for seriously ill patients, but not enough nurses to deliver essential, safe care.

Source:https://www.nejm.org/doi/full/10.1056/NEJMp2202662

Skin injuries to babies in neonatal care could be avoided with new splint, trial shows

by Victoria University of Wellington – MAY 26, 2022

A new device to prevent skin injuries to babies in neonatal intensive care units has been successfully trialed in a study led by Dr. Deborah Harris, a neonatal nurse practitioner at Te Herenga Waka—Victoria University of Wellington.

Most babies admitted to hospital need an intravenous drip to deliver fluids and medications, says Dr. Harris. This drip is secured to the baby’s skin using adhesive tape.

“Removing the adhesive tape is painful and can cause skin injuries and scarring. Skin damage also increases the risk of the baby getting an infection and being in hospital longer. We designed a device called a Pēpi Splint that can be used to secure the drip without the need to apply adhesive tape to the baby’s skin,” Dr. Harris says.

A trial of the Pēpi Splint on 38 babies at Wellington Hospital’s neonatal intensive care unit showed it was effective and avoided the skin damage caused by adhesives.

“The Pēpi Splint held the drips secure for 34 of the 38 babies in our trial. In four cases, the splint became loose either because it hadn’t been secured properly or was dislodged when the baby was removed from the cot for breastfeeding.”

Dr. Harris says the results provide support for a larger randomized controlled trial.

“Skin injuries are common in neonatal units and the damage caused to a baby’s skin by adhesive tape can be considerable. Removing the tape has the potential to strip 70% to 90% of a baby’s epidermis. We hope the Pēpi Splint will help reduce these injuries to newborns.”

The splint is made from medical-grade silicon gel and contains an aluminum mesh, allowing it to be molded to the baby’s limb. Adhesive tape is used on the Pēpi Splint itself to secure it to the drip, but tape is not applied to the baby’s skin.

During the trial, modifications were made to the splint to make it easier to use. “After these changes, clinicians involved in the trial reported the splint was easy to apply,” Dr. Harris says.

Most parents supported the device’s use: 52 of 58 (90%) said they would participate in the study again if they had another eligible baby.

The Pēpi Splint, developed in collaboration with a design engineer, can be washed and sterilized for reuse.

Source:https://medicalxpress.com/news/2022-05-skin-injuries-babies-neonatal-splint.html

PREEMIE RISING STAR!!!

Golden Buzzer: Avery Dixon’s Emotional Audition Moves Terry Crews to Tears | AGT 2022

May 31, 2022  –    #AGT #AmericasGotTalent #Auditions

     America’s Got Talent

Grab your tissues; Avery Dixon’s emotional audition might make you cry. Terry Crews was moved to tears when he heard Avery’s sensational saxophone skills and harrowing story about being bullied.

Kat’s Korner

Fellow Warriors and Preemie Parents,

As per the NTNU St. Olay Hospital’s Study, “ the risk of dying before the age of 50 is 40 percent higher for preemies than for the population as a whole. Researchers found that the risk of dying for individuals born before full gestation and who have chronic heart disease, lung disease, or diabetes is twice that of the population as a whole.” These findings provide valuable information in regard to the morbidity risk of preemie infant survivors and highlight the need for further research. 

Increased diagnosis and early detection of disease conditions that preemie survivors are more prone to experience are critical as our rate of survival is improving and more of us are thriving well into adulthood. While research efforts to improve outcomes, reduce mortality and enhance care for neonates have drastically improved over the past 50 years, few studies have investigated long-term outcomes, health disparities, and the impact of the life-long physical and psychological impact of being premature among the adult population. We need to establish specialist education/credentialing that support workforce opportunities to partake in diagnostics, treatment, research and  development aimed at addressing adult care for preemie infant survivors.

As a community that makes up 11-12% of the global population, we can connect and engage with each other as preemie survivors, promote collaboration between all members of our community, and actively advocate for change in the clinical management of preemie infant survivors to include long-term and specialized care.

If you or someone you know is interested in learning more about ways to connect with our adult preemie community a great resource is the Adult Preemie Advocacy Network, sharing safe space communication platforms for preemie survivors and opportunities to participate in research activities, and partake in advocacy activities to support our resilient community. Check out this great resource below-

Source:https://adultpreemies.com/

Surfing Under the Northern Lights w/ Mick Fanning | Chasing the Shot: Norway Ep 1

Mar 20, 2017

AUGMENTED REALITY, CPR, WORKFORCE, ADVOCACY AUGMENTED REALITY, CPR, WORKFORCE, ADVOCACY

JAPAN

Japan is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the north toward the East China Sea and Taiwan in the south. Japan is a part of the Ring of Fire, and spans an archipelago of 6852 islands covering 377,975 square kilometers (145,937 sq mi); the five main islands are HokkaidoHonshu (the “mainland”), ShikokuKyushu, and Okinawa. Japan is the eleventh most populous country in the world, as well as one of the most densely populated and urbanized. Japan is a great power and a member of numerous international organizations, including the United Nations (since 1956), OECDG20 and Group of Seven. Although it has renounced its right to declare war, the country maintains Self-Defense Forces that rank as one of the world’s strongest militaries. After World War II, Japan experienced record growth in an economic miracle, becoming the second-largest economy in the world by 1972 but has stagnated since 1995 in what is referred to as the Lost Decades. As of 2021, the country’s economy is the third-largest by nominal GDP and the fourth-largest by PPP. Ranked “very high” on the Human Development Index, Japan has one of the world’s highest life expectancies, though it is experiencing a decline in population. A global leader in the automotiverobotics and electronics industries, Japan has made significant contributions to science and technology. The culture of Japan is well known around the world, including its artcuisinemusic, and popular culture, which encompasses prominent comicanimation and video game industries.

The level of health in Japan is due to a number of factors including cultural habits, isolation, and a universal health care system. John Creighton Campbell, a professor at the University of Michigan and Tokyo University, told the New York Times in 2009 that Japanese people are the healthiest group on the planet. Japanese visit a doctor nearly 14 times a year, more than four times as often as Americans. Life expectancy in 2013 was 83.3 years – among the highest on the planet. 

A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. Japan had the highest level of expected human capital among the 20 largest countries: 24.1 health, education, and learning-adjusted expected years lived between age 20 and 64 years.

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

PRETERM BIRTH RATES – Japan

Rank: 175  –Rate: 5.9%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

COMMUNITY

Resilience is at the core of each and every Neonatal Womb Warrior/Preterm Birth Community member. We have all been challenged and have responded with such great love, commitment, and to the best of our abilities.

From the perspective of a parent who has experienced the death of a preemie baby, and the rigorous commitment it took to support the ultimate well-being of a surviving preterm birth twin, the needless death of our children due to war, school shootings in the USA, lack of adequate healthcare in many global communities, including the USA, the challenges we face as we are called to navigate pandemics and global warming calls my heart to weep at times and my soul to act.

Now more than ever, we have an opportunity in our lives to step in and focus our energies on building strong and resilient solutions that protect, heal, and empower our mutual wellness through collaborative innovation. Together we can engage in creating new systems and resources to act, not react, to the issues heavily impacting our world.

The first step towards effective collaboration with our Pre-term Birth Community and the Global Community starts with a look within. As we look into our individual personal internal habitat in order to develop and secure a solid foundation to carry with us, we acknowledge our personal responsibility and ability to empower our personal well-being and to establish and maintain trust within.

The more we each seek our own health and happiness, the stronger the world becomes. Start with you and yours. Each one of us is called to travel a unique path. Follow your guidance, embrace your journey. Your happiness and well-being itself are transformative. Ultimately, action based on a foundation of love will prosper and triumph. Kathy, Kat and Gannon (the other cat).

The clinical management and outcomes of extremely preterm infants in Japan: past, present, and future

Tetsuya Isayama Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan Correspondence to: Tetsuya Isayama, MD, MSc, PhD. Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan. Email: isayama-t@ncchd.go.jp. Submitted Apr 10, 2019. Accepted for publication Jul 08, 2019.

Abstract: There is a wide variation in neonatal mortality rates across regions and countries. Japan has one of the lowest neonatal mortality rates in the world; in particular, the mortality rate of extremely preterm infants (i.e., those born before 26 weeks of gestation) is much lower in Japan than in other developed countries. In addition, Japan has low incidences of intraventricular hemorrhage, necrotizing enterocolitis, and late-onset sepsis, a very high incidence of retinopathy of prematurity, and a relatively high incidence of chronic lung disease. In Japan, general perinatal medical centers (PMCs), which are PMCs that offer the highest levels of care, are required to have an obstetric department with maternal-fetal intensive care units as well as a neonatal or pediatric department with neonatal intensive care units (NICU), in order to promote antenatal rather than neonatal maternal transfer of high-risk cases. The limit of viability of extremely preterm infants is 22 weeks of gestation, and approximately half of them are estimated to receive active resuscitation. The clinical management of extremely preterm infants in Japan are characterized by (I) circulatory management that is guided by neonatologist-performed echocardiography, (II) relatively invasive respiratory management, (III) nutritional management, which entails the promotion of breast milk feeding, early enteral feeding, routine glycerin enema, and the administration of probiotics, (IV) neurological management by means of minimal handling, sedation of ventilated infants, and serial brain ultrasounds, and (V) infection control with the assistance of serial C-reactive protein (CRP) monitoring. Thus, this review provides a brief description of the development of neonatology in Japan, introduces the unique features of Japanese clinical management of extremely preterm infants, and overviews their outcomes.

FULL ARTICLE  

Source: https://tp.amegroups.com/article/view/27505/24536

We

this music video!

Novelbright – 愛とか恋とか [Official Music Video]

#Novelbright #愛とか恋とか #関水渚 2,332,778 views  Premiered Apr 22, 2022

Affordable, Lightweight, Neonatal Incubators – mOm Incubators#HeroSeries

Apr 20, 2022  Innovate UK KTN

15 million babies are born prematurely every single year, and of that about 7% don’t make it due to poor healthcare. Decreasing infant mortality rates by addressing accessibility issues is at the heart of what they do at mOm incubators. CEO and product designer of mOm incubators James Roberts is rethinking the way neonatal healthcare is delivered. Their neonatal incubator is a unique solution that contrasts traditional incubators in that it is a 20 kg portable, collapsible, and accessible solution that provides flexibility to medical staff, allowing them to provide the necessary care to infants whenever and wherever it is needed, in any environment and even during transportation. As any traditional incubator, mOm incubators provide a high spec thermally stable and safe environment for premature infants. However, these particular incubators run on 100 watts in steady state, making them very energy efficient and thus have a low carbon footprint. Innovate UK’s Sustainable innovation Fund allowed the company to perform a usability study to gather data and detailed feedback on how to improve the performance of the incubator. The fund also allowed the company to test their product in a clinical setting for the first time. This technology can benefit thousands of premature babies not only throughout the UK but internationally, changing the landscape for neonatal care on a global scale through a high-tech and sustainable solution.

When a mom and baby are cuddling, talking and cooing warmly with each other, making eye contact, listening and responding to each other, they are influencing the very physiological functions that underlie their health.

Relational Health Through the Lens of Emotional Connection

February 17, 2022

“Toxic stress” as a concept has gained a firm foothold in our health discourse and even crossed over into the mainstream. That’s because we can so clearly see the physiological and behavioral effects it is having on our children. 

But what do we do about it? And how do we shift our attention from merely identifying toxic stress as a problem to buffering it? How do we build healthy, resilient children and families?

The American Academy of Pediatrics released a policy statement last year that says the answer lies in fostering relational health between children and adults in pediatric primary care practice. 

But how we foster relational health remains up for interpretation. As the policy statement reports, many pediatric and early childhood professionals have long recognized the vital importance of the parent-child relationship, and yet “the elemental nature of relational health is not reflected in much of our current training, research, practice, and advocacy.” 

From our perspective here at the Nurture Science Program, there are three central reasons relational health has not become an integral component of pediatric care. 

1. Relational Health is still largely considered psychological. 

2. Most existing relational health screens look separately at parent or child, take time, and are difficult to code.

3. Within existing frameworks, such as attachment theory, each individual develops a fixed attachment style, which means it does not change. Early intervention then becomes the only hope for the developing child.

Through our lens and work on autonomic emotional connection, we hope to provide a practical, scalable solution. 

1. Relational health is biological, physiological, and interpersonal. 

Over decades of research we have uncovered that there is something happening between mother and infant when they get emotionally connected—not just in the brain, but on a deep body-to-body level, which is where we can observe and measure it. That is why we call it autonomic emotional connection. 

The autonomic nervous system is the nervous system that modulates our stress response; it makes our hearts beat and lungs breathe without our having to think about it; these processes regulate our emotional behavior. When mom and baby are emotionally connected on the autonomic level, they are actually regulating each other’s heart rates and hormones and positively affecting each other’s stress responses. In other words, when a mom and baby are cuddling, talking and cooing warmly with each other, making eye contact, listening and responding to each other, they are influencing the very physiological functions that underlie their health. 

It sounds strange, I know. We don’t think of things like cuddling and cooing as science—but they are behavioral manifestations of essential physiological and biological processes happening between two bodies. 

And the impacts these behaviors have on our physiology are profound. Through our randomized control trial of Family Nurture Intervention (FNI) in NICU, we found that engaging mothers and children in autonomic emotional connection dramatically improves babies’ development, sleep, stress resilience, attention, cognitive, learning, and language scores. Mothers also saw improved mental health and lower cardiac risk. Five years later, both mother and child still had better physiological regulation and stress resilience (which is important when we’re worried about the effects of toxic stress). 

Once parent-facing professionals can understand that relational health produces physiological outcomes  and observable behaviors—rather than being an ephemeral concept—they can seamlessly integrate relational health observation into an office visit where they are already checking vital signs and motor skills. 

All they need is a brief observational tool that evaluates parent and child in relationship with each other. 

2. To measure relational health, we need to observe parent and child interacting with each other face-to-face. 

Unlike existing relational health screens that only look at the child or the parent, the Welch Emotional Connection Screen (WECS) focuses on the behaviors between parent and child. It is a quick (20-30 second), easy to use, non-invasive, validated screen that a parent-facing professional can employ while observing a mother and infant interacting face-to-face with the child on the parent’s lap. 

The WECS organizes the visible behaviors of their relationship into the following four domains:

  • Mutual Attraction (Do mom and baby want to be close to each other?)
  • Vocal Communication (Is their vocal tone warm and engaging?)
  • Facial Expressiveness (Are they trying to communicate using their faces?)
  • Reciprocity (Are they sensitive to each other’s expressed emotions? Do they follow-up with each other?)

In clinical research, pairs who exhibit all of the above receive a high WECS score. And in mother-baby pairs with high WECS scores, we see improved neurobehavioral outcomes, both short and long-term. 

In widespread practice, a parent-facing professional can use the WECS, even without formally scoring it, to help identify the families that can most benefit from support. 

3. Emotional connection is a state not a trait. 

The fact that emotional connection is a state between two people and not a trait of just one person is the most hopeful takeaway from our work. It means we are not fully “baked” with a maladaptive attachment style based on whether our needs were met in childhood. It means your toddler with behavioral problems is not destined to always have behavioral problems. No matter our age or life experience, we can enter into a state of emotional connection and share its health benefits. 

Fortunately, the very same behaviors that the WECS observes can also be used to get two people connected—by conditioning the underlying physiological mechanisms of relational health. The context is still sensory—physical touch, eye contact, vocal communication—but the activity is emotional expression. 

In a pediatric primary care setting, the intervention is brief: emotional exchange between parent and child, with the child sitting on the parent’s lap. Parents respond to a prompt on an emotional topic (such as “tell your child the story of how you picked their name,” or “tell your child the story of their birth”), in their primary language. The prompt works when it elicits deep emotional expression from the parent.

During FNI (an intervention used in extreme cases, such as preterm birth), mothers are guided through what we call calming cycles. A nurture specialist prompts mothers to express their feelings to their babies while engaging their senses (e.g. skin-to-skin, making eye contact, etc). This emotional expression engages the child’s orienting reflex, and often prompts some kind of response (their oxygen saturation may go up or they may look at their mom for the first time). This cycle continues as parent and child move from mutual states of distress to mutual states of calm. Once calm and connected, we can see evidence that their physiological co-calming mechanism (what we call co-regulation) is in effect. Any further nurturing interactions between them will continue to strengthen and condition that mechanism. 

We hypothesize that the mechanism of co-regulation underlies and facilitates all of the physiological improvements, developmental gains, and emotional and mental well-being we see in our results. And because emotional connection and co-regulation feel good, moms and babies will continue to do these sensory and emotional activities, not because they have been told to, but because they want to. That may be part of why mothers and children show physiological benefits related to stress resilience (HRV) even 5 years after the intervention.

It’s Time for a Paradigm Shift

The quality of our relationships can alter the landscape of our physical and mental health, lifelong. Relational health, it turns out, is an absolutely essential part of our wellbeing, and we can foster it by looking through the lens of autonomic emotional connection. 

When we do so, we will see that relational health is behavioral and can be observed; its impacts are physiological and can be measured; and it is a state that we move in and out of with our loved ones throughout our lifetimes. The reason to start early, and to target the mother-infant relationship as a mediator of positive effects on relational health, is not merely to prevent later problems, it is to experience maximum benefit at every stage of our lives. 

This paradigm shift would necessarily impact the way that health conditions are viewed and treated: by creating environments and relationships capable of fostering the growth and health we all deserve.

Disseminating these tools and practices to researchers, clinicians, and parent-educators has the potential to help children and their families experience deep autonomic emotional connection with each other—opening the door to intergenerational health and thriving.

Source: https://nurturescienceprogram.org/relational-health-through-the-lens-of-emotional-connection/

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When can babies go home from the NICU

Jul 5, 2020   The NICU Doc

Do you want to know when can babies go home from the NICU? You have been in the NICU for days, weeks, sometimes even months and you are SO CLOSE! Find out what things need to happen for your baby to be discharged from the NICU. How can you best prepare to be ready for the day of discharge. What actually happens the day of discharge? The NICU Doc will go over the things that your baby and you need to be doing to be ready for discharge. And also, I will go over the events of the day of discharge.

*Disclaimer: Although I work in an academic institution and unless stated, the videos posted are of my sole creation. Any opinions, comments, or postings are not a representation or a reflection of our institutions. **Any medical advice or topics discussed are NO substitute for your physician’s advice and care. Actions taken on advice from the videos are done so at your own risk.

CPR Training of Parents of Preterm Babies before Discharge – Experience from a Tertiary Care NICU

Mathew Jisha, MBBS, DNB, Nagar Nandini, MBBS, DCH, DNB, Rajagopal Kumar Kishore, MBBS, DCH, MD, FIAP, DCH, MRCP, FRCPCH, FRCPI, FRACP, FNNF, MHCD

Abstract:

Objectives: To evaluate the feedback of CPR training given to parents of preterm babies discharged from the NICU.

Methods: This was a retrospective study conducted using a questionnaire sent to parents of preterm neonates admitted to a neonatal intensive care unit (NICU) from January 2007 to May 2020. All parents of newborns under 30 weeks gestation who survived to discharge were considered eligible. Parents were given CPR training on a manikin by a Neonatal resuscitation provider (NRP) certified doctor. Babies less than 30 weeks were sent home with a disposable bag and mask after the training of the parents. The responses thus received were analysed.

 Results: We analysed data from 60 responses (48.3%). 85% of the parents were given one-on-one training, the rest as classroom training. 68.3% felt that the addition of video demonstrations would be beneficial. 95% of parents said that the training helped increase their confidence in taking care of their babies. 78% felt it did not add to unnecessary parental anxiety. 5 babies received CPR at home, and all were told that the home CPR was successful on assessment at the hospital after the episode. 65% felt a repeat training would be helpful. All the parents educated about CPR opined that this training is essential for discharge preparation.

Conclusion: We conclude that parental CPR training backed by video demonstration prior to the instructor-led session and followed by repeat training after 3 months is desirable in the holistic care of preterm babies post-discharge.

Key Message – Routine CPR education of parents of preterm neonates, backed by video demonstration and repetition of training after 3 months is desirable; it improves the confidence of parents and reduces anxiety in the care of their premature infants.

Introduction: Cardiopulmonary resuscitation (CPR) is an emergency lifesaving procedure performed when the heart stops beating. Around the turn of the 20th century, preterm infants were discharged only when they achieved a certain weight, typically 2000 gm(5lb). Studies have shown that preterm neonates can be sent home earlier without adverse health effects based on physiologic criteria rather than body weight. Evidence has shown that preterm neonates with low birth weight who require neonatal intensive care experience a much higher rate of hospital readmission and sudden deaths during the first year after birth than healthy term infants. The most important predictor of infant survival from an acute life-threatening event (ALTE) is the time from cardiopulmonary arrest to resuscitation. More so in neonates, this is the case, who are likely to suffer a respiratory arrest that responds quickly to resuscitation. This emphasizes the importance of systematic preparation for discharge and good follow-up thereafter of high-risk preterm neonates to reduce the chances of such life-threatening events.

Preterm neonates should demonstrate some physiologic competencies before being discharged from the hospital. These include oral feeding sufficient to support appropriate growth, thermoregulation in a home environment, and sufficiently mature respiratory control. The first two are usually achieved around 34-36 weeks’ postmenstrual age, but the maturation of respiratory control to the point that allows safe discharge may occasionally take up to 44 weeks’ postmenstrual age. Infants born as very or extremely preterm and have a prolonged and complicated stay in the hospital tend to take longer to achieve these competencies. But they may be discharged home much earlier if they exhibit thermostability and reasonable weight gain, as plotted on the Fenton’s growth chart. NICU graduates are discharged when they satisfy the above criteria. Their parents have demonstrated the necessary skills to provide all care components at home, including CPR should the need arise.

At the time of discharge, most parents lack confidence and are anxious about their capability to handle the babies at home. Hence, we thought that our intervention of training parents of neonates born at home. Hence, we thought that our intervention of training parents of neonates born < 34 weeks would help in the holistic care of these babies, including handling emergencies at home post-discharge. Many studies have emphasized that pre-discharge infant cardiopulmonary resuscitation training is essential or highly desirable. As shown by literature, it is a routine pre-discharge requirement in most developed countries, but this training is not reported or published in our country. Based on our hospital protocols, we initiated this training at its inception 13 years ago. We wanted to review our data over these years to see if it has made an impact or a difference.

Materials and methods:  This retrospective study was conducted at a tertiary care neonatal intensive care unit in India from January 2007 to May 2020. Informed consent for the survey was taken, and the Institutional Review Board approved the study. Initially, only parents of babies less than 30 weeks gestation were being given the training to perform CPR; however, since December 2019, due to a change in the unit protocol, all parents of babies with gestational age less than 34 weeks were admitted to the NICU were trained and included in the study. Babies (less than 30 weeks initially and less than 34 weeks later), deceased, and babies more than these respective gestational age groups were excluded. Parents of these babies were given CPR training (AHA NRP guidelines) in a language they could understand using a manikin, on the day of the transfer to wards or discharge from the NICU, by an NRP-certified doctor who is recertified every 2 years. The training included a brief description of CPR, when it needed to be initiated, and the steps of CPR, and ended with a physical demonstration of the same on a manikin. Parents were also given a chance to practice the steps on the manikin. Each session lasted around 20 minutes. At no additional cost, a new disposable self-inflating bag and mask were procured for each of these neonates and sent home at discharge after their parents underwent CPR training. The authors prepared a questionnaire/survey in English or the local language on request, with 22 questions. Parents were first called and spoken to and were then messaged a web link to complete this survey. All parents had access to the internet and the necessary device. The data from the survey was later analysed and reported.

Results:  During the study period, parents of 126 preterm babies were trained, out of which parents of 84 neonates were attempted to be contacted. The overall response rate to the survey was 71.4%, as shown in Figure 1. We analysed the data of 60 responses we received, and the following results refer to only those that participated in the survey. 46.6% of the babies were between 32-34wks as seen in Table 1. 27 were twins (with one survivor of a pair), and the rest were singleton babies. 85% of the parents were given one-on-one training, the rest as classroom training; however, only 23% of these parents perceived that classroom training may be better than one-on-one training. A majority of 95% found that the training given was easy to follow, and 68.3% thought that providing a video demonstration and one-on-one training would be more helpful. Bag and mask were used in 58% for demonstration. Only manikins with the demonstration of mouth-to-mouth breathing and chest compressions were used for the rest. 63.3% of parents thought it would be good to use a bag and mask for training. Of the total number who responded, 92% understood in what way CPR helped babies in an acute life-threatening event. 90% of them felt that they could identify when their babies required CPR.

Most parents (95%) said that the training helped increase their confidence in taking care of their babies. 78% felt it did not add to unnecessary parental anxiety. 5 babies received CPR at home. Of these babies, 3 received CPR in the first week after discharge and 2 after a month since discharge from the hospital, as shown in Table 2. 4 recovered from the episode quickly following home CPR. All parents correctly followed the steps as they had been advised to initiate CPR according to the assessment at the hospital after the episode. These parents, who found themselves in a situation that needed CPR, felt that they could execute it as taught. 67% of parents said that after three months, they could still recollect the steps of CPR taught during the training session. The need for repetition of training was felt by 65%, and they opined that it should be conducted after a time interval of 3 months since the last session. All 60 parents educated on CPR thought that this training is an essential part of discharge preparation.

Discussion: The American Heart Association (AHA) educates more than 9 million persons annually about CPR. Parents need to be trained in infant CPR. In the United States, 2230 infants (<1 yr. of age) died of sudden infant death syndrome (SIDS) in 2005, making it the third leading cause of death there. Drake et al. found that parents considered CPR a priority when asked to rank discharge teaching topics in order of importance.

We chose to do this study as CPR training is an important aspect of pre-discharge preparation for parents of preterm babies, as has been shown previously. Still, it is not routinely being done in most hospitals in our country, as evidenced by the lack of literature on the same. We hypothesised that getting feedback from parents who had received training in infant CPR would give us an overview of the effectiveness and scope for improvement of what we consider an essential practice.

Conventionally, CPR is taught using a combination of didactic instruction and hands-on practice, followed by a written test. Most of our parents had one-on-one training sessions, occasionally a group training. It was a manual demonstration, and in response to the questionnaire, parents did express that a video-backed demonstration would be more helpful. Brannon et al. used an instructional video as an adjunct to the instructor-led demonstration. The group concluded that CPR is a psychomotor skill, so learning it requires more than just acquiring knowledge. Practice with a manikin is essential to ensure competence. An effective video instruction, while most likely cannot totally replace an instructor-led class, could be helpful in learning infant CPR. A literature review by Parsons et al. opined that teaching infant CPR to parents of high-risk neonates is considered beneficial in decreasing mortality. However, the evidence for this is very limited. The overall trend is supportive of CPR training. It increases parental confidence and decreases anxiety levels. Parents’ memory of knowledge regarding CPR decreases over time. Our survey also showed similar findings. At discharge, the training did seem to have boosted their confidence in taking care of their newborn, and it did not add to the overall anxiety among most parents. In those instances where CPR was required at home, parents could resuscitate and then bring their infant to the hospital for continuing care. It was heartening to learn that the training was hugely successful, considering that most parents had understood when to use CPR and how it helps resuscitate. The aim is to increase this to 100%. Parents of one baby who required home CPR could not self-assess the effectiveness of CPR given. Henceforth, our training should also focus on educating parents on assessing the baby post-resuscitation. All parents were given adequate pre-discharge teaching regarding other aspects of their preemies’ care and the resuscitation training that we provided. Wintch et al. showed that 80% of their subjects who required CPR post-discharge survived complete resuscitation efforts after full cardiopulmonary arrest and were neurologically intact. In all of our 5 babies who required home CPR, parents had correctly followed the steps as they had been advised to initiate CPR as per the post-resuscitation assessment done once they reached the hospital.

The AHA gives CPR training kits to parents of high-risk neonates at discharge at a nominal fee. Providing these kits to carry home may also be useful. Hence, we also provide a complimentary manual resuscitator kit with masks of two sizes to parents of those born <30 wks., and neonates born at 30-34 weeks who are discharged after a very stormy course in NICU.

The inability to retain learned CPR skills has been researched. Studies have documented deficits in retention and performance skills beginning as early as 2 weeks after initial instruction, with continued deterioration up to one year later. The peak incidence of SIDS occurs between 1 and 4 months of age, so long-term retention of infant CPR skills is critical. Therefore, it has been reported that 3 to 6 months after initial instruction is the optimal timeframe for recertification. Most of our parents, too, felt the need for a repeat training session 3 months after the first one.

The limitation of this study was the sample size, which could have been better. The contact details of many parents were either changed or unavailable. There is also an element of recall bias as the survey was conducted after a long time for some. One of the main reasons for more responses from parents in recent years was a better recall. As it was a retrospective study, contacting and convincing parents to take the survey was arduous. Not all parents agreed to participate. Some did not receive phone calls and some responded by saying they were busy and would not be able to complete the survey. Also, during the study period, there was a change in unit protocol, and parents of all preterms, 34 wks. were being trained instead of those only <30 wks.  as was done previously. We noticed that there were babies in the gestational age group of 30-34weeks who had episodes of apnoea at home and thereby changed the Unit protocol to include these parents to improve outcomes in these babies. The study’s strengths were the simplicity of the survey method used and the number of responses we received, considering that the oldest of the babies whose parents responded was born 13 years ago.

Conclusion:  Our study shows that parental CPR education seems to have improved their confidence in the care of these preemies and has not added to general parental anxiety. All parents also agreed that it is an essential step in the pre-discharge planning of preterm babies. Parental CPR training backed by video demonstration before the instructor-led session and followed by repeat training after 3 months is vital in the holistic care of preterm babies post-discharge and is highly recommended at all centres catering to this major subgroup of neonates admitted to the NICU.

*** Access in-person and online training through numerous resources worldwide- Ask your health care provider

PLEASE ENTER HERE TO ACCESS GRAPHS/CHARTS

Source:http://neonatologytoday.net/newsletters/nt-may22.pdf

Day in the life of a DOCTOR: Shadowing NICU NURSE PRACTITIONER (ft. premature babies)

Violin MD

Babies born at 22 weeks (5.5 months) can survive!! Join me in the largest NICU in Canada and learn about the lifesaving treatments for premature babies! I’ll be shadowing Nikki, a nurse practitioner who works in the neonatal ICU. Plus you’ll meet baby Kalani who was born at 23 weeks and her mother, Paola.

Still a Preemie

The National Coalition for Infant Health explains why all preemies — regardless of how prematurely they’re born or what challenges they face — deserve proper care and appropriate health coverage.

The National Coalition for Infant Health explains why all preemies — regardless of how prematurely they’re born or what challenges they face — deserve proper care and appropriate health coverage.

The science of nurturing and its impact on premature babies

May 31, 2017  

A long-term study on helping preterm babies, using the simplest of interventions, is showing signs of promise. In part two of our story, William Brangham explores the study’s outcomes, as well as questions about the complex past of the doctor behind it.

HEALTH CARE PARTNERS

Preterm birth and Kawasaki disease: a nationwide Japanese population-based study

Published: 08 October 2021

Abstract

Background

Previous studies showed that preterm birth increased the risk for hospital admissions in infancy and childhood due to some acute diseases. However, the risk of preterm children developing Kawasaki disease remains unknown. In the present study, we investigate whether preterm birth increased the morbidity of Kawasaki disease.

Methods

We included 36,885 (34,880 term and 2005 preterm) children born in 2010 in Japan. We examined the association between preterm birth and hospitalization due to Kawasaki disease using a large nationwide survey in Japan.

Results

In log-linear regression models that were adjusted for children’s characteristics (sex, singleton birth, and parity), parental characteristics (maternal age, maternal smoking, paternal smoking, maternal education, and paternal income), and residential area, preterm infants were more likely to be hospitalized due to Kawasaki disease (adjusted risk ratio: 1·55, 95% confidence interval: 1.01–2.39). We then examined whether breastfeeding status modified the potential adverse effects of preterm birth on health outcome. Preterm infants with partial breastfeeding or formula feeding had a significantly higher risk of hospitalization due to Kawasaki disease compared with term infants with exclusive breastfeeding.

Conclusions

Preterm infants were at a high risk for Kawasaki disease, and exclusive breastfeeding might prevent this disease among preterm infants.

Impact

  • Previous studies showed that preterm birth increased the risk for hospital admissions in infancy and childhood due to some acute diseases, however, the risk of preterm children developing Kawasaki disease remains unknown.
  • This Japanese large population-based study showed that preterm infants were at a high risk for Kawasaki disease for the first time.
  • Furthermore, this study suggested that exclusively breastfeeding might prevent Kawasaki disease among preterm infants. Full Study available.

Source: https://www.nature.com/articles/s41390-021-01780-4

Relationships between overwork, burnout and suicidal ideation among resident physicians in hospitals in Japan with medical residency programmes: a nationwide questionnaire-based survey

2022 Mar 10;12(3):e056283. doi: 10.1136/bmjopen-2021-056283.Masatoshi Ishikawa 1 2

Abstract

Objectives: This study examined the relationships between overwork, burnout and suicidal ideation among resident physicians working in hospitals throughout Japan.

Design: A nationwide, questionnaire-based survey.

Setting: Participating hospitals (n=416) were accredited by the Japanese Medical Specialty Board to offer medical residency programmes in 19 core specialties. Surveys were conducted in October 2020.

Participants: Valid responses were obtained from 4306 physicians (response rate: 49%).

Outcome measures: Items pertaining to the Japanese Burnout Scale, depressive tendencies and suicidal ideation were included in questionnaires. Multiple regression analyses were performed: suicidal ideation was the response variable; sex, age, core specialty, marital status, income, weekly working hours and workplace (ownership, number of beds, number of full-time physicians and regional classification) were explanatory variables.

Results: Regarding the Japanese Burnout Scale, the highest score was recorded for ‘sense of personal accomplishment’, followed by ’emotional exhaustion’ and ‘depersonalization’. Increased emotional exhaustion and depersonalisation were associated with longer working hours, but there was no such trend for sense of personal accomplishment. Depressive tendencies and suicidal ideation were noted in 24.1% and 5.6% of respondents, respectively. These percentages tended to increase when respondents worked longer hours. Several factors were significantly associated with suicidal ideation: female sex (reference: male, OR: 2.08, 95% CI: 1.56 to 2.77), ≥12 million yen income (reference: <2 million yen, OR: 0.21, 95% CI: 0.05 to 0.79), ≥100 working hours/week (reference:<40 hours/week, OR: 3.64, 95% CI: 1.88 to 7.04) and 600-799 hospital beds (reference: <200 beds, OR: 0.23, 95% CI: 0.07 to 0.82).

Conclusions: Many Japanese residents demonstrated a tendency to experience burnout and suicidal ideation. Female sex, low income, long working hours and insufficient hospital beds were associated with suicidal ideation. To ensure physicians’ health and patients’ safety, it is necessary to advance workstyle reform for physicians.

<a href=”http://Abstract Objectives: This study examined the relationships between overwork, burnout and suicidal ideation among resident physicians working in hospitals throughout Japan. Design: A nationwide, questionnaire-based survey. Setting: Participating hospitals (n=416) were accredited by the Japanese Medical Specialty Board to offer medical residency programmes in 19 core specialties. Surveys were conducted in October 2020. Participants: Valid responses were obtained from 4306 physicians (response rate: 49%). Outcome measures: Items pertaining to the Japanese Burnout Scale, depressive tendencies and suicidal ideation were included in questionnaires. Multiple regression analyses were performed: suicidal ideation was the response variable; sex, age, core specialty, marital status, income, weekly working hours and workplace (ownership, number of beds, number of full-time physicians and regional classification) were explanatory variables. Results: Regarding the Japanese Burnout Scale, the highest score was recorded for ‘sense of personal accomplishment’, followed by ’emotional exhaustion’ and ‘depersonalization’. Increased emotional exhaustion and depersonalisation were associated with longer working hours, but there was no such trend for sense of personal accomplishment. Depressive tendencies and suicidal ideation were noted in 24.1% and 5.6% of respondents, respectively. These percentages tended to increase when respondents worked longer hours. Several factors were significantly associated with suicidal ideation: female sex (reference: male, OR: 2.08, 95% CI: 1.56 to 2.77), ≥12 million yen income (reference: <2 million yen, OR: 0.21, 95% CI: 0.05 to 0.79), ≥100 working hours/week (reference:<40 hours/week, OR: 3.64, 95% CI: 1.88 to 7.04) and 600-799 hospital beds.)

Source: https://pubmed.ncbi.nlm.nih.gov/35273058/

Protecting workers’ health and safety: Online training resources at your fingertips

28 April 2022

Everyone deserves to work in a place that is healthy and safe. Each year on 28 April, we celebrate World Day for Safety and Health at Work to raise awareness of this right and the steps we can take to ensure it is a reality for workers across the globe.

Training is key. Nearly half of the world’s population works. Providing workers with the latest occupational health and safety knowledge can help protect them from work-related injuries, diseases and deaths. This is especially important during public health emergencies like the COVID-19 pandemic.

Workplaces have played an important role in both the spread and mitigation of COVID-19. Health workers of all kinds have been particularly affected by the pandemic. Not only have they been sick, they have suffered adverse effects of prolonged use of personal protective equipment, fatigue and mental health problems, violence and harassment and exposure to hazardous disinfectants.

The pandemic has stimulated many work settings around the world to expand telework and hybrid work arrangements. All these can impact the health, safety and wellbeing of workers.

So the World Health Organization (WHO) is offering free online courses on these topics on its OpenWHO.org learning platform. Materials are available in multilingual and low-bandwidth formats to maximize access.

WHO has also collaborated with partners like the International Labour Organization (ILO) on additional training materials to protect health workers and responders and prepare workplaces for future health emergencies. To access these learning resources, please visit the links below.

  • Healthy and safe telework (OpenWHO): This course provides guidance to teleworkers and their managers on protecting and promoting health and wellbeing while teleworking.
  • All-Hazard Rapid Response Teams Training Package (WHO Health Security Learning Platform): The all-hazard Rapid Response Teams Training Package is a structured comprehensive collection of training resources and tools enabling relevant training institutions to organize, run and evaluate face-to-face training for Rapid Response Teams tailored to country specific needs.
  • HealthWISE – Work Improvement in Health Services (ILO/WHO publication): HealthWISE is a practical, participatory quality improvement tool for health facilities. The HealthWISE package consists of an Action Manual and a Trainers’ Guide to combine action and learning. Topics include occupational safety and health, personnel management and environmental health.

Source:https://www.who.int/news-room/feature-stories/detail/protecting-workers–health-and-safety–online-training-resources-at-your-fingertips

 

New Survey Shows That Up To 47% Of U.S. Healthcare Workers Plan To Leave Their Positions By 2025

Jack Kelly   Senior Contributor  Apr 19, 2022

The Covid-19 pandemic unleashed wave after wave of challenges and feelings of burnout for United States healthcare workers, and unless changes are made to the industry, nearly half plan to leave their current positions, according to a new report examining the work environment and industry’s future for clinicians.

Elsevier Health, a provider of information solutions for science, health and technology professionals, conducted its first “Clinician of the Future” global report. It revealed current pain points, predictions for the future and how the industry can come together to address gaps—including that 31% of clinicians globally, and 47% of U.S. healthcare workers, plan to leave their current role within the next two to three years.

Dr. Charles Alessi, chief clinical officer at Healthcare Information and Management Systems Society (HIMSS), said, “As a practicing doctor, I am acutely aware of the struggles today’s clinicians face in their efforts to care for patients.” Alessi continued, “This comprehensive report from Elsevier Health provides an opportunity for the industry to listen—and act—on the pivotal guidance given by those on the frontlines. I commend this important initiative and look forward to next steps in supporting our doctors and nurses.”

In the new report from Elsevier Health, published two years after the Covid-19 pandemic began, thousands of doctors and nurses from across the globe revealed what is needed to fill gaps and future-proof today’s healthcare system. The comprehensive “Clinician of the Future” report was conducted in partnership with Ipsos and uncovered how undervalued doctors and nurses feel, as well as their call for urgent support, such as more skills training—especially in the effective use of health data and technology—preserving the patient-doctor relationship in a changing digital world and recruiting more healthcare professionals into the field. The multiphase research report not only understands where the healthcare system is following the Covid-19 pandemic, but where it needs to be in 10 years to ensure a future that both providers and patients deserve.

Jan Herzhoff, president at Elsevier Health, said, “Doctors and nurses play a vital role in the health and well-being of our society. Ensuring they are being heard will enable them to get the support they need to deliver better patient care in these difficult times.” Herzhoff added, “We must start to shift the conversation away from discussing today’s healthcare problems to delivering solutions that will help improve patient outcomes. In our research, they have been clear about the areas they need support; we must act now to protect, equip and inspire the clinician of the future.”

There has never been a greater need for lifting the voices of healthcare professionals. The global study found 71% of doctors and 68% of nurses believe their jobs have changed considerably in the past 10 years, with many saying their jobs have gotten worse.

The “Clinician of the Future” report includes a quantitative global survey, qualitative interviews and roundtable discussions with nearly 3,000 practicing doctors and nurses around the world. The data helps shed light on the challenges impacting the profession today and predictions on what healthcare will look like in the next 10 years, according to those providing critical patient care.

According to the report, 56% of respondents said that there has been growing empowerment amongst patients within the last 10 years, as people take charge of their health journeys. When referring to soft skills, 82% said that it’s important for them to exhibit active listening and empathy to the people they serve. Furthermore, nearly half of clinicians cite the allocated time they have with patients as an issue, as only 51% believe that the allotted time allows them to provide satisfactory care.

To ensure a positive shift moving into the future and to fill current gaps, clinicians highlight the following priority areas for greater support:

  • Clinicians predict that over the next 10 years “technology literacy” will become their most valuable capability, ranking higher than “clinical knowledge.” In fact, 56% of clinicians predict they will base most of their clinical decisions using tools that utilize artificial intelligence. However, 69% report being overwhelmed with the current volume of data and 69% predict the widespread use of digital health technologies to become an even more challenging burden in the future. As a result, 83% believe training needs to be overhauled so they can keep pace with technological advancements.
  • Clinicians predict a blended approach to healthcare with 63% saying most consultations between clinicians and patients will be remote and 49% saying most healthcare will be provided in a patient’s home instead of in a healthcare setting. While clinicians may save time and see more patients, thanks to telehealth, more than half of clinicians believe telehealth will negatively impact their ability to demonstrate empathy with patients they no longer see in person. As a result, clinicians are calling for guidance on when to use telehealth and how to transfer soft skills like empathy to the computer screen.
  • Clinicians are concerned about a global healthcare workforce shortage, with 74% predicting there will be a shortage of nurses and 68% predicting a shortage of doctors in 10 years’ time. This may be why global clinicians say a top support priority is increasing the number of healthcare workers in the coming decade. Clinicians require the support of larger, better-equipped teams and expanded multidisciplinary healthcare teams, such as data analysts, data security experts and scientists, as well as clinicians themselves.

“While we know that many nurses are leaving the profession due to burnout, we also know that the pandemic has inspired others to enter the field because of a strong desire for purposeful work,” said Marion Broome, Ruby F. Wilson professor of nursing at Duke University’s School of Nursing. “We must embrace this next wave of healthcare professionals and ensure we set them up for success. Our future as a society depends on it.”

Looking To The Future

“Ultimately, we asked clinicians for what they need, and now it’s our responsibility as a healthcare industry to act,” said Dr. Thomas “Tate” Erlinger, vice president of clinical analytics at Elsevier Health. “Now is the time for bold thinking—to serve providers and patients today and tomorrow. We need to find ways to give clinicians the enhanced skills and resources they need to better support and care for patients in the future. And we need to fill in gaps today to stop the drain on healthcare workers to ensure a strong system in the next decade and beyond.”

Source: https://www.forbes.com/sites/jackkelly/2022/04/19/new-survey-shows-that-up-to-47-of-us-healthcare-workers-plan-to-leave-their-positions-by-2025/?sh=1b883b0b395b

INNOVATIONS

Artificial Intelligence Getting Smarter! Innovations from the Vision Field

Posted on February 8th, 2022 by Michael F. Chiang, M.D., National Eye Institute

One of many health risks premature infants face is retinopathy of prematurity (ROP), a leading cause of childhood blindness worldwide. ROP causes abnormal blood vessel growth in the light-sensing eye tissue called the retina. Left untreated, ROP can lead to lead to scarring, retinal detachment, and blindness. It’s the disease that caused singer and songwriter Stevie Wonder to lose his vision.

Now, effective treatments are available—if the disease is diagnosed early and accurately. Advancements in neonatal care have led to the survival of extremely premature infants, who are at highest risk for severe ROP. Despite major advancements in diagnosis and treatment, tragically, about 600 infants in the U.S. still go blind each year from ROP. This disease is difficult to diagnose and manage, even for the most experienced ophthalmologists. And the challenges are much worse in remote corners of the world that have limited access to ophthalmic and neonatal care.

Artificial intelligence (AI) is helping bridge these gaps. Prior to my tenure as National Eye Institute (NEI) director, I helped develop a system called i-ROP Deep Learning (i-ROP DL), which automates the identification of ROP. In essence, we trained a computer to identify subtle abnormalities in retinal blood vessels from thousands of images of premature infant retinas. Strikingly, the i-ROP DL artificial intelligence system outperformed even international ROP experts [1]. This has enormous potential to improve the quality and delivery of eye care to premature infants worldwide.

Of course, the promise of medical artificial intelligence extends far beyond ROP. In 2018, the FDA approved the first autonomous AI-based diagnostic tool in any field of medicine [2]. Called IDx-DR, the system streamlines screening for diabetic retinopathy (DR), and its results require no interpretation by a doctor. DR occurs when blood vessels in the retina grow irregularly, bleed, and potentially cause blindness. About 34 million people in the U.S. have diabetes, and each is at risk for DR.

As with ROP, early diagnosis and intervention is crucial to preventing vision loss to DR. The American Diabetes Association recommends people with diabetes see an eye care provider annually to have their retinas examined for signs of DR. Yet fewer than 50 percent of Americans with diabetes receive these annual eye exams.

The IDx-DR system was conceived by Michael Abramoff, an ophthalmologist and AI expert at the University of Iowa, Iowa City. With NEI funding, Abramoff used deep learning to design a system for use in a primary-care medical setting. A technician with minimal ophthalmology training can use the IDx-DR system to scan a patient’s retinas and get results indicating whether a patient should be sent to an eye specialist for follow-up evaluation or to return for another scan in 12 months.

Many other methodological innovations in AI have occurred in ophthalmology. That’s because imaging is so crucial to disease diagnosis and clinical outcome data are so readily available. As a result, AI-based diagnostic systems are in development for many other eye diseases, including cataract, age-related macular degeneration (AMD), and glaucoma.

Rapid advances in AI are occurring in other medical fields, such as radiology, cardiology, and dermatology. But disease diagnosis is just one of many applications for AI. Neurobiologists are using AI to answer questions about retinal and brain circuitry, disease modeling, microsurgical devices, and drug discovery.

If it sounds too good to be true, it may be. There’s a lot of work that remains to be done. Significant challenges to AI utilization in science and medicine persist. For example, researchers from the University of Washington, Seattle, last year tested seven AI-based screening algorithms that were designed to detect DR. They found under real-world conditions that only one outperformed human screeners [3]. A key problem is these AI algorithms need to be trained with more diverse images and data, including a wider range of races, ethnicities, and populations—as well as different types of cameras.

How do we address these gaps in knowledge? We’ll need larger datasets, a collaborative culture of sharing data and software libraries, broader validation studies, and algorithms to address health inequities and to avoid bias. The NIH Common Fund’s Bridge to Artificial Intelligence (Bridge2AI) project and NIH’s Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity (AIM-AHEAD) Program project will be major steps toward addressing those gaps.

So, yes—AI is getting smarter. But harnessing its full power will rely on scientists and clinicians getting smarter, too.

Source: https://directorsblog.nih.gov/2022/02/08/artificial-intelligence-getting-smarter-innovations-from-the-vision-field/

MaineHealth Innovation: Augmented Reality for Neonatal Resuscitation

Jan 26, 2022           MaineHealth

Helping newborns in distress is the goal of Augmented Reality Technology for Medical Simulation (ARTforMS) – an immersive experience that layers AR over traditional manikins. Learn how MaineHealth Innovation is supporting pediatric hospital medicine and critical care experts, Dr. Mary Ottolini and Dr. Michael Ferguson, as they continue leading a pilot with the software application at Maine Medical Center and throughout the MaineHealth system.

Association of Prenatal Exposure to Early-Life Adversity With Neonatal Brain Volumes at Birth

Original Investigation   Pediatrics   April 12, 2022

Regina L. Triplett, MD, MS1Rachel E. Lean, PhD2Amisha Parikh, BS3; et alJ. Philip Miller, AB4Dimitrios Alexopoulos, MS1Sydney Kaplan, BS1Dominique Meyer, BS1Christopher Adamson, PhD5,6Tara A. Smyser, MSE2Cynthia E. Rogers, MD2,7Deanna M. Barch, PhD2,8,9Barbara Warner, MD7Joan L. Luby, MD2Christopher D. Smyser, MD, MSCI1,7,9

Author Affiliations Article Information

JAMA Netw Open. 2022;5(4):e227045. doi:10.1001/jamanetworkopen.2022.7045

Key Points

Question:  Is prenatal exposure to maternal social disadvantage and psychosocial stress associated with global and relative infant brain volumes at birth?

Findings:  In this longitudinal, observational cohort study of 280 mother-infant dyads, prenatal exposure to greater maternal social disadvantage, but not psychosocial stress, was associated with statistically significant reductions in white matter, cortical gray matter, and subcortical gray matter volumes and cortical folding at birth after accounting for maternal health and diet.

Meaning:  These findings suggest that prenatal exposure to social disadvantage is associated with global reductions in brain volumes and folding in the first weeks of life.

Abstract

Importance:  Exposure to early-life adversity alters the structural development of key brain regions underlying neurodevelopmental impairments. The association between prenatal exposure to adversity and brain structure at birth remains poorly understood.

Objective:  To examine whether prenatal exposure to maternal social disadvantage and psychosocial stress is associated with neonatal global and regional brain volumes and cortical folding.

Design, Setting, and Participants:  This prospective, longitudinal cohort study included 399 mother-infant dyads of sociodemographically diverse mothers recruited in the first or early second trimester of pregnancy and their infants, who underwent brain magnetic resonance imaging in the first weeks of life. Mothers were recruited from local obstetric clinics in St Louis, Missouri from September 1, 2017, to February 28, 2020.

Exposures:  Maternal social disadvantage and psychosocial stress in pregnancy.

Main Outcomes and Measures:  Confirmatory factor analyses were used to create latent constructs of maternal social disadvantage (income-to-needs ratio, Area Deprivation Index, Healthy Eating Index, educational level, and insurance status) and psychosocial stress (Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Everyday Discrimination Scale, and Stress and Adversity Inventory). Neonatal cortical and subcortical gray matter, white matter, cerebellum, hippocampus, and amygdala volumes were generated using semiautomated, age-specific, segmentation pipelines.

Results:  A total of 280 mothers (mean [SD] age, 29.1 [5.3] years; 170 [60.7%] Black or African American, 100 [35.7%] White, and 10 [3.6%] other race or ethnicity) and their healthy, term-born infants (149 [53.2%] male; mean [SD] infant gestational age, 38.6 [1.0] weeks) were included in the analysis. After covariate adjustment and multiple comparisons correction, greater social disadvantage was associated with reduced cortical gray matter (unstandardized β = −2.0; 95% CI, −3.5 to −0.5; P = .01), subcortical gray matter (unstandardized β = −0.4; 95% CI, −0.7 to −0.2; P = .003), and white matter (unstandardized β = −5.5; 95% CI, −7.8 to −3.3; P < .001) volumes and cortical folding (unstandardized β = −0.03; 95% CI, −0.04 to −0.01; P < .001). Psychosocial stress showed no association with brain metrics. Although social disadvantage accounted for an additional 2.3% of the variance of the left hippocampus (unstandardized β = −0.03; 95% CI, −0.05 to −0.01), 2.3% of the right hippocampus (unstandardized β = −0.03; 95% CI, −0.05 to −0.01), 3.1% of the left amygdala (unstandardized β = −0.02; 95% CI, −0.03 to −0.01), and 2.9% of the right amygdala (unstandardized β = −0.02; 95% CI, −0.03 to −0.01), no regional effects were found after accounting for total brain volume.

Conclusions and Relevance:  In this baseline assessment of an ongoing cohort study, prenatal social disadvantage was associated with global reductions in brain volumes and cortical folding at birth. No regional specificity for the hippocampus or amygdala was detected. Results highlight that associations between poverty and brain development begin in utero and are evident early in life. These findings emphasize that preventive interventions that support fetal brain development should address parental socioeconomic hardships.

Source:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790989

Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies

Momma1,  Ryoko Kawakami2, Takanori Honda3, Susumu S Sawada2

Correspondence to Dr Haruki Momma, Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; h-momma@med.tohoku.ac.jp

Abstract

Objective: To quantify the associations between muscle-strengthening activities and the risk of non-communicable diseases and mortality in adults independent of aerobic activities.

Design: Systematic review and meta-analysis of prospective cohort studies.

Data sources: MEDLINE and Embase were searched from inception to June 2021 and the reference lists of all related articles were reviewed.

Eligibility criteria for selecting studies: Prospective cohort studies that examined the association between muscle-strengthening activities and health outcomes in adults aged ≥18 years without severe health conditions.

Results: Sixteen studies met the eligibility criteria. Muscle-strengthening activities were associated with a 10–17% lower risk of all-cause mortality, cardiovascular disease (CVD), total cancer, diabetes and lung cancer. No association was found between muscle-strengthening activities and the risk of some site-specific cancers (colon, kidney, bladder and pancreatic cancers). J-shaped associations with the maximum risk reduction (approximately 10–20%) at approximately 30–60 min/week of muscle-strengthening activities were found for all-cause mortality, CVD and total cancer, whereas an L-shaped association showing a large risk reduction at up to 60 min/week of muscle-strengthening activities was observed for diabetes. Combined muscle-strengthening and aerobic activities (versus none) were associated with a lower risk of all-cause, CVD and total cancer mortality.

Conclusion: Muscle-strengthening activities were inversely associated with the risk of all-cause mortality and major non-communicable diseases including CVD, total cancer, diabetes and lung cancer; however, the influence of a higher volume of muscle-strengthening activities on all-cause mortality, CVD and total cancer is unclear when considering the observed J-shaped associations.

Source: https://bjsm.bmj.com/content/early/2022/01/19/bjsports-2021-105061

How to Tap Into Your Joy

By Emily Madill, Contributor

Author and Certified Professional Coach Sep. 20, 2017, 12:52 PM EDT

“Whether you think you can, or you think you can’t– you’re right”. ― Henry Ford

I love this quote, I believe it applies to so much in life. There is no doubting perception is powerful. What could be added to the above quote, is that regardless of what we think, the object of our heart’s desire is always right here  whether or not we think it exists.

In relation to joy, this is wonderful news because it speaks to the idea that the experience of joy is always available to us. It’s not something we have to tirelessly search for or jump through hoops to arrive at. Rather, it’s something we can access right now in this very moment, if we choose.

If that seems like it’s too easy to be true, try these 5 added tips and see if they may help you tap into your joy.

1. Listen for Joy

The fast track way to accessing our personal joy is to be still and quiet enough to hear our unique inner voice and spirit. Often the outside noise drowns out the wise voice within is. When we give ourselves the space to really listen, it becomes very clear our joy is right below the surface just waiting to play. When we listen, our joy will show us the way.

2. Keep Joy Simple

Joy is not complicated and neither is accessing it. We don’t need to read endless books, listen to podcasts and spend copious amounts of money searching for joy. It’s much easier to take the simple route. Sometimes it’s a matter of reminding ourselves we are all worthy and capable of experiencing joy, it’s as simple as knowing our joy lives within us.

3. Just Be Joy

I love the idea that in order to have something — whether it’s love, peace, joy etc. that we must first be the very thing we are wanting. If we want joy, we can start by ‘being joy’. We can be joyful in our thoughts, the words we speak, our interactions with others and our overall demeanor. We humans are blessed to have the creative license to actually try on and be whatever it is we most want — that’s amazing!

4. Laugh Your Way to Joy

Laughing is powerful. Laugh at yourself, laugh with a friend, laugh with your pet. Whatever you do, be sure to laugh as often and as loud as you can. It’s nearly impossible to not feel joy when you are midway through a belly laugh with happy tears streaming down your cheeks. Laughter is a gift that’s available to us all the time. There isn’t a limit to how often we can bust a gut. The more we laugh, the greater sense of joy we feel and spread out into the world.

5. See Joy

If you want to prove to yourself that joy exists everywhere, all the time, see what happens when you start looking for the evidence of it. Try it out for a day, I dare you. When we start seeing joy in the faces of people around us and the pure magnificence of our surroundings, we experience a deep feeling of joy within ourselves. Breathe it all in. Give yourself the gift of becoming an expert at finding joy in the most mundane and simplest places. You may be surprised to see how much joy exists in our world, and even more so in recognizing it’s always present within you.

Source:https://www.huffpost.com/entry/how-to-tap-into-your-joy_b_59c29c13e4b0f96732cbcaf7

After a week of working hard on studies and research I decided to take a break this weekend to escape London and visit the coastal city of Brighton. Taking the time to try new things, explore new places and go on an adventure even for a day is something that can bring great joy in our lives. Having the opportunity to explore the seaside, swim in the Atlantic ocean and enjoy my first proper English fish and chips was a delight. Finding balance and slowing down to enjoy the simple moments in life is empowering and instrumental in helping us build our relationship to better know ourselves and positively grow our friendships with others.

Kanoa Igarashi 🇯🇵 is bringing surfing home to Japan!

Jul 23, 2021  Olympics

Kanoa Igarashi is a Japanese-American surfer who has competed professionally worldwide since 2012. He was the youngest rookie on the World Surf League Championship Tour in 2016 and collected more Round One wins than any other surfer. He talks to the Olympic Channel about going all-in, pressure, what the Olympics symbolise, and more. Enjoy watching this interview with Kanoa Igarashi!

Crisis, Coalitions, Shinrin-Yoku

Serbia, officially the Republic of Serbia, is a landlocked country in Southeast Europe, at the crossroads of the Pannonian Plain and the Balkans. It shares land borders with Hungary to the north, Romania to the northeast, Bulgaria to the southeast, North Macedonia to the south, Croatia and Bosnia and Herzegovina to the west, and Montenegro to the southwest, and claiming a border with Albania through the disputed territory of Kosovo. Serbia has a population of roughly 7 million inhabitants. Its capital Belgrade is also the largest city.

Serbia is an upper-middle income economy, ranked 64th in the Human Development Index domain. It is a unitary parliamentary constitutional republic, member of the UN, CoE, OSCE, PfP, BSEC, CEFTA and is acceding to the WTO. Since 2014, the country has been negotiating its EU accession, with the aim of joining the European Union by 2025. Serbia formally adheres to the policy of military neutrality.

The country provides universal health care and free primary and secondary education to its citizens. The healthcare system in Serbia is organized and managed by the three primary institutions: The Ministry of Health, The Institute of Public Health of Serbia “Dr Milan Jovanović Batut” and the Military Medical Academy. The right to healthcare protections is defined as a constitutional right in Serbia. The Serbian public health system is based on the principles of equity and solidarity, organized on the model of compulsory health insurance contributions. Private health care is not integrated into the public health system, but certain services may be included by contracting.

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

COMMUNITY

UNICEF delivered a life-saving machine for newborns

A valuable donation to the Institute for Health Care of Children and Youth of Vojvodina provided by Delhaize Serbia

Belgrade, 4 November 2021

The Institute for Health Care of Children and Youth of Vojvodina from Novi Sad received today a therapeutic hypothermia device for asphyxiated newborns, provided by the Delhaize Serbia company as part of the So Small They Could Fit Inside a Heart campaign.

The therapeutic hypothermia device for asphyxiated newborns is intended for treating babies who suffered oxygen deprivation during birth. This device prevents brain damage in these babies by applying a modern controlled cooling method and is worth2,419,000 dinars.

“This valuable device is used for applying a proven therapeutic method in preventing brain damage in newborns, thus saving lives of asphyxiated babies. In the previous period, the Institute received valuable equipment from UNICEF, which helped equip the Institute. However, in order to reach the highest standards in developmental care, professional support we receive from UNICEF experts and partners is equally important. I would also like to thank the Delhaize Serbia company, which provided funds for the purchase of this life-saving device. UNICEF is our reliable partner that knows that many newborn babies need daily support of the health care system, regardless of the crisis, and we are grateful for it,” stated the Director of the Institute, Doc. Dr. Jelena Antić.

In Serbia, 65 thousand children are born every year, 4000 of whom are premature babies, and every day seven new babies require some form of urgent support. Premature birth is responsible for more than 60% of infant deaths in Serbia. The So Small They Could Fit Inside a Heart campaignwas launched by UNICEF late last year in order to provide additional equipment for neonatal units in Serbia, which will also contribute to reducing the mortality of premature babies in the country.

“The Institute for Health Care of Children and Youth in Novi Sad provides care to the most vulnerable babies from all over Vojvodina. For years, it has ensured that every newborn child gets the highest quality support in order to survive and thrive. The Institute is a good-practice example in the country when it comes to the provision of family-oriented developmental care, which also includes conditions for the continuous and irreplaceable contact between mum or dad and baby from the first days of baby’s life.

This is one of the few institutions in Serbia that has managed to preserve this practice during the pandemic, which opens up opportunities for us to jointly support other neonatal intensive care units in Serbia to persist in that endeavour. Maintaining the highest standards of child health care, despite the challenges imposed by the COVID19 pandemic, is a common priority, and we would like to thank Delhaize Serbia for providing the funds to support the most vulnerable, but also the bravest among us, who fight like true “little giants”, said Jelena Zaganović Jakovljević, UNICEF Early Childhood Development Specialist.

The COVID-19 epidemic has also been affecting pregnant women, newborns and children lately, so it is particularly important to invest efforts in adequate treatment of the infected and combating the epidemic, which is not sparing the youngest either. UNICEF has supported the equipping of neonatal units in Serbia, so that the most vulnerable among us, prematurely born babies and ill newborns, are given adequate support to survive and thrive. Starting from 2017, UNICEF has invested a total of 59,628,463 dinars in modernising the operation of the neonatal service in Serbia. The So Small They Could Fit Inside a Heart campaign was supported by the Ministry of Health of the Republic of Serbia.

“Delhaize Serbia has recognised UNICEF as the right partner and supported the modernisation of neonatal units in Novi Sad and Kragujevac, because we are aware of how important it is to help the most vulnerable babies that are also affected by the Corona virus crisis. Helping such small babies to get a chance at life is a reflection of our belief that help should be provided to those who need it most,” said Milica Popović, Corporate Communications Manager at Delhaize Serbia.

In all Maxi, Mega Maxi, Tempo and Shop&Go stores across Serbia, customers have the opportunity to round their bill up to the amount they wish, and in this way support the provision of equipment to neonatal units in our country.

Delhaize Serbia donated a total of 200,000 euros to UNICEF for equipping neonatal units in our countryFrom this donation, another therapeutic hypothermia device for asphyxiated newborns will be provided to the Kragujevac Neonatal Care Centre, which will also receive the first ambulance for prematurely born and ill newborn babies. Since the start of the campaign, this is the largest private sector donation in the So Small They Could Fit Inside a Heart campaign.

Source:https://www.unicef.org/serbia/en/press-releases/unicef-delivered-life-saving-machine-newborns

Coalition for Preemies – We Help Polish Parents of Preemies and Rescue Ukrainian NICUs

Maria Katarzyna Borszewska-Kornacka, MD, Elzbieta Brzozowska, Adriana Misiewicz, Joanna Nycz

Coalition for Preemies is an organization operating in Poland for ten years – initially as a social movement that brought together people and institutions working for the health of premature babies in Poland, and from 2019 as a Foundation.

The goals of the Foundation have been unchanged for many years – to work for the smallest of the youngest – premature babies and their parents. Our goal is education – starting with the health of pregnant women and preventing premature births, ending with the health of premature babies, their development, and rehabilitation. We reach out to parents of premature babies to help them care for their premature babies and to the general public to help them understand that a premature baby is the most vulnerable person who needs our help. Nobody who has not encountered a premature baby in their environment knows what complications the baby and its loved ones face and how much effort is needed to ensure healthy development.

During the pandemic, we got involved with an international campaign initiated by EFCNI #zeroseparation. It aimed to restore the possibility of visiting preemies in neonatal departments for their parents. In Poland, as part of the #zeroseparation campaign, we included parents of preemies in the group “zero” for vaccination against COVID-19 – the group that could be vaccinated first together with medical staff. We wanted parents of premature babies to be protected from the virus as soon as possible and to be able to visit their children in hospitals. It was possible thanks to the immediate decision of the Ministry of Health after we sent a request on this matter.

In 2021, we launched advice for parents of premature babies with specialists as part of the “Ask for a premature baby” campaign – it consists of a telephone conversation or via online communicators. Parents can talk to a neonatologist, psychologist, pediatric neurologist, lactation consultant, and physiotherapist.

Currently, we are involved in helping premature Ukrainian babies. Together with the Neonatus Foundation, the Tęczowy Kocyk Foundation, and the blogger MatkoweLove, we organized a fundraiser. With the collected money, we finance the purchase of the necessary equipment and medicines for Ukrainian neonatal units and transport the equipment to the neediest hospitals in Ukraine. The President of our Foundation- prof. Maria Katarzyna Borszewska-Kornacka is in constant contact with the national consultant for neonatology in Ukraine, and therefore we know what their needs are. First shipments of medical equipment, drugs, and milk were sent to Lviv, Kyiv, Charkov, Brovary, Ivano-Frankovsk, and Dniepro.

It is possible to donate to the Coalition for Preemies Foundation: https://www.koalicjadlawczesniaka.pl/numer-konta-fundacji-koalicja-dla-wczesniaka-i-dane-do-przelewow-z-zagranicy/

We have also started the “Package for a Newborn” campaign, the purpose of which is to equip Ukrainian babies born in Warsaw with necessities such as clothes for newborns, sizes 50-68, including bodysuits, rompers, socks, hats, nipples, small toys, cosmetics, and hygiene articles.

We also plan to prepare a warehouse of clothes/things useful for newborns, which will be issued in response to the specific needs of single Ukrainian mothers in Poland. From the warehouse, mothers will be able to receive rockers, carriers, scarves for carrying babies, prams, changing mats, bathtubs, and breast pumps.

Since the outbreak of war, we have had over a dozen requests to help in transferring newborns from Ukraine to Poland.

Initially, there were babies of US and UK citizens born in Ukraine, followed by several neonatal transfers or personal admissions of Ukrainian newborns from the border zone brought personally by parents.

Our triage center has different scenarios comprising both stabilization and subsequent transfer to different Polish neonatal/pediatric centers and diagnostic and treatment approaches on site.

Requests regarding medical transfers of premature babies were formulated predominantly by aid organizations, governmental or family activities, and not specifically by medical referrals.

Recently we have received several inquiries about the possibility of admission of newborns/small infants with chronic and/or rare genetic problems. Until now, the utility of the database created for the quick electronic exchange of medical data regarding the transfer of newborns from Ukraine to Poland seems suboptimal as there was perhaps no need for such transfers on a larger scale.

Further information can be found on the Foundation website: Source:https://www.koalicjadlawczesniaka.pl/aktualnosci/

Serbia to Use Cash to Boost Birth Rate, Avert Population Decline

By Misha Savic  November 24, 2021

Serbia will triple a cash incentive to parents for their first-born child and prop up support for bigger families to fight a crippling demographic decline, President Aleksandar Vucic said.

“We’re vanishing as a nation,” the Balkan country’s leader told reporters on Wednesday as he announced tripling the one-time incentive for mothers for their first child to 300,000 dinar ($2,862) as of January. Serbia will also increase its existing cash and other support to families to have and raise more children, he said.

The plan comes as Vucic, whose party and allies control an absolute majority in Serbia’s parliament, is gearing up for general elections expected in the spring. Mainstream opposition parties boycotted a previous ballot in 2020 but are likely to challenge Vucic’s dominance in the race that will also include his job.

The average monthly net wage equals $616 in the nation of 6.9 million. The population is falling by around 30,000 a year amid a low birth rate and emigration. The median age is almost 43 years, among the highest in Europe. 

Serbia’s current birth rate of 1.5 needs to go up to at least 2.15 just to maintain the current population size, Vucic said.

Additional steps will help young people to stay in colleges and universities even if they become parents while studying, he said. The government is weighing giving grants to young couples of as much as $22,000 to help them buy their first home and start a family, he said.

“We’re getting older and older, and our economic progress will depend on how we ensure the nation’s progress with the demographic measures,” Vucic said. 

Source:https://www.bloomberg.com/news/articles/2021-11-24/serbia-to-use-cash-to-boost-birth-rate-avert-population-decline

Ukraine crisis: Premature babies born into war as deliveries forced to take place in hospital basement

I’m incredibly sad,’ doctor says, ‘babies are going to die because they cannot live in these conditions’

As women are forced to give birth in the basements of hospitals in war-torn Ukraine, health officials have raised fears that not all newborn babies can survive in such conditions.

Devastating images coming out of the Eastern European nation show the makeshift wards being used after medical staff work tirelessly to convert basements of maternity hospitals – all the while, using them as bomb shelters.

Most at risk are premature babies, who require special medical attention in their first few days, weeks or even months of life.

More than 1,000 babies are born in Ukraine per day, according to data from research platform Macrotrends. Of those, around 100 will need some form of neonatal intensive care.

Footage from one perinatal care unit in Kyiv, published by ITV News, showed parents and their

At one point, a man is filmed attending to a tiny baby in an incubator.

The machine beeps momentarily as he reaches for some medical equipment, then the clip cuts to night time where nurses and parents can be seen sat underneath what looks like the building’s water or gas pipes.

Speaking to the broadcaster, Dr Olena Kostiuk, a neonatologist associate professor in Ukraine’s capital city, described how the basement unit was set up in just a few days.

“It’s usually a technical room for water, for electricity and heating… never, never, ever is this space used in this way,” she said. “Very sick babies, babies which we cannot move… they permanently live in the basement.”

Pregnant women and newborn babies in the basement of a maternity hospital converted into a medical ward, and used as a bomb shelter during air raid alerts in Kyiv.

Clearly frustrated, and upset, Dr Kostiuk said plainly that “babies are going to

“I’m incredibly sad,” she added, “for myself the biggest problem is, I don’t know when it’s going to finish and how long our pregnant women, our babies delivered in a basement, our babies have no normal support.”

Over in the city of Zhytomyr, as reported by The Independent earlier today, staff of the maternity ward at Pavlusenko hospital – all taking cover under Russian missile fire – helped a pregnant woman who had started giving birth on the floor of the bomb shelter after the shock of a nearby explosion sent her into labour.

Medical workers show a newborn baby to a woman who gave birth in a maternity hospital basement converted into a medical ward in Mariupol, Ukraine

It came after an airstrike in the city on Tuesday which struck a military base just 200 metres away from the hospital, seriously damaging multiple wards.

Among those worst hit was the maternity wing, where 45 women and 15 newborn babies were being cared for at the time. All were subsequently evacuated to the basement, where they remain.

The Russian strike on Zhytomyr, in Ukraine’s northwest, also hit a residential area and killed at least two people, emergency services said afterwards.

Dr Cora Doherty, a neonatologist speaking on behalf of the British Association of Perinatal Medicine (BAPM), said she had seen the footage from Kyiv’s perinatal centre and was concerned the babies’ care was being compromised.

“We know that if babies do not get the proper care around the time at birth, that particularly if they’re ill, there is an increased risk of death in those babies,” she told ITV News.

And she added: “That’s essentially the, you know, the future denigrate generation there. So, it is really, really important that we support both these mothers and their babies in their plight.”

Four “loud explosions” were heard in the centre of Kyiv late on Wednesday night, with the Kyiv Independent taking to Twitter to advise its readers to take cover in their “nearest shelter” at around

It came as Russian troops appeared to take “complete control” of Kherson, the first major city to be captured during Vladimir Putin’s war.

Igor Kolykhayev, Kherson’s mayor, said in a Facebook post on Wednesday that the Black Sea port had been lost.

He urged the Kremlin’s soldiers not to shoot at civilians and publicly called on Ukrainians to walk through the streets only in daylight and with no more than one other person.

Cars will only be allowed to enter the city to bring food and medicine and other essentials. They must drive at minimum speed and be prepared to stop to be searched by Russian troops, he said.

Mr Kolykhayev added: “Ukrainian flag above us. And to keep it the same, these requirements must be met. I have nothing else to offer yet.”

Source:https://www.independent.co.uk/news/world/europe/ukraine-premature-babies-hospital-basement-b2027609.html

ALEKSANDRA MLADENOVIC X NENAD MANOJLOVIC – TI MENI, JA TEBI

Oct 21, 2021      IDJVideos.TV

Official music video for “Ti Meni, Ja Tebi” by Aleksandra Mladenović and Nenad Manojlovi

HEALTH CARE PARTNERS

SHEA NICU White Paper Series: Practical approaches for the prevention of central line-associated bloodstream infections\

Pediatrics AUTHOR: SHEA PUBLISHED:MARCH 4, 2022 CURRENT – CLABSI, Clinical Practice, Guidelines, Immunocompromised Patients, Infection Prevention

ABSTRACT:

This document is part of the “SHEA neonatal intensive care unit (NICU) white paper series.” It is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about CLABSI detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Infections in Neonatal Intensive Care Unit Patients. Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality. Infants who survive CLABSIs have prolonged hospitalization resulting in increased healthcare costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates, but challenges remain. This document was authored by pediatric infectious diseases specialists, neonatologists, advanced practice nurse practitioners, infection preventionists, members of the HICPAC guideline-writing panel, and members of the SHEA Pediatric Leadership Council. For the selected topic areas, the authors provide practical approaches in question-and-answer format, with answers based on consensus expert opinion within the context of the literature search conducted for the companion HICPAC document and supplemented by other published information retrieved by the authors. Two documents in the series precede this one: “Practical approaches to Clostridioides difficile prevention” published in August 2018 and “Practical approaches to Staphylococcus aureus prevention,” published in September 2020.

Source:https://www.healio.com/news/primary-care/20220318/shea-publishes-white-paper-on-clabsis-in-nicu

American Nurse Journal/Cedars-Sinai Hospital: Fostering nurse-physician collaboration

February 1, 2022

Author(s): Sarah Low, MSN, RN, OCN, CMSRN; Emily Gray, MSN, RN-BC; Amanda Ewing, MD, FACP; Patricia Hain, MSN, RN-BC, NE-BC, FACHE; and Linda Kim, PhD, MSN, RN, PHN, CPHQ

>>>>>>>>>>>>>>><<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<

Eat, Sleep, Console Approach

A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome

Grisham, Lisa M. NNP-BC; Stephen, Meryl M. CCRN; Coykendall, Mary R. RNC-NIC; Kane, Maureen F. NNP-BC; Maurer, Jocelyn A. RNC-NIC; Bader, Mohammed Y. MD

Advances in Neonatal Care: April 2019 – Volume 19 – Issue 2 – p 138-144

doi: 10.1097/ANC.0000000000000581

Abstract:

Background: 

The opioid epidemic in the United States has resulted in an increased number of drug-exposed infants who are at risk for developing neonatal abstinence syndrome (NAS). Historically, these infants have been treated with the introduction and slow weaning of pharmaceuticals. Recently, a new model called Eat, Sleep, Console (ESC) has been developed that focuses on the comfort and care of these infants by maximizing nonpharmacologic methods, increasing family involvement in the treatment of their infant, and prn or “as needed” use of morphine.

Purpose: 

The purpose of this evidenced-based practice brief was to summarize and critically review emerging research on the ESC method of managing NAS and develop a recommendation for implementing an ESC model.

Methods: 

A literature review was conducted using PubMed, Cochrane, and Google Scholar with a focus on ESC programs developed for treating infants with NAS.

Finding/Results: 

Several studies were found with successful development and implementation of the ESC model. Studies supported the use of ESC to decrease length of stay, exposure to pharmacologic agents, and overall cost of treatment.

Video Abstract Available at:

PREEMIE FAMILY PARTNERS

HAPPY MOTHERS DAY VIDEO

Acknowledging and Supporting NICU Moms this Mother’s Day

Leah Sodowick, B.A., Pamela A. Geller, Ph.D., Chavis A. Patterson, Ph.D.

Each year on the second Sunday in May, people across the United States and around the globe honor and celebrate mothers (Our use of the term “mothers” includes anyone who identifies as a mother, grandmother, gestational parent, or caregiver.) on Mother’s Day. This holiday is full of joy, celebration, pride, and gratitude for many. There may be hugs, handmade and store-bought cards, photos posted and shared on social media, breakfast in bed, family gatherings, flower bouquets, and tokens of appreciation. Mother’s Day can be challenging and emotionally fraught for some, including mothers with an infant hospitalized in a neonatal intensive care unit (NICU). With the help of NICU staff and providers, mothers can anticipate and cope with the challenges and emotions that they may experience this Mother’s Day, on May 8th. This article will discuss the emotions and challenges NICU mothers may experience on the holiday and suggest ways to acknowledge, support, and celebrate NICU mothers and caregivers.

Parents in the NICU may grieve the loss of anticipated postpartum plans and experiences, such as caring for and bonding with their baby at home. Mothers in the NICU may also grieve the loss of expected holiday events and experiences (1). Grief is one of the many normal and common reactions NICU parents may have. On Mother’s Day and the days surrounding this holiday, mothers in the NICU may feel disappointed, disheartened, and sorrowful if their expectations, visions, and anticipations for Mother’s Day do not match their current reality—one that is often characterized by long hours at their baby’s bedside and concern and worry about their baby’s health and survival. Current realities may also involve difficult decision making about treatment options and endof-life care. NICU parents may be juggling multiple responsibilities, such as caring for older children and work. Parents may also experience physical separation from their baby when the gestational parent is recovering from childbirth, the baby is in an isolette, the baby is undergoing a surgical procedure, or when parents leave the hospital to go home or to their temporary residence. Furthermore, by spending time in the NICU, mothers may miss traditional family gatherings and their usual Mother’s Day celebrations (1). Not being present for these events may exacerbate feelings of isolation as many families begin to reunite after separations due to COVID-19 restrictions.

Some mothers in the NICU may have difficulty or delays in forming their maternal identity due to limited opportunities for caregiving and interacting with their infant, shared caregiving responsibilities with NICU staff providers, disrupted mother-infant bonding, perceived lack of control, and increased psychological distress (2–5). Difficulty or delays in forming maternal and parental identity are part of an array of normal reactions and experiences that a parent may have. In a qualitative examination of NICU mothers’ perceptions of the development of their maternal role in the context of NICU, the thematic analysis revealed that some respondents characterized themselves as mothers only while they were in the NICU; they reported not feeling like mothers when they left the hospital because they were not with their babies or serving as a primary caretaker (3). Researchers have found that mothers’ perceived loss of parental role was one of the most stressful aspects of their infant’s NICU hospitalization (6,7)predictors, and child outcomes associated with NICU-related stress for mothers of infants born very preterm (VPT. For mothers in the NICU who have not yet fully developed their maternal identity or perceive a loss of their parental role, Mother’s Day may feel conflicting and isolating. Of note, mothers in the NICU who have experienced neonatal losses or are anticipating and planning for neonatal loss may experience an intensification of grief and have particularly difficult emotional experiences on Mother’s Day.

We encourage NICU staff and providers to thoughtfully acknowledge and celebrate mothers and caregivers in the NICU this Mother’s Day. Listed below are some suggestions:

Acknowledge Mother’s Day Staff and providers can communicate their acknowledgment of Mother’s Day, even when it may not be a “happy” Mother’s Day for mothers and other caregivers in the NICU. If this is the case, instead of wishing mothers a “happy” Mother’s Day, one can express, “I am thinking about you today on Mother’s Day.”

Validate and reflect emotions – NICU staff and providers can help mothers and caregivers cope with emotions that may arise during this holiday by validating and reflecting on mothers’ expressed feelings. Offering opportunities for parents to share their feelings by asking open-ended questions about how they are feeling and allowing time to listen to the responses can be very empowering for parents. Responding with statements that validate their experience also can be very helpful. For example, one could respond to a mother who expresses grief about the loss of expected Mother’s Day experiences by stating, “it makes sense why you would feel especially sad and disappointed today.”

Provide opportunities for caretaking – If possible, NICU staff and providers can find ways for parents to interact with their babies more on Mother’s Day. For example, mothers could be encouraged to take on a meaningful hands-on caretaking task, like feeding or bathing their baby or changing a diaper. Mothers also can be encouraged to engage in skin-to-skin care.

Encourage mothers to communicate with their babies – On Mother’s Day, NICU mothers can communicate and bond with their babies by reading them a book, story, or poem. Mothers could write and share a personal letter to their babies about their love, their family, and what it means to be their mother. Mothers may also wish to sing to their babies.

Praise mothers’ efforts to care for their babies – On Mother’s Day (and regularly), NICU staff and providers are encouraged to acknowledge and praise mothers’ efforts to care for their babies in the NICU. A simple phrase like “you are doing a great job” can be meaningful and impactful to mothers who may be lacking confidence and feeling uncertain about their maternal role.

 Encourage mothers to attend parent support groups – NICU staff and providers can encourage mothers to attend parent support groups on Mother’s Day. Peer sharing of positive and negative maternal experiences in NICU support groups can strengthen social relationships and networks, provide therapeutic benefits, foster feelings of safety and comfort, and encourage parent advocacy (3,9). On Mother’s Day, NICU parent support groups can feature topics related to Mother’s Day. Mother’s Day themed activities, such as scrapbooking, crafting, and even expressive writing or journaling that allow for both positive and adverse feelings can also be incorporated.

Create cards or keepsake gifts for mothers – There are several ways Mother’s Day can be celebrated in the NICU. One way to celebrate the holiday is for NICU staff to take a photo of each baby or each mother with their baby and put it inside of a card that can be placed by the baby’s bedside. Staff may also wish to create small keepsake gifts for mothers. At Denver Health Medical Center, NICU nurses make keychains to give to each mother (8). Each keychain contains a photo of the mom with their baby. Provide scent cloths for mothers Small pieces of soft fabric with the baby’s and the mother’s familiar scent can bring comfort to mothers and babies and help facilitate bonding. The cloth can be placed in the baby’s be against the mother’s skin to absorb scent and then exchanged. The scent cloths can even be shaped like hearts.

 Enlist volunteer assistance from past NICU graduate families – Staff and providers can consider enlisting volunteer assistance from past graduate families of the NICU to help support and celebrate mothers in the NICU on Mother’s Day (1). Former NICU mothers and caregivers with first-hand lived experience and expertise could write cards with encouraging and supportive messages to current NICU mothers and assist with running parent activity groups. It is important to remember that each mother in the NICU will experience Mother’s Day differently, and some families may not be open to celebrating or participating in Mother’s Day activities.

As a final note, we would like to acknowledge NICU staff, providers, and readers this Mother’s Day. We recognize those who are mothers, grandmothers, and caregivers. We recognize those who have or have had infants hospitalized in the NICU. We recognize those who have lost children and those who have lost mothers. We recognize those with strained relationships with their mothers, those with strained relationships with their children, those who have chosen not to be mothers, and those who are yearning to be mothers. We honor you all and wish you a peaceful Mother’s Day.

Source:http://neonatologytoday.net/newsletters/nt-apr22.pdf

Timely examination can save premature babies from permanent blindness

By Muhammad Qasim     April 20, 2022

Rawalpindi : Over eighty-five per cent of premature babies who weigh less than 1.5 kilograms at the time of birth have a high risk of developing the disorganised growth of retinal blood vessels, which can cause vision problems including permanent blindness.

Babies born prematurely, before 266 days, have many obstacles to overcome in their first fragile weeks, one of which is eye development that can be resolved through screening and surgical procedures to help avoid serious eyesight problems like vision impairment and blindness.

Chief Consultant and Head of Retina Department at Al-Shifa Eye Hospital Dr Nadeem Qureshi said this while talking to the media persons. He said that the blood vessels of the retina develop three months after conception and complete their growth at the time of normal delivery. If an infant is born prematurely, eye development can be disrupted, as the smaller a baby is at birth, the more likely that baby is to develop difficulties, he said.

Using excess oxygen to treat premature babies in the hospitals stimulates abnormal vessel growth in the eyes, with the smallest and sickest having the highest risk of devastating effects of Retinopathy of Prematurity (ROP), he said.

He added that studies have shown that keeping the oxygen saturation at a lower level from birth can reduce the rate of advanced ROP, a blinding eye disorder.

All parents must include a vision screening in their list of baby check-ups between six and twelve months of age as every premature infant deserves the constant attention of an ophthalmologist because of his or her increased risk for eye misalignment, amblyopia, and the need for glasses to develop normal vision.

Dr Qureshi said that Al-Shifa Eye hospital has already signed MoUs with Fauji Foundation Hospital, Combined Military Hospital, and Benazir Bhutto Hospital to treat newborns with vision complications.

Al-Shifa Eye Hospital is the only facility in the SAARC region and among few in the world having the latest equipment and excellent skills to treat newborns having vision complications, he claimed. So far, the trust has treated around 6000 infants in the last seven years and the number is bound to increase as the awareness grows, he said.

He added that we are here to provide free guidance to all the state-owned and private healthcare facilities, including those in other countries, to help save thousands from plunging into darkness for life. The Retina Department of Al-Shifa Hospital has 12 surgeons, assisted by trainees, and it performs Retinal OPD, lasers, injections and surgery every day of the week, said Dr Qureshi.

Average OPD at the Retina Department is 215 patients per day, average lasers are 35 per day, average injections are 50 per day and on average 25 surgeries are conducted daily, he added. A retinal surgery costs around Rs95 thousand, but 75 per cent of patients are treated free of cost, he said.

Source:Timely examination can save premature babies from permanent blindness (thenews.com.pk)

UCSF NICU-How To Do A Swaddled Bath

(Spanish subtitles)

197,922 views   Nov 28, 2018

UCSF Benioff Children’s Hospital Oakland

Watch the dramatic moment a preemie leaves his tubes behind and starts a new life (VIDEO)

Aleteia

Paola Belletti – published on 09/14/17aa

Ward Miles Miller’s scary and moving first year of life was captured by his father.

Ward Miles Miller was born on July 20, 2012 — three months early. Fear and anxiety initially overshadowed (but didn’t suffocate) his parents’ joy and hope. The story of Ward’s first year of life is a beautiful, moving, and dramatic one, as told through the video and photos taken by his father Benjamin.

Little Ward received all the medical support possible and necessary until he was able to go home safely; he spent 107 days in the hospital, most of them in an incubator. His mom and dad, Lindsay and Benjamin Scott, are devoted and loving parents who fought for Ward and celebrated every ounce he gained as a milestone.

Today, Ward is navigating the stormy waters of life in a vessel that is stronger and more stable every day.

INNOVATIONS

Association of Abnormal Findings on Neonatal Cranial Ultrasound With Neurobehavior at Neonatal Intensive Care Unit Discharge in Infants Born Before 30 Weeks’ Gestation

JAMA Netw Open. 2022;5(4):e226561. doi:10.1001/jamanetworkopen.2022.6561

Original Investigation –  Pediatrics April 8, 2022

Key Points

Question  What is the association between neonatal cranial ultrasound findings and neurobehavioral examination at term-adjusted age?

Findings  In this cohort study of 675 infants born before 30 weeks’ gestation, abnormal findings on cranial ultrasound were associated with decreased tone, poor regulation of attention, and movement outcomes as the infants matured to term-adjusted age.

Meaning  Among very preterm infants, abnormal findings on cranial ultrasound identifiable in the first 14 postnatal days were associated with neurobehavior outcomes at or near term-equivalent age and could be used to help counsel and educate parents as well as inform treatment strategies for therapy service in the neonatal intensive care unit and after discharge.

Abstract

Importance  Cranial ultrasound (CUS) findings are routinely used to identify preterm infants at risk for impaired neurodevelopment, and neurobehavioral examinations provide information about early brain function. The associations of abnormal findings on early and late CUS with neurobehavior at neonatal intensive care unit (NICU) discharge have not been reported.

Objective  To examine the associations between early and late CUS findings and infant neurobehavior at NICU discharge.

Design, Setting, and Participants  This prospective cohort study included infants enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study between April 2014 and June 2016. Infants born before 30 weeks’ gestational age were included. Exclusion criteria were maternal age younger than 18 years, maternal cognitive impairment, maternal inability to read or speak English or Spanish, maternal death, and major congenital anomalies. Overall, 704 infants were enrolled. The study was conducted at 9 university-affiliated NICUs in Providence, Rhode Island; Grand Rapids, Michigan; Kansas City, Missouri; Honolulu, Hawaii; Winston-Salem, North Carolina; and Torrance and Long Beach, California. Data were analyzed from September 2019 to September 2021.

Exposures  Early CUS was performed at 3 to 14 days after birth and late CUS at 36 weeks’ postmenstrual age or NICU discharge. Abnormal findings were identified by consensus of standardized radiologists’ readings.

Main Outcomes and Measures  Neurobehavioral examination was performed using the NICU Network Neurobehavioral Scale (NNNS).

Results  Among the 704 infants enrolled, 675 had both CUS and NNNS data (135 [20.0%] Black; 368 [54.5%] minority race or ethnicity; 339 [50.2%] White; 376 [55.7%] male; mean [SD] postmenstrual age, 27.0 [1.9] weeks). After covariate adjustment, lower attention (adjusted mean difference, −0.346; 95% CI, −0.609 to −0.083), hypotonicity (mean difference, 0.358; 95% CI, 0.055 to 0.662), and poorer quality of movement (mean difference, −0.344; 95% CI, −0.572 to −0.116) were observed in infants with white matter damage (WMD). Lower attention (mean difference, −0.233; 95% CI, −0.423 to −0.044) and hypotonicity (mean difference, 0.240; 95% CI, 0.014 to 0.465) were observed in infants with early CUS lesions.

Conclusions and Relevance  In this cohort study of preterm infants, certain early CUS lesions were associated with hypotonicity and lower attention around term-equivalent age. WMD was associated with poor attention, hypotonicity, and poor quality of movement. Infants with these CUS lesions might benefit from targeted interventions to improve neurobehavioral outcomes during their NICU hospitalization.

Full Article:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790902

Can a new effort end ‘equipment graveyards’ at neonatal ICUs?

By Catherine Cheney /09 September 2021

Just outside of San Francisco, product engineers at a manufacturer and supplier of health technologies are hard at work on devices to save newborn lives in settings far different from this bayside facility.

The 3rd Stone Design warehouse features a display of lifesaving technologies for newborns, including a continuous positive airway pressure — or CPAP — machine that the team helped develop.

The company is part of a global coalition of organizations working to get such devices to babies in low-income countries, where they confront inequity from the moment they’re born. The coalition is called Newborn Essential Solutions and Technologies, or NEST360, and it targets neonatal intensive care units.

Infants born in sub-Saharan Africa or Southern Asia are 10 times more likely to die during the first month of life compared with those born in high-income countries, due in part to a lack of access to medical devices. About 75% of babies born prematurely can be saved with the right medical care.

“People who come up with product ideas are not the same people who figure out how to sell something, and the people who figure out how to sell it are not the same people who figure out how to service it.”

But when health facilities end up with devices that are not designed with their constraints in mind — or when staffers lack training in using these tools and there are no plans to fix products when they break — potentially lifesaving technologies can end up in what are often called medical equipment graveyards.

NEST360, which aims to reduce newborn mortality in sub-Saharan African hospitals by 50%, is trying to change that. It’s taking what it describes as a “holistic approach” to neonatal care — distributing newborn health technologies, educating clinicians and technicians on how to maintain these tools, and supporting local innovators to build the technologies that work best for their contexts.

The coalition launched in 2019, with an initial focus on Malawi, Kenya, Tanzania, and Nigeria. From the beginning, NEST360 has said there is a need for not just low-cost technology but high-quality distribution. With assistance from 3rd Stone Design, which helped develop a new nonprofit called Hatch Technologies, NEST360 may have found the end-to-end solution for distribution that it sought.

Hatch provides distribution and support services for devices designed for newborn care units in sub-Saharan Africa. And partners involved in NEST360 say they hope it can serve as a model for ensuring medical equipment reaches low birth weight and premature babies in time to save their lives.

Steve Adudans, Kenya country director at the Rice360 Institute for Global Health Technologies — which is also part of the NEST360 partnership — has seen many examples of donated medical devices piling up instead of being used in neonatal ICUs.

“We need to bury the medical equipment graveyards,” he said during an online webinar on innovations in newborn health in Africa organized by The Elma Philanthropies, one of NEST360’s funders. “That’s what NEST is about.”

The NEST360 bundle of technologies includes 18 medical devices focused on areas including temperature stability, respiratory support, and neonatal jaundice treatment. Each of them meets target product profiles for newborn care in low-resource settings developed by NEST360 in partnership with UNICEF.

Many of the NEST360 technologies that meet these operational and performance characteristics were developed by innovators focused on low-resource settings, where it is often impossible to repair products made by corporations that impose restrictive warranties, lock their software, and limit access to spare parts.

But these devices cannot fulfill their vital potential when they are introduced into a broken system, Adudans said.

NEST360 needed a solution to get products from manufacturers to distributors to facilities in the countries where it works. That’s where Hatch Technologies comes in.

Often, nations with the highest rates of neonatal mortality receive donated equipment that fails when placed in environments with unreliable electricity, temperature variation, and too much dust and dirt.

Bottom of Form

But even when countries can procure medical supplies, they often don’t know which devices would work best for their settings. So they end up with cheap devices that break because they are poor quality or high-end ones that never get fixed because maintenance is too expensive, said Dick Oranja, CEO at Hatch Technologies.

Based in Nairobi, Kenya, Hatch Technologies launched in March 2020 with a mission to transform the way newborn care devices are distributed, supported, and used in Africa. To date, Hatch has helped NEST360 distribute almost 2,000 pieces of equipment reporting over 95% functionality, meaning they are working as they should. It is starting with support from the same backers as NEST360 but is an independent nonprofit that could continue to seek support elsewhere.

Hatch uses asset tracking — with a bar code-type sticker on each of its products — to follow each shipment from the initial logistics and warehousing to shipment and ultimately the use of the device.

“Distributors will mention they provide a level of service. They have to assure their customers. But the truth of the matter is distributors do not offer targeted service,” Oranja said. “We measure customer service parameters a routine medical equipment manufacturer will not measure.”

Beyond delivering medical devices, Hatch installs the equipment, trains staffers, and stops by to see how the technology is working, based in part on its measure of the functional status of the equipment — meaning whether it is being used as intended or at all.

A number of supply chain bottlenecks prevent newborn health products from reaching babies in low-income countries during critical moments of life and death.

“People who come up with product ideas are not the same people who figure out how to sell something, and the people who figure out how to sell it are not the same people who figure out how to service it and support it,” Robert Miros, CEO at 3rd Stone Design, told Devex.

That reality is part of what led 3rd Stone Design to work with partners to develop Hatch Technologies.

NEST360’s expanded model, which includes Hatch, reflects a growing understanding that no matter how innovative medical devices are, they are only one part of the solution to saving newborn lives. The other crucial piece is distribution.

Hatch Technologies began after Miros and his colleagues formed a task team to brainstorm the effort together with other NEST360 partners and funders. They drew on the expertise of 3rd Stone Design’s Danica Kumara, a director of product management who formerly worked on medical device efforts in Southeast Asia, and Vikas Meka, a senior product manager who was formerly a senior adviser on global health innovation at the U.S. Agency for International Development.

Now that NEST360 has launched in four African countries, it intends to demonstrate a path to scale across the continent, said Rebecca Richards-Kortum, director at the Rice360 Institute for Global Health Technologies, during the webinar.

But what turned the tide on newborn survival in the United States and the United Kingdom was a network of neonatal ICUs — “a regional system with people and products that are ready to help babies,” she said.

So as NEST360 partners with Hatch Technologies to bridge the gap from manufacturers to distributors and ensure that lifesaving medical devices can reach health care facilities, it is also calling for stronger hospital systems for newborn care.

Source:https://www.devex.com/news/can-a-new-effort-end-equipment-graveyards-at-neonatal-icus-99571

The transition to the artificial uterus should be as natural as possible. Photo: Bart van Overbeeke

Without gasping for air safely in the artificial womb

   APR 07, 2022

An artificial uterus significantly increases the chances of survival for extremely premature babies. That is why researchers at TU Eindhoven are doing a lot of research on this topic. One of the biggest challenges  is preventing the fetus from breathing oxygen just after birth, because that is harmful to the not yet mature alveoli. The solution? A wound spreader, coupling elements and a biobag filled with amniotic fluid.

The development of the artificial uterus has accelerated in recent years, not least because of the Perinatal Life Support partnership, which includes TU Eindhoven. According to Professor Frans van de Vosse (Professor of Cardiovascular Biomechanics within the Faculty of Biomedical Technology) and Guid Oei (Gynecologist and part-time Professor within the Faculty of Electrical Engineering), within ten years it should be possible to significantly increase the chances of survival and quality of life of extremely premature babies via a so-called incubator 2.0.

QUALITY OF LIFE

In the Netherlands alone, 700 children are born extremely prematurely each year – between 24 and 28 weeks. Almost half die, while a large proportion retain permanent health problems because organs have not yet matured. “Think of lung problems or brain damage,” clarifies Frank Delbressine (Assistant Professor of Industrial Design). “We want to increase both the life chances and the quality of life of newborn babies with an artificial uterus.”

Delbressine is the supervisor of PhD student Juliette van Haren. Together with a group of Industrial Design students, she is concerned with, among other things, the way in which childbirth should take place. One of the biggest challenges is to prevent the fetus from gasping for air just after birth (in this case by caesarean section). The birth procedure to the artificial uterus should be as natural as possible, which is why Van Haren is developing a safe way for the premature baby to be transferred from the natural uterus to the artificial uterus.

LUNG ALVEOLI NOT FULLY GROWN

“We want to prevent the fetus from breathing oxygen, because the alveoli are not yet mature and can be damaged. A 24-week-old baby belongs in an artificial amniotic fluid environment, and we’re trying to mimic that. The transition from the real uterus to the artificial one must occur in a way that the baby barely notices, both physically and mentally, that he or she is being taken to a different location,” explains Delbressine.

The principle works as follows: a so-called wound spreader holds open the wound created by the C-section, after which a biobag filled with artificial amniotic fluid is attached to the wound spreader via a connector. The baby can then be carefully transferred to the artificial uterus at the correct temperature via a glove in the biobag. 

Delbressine: “A filled biobag may sound crazy or disrespectful at first, but this is exactly how the fetus is ‘wrapped up’ in the womb as well, we are trying to imitate that as real as possible.”

The baby can be carefully transferred to the artificial uterus via the biobag at the correct temperature, through a glove.

CERTIFICATION

The system that Van Haren is currently developing consists of several components. Think, for example, of a mechanism that supports the doctor during transfer, as the combination of fetus and fluid can become quite heavy.

Of all these parts, the wound spreader is already in medical use and therefore clinically certified. The rest of the system is completely new and must go through a rigorous clinical approval process. Delbressine: “That’s logical, what we are doing is brand new. Pioneering. It will therefore be years before we can actually start using this system.”

The two are in close contact with the working field, such as specialists from the Máxima Medical Center in Eindhoven. Van Haren: “It’s a nice interaction, we get a lot of feedback from doctors. They have the medical knowledge, we know how to design systems.”

SENSES

There is a lot involved in developing the artificial uterus itself. Elements must be taken into account that you might not immediately think about at first. Delbressine: “At 24 weeks, the senses are still developing, and babies are sensitive to light, sound and vibrations. The impulses they receive in the natural womb we try to imitate in the artificial womb. The senses need to be stimulated, but in such a way that the brain can handle it. This is still work in progress”

There is still a lot of work to be done before the system can actually be used. We’re talking years. For Delbressine and Van Haren, no problem. Their driving force is in helping children. Van Haren: “Improving the lives of premature babies and increasing their chances of living a beautiful life, that’s what we ultimately do it for.”

COOPERATION

Perinatal Life Support is a larger partnership that conducts research into a ‘Perinatal Life Support’ system. Partners are TU/e, the universities of Aachen and Milan, and the companies LifeTec Group and Nemo Healthcare. In 2024 the European funding (from Horizon 2020) ends, then the prototype of the artificial uterus must be ready. After that, the preclinical and clinical tests and the certification process will start.

Source:https://www.tue.nl/en/news-and-events/news-overview/07-04-2022-without-gasping-for-air-safely-in-the-artificial-womb/?utm_source=miragenews&utm_medium=miragenews&utm_campaign=news

Nature: free, accessible, healing

Forest Bathing | Shinrin-Yoku | Healing in Nature | Short

Learn how to create healing experiences in nature for yourself and your loved ones. Visit the link for a course on Shinrin-yoku / Forest bathing. Learn calming nature meditations, forest bathing exercises, and mindfulness activities that reconnect us with nature and ourselves. Please share the forest calm and spread some healing.

City Dweller? You can do this!

SELF GUIDED FOREST BATHING/UNIVERSITY OF WASHINGTON BOTANICAL GARDENS

We’re Going On A NATURE HUNT

Nov 24, 2020    Stories For Kids

Come join in the adventure of a nature hunt. This book is written by Steve Metziger and illustrated by Niki Sakamoto. Thanks for listening!

Medical empirical research on forest bathing (Shinrin-yoku): a systematic review

Abstract

Aims

This study focused on the newest evidence of the relationship between forest environmental exposure and human health and assessed the health efficacy of forest bathing on the human body as well as the methodological quality of a single study, aiming to provide scientific guidance for interdisciplinary integration of forestry and medicine.

Method

Through PubMed, Embase, and Cochrane Library, 210 papers from January 1, 2015, to April 1, 2019, were retrieved, and the final 28 papers meeting the inclusion criteria were included in the study.

Result

The methodological quality of papers included in the study was assessed quantitatively with the Downs and Black checklist. The methodological quality of papers using randomized controlled trials is significantly higher than that of papers using non-randomized controlled trials (p < 0.05). Papers included in the study were analyzed qualitatively. The results demonstrated that forest bathing activities might have the following merits: remarkably improving cardiovascular function, hemodynamic indexes, neuroendocrine indexes, metabolic indexes, immunity and inflammatory indexes, antioxidant indexes, and electrophysiological indexes; significantly enhancing people’s emotional state, attitude, and feelings towards things, physical and psychological recovery, and adaptive behaviors; and obvious alleviation of anxiety and depression.

Conclusion

Forest bathing activities may significantly improve people’s physical and psychological health. In the future, medical empirical studies of forest bathing should reinforce basic studies and interdisciplinary exchange to enhance the methodological quality of papers while decreasing the risk of bias, thereby raising the grade of paper evidence.

Source:https://environhealthprevmed.biomedcentral.com/articles/10.1186/s12199-019-0822-8

Windsurfing Serbia Surduk 2020 50 kts

lunelun – Dec 8, 2020 un
Windsurfing in Serbia on Danube river. Wind 50 kts, sales 3.7-4,7 m2, boards 74-100l.


Provider Crisis, Nurse Needs, WHO

Costa Rica officially the Republic of Costa Rica is a country in Central America, bordered by Nicaragua to the north, the Caribbean Sea to the northeast, Panama to the southeast, the Pacific Ocean to the southwest, and maritime border with Ecuador to the south of Cocos Island. It has a population of around five million in a land area of 51,060 km2 (19,710 sq mi). An estimated 333,980 people live in the capital and largest city, San José, with around two million people in the surrounding metropolitan area.

The sovereign state is a unitary presidential constitutional republic. It is known for its long-standing and stable democracy, and for its highly educated workforce. The country spends roughly 6.9% of its budget (2016) on education, compared to a global average of 4.4%. Its economy, once heavily dependent on agriculture, has diversified to include sectors such as finance, corporate services for foreign companies, pharmaceuticals, and ecotourism. Many foreign manufacturing and services companies operate in Costa Rica’s Free Trade Zones (FTZ) where they benefit from investment and tax incentives.

Costa Rica provides universal health care to its citizens and permanent residents. Both the private and public health care systems in Costa Rica are continually being upgraded. Statistics from the World Health Organization (WHO) frequently place Costa Rica in the top country rankings in the world for long life expectancy. WHO’s 2000 survey ranked Costa Rica as having the 36th best health care system, placing it one spot above the United States at the time. In addition, the UN (United Nations) has ranked Costa Rica’s public health system within the top 20 worldwide and the number 1 in Latin America.

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

COMMUNITY

Our blog this month is focused on the Global Healthcare Workforce Shortage Crisis.

Kat and I would not be writing this blog were it not for the life-saving care she received by skilled healthcare providers at and after her birth. Each and every one of you who has experienced a preterm birth knows the value of care access. Our healthcare provider workforce deserves our attention and support.

The Global Healthcare Workforce Shortage Crisis pre-existed the Covid pandemic. The pandemic has severely impacted the shortage of healthcare providers and the further development of the healthcare workforce. The need for healthcare access has substantially increased due to provider shortages, delayed medical assessment and care, postponed access to “elective” surgeries, fear of seeking treatment due to Covid exposure risks, worsening of untreated conditions, and mental health barriers resulting from the stresses the pandemic has created in our lives. 

Preterm birth accounts for 11-12% of the global births at large and connected to our preemie  survivors is a much larger population of family members, healthcare providers, teachers, scientists, community members, employers and so on that also have a critical need for healthcare access. We are and will continue to be significantly impacted by our lack of access to healthcare provider care, and it is absolutely vital that all of us have access to healthcare services that are not limited to pharmaceutical options. We must protect, value, and build our healthcare workforce by making becoming a healthcare provider affordable, accessible, safe, humane, attractive, and available to all economic classes in order to build a healthy, vital, educated, effective and sustainable healthcare workforce that represents our populations at large.

Investing in our Healthcare Workforce is essential. Thank you for supporting our healthcare workforce in ways that are meaningful to you and impactful to our Preterm Birth Family.

Elsevier Health’s first “Clinician of the Future” global report reveals current pain points, predictions for the future and how the industry can come together to address gaps

New York, March 15, 2022

“There has never been a greater need for lifting the voices of healthcare professionals. The global study found 71% of doctors and 68% of nurses believe their jobs have changed considerably in the past 10 years, with many saying their jobs have gotten worse. One in three clinicians are considering leaving their current role by 2024, with as many as half of this group in some countries leaving healthcare entirely. This comes on top of the existing global healthcare workforce shortage, where clinicians continue to experience severe levels of fatigue and burnout since COVID-19 was declared a pandemic”.

Full Article : https://www.elsevier.com/about/press-releases/corporate/doctors-and-nurses-worldwide-point-to-roadmap-to-future-proof-healthcare

The Play’s the Thing for Nurses Coping with Pandemic’s Sting

— How the age-old themes of a Greek tragedy can spark new conversations

by Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today March 23, 2022

Last Thursday, Amy Smith, MS, APRN, took part in a virtual reading of Sophocles’ ancient Greek tragedy “Antigone.” But the production wasn’t ordinary theater.

Smith and more than 3,000 attendees sat in on a Zoom webinar of “The Nurse Antigone” as part of a new effort to help frame and spark discussions about the challenges faced by nurses, especially during the pandemic.

“Antigone” is a famed Greek tragedy for a reason. Its young titular heroine risks her life to stand up for what she believes is right, and the play focuses on her quest to properly bury and mourn her deceased brother. Many themes from the play resonate with nurses, especially today.

Smith, who acted in the performance as part of the chorus, said that she feels many nurses who took park in the inaugural event “saw in Antigone the kind of anguish that a lot of people felt when we were in the middle of the pandemic, especially in the hospital setting.”

Nurses were “unable to get past one horrible tragedy when the next person would code, or the next person would come in,” Smith said. It’s “this concept of delayed healing.”

After her own experience with the production, Smith, director of the Sexual Assault Nurse Examiner (SANE) Program at the Hofstra Northwell School of Nursing and Physician Assistant Studies, told MedPage Today that she believes many other nurses will want to take part.

The production was one of 12 that have been scheduled over the coming year. Though “The Nurse Antigone” features headliners such as author Margaret Atwood, and actresses Tracie Thoms and Taylor Schilling, in addition to a chorus comprised of working nurses, the performance itself is hardly the main event.

That’s according to Bryan Doerries, artistic director for Theater of War Productions, which for the past 14 years, has produced community-focused theater projects designed to address public health and social justice issues.

“The performance is the table dressing for the conversation that follows it,” Doerries told MedPage Today.

Some of the themes present in “Antigone” that resonate with the nurse workforce today include deferred grief, moral injury, structural violence and misogyny, as well as women speaking out and living up to standards of care, he said.

“Talking about these things requires energy, and sometimes nurses who are overworked don’t have the energy … the play provides the energy,” Doerries said.

The actors commit emotionally to the material, so that the nurses can then follow them, he explained.

Though each event is expected to be different and yield varying discussions due to the unique makeup and interpretation of each audience, the general format will remain the same, Doerries said.

The chorus of the play is performed by nurses, who are joined by a community panel, also comprised of nurses, after the reading to respond to what they heard that spoke to them, he said. There are then a series of questions posed to the audience and a discussion of themes important to nursing. The performance itself runs about 45 minutes, and the discussions that follow consist of about 15 minutes for the community panel and about 1 hour for the audience discussion.

“We’re not asking people to agree,” Doerries said. And “it’s not therapy, to be clear.”

“The point is that, once people have walked through the door of this project, the hope is that they may be open to walking through the other door to healing,” he said.

Cynda Rushton, PhD, RN, lead nursing advisor on the project, concurred.

“The use of the Greek tragedy, particularly ‘Antigone,’ seemed like a really important way to engage nurses to explore their experiences during the pandemic — and before the pandemic — and to create a space where we could really honor their challenges and sacrifices,” Rushton said.

Rushton, professor of clinical ethics at the Johns Hopkins Berman Institute of Bioethics and School of Nursing, said that, as a nurse herself, she “feels very committed to helping our profession heal.”

In addition to connecting nurses with each other, another goal of the production is to “invite the public to bear witness to the experiences of nurses,” Rushton said.

Theater of War Productions, the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and the Resilient Nurses Initiative – Maryland, have partnered to co-present “The Nurse Antigone.” The production is supported by the Laurie M. Tisch Illumination Fund, and the theater’s digital programming is provided, in part, by The Andrew W. Mellon Foundation.

All of “The Nurse Antigone” events are free and have unlimited capacity, Doerries said.

The next event is scheduled for April 21, and is being hosted by the Greater NYC Black Nurses Association.

“It’s not therapy, but it is therapeutic,” Smith said of “The Nurse Antigone.” “Certainly it was for me, and I hope other people felt that as well.”

Added benefits of the production include helping others to feel like they’re not alone in their experiences, and making difficult discussions easier to have, she noted.

“The reason that the themes keep recurring is because nobody talks about it,” Smith said.

Source:https://www.medpagetoday.com/special-reports/exclusives/97836

Preterm Birth and Low Birth Weight

Health at a Glance: Latin America and the Caribbean 2020 (Book)

Globally, preterm birth (i.e. birth before 37 completed weeks of gestation) is the leading cause of death in children under 5 years of age, responsible for approximately 1 million deaths in. In almost all countries with reliable data, preterm birth rates are increasing. Many survivors of preterm births also face a lifetime of disability, including learning disabilities and visual and hearing problems as well as long-term development (WHO, 2018).

In LAC, most countries are near the regional average of 9.5% of births being preterm. Colombia is the only country significantly above average with near 15% of preterm births, followed by Brazil with 11%. The lowest rates were observed in Cuba (6%) and Mexico (7%) Most LAC countries rates are lower than the global rate, but there are opportunities for further improvements through interventions such as a national focus on improved obstetric and neonatal care, and the systematic establishment of referral systems with higher capacity of neonatal care units and staff and equipment (Howson, Kinney and Lawn, 2012). On average, 10 new-borns out of 100 had low weight at birth across LAC countries. There are very significant differences between countries in the region, ranging from a low 5% in Cuba and 6% in Chile, to the highest rate of 23% in Haiti, followed by Guyana with 16%.

Low birth weight has decreased an average of 0.4 percentage points in LAC26 countries in the 2000-15 period, suggesting that, overall, the region still has room for improvement in regards to this indicator. Chile, Brazil, Venezuela and Costa Rica are the only LAC countries to have increased low birth weight new-borns, while the largest reduction happened in Surinam, Guatemala and Honduras with more than 1 percentage point of decrease between 2000 and 2015.

Antenatal care can help women prepare for delivery and understand warning signs during pregnancy and childbirth. Higher coverage of antenatal care is associated with higher birth weight in LAC countries, suggesting the significance of antenatal care over infant health status across countries . However, the correlation does not apply equally in all countries. For instance, Trinidad and Tobago and Barbados report to have 100% and 98% of at least four antenatal care visits, but their low birth weight prevalence is 12%, over the LAC average of 10%. This might be explained partly by a low quality of care in their antenatal care visits. On the other hand, countries like Grenada, Paraguay and Bolivia show an antenatal care coverage below the LAC24 average of 87%, but also a low birth weight prevalence of 7-9%. Some of the differences between countries can be attributed to cultural practices and preferences, such as different approaches to privacy or perceptions about what antenatal and postnatal care entail.

Preterm birth can be largely prevented. Effective interventions to reduce preterm births include smoking cessation, progesterone supplementation, cervical cerclage, preterm surveillance clinics and screening, diagnosis and preparation, corticosteroids, magnesium sulphate, and tocolysis (Osman, Manikam and Watters, 2018). Most of these exist in several LAC countries and could be further developed. In addition, three-quarters of deaths associated with preterm birth can be saved even without intensive care facilities. Current cost-effective interventions include kangaroo mother care (continuous skin-to-skin contact initiated within the first minute of birth), early initiation and exclusive breastfeeding (initiated within the first hour of birth) and basic care for infections and breathing difficulties (WHO, 2018), all of which can also be scaled up in LAC countries.

Source: https://www.oecd-ilibrary.org/sites/53620b68-en/index.html?itemId=/content/component/53620b68-en

COVID-19: Health workers face ‘dangerous neglect’, warn WHO, ILO

21 February 2022

Health teams worldwide need much safer working conditions to combat the “dangerous neglect” they have faced during the COVID-19 pandemic, the UN health and labour agencies said on Monday.

Approximately 115,500 health workers died from COVID-19 in the first 18 months of the pandemic, linked to a “systemic lack of safeguards”, they noted. 

In a joint call for action from the World Health Organization (WHO) and the International Labour Organization (ILO), the UN bodies insisted that the coronavirus crisis had contributed to “an additional heavy toll” on health workers. 

“Even before the COVID-19 pandemic, the health sector was among the most hazardous sectors to work in,” said WHO’s Maria Neira, Director, Department of Environment, Climate Change and Health. 

Physical injury and burnout 

“Only a few healthcare facilities had programmes in place for managing health and safety at work,” Dr. Neira continued. “Health workers suffered from infections, musculoskeletal disorders and injuries, workplace violence and harassment, burnout, and allergies from the poor working environment.”  

To address this, WHO and ILO have released new country guidelines for health centres at national and local levels. 

“Such programmes should cover all occupational hazards – infectious, ergonomic, physical, chemical, and psycho-social,” the agencies noted, adding that States that have either developed or are actively implementing occupational health and safety programmes in health settings had seen reductions in work-related injuries and absences due to sickness and improvements in the work environment, productivity and retention of health workers. 

Workers’ rights 

“Like all other workers, should enjoy their right to decent work, safe and healthy working environments and social protection for health care, sickness absence and occupational diseases and injuries,” insisted ILO’s Alette van Leur, Director, ILO Sectoral Policies Department. 

The development comes as the agencies indicated that more than one-in-three health facilities lack hygiene stations at the point of care, while fewer than one-in-six countries had a national policy in place for healthy and safe working environments within the health sector. 

“Sickness absence and exhaustion exacerbated pre-existing shortages of health workers and undermined the capacities of health systems to respond to the increased demand for care and prevention during the crisis,” said James Campbell, Director, WHO Health Workforce Department.  

“This guide provides recommendations on how to learn from this experience and better protect our health workers.” 

Source: https://news.un.org/en/story/2022/02/1112352

Debi Nova, Pedro Capó – Quédate (Official Video)

9,183,561 views

Premiered Nov 21, 2019                    Debi Nova

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When the Brain Sees a Familiar Face

Los Angeles, Mar 18, 2022

Cedars-Sinai Investigators Show How the Action of the Eye Triggers Brain Waves to Help Remember Socially Important Information.

In a study led by Cedars-Sinai, researchers have uncovered new information about how the area of the brain responsible for memory is triggered when the eyes come to rest on a face versus another object or image. Their findings, published in the peer-reviewed journal Science Advances, add to scientific understanding of how memory works, and to evidence supporting a future treatment target for memory disorders.

While vision feels continuous, people move their eyes from one distinct spot to another three to four times per second. In this study, investigators found that when the eyes land on a face, certain cells in the amygdala, a part of the brain that processes social information, react and trigger memory-making activity.

“You could easily argue that faces are one of the most important objects we look at,” said Ueli Rutishauser,  PhD, director of the Center for Neural Science and Medicine at Cedars-Sinai and senior author of the study. “We make a lot of highly significant decisions based on looking at faces, including whether we trust somebody, whether the other person is happy or angry, or whether we have seen this person before.”

To conduct their experiments, the investigators worked with 13 epilepsy patients who had electrodes implanted in their brains to help determine the focus of their seizures. The electrodes also allowed investigators to record the activity of individual neurons within the patients’ brains. While doing so, the researchers tracked the position of the subjects’ eyes using a camera to determine where on the screen they were looking.

The researchers also recorded the study participants’ theta wave activity. Theta waves, a distinct type of electrical brain wave, are created in the hippocampus and are key in processing information and forming memories.

Investigators first showed study participants groups of images that included human and primate faces and other objects, such as flowers, cars and geometric shapes. They next showed participants a series of images of human faces, some of which they had seen during the first activity and asked whether or not they remembered them.

The investigators found that each time participants’ eyes were about to land on a human face—but not on any other type of image—certain cells in the amygdala fired. And every time these “face cells” fired, the pattern of theta waves in the hippocampus reset or restarted.

“We think that this is a reflection of the amygdala preparing the hippocampus to receive new socially relevant information that will be important to remember,” said Rutishauser, the Board of Governors Chair in Neurosciences and a professor of Neurosurgery and Biomedical Sciences.

“Studies in primates have shown that theta waves restart or reset every time they make an eye movement,” said Juri Minxha, PhD, a postdoctoral scholar in neurosurgery at Cedars-Sinai and co-first author of the study. “In this study, we show that this also happens in humans, and that it is particularly strong when we look at faces of other humans.”

Importantly, the researchers showed that the more quickly a subject’s face cells fired when their eyes fixed on a face, the more likely the subject was to remember that face. When a subject’s face cells fired more slowly, the face they had fixed on was likely to be forgotten.

Subjects’ face cells also fired more slowly when they were shown faces they had seen before, suggesting those faces were already stored in memory and the hippocampus didn’t need to be prompted.

Rutishauser said these results suggest that people who struggle to remember faces could have a dysfunction in their amygdala, noting that this type of dysfunction has been implicated in disorders related to social cognition, such as autism.

“If theta waves in the brain are deficient, this process triggered by the amygdala in response to faces might not take place,” Rutishauser said. “So restoring theta waves could prove to be an effective treatment target.”

The study was funded by National Institute of Mental Health Grands number R01MH110831 and P50MH100023, National Science Foundation Grant number 1554105, National Institute of Neurological Disorders and Stroke Grant number U01NS117839, a Center for Neural Science and Medicine Fellowship and European Research Council Grant number 802681.

Source:https://www.cedars-sinai.org/newsroom/when-the-brain-sees-a-familiar-face/

PREEMIE FAMILY PARTNERS

On parenting preemies: Gratitude, fear and a lingering sense that nothing is in your control

By Anna Nordberg  March 9, 2020

My son was born at 8:15 a.m. on Halloween, a long, skinny four pounds and crying in great angry gulps. With a kindness I’ve never forgotten, the anesthesiologist leaned down and said to me, “A lot of full-term babies don’t even sound that loud.”

The doctors laid my baby on my chest in his footprint-patterned swaddle, and for a moment he stopped crying. Then he was whisked away to the neonatal intensive care unit and I didn’t see him for 30 hours.

That’s how my life as a parent started.

In the United States, 10 percent of babies, or more than 380,000 a year, are born premature, before 37 weeks of gestation. The majority will need time in the NICU, meaning parents are shut out from many of the rituals surrounding a birth. You don’t leave the hospital with your child. Grandparents and friends can’t hold your newborn.

Now that my son is 7 and my daughter is 5 (she was born 19 months later, also premature), I think about how much support our family received in those early weeks, but how little guidance there was about how the experience could impact us over time. I wonder if who I am as a mother was influenced by that early start.

I interviewed parents of preemies, and while each experience was different, there were many consistent themes. Here are some of their stories.

The delay of grief

More than a year after my son was born, one of my closest friends had a placenta abruption and delivered her son at 34 weeks. She called me while I was in the car, and I tried to be as calm and loving as possible. Afterward, though, I pulled over in a parking lot and starting sobbing. My hands were shaking.

I cried with a force I’d never felt when my own pregnancy was going off the rails and all my focus had been on my baby. Until that morning, I hadn’t realized that my son’s premature birth, which I’d filed away as a bumpy start to an otherwise normal parenting journey, had imprinted in my brain like a trauma.

Other mothers said it was not until they had a full-term child that they fully processed their grief. “I didn’t really have a sense of loss or understand what I had missed until I had my son,” says Ame McClune, whose twin girls were born at 24 weeks and required feeding tubes and full-time nursing care for several years. “With my twins, I took it in stride because it was all I knew. Now, here was a baby I could hold and breast-feed and cuddle. I loved it. I had no idea.”

Teira Gunlock, whose daughter Lake was born at 29 weeks when Gunlock developed severe preeclampsia, was diagnosed nine months later with PTSD. “While everything worked out, it was a traumatic experience,” says Gunlock, who for six days had not been able to see her baby. “It makes me emphasize my daughter’s emotional health and growth in my own parenting more than I likely would have.”

Taking setbacks in stride, supercharged gratitude

At some point in everyone’s parenting journey, things don’t go according to plan. But preemie parents get that message early.

“Nothing is a crushing blow,” McClune says. Instead, when there are challenges, she just thinks, “Okay, how do we deal with this?”

In my experience, it was freeing to step off the hamster wheel of worry over milestones, because my children weren’t going to hit any of them. Instead, the NICU distilled things: Are we healthy? Are we happy(ish)? Are we okay? Given the anxiety many parents have over their children’s accomplishments, that perspective can feel like a gift.

Preemie parents also occupy a strange space between intense thankfulness and the early recognition that things can go wrong. In the NICU, most parents understand that there are babies in more precarious positions that their own and are sensitive to that.

The experience also yields daily opportunities for gratitude — to the nurses and doctors caring for your child; to the progress your baby is making; to the much-anticipated car-seat day when you get to take your baby home.

“I think about how lucky we are that both my daughter and my wife survived, and that hits me hard sometimes,” says Michael Zimmer, Gunlock’s husband. “We benefited from scientific advances that stemmed from a lot of tragedy in the past. That provides perspective — our daughter, and my wife, frankly — have a chance at life they might not have had 50 or even 25 years ago.”

Danger ahead

If having a preemie makes you more resilient as a parent, it can also put you in a defensive crouch, waiting for the other shoe to drop.

When we brought my son home from the NICU after two weeks, my husband and I felt the normal terror of first-time parents with our own, special terror thrown in. He had been hooked up to monitors and cared for by professionals since he was born. Once he was home, though, he had to rely only on our loving, possibly incompetent care. That first night, my husband slept on the floor next to the bassinet while I feverishly pumped milk.

Gunlock and Zimmer spent the first year on high alert after their daughter had a choking episode in the NICU, and then again a few days after she came home.

Several parents told me that the strengths of the NICU — the care your baby receives; the nurses you learn from — can also feel like a weakness when you leave, because you think you will never measure up. That fades over time, outweighed by the support and confidence you built during those early weeks, but a tiny part of you always remains on alert.

Naming the sadness

All these years after my children were born, I still feel sad my body didn’t get them over the finish line. Not guilty, not angry, just sad. Is this normal? Is this weird? I don’t know.

I regret that I never got those final weeks of nesting, that I missed my baby shower, that I never felt a contraction. To many people, I’m sure that skipping labor twice makes me lucky. But it feels strange.

Stacey D. Stewart, chief executive of the March of Dimes, a nonprofit that works to improve maternal and infant health outcomes and supports more than 50,000 families a year who are in the NICU, says there needs to be more attention given to the impact the experience has on parents’ mental health.

“You’re pregnant and then one day you’re not, sooner than it was supposed to happen,” she says. “There’s a lot of anxiety and grief and helplessness and fear. It takes an immense emotional toll.”

It can also be very isolating. “I found it incredibly lonely,” says Kate Bosanquet, who had her daughter at 31 weeks. “I missed out on most of my prenatal classes, and while my group was very sweet and continued to meet, we weren’t having the same shared experiences you hope for.”

It doesn’t help that the entire baby industrial complex caters to parents of full-term babies. There’s the books and websites telling you your baby should be doing things months before she will. The carrier that requires your child to be a monstrous eight pounds. The email updates that continue to cheerfully inform you about the progress of your pregnancy when your baby is already out in the world. It can all hurt. One mother told me she wished there was a switch to turn off all the marketing and email that assumed she’d delivered full-term. (March of Dimes has a My NICU Baby app for parents of premature and full-term babies that started out in the NICU.)

And yet many of us hope and believe that these birth stories will become a source of strength for our children.

When my son was in kindergarten and it was his turn to be “Friend of the Week,” he shared that he weighed four pounds at birth, telling his class he “surprised us” seven weeks early. To him, it was an interesting fact and also, I think, a small source of pride.

It should be. Preemie babies, and their parents, have to come so far. I hope that every mom and dad who started out that way — confused, scared, fierce, loving — feels pride in their parenting. They’ve earned it.

Source: https://www.washingtonpost.com/lifestyle/2020/03/09/parenting-preemies-gratitude-fear-lingering-sense-that-nothing-is-your-control/

Determinants of mothers knowledge about breastfeeding in neonatology intensive care

A SyllaA SanaS NaniS HassouneM LehlimiA BadrS HajjajiM ChemsiA HabziS Benomar

European Journal of Public Health, Volume 31, Issue Supplement_3, October 2021, ckab165.285, https://doi.org/10.1093/eurpub/ckab165.285

20 October 2021

Abstract

Background

Breastfeeding (BF) is one of the most effective ways to ensure child health and survival. In Morocco the BF rate decreased from 51% to 27,8% between 1992 and 2011. The breast feeding rate in neonatal intensive care unit (NICU) is lower 12,4%. Studies showed if we improve the mothers knowledge, the BF practice rate increase in NICU. We aim to determine associated factors of mothers knowledge about BF in NICU of Ibn Rochd teaching hospital in Casablanca (Morocco).

Methods

A cross-sectional study was conducted between 04 January and 23 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan mothers who can practice the BF presents during the study period. We used face to face interview using questionnaire. A scoring system from 0 to 16 points was used to measure the knowledge. The student, ANOVA, Mann-Whitney-Wilcoxon, Kruskal Wallis, Pearson and spearman correlation tests were used to test association between BF and potential associated factors. Associated factors with p ≤ 0.05 were considered as determinants of BF. Data were analyzed using R 3.6.3.

Results

We included 111 mothers. The mean score of knowledge was 10.38 ± 2.31. Associated factors with BF knowledge were: healthcare staffs support (yes mean score =11.06 and no = 9.72; p = 0.002); getting prior information about BF (yes mean score =10.53 and no = 9; p = 0.012). The knowledge increase with age of mother (correlation coefficient = 0.26; p = 0.005) and parity (correlation coefficient = 0.30; P = 0.001).

Conclusions

Mothers and specifically younger primiparous should receive more attention from training program and healthcare staffs in NICU to improve the knowledge and practice of BF.

Key messages

  • we can enhance significantly the survival and health of newborn hospitalized in NICU by simple actions as advices, encouragement toward the newborn mothers to improve their knowledge about BF.
  • Healthcare staffs and facilities have to be the teachers and school about breast feeding.

Source:https://academic.oup.com/eurpub/article/31/Supplement_3/ckab165.285/6404982

Your Premature Baby’s Sense of Vision

Babies born preterm (before 37 weeks) are still developing their sense of vision.  Babies born before the age of 32 weeks are unable to limit the amount of light entering their eyes even when their eyes are closed.  It is therefore important to protect premature babies from bright lights.

Effects of Vision on your Baby

  • Babies born at term have a preference for looking at faces.  Older premature babies too can fixate on your face briefly if you are holding them closely (approximately 25-30cm or 10-12 inches from your face), as they are very near sighted at this stage.
  • Your baby is likely to have an incubator cover over their incubator whilst in intensive care.  This reduces their exposure to bright light and aims to recreate the conditions of the womb.  As your baby matures these incubator covers are pulled back.
  • It is important that you enjoy your baby.  Talk to them, smile, be expressive; your baby learns from watching your facial expressions.

Source: https://www.nhsggc.org.uk/kids/resources/health-a-z-resources/premature-baby-sense-of-vision/

March of Dimes/Signs of Preterm Labor

HEALTH CARE PARTNERS

Risks of Delays in Emergency Neonatal Blood Transfusions Highlighted in New Safety Report

Priscilla Lynch    March 04, 2022

New recommendations on emergency neonatal blood transfusions have been issued by the Healthcare Safety Investigation Branch (HSIB) following a number of serious adverse outcomes including brain injury and death following delays in such transfusions.

Concerns around emergency neonatal blood transfusions were highlighted in 22 of the HSIB’s maternity investigation programme reports between 2018 and 2021.

This latest HSIB national investigation explored issues influencing timely administration of blood transfusion to newborn babies following acute blood loss during labour and/or delivery. Delays in the administration of a blood transfusion in this scenario can result in brain injury caused by lack of oxygen to the baby’s brain.

Whilst it is rare, and there is a gap in data on incidences of neonatal blood transfusion delays, the impact can be significant. As a reference event, the HSIB investigation examined the experience of a couple, Alex and Robert, whose baby, Aria, was born by emergency caesarean section following an acute blood loss, and sadly died.

Specifically, the investigation examined communication between the different medical teams involved in the care of women/pregnant people and their babies during labour and birth; and national guidance for medical staff on when to consider the option of a blood transfusion for a newborn baby.

Findings

The HSIB’s investigation found that administration of a blood transfusion as part of resuscitation requires a number of preparatory steps, including collecting the blood and undertaking various checks before using it, which can cause delays in emergency situations. Inclusion in resuscitation training of a prompt for clinicians to consider the need for a transfusion, and to prepare for it if appropriate, may help reduce any delay, the HSIB said.

The investigation also found that involving members of neonatal teams in multidisciplinary training in maternity units is not routine. Standardising their inclusion in such training would promote a shared understanding of relevant clinical information and ways of working, the HSIB advised.

The HSIB’s final report made two key safety recommendations which focus on training between multidisciplinary maternity and neonatal teams, and through the Newborn Life Support training course.

  1. HSIB recommends that NHS Resolution, working with relevant specialities through the clinical advisory group, amends the maternity incentive scheme guidance for year five to include the neonatal team as one of the professions required to attend multi-professional training.
  • HSIB recommends that the Resuscitation Council (UK)’s Newborn Life Support training course highlights that neonatal resuscitation teams should consider fetal blood loss in the event of neonatal resuscitation that includes chest compressions. In addition, this consideration should be included in the guidance to support the newborn life support algorithm.

Investigator’s View

Commenting on the report’s findings, Melanie Ottewill, National Investigator at HSIB, said: “The need for blood transfusions during resuscitation is rare, but the impact of a delay can be devastating as we heard from Alex and Robert, Aria’s parents.

“Our report forms an important piece of literature in an area with limited research and can support any future work that explores safety issues relating to neonatal blood transfusions.

“The aim is that our safety recommendations can raise awareness of the issue and prompt clinicians to consider the option of a blood transfusion in the early stages of resuscitation.”

Previous Concerns

previous report by the HSIB identified a key safety risk in maternity care relating to delays to intrapartum intervention once foetal compromise is suspected.

The report was compiled by the HSIB after a review of 289 of its maternity investigations into intrapartum stillbirths, neonatal deaths and potential severe brain injuries, which found that in 14.9% of the cases the delay was a contributory factor.

Source: Risks of Delays in Emergency Neonatal Blood Transfusions Highlighted in New Safety Report (medscape.com)

Acknowledging Stigma and Embracing Empathy When Treating Neonatal Opioid Withdrawal Syndrome – Episode 106

03/15/2022

In this episode Kenneth Zoucha, MD, FAAP, a recognized leader in addiction medicine for the state of Nebraska, talks about the stigmas around substance use disorder and Neonatal Opioid Withdrawal Syndrome. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Tamela Milan-Alexander, MPPA, about her history with opioid use disorder, which led to a high-risk pregnancy, and her subsequent advocacy for mothers and their babies.

PEDIATRICS ON CALL Acknowledging Stigma and Embracing Empathy When Treating Neonatal Opioid Withdrawal Syndrome – Ep. 106

Source:https://www.aap.org/en/pages/podcast/acknowledging-stigma-and-embracing-empathy-when-treating-neonatal-opioid-withdrawal-syndrome/

Residency Is Broken. We’re Unionizing to Fix It.

More fair working conditions and pay are long overdue

by Dipavo Banerjee, DO, MS, and Pratiksha Yalakkishettar, MD – March 19, 2022

On its website, UMass Memorial Health states that the hospital system was created to “make health and healthcare available to everyone.” This mission is made possible by the “people of UMass Memorial Health” and their “relentless pursuit of healing in all its forms.”

As frontline resident physicians who work day in and day out to care for patients at UMass Memorial, this mission is also at the core of our values. That’s why we are bargaining for our first union contract: In order to ultimately improve residency for ourselves, those that come after us, and the people of central Massachusetts who need quality healthcare most. But unfortunately, since the bargaining process began this fall, the hospital system’s leaders have not been as responsive to our proposals as we would have hoped.

A Wave of Resident Physician Organizing

While the COVID-19 crisis dramatically exacerbated issues UMass residents face, our struggle to make ends meet and stay well during residency is nothing new. Before the pandemic, we came together and started the process of unionizing with the Committee of Interns and Residents (CIR/SEIU) to gain a voice at the table where we could better advocate for ourselves and our patients. When the pandemic struck, securing better conditions became even more urgent, as the inequities in our healthcare system were laid bare — and in light of the rapid changes that left residents scrambling to keep up within traumatizing and sometimes dangerous practice conditions.

UMass residents are not alone. In just the past few weeks, hundreds of frontline physicians at Stanford University Medical Center, the University of Vermont Medical Center, and the University of Southern California-Keck recently demanded union recognition with a supermajority of support — a landmark residents and fellows celebrated at UMass not too long ago. In labor organizing, this means over 65% of the bargaining unit voted to unionize, but so far, all of these employers have refused to voluntarily recognize their union. This refusal then forces workers to move to an arduous National Labor Relations Board (NLRB) election process, which can draw out for months and creates an array of complications. (Residents at nearby Greater Lawrence Family Health Center recently won their union through an NLRB election).

Importantly, establishing a union is only the first step. Next, the workers who are organizing must prepare to negotiate with management to approve a collective bargaining agreement, which is a contract between the workers and the organization or company that sets pay, benefits, and other conditions over a period of time. Although we have been organizing for years at UMass, our union protections won’t truly be secure until we sign our first contract.

At the Top of Our List of Demands

Among the most important demands in our contract negotiations with management is the pay we need to live and work in an area with an increasing cost of living. Currently, UMass resident physicians are barely making the state minimum wage when our hours are considered. But so far, UMass has denied residents the basic ask of a fair wage. Instead, they’ve made only a meager wage proposal that fails to keep pace with the cost of living in Worcester — where the main UMass Memorial campus is located — while continually refusing to acknowledge several of our proposals. However, this disregard is perhaps unsurprising given how undervalued resident physicians’ labor is nationwide, a fact reflected in everything from our pay and working conditions to the gaps in our labor protections and benefits.

During residency, many of us are working to establish ourselves in a new location, while in some cases starting families or bringing families with us. We must stretch our dollars to cover the cost of essentials, from rent to childcare to gas to groceries. According to RentData.org, the fair market rent for a two-bedroom apartment in Worcester was $1,450 per month in 2021, which is more expensive than 96% of areas the site calculates. At the same time, the average student loan debt for graduating physicians is almost a quarter of a million dollars.

It is disheartening, to say the least, that the hospital system has so far refused to give us what we need after all we’ve sacrificed during this global catastrophe. We have worked sometimes to the point of physical and emotional exhaustion while witnessing far too many patient deaths during multiple COVID-19 surges.

Working Conditions Impact Patient Care and Health Equity

This pandemic has made it clearer than ever that resident physician well-being and patient care are inseparable. UMass Memorial residents are willing to work 80 hours per week because we know exceptional care is critical to community well-being, but we are significantly underpaid for doing so. A meaningful pay increase and adequate health and leave benefits would mean that we would be able to better focus on caring for our patients without burning out or completely neglecting our families and our own well-being.

Fair pay and benefits for residents is also a matter of health equity. Currently, residency at UMass is unaffordable, which limits who can come work and train here. UMass Memorial cannot claim to care about the most vulnerable communities in Massachusetts while helping to entrench inequities during residency. Through our union, we hope to foster a more diverse body of residents within the historically oppressive systems of healthcare — starting with UMass.

Hospitals Must Respect Resident Physicians’ and Fellows’ Labor Power

The surge in resident physician and fellow organizing around the country shows it is long past time for hospitals like UMass Memorial Health to respect the labor power of residents — first by recognizing our unions and then by agreeing to contracts that reflect the importance of our work and patient well-being. Graduate medical education should not be a burden on would-be physicians. At UMass Memorial, we hope to ultimately make residency more sustainable financially and otherwise, so we can continue to provide the highest quality care to our communities without burning out.

We won’t stop fighting until UMass agrees to invest in its future physician workforce and to treat us with the respect and dignity we deserve. Our families can’t wait — and neither can the communities in Massachusetts who need quality healthcare the most.

Source: Residency Is Broken. We’re Unionizing to Fix It. | MedPage Today Residency Is Broken. We’re Unionizing to Fix It. | MedPage Today

Difficult Times Without Easy Solutions: Nurses Want to Be Heard!

Annette M. Bourgault, PhD, RN, CNL, FAAN Editorial February, 2022

Crit Care Nurse (2022) 42 (1): 7–9. https://doi.org/10.4037/ccn2022577

Many articles have been written during the COVID-19 pandemic about the serious workplace and personal issues experienced by nurses. Although I have mentioned some of these struggles in previous Critical Care Nurse (CCN) editorials, I have not dedicated a full column to the deplorable situation in which so many nurses find themselves. I mistakenly assumed readers were overloaded with pandemic-related information and aware that many organizations are advocating on behalf of nurses to improve the environment and overall working conditions. I now realize that many nurses at the bedside are justifiably concerned that your voices are not being heard.

A national US survey of critical care nurses reported physical and emotional symptoms of exhaustion, anxiety, sleeplessness, and moral distress.1  Working conditions have become increasingly demanding during the pandemic, patient acuity is high, the nursing shortage continues, nurse-to-patient ratios regularly exceed recognized standards, nurses are working extreme amounts of overtime, and many nurses have seen too much death, feel disrespected and undervalued, and are frustrated that they cannot provide the level of excellent care required for positive patient outcomes. In other words, many of you are working in unhealthy and unsafe work environments.

Nurses’ Reality

Nurses are angry. I hear you and I hear your pain. As a nurse, I share your deep concerns about the future of nursing. As Editor of CCN, I recognize the importance and privilege of having a national platform to call for positive change for all critical care nurses.

I should explain one of the realities of publishing, however. Early in the pandemic, I often sat down to write these editorials thinking the worst of the pandemic might be over by the time my words were printed. It is clear now that we will not be out of this mess by the time this editorial goes to press. A recent quote I encountered resonated with me: “Any effort to predict a future course beyond 30 days relies on pixie dust for its basis.” To meet deadlines for print, I am typically writing editorials 3 to 4 months before the final version will be seen by readers, leaving me to guess what lies ahead. Sometimes I miss the mark.

Thus far, COVID-19 waves have fluctuated throughout the country with respect to timing and impact. During various waves of the pandemic, we hoped for a final resolution. While our government instructed the vaccinated public to resume elements of usual life, the work environment for nurses and other health care providers continued to worsen. Nurses in one state might be breathing easier and hoping the pandemic was ending while nurses in another city or state might be experiencing a huge influx of acutely ill patients and worsening work conditions. Each wave came and went leaving more destruction in its path. Some of our international readers experienced virus-related surges before their arrival in the United States. Due to geography and other variables, some of the situations I discuss may not apply to all readers in all places at all times, and sometimes I may overgeneralize about your experience.

Our System Needs an Overhaul

One thing is clear: many critical care nurses have been working in unfathomable work environments that appear to be worsening. A major overhaul of acute and critical care nursing is needed. Nurses have told us loud and clear that they do not want to be heroes—you want a healthy, sustainable work environment. You are willing to work hard, but you also need time to care for yourselves. You deserve the simple things that other professions take for granted, such as having time to eat a meal or empty your bladder during a shift. You deserve to be fairly compensated for the difficult work you perform. You deserve to work in a healthy work environment that supports you and allows you to provide expert nursing care to the best of your ability.

In the spirit of the American Association of Critical-Care Nurses (AACN) Healthy Work Environment standards, health care organizations must strive for skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.  As the health care system is revamped, it is critical to ensure that adequate support and leadership are provided not only for bedside nurses,  but the entire team, including nurse managers.  Strong consideration should be given to other supportive roles such as clinical nurse specialists, whose engagement in patient care has been associated with improved patient outcomes and decreased cost.

No Easy Answers

This editorial does not contain answers to fix our broken health care system; there are no easy answers. Major changes will take time, not only to create a system that works for all, but to create changes that are sustainable. Across the globe, nursing associations, hospitals, schools of nursing, and others are working to make substantive changes to acute and critical care nursing practice. They also are exploring how we train new nurses and looking to models that have worked in other health care disciplines. Frontline nurses have been involved in many of these initiatives. Your input is important to help create a system that works for you.

Many nurses I talk to believe we already had a nursing crisis before the pandemic. Now we have a crisis on steroids. Our nursing shortage was exacerbated by the pandemic, and the current situation is unsustainable. If changes are not made quickly, we risk losing more nurses, including experienced, expert nurses. Intensive care unit nurse and advocate Sandy Summers expressed this well: “Without nurses, an ICU bed is just a bed.”  Obviously we cannot continue to work within this broken system; radical and meaningful change is needed. Many are trying to develop innovative ways to provide safe nursing care to acute and critically ill patients and their families.

A number of solutions have been implemented and others are under development. Some institutions have reduced documentation requirements to free up nursing time for direct patient care, which is a great example of de-implementation to remove or revise current practices to free up valuable nursing time.  There may be other opportunities to de-implement tradition-based practices that are not evidence based. Also, other practices or tasks that do not require critical thinking or high levels of nursing skill might be delegated to trained assistants.

Team nursing models are being used to manage increasing workloads with fewer registered nurses.9  In some cases, one nurse leads a team of nurses and/or health care providers from other disciplines to care for critically ill patients. I have heard stories of patient care being provided by student nurses, medical residents, and other allied health professionals. Although such solutions are intended to support nurses, they risk increasing nurse workload and stress depending on how thoughtfully they are implemented.

Although travel nurses and military nurses are being used to fill some of our patient care needs, this situation is not sustainable either. Some of you have reported working with travel nurses who have no experience caring for critically ill patients. This type of situation places additional burdens on the entire team, including local intensive care unit nurses and the nurse manager, not only to help the travel nurse become familiar with the local work environment and policies, but to become familiar with safe, evidence-based critical care nursing. The additional discrepancy in financial compensation between travel nurses and local nurses has become another great source of frustration.

Giving Nurses a Voice

Internationally, organizations such as Johnson & Johnson have been working with nurses and others to create a more sustainable workforce. Here at home, AACN has worked tirelessly throughout the pandemic to advocate for nurses, beginning with a board member’s visit to the White House in March 2020 to brief officials and the Coronavirus Task Force, demand safe work environments, and advocate for adequate personal protective equipment for frontline health care workers.

AACN also has launched campaigns, educational efforts, and well-being resources during the pandemic to provide various opportunities to improve working conditions and to give nurses a voice. Here are examples:

  • An online portal for nurses to share stories in writing or through use of video
  • The Hear Us Out Campaign to encourage vaccination in an unthreatening way
  • Healthy Work Environment resources including implementation of a fifth national survey to capture nurses’ feedback during the crisis and recommend strategies for action 
  • A national staffing initiative co-led with the American Nurses Association to identify lasting solutions to chronic challenges to provide for safe and appropriate nurse staffing in the future
  • Partnerships on the American Nurses Foundation’s Nurse Well-Being Initiative  and the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience
  • Relationships with organizations such as the Office of the Surgeon General to ensure that your voices are heard at high-profile tables of influence
  •  

Nurses collectively have a powerful voice and want to be heard. You want employers, administrators, policy makers, government, nursing associations (including AACN), schools of nursing, the public, and other stakeholders to recognize that your current work situation is unhealthy and unsustainable. We cannot afford to lose more nurses, but we also cannot continue to expect nurses to work within this broken health care system without meaningful change.

In closing, I strongly echo the sentiments expressed by Sandy Summers and others: “We must treat nurses as a vital resource.” Nurses want to be heard. They want ACTION and they need it NOW!

Source: https://aacnjournals.org/ccnonline/article/42/1/7/31660/Difficult-Times-Without-Easy-Solutions-Nurses-Want

INNOVATIONS

Risk of preterm birth in relation to history of preterm birth: a population-based registry study of 213 335 women in Norway

T Tingleff,Å Vikanes,S Räisänen,L Sandvik,G Murzakanova,K Laine

First published: 14 November 2021 https://doi.org/10.1111/1471-0528.17013

Abstract

Objective

To assess the association between preterm first birth and preterm second birth according to gestational age and to determine the role of placental disorder in recurrent preterm birth.

Design

Population-based registry study.

Setting

Medical Birth Registry of Norway and Statistics Norway.

Population

Women (n = 213 335) who gave birth to their first and second singleton child during 1999–2014 (total n = 426 670 births).

Methods

Multivariate logistic regression analyses, adjusted for placental disorders, maternal, obstetric and socio-economic factors.

Main outcome measures

Extremely preterm (<28+0 weeks), very preterm (28+0–33+6 weeks) and late preterm (34+0–36+6 weeks) second birth.

Results

Preterm birth (<37 weeks) rates were 5.6% for first births and 3.7% for second births. Extremely preterm second births (0.2%) occurred most frequently among women with an extremely preterm first birth (aOR 12.90, 95% CI 7.47–22.29). Very preterm second births (0.7%) occurred most frequently after an extremely preterm birth (aOR 12.98, 95% CI 9.59–17.58). Late preterm second births (2.8%) occurred most frequently after a previous very preterm birth (aOR 6.86, 95% CI 6.11–7.70). Placental disorders contributed 30–40% of recurrent extremely and very preterm births and 10–20% of recurrent late preterm birth.

Conclusion

A previous preterm first birth was a major risk factor for a preterm second birth. The contribution of placental disorders was more pronounced for recurrent extremely and very preterm birth than for recurrent late preterm birth. Among women with any category of preterm first birth, more than one in six also had a preterm second birth (17.4%).

Source:https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17013

Increased Severe Neonatal Hyperbilirubinemia During Social Distancing

By Sara K. Berkelhamer, Department of Pediatrics, University of Washington, Seattle
Feb 21, 2022

As a neonatologist, I was concerned about an apparent increase in the number of neonates being readmitted to the hospital with severe hyperbilirubinemia during the COVID-19 pandemic and social distancing mandate. I envisioned that the postpartum social support provided by visiting family and friends was being disrupted, impacting successful breastfeeding and the recognition of jaundice in infants. I was also worried about inadequate access to professional support coupled with apprehension to seeking medical care. As severely elevated bilirubin levels can impact an infant’s neurodevelopment, early identification and intervention (including feeding supplementation, lactation support, and phototherapy) is key to avoiding both long-term sequelae and hospitalization. Therefore, there was a need to explore if an increase in severe hyperbilirubinemia cases was truly occurring, if these cases represented more severe disease, and if risk factors could be identified to guide targeted counseling and closer follow up.

For a paper published in the Journal of Paediatrics and Child Health, my colleagues and I aimed to determine rates of severe hyperbilirubinemia admission during social distancing in comparison to historical norms. A retrospective chart review identified all readmissions for hyperbilirubinemia between January 2018 and April 2020 in Western New York. Our study team collected both maternal and infant data as well as details on the infant’s admission to the hospital and clinical course. Infants were categorized according to the period of hospital admission, which was characterized as pre-pandemic or control. In addition, 19 outpatient clinics were surveyed regarding lactation support.

Rates of Readmission Nearly Tripled

While rates of readmission for hyperbilirubinemia nearly tripled during early social distancing mandates, we found that there was no change in the severity of disease as determined by signs of dehydration, rates of suspected sepsis, peak bilirubin levels, duration of phototherapy, rates of bilirubin above exchangeable levels, use of IV immunoglobulin or exchange transfusion, and length of hospital stay.

Mothers who had infants readmitted during social distancing were observed to be younger than mothers of infants readmitted before the pandemic (25.8±3.3 vs 31.3±4.7 for COVID-19 and controls, respectively), with rates of primiparity and exclusive breastfeeding higher than national norms, but not significantly higher than controls in the cohort (62.5% vs 37.0% for primiparity; 87.5 % vs 81.5 for breastfeeding). A survey of outpatient clinics in the region identified limited options for access to lactation support via telemedicine; of the 19 clinics surveyed, only six offered a telemedicine option for lactation support.

Greater Access to Virtual Lactation Support Needed

To our knowledge, this is first study to examine increased rates of readmission for hyperbilirubinemia during the stay-at-home mandate. Our data supported our hypothesis that social distancing impacted access to healthcare, critical social support, and utilization of services for at-risk cohorts, which included young, primiparous women who breastfeed.

Based on our observations, there is a critical need for proactive identification and monitoring of at-risk mother-infant dyads during recurrent COVID-19 surges, not only during the postpartum period in the hospital but after discharge into the community. Our data further advocates for greater expansion of access to virtual lactation support, an option that has grown exponentially for physician visits during the pandemic.

Going forward, we would like to see more research on the design and application of remote lactation support, as well as on the clinical and cost efficacy of these programs. As our data represents a regional experience, we would welcome a secondary analysis comparing severity of disease in cases of hyperbilirubinemia that occurred before and during COVID-19 and the demographics associated with at-risk populations.

Source:increased-severe-neonatal-hyperbilirubinemia-during-social-distancing (physiciansweekly.com)

Building Baby Brains With smallTalk: From Foreign Language Learning at Home to Bridging Gaps in the NICU

January 28, 2022   Jessica Nye, PhD

The best language learners on the planet are children — especially babies. Your brain is most active in creating the language center of your brain, connecting neurons and creating the highways and pathways for processing language, during infancy. In fact, language learning begins in utero. The developing brain of a fetus starts to wire language circuitry around the speech sounds and rhythms of its mother’s voice. This process accelerates when a baby is born.

The brain does more language-associated wiring during the first year of life than any other time in a person’s life. These brain changes occur rapidly as a result of exposure to adult voices speaking to the baby in “infant-directed speech,” characterized by a higher pitch and more melodic, emotional tones.

Ohio-based startup smallTalk (formerly Thrive Neuromedical) is developing the SmallTalk™ platform to enrich the neurological development of babies who don’t have regular, consistent access to their parents’ voices. smallTalk has licensed technology developed at Nationwide Children’s Hospital that delivers recorded voices to infants via devices intended for use in the neonatal intensive care unit (NICU) and at home. These devices support critical brain development for language.

Around 10% of all infants spend some amount of time in the NICU, where they may be exposed to more passing adult speech and sounds of alarms and machinery than infant-directed speech during critical periods for language-associated brain development. This lack of exposure to infant-directed speech may, in part, be responsible for the documented association between NICU care and developmental language delays.

At Nationwide Children’s, where the average stay in the NICU exceeds 100 days, researchers developed and studied an infant-safe, unibody, Bluetooth-enabled speaker device to increase babies’ exposure to their caregivers’ voices with the appropriate sound characteristics to provide a clinical, therapeutic effect. The speaker can easily fit into an incubator and uses technology and volumes that is safe for babies and their sensitive ears.

Beginning this year, nurses and therapists in the NICU will be able to use a specially designed iPad application to help parents or caregivers record lullabies, songs or stories. Playlists of these recordings can be transferred wirelessly to egg-shaped speaker devices placed with the babies in the NICU and played for them several times each day.

The technology has also led to the development of an innovative foreign language learning product, the smallTalk Egg™, designed to help parents plan expose their babies to foreign language learning before age two.

“This is the only time of life when language learning actually helps babies brains develop differently. Infants in bilingual or multilingual household environments develop much broader speech sound recognition capabilities. By 1 or 2 years of age, they’re able to hear and verbalize more speech sounds and adapt to those languages very quickly,” says Dean Koch, CEO of smallTalk.

Infants can be exposed to these songs and stories passively, but studies have shown the most effective changes to the brain occur during interaction. Because the smallTalk Egg™ comes with a sensor device which fits into three different commercially available types of pacifiers, infants can request additional content by sucking on their pacifiers during 20-minute educational sessions. As the infant sucks, they are rewarded with 10 seconds of the foreign language lullaby, which then fades away. The baby recognizes this contingency quickly and will happily engage for a 20-minute learning session.

“Our research on brain imaging and how babies process speech sounds found that 20 sessions of 10-20 minutes over a month or month and a half is all that’s required to make a real, lasting, positive brain change,” says Koch.

The smallTalk Egg™, which will also be available this year, will allow parents and caregivers to bring this brain-enhancing technology into their homes. Currently, content is available in seven languages for use on the smallTalk Egg™, and there are plans to expand to include more languages spoken around the world.

Source: https://pediatricsnationwide.org/2022/01/28/building-baby-brains-smalltalk/

Discover Your Learning Style

GCFLearnFree.org

In this video, you’ll learn more about the different types of learning styles, to see which one works best for you!  Visit https://www.gcflearnfree.org/ to learn even more.

Traditionally western academic institutions have not adequately developed teaching methods that are geared towards visual, kinesthetic, and combined learning styles. The world is composed of people with diverse, meaningful, and valuable learning styles. Often academic teaching, testing, and programming is aimed towards auditory learning. I propose that we transition from labeling students as “learning disabled” and focusing on the possibility that our education systems are teaching disabled. We can do better.

SURFING COSTA RICA – SANTA TERESA SURF CLASSIC 2020

4/10/2020  by  Surfing Republica

 

Ideal; Preemie Life Course

Uzbekistan, officially the Republic of Uzbekistan, is a double-landlocked country in Central Asia. It is surrounded by five landlocked countries: Kazakhstan to the northKyrgyzstan to the northeastTajikistan to the southeastAfghanistan to the southTurkmenistan to the south-west. Its capital and largest city is Tashkent. Uzbekistan is part of the Turkic languages world, as well as a member of the Organisation of Turkic States. While the Uzbek language is the majority-spoken language in Uzbekistan. Islam is the predominant religion in Uzbekistan, most Uzbeks being Sunni Muslims.

Uzbekistan is a secular state, with a presidential constitutional government in place. Uzbekistan comprises 12 regions (vilayats), Tashkent City and one autonomous republic, Karakalpakstan. While non-governmental human rights organisations have defined Uzbekistan as “an authoritarian state with limited civil rights”, significant reforms under Uzbekistan’s second president‘s administration have been made following the death of the first president Islam Karimov. Owing to these reforms, relations with the neighbouring countries Kyrgyzstan, Tajikistan and Afghanistan have drastically improved. A United Nations report of 2020 found much progress toward achieving the UN’s sustainable development goals.

In the post-Soviet era, the quality of Uzbekistan’s health care has declined. Between 1992 and 2003, spending on health care and the ratio of hospital beds to population both decreased by nearly 50 percent, and Russian emigration in that decade deprived the health system of many practitioners. In 2004 Uzbekistan had 53 hospital beds per 10,000 population. Basic medical supplies such as disposable needlesanesthetics, and antibiotics are in very short supply. Although all citizens nominally are entitled to free health care, in the post-Soviet era bribery has become a common way to bypass the slow and limited service of the state system. In the early 2000s, policy has focused on improving primary health care facilities and cutting the cost of inpatient facilities. The state budget for 2006 allotted 11.1 percent to health expenditures, compared with 10.9 percent in 2005.

PRETERM BIRTH RATES – Uzbekistan

Rank: 118  –Rate: 8.7%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

The World Community has experienced increased chaos and stress these past few years, and our community members further impacted by war and climate disasters face escalating healthcare disparity and preterm birth influences. Access/exposure to media provides the opportunity to see for ourselves the challenges our Neonatal Womb Warrior/Preterm Birth community members face globally.  We have the ability to impact change. No matter how big or small our efforts seem, each and every effort to provide support and manifest positive change is both acknowledged and appreciated. Thank you. Kathy and Kat.

We need to talk about prematurity

São Paulo Ambulatory in Brazil carries out pioneering work in nurturing care for preterm infants.

By Emilia Afrange  Last updated: October 6, 2021 Date created: September 24, 2021

                                   International Psychology

The issue of premature births is a global and growing public health concern. Stressing its importance, the United Nations Sustainable Development Goals aim to reduce the rate of global maternal mortality to less than 70 deaths per 100,000 live births by 2030 (United Nations, 2015).

Prematurity is the main cause of neonatal mortality (children up to 28 days old) and infant mortality (children under 5 years old) worldwide and a relevant cause of serious morbidity, associated with long hospital stays in the Neonatal Intensive Care Unit (World Health Organization, 2019)

The sequelae of prematurity are not limited to the period immediately after birth. Premature birth survivors can face adverse health consequences throughout their lives, creating a significant burden for their families and society. Coming into the world before 37 weeks of gestation, or even earlier, can determine the baby’s biopsychosocial development, since biological birth and psychological birth do not coincide (World Health Organization, 2019)

Premature births are a serious issue in Brazil

“Born in Brazil” is a national survey on labor and birth, coordinated by the Sergio Arouca National School of Public Health (ENSP), linked to the Oswaldo Cruz Foundation (Fiocruz). The survey reveals that the rate of prematurity in the country reached 11.5%, almost twice the rate observed in European countries, with 74% of these babies being late preterm (between 34 and 36 weeks of gestation).

More recent information (2014), from the Information System on Live Births (Sinasc) and the Ministry of Health, indicate a prematurity rate in the country corresponding to 12.4% of live births. According to the general coordinator of the study, Maria do Carmo Leal, PhD, “prematurity is the biggest risk factor for the newborn to get sick and die, not only immediately after birth, but also during childhood and adulthood. The damage goes beyond the field of physical health and reaches the cognitive and behavioral dimensions, making this problem one of the greatest challenges for contemporary public health” (Oswaldo Cruz Foundation, 2011/12).

Between October 2016 and June 2019, the Brazilian Association of Parents, Families, Friends and Caregivers of Premature Babies (2019) conducted a survey with 2,900 families of premature babies. The objective was to identify possible actions to provide benefits to aid families with premature babies in the country.  Among the results, it was highlighted that the average period of hospitalization of premature babies in the NICU was 51 days; 63.7% of the babies were hospitalized for more than 60 days and 26% of them stayed between two and five months.

Care for infants born prematurely and their families in Brazil

In the city of São Paulo (SP), the Preterm Outpatient Clinic of the Escola Paulista de Medicina (EPM), of the Federal University of São Paulo (Unifesp), is a national reference in the care of children and adolescents born preterm. Since its foundation, in 1981, it has followed an efficient nurturing care model.

We work with four affiliated hospitals (Hospital São Paulo, Hospital Municipal Vereador José Storopolli, Hospital Estadual de Diadema e Hospital Geral de Pirajussara), which together register approximately 800 premature births/month. Currently, around 900 children and adolescents are being monitored at the Ambulatory. The Premature Clinic offers medical and multidisciplinary care to children and adolescents born prematurely until they reach 20 years of age.

Children born prematurely also receive support for medical treatment, and their families receive social assistance aiming at improving their health and quality of life from the ‘Instituto do Prematuro – Viver e Sorrir,’ founded in 2004 and, since then, a partner of the Clinic (Instituto do Prematuro, 2018).

Children born prematurely and their families also require psychological support. In 2007, the Psychology area at the Premature Outpatient Clinic was created, a unique experience in Brazil. A team of psychologists and psychotherapists support the psycho-emotional health of the premature baby and the mother/caregiver, stimulating the physical and emotional development of the infant, aiding the construction of the loving and empathetic mother/child bond, and supporting the multidisciplinary team helping the family.

Incoming patients are first separated into Operational Groups to address common themes that aim at the psychic expansion, e.g., narrating their anguishes and difficulties while discovering ways of dealing with them – sometimes even in a playful and grateful way. The Operational Groups are as follows:

  • Guidance Group with mothers and children from 0 to 3 years old.
  • Operational Group of mothers and children from 4 to 7 years old.
  • Operational Group of mothers and children from 8 to 10 years old.
  • Operational Group with teenagers.
  • Operational group of caregivers.

Psychological interventions are then created, which can consist of:

  • Psychological screening to verify the patient’s needs and to which type of care s/he should be referred.
  • Individual psychological care.
  • Play therapy.
  • Psychiatric referral.
  • Group service.
  •  

Periodically, meetings are held with the specialists from the Outpatient Clinic and with the EPM resident physicians, in order to promote the quality and improvement of the therapeutic practice, according to the modules created by the physician and psychoanalyst Michael Balint, MD, MS (1984).

In this way, we are able to provide an innovative system of psychological support to address the needs of children born prematurely and their families.

Source:https://www.apa.org/international/global-insights/prematurity

Improving mother and child health in Aral Sear are: Baby Gulnara’s story

UNICEF Uzbekistan-  03 February 2022

Gulnara was born after only 30 weeks of gestation. She weighed just 1,000 grams. After two months in an incubator at the Neonatal Intensive Care ward of the Nukus City Perinatal Center, she weighs 2.450 kilograms.

Gulnara’s mother was admitted with a history of miscarriage. She suffered from multiple health conditions which led to premature labor. The head of the department, Dr. Kahramon Kabulov, who performed an emergency cesarean section to assist with Gulnara’s birth, explained that Gulnara would have had slim chances for survival just a few years before. Thanks to the up-to-date, evidence-based advanced newborn care resuscitation protocols recommended by WHO and UNICEF, and the latest equipment and upgraded infrastructure, maternity staff can now save Gulnara and the other babies who are born preterm.

In 2019, within the framework of the ‘Improving Quality of Perinatal Care Service to Most Vulnerable Mothers and Newborns’ Programme, UNICEF and UNFPA had assisted three perinatal facilities in Karakalpakstan (in Nukus City, Kungrad, and Beruniy) to enhance the capacity of neonatologists, obstetricians, and resuscitation specialists to strengthen staff capacities, through comprehensive training and support. UNICEF and UNFPA have also equipped the perinatal center’s new Neonatal Intensive Care Unit with the latest medical equipment such as ventilators, oxygenators, laryngoscopes, and training equipment. Today all premature babies that come through the perinatal center have a real chance of survival.

At the Neonatal Intensive Care Unit, little Gulnara is getting better every day. She can now see lights and hear sounds and uses her strength to drink her mother’s breastmilk. Once she reaches 2.5 kilograms, she will be released to go home. Her parents have been trained on how best to care for her and are looking forward to her arrival at home.

UNICEF and UNFPA significantly contributed to the Government’s efforts to improve the quality of perinatal services in the Kungrad and Beruniy districts and Nukus City. Since the project started, 21% of all mothers and newborns in Karakalpakstan (more than 12,000 mothers and 12,000 newborns) have benefited from upgraded infrastructure and improved quality of care at the target perinatal centers.

A significant reduction in early neonatal mortality has been achieved in all three target facilities on average by 22%. It is expected that the target perinatal centers will extend their specialized service to mothers and newborns from the neighboring districts.

Source: https://www.unicef.org/uzbekistan/en/maternal-and-child-health-in-aral-sea-region

Keeping up with technology and terminology ….. Next up: Deep Learning

What is Machine Learning?

822,603 views – Aug 24, 2017 Google Cloud Tech

Got lots of data? Machine learning can help! In this episode of Cloud AI Adventures, Yufeng Guo explains machine learning from the ground up, using concrete examples.

Ziyoda va Ulug’bek Rahmatullayev – Tor ko’cha

835,425 views              Jan 3, 2022

Gravens By Design: What the Ideal NICU Would Look Like

Robert D. White, MD Director, Regional Newborn Program Beacon Children’s Hospital

It is sometimes hard to imagine the ideal NICU – the concept is still evolving, so there is no one available to visit, and even the elements of what could be optimal are evolving. For example, if this exercise were undertaken a few decades ago, it would be difficult to imagine what the digital transformation might permit – and even now, we cannot predict its full potential. Still, the effort seems worthwhile, not only for those who will soon be building a NICU that will have to meet the needs and expectations of its inhabitants for the next 20-30 years but also for those who cannot rebuild soon but could undertake an interim facelift that would be of value to all its constituents.

A NICU should be welcoming to families.

 This concept has many elements, starting even before one enters the hospital doors. It is usually easy to find the hospital, especially in the digital age, but there are often many places to park and enter the massive complex where most higher-level NICUs are located. Few people will say that finding their way from the street to the NICU is easy; it is hardest for young parents or other family members coming from an outlying community – often at night and almost always under stressful conditions. Proper signage on the street, at the preferred entrance, and through the hallways can greatly facilitate this first encounter. Written directions, both on paper and a hospital website, can also be helpful and allay anxiety even at the start of the journey.

Many hospitals have a foreboding “front door” because of where they are located, how old they are, and their restrictions to entry, but once one reaches the entrance to the NICU, none of these should be factors. The entrance should be well-lit with an attractive color scheme and devoid of stern signage. An individual to welcome and direct families and visitors should always be available. The décor should have more in common with a hotel lobby than an ICU – spacious, relaxing, and, where appropriate, informative. Both signage and artwork should reflect the diversity of cultures served by the NICU and should address parents as members of the care team rather than as visitors.

This paper is not intended to explore the operational aspect of the ideal NICU, but these are immensely important to how families can be made to feel welcome. I have vivid memories of an old NICU in Madrid where several mothers sat in a circle rocking their premature infants while talking and singing together – a stark contrast to most similar NICUs in much wealthier countries I have seen that were largely devoid of parents and dominated by the sights and sounds of technology. The Madrid parents were made to feel welcome not by the physical environment but by the policies of the NICU, and they, in turn, made it more welcoming to every new family.

The NICU should only separate babies from their parents under the most extreme circumstances.

 There is now abundant evidence of the value of early and extensive intimate contact of a baby with its parents and the safety of single-family rooms. There is no evidence that separating babies from their mothers for extended periods in the first days of life benefits either baby or parent. The ideal NICU would provide space and caregivers for all mothers after their delivery except for those who require highly specialized care. Likewise, accommodation would be provided for fathers or other support persons that will be sufficient for their comfort over extended periods.

A NICU should present sights and sounds to all inhabitants that are nurturing rather than stressful.

There was a point in the early NICU days when audio alarms and bright lights were imperative, but we have known how to minimize these stressors for decades now. Most alarms can be transmitted electronically and visually, a technique learned in every other part of the hospital and adopted in some NICUs as early as the 1980s but has only recently achieved widespread acceptance and is still not a reality for some NICUs. Similarly, there was a time before the advent of transcutaneous oximetry when constant bright lights were needed to assess skin color and perfusion. However, the pendulum swung to a constantly dim environment based on the premise that this was the expected environment in utero and, therefore, safer and less stressful for premature infants. This belief has persisted long after it was disproven (1); it is past time for the pendulum to swing back to a middle ground where babies are presented with a circadian rhythm for lighting while still protected from direct light sources.

Adult caregivers and families need appropriate lighting as well. Lighting should be of sufficient intensity and the proper spectrum to provide a circadian and alerting stimulus for caregivers (2) and a welcoming signal to families. In contrast, lighting levels and spectrum at night will minimize melatonin suppression in caregivers while still supporting alertness.

Daylight and views of the outside world and nature provide a substantial psychological benefit to many adults. However, most NICUs will not have an opportunity to improve access to these features until new construction occurs because of the misguided belief in past years that because babies did not need access to daylight, their caregivers and families did not need it either. The ideal NICU will provide windows in almost all spaces where adults spend extended periods during the day. Even hallways should have a window on at least one end rather than closing off that vista by making an office a little larger or for storage space. In the meantime, attention to the visual environment remains even more important. The walls of NICUs have the potential to be palettes conveying subtle messages through artwork, photos, and stories of NICU grads. Even ceilings and floors have been used creatively to provide additional opportunities for the eye to find the color, whimsy, distraction, and information.

Sound control has been difficult to achieve in many NICUs, even after monitor alarms were tamed. For many NICUs, there are still too many sources of noise and too few sound-absorbing surfaces. There are now alternatives to the hard flooring that transmits and reflects the sound of everything that moves across it, for example. All surfaces should absorb more noise than they generate. HVAC systems were often designed in an era when high airflow was recognized as valuable but not understood as an important source of ambient noise, above which all other desirable sounds such as voices and even monitor alarms must be heard. Design or redesigning these HVAC systems to be quiet and where air can be extensively cleaned and filtered are overdue for many NICUs.

Infection control can be improved in most NICUs.

Nosocomial infection continues to be a frustratingly common complication of neonatal intensive care. Something as basic as a handwashing sink is often designed to fail and, even when welldesigned, can be misused in a way that contributes to ongoing contamination of NICU surfaces. The ideal NICU will have sinks readily accessible in all patient care and support areas; these sinks should be hands-free, large enough for cleaning hands and forearms, have drains that are offset from the faucets, rims that do not permit objects to be placed on them (and thereby contaminated), splash guards to protect adjacent areas from splatter, quiet paper towel dispensers, and should be handicapped-accessible.

Among new sanitizing techniques being explored, ultraviolet light in the UV-C spectrum has been demonstrated to reduce bacterial and viral presence in circulating air and on certain devices, including hand-held communication devices. There is also increasing evidence that UV-A can be used to reduce contamination of surfaces in occupied spaces (3).

Support spaces should provide respite and support for families and caregivers.

In many NICUs, support spaces for caregivers and families are cramped and windowless. These spaces would be large and relaxing in the ideal NICU with abundant daylight and access to an outdoor garden. Likewise, there would be smaller individual spaces that provide privacy and an opportunity to nap, pray, exercise, or do yoga.

The patient care space should be a home away from home for those families who desire it and those babies for whom it is appropriate.

This principle comes with qualifiers. Babies whose families rarely interact with them may benefit from being in a shared space with other such babies. A few families prefer being in a space where their baby can be easily seen by caregivers, although this often is based on a misunderstanding of how little we can tell about a baby when we are not directly at the bedside and how much we depend on monitors to provide us information about a baby’s status. Most families, though, appreciate a space they can call their own with comfortable seating, a private sleep surface and shower, a refrigerator, and the opportunity to personalize the space with decorations suitable for the baby and the season. Even in a more open setting, parents should have the opportunity for privacy, especially for breastfeeding and skin-to-skin care and space to store their personal belongings.

The ideal NICU should look better than the day it opened.

To some extent, this is an unreachable goal – walls will get nicked, floors will get stained, equipment will look worn. However, accumulating items in hallways and on counters and signs taped to walls or doors is not inevitable. Instead, it is tolerated mainly by people who get desensitized to its presence and forget that for families in this crucial moment, it announces a lack of attention to details and cleanliness that we would not tolerate in other public venues or indeed in our own homes if we were expecting visitors. It is a rare NICU that cannot find ways to enhance its appearance from time to time with upgrades as mundane as light bulbs with a warmer spectrum or as heart-warming as a piece of art from a graduate or the child of a staff member. Likewise, if allowed, families and staff can transform a patient care area from a sterile medical unit to something that feels more like home.

Source:http://www.neonatologytoday.net/newsletters/nt-feb22.pdf

The proactive approach to mother-infant dyads at 22-24 weeks of gestation: Perspectives from a Swedish center

Johan Ågren    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

Abstract

The care of infants born at the lowest extreme of gestation requires dedication, skill, and experience. Most centers apply a selective approach where intensive care at these gestational ages is being offered to a varying proportion of infants depending on the views and experiences of the medical community, the individual physician, and the parents. Consequently, the outcomes differ dramatically with survival rates at 22-23 weeks ranging from 0 to greater than 50%. This paper presents the approach in a center with a long tradition of providing a comprehensive and uniformly active care to all mother-infant dyads from 22+0 weeks of gestation. Important features outlined include prenatal maternal referral and transfer, delivery room management, and initial intensive care.

Full Article/PDF: https://reader.elsevier.com/reader/sd/pii/S0146000521001506?token=B5AD098B8AEB9D5919C458B4CCF3C20E76E11BEA54DE5F07A5224485F86A29707C6DB08D3049A1707894F425ED3E7814&originRegion=us-east-1&originCreation=20220220175145

Thin Endometrium, PCOS, and Risk for Preterm Birth, Low Birthweight Infants

Jessica Nye, PhD – January 26, 2022

Women underwent controlled ovarian stimulation using gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or progestin for pituitary suppression. Hormone therapy cycle or ovulation induction cycle for endometrial preparation. 

Among pregnant women with polycystic ovary syndrome (PCOS), decreased endometrial thickness (EMT) was associated with increased risk for preterm birth (PTB), low birthweight (LBW), and small-for-gestational age (SGA) infants. These findings were published in Frontiers in Endocrinology.

Health records of women (N=1755) who had PCOS and a singleton livebirth after frozen-thawed embryo transfer (FET) between 2009 and 2019 at the Shanghai Ninth People’s Hospital in China were retrospectively reviewed for the study. Prior to pregnancy, the women underwent controlled ovarian stimulation using gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or progestin for pituitary suppression. All women underwent hormone therapy cycle or ovulation induction cycle for endometrial preparation.

Of the entire cohort of 1755 women with PCOS, 10.5% had EMT of £8 mm, 78.6% had EMT of >8-13 mm, and 10.9% had EMT of >13 mm EMT.  The 3 EMT categories were classified as “thin”, “intermediate” and “thick”, respectively, for this study. Patients in these 3 EMT cohorts were aged mean 29.9±3.3, 30.0±3.5, and 30.1±3.5 years; body mass index (BMI) was 23.44±3.70, 23.45±3.85, and 24.02±4.26 kg/m2; and 37.5%, 29.6%, and 25.0% had PCOS without any other fertility issues, respectively.

The patients differed significantly for gravidity and endometrial preparation regimen (both P <.001) among the thin, intermediate, and thick EMT categories. No significant differences in pregnancy complications were found on the basis of maternal age, BMI, parity, or other factors.

For neonatal outcomes, thin EMT associated with increased PTB (13.6% vs 9.3% vs 3.6%; P =.003), lower birthweight (mean, 3260.1 g  vs 3314.6 g vs 3443.3 g; P =.004), LBW (9.2% vs 5.6% vs 2.1%; P =.010), lower birthweight Z-score (mean, 0.33 vs 0.39 vs 0.61; P =.006), and SGA (9.2% vs 4.3% vs 1.6%; P =.001) compared with the intermediate and thick EMT cohorts, respectively.

Using multiple logistic regression models for the same 3 groups, researchers discovered that a 1 mm decrease of EMT led to a 9% decrease ([adjusted odds ratio] 1.09, 95% CI, 1.00-1.19, P = .053), 14% ([aOR]1.14, 95% CI, 1.02-1.38, P=.002), and 22% ([aOR]1.22, 95% CI, 1.07-1.38] P= .003) led to a greater likelihood of developing PTB, LBW, and SGA, respectively.

Researchers acknowledged their study was limited by not adjusting for variants of PCOS or metabolic patterns before pregnancy. Only frozen-thawed embryo transfer (FET) cycles were included in the analysis, so generalization of the study findings should be done with caution.

“Our study demonstrated that decreased EMT was an independent risk factor for PTB, LBW, and SGA in PCOS,” the researchers concluded. “This novel finding suggests that EMT may be applied as a simple indicator of neonatal complications among women with PCOS.”

Reference

Huang J, Lin J, Xia L, et al. Decreased endometrial thickness is associated with higher risk of neonatal complications in women with polycystic ovary syndrome. Front. Endocrinol. 2021;12:766601. doi:10.3389/fendo.2021.766601

Thin Endometrium, PCOS, and Risk for Preterm Birth, Low Birthweight Infants – Endocrinology Advisor

Health Equity and Cultural Competency in the NICU: Challenges and Solutions

Jan 28, 2021 National Association of Neonatal Nurses

In this Bonus General Session from 2020 NANN Virtual, Jenne Johns, MPH, takes listeners through an educational and empowering journey to encourage the delivery of high quality and equitable care to all preemie families, regardless of race, language, and socioeconomic status.

We are excited to see the emphasis and progression of efforts towards developing and conducting research that may build a foundation for understanding and addressing the unique needs of preemies as they navigate their FULL life journeys.

Addressing Preterm Birth History With Clinical Practice

Recommendations Across the Life Course

Michelle M. Kelly, PhD, CRNP, CNE, Jane Tobias, DNP, CPNP-PC, & Patricia B. Griffith, MSN, CRNP, ACNP-BC

INTRODUCTION

Preterm birth is defined as birth before the completion of 37 weeks of gestation (World Health Organization, 2018). Worldwide, preterm birthrates range from 5% to 18% (Synnes & Hicks, 2018), and two-thirds of all preterm births occur without an identifiable cause (Ferrero et al., 2016). Over the past decade, despite increased attention to perinatal management, the United States’ preterm birthrate hovered steadily at just below 10% (Martin, Hamilton, Osterman, Driscoll, & Drake, 2018). Advances in perinatal and neonatal management such as prenatal steroids, exogenous surfactant, and advanced respiratory management resulted in preterm birth survival rates in developed countries of 90% to 95% (Philip, 2005; Raju, Buist, Blaisdell, Moxey-Mims, & Saigal, 2017a).

Stable preterm birthrates and high survival rates combine to ensure that preterm born infants will reach adolescence and adulthood in significant numbers such that every health care provider, regardless of specialty, is caring for a patient who was born preterm.

Long-term health outcome research of preterm birth survivors has shown that preterm birth has implications for individual health throughout the life course (Raju et al., 2017a). The National Institutes of Health in The Adults Born Preterm: Epidemiology and Biological Basis for Adult Outcomes (Raju et al., 2017b) calls for an increase in awareness of and education for health care providers regarding the long-term health outcomes of preterm birth survivors. Health care providers report limited knowledge and training related to preterm birth survivors’ life course outcomes (Kelly & Dean, 2017; Luu, Rehman Mian, & Nuyt, 2017; Raju et al., 2017b). Limited content addressing preterm birth survivors’ life course health outcomes is evident in commonly used pediatric-focused textbooks (Kelly & Michalek, 2019).

Current recommendations from the American Academy of Pediatrics, specific to children born preterm, focus on the immediate newborn period and the high-risk infant referral to developmental follow-up (American Academy of Pediatrics Committee on Fetus and Newborn, 2008). Most preterm births occur between 32 and 36 weeks of gestation and subse- quently require limited neonatal intensive care unit (NICU) intervention and are often discharged without significant peri- natal complications. Therefore, many children born preterm are not included in high-risk developmental follow-up pro- grams and are not deemed appropriate for early intervention.

Problem Statement

No formal recommendations or guidelines exist regard- ing preterm birth implications across the life course despite the proliferation of long-term outcome research published in the last decade and the National Institutes  of Health call for increased attention to an individual’s preterm birth history (Raju et al., 2017b). Just as obesity was identified as a risk for coronary artery disease in 1998 (Mitchell, Catenacci, Wyatt, & Hill, 2011), it is time for the health care community to recognize preterm  birth history as an independent risk for developmental and educational success, as well as noncommunicable cardiovascular and respiratory diseases. Recommenda- tions for addressing preterm birth  history  throughout the life course are essential to improving health care pro- vider knowledge, and through their implementation, improving the health of those born preterm.

Following an extensive review of the literature (Kelly & Griffith, 2020a; Kelly & Griffith, 2020b), a set of recommendations for pediatric and adult primary care providers were developed that incorporate findings from national and international meta-analyses, systematic reviews, executive summaries, and professional guide- lines. There is no specific phenotype of the individual born preterm; however, those born preterm experience common chronic childhood and adult conditions at an increased incidence (Kelly, 2018). Initially, those born preterm may not vary from the typical developmental course or raise significant concerns over health or development. However, children born preterm benefit from high-quality and comprehensive interventions and special educational accommodations to promote literacy, numeracy, and life skills (Msall, Sobotka, Dmowska, Hogan, & Sullivan, 2018). The following guidelines aim to enhance the identification of those born prematurely, empower health care providers to employ familiar screening strategies, and advocate for mitigations strategies with anticipatory guidance and health promotion.

METHODS

Review of Literature

In anticipation of developing these evidence-based recommendations, the authors undertook an extensive review of the existing preterm birth survivor outcome literature. The literature reviewed in preparation for the coalescing of these recommendations included meta-analyses or systematic reviews identified through a systematic search in PubMed, CINAHL, PsychInfo, and Cochrane databases, with assistance and input from a medical librarian. Including only meta-analyses or systematic reviews, umbrella reviews are designed to provide a broad picture of the research base (Aromataris et al., 2015) and may be used to inform practice guidelines or to highlight known strengths or gaps in an area of research or practice (Cantrell, Franklin, Leighton, & Carl- son, 2017). Search terms included: (“Premature birth” OR “Preterm” OR “Preterm infant” OR “Infant, premature, extremely premature”) AND (Adolescen* OR Adult) AND (“Outcome” OR “Outcome assessment” OR “Outcome assessment healthcare” OR “Outcome and process assessment” OR “Prognosis” OR “Long-term adverse effects”). Additional filters included systematic review, meta-analysis, Cochrane review, and review. Search years were from 2010 to 2019 for the school-age review and from 2010 to 2018 for the adolescent and adult review. The methodologic qual- ity of all reviews was assessed using the Joanna Briggs Insti- tute Critical Appraisal Checklist for Systematic Reviews and Research Synthesis (Aromataris et al., 2020).

These findings were published as two umbrella reviews, one focused on  adolescents and  adults  (Kelly  & Griffith, 2020a) and the other focused on school-aged children (2−12 years of age; Kelly & Griffith, 2020b). Additional details of the umbrella review methodology and search parameters are available in the publications (Kelly & Griffith, 2020a; Kelly & Griffith, 2020b). The review of school-aged outcomes included 29 reviews: 14 meta-analyses, eight systematic reviews, and seven described as both meta-analysis and systematic review (Kelly & Griffith, 2020b). The adolescent and adult outcomes include 16 reviews: five meta-analyses, five systematic reviews, and five described as both meta-analysis and systematic review, and one comprehensive review (Kelly & Griffith, 2020a). The researchers also explored literature published between the umbrella reviews publications the development of these recommendations (from 2018 to 2020) to ensure a comprehensive literature review.

Development of Recommendations

Following the extensive review of the literature, the researchers coalesced the currently available research, formal and gray literature (manuals, guidelines, curricula, and recommendations) into clinical practice recommendations. The set of recommendations aims to guide the primary care provider to elicit, understand, and incorporate a patient’s pre- term birth history across the life course. Thirty-six meta- analyses, systematic reviews, guidelines, and recommendations were incorporated into the preterm birth history recommendations (see Table 1).

The recommendations were organized into patient care categories: assessment and diagnosis, prevention and management, and referral and treatment. Assessment and diagnosis recommendations focus on identifying a pattern of risk and recognizing the relative importance that risk confers to individual health. Prevention and management recommendations address the importance of surveillance, anticipatory guidance, and patients and family education. This process should begin at birth, continue through adolescence, and into the transferal of care to the adult provider. Because of the importance of prevention and management in health care, categories were further separated into general recommendations, cardiovascular surveil- lance, and pulmonary surveillance. Referral and treatment recommendations focus on a process that ensures the necessary connections are made, and the patient is partnered with the appropriate health care team to recommend treatment plans for supportive resources. Proper screening and identification may mitigate potential medical and psychological challenges that will affect the patient’s quality of life.

The American Association of Critical-Care Nurses’ level of evidence grading system was used to assess the literature supporting the recommendations (Peterson et al., 2014). Twenty-two references were level A (meta-analysis), one was level B (well-controlled studies), 10 were level C (systematic and integrative reviews), and three-level D (peer-reviewed standards). Table 1 includes the recommendations and the references that support the specific recommendations, with the American Association of Critical-Care Nurses grading. Tables 2−4 highlight the relevant findings from each study and reference. It is important to note that the recommendations are not dissimilar to guidelines for full-term children. Rather they address the importance of recognizing preterm birth as a portion of a patient’s history that increases their risk for commonly occurring conditions.

Health care provider feedback was solicited to help refine and validate the recommendations. Specifically, the feedback was solicited from physicians and nurse practitioners practicing in neonatology, pediatric primary care, pediatric specialty care, and family medicine. The initial e-mail listing was sent to numerous contacts of the researchers across several states and health systems. Responses were anonymous, and participants were asked to share the guidelines with other health care provider colleagues. Literature suggests that most practicing physicians and nurse practitioners would not be familiar with the long-term outcome literature (Kelly  & Dean, 2017; Raju et al., 2017b), so efforts were made to facilitate a review of the supporting literature. Recruitment e-mails and recommendation documents included embedded hyperlinks of the literature used to support each recommendation. Respondents were asked to review the literature before completing the evaluation survey. Respondents were asked to report the level of agreement with each recommendation and the feasibility of implementation in practice. Open-ended comment sections were included following each patient care category and after reviewing the entire set of recommendations.

The research plan was evaluated and deemed an exempt study by the Villanova University Institutional Review Board.

Results from Review of Literature

Conditions experienced by preterm birth survivors after the NICU are not unique to the preterm birth phenomena. In an exploration of the 2011−2012 National Sur- vey of Children’s Health data, the six most commonly occurring chronic health conditions in children were the same in full-term and preterm groups (Kelly, 2018), yet the preterm group experienced these conditions more often. Aylward (2005) described these conditions experienced by those born preterm as low severity, high-frequency conditions. The adult outcome literature supports similar patterns, that preterm birth survivors experience these conditions, whether in childhood or adulthood,  with increased frequency. Because most adult patients do not share or are not asked about their preterm birth his- tory, such conditions are not attributed to being born early.

Tables 2−4 present the findings that support the preterm birth history recommendations. The findings from the literature may be summarized in a few key points.

Preterm birth history increases an individual’s risk for:

1.Impaired school performance related to math, spelling, reading, receptive language, and decreased executive function (cognitive flexibility, working memory, and verbal fluency).

2.Behavioral and mental health concerns including depression, anxiety, and attention deficit hyperactivity disorder.

3.Cardiovascular disease, specifically hypertension, which poses an increased risk for females.

4.Pulmonary disease, specifically wheezing, asthma, and reduced lung capacity. This risk exists even for those without a history of bronchopulmonary dysplasia.

5.Motor delay, visuomotor integration disorders, and coordination impairment.

Results From External Review of Preterm Birth History Recommendations:

From the approximately 75 initial e-mail addresses, 28 respondents completed the evaluation survey (response rate of 37%). Responses were excluded if less than 25% of the survey was completed (n = 10 surveys). There were some items skipped on the survey, resulting in variation in responses per item from a maximum of 28 responses to a minimum of 20 responses. Agreement and feasibility per- percentages, as reported, are listed in Table 1.

There was an overwhelmingly positive response to the recommendations in both agreement and feasibility. Only two recommendations resulted in less than 85% agreement; both items related to screening for metabolic syndrome. There was an 83% agreement with the recommendation for monitoring of body fat mass at annual visits. There was a 78% agreement with screening to include fasting glucose, serum insulin levels, and lipid profile. Although some respondents disagreed with the recommendation, both were deemed feasible by 95% of respondents, suggesting that it could be accomplished without a significant burden to the patient, provider, or practice. None of the respondent’s feedback suggested significant adjustments to the individual recommendations.

Respondents shared suggestions for implementing the recommendations, including programming a hard stop in the electronic medical record for recording preterm birth history.

Respondents’ feedback related to implementation focused on the basic availability of necessary equipment such as appropriately sized blood pressure cuffs for all ages and sizes. Adherence to current American Academy of Pediatrics Guidelines for cholesterol screening was asserted. Respondents agreed with the recommendations and the need for avoidance of air and environmental toxins. Related to respiratory conditions, implementation recommendations included a call for upstream interventions to reduce overall air and environmental toxins.

Others shared concerns for implementation related to the availability of community support and patient resources varying by geographic region, which leads to difficulty in helping families in resource-poor areas. Concerns were raised regarding the accessibility and feasibility of lifestyle modification recommendations in patients without necessary resources. Respondents encouraged referrals to special infant care clinics, yet this is only available in some regions and typically only until 2 years of age. Others questioned if providers should reflexively screen all children born preterm for autism spectrum disorders or recommend starting elementary education with individualized education plans. Access to services and the importance of communication with the school system was represented in this response: “Access to services is often the biggest hurdle, as the PCP for a child/teen, supporting their needs in school is essential; however, much of those decisions are based upon the district.” Further concerns were related to the systemic racism and inherent inequities that contribute to preterm birth rates.

Recommendations related to metabolic syndrome risk had the lowest agreement percentages; 83% for monitoring body fat at annual visits and 78% for fasting glucose, serum insulin levels, and lipid profile screenings. One participant questioned the need for annual invasive testing. Other participants voiced concerns about the early onset of metabolic syndrome and obesity in preterm birth survivors and supported the recommendations suggesting that these were interventions currently being implemented in their practice. This response represented the recognition of the importance of weight gain early in the preterm birth survivor’s life and the difficulty in discussing obesity: “When preterm infants have struggled to gain weight, I think it’s really hard to discuss watching child’s weight post-discharge.”

Several agreed that premature birth should be a history feature that follows the patient into adult care. One pediatric provider shared:

I believe my practice is very good with identifying the needs for babies born prematurely. I also believe that for most this history does follow with them throughout their stay in pediatric practice. We do have diagnosis on their problem lists, but after they transition out, I do not know how the adult world cares for these patients or if they recognize that there are developmental or psychological issues created from prematurity.

Limitations

Although the researchers attempted to coalesce the most recent publications and findings related to broad outcomes for individuals born preterm, some cohorts analyzed in meta-analyses were born before the 1990s when exogenous surfactant became available and mechanical ventilation techniques improved considerably. It is important to recognize the heterogenicity of preterm birth outcomes and the varied proximal and distal protective factors that may alter those outcomes.

Implications

This set of preterm birth history recommendations is the first comprehensive document to advocate for universal recognition and appreciation of life course health risks related to an individual’s preterm birth history. These recommendations advocate a paradigm shift toward proactive intervention, rather than the reactive practice of waiting for children to fail to meet specific milestones or begin to show comorbid tendencies. The recommendations acknowledge the need for early identification, intervention, and family support for not just the most vulnerable infants but for all who were born before the completion of 37 weeks of gestation. It is with conscious intent that the authors make recommendations for surveillance and referral rather than for specific interventions. Each individual must be evaluated and managed as dictated by the specific features of their strengths and limitations.

Healthcare providers caring for an individual born pre-term should not assume that preterm birth concerns are left in the NICU or resolve at 2 years of age. Assumptions that individuals born preterm had the benefit of neonatal follow-up or even coordinated primary care on the basis of preterm birth status should not be made. Boone, Nelin, Chisolm, & Keim (2019) found that 47% of preterm participants lacked a medical home. The evidence for creating recommendations specific to individuals with a history of preterm birth through the life course is well established. However, dissemination directed at concrete ways to improve patient care has been limited.

The research aimed to coalesce the best available evidence to guide the development of initial recommendations. It is hoped that increased attention to potential risks will result in improved outcomes and decreased noncommunicable risk-based conditions in adulthood. With any new set of recommendations, there may be unanticipated risks. The increased provider attention to potential risk could result in perceptions of vulnerability in the patient or family. To balance this risk, the researchers support providers addressing preterm birth history in the same manner a family history of heart disease is addressed. Recognize it as a risk, advocate for lifestyle modifications that mitigate the risk, and intervene as necessary.

The patient care recommended is not vastly different from that provided to children born at term. Rather, the usual practice would be enhanced by a recognition of the potential increased risks. Health care providers should focus on facilitating chronic disease prevention by promoting healthy lifestyles and recommending early and continued support services for psychosocial and neurodevelopmental difficulties (Luu et al., 2017; Nuyt et al., 2017; Raju et al., 2017a; Raju et al., 2017b). Cardiovascular and pulmonary risk are discrete conditions with well-recognized management. It is important to highlight the psychological and behavioral conditions that may accompany preterm birth history. Behavioral and mental health are critical to development and transition to adulthood. Recognition and the early support of patients with these conditions are essential.

The implementation of these recommendations may look different in each practice setting. Resources are necessary to enact these recommendations fully. Geographic variation related to access to services will challenge an already stressed system. Concrete recommendations such as changing patient intake forms and built-in data entry requirements for electronic health records are a start. Further research will be required to evaluate implementation strategies and best practices.

The preterm birth history recommendations should continue as adolescents transition to adult health care. Respondents verbalized a lack of knowledge regarding adult provider preparedness in recognizing the implication of pre-term birth history. Recognition of the hypertension risks for adults with preterm birth history may mean intervening earlier with medications to decrease stroke risk. By developing practice recommendations supported by the evidence, there is a mechanism to increase provider awareness and subsequently improve physical and mental health outcomes. Increasing awareness through current and future health care provider education is imperative in bridging this gap (Kelly & Dean, 2017; Kelly & Michalek, 2019) and decreasing the challenges associated with the transference of care (Fernandes et al., 2010). Education is just one area of focus; advocacy and support of community resources must also be addressed. As noted by the respondents, there is a discrepancy in access to appropriate and necessary services that will require a collective approach in ensuring equity in obtaining the necessary community resources.

Conclusions

Through an in-depth review of literature and contributions from health care experts in pediatric and adult care, evidence-based recommendations were made that will assist in transformational health care for children, adolescents, and adults with a preterm birth history. The goal of these recommendations is the mitigation of chronic health sequelae throughout the life course. The researchers recognize that further investigation into the education and training of adult health care providers related to the implication of preterm birth history is warranted. The first step in reducing the potential for chronic health sequelae is incorporating the question, “Were you born preterm?” into all patient health histories and appreciating the implications of a positive response.

Preemie Triplets Overcome the Odds

August 7, 2020UVM Health Network Logo

They are miracle micro-preemies triplets Cian, Declan and Rowan DeShane, survivors of extremely premature deliveries whose birthdays span not just different days and months, but two different years and decades.

Cian was born first on Dec. 28, 2019. At just 22 weeks, 6 days, he was one of the youngest infants to arrive at UVM Medical Center’s Neonatal Intensive Care Unit (NICU). He weighed only 1.08 pounds, not much more than a 16-ounce bottle of soda.

On Jan. 2, 2020 – five days later – Cian’s identical twin brother, Declan, was born. He weighed 1.47 pounds. Within moments, the boys’ sister, Rowan, entered the world at 1.08 pounds.

Remarkably, each made it through the natural birth process. “When my water broke, I burst into tears because I didn’t think they could survive being born so early. I thought it was all over,” says their mom, Kaylie, who had worked with a fertility clinic to get pregnant.

Life-Saving Interventions

To put the DeShane triplets’ very early births into perspective, a baby is considered full-term at 39 weeks. The World Health Organization defines preterm as babies born before 37 weeks of pregnancy. Less than 32 weeks is defined as “very preterm” and at or under 25 weeks is “extremely preterm.” Until the past year or so, health care organizations like UVM Medical Center did not attempt high-tech intensive medical interventions to resuscitate infants born at 23 weeks or less because their survivability rate was so low and the and the list of diseases and disabilities so long for those infants who lived.

“Every organ and system in these extremely low birth-weight babies is ill-prepared to meet the world,” explains Roger Soll, MD, a neonatologist at UVM Medical Center and the  H. Wallace Professor of Neonatology at the Larner College of Medicine. He says there isn’t any one breakthrough that accounts for his team’s recent successes with extremely preterm babies.“ We’ve perfected our team approach to an optimal system of care, starting with maternal-fetal medicine during the pregnancy and delivery, and continuing to the NICU where respiratory therapists, nurse practitioners and nurses all work together to provide round-the-clock care.”

Hannah Jackman, RN, has a vivid memory of the day Cian was born. “It seemed like there were dozens of healthcare workers in the delivery room, all in yellow gowns, awaiting three tiny triplets. I was one of them, and I remember my heart feeling like it was leaving my chest as I watched Cian’s parents sob and pray,” she says. “I wanted a miracle for this family so badly.”

For Kaylie and her husband, Brandon, the decision was easy. They told the medical team: “Do everything to save them.”

Cian was immediately intubated. Declan and Rowan were both septic at birth and given intravenous antibiotics. The infants were placed in incubators, wires connecting them to monitors so caregivers could keep track of their temperatures, heart rates and breathing. Tubes delivered medicines and fluids to their tiny veins. Pulse oximeters measured the oxygenation of their blood.

Despite the tangle of equipment, mom and dad were encouraged to hold their infants skin-to-skin. During the triplets’ months-long stay in the NICU, the couple made certain one of them was there every day. They each spent weeks at a time at the Ronald McDonald House while the other tended to their two older children at home three hours away in Norwood, N.Y. When visitors were restricted to one parent per pediatric patient due tothe COVID-19 pandemic, the couple joked that they had more than enough babies to be allowed in the NICU together on weekends.

“We were already in survival mode when COVID hit, so it was just one more thing,” Kaylie says. “We were already washing our hands constantly and being especially careful to keep them safe from any germs.”

It Takes a Team

The infants had their own primary nurses assigned to them during every shift of every day. This consistency of care meant that every potential problem was noticed and immediately attended to.

After Cian’s birth, nurse Jackman signed up to be his primary nurse during her 12-hour day shifts.

“I got to spend four months caring for this tiny but mighty human, watching in amazement as he overcame obstacle after obstacle.” Hannah Jackman, RN,University of Vermont Medical Center.

“It is a relationship like no other – these parents are trusting you with their newborn. Advocating for Declan became my biggest priority,” says Julia Watsky, RN, one of the trio of primary nurses dubbed the “dream team” who worked the night shift on Sundays, Mondays and Tuesdays. “I learned every aspect of Declan’s care – from how he liked to be positioned to knowing when

One night Ashley Ostler, RN, noticed that the normally lively Rowan was hardly reacting to her.

“Rowan is typically a sweet, feisty lady. She is not exactly patient and she makes her demands known,” observes Ostler. “She often made me laugh late at night because she really does know how to push your buttons while melting your heart with her adorable little face.”

When Rowan went limp and her abdomen became distended, Ostler rightly suspected she had developed a common but serious intestinal disease called necrotizing enterocolitis, or NEC, which required many interventions until she stabilized.

Cian also developed NEC and, at one point, his parents were asked to create an end-of-life plan. “That taught me to never think we were out of the woods,” Kaylie says.

Lindsey Flanders, RN, remembers the night when Cian’s oxygen needs kept climbing until he reached 100 percent and couldn’t go any higher. “Knowing Cian, I knew this wasn’t his norm and that he needed additional support to bring his oxygen requirement back down.” He was started on nitric oxide to relax the vessels in his lungs and that did the trick.

After 106 days in the NICU, Declan, nicknamed “the Chunkster” because he was the heaviest of the bunch, was the first to go home on April 17. “It was truly a bittersweet moment” says nurse Watsky, who made certain to be there to say goodbye to Declan, even though it was her day off. “After seeing him grow from just over 1 pound, to learning how to eat, how to breathe on his own, and so much more in between – I was so proud of him,” she says.

“Rockstar Rowan” went home on April 30. And firstborn Cian finally joined the rest of his family on May 4. “I’m so proud of the chubby, feisty, blue-eyed, beautiful boy he is,” nurse Jackman says.

The triplets left the NICU with respiratory support and monitors but eating all of their foods without issue. As of July 15: Cian was 13 pounds, 1 ounce; Declan was 14 pounds, 11 ounces; and Rowan was 10 pounds. They are hitting all of their milestones — babbling, cooing, laughing, smiling and rolling over.

The DeShanes’ relationship with UVM Medical Center is far from over. They make regular visits to see a pediatric pulmonologist and ophthalmologist. And neonatologist Deirdre O’Reilly, MD, director of UVM Medical Center’s Neonatal Medical and Developmental Follow-up Clinic, will see the preemies regularly during their first three years to assess their progress, especially regarding motor, language and cognitive skills. If there are gaps, her staff will connect them to the appropriate supportive services. “Getting adequate and targeted therapies can be life-changing for babies,” she says.

In her 13 years of practice, Dr. O’Reilly had never seen a baby born as early as Cian survive. Each of the triplets are doing better than she expected, and that success is what makes her work so worthwhile. She says: “It really is amazing, because you can learn about the numbers of premature infants that survive, but really experiencing it with the parents and seeing the joys in their faces, and the kids too, it’s just magnificent.”

Source:https://www.uvmhealth.org/healthsource/miracle-micro-preemie-triplets-overcome-odds

Breastmilk for preterm babies | pumping | exclusive human milk diet and donor human milk bank

CanadianPreemies  Aug 3, 2020

Fabiana Bacchini, CPBF’s Executive Director, talks with Natalie Millar about the importance of breastmilk for preterm babies, pumping, exclusive human milk diet and donor human milk bank. . Natalie has been a clinical dietitian for 15 years with 10 years dedicated to the Regina General Hospital NICU. She is a certified lactation consultant; co-chair of the Donor Human Milk committee of Saskatchewan and Coordinator of the Regina General Hospital’s Milk Drop for NorthernStar Mothers Milk Bank Milk. According to her two young kids, Natalie’s job is to steal milk from ladies and feed it to all the teeny babies.

Strategies to Improve Mother’s Own Milk Expression in Black and Hispanic Mothers of Premature Infants

Cartagena, Diana PhD, RN, CPNP; McGrath, Jacqueline M. PhD, RN, FNAP, FAAN; Reyna, Barbara PhD, RN, NNP-BC; Parker, Leslie A. PhD, RN, NNP-BC, FAAN; McInnis, Joleen MS, LIS, MFA Strategies to Improve Mother’s Own Milk Expression in Black and Hispanic Mothers of Premature Infants, Advances in Neonatal Care: February 2022 – Volume 22 – Issue 1 – p 59-68 doi: 10.1097/ANC.0000000000000866

Abstract

Background: 

Mother’s own milk (MOM) is the gold standard of nutrition for premature infants. Yet, Hispanic and Black preterm infants are less likely than their White counterparts to receive MOM feedings. Evidence is lacking concerning potential modifiable factors and evidence-based strategies that predict provision of MOM among minority mothers of premature infants.

Purpose: 

A review of the literature was conducted to answer the clinical question: “What evidence-based strategies encourage and improve mother’s own milk expression in Black and Hispanic mothers of premature infants?”

Methods/Search Strategy: 

Multiple databases including PubMed, Cochrane, and CINAHL were searched for articles published in the past 10 years (2010 through May 2020), reporting original research and available in English. Initial search yielded zero articles specifically addressing the impact of lactation interventions on MOM provision in minority mothers. Additional studies were included and reviewed if addressed breastfeeding facilitators and barriers (n = 3) and neonatal intensive care unit breastfeeding support practices (n = 7).

Findings/Results: 

Current strategies used to encourage and improve MOM expression in minority mothers are based on or extrapolated from successful strategies developed and tested in predominantly White mothers. However, limited evidence suggests that variation in neonatal intensive care unit breastfeeding support practices may explain (in part) variation in disparities and supports further research in this area.

Implications for Practice: 

Neonatal intensive care unit staff should consider implementing scaled up or bundled strategies showing promise in improving MOM milk expression among minorities while taking into consideration the cultural and racial norms influencing breastfeeding decisions and practice.

Implications for Research: 

Experimental studies are needed to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers.

Source:https://journals.lww.com/advancesinneonatalcare/Abstract/2022/02000/Strategies_to_Improve_Mother_s_Own_Milk_Expression.12.aspx

Cardiologists are using a new device to help treat micro-preemies — babies born before the 26th week of pregnancy and/or weighing less than 2 pounds — who develop a life-threatening heart defect at birth.

By: Sara Sidery • Posted: January 17, 2022

State-of-the-art technology is helping save the lives of some of Louisville’s youngest patients.

Cardiologists are using a new device to help treat micro-preemies — babies born before the 28th week of pregnancy and/or weighing less than 2 pounds — who have a heart defect caused by part of the fetal structure that remains at birth.

Joshua Kurtz, M.D., pediatric cardiologist with Norton Children’s Heart Institute, affiliated with the U of L School of Medicine, has performed numerous successful procedures to treat this defect known as a patent ductus arteriosus (PDA). It is one of the most common congenital heart defects in premature babies.

The PDA is a connection between the blood vessels that carry blood from the heart to lungs and the rest of the body. A normal part of fetal development, the opening allows the mother’s body to provide enough blood and oxygen until birth. Soon after a newborn takes its first breaths, the opening typically closes automatically, but with some premature babies, it remains open.

“The PDA causes excess blood from an infant’s heart to pump into their lungs, which can lead to fluid in the lungs or heart failure and make it difficult to breathe and grow  if not addressed,” Dr. Kurtz said. “This new advancement in technology allows us to respond quickly with a minimally invasive procedure.”

The Amplatzer PiccoloTM Occluder, approved by the Food and Drug Administration in 2019, is an alternative to open  surgery and can close the opening in a baby’s heart with fewer risks and a speedier recovery. The “PiccoloTM” device, which is the size of a small pea, is implanted by using a special IV known as a sheath in the infant’s leg and guiding the device through blood vessels to seal the connection in the blood vessels. Healthy tissue eventually grows around the small mesh piece.

Recently, a team at Norton Children’s Heart Institute successfully performed the procedure on a 2.4-pound micro-preemie who was born at 24 weeks and  had  heart failure due to the PDA. Dr. Kurtz and his colleague Dr. Edward Kim performed three additional procedures in early December, and the babies — who weighed less than 2.5 pounds — were able to continue their recovery in the neonatal intensive care unit.

The Amplatzer PiccoloTM Occluder is just one piece of advanced equipment at Norton Children’s Heart Institute that can help treat heart defects commonly seen in babies. Using the latest technology means children undergoing treatment or diagnosis in the catheterization lab will receive less radiation, speedier, and more accurate procedures, according to Dr. Kurtz.

Source:https://nortonchildrens.com/news/heart-defects-in-babies/

The Teladoc device connects consultants.

Hospital robots will save the lives of hundreds of premature babies

The technology is already enabling consultants to work at multiple sites at once, saving vital time

James Tapper Sun 21 Nov 2021

Hundreds of premature babies could be saved by using new technology trialled during the pandemic that will allow doctors to treat them remotely, leading doctors say.

Telemedicine “robots” that enable consultants to make bedside video calls have been used at Liverpool Women’s and Alder Hey children’s hospitals to treat sick babies.

Now the head of the hospitals’ neonatal unit is putting together plans to use the Teladoc devices, so that specialists can use their expertise to help teams at smaller hospitals treat children, even in emergencies.

Dr Chris Dewhurst, the clinical director of the Liverpool Neonatal Partnership, said: “This definitely has the potential to save the lives of extremely preterm infants who were born outside of specialist centres, and improve their outcomes.

“What we’ve demonstrated is that it’s easy to use, it improves the quality of care for babies and their families, improves the speed of review, and it is very close to being there in person.”

The device, which sits on a mobile frame, has cameras, a screen and even a stethoscope, and can also link to MRI scanners and thermal-imaging cameras. It allows a consultant watching from elsewhere to view a patients’ medical records on the spot.

Dewhurst and his team began using two of the devices in March 2020. “We lost seven of our 14 consultants due to shielding or isolation – 40% of the time available for clinicians to be in hospital. It [the robot] kept us going.”

On some occasions, using the robots was better than being there in person, because the device has a camera on a boom that can be placed above the baby to show what’s happening, he said. “If I was there in person, I wouldn’t be able to see that because there were people around the baby.”

About 90,000 babies a year in England need some sort of specialist care after they are born. There are 54 Neonatal Intensive Care Units (NICUs) such as the one in Liverpool that treat the most serious cases of premature babies and those with serious conditions. Another 83 hospitals have Local Neonatal Units (LNUs) that offer short-term intensive care. And there are 44 Special Care Baby Units for monitoring the least serious cases.

Doctors try to identify which foetuses might require help after birth, but that is not always possible, and 9,523 babies needed to be transferred between hospitals at least once in 2015, according to figures from the National Neonatal Audit Programme compiled by Bliss, the charity for babies born sick or prematurely.

“For babies who are extremely preterm, and have not been able to move into an NICU, then they’re not going to be looked after by people with the specialist skills. And we know that those babies have worse outcomes,” Dewhurst said.

He is bidding for funding for the devices in hospitals with SCBUs so that clinical teams can call on specialist advice quickly.

“We now need to find the funding so that babies who were born in other hospitals who need immediate intervention can have an neonatologist there immediately, within minutes, rather than them not being there at all, because they’re 40 to 50 miles away.”

A similar system has been run by the Mayo clinic in Rochester, Minnesota, where neonatologists support teams at 19 regional hospitals.

Dr Jennifer Fang, medical director for the Mayo Clinic’s teleneonatology programme, said that only babies in a critical condition needed to be transferred, and fewer parents had to go through the stress of being separated from their babies.

“What we’ve observed is that the odds of a baby needing a transfer to a higher level of care or transfer to a hospital with an NICU are reduced by anywhere from 30 to 50%,” she said.

With difficult births or injuries to babies during birth, the Mayo specialists have a target to be on hand for remote consultations within five minutes.

Before the programme, the clinic was involved in birth-injury lawsuits about every eight to nine months, Fang said. “Now that our programme’s in place, we haven’t had a single birth-injury case for the last eight years.”

A study by the clinic showed that having neonatologists involved remotely meant that clinical teams in smaller hospitals were less likely to be overwhelmed by the complexity of dealing with a sick baby. Babies were more likely to have checks on temperature, breathing and glucose levels.

Jonathan Patrick of Consultant Connect, which supplied the robots, said the devices could be used in other circumstances. “It allows you to have access to clinicians, for example, who have retired but still want to be part of the workforce, yet can’t go to hospital every day.”

A trial is underway at University Hospitals Leicester NHS Trust where consultants doing elective surgery are often split across two sites. Dr Steve Jackson, who is running the trial, said that consultants on different sites could dial in to a consultation and discuss the case on the spot rather than doing separate ward rounds.

Source:https://www.theguardian.com/society/2021/nov/21/hospital-robots-will-save-the-lives-of-hundreds-of-premature-babies

Retinopathy of Prematurity Requiring Treatment Is Closely Related to Head Growth during Neonatal Intensive Care Unit Hospitalization in Very Low Birth Weight Infants

 Bae S.P.a · Kim E.-K.b · Yun J.c · Yoon Y.M.d · Shin S.H.b · Park S.Y.e

      Neonatology  https://doi.org/10.1159/000519714

Abstract

Background: Retinopathy of prematurity (ROP) is caused by prenatal sensitization and postnatal insults to the immature retina. This process can be associated with the postnatal growth of preterm infants. We investigated whether ROP requiring treatment was associated with the postnatal growth failure of very low birth weight (VLBW) infants. 

Method: From a cohort of VLBW infants (birth weight <1,500 g) registered in the Korean Neonatal Network from January 2013 to December 2017, 3,133 infants with gestational age (GA) between 24 and 28 weeks were included in the study. Postnatal growth failure was defined when the change in each anthropometric z-score between birth and discharge was <10th percentile of the total population. Propensity score matching (PSM) at 1:1 was performed to match the distribution of GA and postnatal morbidities between infants with and without ROP requiring treatment. Prenatal factors and ROP were analyzed by conditional logistic regression. 

Results: Of 3,133 enrolled infants, 624 (19.9%) were diagnosed with ROP requiring treatment. After PSM, ROP requiring treatment was associated with postnatal growth failure assessed by head circumference (adjusted odds ratio [aOR] 1.91, 95% confidence interval [CI] 1.18–3.09), but not weight (aOR 1.45, 95% CI 0.97–2.17) and length (aOR 1.21, 95% CI 0.81–1.82). 

Conclusion: ROP requiring treatment was associated with poor head circumference growth, not with weight and length. Our findings suggest that ROP requiring treatment and poor head growth during NICU hospitalization are fundamentally related.

Source: https://www.karger.com/Article/FullText/519714

A digital decision aid for shared decision-making in prenatal counseling

February 10, 2022   Lindsey Carr, Associate Editor

van den Heuvel JFM, Hogeveen M, Lutke Holzik M, van Heijst AFJ, Bekker MN, Geurtzen R. Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing. BMC Med Inform Decis Mak. 2022;22(1):7. Published 2022 Jan 6. doi:10.1186/s12911-021-01735-z

When pregnant women and their partners experience imminent extreme premature labor, they must decide how to proceed if labor continues. With the risks of morbidity and mortality in extremely premature infants, 2 procedures are considered treatment options. Through shared decision-making with their provider, patients choose treatment based on their values and preferences; Palliative comfort care—providing warmth and comfort with no medical assistance—or early intensive care—resuscitation of the infant and initiation of neonatal intensive care (NICU).

Because the treatment options for imminent extreme premature labor center largely on patient preference, decision aids (DA) can help facilitate the patient-provider discussion and guide the shared decision-making process.

Providers often use DA tools to assist in patient education, prenatal counseling, and shared treatment decisions regarding imminent extreme premature labor, including:

  • A card set with images and illustrations of survival rates and NICU complications
  • 10-minute video clips of parents discussing treatment choice and explaining their decision
  • a tablet application
  • a virtual reality experience

Researchers in the Netherlands developed an open-access, web-based DA that informs, guides, and supports the prenatal counseling process for patients and providers.1

Dutch national guidelines for prenatal counseling in imminent extreme preterm labor were published in 2019 using the International Patient Decision Aid Standards (IPDAS) process. They conducted surveys and interviews with patients and providers to determine general views and preferences on prenatal counseling, as well as DA preferences and concerns. They concluded that, while both patients and providers wanted supportive materials to assist verbal conversation, they were not readily available.

Researchers in the Netherlands used these initial findings to inform development of a digital DA. To create the prototype, they recruited individuals previously involved in the Dutch guidelines’ development for multiple rounds of testing—6 sets of parents with children born extremely premature (between 240/7 weeks and 246/7, 2 obstetricians, 1 neonatologist, 1 expert in quality-of-care improvement, 1 DA-development professional, and 1 Dutch language expert.

An online module, complete with graphics, then became the initial prototype. Researchers tested feasibility on a group of providers and pregnant women who were not involved in earlier testing. Patients comprised of 2 groups—group 1 comprised pregnant women between 240/7 and 24 6/7 weeks gestation who presented to an outpatient clinic for a routine antenatal visit with no history of premature delivery (n=4). The second group included pregnant women admitted for imminent preterm labor <246/7 weeks gestation and received antenatal counseling (n=3).

Clinician participants included 4 obstetricians and 4 neonatologists from 2 Dutch university hospitals with NICU facilities. Both parties filled out a questionnaire consisting of a rating from 1-5 (very much disagree-very much agree), plus 3 elements they liked and 3 that could be improved.

Researchers ultimately included the following informational content into the DA:

  • General information on imminent extreme premature labor
  • explanation of the 2 options: early intensive care or palliative comfort care
  • consequences of comfort care (such as, no need for invasive procedures, expected death within hours following birth)
  • mortality and survival rates
  • risks and long-term results for extreme preterm infants to have neurodevelopmental
  • physical, visual, and hearing problems

For decision support, they included a comparison page, key points, and “my choice,” which reflected parental values and standards. Visual elements in the DA included an illustration of 2 neonates to compare size and weight after extreme preterm birth and term delivery, an image of an extremely preterm infant in an incubator (active care) with notes on all life-supporting devices, an image of parents holding an infant in blankets (comfort care) and illustrations to show possible disabilities.

In its final form, the DA became a web-based platform available to Dutch providers and patients via internet, tablet, and smartphone browsers. It has been approved by the Dutch Society of Obstetrics and Gynecology, the Dutch Pediatric Society, and the Dutch patient organization CARE4NEO.

The decision-support elements in this web-based DA tool set it apart from others currently available. Researchers noted that the DA should support, not replace, the verbal counseling conversation. It may also be used by patients prior to and following counseling.

“Focusing on the format and distribution of our DA, we developed a freely available online DA and, moreover, included features to support decision making and help parents think about their values and preferences,” the authors wrote. “This is anticipated to enhance the uptake and use of the DA amongst different types of users, and we hope to increase the involvement of parents in decision-making.”

Source:https://www.contemporaryobgyn.net/view/a-digital-decision-aid-for-shared-decision-making-in-prenatal-counseling

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Feb 24, 2018       SUCCESS INSIDER

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