Let’s Thrive, Compendiums, Navigation

Kuwait, officially the State of Kuwait, is a country in West Asia and the geopolitical region known as the Middle East. It is situated in the northern edge of the Arabian Peninsula at the tip of the Persian Gulf, bordering Iraq to the north and Saudi Arabia to the south. With a coastline of approximately 500 km (311 mi), Kuwait also shares a maritime border with Iran, across the Persian Gulf. Most of the country’s population reside in the urban agglomeration of Kuwait City, the capital and largest city. As of 2024, Kuwait has a population of 4.82 million, of which 1.53 million are Kuwaiti citizens while the remaining 3.29 million are foreign nationals from over 100 countries. Kuwait has the third largest foreign-born population in the world.

Like most other Arab states of the Persian Gulf, Kuwait is an emirate; the emir is the head of state and the ruling Al Sabah family dominates the country’s political system. Kuwait’s official state religion is Islam, specifically the Maliki school of Sunni Islam. Kuwait is a high-income economy, backed by the world’s sixth largest oil reserves.

Kuwait has a state-funded healthcare system, which provides treatment without charge to holders of a Kuwaiti passport. A public insurance scheme exists to provide healthcare to non-citizens. Private healthcare providers also run medical facilities in the country, available to members of their insurance schemes. As part of Kuwait Vision 2035, many new hospitals have opened.

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

Published 15April 2024

Reem Al-SabahAbdullah Al-TaiarAli H. ZiyabSaeed Akhtar & Majeda S. Hammoud

Abstract

Background

Pregnant and postpartum women are at high risk of depression due to hormonal and biological changes. Antenatal depression is understudied compared to postpartum depression and its predictors remain highly controversial.

Aim

To estimate the prevalence of depressive symptoms during pregnancy and investigate factors associated with this condition including vitamin D, folate and Vitamin B12 among participants in the Kuwait Birth Study.

Methods

Data collection occurred as part of the Kuwait Birth Cohort Study in which pregnant women were recruited in the second and third trimester during antenatal care visits. Data on antenatal depression were collected using the Edinburgh Postnatal Depression Scale (EPDS), considering a score of ≥ 13 as an indicator of depression. Logistic regression was used to investigate factors associated with depressive symptoms in pregnant women.

Results

Of 1108 participants in the Kuwait Birth Cohort study, 1070(96.6%) completed the EPDS. The prevalence of depressive symptoms was 21.03%(95%CI:18.62–23.59%) and 17.85%(95%CI:15.60-20.28%) as indicated by an EPDS ≥ 13 and EPDS ≥ 14 respectively. In the multivariable analysis, passive smoking at home, experiencing stressful life events during pregnancy, and a lower level of vitamin B12 were identified as predisposing factors. Conversely, having desire for the pregnancy and consumption of fruits and vegetables were inversely associated with depressive symptoms.

Conclusion

Approximately, one fifth of pregnant women had depressive symptoms indicating the need to implement screening program for depression in pregnant women, a measure not systematically implemented in Kuwait. Specifically, screening efforts should focus on pregnant women with unintended pregnancies, exposure to passive smoking at home, and recent stressful live events.

Source: https://link.springer.com/article/10.1007/s44197-024-00223-7

18 July 2024

 | Technical document

Overview

Access to appropriate, affordable, effective, and safe health technologies is paramount, especially in low-resource settings, where burden of  non-communicable diseases adds on to the infectious diseases.   

NCDs account for a staggering 74% of global deaths, with 86% of premature fatalities occurring in resource-constrained regions. Cardiovascular diseases, cancers, chronic respiratory conditions, and diabetes collectively contribute to over 80% of these premature NCD-related deaths. Addressing this challenge requires targeted interventions and innovative solutions tailored to LMICs.

The 2024 Compendium of Innovative Health Technologies for low-resource settings includes commercially available solutions and prototypes. This 7th edition showcases 21 technologies, each with a full assessment. It also includes updates for technologies previously featured in previous compendia editions. Assessments include clinical aspects, relation to WHO technical specifications, regulatory compliance, criteria on health technology assessment and health technology management, local production viability, and intellectual property considerations.

Beyond presenting these innovations, the Compendium serves as a catalyst for increased interaction among stakeholders—ministries of health, procurement officers, donors, developers, biomedical engineers, clinicians, and users. By providing evidence-based assessments and relevant information, it aims to drive use of innovative health technology and expand global access, particularly for low-resource settings for populations in need.

WHO Team

Access to Assistive Technology and Medical Devices (ATM), Access to Medicines and Health Products (MHP), Health Product Policy and Standards (HPS), Medical Devices and Diagnostics (MDD)

Editors World Health Organization ISBN: 978-92-4-009521-2

Source:https://www.who.int/publications/i/item/9789240095212

Humood – Kun Anta | حمود الخضر – كن أنت | Official Music Video

Humood Othman AlKhudher, commonly known as Humood Alkhudher, is a Kuwaiti singer and music producer.

* English Translation https://youtu.be/9JPaGW21Rzg

Benjamin Hopkins, DO, Andrew Hopper, MD

Welcome back to another installment. My name is Benjamin Hopkins, and I am currently a post-grad year one pediatric resident at the University of California, San Francisco–Fresno. When ‘I grow up,’ I want to be a Neonatologist. Look at previous months’ journals for my earlier articles and follow along with this column as I navigate my way to becoming a neonatologist.

 I am just over halfway done with my residency intern year. I have recently completed a rotation through inpatient wards, getting to see a variety of ages and patient presentations, along with consults to other specialties helping care for pediatric patients. I have been privileged to work closely with my fellow residents and supervising attendings who tailor their care for each patient they see.

This month, I had the privilege to talk with Dr. Andy Hopper, Chair of the LLU School of Medicine Promotions Committee and professor of pediatrics and neonatologist at Loma Linda University. We discussed the characteristics of an outstanding neonatologist, how he became a neonatologist, what a resident should prioritize, and some of his current interests and research.

What qualities are most essential to excel as a neonatologist?

 First, you’ve got to like working with babies and the excitement of thinking about and caring for a young patient who has their entire life in front of them. Your interaction with them will allow them to achieve health so they can have that life in front of them. That’s always the prime directive for me when I’m looking to look after a baby. Can we get these kids through whatever problem they’re having so they can go home and live their best life? You have to have a passion for the patient population that you’re going to serve.

That goes for any specialty, but especially for the specialties that are critical care, where it takes more of an emotional burden from time to time and with the care and investment you have towards that patient population when there is, you know, loss or things don’t go the way we want them to and just making sure like we have support and things like that for those areas.

You’re also the doctor to the parents. Most parents, when they landed in the NICU, never planned for this to be the outcome. They’re immediately thrown into this rather harsh environment of bells, whistles, monitors, and people doing things that they’re not sure what they’re doing for their child, but it’s pretty scary. As the neonatologist, this is one of the areas that you have to work with them, and you’re educating them. We’re also trying to give them peace, and you’ll help them get through this. It is a team effort in our specialty, but the physician and the parents have to collaborate to make it work.

We have two daughters, and when I was a pediatric resident, my first daughter was born at 33 weeks. I don’t think we were particularly freaking out about that, but she was preterm. Then, my younger daughter was born when I was in my neonatology fellowship at Stanford. She was 27 weeks, and back in 1982, the year she was born, 28 weeks was considered the limit of viability; they’re different now, and the numbers have come down dramatically. However, I remember my faculty members saying that if she is not too aggressive, we may not want to go all out to resuscitate her because they were thinking the worst. Fortunately, she came out, and she was vigorous. Four hours out, she reached up and pulled her ET tube out; the rest is history.

Another beneficial quality in intensive care is when you’re looking at things to map out what you think will happen in the next 12 to 24 hours; what’s the worst-case scenario, and am I ready to deal with that? When they don’t happen, you’re thrilled, but when they do happen, you’re not caught off guard. I was the director of the ECMO program at Loma Linda for 10 years, and it was always determining who we would put on ECMO and when to do it. That’s where you have to sit down and map out what would be the things that would make me push towards putting this kid on ECMO. It’s an approach that uses differential and critical thinking so that you can be proactive rather than reactive. It’s not a good idea to be catching up with a kid in a code where you thought four hours ago we should have picked up on this, and we could have prevented this.

An excellent bedside nurse will make your night much better because you trust their assessment; I’ve had nurses call me and say, “I was here yesterday. I can’t put my finger on it today, but something’s not right with this kid.” That’s all I need to hear because then I will look carefully to say, what’s different? Is it a heart rate change since the kid has early onset sepsis, or is this a baby with a cardiac lesion that’s ductal dependent, and maybe the duct is closing? Very few things are crash-and-burn type things, but you need to be ready to recognize when those things are happening to connect on that.

When I was in training, we had fewer options; now, there are five or six different kinds of mechanical ventilation, and you use them for various reasons. When I was in training, you either mechanically ventilated them with a pressure-limited time cycle ventilator or didn’t. Those were the times when faculty were home at night, and you were there on the front lines. Part of that, I’m not saying it was always a good thing, but you were the person who had to make those decisions at 2 a.m.; there wasn’t anybody else around.

I remember, as a first-year fellow at Stanford, when I would call the attending and say, “I’ve got this sick kid with meconium aspiration and pulmonary hypertension; these are the things I’m doing. This is what I’m thinking about.” I remember the attending said, “Wow, that kid sounds sick. Good luck. I’ll see you tomorrow.” Then you think, “You know what, this is on me.” They don’t do that anymore, and I’m not saying that was a good role model of the time; it was just different in those days.

What caused you to pursue a career in neonatology?

I can tell you precisely what happened when I was doing my pediatric rotation as a third-year medical student, and I was assigned to a NICU. I went to the University of Texas in San Antonio, and we were down at a county hospital. The intern became ill and was off. The senior resident and attending said, “Okay, you’re a third year medical student; you’re now the intern.” I got promoted very quickly, which was scary, but it was also exciting to be given that responsibility. I had a lot of guidance; that wasn’t something I just did, but I enjoyed the mix of doing procedures, putting in lines, being able to intubate, and putting in chest tubes. Plus, you’re the doctor, the whole doctor, not just the orthopedist or the hematologist. You’re the doctor, covering everything for this unique population. I wouldn’t do well in a clinic setting because I like the adrenaline rush of helping a kid when you don’t know which way things are going. I like the excitement of inpatient medicine and the ability to be that detective to figure out the most likely thing that’s going on. I did my neonatal training at Stanford, but then I was in a quandary about whether I wanted to do PICU. I had the option of going to CHOP, but the way they did their PICU training was they had you go through anesthesia training and then, on top of that, to PICU. After three years of residency and neonatology, my family asked if I was serious about another five or six years. I then ended up going to UCSF to do an additional year there in the old hospital in Parnassus, where we had a Peds ICU on  the sixth floor, and we had cardiac and post-cardiac recovery.

As the PICU fellow, the cardiac surgeon would come in, do an extensive surgery, and it’s five o’clock, and he’s telling you about all the horrible things that could happen after the surgery, and then, his parting words are, “don’t let this kid die.” That was before we had good monitoring or many medications. We had isoproterenol and epinephrine, and it was a juggling act, where you were at the bedside all night trying to keep this kid in bounds so that the following day, you could sign out to the next person; the whole mindset was to keep him alive till 8.05. There was much fear back then; it’s much better now, but it was through fear and intimidation for some of those encounters.

What do you now know that you wish you knew before going into neonatology?

That’s a good question; if I replayed my career, I was focused on clinical stuff. When I was a fellow at Stanford, we had a rotation where you were on service for an entire month, morning and night, seven days a week; you would rely on your colleagues to support you. I would have liked to have had an opportunity to focus on research and academics for a year after the clinical training. If I could replay what I did again now, I would have taken that extra year in pulmonology or neurology because those are the things I’m passionate about. You learn on the job; at the time, I didn’t think I could put my family through that. It’s not always apparent that that’s something I could have done. But if I could replay that, I would have tried to do an extra year or two. Many people now have MD/PhD degrees, which is fine. I didn’t need a PhD, but an additional year of training in working with people would have been a way to solidify a more substantial research career for me.

What are you currently working on? I’m working part-time now and fill in when people need help. We have a fellowship program, and I have three fellows I mentor and help with their SOC projects required for fellowship. I miss bedside teaching, but I give lectures and didactics for fellows. We have a couple of new faculty members that I’m also trying to work with, and I am trying to educate our nurses because you need to have excellent nurses. That’s what makes a unit good: good nurses and RTs. It was much different then, but one of the reasons you could survive a crazy month of fellowship was because you had RTs that were on to help you, and they were very professional in what they were doing. Fostering teamwork and education is something I still enjoy.

I am still particularly energized when I go to a good research meeting. It excites you; I’m jealous of guys like you who are beginning their careers because I can only imagine what new neonatology will be like in 10 years. You’ll also have all kinds of genetic capabilities to make diagnoses and genetic-based treatments. Neonatology is a relatively new field with new treatments. My career has been almost 40 years, and when I started, we didn’t have surfactants or artificial surfactants. We barely had TPN, which was adult TPN watered down for babies. We didn’t have nitric oxide treatment or neonatal ECMO. All these things resulted from people doing research and wanting to improve the outcome of kids.

Even in a unit like Kaiser, the way that they do their research may be less of a bench-top approach, but they do some incredible QI work that helps develop protocols. We have a small baby unit with extremely preterm kids, and everything is driven by protocol. However, the idea is that you’re constantly refining and evaluating those protocols to see if they’re the best. You’re analyzing, making changes, and evaluating the changes to see if that makes things better. It is a good way to do medicine in general, and neonatology thrives on that approach.

What would you encourage a future neonatologist to prioritize and be involved in? I

t’s a little different now; people come into the fellowship, and they have been doing neonatal electives, and that is to their advantage is to have a little bit of familiarity with neonatology so you’re not going to freak out. We have a massive unit with high acuity, which can be overwhelming for somebody with no neonatal background before the pediatric residency program. I’m not saying it’s right or not, but residents in pediatrics used to have six months of neonatology. Now that’s been watered down by the ACGME, you only have three months. You’re coming into a fellowship with a significantly different background than we did before. You’ll learn to be an outstanding neonatologist.

What you want to do now is take advantage of some ancillary subspecialties like cardiology. I would also consider doing a PICU elective because many of these babies will graduate and go to the PICU. We have babies in our unit in Loma Linda that are seven or eight months old. They’re no longer neonates, so having that experience is beneficial. Neurology is another area where there’s so much of it in neonatology that a good neurology background, teaming up with a neonatal neurologist who cares about those babies, can show you how to do an appropriate, careful physical and neurologic exam. Take advantage of that stuff because you don’t get a chance to do that later on.

Having been in this field for this long, I have a couple of things I did that I have enjoyed: working at Loma Linda and the friendships of my colleagues—I value what they do. They’re good people, and our group is collegial. It’s stressful, so the ability to work with people who care for you makes a big difference. You may not be close buddies with them all, but they respect you, and you respect them. An example is if you were sick and you couldn’t do your call, I can tell you my experience has been if I call in and say, “Hey, you know, I’m sick this evening. Can anybody take my call?” Usually, within 10 minutes, somebody says, “Yeah, I’ll do your call.” That kind of support makes a big difference; people have your back, which is nice; generally, it’s a great specialty.

Developmental Care

The majority of babies born prematurely do well and develop normally, however, the risk of developmental problems is considerably higher than in the rest of the  population and the risk increases proportionately with the degree of prematurity.  About half of the infants born preterm (before 28 weeks) will require some form of specialist help when they start school: for those born between 28 and 32 weeks this figure decreases to 30%. The range of problems is wide and they often overlap or present in clusters so that a child may have a complex developmental profile.

Problems include:

  • Altered pain perception
  • Anxiety and Depression
  • Attachment disorders
  • Attention deficit disorder
  • Autism
  • Behavioural problems
  • Cerebral Palsy
  • Cognitive deficits
  • Co-ordination disorders
  • Executive Functions
  • Feeding problems
  • Hearing loss
  • Hyperactivity (related to attention deficit)
  • Language delay
  • Memory
  • Perceptual motor problems
  • Sensory Processing
  • Social isolation
  • Specific learning deficits (e.g maths)
  • Timidity/withdrawal
  • Visual deficits

Developmental care improves the potential of infants who are disadvantaged by premature birth or adverse perinatal events by supplementing and humanizing high tech medical care.

In many units the focus of developmental care is Family Centered Care (FCC). In FCC units the importance of the family as the most significant influence on the infant’s well being and development is underlined and parents and healthcare professionals work in partnership, with open communication. FCC places the infant firmly in the context of the family, acknowledging that the family is the most constant influence on an infant’s development. Adjusting to parenting in the NICU following a traumatic birth experience or pre-term delivery can be difficult. Assisting mothers and fathers adapt to their parenting roles in the NICU is part of developmental care. FCC is sensitive to the nature of personal, social and cultural influences upon each family.

Another view of developmental care focuses on the NICU environment, particularly in adapting the physical environment to provide appropriate sensory stimulation, to protect the baby from stress and to promote sleep. The immature central nervous system of the neonate is in a critical period of rapid growth and increasing specialization, all designed to take place in quite a different settling e.g. the mothers womb. The NICU is not the optimal sensory environment for preterm and newborn development. The infants’ behavioural cues are the best guide to whether or not the environment (sensory, temporal and social) is conducive to the current development needs of the infant and the environment needs to be organized in such a way to meet the infant’s developmental expectations.

Individualised developmental care is care that is responsive to the ever changing needs of the infant. Behavioural cues help us understand the infant’s competency, strengths, sensitivity, vulnerability and developmental goals. The leading mode of individualized developmental care is the NIDCAP- Newborn Individualised Developmental Care and Assessment Programme. Many of the NICUs in Ireland have NIDCAP trained professionals. To learn more about NIDCAP visit www.nidcap.org.

MEETING THE NEEDS OF THE NEONATE

Physiological stability is important for brain development. The way that the NICU environment, light and noise, the timing of events, handling and positioning can have a positive or negative effect on heart beat, respiratory pattern, oxygenation, intracranial pressure, temperature and oxygen consumption.

Minimising the pain and stress of the neonate because of the long term impact on behaviour and sensory processing is an important aspect of developmental care. Many benign routine aspects of neonatal care such as nappy change and bathing can be stressful for the premature infant and developmental care ensures that such procedures are adapted to minimize distress to the infant.

Protecting Sleep. REM or active sleep is associated with brain development whilst quiet sleep is associated with growth. Sleep protection relies on the caregiver’s ability to distinguish different states of arousal.

Enhanced nutrition. Developmental care can support nutrition by helping the infant to conserve energy and to digest food in addition to providing effective support for breast feeding.

Appropriate sensory experience.  Certain kinds of stimulation are required to trigger normal development whilst inappropriate stimulation that is out of phase with developmental brain expectation can result in some systems failing to develop. By observing the infants behaviour the caregiver can learn which sensory stimulations are appropriate.

Parenting and attachment. Parenting style has a significant impact on development and learning how their infant communicates is an integral component of developmental care for families. The high tech environment of the NICU can have an adverse impact upon attachment. Developmental care facilitates this attachment process and allows the parent/infant relationship to develop, supports the parents as they get to know their infant and grows their confidence as primary caregivers.

Protecting postural development. Development care can protect infants from the acquired postural deformities that can result from long periods of lying flat on a bed (e.g flat head syndrome), retracted shoulders (e.g.arms held in the W position), legs abducted and externally rotated (e.g. frog leg position), and torticollis. Adequate positioning support combined with frequent position changes can counteract these deformities which can otherwise delay the acquisition of skills such as sitting and walking, self comforting, feeding and fine motor co-ordination. 

EXAMPLES OF DEFENSIVE/AVOIDANCE BEHAVIOUR IN THE NEONATE

Agitation Arching Bracing position of legs Colour changes Coughing Crying Diffuse states Eye floating Finger splay Fussing Glazed look

Grimmacing Hiccoughs High guard hands Jerky movement Limp or stiff posture Looking away Mouth hanging open Pauses in breathing Positioning Salute Sighing

Sneezing Staring Sudden movement Straining Squirming Tongue thrusting Tremulousness Twitching Whimpering Yawning

EXAMPLES OF COPING/APPROACH BEHAVIOUR IN THE NEONATE

Easily consoled Frowning Grasping Healthy Colour Holding on Hands to mouth

Hands clasped together
Moving hand to face
One foot clasping the other
Orientation to voice or sound
Perky attentive expression
Relaxed open face

Responsive smiling Restful sleep Smooth movements Soft flexed position Settles self Snuggling when held

SENSORY DEVELOPMENT

The senses mature in the following order:

  • Touch
  • Vestibular (response to movement in space)
  • Chemosensory (taste and smell)
  • Hearing
  • Vision

TOUCH

Different kinds of touch activate different sensory receptors in the skin. Light, feathery touching can be arousing and preterm infants may react irritably. Gentle deep pressure touch is more soothing for the infant. Infants may seek comfort through tactile self-regulatory strategies such as grasping and bracing. Boundaries (nesting) , wrapping and cradling the feet, head or body with still hands have an organizing input.

VESTIBULAR

The vestibular apparatus located in the inner ear responds to movement through space and the effects of gravity. Vestibular input is thought to promote maturation of the other systems.
The movement experienced by infants in the NICU is often sudden and unpredictable and their fragile vestibular systems can become easily overloaded. It is important that infants are prepared for position changes by providing adequate support and moving slowly and gently.

TASTE AND SMELL

The infant is exposed to many noxious smells in the NICU. Staff should minimize unpleasant olfactory experiences e.g alcohol wipes, plaster removers, strong perfume, strong hand creams etc, deliver medications separately from milk, and facilitate positive olfactory experiences by encouraging close contact with parents.
Taste may be affected by intrusive oral experience e.g. prolonged use of endotracheal tube and this may contribute to later feeding difficulties.

HEARING

Protecting sleep is an important factor in auditory development and the sound environment of the NICU should be monitored to reduce background noise (e.g bins, phones, placing objects on the incubator). Background noise should be kept very quiet, average max. 45 decibels per hour as noise makes it difficult for the infant to hear and respond to the human voice. Parents should be encouraged to speak softly with their infant.

VISION

REM sleep is essential for development of the visual system. As the eyelids of the neonate are thin and let considerable light through, the ambient lighting of the NICU should be adapted e.g placing incubator covers over the isolettes. Pupil contraction reflex is only effective from 32 weeks and the infant is unable to regulate light entering the eye before then.

INTEROCEPTION

Interoception is a sense that allows us to notice internal body signals like a growling stomach, racing heart, tense muscles or full bladder. Our brain uses these body signals as clues to our emotions. Research shows that the ability to clearly notice body signals is linked to the ability to identify and manage the following emotions and more:

Hunger Tiredness Focus Fullness/Thirst Need for Bathroom Calm Pain Anger Boredom Illness Anxiety Sadness Body Temperature Distraction

ATTENTION AND INTERACTION

  • Up to 32 weeks   Infants are easily overloaded by sensory experience.

The snuggle is real: Banners in the hospital hallway remind the families of premature babies of the importance of kangaroo care.

Helen Adams    May 17, 2024

Maggie Gambon hadn’t had a baby shower yet or even bought maternity clothes. The lawyer-turned-marketer was still pretty far away from her due date. But her son Eli was arriving anyway – born March 8. “He weighed 1 pound, 11 ounces,” his mom said.

She’d known she was at risk for premature birth. Gambon had preeclampsia, “a life-threatening hypertensive disorder,” according to the Preeclampsia Foundation. It can lead to “a rapid rise in blood pressure that can lead to seizure, stroke, multiple organ failure and even death of the mother and/or baby,” the foundation’s website says.

“My OB at East Cooper sent me over here to MUSC for observation because of the preeclampsia. And then, while I was here for observation, pulmonary edema set in.” Pulmonary edema, which means too much fluid in the lungs, is life-threatening. That was a signal that her baby had to be born.

“They did an emergency C-section,” Gambon said of her cesarean section, a procedure that may have saved both her life and her baby’s.

 Nurse Kara St Laurent, left, and respiratory therapist Rebecca Barbrey help Maggie Gambon settle in to snuggle with Eli. She’ll stay there for two or three hours at a time.

Eli was rushed to the neonatal intensive care unit at the MUSC Shawn Jenkins Children’s Hospital, where he’s had round-the-clock care ever since. His tiny body still needs time to grow before he’ll be big and healthy enough to go home to Summerville with his mom and dad.

Gambon or her husband visit every day. And they’ve learned something special that MUSC Children’s Health doctors and nurses know can help Eli thrive. Julie Ross, M.D., a neonatal specialist at the hospital, said it’s called kangaroo care or skin-to-skin care. Kangaroo, because kangaroo babies rush into their mothers’ pouches after birth, then stay there for months, feeding on their mothers’ milk and growing.

Whatever you call it, human babies need physical contact with a parent’s skin every day if possible. “Our goal is for parents to be able to do skin-to-skin care with their baby as soon as possible after delivery, ideally within the first 72 hours of life if they’re able. And then continuing that up to twice a day for as long as they would like to do that,” Ross said.

“Kangaroo care has significant benefits for preterm babies, including improved neurodevelopment. There are situations where skin-to-skin care can be challenging, based on how sick babies are at times, but we really try everything possible to make sure that it can happen, and when it’s not possible, we encourage parental contact in other ways, such as hand hugs and gentle touch during cares.”

It can be a little scary for the parents of a fragile-looking preemie like Eli. “It’s kind of a big production,” his mother said.

A nurse and a respiratory therapist are on hand to set them up for kangaroo care. Since Eli’s hooked up to machines, they slowly move him toward the bottom of his hospital bed. There, his mother leans over to pick him up carefully. They help her ease into a chair with her baby, where mother and son rest peacefully. She and her husband have seen what a difference it makes.

“We noticed that the days that we did kangaroo, he seemed to have a marked difference in how well he was doing. So we committed to doing it every day. Either I or my husband will be here to kangaroo with him,” Gambon said.

“And I don’t know if the research says if there’s any difference between mom or dad holding them or just human contact. We committed to ensuring he’s going to get skin to skin with one of us every single day, and he’s been doing so much better since we did.”

There’s plenty of science to back up the practice of skin-to-skin care. For example, the World Health Organization said research shows that it “significantly improves a premature or low-birthweight baby’s chances of survival.” It also can save up to 150,000 lives a year, according to the organization.

 Delisa Abson smiles as her son, Braxton Abson grips her hand in the neonatal intensive care unit at the MUSC Shawn Jenkins Children’s Hospital. She regularly bonds with him through skin-to-skin contact.

Families in the MUSC Shawn Jenkins Children’s Hospital see banners in the hallways promoting the importance of kangaroo care. Delisa Abson, another mother whose baby needs a little time in the hospital before he’ll be healthy enough to go home, makes it part of her routine, too.

Ross, the neonatal specialist, described some of kangaroo care’s other benefits. “It helps with the baby’s temperature control; reduces stress, including decreasing pain during procedures; increases weight gain; and improves overall stability in heart rate and oxygen saturations. It benefits mom as well in terms of breast milk production and can decrease parental stress and support bonding. The body responds to the baby’s closeness.”

Gambon said she can feel it happening during and after skin-to-skin time with Eli. “Every time I put him back in bed, my breasts feel like they’re gonna explode.” That may not sound like a great feeling, but she’s thrilled to be able to supply that milk to her son. A nurse noticed he’s getting baby fat rolls – a good sign for a little boy who’s still weeks from his original due date.

And the connection Gambon has been able to solidify with Eli while still in the hospital has been remarkable. “It helped tremendously with bonding early on. He was born at 26 weeks gestation, so, initially, I kind of felt like, ‘Man, what just happened to me? Did I have a baby?’ It felt kind of like a mirage. But getting to have skin to skin with him and smell him and feel him … it’s real. It made it real.”

Source: https://web.musc.edu/about/news-center/2024/05/17/how-kangaroo-care-is-helping-tiny-preemies-grow-and-bond-with-parents

Preparing to welcome a new baby home is a time of joy—and stress!—under the most ideal circumstances. But if your baby arrived early and is being cared for in the NICU, bringing them home comes with all of that joy — and a double helping of the stress.

Bringing a preemie home from the NICU requires some extra preparation so you can give your new baby the care they’ll need to grow and thrive. As you make your plans for your preemie’s homecoming, having the right gear and supplies can help to ease the transition and make it through the early days.

This guide can help you get ready, with a comprehensive checklist of preemie must-haves.

What do you do when baby comes home from NICU?

Hospital NICU’s are fully stocked with all the supplies and gear that are needed to care for premature babies. To make the transition from caring for your baby in the NICU to caring for your baby at home as easy as possible, it helps to make sure you have all the preemie must-haves on hand before your baby comes home. This checklist of preemie essentials can help you get organized and get ready: 

  • Diapers and Wipes: Most preemies require special-sized diapers so be sure to stock up on the sizes you need. 
  • Bottles: Ask the NICU staff about the best nipple types and bottles for your baby. 
  • Clothing: Newborn-sized clothing will likely be too big for your baby. You’ll need some cozy preemie-sized onesies and pajamas that fit your baby. 
  • Swaddle Blankets and Sleep Sacks: Keeping premature babies warm at home is essential, and swaddling can help your baby sleep longer and better. Ask the NICU nurses to help you perfect your swaddling techniques so your baby can get the rest they need.   
  • Sleeping Arrangements: The American Academy of Pediatrics recommends that babies sleep in a crib or bassinet with a firm mattress in their parents’ room for at least the first six months of their life. The MamaRoo Sleep® Bassinet offers a firm, flat sleeping surface and adjustable legs, making it a great preemie bassinet that you can use until your baby is 25 pounds or can push up on their arms and legs. Plus it has over 100 motion, speed, and sound combinations that can be tailored to baby’s needs.  
  • Baby Thermometer: A thermometer is an important part of premature baby care and health monitoring. Choose a thermometer that’s suitable for newborns. 
  • Bathtub: Make bath time easier with a tub designed for infants that can also double as a preemie essential, like the Cleanwater™ Tub—it comes with a newborn insert to cradle your preemie safely and is designed to grow with your baby. 
  • Nasal Aspirator: A basic bulb syringe or a device that helps to suction mucus from your baby’s nose, making it easier for them to breathe, suck, and eat. 
  • Medication Management: If your baby needs medications, consult with your NICU team to make sure you have all the medical supplies and prescriptions you need on hand to continue premature baby care at home.

The extended “bringing preemie home” checklist

Beyond these preemie must-haves, you may want some other items that can make premature baby care a little easier:

  • Baby Monitor: Being able to keep an eye (and an ear) on your baby can give you some added peace of mind when you’re not in the same room. 
  • Baby Swing: A baby swing can be a familiar and safe space for your preemie when your tired arms need a break. More than 600 hospital NICUs across the country trust the MamaRoo® Multi-Motion Baby Swing™ to comfort the tiny babies in their care. Want to learn more about this preemie must-have? A NICU nurse explains why its parent-inspired motions keep preemies content and comfortable. 
  • Skin-to-Skin Gear: A specially made wrap or shirt makes it easy to give your baby the beneficial skin-to-skin contact they need.

Do NICU babies have a hard time adjusting to home?

Bringing a  preemie home from the NICU might feel overwhelming, but there are ways to make it a little easier on you.

Use your time in the NICU to gain the confidence you need to care for your baby; the nurses can teach you how to care for preemies and provide any special care your baby needs, including soothing techniques that will calm your baby and help you all settle more easily into a routine. You can also turn to preemie essentials made to soothe babies.

As you and your baby adjust to life at home, it’s vital to establish a support system to help you cope with the sometimes overwhelming responsibilities and emotions that go along with premature baby care. Your partner, parents, relatives, and friends are probably eager to pitch in and help in whatever ways they can—providing meals, helping with household chores, or coming over to hold the baby so you can shower, eat, or just get a little break.

You may also want to seek out a support group that connects you with other parents whose babies were in the NICU to share stories about preemie parenting, trade tips, and get comfort from other new parents who are having similar experiences. A pediatrician who is experienced with caring for preterm babies can help you find a local or online group and can also direct you to any specialists you might need as your baby grows.

Get ready to bring your baby home

Bringing your preemie home from the NICUE is a time that’s both joyful and challenging for your family—but the right tools can help. Preemie must-haves like the  MamaRoo® Multi-Motion Baby Swing™—which is used and trusted in more than 600 NICUs in the US—can help you re-create the nurturing environment of the NICU so your preemie can flourish.

And when you purchase these products for your baby, you’re helping –https://www.4moms.com/blogs/the-bib/12-preemie-must-haves-for-bringing-your-preemie-baby-home

Surviving Residency: Insider Secrets from a Chief Resident (Don’t Be THAT Intern!) #residency

     Prerak Juthani

2,242 views Jan 20, 2024

I had the pleasure of interviewing one of my chief residents about the tips that he would give himself if he were to do residency again. What he shared with me was beyond inspiring. The individual who I had the pleasure of interviewing was Peter Konyn. He graduated from UC Davis with a B.S. in Pharmaceutical Chemistry, as part of the University Honors Program. He then enrolled at UCLA for medical school, where he graduated at the top of his class, including earning induction into both the AOA Honors Society and the Gold Humanism Honors Society. I think that the tips he shares here are things that I still think about to this day!

Mandatory Reporting in the NICU: Supporting Families with Substance Abuse

Wednesday Jan 08, 2025

In this episode, we explore the intersection of neonatal care, substance use disorders, and mandatory child protective services (CPS) reporting, particularly in the NICU setting. NICU nurses and advanced practice professionals often focus on managing neonatal withdrawal and supporting the baby’s immediate needs, but what happens when mandatory reporting policies impact the delicate relationship between mother and infant? How do these policies affect long-term bonding and family-centered care?

We’re joined by Dr. Kelly McGlothen-Bell, a nursing scientist and expert in reproductive justice and health equity, who brings a wealth of knowledge on the complexities of caring for families affected by substance use during pregnancy. Dr. McGlothen-Bell discusses the stigma surrounding substance use, the emotional and systemic challenges mothers face, and the significant role of CPS interventions, which can create barriers to consistent visitation and strain the mother-infant bond. She also highlights the need for a more integrated, compassionate approach to care, ensuring that families receive necessary services without punitive actions such as child removal when not warranted.

With 31% of births occurring in states with mandatory reporting laws, and nearly half of child removals linked to substance use, understanding the policies at play is critical for healthcare providers. Dr. McGlothen-Bell emphasizes the importance of understanding these policies, advocating for more equitable care, and addressing racial disparities within the child welfare system. The episode also explores how CPS involvement can affect long-term outcomes for families, including stress, relapse, and strained recovery.

Listeners will gain insights into the importance of clear communication, prenatal care, and the role of nurses and social workers in advocating for families both within and outside the NICU. We discuss how healthcare professionals can balance mandatory reporting with compassionate care, ensuring that families navigate the complexities of recovery, legal systems, and childcare with dignity and respect.

This episode is a must-listen for NICU nurses, social workers, and anyone working at the intersection of maternal and neonatal care, as well as those interested in the policy and systemic factors that influence family outcomes in the NICU and beyond.

Source:https://nanncast.podbean.com/e/mandatory-reporting-in-the-nicu-supporting-families-with-substance-abuse/?token=ff2bab9aaa8cb066c48cb2b67b2cc920

The Incubator Channel    Oct 28, 2024

Ben and Daphna speak with Dr. Melissa House, Chavis Patterson, and Kathleen Stanton about creating a “psychologically-minded” NICU, where mental health support is essential for families, staff, and patients alike. They discuss the upcoming CHNC workshop, “Combating Distress, Dissatisfaction, and Discord,” which introduces trauma-informed care, caregiver support, and the impact of chronic stress on NICU staff and families. Listen in as they share insights on fostering empathy, self-awareness, and a supportive NICU culture, helping caregivers bring their best selves to the bedside.

Zsuzsanna Nagy, MDMahmoud Obeidat, MDVanda Máté, MD; et al Rita Nagy, MD, PhDEmese Szántó, MDDániel Sándor Veres, PhDTamás Kói, PhDPéter Hegyi, MD, DSc9Gréta Szilvia Major, MD

JAMA Pediatr. Published online December 30, 2024. doi:10.1001/jamapediatrics.2024.5998

Key Points

Question  What are the occurrence and temporal distribution of intraventricular hemorrhage (IVH) in very preterm neonates during the first week of life?

Findings  This systematic review and meta-analysis including 64 studies and 9633 preterm neonates found that the overall prevalence of IVH in preterm neonates has not changed significantly over the past 20 to 40 years. However, IVH earlier than 6 hours of life has been reduced to less than 10% of all IVH events.

Meaning  These data suggest that although preventive measures have been implemented, IVH has occurred later but its prevalence has not been reduced.

Abstract

Importance  Intraventricular hemorrhage (IVH) has been described to typically occur during the early hours of life (HOL); however, the exact time of onset is still unknown.

Objective  To investigate the temporal distribution of IVH reported in very preterm neonates.

Data Sources  PubMed, Embase, Cochrane Library, and Web of Science were searched on May 9, 2024.

Study Selection  Articles were selected in which at least 2 cranial ultrasonographic examinations were performed in the first week of life to diagnose IVH. Studies with only outborn preterm neonates were excluded.

Data Extraction And Synthesis  Data were extracted independently by 3 reviewers. A random-effects model was applied. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The Quality in Prognostic Studies 2 tool was used to assess the risk of bias.

Main Outcomes And Measures  The overall occurrence of any grade IVH and severe IVH among preterm infants was calculated along with a 95% CI. The temporal distribution of the onset of IVH was analyzed by pooling the time windows 0 to 6, 0 to 12, 0 to 24, 0 to 48, and 0 to 72 HOL. A subgroup analysis was conducted using studies published before and after 2007 to allow comparison with the results of a previous meta-analysis.

Results  A total of 21 567 records were identified, of which 64 studies and data from 9633 preterm infants were eligible. The overall rate of IVH did not decrease significantly before vs after 2007 (36%; 95% CI, 30%-42% vs 31%; 95% CI, 25%-36%), nor did severe IVH (10%; 95% CI, 7%-13% vs 11%; 95% CI, 8%-14%). The proportion of very early IVH (up to 6 HOL) after 2007 was 9% (95% CI, 3%-23%), which was 4 times lower than before 2007 (35%; 95% CI, 24%-48%). IVH up to 24 HOL before and after 2007 was 44% (95% CI, 31%-58%) and 25% (95% CI, 15%-39%) and up to 48 HOL was 82% (95% CI, 65%-92%) and 50% (95% CI, 34%-66%), respectively.

Conclusion And Relevance  This systematic review and meta-analysis found that the overall prevalence of IVH in preterm infants has not changed significantly since 2007, but studies after 2007 showed a later onset as compared with earlier studies, with only a small proportion of IVHs occurring before 6 HOL.

Source:https://jamanetwork.com/journals/jamapediatrics/fullarticle/2828319

12/18/2024

Carle Foundation Hospital (CFH) is the only Neonatal Intensive Care Unit (NICU) in the region offering Level III perinatal care for newborns with critical conditions. On average, staff care for 35 babies each day in the NICU from an area that stretches west from Bloomington and Decatur, east to Danville and south to Olney. This distance, and potentially long NICU stays, mean some parents may need to leave their healing babies at times in the care of CFH staff.

Now, Carle’s Neonatal Intensive Care Unit is helping parents stay connected with their babies through technology. It is the first unit in the U.S. to offer an innovative and secure application where nurses share photos and video as the baby progresses. It’s called vCreate and is already in use in the U.K.

“Leaving a newborn at the hospital is naturally stressful for parents, some with limited visits for a variety of reasons such as distance from the hospital, work commitments, or caring for siblings of the newborn,” Kara Weigler, RN, manager, Neonatal Intensive Care Unit said. “We receive such positive feedback from parents about having this application available. We can take video of a baby having a bath or photos of the newborns as they progress.”

Not only do parents receive visual updates on their baby’s progress, but nurses also mark special occasions such as visits with Santa Claus.

For Carle Health team members, offering this free tool is just part of the type of care experience they strive for every day. And with such limited options for the level of care the CFH NICU provides, they take that responsibility very seriously.

“If someone cannot deliver, due to a complex pregnancy, at their community hospital, they are transported here,” Weigler said. More than 100 transports arrive at Carle yearly.

Syvanna Keith, who also has a 3-year-old, drives an hour to see her baby who is in the NICU after surgery due to an intestinal blockage. “Having a baby in the NICU is stressful and the nurses in the NICU have been wonderful to work with. Seeing photos of baby Bryan Duane when I am not there really helps a lot.”

A Carle nurse discovered the vCreate application at a conference and introduced the idea to her colleagues. The only equipment the family needs is a smart cell phone to start receiving the photos and videos nurses record in the NICU. Parents may review the message in the language of their choice.

Source:https://carle.org/newsroom/community/2024/12/nicu-nurses-first-in-nation-to-use-new-technology

Burstein, Or Aryeh, Tamara Geva, Ronny Burstein, O., Aryeh, T., & Geva, R. (2024). Neonatal care and developmental outcomes following preterm birth: A systematic review and meta-analysis. Developmental Psychology. Advance online publication. https://doi.org/10.1037/dev0001844

Abstract

Major amendments in neonatal care have been introduced in recent decades. It is important to understand whether these amendments improved the cognitive sequelae of preterm children. Through a large-scale meta-analysis, we explored the association between prematurity-related complications, neonatal care quality, and cognitive development from birth until 7 years. MEDLINE, APA PsycInfo, and EBSCO were searched. Peer-reviewed studies published between 1970 and 2022 using standardized tests were included. We evaluated differences between preterm and full-term children in focal developmental domains using random-effects meta-analyses. We analyzed data from 161 studies involving 39,799 children. Preterm birth was associated with inferior outcomes in global cognitive development (standardized mean difference = −0.57, 95% CI [−0.63, −0.52]), as well as in language/communication, visuospatial, and motor performance, reflecting mean decreases of approximately 7.3 to 9.3 developmental/intelligence quotients. Extreme prematurity, neonatal pulmonary morbidities, and older assessment age in very-to-extreme preterm cohorts were associated with worse outcomes. Contemporary neonatal medical and developmental care were associated with transient improvements in global cognitive development, evident until 2 to 3 years of age but not after. Blinding of examiners to participants’ gestational background was associated with poorer outcomes in preterm cohorts, suggesting the possibility of a “compassion bias.” The results suggest that preterm birth remains associated with poorer cognitive development in early childhood, especially following pulmonary diseases and very-to-extreme preterm delivery. Importantly, deficits become more pervasive with age, but only after births before 32 gestational weeks and not in moderate-to-late preterm cohorts. Care advancements show promising signs of promoting resiliency in the early years but need further refinements throughout childhood.

Impact Statement

Preterm birth is related to persistent neurodevelopmental difficulties, yet it remains unclear whether changes in care improve outcomes. Covering 50 years of research, including 37,999 children (0–7 years), we found considerable cognitive disadvantages that steepen the earlier the preterm birth occurs and following neonatal brain or lung damage. These early-life difficulties intensify with age but only in very and extreme cases of prematurity. Importantly, changes in neonatal intensive care unit care protocols show some positive, though yet transient, signs of promoting resiliency.

Source:https://psycnet.apa.org/search/display?id=e23f63e6-6b37-757e-0c5d-25a37874dfb3&recordId=1&tab=PA&page=1&display=25&sort=PublicationYearMSSort%20desc,AuthorSort%20asc&sr=1

Griffith, Thao PhD, RN; White-Traut, Rosemary PhD, RN, FAAN; Tell, Dina PhD; Green, Stefan J. PhD; Janusek, Linda PhD, RN, FAAN

Advances in Neonatal Care 24(6):p E88-E95, December 2024. | DOI: 10.1097/ANC.0000000000001216

Abstract

Background: 

Preterm infants face challenges to feed orally, which may lead to failure to thrive. Oral feeding skill development requires intact neurobehaviors. Early life stress results in DNA methylation of NR3C1 and HSD11B2, which may disrupt neurobehaviors. Yet, the extent to which early life stress impairs oral feeding skill development and the biomechanism whereby this occurs remains unknown. Our team is conducting an NIH funded study (K23NR019847, 2022-2024) to address this knowledge gap.

Purpose: 

To describe an ongoing study protocol to determine the extent to which early life stress, reflected by DNA methylation of NR3C1 and HSD11B2 promoter regions, compromises oral feeding skill development.

Methods: 

This protocol employs a longitudinal prospective cohort study. Preterm infants born between 26 and 34 weeks gestational age have been enrolled. We evaluate early life stress, DNA methylation, cortisol reactivity, neurobehaviors, and oral feeding skill development during neonatal intensive care unit hospitalization and at 2-week post-discharge.

Results: 

To date, we have enrolled 70 infants. We have completed the data collection. Currently, we are in the data analysis phase of the study, and expect to disseminate the findings in 2025.

Implications for Practice and Research: 

The findings from this study will serve as a foundation for future clinical and scientific inquiries that support oral feeding and nutrition, reduce post-discharge feeding difficulties and lifelong risk of maladaptive feeding behaviors and poor health outcomes. Findings from this study will also provide further support for the implementation of interventions to minimize stress in the vulnerable preterm infant population.

Source:https://journals.lww.com/advancesinneonatalcare/fulltext/2024/12000/epigenetics_embedding_of_oral_feeding_skill.17.aspx

Dear Fellow Warriors,

I want to take a moment to talk to you about love—not just the love we’ve received but the love we carry within ourselves. You’ve come so far, and every step of your journey has been marked by resilience fueled by love.

Love is what surrounded you in those early days. It’s the hands that held you, the whispers of encouragement when things felt uncertain, and the hope that never wavered. That love wasn’t just given to you—it became part of you, a quiet strength you carry forward every single day.

But here’s the beautiful thing about being a preemie: you’ve learned that love isn’t just something you receive; it’s something you radiate. Every time you take a step forward, every milestone you achieve, and every moment you choose to persevere, you remind the world what love in action looks like.

Life may present challenges, but love is your greatest ally. It’s the love you show yourself when you celebrate how far you’ve come. It’s the love you give others when you share your story, offering hope and inspiration. And it’s the love that reminds you that you are more than capable of facing anything that comes your way.

Resilience doesn’t mean you don’t face hardships. It means you face them with courage, with the knowledge that you’ve already overcome so much. Love and resilience go hand in hand—they’ve carried you this far, and they’ll continue to carry you wherever you dream of going.

So, to every preemie reading this: You are enough. You are strong. You are loved. And because of that love, there is nothing you can’t do.

Keep shining, keep thriving, and never forget the power of love within you.

With pride and encouragement, Kathryn Campos

This song aims to carry the premature cause and gather around common values. The video clip represents the struggle of prematurity through our little magician Julia, a former premature baby, who gets to the end of the race despite the obstacles with the help of caregivers.

It’s Valentine’s Day and Biscuit is ready to play. What will he do? Woof! Let’s find out in this wonderful tale, “Biscuit’s Valentine’s Day” by Alyssa Capucilli.

Make Eat Happen

AsianNeo, Mentors, SOS Préma

Malaysia is a country in Southeast Asia. A federal constitutional monarchy, it consists of 13 states and three federal territories, separated by the South China Sea into two regions: Peninsular Malaysia and Borneo‘s East Malaysia. Peninsular Malaysia shares a land and maritime border with Thailand and maritime borders with SingaporeVietnam, and Indonesia. East Malaysia shares land borders with Brunei and Indonesia, as well as a maritime border with the Philippines and Vietnam. Kuala Lumpur is the national capital, the country’s largest city, and the seat of the legislative branch of the federal governmentPutrajaya is the administrative centre, which represents the seat of both the executive branch (the Cabinetfederal ministries, and federal agencies) and the judicial branch of the federal government. With a population of over 34 million, the country is the world’s 43rd-most populous country. Malaysia is tropical and is one of 17 megadiverse countries; it is home to numerous endemic speciesTanjung Piai in the Malaysian state of Johor is the southernmost point of continental Eurasia.

Healthcare in Malaysia is under the purview of the Ministry of Health of the Government of MalaysiaMalaysia generally has an efficient and widespread system of health care, operating a two-tier health care system consisting of both a government-run public universal healthcare system along with private healthcare providers. Within the public universal healthcare system, specialist services are either free or have low user fees for procedures (however, appliances are fully self-funded out of pocket by the patient, even within the public healthcare system); as such the public healthcare system suffers from high demand, routine congestion, long wait lists, chronic widespread delays along with persistent shortages in healthcare personnelmedical equipment and healthcare supplies.

Therefore, private healthcare providers play a pivotal role in providing specialist consultants and general practitioner (GP) services to the Malaysian population; the private healthcare providers complements or supplants the public healthcare system in terms of availability, types of treatments provided and types of materials used.

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

Introduction

Reducing neonatal deaths in premature infants in low- and middle-income countries is key to reducing global neonatal mortality. International neonatal networks, along with patient registries of premature infants, have contributed to improving the quality of neonatal care; however, the involvement of low-to-middle-income countries was limited. This project aims to form an international collaboration among neonatal networks in Asia (AsianNeo), including low-, middle- and high-income countries (or regions). Specifically, it aims to determine outcomes in sick newborn infants, especially very low birth weight (VLBW) infants or very preterm infants, with a view to improving the quality of care for such infants. Methods and analysis Currently, AsianNeo comprises nine neonatal networks from Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan and Thailand. AsianNeo will undertake the following four studies: (1) institutional questionnaire surveys investigating neonatal intensive care unit resources and the clinical management of sick newborn infants, with a focus on VLBW infants (nine countries/regions); (2) a retrospective cohort study to describe and compare the outcomes of VLBW infants among Asian countries and regions (four countries/regions); (3) a prospective cohort study to develop the AsianNeo registry of VLBW infants (six countries/regions); and (4) implementation and evaluation of educational and quality improvement projects in AsianNeo countries and regions (nine countries/regions). Ethics and dissemination The study protocol was approved by the Research Ethics Board of the National Center for Child Health and Development, Tokyo, Japan (reference number 2020–244, 2022–156). The study findings will be disseminated through educational programmes, quality improvement activities, conference presentations and medical journal publications.

ABSTRACT

Introduction  Reducing neonatal deaths in premature infants in low- and middle- income countries is key to reducing global neonatal mortality. International neonatal networks, along with patient registries of premature infants, have contributed to improving the quality of neonatal care; however, the involvement of low- to- middle- income countries was limited. This project aims to form an international collaboration among neonatal networks in Asia (AsianNeo), including low-, middle- and high- income countries (or regions). Specically, it aims to determine outcomes in sick newborn infants, especially very low birth weight (VLBW) infants or very preterm infants, with a view to improving the quality of care for such infants. Methods and analysis  Currently, AsianNeo comprises nine neonatal networks from Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan and Thailand. AsianNeo will undertake the following four studies: (1) institutional questionnaire surveys investigating neonatal intensive care unit resources and the clinical management of sick newborn infants, with a focus on VLBW infants (nine countries/regions); (2) a retrospective cohort study to describe and compare the outcomes of VLBW infants among Asian countries and regions (four countries/regions); (3) a prospective cohort study to develop the AsianNeo registry of VLBW infants (six countries/regions); and (4) implementation and evaluation of educational and quality improvement projects in AsianNeo  countries and regions (nine countries/regions).Ethics and dissemination  The study protocol was

approved by the Research Ethics Board of the National Center for Child Health and Development, Tokyo, Japan (reference number 2020–244, 2022–156). The study findings will be disseminated through educational programmes, quality improvement activities, conference presentations and medical journal publications.

Full (compelling!) publication: https://www.researchgate.net/publication/382243432_Asian_Neonatal_Network_Collaboration_AsianNeo_a_study_protocol_for_international_collaborative_comparisons_of_health_services_and_outcomes_to_improve_quality_of_care_for_sick_newborn_infants_in_Asia_-

Authors: Wan Mazwati Wan Yusoff,  International Islamic University Malaysia Mashitah Zainol Abidin

Abstract

Premature babies are very vulnerable and exposed to various life-threatening diseases. World Health Organization reported that many premature babies were saved from morbidity and mortality when they were fed with breastmilk starting from within the first hour after their birth. The rate of premature birth in Malaysia has increased exponentially since 2018—more than 20 percent premature births. Therefore, hospitals should have enough supplies of breastmilk to save the lives of the precious premature babies. However, only one hospital in Malaysia provides supplies of breastmilk on demand. This study employed philosophical method to argue for the establishment of breastmilk collection centre. It examined the concept of maqāṣid al-sharīʿah to justify the proposal of the establishment of breastmilk collection centres in hospitals throughout Malaysia to save the lives, intellects, and progenies of the at-risk premature babies. The primary issues resulting from breastmilk sharing according to Islamic perspective were examined and practical steps were proposed to rectify them. The steps involved obtaining signed consent from wet nurse and her husband; screening of wet nurse’s health and personality characteristics; screening of the breastmilk by the milk collection centre; obtaining signed consent from the premature baby’s parents; feeding breastmilk to the premature baby with the consent of witnesses; meeting between wet nurse and her family and the baby’s parents and family; and completing wet nursing document to be given to the newly formed milk kinship family. 

Source:https://doi.org/10.31436/alburhn.v7i2.310

Rody Azar, MHA, RRT-NPS

Introduction:

Trust is an essential element of effective teamwork. It fosters an environment where team members feel safe communicating openly, sharing ideas, and collaborating towards common goals. Without trust, relationships become strained, communication breaks down, and organizational performance suffers. According to a study by Gallup, organizations with high employee engagement, which is closely related to trust, report 21% higher profitability (Gallup, 2020). This paper explores trust in teams, examining how it can be fostered and its profound impact on organizational success.

The Importance of Trust in Teams:

1. Enhanced Communication: Trust creates a safe space where team members can share their thoughts and feelings without fear of judgment. This openness leads to improved communication, enabling teams to function more effectively. When team members trust each other, they are more likely to engage in candid discussions, ask for feedback, and share constructive criticism. This process encourages continuous improvement and innovation.

2. Improved Collaboration: Teams characterized by trust collaborate more seamlessly. Trust encourages team members to share resources, support one another, and seek each other’s abilities. This collaborative spirit leads to better problem-solving and decision-making, as individuals are more willing to listen to diverse perspectives.

3. Increased Engagement: Trust enhances commitment and engagement within teams. Employees who feel trusted and valued are more likely to invest their time, energy, and creativity into their work. This higher level of engagement results in better performance and productivity, as engaged employees are motivated to achieve team goals.

4. Effective Conflict Resolution: Conflict is a natural occurrence in any team dynamic. However, team members are more likely to address conflicts directly and constructively in a trusting environment, allowing them to express their disagreements without fear of damaging relationships. This approach leads to more effective and quicker resolutions, which helps support a positive team atmosphere.

5. Greater Accountability: When trust exists within teams, members are more likely to hold themselves and each other accountable for their roles and responsibilities. Trusting teams create a culture of accountability where individuals take ownership of their work, leading to higher standards and better performance.

Characteristics of Trusting Teams:

  1. Open Communication: Team members communicate transparently and honestly, fostering a culture of openness and inclusivity.
  2. Mutual Respect: Trusting teams recognize and appreciate each other’s strengths, value  

 diversity, and promote an inclusive environment.

  • Shared Goals: All team members are aligned with common goals, reinforcing collaboration

        and commitment.

  • Empathy and Support: Team members show care and understanding for one another,   

 creating a supportive atmosphere that encourages sharing and vulnerability.

  • Reliability: Trusting teams foster a sense of reliability, where members can depend on each

other to fulfill commitments and responsibilities.

Strategies for Building Trusting Teams:

Building trust is an ongoing process requiring intentional effort from leaders and team members. Below are strategies to cultivate trust in teams:

1. Lead by Example: Leaders play a crucial role in shaping team dynamics. By showing trustworthy behaviors, such as honesty, integrity, and accountability, leaders set the standard for others to follow. Vulnerability in leadership (e.g., admitting mistakes and seeking feedback) can also strengthen trust within the team.

2. Foster Open Communication: Encourage team members to openly share their thoughts, ideas, and feedback. Create an environment where communication is valued, and actively listen to team members. Regular check-ins, team meetings, and one-on-one discussions can help open dialogue and build trust.

3. Encourage Collaboration: Design opportunities for team collaboration across various projects. Creating diverse project teams allows members to collaborate, share knowledge, and build relationships. Activities such as brainstorming sessions or team-building exercises can strengthen interpersonal connections.

4. Recognition and Appreciation: Regularly acknowledge and celebrate the contributions of team members. Recognition fosters an environment of appreciation, reinforcing the value of individual efforts. Simple gestures such as expressing gratitude during meetings or highlighting achievements can significantly boost trust within the team.

5. Create a Safe Environment for Risk-Taking: Encourage team members to take thoughtful risks and innovate without fear of negative consequences. Providing autonomy and support for innovative ideas helps build trust, as team members feel empowered and valued for their contributions.

6. Establish Clear Roles and Expectations: Clarify the roles and responsibilities of each team member. When individuals understand their specific roles and expectations, it fosters accountability and reduces uncertainty. Clear roles create a sense of security, allowing team members to trust that everyone is working towards the same goals and can depend on one another to fulfill their responsibilities.

7. Promote Team-building Activities: Engaging in in-person or virtual team-building activities can significantly strengthen team members’ interpersonal relationships. These activities should encourage collaboration, promote understanding, and foster positive interactions outside of day-to-day work. Such experiences can help individuals develop personal connections, creating a more profound sense of trust.

8. Provide Opportunities for Professional Development: Encouraging continuous learning and professional growth shows team members that the organization values their development. Offering training, workshops, and mentorship opportunities improves individual skills and reinforces trust, as team members see that their organization is invested in their success.

9. Practice Transparency: Transparency is a key part of trust. Leaders should share relevant information about the organization’s goals, decision-making processes, and performance metrics with their teams. When team members are informed about what is happening within the organization, they feel more involved and valued, strengthening trust.

10. Encourage Feedback: Creating a culture where feedback is valued encourages trust among team members. Implementing regular feedback mechanisms—such as one-on-one check-ins and anonymous surveys—allows team members to express their thoughts and concerns. Moreover, showing that feedback is taken seriously and leads to action, reinforcing the notion that everyone’s input is valuable.

The Impact of Trusting Teams on Organizational Success:

The presence of trusting teams can lead to transformative outcomes in an organization:

1. Higher Performance and Productivity: Organizations with trusting teams have been shown to achieve higher performance levels. Trust enhances collaboration and reduces time spent on conflicts, resulting in teams completing projects more efficiently and effectively.

2. Improved Employee Well-being: A trusting environment improves employee morale and job satisfaction. Employees who feel trusted are less likely to experience stress and burnout, resulting in a healthier workforce with higher retention rates.

3. Greater Innovation: Trust allows teams to embrace creative solutions and explore innovative ideas without fear of failure. This environment fosters innovation as team members confidently share their insights and experiment with novel approaches to work.

4. Stronger Organizational Culture: A trust-based culture promotes a sense of belonging and shared purpose. Employees are more likely to feel aligned with the organization’s mission and values, which enhances overall engagement and loyalty.

5. Resilience to Change: Organizations characterized by trust navigate change effectively. Trusting teams adapt more readily to new initiatives and challenges as members communicate openly and support one another during transitions.

Conclusion:

Building trusting teams is not just a desirable outcome but essential for organizational success. Trust enhances communication, collaboration, and accountability while fostering a positive work environment. Organizations can cultivate a culture where teams thrive by implementing strategies that promote trust-building, such as leading by example, fostering open communication, and providing opportunities for development.

Leaders must recognize that trust is a pivotal part of team dynamics and should actively work to nurture it. The benefits of trusting teams extend beyond individual relationships; they affect organizational performance, employee satisfaction, and innovation. As organizations navigate complexities in the modern workplace, prioritizing trust will be paramount for achieving sustainable success.

By building trust within teams, organizations can strengthen their foundation and position themselves for future success. As shown throughout this paper, trusting teams are the cornerstone of an effective and resilient organizational culture.

Posted on 13 November 2024

10-11 October saw 340 healthcare professionals gather in France for SOS Préma’s 15th annual training days, a pivotal event offering an empathetic view into the realities faced by families of preterm infants.

Each year, “SOS Préma”, our valued partner in France, hosts training sessions to deepen the understanding of healthcare providers around the unique challenges encountered by preterm infants and their families. Established in 2011, these events now bring together hundreds of healthcare professionals, all committed to improving neonatal care. The 15th edition, held on 10 and 11 October, attracted over 340 participants, all united in their commitment to advancing care for these vulnerable newborns.

The event revolved around four main themes, each addressing key aspects of neonatal care:

  1. Zero Separation: Couplet care from birth
    Promoting uninterrupted contact between newborns and parents from birth through hospitalisation, ensuring that critical family bonds are supported from the earliest moments.
  1. Supporting late preterm babies
    Exploring breastfeeding and Kangaroo Mother Care as essential practices to help these infants grow and thrive, reinforcing the importance of holistic approaches.
  1. Navigating difficult moments with Zero Separation
    Addressing challenging periods during hospitalisation and equipping professionals with strategies to provide consistent infant- and family-centred support.
  1. Observing newborns with family involvement
    Encouraging healthcare providers to incorporate parents as essential members of the caregiving team, fostering a collaborative environment for a more comprehensive understanding of each infant’s needs.

SOS Préma’s Charter for the Hospitalised Newborn, a cornerstone of these discussions, continues to influence practices by promoting humane and inclusive neonatal care. Parental testimonials were central to the event, with families sharing their firsthand experiences, followed by scientific insights, ensuring that every healthcare professional gains practical tools and empathetic perspectives.

Source:https://www.efcni.org/news/sos-prema-15th-annual-training-days/

Before you complete your family medicine residency or even finish medical school, there are ways that you can begin to nurture your interest in global health and prepare for service you may want to provide in the future. Here’s how to get started.

Integrating Global Health into Your Medical Education

Seeking out as many global health-related opportunities as possible during your time in medical school can help you clarify your vision for working and serving globally, and cultivate relationships through which you may contribute and be mentored.

Opportunities you should consider include the following:

  • Develop knowledge, skills, and understanding that will prepare you to work effectively in a global context. 
  • Participate in your medical school’s global health track (if available). Getting involved in a global health track during medical school is strongly recommended. A well-designed global health track provides necessary background information and skills. It can also facilitate networking, which is key to short-term international rotations, and help you find individual mentors who can help guide your decisions.
  • Participate in activities that focus on local underserved populations and/or global health (e.g., journal clubs, courses, electives, service projects, service-oriented student groups, research)
  • Volunteer for a not-for-credit experience serving an underserved population during your M1-M2 summer, or during a fall, spring, or holiday break
  • Do a research project or a scholarly/capstone project focused on a population outside of the United States or an underserved population in the United States
  • Advocate for the value and relevance of global health curriculum and experiences to your medical school. For example, you could provide the dean and the family medicine chair with information about the value of global health experiences and curriculum for your development as a physician and the school’s achievement of its mission.
  • Get involved in your medical school’s global health-related student interest group (if available)
  • Lead your Family Medicine Interest Group (FMIG) in serving a local underserved population; you might want to partner with other student groups to develop a sustainable program.
  • Engage with your medical school’s office/center/institute for global health (if available)
  • Build a foundation for long-term collaboration by developing relationships with people and organizations involved in global health; tap into your medical school’s existing partnerships and relationships, if available.
  • Aim for a longitudinal experience throughout medical school
  • Use the AAFP global health resources and network
  • Cultivate relationships with mentors who can guide your development of abilities and attributes you will need to pursue your interest in global health

Finding a Family Medicine Mentor in Global Health

Finding a mentor can be a huge help in navigating the many questions you’ll have as you become more aware of global health needs and opportunities. Here are some suggestions on finding a mentor for yourself.

  • Attend the American Academy of Family Physicians’ (AAFP’s) annual Global Health Summit. This conference is specifically designed to facilitate networking and is attended by experienced global health workers who have long-term involvement in specific cultures and countries.
  • Try personal networking. Ask colleagues, friends, and family members whether they know anyone who works in global health, and contact potential leads with emails and phone calls. The more connections you make, the greater your chances of identifying one or more physicians who would be an appropriate mentor.
  • Look for someone who is doing the type of global health work you would like to do or working in a region that interests you. Contact that person to share your background and aspirations.
  • Reach out to presenters at meetings or to authors of articles/books of interest. Ask for advice or offer to help someone with a project. People working in global health often find it rewarding to advise and work with those who are exploring an interest in global health.

For Residents

Preparing for Global Health During Family Medicine Residency

An accredited family medicine residency program provides ideal preparation for short- and long-term global health work. Family physicians are specifically trained to provide the care that is most needed in the developing world—care for patients of all ages that is comprehensive, continuous, integrated, community oriented, and team based. If you are seriously considering global health work, you should select a residency program that offers:

  • Support and guidance for interest in global health
  • A patient population that includes a variety of ethnicities, cultures, and languages so that you can become proficient in the use of translators and cultural interpreters
  • A robust global health track that provides additional training in tropical and poverty-related diseases, advanced procedural skills, and cultural competence; the opportunity to participate in global rotations; and a network of international contacts. Getting involved in a global health track during residency is strongly recommended.

Once you have started your family medicine residency, the following steps can help you prepare for global health work:

  • Develop competence in a team-based approach to medical care; attention to the whole family; preventive and community-oriented care; and provision of continuous care to a defined population
  • Develop specific interventional skills (e.g., procedures that are commonly performed at the primary care level in developing countries, such as repair of complex lacerations and interpretation of diagnostic ultrasound examination)
  • Find a faculty mentor or advisor who is involved in global health work and can help you prepare yourself and your family. A faculty mentor might also be able to help you use your global health experience to develop a scholarly presentation or paper.
  • Complete additional (e.g., fellowship-based) training in advanced obstetrics and gynecology (including c-section) or disaster relief. Although a fellowship is not essential for an effective contribution to global health, it can be helpful.

Family Medicine Residency Programs with International Rotations

The AAFP Center for Global Health Initiatives has compiled a director of family medicine residency programs that include international rotations. Search our free database to explore these programs.

INTERNATIONAL ROTATIONS DIRECTORY

Ways to Integrate Global Health into Your Residency Experience

Find your passion within global health.

If you want to make a lasting impact in a global health setting, it is important to find your niche within the vast array of family medicine global health opportunities. It may take time and several different experiences to discover and develop your passion. You may find that you are drawn to a certain country, culture, language area, or area of need (e.g., maternal and child health, social determinants of health, disaster relief, policy, noncommunicable diseases). Be open to the many types of experiences that are available. If possible, explore them before you are committed to long-term employment.

There may be faculty mentors in your residency program who have experience in certain areas of global health. The AAFP offers a directory of global health opportunities.

Attending conferences such as the AAFP Global Health Summit also will expose you to many different areas of interest within global health.

Form partnerships. 

Once you find your passion, partnering with individuals and organizations that share your enthusiasm will further your interest and help you have a lasting, sustainable impact. Cultivate relationships by staying connected with particular organizations or international communities. If you travel, try to return to the same area so you can deepen your commitment to that population. Partnerships and connections will help you integrate global health fully into your career, and expand your capabilities in sustainable global health efforts.

Connect with others. 

There is significant interest in global health among family medicine residents in the United States and abroad. The World Organization of Family Doctors (Wonca) Young Doctors’ Movements (YDMs) around the world connect passionate residents and young physicians in conversations about family medicine in global health.

  • The Polaris Movement for New and Future Family Physicians in North America is a YDM launced in 2014 that provides an international platform for medical students, residents, and new family physicians. Connect on their Facebook page
  • Another initiative of the Wonca YDMs is Family Medicine 360°an exchange program for family medicine residents during their elective months. These four-week exchanges allow participants to travel to a country of interest and experience primary health care delivery in that setting.
  •  

Consider completing a Master of Public Health (MPH) degree. 

Proficiency in public health is becoming increasingly important in the global health arena, especially if you want to make lasting impact on prevention and social determinants of health. Some residency programs and fellowship programs pay for pursuit of an MPH while in training. Find out if your residency program is among them.

Explore fellowships in global health.

It is becoming easier to find residency programs that offer a family medicine global health fellowship; however, there are currently more global health fellowships in emergency medicine (EM) and internal medicine (IM) than in family medicine. If this is the case at your residency program, talk with the fellowship program to find out whether these fellowships can be adapted to family medicine.

Explore electives in global health. 

Many residencies already have global health electives or tracks in place. If your residency does not offer these, consider creating your own global health elective in your area of interest. Most residency programs will accept your ideas for an elective, especially if you already have a relationship with the organization with which you will be working.

If you are unable to travel due to time or financial constraints, pursue or create electives locally that encompass global health ideals. Working with underserved or marginalized populations in your own community can create lasting positive changes. Remember, global health is not just international health; it includes efforts in your own backyard as well!

Source: https://www.aafp.org/family-physician/patient-care/global-health/education.html

Kristen Leeman, MD

Posted on March 21, 2023 by Nancy Fliesler | Our CommunityPeople

While the majority of neonatologists are women, women make up a far smaller proportion of neonatologists in leadership positions. A recent national survey led by Kristen Leeman, MD, in the Division of Newborn Medicine at Boston Children’s and Lindsay Johnston, MD, at Yale, finds that many female neonatologists face roadblocks to career development. They often miss out on speaking engagements, career guidance, additional training, networking opportunities, and above all, mentors.

To learn more about their needs, Leeman and her colleagues contacted nearly 4,000 female neonatologists from the AAP-affiliated Women in Neonatology group and a Facebook group for female neonatologists. They received 451 survey responses, revealing several additional challenges:

  • gender-based salary discrepancies, reported by 49 percent of respondents
  • delayed promotion (37 percent)
  • harassment by colleagues (31 percent), trainees (8 percent), staff (24 percent), and patient families (32 percent)
  • lack of an established mentor (61 percent).

Female neonatologists also tend to struggle more than their male counterparts with work/life balance issues, Leeman notes, making it hard to advance. “Women commented on child care stress and burnout,” she says. “The supports are not there at vulnerable times in their careers. It’s a leaky pipeline.”

Building a mentoring program for female neonatologists

Leeman and Johnston decided to address what they see as the key missing ingredient — mentors.

“Both of us have had the benefit of superb mentorship, which has been integral to our careers,” says Leeman. “We wanted to offer an opportunity for all women across the U.S. to have access to female role models to help mentor them through different elements of their careers.”

With colleagues across the country, they created the National Women in Neonatology Mentorship Program. Bringing together senior, mid-career, and junior neonatologists, the year-long pilot program, which concludes in August, has three goals:

  • to provide resources to facilitate career advancement and professional and personal satisfaction
  • to identify strategies to help female neonatologists gain appropriate compensation, promotions, and professional recognition
  • to foster a feeling of community.

In virtual and in-person meetings, the program’s 250-plus participants read and discuss materials, hear speakers, share their thoughts and experiences, network, offer mutual encouragement, and consult with mentors. The program has various subgroups, including groups for women practicing in community NICUs, groups for specific interests like global health or lab research, and groups for women from backgrounds that tend to be underrepresented in medicine.

Neonatology mentorship at Boston Children’s: Balancing medicine, research, and family

Patricia Davenport, MD, and Martha Sola-Visner, MD, neonatologists at Boston Children’s, illustrate the value of mentorship. As a junior faculty member, Davenport found herself juggling her clinical, research, and family responsibilities. In addition to caring for patients in the NICU, she joined Sola-Visner’s lab to conduct research on neonatal platelet transfusions. Sola-Visner quickly became a mentor.

“Martha’s mentorship has been crucial to me,” Davenport says. “She values her patients, her research, and her family. Holding those three things equally in your hands is really important. I had never done basic science before and needed a lot of mentoring, not just at the bench but also writing and presenting.”

Whether it’s an unfortunate patient outcome, an experiment that didn’t work, or a family emergency, Sola-Visner has been a vital support and sounding board. And the benefits of mentorship flow in both directions.

“I’m established now, and at this stage in my career, seeing other people progress and move forward is the most rewarding part of what I do,” says Sola-Visner. “Making sure that the people who I’ve mentored are succeeding becomes more and more important over time. I get great joy to see that.”

Davenport is also an enthusiastic participant in the national pilot mentorship program, where she is part of a subgroup on basic science.

“We talk about funding difficulties, how to organize a lab, wellness, how to care for yourself,” she says. “There’s a real sense of community across the nation. You’re always asking, ‘am I good enough?’ and it’s nice to hear other women having the same thoughts and feelings of ‘imposter syndrome.’ But we’re all doing good work.”

Source: https://answers.childrenshospital.org/mentorship-neonatology/

Wanglong Gou, PhD1,2,3Congmei Xiao, PhD1,2Xinxiu Liang, PhD1,2; et alZelei Miao, PhD1,2,3Meiqi Shi, MS4Yingying Wu, MS4Sha Lu, PhD4Xuhong Wang, MS4Yuanqing Fu, PhD1,2Wensheng Hu, PhD5,6Ju-Sheng Zheng, PhD1,2,3,7

Key Points Original Investigation Public Health December 19, 2024

Question  Is physical activity during pregnancy associated with preterm birth among women with gestational diabetes (GD)?

Findings  In this cohort study of 1427 pregnant women with GD, accelerometer-derived moderate-to-vigorous intensity physical activity (MVPA) demonstrated an inverse association with preterm birth. The dose-response curve for MVPA in relation to the risk of preterm birth exhibited an L-shaped pattern, with a steady decline in preterm birth rate up to approximately 74 minutes per day.

Meaning  These findings provide key evidence for the health benefits of MVPA during pregnancy and lay the foundation for establishing physical activity guidelines for pregnant women with GD.

Abstract

Importance  Physical activity, as a modifiable factor, emerges as a primary intervention strategy for the prevention and management of gestational diabetes (GD). Among women with GD, the association of physical activity during pregnancy with preterm birth remains unclear.

Objective  To examine the association of accelerometer-derived physical activity metrics and patterns with preterm birth among women with GD.

Design, Setting, and Participants  This prospective cohort study recruited pregnant women with GD in Hangzhou, China, from August 2019 to August 2023 as part of the Westlake Precision Birth Cohort study. Statistical analysis was performed between August and November 2023.

Exposures  Wearable accelerometer–derived physical activity metrics and patterns. Measurements of physical activity via wearable accelerometer were performed at a median (IQR) of 25.4 (24.6-26.6) weeks’ gestation.

Main Outcomes and Measures  Preterm birth was determined through the examination of delivery records. Incident preterm birth was defined as the delivery of infants before completing 37 weeks of gestation.

Results  Among the 1427 women meeting the inclusion criteria, the mean (SD) age was 31.3 (3.8) years, and there were 80 cases of preterm birth. An increase in moderate-to-vigorous intensity physical activity (MVPA) and the fraction of physical activity energy expenditure derived from MVPA exhibited an inverse association with preterm birth, with an odds ratio per 30 minutes of 0.64 (95% CI, 0.42-0.98) and an odds ratio per SD of 0.69 (95% CI, 0.55-0.88). In the dose-response analysis, there was a progressive decrease in the odds of preterm birth with increasing duration of MVPA per day, reaching a plateau at approximately 74 minutes per day. Furthermore, the findings indicated that active MVPA (MVPA ≥30 minutes per day), whether it was concentrated into a few days or followed a more regular pattern, had similar beneficial association with preterm birth.

Conclusions and Relevance  In this prospective cohort study, MVPA during pregnancy exhibited an inverse association with preterm birth among women with GD. Concentrated physical activity was associated with similar benefits in reducing preterm birth risk as regular physical activity.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828262

Mount Sinai Hospital   Sinai Health  March 21, 2024

Two years ago, Adiah and Adrial Nadarajah defied the odds when they were born at just 22 weeks at Mount Sinai Hospital.

The twins, who share the Guinness World Records for the youngest and lightest premature babies born, recently celebrated their second birthday, and we caught up with the family to find out how they’re doing.

Things certainly are much different in the Nadarajah household these days. “The first year of their lives was spent constantly tending to their medical needs,” reflects Shakina. And today, as the twins’ mother puts it, the family is now in the phase of “full throttle toddler parenting.”

“In the first year, the twins didn’t have much recognition of each other, so it’s beautiful to see how close they are becoming,” says Shakina. “Adrial is very affectionate and is always trying to hug his sister. He has started saying a few words too.” Some of which include: banana, potato, purple, car and of course – mama and papa.

Adiah is “the bossy one,” calling all of the shots when it comes to play time. She loves reading books, and given that both of her parents play the piano, Adiah has been naturally drawn to it.

“She is mesmerized by the piano and enjoys watching us play on it, or playing it herself,” says Shakina. “That is how she spends quality time with her dad, Kevin.”

The younger twin, Adrial was on oxygen for a period of time following a re-hospitalization after their discharge from the NICU, but went off it shortly after the twins’ first birthday. And while checking oxygen tanks and figuring out wiring across the house were not what they envisioned for their first year of parenthood, these add to their unique story of parenthood and to the twins’ story of resilience.

The twins continue to attend standard follow up appointments at Mount Sinai Hospital’s neonatal follow-up clinic, which provides families with developmental assessments for their infant(s) who received care in the NICU, and also counselling for early intervention, depending on the needs of children. The detailed assessment of a baby’s growth, feeding and development includes movement patterns, speech, play skills and problem-solving abilities, and guides families in supporting activities to enhance their development to the full potential.

“Infants who spend an extended period of time in the NICU can face long-term challenges, which is why it is important to continuously monitor these children to identify any challenges they may face as early as possible,” says Dr. Prakesh Shah, Paediatrician-in-Chief at Sinai Health. “This allows us to proactively provide optimal support, planning and timely therapy referrals for families.”

The twins were referred to different specialists, including a speech therapist, physiotherapist and an occupational therapist, and continue to get support on an ongoing basis.

“This family is a living example of what hope can do,” says Dr. Shah. “The family continuously advocated for their babies and persevered and now the twins are two years old, defying many odds.”

Although so much has changed for the Nadarajah family over the past two years, Shakina shares that “not a single day goes by” that they don’t think about the Mount Sinai Hospital NICU.

“It holds such a special place in our hearts, and was where we spent the first half year of our babies’ lives. It was our everything – our whole world. And it was amazing to have the support we received from the hospital, especially in the first year.”

Source:https://www.sinaihealth.ca/news/the-worlds-most-premature-twins-turn-two

The first app of its kind to offer information SPECIFIC to the weekly growth and development of the premature baby.”

“A comprehensive guide for parents of premature babies that helps to reshape the NICU experience. Providing and educational and empowering platform to document, record, and celebrate their preemie’s story.”

“The Peekaboo ICU PREEMIE App is inspiring parents and making an impactful difference for NICU families.”

Jun 29, 2024

The realm of neonatal care has always been a critical aspect of medical science. The delicate nature of newborns, especially preterm infants, necessitates constant innovation and improvement in technology. 

As we advance through 2024, several groundbreaking developments are revolutionizing neonatal care, ensuring better survival rates and improved health outcomes for infants. In this blog, we will delve deeper into the significant advancements in neonatal technology that are shaping the landscape this year. 

  1. Neonatal Intensive Care Units (NICUs): Modern NICUs are increasingly integrating smart technology and artificial intelligence (AI) to enhance care delivery. In 2024, many hospitals have adopted AI-driven monitoring systems that continuously analyze vital signs and predict potential complications before they become critical.

The modern NICUs use machine learning algorithms to identify patterns that may be missed by human observation, providing early warnings for serious medical conditions. In fact, more seizures are recorded in real-time when the AI algorithms are applied.

Additionally, NICUs are now equipped with advanced incubators that offer more than just a controlled environment. These incubators come with integrated sensors that monitor temperature, humidity, oxygen levels, and even the infant’s movements. Real-time data from these sensors helps healthcare providers make immediate adjustments to optimize the infant’s environment, significantly reducing the risk of complications.

  • Telemedicine and Remote Monitoring: Telemedicine has become a crucial tool in neonatal care, particularly in remote or underserved areas. In 2024, advancements in telehealth technology allow for real-time video consultations between neonatologists and local healthcare providers. 

Remote monitoring technology has also made significant strides. Wearable devices designed for neonates can now continuously track vital signs and other health metrics, transmitting data to healthcare providers instantly. These devices are minimally invasive, ensuring that they do not interfere with the infant’s comfort while providing critical health information. 

  • Respiratory Support: Respiratory support is a cornerstone of neonatal care, especially for preterm infants whose lungs are not fully developed. In 2024, advancements in this area are particularly noteworthy. 

The high-frequency ventilation and non-invasive procedures are two examples of innovations in the respiratory support systems that have been able to improve the prognosis for neonates suffering from respiratory distress syndrome. These developments also lower the likelihood of long-term problems by offering mild and efficient breathing assistance.

Furthermore, innovations in surfactant therapy, which helps to reduce the surface tension in the lungs and keep the airways open, are enhancing the survival rates and respiratory outcomes for preterm infants. 

  • Personalized Medicine and Genomics: Personalized medicine is transforming neonatal care by customising treatments to the individual needs of each infant. Advances in genomic sequencing allow for the early identification of genetic disorders enabling targeted interventions.

In 2024, whole-genome sequencing is becoming more accessible and faster, allowing for timely diagnosis and treatment of congenital conditions. Pharmacogenomics, which studies how genes affect a person’s response to drugs, is also making its way into neonatal care. 

  • Advanced Imaging Techniques: Imaging technology has seen remarkable improvements, providing clearer and more detailed views of neonatal anatomy and physiology. High-resolution screening devices such as CFM Olympic Brain Monitor specifically designed for neonates are now available, offering non-invasive ways to screen brain conditions. 

In addition, there are other advanced imaging techniques help in early detection of issues such as brain injuries, congenital heart defects, and other critical conditions, allowing for prompt and appropriate interventions.

  • Parental Involvement and Support Technologies: A number of technologies have been introduced in 2024 to encourage parental involvement in neonatal care, in recognition of the vital role that parents play in this process. 

Throughout their child’s time in the NICU, parents are offered resources to remain informed, involved, and supported. Furthermore, specially made wraps and clothes are making skin-to-skin contact—also referred to as Kangaroo care. These items enable parents to comfortably hold their infants while providing the essential medical supervision and assistance.

Summing It Up:

The advancements in neonatal technology in 2024 are profoundly transforming the care and outcomes for newborns, especially those born prematurely or with critical conditions. 

As technology continues to evolve, the hope is that these advancements will become accessible to all, ensuring that every newborn receives the highest standard of care, regardless of their circumstances.

Source: https://www.genworkshealth.com/blog/advancements-in-neonatal-technology-whats-new-in 2024#:~:text=In%202024%2C%20whole%2Dgenome%20sequencing,its%20way%20into%20neonatal%20care.

Abstract

Background

Despite healthcare improvements in Rwanda, newborn mortality remains high. This study assesses the impact of neonatal mentorship on enhancing nurses’ competencies within neonatal units, aiming to address this mortality concern and strengthen healthcare providers’ abilities.

Methods

The prospective cohort study included 25 health facilities supported by Ingobyi Activity in Rwanda, which were beneficiaries of a monthly mentorship program focusing on five critical neonatal competencies. These included adopt manipulation of neonatal equipment, effective management of small and sick newborns, stringent infection prevention and control (IPC), kangaroo mother care (KMC) implementation, and family-centered care provision. We employed an observation checklist to measure neonatal practice competencies, comparing practices at the time point of the baseline, at the 6th mentorship session, and finally at the 12th mentorship session.

Results

The program engaged 188 neonatal nurse mentees. Data analysis highlighted a substantial increase in overall neonatal practice competencies from a baseline of 42.7%–75.4% after 12 mentorship sessions. Specific competency enhancements included family-centered care (40.3%–70.3%), IPC (43.2%–84.2%), KMC (56.9%–73.3%), management of small and sick newborns (38.5%–77.6%), and manipulation of neonatal equipment (42.7%–75.4%).

Conclusions

This neonatal mentorship program was effective in enhancing nursing competencies, leading to significant improvements in neonatal care practices. Future work should evaluate the program’s cost-effectiveness and explore its potential to positively impact neonatal health outcomes, thus ensuring sustainable healthcare advancements.

Source:https://onlinelibrary.wiley.com/doi/full/10.1002/puh2.141#:~:text=Neonatal%20nurse%20mentorship%20intervention,by%20the%20project%20throughout%20Rwanda.

We are delighted to present an editorial for the Special Issue ‘Advances in Healthcare for Neonates’. This Special Issue is a testament to the excellent quality of the eleven articles submitted in the short span of just one year, far exceeding our expectations. We are humbled by the commitment of the scientific community to pursue neonatal research across the globe, which bodes well for improvements in quality of life as newborns grow into children and adults.

The survival of extremely preterm infants in the past few decades is closely linked to the discovery of surfactants in the early 1990s. Advances in neonatal care, including parenteral nutrition, gentle ventilation, and infection control practices, have further contributed to the increasing survival of extremely low birth weight (ELBW) infants. The extensive use of continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) techniques is essential for the close monitoring of infants on NIV to ensure appropriate clinical decision-making. One such method is standardizing the weaning process when using non-invasive ventilatory support. Nussbaum et al. attempted to standardize the weaning of NIV using the Silverman–Andersen score (SAS). The study did not find any differences among the groups, highlighting the fact that various factors, including interrater reliability, influence weaning from NIV, thereby limiting the predictive value of the SAS. However, the study addresses an important knowledge gap in weaning infants on NIV off respiratory support.

Neonatal units have traditionally used chest X-ray for the diagnosis of respiratory disorders in neonates. However, more recently, lung ultrasound has emerged as a useful clinical tool at the bedside. Ismail et al. have demonstrated that imaging using lung ultrasound can not only be used as an alternative to chest X-ray, but also as a high-precision tool for diagnosing various respiratory diseases in neonates, such as respiratory distress syndrome, pneumonia, transient tachypnea of the newborn, meconium aspiration syndrome, pneumothorax, and atelectasis. Incorporating point-of care-ultrasound scanning in scientific studies and training programs would certainly enhance the existing clinical applications of ultrasound, thus helping to advance the care of neonates.

Despite advances in neonatal care leading to the increased survival of ELBW infants, premature infants are at an increased risk of adverse long-term neurodevelopmental outcomes, including cerebral palsy. Assessment of motor movements based on heart rate is a novel way of detecting abnormal pathologies that could help in earlier detection of cerebral palsy. In this Special Issue, Maeda et al., from Japan, present an algorithm to extract the movement patterns of premature neonates, as assessed through a combination of heart rate and video recordings of general movements. The authors demonstrated that it is possible to use an algorithm-based approach to assess general movements using instantaneous heart rate monitoring; however, they caution that it is essential to distinguish artifacts, such as a care intervention, using a supplemental video recording . Nevertheless, as fetal movements indicate fetal wellbeing, movement pattern assessment using algorithmic tools could be valuable for assessing motor and cognitive functions in premature infants after birth.

Early diagnosis and appropriate intervention can minimize the risk of developmental delays sometimes seen in premature neonates. A randomized controlled study comparing standardized early physical therapy versus no intervention in preterm infants from 32 weeks of gestation to 2 months corrected age demonstrated no differences between the group. However, factors such as the dose, intensity of intervention, parental compliance, and the shorter duration of intervention might have contributed to an absence of difference between the groups. The authors also highlight that engaging with and educating parents demonstrating poor compliance with therapy techniques for prolonged periods is essential to derive benefits .

Implementation of neuroprotective care in the neonatal intensive care unit is essential for optimal neurodevelopmental outcomes in premature neonates. Therefore, reducing pain is critical for neuroprotective care in premature infants. Dusek et al. studied the possibilities of influencing the procedural pain associated with retinopathy of prematurity (ROP) screening using oral clonidine. The authors assessed the pain and vegetative scores of using oral clonidine versus standard care during routine ROP exams. Although they did not demonstrate any difference between the groups, the absence of severe complications with clonidine may make it a potential candidate in future studies addressing neonatal pain.

The clinical care of neonates is the focus of this Special Issue. Traumatic lumbar puncture (LP) has been a problem confounding the diagnostic evaluation of neonates, especially in extremely low birth weight infants. In addition to ensuring the proceduralist′s technique, skills, and experience, it is also essential to use the correct size of needle when performing a procedure. In a study in this Special Issue, a smaller gauge (25G) lumbar puncture needle not only resulted in a decreased incidence of traumatic LP, but also a reduction in desaturation episodes during the procedure. This study is a step in the right direction for providing neuroprotective care to these fragile infants. Future studies should address optimal positioning, non-invasive imaging techniques to facilitate easier insertion, and needle size stratification based on gestational age or birth weight in order to optimize the success of vital neonatal procedures.

Improving the outcomes of neonates is best accomplished by preventing hospital-acquired infections and ensuring the optimal screening of newborns in the intensive care unit. The World Health Organization has described antimicrobial resistance as a serious threat to public health; hence, screening fragile infants for multidrug-resistant microbes is essential. Out born infants admitted to neonatal units in Turkey were meticulously screened using perirectal swab cultures and were found to have a 27.2% and 4.8% positive screening rate for carbapenem-resistant Enterobacterales (CRE) and vancomycin-resistant Enterococci (VRE), among the 125 referrals from the outside hospitals. This result reinforces the need for antibiotic stewardship to prevent multidrug resistance, and high vigilance and attention to screening when these vulnerable neonatal patients are referred from centers in which antibiotic policies are unclear.

Next-generation sequencing (NGS) and exome and genome sequencing using targeted panel molecular genetic analysis have contributed significantly to advances in newborn care. In this issue of Advances in Newborn Care, Zaza et al. describe a neonate with a cleft palate and an aortic root aneurysm, with a pathogenic mutation of exon 8 of TGFBR2 confirming a diagnosis of Loeys–Dietz syndrome. Advances in molecular genetics will help better diagnose rare conditions using genetic mutations, thus contributing to earlier detection of conditions and better management of these infants. Neonates with special conditions and genetic syndromes require a higher level of care and treatment strategies, and standardized tools to enhance their recovery. Vogt et al. propose an enhanced recovery protocol for patients undergoing the Kasai procedure for biliary atresia. The checklist includes, among other elements, parental education, preoperative dextrose-containing fluids, maintaining normothermia, adequate analgesia, and initiation of early feeds. The checklists almost always provide a framework for clinicians to optimize outcomes in complex patients such as those requiring the Kasai procedure.

With the increasing survival of premature infants, many patients go home with an accompanying increase in respiratory morbidities post-discharge. The widespread use of palivizumab helps to reduce re-admission rates and complications from infection with respiratory syncytial virus. The feasibility of home immunization with palivizumab without any serious adverse events is reported in this Special Issue . The advantages of home immunizations include higher parental satisfaction and well-being for the whole family. This study is a step towards personalized medicine within a unique population, which may help them to avoid visiting the hospital or clinic and potentially being exposed to children with other droplet infections. On the note of personalized medicine, there is an increase in the growing adult population who were born prematurely and are thus at extremely high risk of developing various comorbidities such as systemic hypertension, metabolic syndrome, reduced exercise tolerance, pulmonary hypertension, chronic obstructive pulmonary disease, and cardiac failure. Holistically addressing the problems of adults born preterm will help promote cardiovascular health, wellness, and quality of life over their lifetime. Despite the large number of resources invested in the survival and care of extremely premature infants, it is surprising that minimal resources are available regarding commitment to wellness as infants grow into children and adults. Vital screening programs, effective communication, targeted counseling and therapeutic interventions, and a seamless transition of care from a pediatric clinician to an adult health care provider would improve the quality and longevity of life of those born extremely preterm.

Source:https://pmc.ncbi.nlm.nih.gov/articles/PMC10297648/#:~:text=Advances%20in%20neonatal%20care%2C%20including,birth%20weight%20(ELBW)%20infants.

Unsafe sleep practices may be a more common cause of sudden unexpected infant death cases where children are born exposed to drugs, according to a new study. The article, “Sleep-Related Sudden Unexpected Infant Death Among Infants Prenatally Substance Exposed,” published in the December edition of Pediatrics, looked at data from the Centers for Disease Control and Prevention SUID and Sudden Death in the Young Case Registry. Data showed that of 2,010 infants with sleep related deaths, 14% had been born drug exposed with nearly a third of all infants dying from suffocation. Among the sleep-related deaths, about half happened in an adult bed with infants sharing the space with a sleeping adult. Overall, 1 in 4 deaths of prenatally exposed infants involved supervisors who were both impaired and bedsharing. Non-Hispanic white infants were disproportionately impacted, making up nearly half of those prenatally exposed who died in their sleep. These infants were also more likely to be exposed to social drivers of poor health and family vulnerability such as poverty and barrier to prenatal care. Study authors advocated for expanded prevention efforts such as safe sleep messaging while arguing more needs to be done to address the social needs of these families.  

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

Source:https://www.aap.org/en/news-room/news-releases/pediatrics2/2024/infants-exposed-to-substances-prenatally-also-have-increased-exposure-to-unsafe-sleep-practices/

The study, led by UBC and SFU researchers in collaboration with the Medical Research Council (MRC) Unit The Gambia, has the potential to help healthcare workers diagnose babies earlier, including in lower- and middle-income countries (LMICs) where neonatal sepsis is of particular concern. The researchpublished today in eBiomedicineis funded by the National Institutes of Health and the Canadian Institutes of Health Research.

“Neonatal sepsis is caused by the body’s irregular response to a severe infection that occurs within the first 28 days of life. Globally, it affects around 1.3 million babies annually, and unfortunately, in LMICs, those rates are higher,” said first author Andy An, a UBC MD/PhD student who completed the research as a doctoral student in the department of microbiology and immunology. “Even when treatment is successful, sepsis can have lifelong effects because it can lead to developmental delay in children, imposing cognitive deficits and long-term health issues. By recognizing it as early as possible, we can treat infants promptly and ideally, head off these harms.”

Neonatal sepsis causes an estimated 200,000 deaths worldwide each year, with the highest rates in LMICs. In Canada, the risk is lower at about one in 200 live births, but higher in prematurely born babies.

Rolling the dice on health

Diagnosing sepsis is challenging for doctors and families. The symptoms can look like many other illnesses, and tests to check if sepsis is present can take several days, aren’t always accurate, and are largely only available in hospitals. The uncertainty can delay urgent treatment with antibiotics.

“Knowing that sepsis is impending would also allow physicians more time to determine the appropriate treatment to use,” said co-senior author Dr. Bob Hancock, professor in the UBC department of microbiology and immunology. “The consequences of neonatal sepsis are so severe in the most vulnerable individuals that providing an early diagnosis to assist and guide physicians could save lives.”

Equitable access to healthcare

The researchers participated in a large study in The Gambia where blood samples were taken from 720 infants at birth. Out of this cohort, 15 babies developed early-onset sepsis.

The researchers used machine learning to map the expression of genes active at birth, in search of biological markers that could predict sepsis.

“We found four genes that, when combined in a ‘signature’, could accurately predict sepsis in newborns nine times out of 10,” said co-senior author Dr. Amy Lee, assistant professor in the SFU department of molecular biology and biochemistry. “This was a unique opportunity where samples were available from all babies in this cohort on the day of birth, meaning we could study the genes expressed in the sepsis babies before they got sick. Most other studies have only published markers that were present when the babies were already ill, and this would therefore not be a predictive signature.”

“The early recognition of sepsis is vital for infants’ survival, and identifying markers that might allow us to ‘predict’ babies at particular risk would be an enormous advantage, since we could then target specific surveillance and treatment of such infants,” said Dr. Beate Kampmann, who led the clinical component of the study at the MRC Unit in The Gambia.

The researchers hope the signature will one day be incorporated not only into PCR tests in hospitals, but also in portable, point-of-care devices.

“There are point-of-care devices available that can test for gene expression, for instance, COVID-19 and influenza, with a single drop of blood. They can operate anywhere with a power source including batteries and can be used by anyone, not just trained healthcare providers,” Dr. Hancock. “These portable devices could be retooled to recognize this ‘signature’ relatively easily and inexpensively.”

The next step for the research would involve a large prospective study to show the signature is successful at predicting sepsis in other populations and prove its methodology, and then the development of point-of-care tools for approval by relevant government bodies.

Source:https://www.sciencedaily.com/releases/2024/10/241028211504.htm

Ready to kick off the new year with fresh goals and BIG dreams? This fun and interactive video is perfect for kids, parents, and educators! We’ll share simple and achievable New Year’s resolution ideas for kids to help them learn goal-setting in a positive and exciting way.

Welcoming the New Year with Hope and Resilience

As preemie warriors, we step into 2025 with gratitude and pride, not just for how far we’ve come but for the people who made our journey possible. This new year is a moment to reflect on the strength and resilience that define us—and to honor the families, parents, caregivers, and healthcare providers who stood by us every step of the way.

Our journey has been shaped by many. For some, families and communities stood as steadfast advocates, offering love and support through difficult decisions and uncertain times. For others, healthcare providers brought their expertise and compassion to the forefront, working tirelessly to help achieve the best possible outcomes. Together, these connections have been a source of strength, ensuring care and hope in moments that mattered most.

2025 is a celebration of this community of support. Together, we’ve proven that resilience is a collective effort. Every milestone we’ve reached—every breath, every step, every moment of growth—is a shared triumph, a testament to the power of unity and the impact of care.

This year, let’s continue to inspire and uplift one another. Our stories remind the world that we as preemie warriors have so much to offer, and that progress in neonatal care depends on the passion and dedication of our neonatal womb community, preemie warriors, families, and professionals alike. By sharing our journeys, we create a ripple effect—sparking change, advancing care, and building a future where every preemie has the best chance to thrive.

Here’s to 2025: a year to honor the bonds that sustain us, the progress we’ve made, and the hope we carry forward. Together, we rise, stronger and more united than ever.

CGI Animated Short Film: “Miles to Fly” by Stream Star Studio | CGMeetup

Follow your Dreams – Miles to Fly is a graduation short made by 4 students from Multimedia University, Malaysia released in 2020. The story is about an ambitious boy who dreams of becoming a pilot but is torn between helping his mother’s bakery to survive, or pursuing his dream.

Mar 12, 2018  Kembara Xscapes

OT, PIONEERS, YOUTH SUPPORT

Colombia, officially the Republic of Colombia, is a country primarily located in South America with insular regions in North America. The Colombian mainland is bordered by the Caribbean Sea to the north, Venezuela to the east and northeast, Brazil to the southeast, Ecuador and Peru to the south and southwest, the Pacific Ocean to the west, and Panama to the northwest. Colombia is divided into 32 departments. The Capital District of Bogotá is also the country’s largest city hosting the main financial and cultural hub. Other major urban areas include MedellínCaliBarranquillaCartagenaSanta MartaCúcutaIbaguéVillavicencio and Bucaramanga. It covers an area of 1,141,748 square kilometers (440,831 sq mi) and has a population of around 52 million. Its rich cultural heritage[15]—including language, religion, cuisine, and art—reflects its history as a colony, fusing cultural elements brought by immigration from Europe and the Middle East, with those brought by the African diaspora, as well as with those of the various Indigenous civilizations that predate colonization.  Spanish is the official language, although Creole, English and 64 other languages are recognized regionally.

Health care in Colombia refers to the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medicalnursing, and allied health professions in the Republic of Colombia.

The Human Rights Measurement Initiative[1] finds that Colombia is fulfilling 94.0% of what it should be fulfilling for the right to health based on its level of income.

The reform of the Colombian healthcare had three main goals:

  • The achievement of an antitrust policy, to avoid the statal health monopoly.
  • The incorporation of private health providers into the healthcare market
  • The creation of a subsidiated healthcare sector covering the poorest population.

The general principles of the law determine that healthcare is a public service that must be granted under conditions of proficiency, universality, social solidarity and participation. Article 153 of the law mandates that health insurance be compulsory, that health providers must have administrative autonomy, and that health users must have free choice of health providers.

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

How to provide neonatal care in low-resource environments | Thomas M. Berger | TEDxGVAGrad

Drawing on historical milestones in neonatology, Professor Thomas Berger highlights the groundbreaking discoveries that revolutionised the care of infants with respiratory distress, ultimately leading to significant reductions in mortality rates. Through his personal experiences in Namibia and the implementation of low-cost interventions in low to middle income countries, he showcases how he has taken matters into his own hands and emphasises the importance of prioritising the patient’s well-being above all else. In this inspiring speech, Professor Berger shows how grit and simple solutions can make a positive impact in saving neonatal babies. Thomas M. Berger is a Swiss paediatrician and neonatologist. His postgraduate training began in Switzerland and continued in the USA (residency in paediatrics at the Mayo Clinic, Rochester, MN; fellowship in neonatology at the Harvard Joint Program in Neonatology, Boston, MA; fellowship in paediatric critical care at the Children’s National Medical Center in Washington, DC). After returning to Switzerland, he led the Neonatal and Paediatric Intensive Care Unit at the Children’s Hospital in Lucerne for almost 20 years. In 2017, together with his wife Sabine (a paediatric nurse), he founded NEO FOR NAMIBIA – Helping Babies Survive. This Swiss NGO helps to improve neonatal care in Namibia by providing affordable and robust equipment, ensuring thorough training of local health care professionals, and measuring impact with appropriate statistics. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx


By Charlotte Gore
  – Mon 18 Mar 24

In short: A program that aims to lower the national rates of preterm and early births says it’s helped 4,000 Australian babies avoid an early birth each year since 2021.

The Every Week Counts program helps maternity hospitals redesign services to identify and treat women at risk of delivering early.

What’s next? Experts involved in the program said they hoped to challenge the belief that full term was 37 weeks gestation. 

Sheree Walsh’s twins Heidi and Connor weighed a combined 1250 grams when she delivered her babies at just 25 weeks gestation. The mother only realised she was at risk of a premature birth after she had concerns over a lack of movement and went to the hospital for a check-up. In an ultrasound she could see both babies moving and was temporarily relieved, until the doctor told her to immediately pack her bags to be admitted to the hospital for bed rest.

“I could still feel the babies, but my cervix had shortened so much that it was a risk for me to remain off bed rest,” Ms. Walsh said.

It was not long before the twins arrived.

“We had Heidi and Connor christened the day after they were born because we didn’t think Heidi would make it. She was so sick,” Ms Walsh recalled.

Every Week Counts 

A world-first Australian program, led by the Australian Preterm Birth Prevention Alliance (APBPA), has said it has managed to significantly lower the number of preterm and early births across the country. 

A preterm birth is one that occurs before 37 weeks gestation, while an early term birth is one that occurs between 37 and 39 weeks — and the Every Week Counts program has aimed to reduce the rates of both.

According to the APBPA, preterm births are the single greatest cause of death and disability in Australians under five years old, and 8 per cent of Australians are born preterm.

Australian Institute for Health and Welfare data has shown that preterm birth rates have fallen by 6 per cent since the APBPA began its work in 2018.

First Nations women are twice as likely as non-Indigenous mothers to experience a preterm or early birth. 

APBPA deputy chair Professor Jonathan Morris said recent data from the federally-funded program suggested early term birth rates had declined by at least 10 per cent.

“Over the course of the program, that means 4,000 babies that would’ve been born early have been born at an appropriate time,” he said.

“Meaning they’re more likely to be with their mothers, more likely to be healthy in the first year of life, and more likely to perform well in later life.”

‘She’s a total miracle’

Ms. Walsh said before delivering her twins she had not heard of a Neonatal Intensive Care Unit (NICU) and was yet to attend birth classes.

“A premature birth is something that you’re not prepared for,” she said.

“With many parents of preemies, their relationship doesn’t survive, but we were really lucky because we were there for each other and we had strong support from our family.”

Now almost seven years old, Heidi is vibrant and energetic, and to her parents she’s “a total miracle”.

Having a premmie baby

Most parents don’t have to leave their baby behind when they go home from the hospital.

“Heidi has very limited core strength, however it doesn’t stop her. She is the most resilient child I’ve ever come across,” Ms. Walsh said.

The mother has had a subsequent pregnancy and was able to deliver Heidi and Connor’s younger brother at full term. She said she believed that was due to the extra monitoring and treatments she received under the Every Week Counts program.

‘Misconception’ of 37 weeks as full term 

Women’s Healthcare Australasia chief executive Barb Vernon said the Every Week Counts program has helped healthcare workers across multiple hospitals reshape some services with the aim of seeing fewer preterm and early term births. Strategies included prescribing vaginal progesterone to people with a shortened cervix or who have a history of spontaneous preterm birth — a treatment that assisted Ms. Walsh in her subsequent pregnancy.

The program has also promoted the continuity of care model which sees expectant mothers meeting with the same staff. Smoking while pregnant is also strongly discouraged.

“What we’ve been doing in this program is working with the hospitals to help them redesign their own local hospital system, to help them do their best care for every woman every time,” she said. “Whether it’s their electronic medical record, their booking process for an induction, the way they communicate with women during pregnancy and the information they might give women to make informed decisions. “All of those elements of care then have an impact on supporting more women to continue their pregnancy to 39 weeks.”

Dr. Vernon said a common misconception they hoped to address with the program was the idea that a baby had reached full term at 37 weeks gestation.

“That’s an idea that has been around for more than 100 years, but what we now know is that the baby’s brain develops much more powerfully if they’re born two weeks later at 39 weeks of pregnancy,” she said.

Dr Vernon said the program was an important opportunity to help pregnant women understand they would be doing “the best possible thing for their baby” if their pregnancy could safely continue to 39 weeks gestation.

“The advice that is being given to women as part of this work is that they should be seeking to have a cervix length measurement taken when they have their mid-pregnancy scan,” she said.

Dr. Vernon said so far the program’s work had been “really inspiring” in terms of the outcomes for women and their families.

“There are hospitals across Australia, from very large services to very small rural centres, that are seeing a drop in the number of babies being born earlier than they should be born,” she said.

Trust, meaningful conversations key to improving Indigenous outcomes

While the program has seen broad improvements across the country, the positive outcomes have not extended to First Nations women, according to Indigenous obstetrician and gynaecologist Kiarna Brown who lives and works on Larrakia country in the Northern Territory.

“I have the amazing privilege of now working as an obstetrician in the town that I grew up in, and so what that also means is that throughout pregnancies, I’m looking after my cousins and my nieces,” Dr Brown said.

The experience has shown her that First Nations women have better birth outcomes when they feel safe and can trust their maternity care providers. 

Dr. Brown was part of a study that examined ten years of births at the Royal Darwin Hospital, finding the prevalence of many risk factors for preterm and early births were the same among Indigenous women compared to other expectant mothers. Those risk factors included preterm membrane ruptures, diabetes in pregnancy, blood pressure issues and whether a woman was carrying more than one baby.

But it did find Indigenous women were more likely to have shorter cervical lengths — an area Dr. Brown said needed more study. She said given preterm birth risk factors were not too dissimilar in Indigenous women, it was likely social determinants of health were responsible for First Nations women being twice as likely to experience preterm births.

“I think it boils down to people’s access to healthcare services … levels of education and employment,” Dr Brown said.

“We also need to find ways to engage and educate women — and I’m not saying we should tell women what to do — but actually getting their perspectives on how [health services] can do better.” “So, that’s what we’ve started in the Top End. We’re doing lots of yarning groups in remote communities, asking:

‘Hey, how can we do better? What do you know about this issue preterm birth? What experience have you had with maternity care?'”

She said the predominantly non-Indigenous workforce urgently needed culturally-informed training, as Western medicine has long ignored how First Nations mothers have traditionally experienced pregnancy.

Dr Brown said one example was that many mothers did not track their pregnancies in weeks or trimesters.

She said instead they might say, “‘My baby’s due in the wet season … or my baby’s as big as a mango'”.

“When they feel safe and trusted, they’re going to come [to maternity services] more often and they’re going to have more meaningful relationships with their healthcare professionals,” Dr Brown said. 

Source:https://www.abc.net.au/news/2024-03-19/australian-program-prevents-preterm-early-births/103601038

May 2, 2024 By Andis Robeznieks, Senior News Writer

Not all telehealth programs began during the COVID-19 pandemic. Ochsner Health started connecting pregnant patients with its digital medicine obstetric program in 2016 and has since achieved success across six key performance metrics including improved clinical outcomes, access to care and health equity.

Ochsner Health’s Connected MOM (Maternity Online Monitoring) initiative uses digital health tools to offer expectant mothers a convenient way to safely manage their pregnancy in collaboration with their physicians at some 20 clinical sites in Louisiana and Mississippi.

In 2022, Ochsner Health enrolled about 205 pregnant patients per month in the program, with nearly 1,600 enrolled at any given time that year and more than 2,250 patients in total for the year, according to an AMA Future of Health case study (PDF).

Ochsner Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Patients are given a blood-pressure cuff to enable them to submit BP readings remotely via their personal smartphone.

This enables ob-gyns and patients to track key health readings and receive alerts when a reading is outside normal thresholds. Once alerted, physicians work with patients on a care plan.

Ochsner Health’s program caught the attention of Sen. Bill Cassidy, MD (R-La.), who then used it as the foundation of his Connected MOM Act, a bipartisan bill supported by the AMA (PDF). The bill would provide state Medicaid programs with remote physiologic monitoring devices and related services through Medicaid.

The Connect MOM program is especially helpful in detecting the hypertensive disorders of pregnancy, like preeclampsia, which is responsible for up to 7% of pregnancy-related deaths in the U.S.

Measures indicate success

The case study notes that the program has achieved significant success across these six dimensions.

Clinical outcomes. 

Connected MOM participants overall had 20% lower odds of pre-term. The program also helped identify patients with “masked hypertension,” which includes those who had hypertension at home but a normal BP measurement in the clinic and are nonetheless at an increased risk for adverse outcomes. Those patients were given early intervention and closer monitoring. 

Access to care. Ochsner Health’s team of more than 120 ob-gyns and certified nurse midwives delivered more than 10,860 babies—of which, about 20% were enrolled in Connected MOM. The option of substituting some in-office visits with virtual visits also was a benefit to patients with transportation challenges, and was helpful to those who otherwise would have had to take time off from work and secure child care to see their physician.

Patient, family and caregiver experience. Ochsner Health data indicates that 10.7% of patients in Connected MOM are re-enrollees, “highlighting a high level of satisfaction with the program,” says the case study.

Clinician experience. Because it is so easy to use the program’s digital tools, staff can better manage their time and offer support to more new patients. For every 1,000 patients enrolled in Connected MOM, the capacity of an ob-gyn’s clinic increases by the equivalent of 0.6 of full-time employee.

Financial operational experience. Connected MOM is offered at no additional cost to patients.

Health equity. Connected MOM supports the recruitment of a diverse demographic of patients, with more than 60% of enrollees being between 26–35 from various racial backgrounds, including 29% Black and 5% Asian, with about 30% of enrollees covered by in-state Medicaid programs.

Grant funding has helped pay for much of the program, so the passage of Dr. Cassidy’s bill would go a long way toward making the program sustainable.

“We’re asking for CMS [the Centers for Medicare & Medicaid Services] to make sure that not just the moms who go to Ochsner, but all moms across the United States are able to benefit from the Bluetooth-enabled blood-pressure devices and remote patient-monitoring devices such as those used in Connected MOM,” Veronica Gillispie-Bell, MD, MAS, head of women’s services at Ochsner Medical Center-Kenner, said in a recent episode of “AMA Update.” 

“If we’re really looking to bring resources to those individuals, to those patients who need it the most, we have to have federal support,” Dr. Gillispie-Bell added.

Support for patients and physicians

The case study also highlights how Ochsner Health leverages the foundational pillars for “addressing the digital health disconnect” described in the AMA-Manatt Health report Closing the Digital Health Disconnect: A Blueprint for Optimizing Digitally Enabled Care (PDF).

The blueprint’s foundational pillars to achieve digitally enabled care are:

  • Build for patients, physicians and clinicians.
  • Design with an equity lens.
  • Recenter care around the patient-physician relationship.
  • Improve and adopt payment models that incentivize high-value care.
  • Create technologies and policies that reduce fragmentation.
  • Scale evidence-based models quickly.

In describing how the program is built for patients, physicians and other health professionals, the case study notes that patients are sent reminders to take their BP reading. Patients also receive a weekly planner and checklist for tracking their vital signs.

“The program has been thoughtfully designed to support both patient and clinician needs,” the case study says.

Regarding the pillar on creating technology that reduces fragmentation, the case study notes that sharing data via the patient’s smartphone app means that patients don’t need to copy or transcribe the data to message their physician. “Connected MOM allows for a centralized location for both the care team and the patient to access information, track progress, [and] identify trends,” the case study says.

Source:https://www.ama-assn.org/practice-management/digital/digital-health-program-cuts-pre-term-births-20

Juanes           3.07M subscribers  

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#JuanLuisGuerra #Juanes #VidaCotidiana

Mitchell Goldstein, MD, MBA, CML

Neonatology, a field dedicated to the care of newborns, is characterized by its rapid pace of evolution. New research findings, advanced technologies, and updated guidelines continuously reshape our understanding and practices. What was considered best practice a decade ago may be outdated as the field progresses. This constant flux can lead to disagreements among professionals, which, though potentially disruptive, play a critical role in advancing care standards and improving patient outcomes.

Navigating these disagreements with finesse ensures they contribute rather than hinder progress. Constructive disagreement is not just about airing differing opinions; it involves engaging in a thoughtful and respectful dialogue that fosters professional growth and enhances patient care. Here are several fundamental principles for managing disagreements effectively in neonatology.

1. Prioritize Respectful Dialogue

The foundation of productive disagreement is respectful.  communication. Interrupting others disrupts the flow of conversation and can escalate tensions. It is crucial to allow each participant to complete their thoughts before responding. This practice ensures that every viewpoint is fully understood and considered. Active listening is a cornerstone of respectful dialogue; it demonstrates that you value the other person’s perspective and are open to their ideas.

2. Let Everyone Speak

Equally important is ensuring that every participant has the opportunity to voice their opinions. Dominating the conversation or dismissing others’ viewpoints can stifle valuable insights and create a skewed discussion. Encourage a balanced exchange where all voices are heard. This inclusive approach not only fosters a more democratic dialogue but also enriches the decision making process by incorporating diverse perspectives.

3. Silence is Golden

In the heat of a debate, silence can be a powerful tool. It provides a moment for reflection and allows participants to process the information being discussed. Rather than rushing to fill every

pause with words, embrace moments of silence as an opportunity to gather your thoughts and consider the points raised by others. Silence can also help de-escalate tensions and allow everyone to cool down before responding.

5. Choose the Appropriate Setting for Discussions

 The context in which disagreements occur can significantly impact their resolution. Sensitive or contentious issues are often better addressed in a private rather than a public forum. A private discussion allows for more candid exchanges without the added pressure of an audience, which can lead to more effective problem-solving and reduce the risk of escalating the conflict.

6. Focus on the Issue, Not the Person

Effective disagreement involves focusing on the issue rather than allowing personal animosities to cloud the discussion. Avoid competitive “pissing contests” where the goal is to outshine or undermine the other person. Instead, concentrate on clearly articulating the opposing viewpoint and contrasting it with evidence based data. This approach ensures that the debate remains centered on the merits of the arguments rather than personal conflicts.

7. Use the Praise Sandwich Approach

One effective method for presenting a differing opinion is the “praise sandwich” approach. This technique involves beginning with a positive remark or acknowledgment of the other person’s perspective, presenting your disagreement, and concluding with another positive note. This approach helps soften the impact of dissent and maintains a positive and constructive tone throughout the discussion. It demonstrates respect for the other person’s contributions while making your point.

8. Know When to Step Back

Sometimes, despite our best efforts, discussions can become too heated to be productive. In such cases, stepping back and taking a break is wise. A pause lets participants cool down and reflect on the discussion with a clearer perspective. Revisiting the conversation later can lead to more thoughtful and constructive dialogue, fostering a better resolution.

9. Cultivate an Open Mind

Approaching disagreements with an open mind is essential for constructive dialogue. Suspend disbelief and be willing to consider new ideas, even if they challenge your current beliefs. This willingness to explore different viewpoints can lead to innovative solutions and improvements in practice. Agreeing to disagree is a natural part of professional discourse and can enhance collaboration and problem-solving.

10. Remember the Shared Goal

Regardless of the intensity of the disagreement, it is essential to remember that all participants share a common goal: improving patient care. Maintaining a sense of camaraderie and mutual respect helps to keep the bigger picture in focus. (4) Disagreements should be viewed as opportunities to refine and enhance practices rather than as personal battles.

 By adhering to these principles, disagreements can be transformed from potential conflicts into valuable opportunities for professional development and innovation. Constructive disagreement enriches the practice environment and contributes to improved physician retention and a more dynamic approach to patient care. Fostering a respectful dialogue ensures that every voice is heard and that the field of neonatology continues to advance in its pursuit of excellence.

Source: https://neonatologytoday.net/newsletters/nt-sep24.pdf

High-quality neonatal intensive care requires diverse specializations and interprofessional teamwork to include the unique contributions of neonatal therapists. Neonatal therapists include occupational therapists (OT), physical therapists (PT), and speech-language pathologists (SLP), who specialize in delivering age-specific evaluations and therapeutic interventions for premature and medically complex infants in the neonatal intensive care unit (NICU)  A neonatal therapist begins with the end in mind to mitigate adverse sequelae, optimize neurodevelopment, and strengthen infant mental health by scaffolding the infant-parent dyad Although therapists are traditionally known for their rehabilitative roots, neonatal therapists utilize a preventative, habilitative approach, emphasizing neuroprotection and neuropromotion .

 What is Neonatal Therapy? 

 Neonatal therapy is an advanced practice area for OTs, PTs, and SLPs as described by the Neonatal Therapy Core Scope of Practice©. All three professional groups share core fundamental knowledge yet recognize that each discipline adds unique and valuable contributions to the field. In part, neonatal therapy is “the art and science of integrating typical development of the infant and family into the environment of the NICU.”.  As interdisciplinary care team members, neonatal OTs, PTs, and SLPs help drive the delivery of Family Centered, developmental care and are often instrumental in the discharge planning process. In level III and IV NICU settings, neonatal therapists are integral to neonatal follow-up clinics, providing neurodevelopmental testing and triage for early intervention services.

Why is neonatal therapy considered an advanced practice area?

 Professional training programs for OT, PT, or SLP entail graduate-level or doctoral degrees. Despite this rigorous education, advanced training in the neonatal therapy subspecialty is required. An entry-level neonatal therapist requires NICU-specific continuing education and mentorship to ensure safe, well-timed, risk-adjusted neonatal care. Neonatal therapists must be familiar with the complexities of the NICU environment, recognize neonatal risk factors, precautions, and medical comorbidities, navigate NICU equipment, safely handle preterm and critically ill infants, apply trauma-informed principles when working with families, and have a solid understanding of typical preterm and newborn neurobehavior and developmental progression (1-3). This extensive education and training instills confidence in neonatal therapists’ expertise and their ability to provide evidence-based services in this highly vulnerable patient population.

What are the requirements to become a certified neonatal therapist (CNT)?

The CNT designation is internationally recognized and obtained throughthe Neonatal Therapy Certification Board (NTCB). The CNT certification requirements include: (a) credentialling as an OT, PT, or SLP for three or more years, (b) 3500 hours of experience in the NICU, (c) Forty hours of NICU-specific education in less than three years, (d) forty hours of NICU mentorship, and (e) successful completion of the Neonatal Therapy National Certification Exam.

What are the neonatal therapy practice domains?

Neonatal OT, PT, and SLP have a shared foundational knowledge, including six practice domains: (1) environment, (2) family/ psychosocial support, (3) sensory system, (4) neurobehavioral system, (5) neuromotor and musculoskeletal systems, and (6) oral feeding and swallowing, which are not fundamentally exclusive to any one discipline (1,2). Neonatal therapists use an integrative collaborative-care model when administering continual assessment and intervention cycles grounded in evidence-based decision-making (9). Ideally, therapeutic interventions begin at the earliest point of the lifespan when therapists collaborate with other disciplines and use their unique lenses to help advance infant competencies, promote parental confidence, and expedite the journey home.

What interventions do neonatal therapists provide?

From the first day of life, neonatal therapists promote healthy postures and movement patterns, reduce pain and stress, and nurture age-appropriate sensory experiences. In tandem with the bedside nurse, neonatal therapists partner with families to engage them in their baby’s activities of daily living, such as diapering, eating, dressing, bathing, etc.. Neonatal therapists can be instrumental in coaching parents with direct hand-overhand support and anticipatory guidance to help develop proficiency and confidence in their co-occupation as parents. The neonatal therapy team helps to advance individualized care plans to include environmental modifications, positive touch, therapeutic handling for posture and regulation, protection of the aerodigestive system, infant-driven feeding strategies, and parent education related to discharge needs (1, 3, 11). In many settings, neonatal therapists are considered feeding specialists with advanced training in pre-feeding strategies, breastfeeding support, and clinical feeding assessments (10, 13). Highly skilled neonatal therapy professionals will often have extensive training in any of the following areas: (a) evaluating an infant’s neurologic integrity using skilled observations and standardized testing, (b) therapeutic management of orthopedic conditions, (c) instrumental swallowing evaluations such as video fluoroscopic swallow studies (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES), and (d) lactation support as a Certified Lactation Counselor (CLC) or International Board Certified Lactation Consultant (IBCLC).

What is the best approach to successful neonatal therapy staffing?

With the rising complexity and volume of premature and medically fragile infants, there is a growing need for highly trained, multidisciplinary NICU teams . Finding and staffing NICUs with all three disciplines who also have NICU-specific expertise can be highly challenging, particularly in units with high fluctuations in their census and for smaller, more rural NICUs. Larger level III and IV NICUs have additional staffing challenges of higher acuity, heavy caseloads, and shortage of qualified therapists. The staffing models of neonatal therapy teams often vary in size and the way they delineate roles between neonatal therapists based on therapist availability, cross-discipline knowledge, therapy service requirements, budget constraints, and the individual therapist’s competence and confidence within the neonatal subspecialty. The American Academy of Pediatrics (AAP) NICU Verification Program includes neonatal therapy services for Level II, III, and IV NICUs, with certified neonatal therapists (CNTs) preferred.

Help celebrate neonatal therapists from around the world!

Every September, the National Association of Neonatal Therapists (NANT) hosts International Neonatal Therapy Week (INTW) to highlight this advanced practice area and unite neonatal OT, PT, and SLP clinicians around the globe. NANT is a professional organization that delivers NICU-specific continuing education, resources, standards, mentorship, and supportive connections to advance this specialty. During the week of September 15th-21st, 2024, NANT will celebrate the impact of this vibrant neonatal therapy community with its members, who span over thirty countries and five continents.

Want To Learn More?

• Celebrate International Neonatal Therapy Week between September 15th and 21st, 2024 and join  

   our vibrant neonatal community.

 • Attend NANT 15, the annual neonatal therapy conference, in Indianapolis, IN, from March 27th to   

   29th, 2025. Attendees typically represent all fifty states and eight or more countries.

• Join NANT’s annual Virtual Summit in December — A FREE educational event— info coming soon! • Stay informed by subscribing to NANT NEWS and visiting www.neonataltherapists.com

• Therapists interested in becoming a CNT can apply online at https://www.ntncb.com/

Cistone, Nicole MSN, RN, RNC-NIC; Pickler, Rita H. PhD, RN, FAAN; Fortney, Christine A. PhD, RN, FPCN; Nist, Marliese D. PhD, RNC Editor(s): Gephart, Sheila PhD, RN, Section Editor; Newnam, Katherine PhD, RN, NNP-BC, CPNP, IBCLE, Advances in Neonatal Care 24(5):p 442-452, October 2024. | DOI: 10.1097/ANC.0000000000001177

Abstract

Background: 

Although routine nurse caregiving is vital for the overall health of preterm infants, variations in approaches may exert distinct effects on preterm infants’ stress responses and behavior state.

Purpose: 

The purpose of this systematic review was to examine routine nurse caregiving in the neonatal intensive care unit and its effect on stress responses and behavior state in preterm infants.

Data Sources: 

A systematic search was conducted using PubMed, Embase, and CINAHL for studies published between 2013 and 2023.

Study Selection: 

Included studies enrolled preterm infants born <37 weeks gestational age and investigated nurse caregiving practices and effects on stress responses and/or behavior state.

Data Extraction: 

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data about study design, methods, findings, and limitations were extracted and summarized. Included studies were evaluated for bias using the National Health, Lung, and Blood Institute quality assessment tools.

Results: 

All 13 studies included in the review received a fair quality rating. Nurse caregiving activities, including suctioning, diaper changes, bathing, and weighing, were associated with increases in heart and respiratory rates, blood pressure, energy expenditure, and motor responses, lower oxygen saturations, and fewer sleep states.

Implications for Practice and Research: 

Adapting nurse caregiving frequency and duration, aligning caregiving with infant state, and integrating developmental care strategies may reduce infant stress responses and support behavioral rest. Further research is needed to understand how caregiving activities affect stress responses and behavior state in preterm infants, aiding in identifying modifiable caregiving stressors to promote optimal development.

Spotsylvania Regional Medical Center    Jul 19, 2021

Meet Occupational Therapist Hayley Chrzastowski and learn how a baby in the Level III NICU at Spotsylvania Regional Medical Center would receive care from an occupational therapist. Dr. C Chrzastowski will also discuss how she works to both include and support baby’s care team to best prepare them to care for baby once transitioned home.

Key Points

Your baby may have tests in the NICU to find out about health conditions and treatments she needs to grow and be healthy.

Some tests, like blood tests, are really common, and lots of babies get them. Others are just for babies with certain health conditions.

Before providers can do certain tests on your baby, you have to give permission. This is called informed consent.

Talk to your baby’s provider about tests your baby needs. Make sure you understand the test and why your baby needs it before you give permission.

Why do babies have tests in the NICU?

Your baby’s health care providers in the newborn intensive care unit (also called NICU) staff give your baby medical tests to find out about your baby’s health conditions. Test results help providers know what treatment your baby needs. For example, providers may do a blood test to check your baby for anemia. Anemia is when your baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of her body. Or providers may take an X-ray to check your baby for a lung infection. Your baby’s provider tells you what tests your baby needs and tells you the test results.

Before providers can do certain tests, they need your consent. This means they’ll ask you to read and sign a consent form. When you sign the form, you give them permission to do the test. Sign the form only when you understand what the test is and why your baby needs it. Ask your baby’s providers any questions you have about the test before you sign the form.  

What tests may your baby have in the NICU?

blood test — Tests your baby’s blood for certain health conditions. Blood tests are the most common tests done in the NICU. Test results give providers important information about your baby’s health.  They also help providers find possible problems before they become serious.

CAT scan or CT scan — Also called computed tomography scan. A test that takes pictures of the inside of the body. It’s like an X-ray, but it gives a clearer, three dimensional (also called 3D) view. Your baby goes to the radiology department for the test. She may need medicine to help keep her still during the test.

echocardiogram — A special kind of ultrasound that takes pictures of the heart. Ultrasound uses sound waves and a computer screen to make the pictures. Providers use this test to help find heart problems, including heart defects. A heart defect is a problem with the heart that’s present at birth.

EKG or ECG— Also called electrocardiogram.  A test that records the heart’s electrical activity. An EKG can show how fast your baby’s heart is beating and if the rhythm of the heartbeat is regular.

hearing test — Also called brainstem auditory evoked response test or BAER. This test checks your baby’s hearing. A provider places a tiny earphone in your baby’s ear and puts small sensors on his head. The provider plays sounds through the earphones, and the sensors send information to a machine that measures your baby’s response to the sounds. All babies get this test as part of newborn screening.

MRI— Also called magnetic resonance imaging. This test uses strong magnets and radio waves to take detailed pictures of the inside of your baby’s body. An MRI gives a more detailed view than a CT scan, X-ray or ultrasound. Your baby may need medicine to help keep her still during the test.

newborn screening test — Checks for serious but rare and mostly treatable conditions at birth. It includes bloodhearing and heart screening.

ROP exam— Also called retinopathy of prematurity exam or eye exam. Providers use this test most often for babies born before 30 weeks of pregnancy or babies who weigh less than 3 1/3 pounds. An eye doctor (also called an ophthalmologist) checks to see if the blood vessels in your baby’s eyes are developing the right way. If the doctor sees signs of problems, he checks your baby’s eyes over time to see if the condition gets better or if it needs treatment.

ultrasound — A test that uses sound waves to make pictures of the inside of the body. A provider puts a special jelly on your baby’s skin over the area of the body she wants to check. Then she rolls a small device shaped like a microphone over the area. Providers often use ultrasound to check for bleeding in your baby’s brain.

urine test — Tests a baby’s urine for certain health conditions. Urine test results can tell providers a lot about your baby’s overall condition. For example, test results can tell provider if your baby’s getting enough fluid, how your baby’s kidneys are working and if your baby has an infection. Your baby’s provider inserts a thin tube called a urinary catheter in the opening where urine passes out of your baby’s body to collect the urine.

weight — Weighing your baby at birth and as he grows and develops. Providers weigh your baby soon after birth and at least once a day in the NICU. It’s a good sign when babies start to gain weight at a steady rate.

x-ray — A test that uses small amounts of radiation to take pictures of the inside of your baby’s body. X-rays show pictures of your baby’s lungs and other organs. If your baby has breathing problems, she may need several lung X-rays each day. X-rays expose your baby to radiation, but the amount is so low that it doesn’t affect her health now or in the future. Radiation is strong energy that can be harmful to your baby’s health if she’s exposed to too much.

See also: shareyourstory.org https://www.marchofdimes.org/find-support/topics/neonatal-intensive-care-unit-nicu/common-tests-nicu

Recognize the warning signs of social anxiety and get help for your teen.

Posted December 20, 2022 |  Reviewed by Gary Drevitch

THE BASICS

Key points

  • Post-pandemic life is harder for teens with social anxiety, as restrictions that curtailed their social activities are no longer present.
  • Parents can watch for a variety of signals that indicate whether their teen is struggling with social anxiety.
  • Cognitive behavioral therapy is the gold standard of effective treatment and management for social anxiety.

Parents continue to grapple with the impact of pandemic restrictions on the mental health of their children. For teens, reentry into “normal” life brings a new set of challenges, especially for those prone to social anxiety. Most teens with social anxiety experienced profound relief during the pandemic because restrictions curtailed their social and performance situations. They didn’t have to face the many situations that commonly trigger their social anxiety, such as raising a hand in class, making idle chitchat with peers, attending a social event, and playing sports. However, their prolonged lack of exposure to these situations also set them back because they didn’t have the opportunity to learn and grow and discover that they can in fact handle being in uncomfortable social situations.

Teens’ anxiety about social and performance situations came roaring back with a vengeance when those situations returned to their daily lives. A national survey of U.S. teens aged 15 to 19 found that nearly half (48%) were concerned about experiencing social anxiety while transitioning back to “normal” life (Steinberg, 2021). Compared with pre-pandemic statistics, which indicated that approximately 10% of teens suffered from social anxiety (NIH, n.d.), this is a remarkable increase that deserves our attention.

In simple terms, social anxiety involves feeling extreme worry and fear related to social and performance situations. Individuals suffering from social anxiety can also fear being observed doing basic everyday activities, such as using a phone, texting, writing, using a computer, eating, or using a public restroom. Their worry and fear focus on concerns about feeling judged, negatively evaluated, and ultimately being rejected by others. Social anxiety doesn’t present the same way in all individuals, but it always exacts a big toll on the well-being of the sufferer.

How do I know if my teenager is struggling with social anxiety?

Observe your teen’s behaviors and listen to what they are saying. If you notice any of the following, your teen is likely experiencing social anxiety:

  • Inordinate focus on and preoccupation with concerns about how others perceive them.
  • Avoidance of social or performance situations that most peers tolerate.
  • Extreme physiological reactions (e.g., sweating, shaking, nausea, hyperventilation) in performance or social situations.
  • Excessive reassurance seeking and/or declarations that others perceive them as weird, odd, etc.
  • Requests for special accommodations from teachers, counselors, etc. to reduce or avoid being in situations that trigger worry and fear (e.g., requests to be excused from oral presentations, public speaking, competitions, or classes or activities that others tolerate easily).
  • Recess and break times spent in the library or other locations less likely to result in social interactions
  • Refusal to attend parties or other events you expect your teen would enjoy, or insistence that they simply dislike these events.
  • Spending time only with kids they know well.

If you observe any of the above, your teen is missing out and may need your help.

Why it’s important to get help for your teen

Untreated social anxiety is associated with depressionsubstance abuse, and other serious psychological problems. It can make your teen’s life miserable and limited.

Studies show that untreated social anxiety has a strong negative impact on various measures of quality of life, including academic achievement, and can interfere with people’s career paths (Vilaplana-Pérez et al., 2021). Without effective intervention, teens often come to define themselves as lacking in basic self-confidence, insecure, self-doubting, and inadequate.

These unfortunate outcomes and suffering are avoidable and repairable if the right steps are taken. Social anxiety or any other type of anxiety disorder should never define a person. These are common, highly treatable problems, just like asthma, diabetes, or allergies.

Finding treatment for social anxiety

Cognitive behavioral therapy (CBT) is the gold standard of effective treatment and management for most anxiety and related problems, including social anxiety. The basic process of CBT for anxiety disorders involves identifying distorted thinking, correcting those thinking errors, and adjusting specific behaviors. Exposures are the single most important element of successful CBT. The basic technique of exposure is to gradually face a situation that triggers anxiety, while at the same time not engaging in any safety, avoidance, or accommodation behaviors or rituals (Walker, 2021).

Finding a qualified CBT clinician, however, can be a huge challenge, and locating one who is truly experienced in CBT is not easy. You may have tried traditional talk therapy for your teen but found it ineffective. Unfortunately, after ineffective treatment, many people feel worse about themselves; like they can’t be helped. This is especially damaging to a young person developing their sense of self.

To find a therapist, visit the Psychology Today Therapy Directory.https://www.psychologytoday.com/us/blog/anxiety-relief-for-kids-and-teens/202212/post-pandemic-reentry-for-teens-with-social-anxiety

Dr Niels Rochow is a researcher and neonatologist at Klinikum Nürnberg, in Nürnberg, Germany, one of the largest municipal hospitals in Europe. 

His work, looking after newborns born early or with medical problems, keeps him very close to the topic of his research. He recalls a tense battle over the weekend to save a premature baby’s life. 

‘She was born early and was in a bad state. We fought for two and a half days to keep her alive.’ The baby’s survival depended on invasive artificial ventilation technology and external lung and kidney support. 

Although sometimes lifesaving, these devices were originally developed for adults and scaled down for neonatal care. They are not well adapted to a baby’s tiny body, are highly invasive and can damage immature lung tissue.

Currently, premature babies frequently need to be heavily medicated and connected to a mechanical ventilator pumping air into their lungs. 

‘These babies are full of tubes and essentially paralysed,’ said Rochow. This treatment often leads to side effects and can cause chronic lung disease, impacting the child’s whole life.’

Short- and long-term impact

Every year, about 15 million babies are born preterm – classified as before the 37th week of pregnancy. A full-term pregnancy is 40 weeks, but a lot happens in those last three weeks. Currently, around 7% of births in the EU are classified as preterm. 

Despite advancements in neonatal intensive care, progress in improving long-term health outcomes for these infants has been slow. Two million preterm babies lose their lives – before they even start – every year. 

In fact, the Global Burden of Disease study in 2010 estimated that preterm births were the leading cause of death and disability in children under the age of five – greater than either malaria or pneumonia.

Having missed the crucial developmental milestones that normally occur in the last part of the pregnancy, survivors also have increased risks of long-term health consequences. They are more likely to suffer respiratory issues like bronchitis and asthma, and be affected by a range of neurodevelopmental disorders due to brain injury.

Like mother’s womb

Dr Rochow is one of a team of European and international researchers that received a grant through the European Innovation Council (EIC) Pathfinder programme to work on a better alternative – a system they call an artificial placenta, or ArtPlac. 

The goal is to simulate the conditions of the mother’s womb, potentially reducing complications and improving outcomes for the most vulnerable newborns.

‘In the womb, the baby is connected to the natural placenta which serves as a lung, a kidney and a feeder,’ said Professor Jutta Arens, one of the lead engineering scientists working on the four-year ArtPlac project, which kicked off in 2023. 

‘This placenta cannot be reconnected after birth, which is why we are developing a device that replaces its functions in the most natural way possible.’ By connecting to the baby’s belly button, the artificial placenta allows the infant to develop and heal naturally, offering a less invasive alternative to current methods. 

ArtPlac will also make it easier for parents to have physical contact with their child from the start. Artificial ventilators are not only very invasive, they are also awful for parents, according to Rochow.

‘If you hear your baby cry, you want to hold it. Yet, you can’t. With ArtPlac, parents could be close to the baby and interact with it more easily.’ 

ArtPlac will undergo initial in-vitro testing in the last quarter of 2024. This will be followed by proof of principle in-vivo testing which will be carried out on a premature lamb. The aim is to be able to perform initial clinical trials on babies within the next few years. 

Early injury, lifetime consequences

Although advances in healthcare mean that more than half of all babies born before 28 weeks survive, a large proportion of these will have a lifelong disability. Even babies born late preterm – between 32 and 37 weeks – are at increased risk.

The brain damage caused by premature birth, known as encephalopathy of prematurity (EOP), can result in long-term disorders like cerebral palsy, severely impaired cognitive functions, attention deficit and hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Brain injury can also be caused by a lack of oxygen during birth (asphyxia) or a stroke around the time of birth. 

For example, it is estimated that a quarter of all cerebral palsy cases are associated with preterm birth. Diagnosing a brain injury in a preterm baby, however, is complicated and can take days to weeks. Even then, there are few options for treatment. 

Dr Bobbi Fleiss is a researcher and senior lecturer at the Royal Melbourne Institute of Technology (RMIT) in Melbourne, Australia. She leads the RMIT Perinatal Brain Injury lab and is passionate about understanding injury to the brain in newborn babies and how to make outcomes for these infants better. 

‘The standard procedure is applying cooling therapy, which has to happen within six hours after birth,’ explains Fleiss. ‘It is very stressful.’ 

Fleiss is part of a global team of researchers that received funding from the EU to develop an effective alternative treatment for preterm brain injury. Led by the French National Institute of Health and Medical Research (INSERM), the PREMSTEM project runs from 2020 to the end of 2024.

It brings together world-leading clinicians, researchers, stakeholder advocacy groups and an industrial partner specialising in neonatology and drug development from eight countries: Australia, France, Germany, Italy, the Netherlands, Spain, Sweden and Switzerland.

Brain-healing stem cells

Like ArtPlac, PREMSTEM takes its inspiration from nature’s own design. Blood that remains in the umbilical cord after birth contains a special kind of cell called a stem cell. 

These cells have the ability to grow into many different kinds of cells, such as bone marrow cells, blood cells or brain cells. This makes them very valuable for treating a wide range of diseases.

PREMSTEM is using stem cells from donated umbilical cords to create a groundbreaking and easy-to-administer new treatment that could help heal neonatal brain injuries. 

‘Think of stem cells as little factories that produce helpful chemicals and support the brain in helping itself,’ said Fleiss. ‘Our goal is to provide an intranasal treatment using a fine mist containing the stem cells.’

Specifically, a simple nasal spray containing stem cells is sprayed into the baby’s nose. From there, the stem cells travel to the brain, find the damaged areas and assist the brain in repairing itself.

PREMSTEM researchers have successfully tested different delivery systems, several of which have proven to be effective in reducing brain injury in animals. They expect that clinical trials testing the new treatment in human babies should begin in 2026. 

The success of these projects could be life-changing for millions of babies and their families. ‘Even if we help one percent of them, it’d be wonderful,’ said Fleiss.

‘My dream is to see every baby leaving the hospital with smiling families. I hope every parent’s biggest stress will be how to strap their baby into a car seat. Nothing more.’ 

Research in this article was funded by the EU’s Horizon Programme including, in the case of ArtPlac, via the European Innovation Council (EIC). The views of the interviewees don’t necessarily reflect those of the European Commission.

Source:https://projects.research-and-innovation.ec.europa.eu/en/horizon-magazine/pioneering-care-preemies-artificial-placentas-brain-healing-stem-cells

Last updated: August 21, 2024

High-risk pregnancies can be treated and managed through telehealth as long as the patient and provider have an emergency plan in place. US Dept. Health and Human Services

What are considerations for using telehealth for high-risk pregnancies?

Telehealth can provide life-saving health care for pregnant patients. Some rural patients live far from high-risk specialists. Others can’t afford to take time off work or find childcare to go to their provider’s office. There are several ways to ensure access to high quality care for high-risk patients through telehealth.

Use remote patient monitoring

There are several devices that can monitor a patient’s health without the patient having to come into the office for multiple check ups. Remote patient monitoring can also be used to gauge whether a patient has breached the high-risk threshold, meaning it’s time to seek immediate medical care.

Pregnancy-related remote monitoring devices may include:

  • Blood pressure monitors
  • Blood glucose testing
  • At home fetal monitors

Patients should be sent to in-person care when:

  • There is decreased fetal movement
  • There are known fetal abnormalities that require multiple check ups
  • The patient is experiencing pre-eclampsia symptoms
  • The patient is experiencing signs of early labor

Know when to seek in-person care

Part of your telehealth workflow should include a protocol for when to send a high-risk patient to the office or hospital. Some high-risk conditions, including pregnancies with multiple babies and certain chronic conditions, need more in-person oversight than telehealth can provide.

Partner with local resources for rural and underserved patients

Telehealth can be a life-saving resource and also the first line of defense for potential pregnancy complications. This is especially true for rural and underserved patients who may delay, or entirely forgo, prenatal care.

High-risk care tends to be more hands on than complication-free maternal health care. But there are many ways telehealth providers can make sure rural and underserved patients get the care they need, when they need it. Some examples include:

  • Identify and partner with the patient’s local clinic or hospital. Local facilities can often provide routine testing that will help you determine the best course of care, and keep an eye on potentially serious complications. This could include baseline 24 urine collection and labs for pre-eclampsia, STI panels, blood sugar monitoring, and ultrasound.
  • Work with local OB-GYNs for in-person appointments. Underserved patients may often feel more comfortable with providers that are not local to their area.
  • Research local resources and online help post-childbirth. Rural and underserved parents don’t stop needing maternal telehealth care once the baby is born. Telehealth providers can help in those first few days and weeks with telehealth lactation consulting and mental health counseling. Other potential resources following high-risk pregnancies could include maternal or pediatric specialists, local and online behavioral health support, substance use counseling, smoking cessation, and parenting classes.

More information

Telehealth for chronic conditions — Health Resources and Services Administration

Statewide Telehealth Program Enhances Access to Care, Improves Outcomes for High-Risk Pregnancies in Rural Area — Agency for Health Care Research and Quality

Spotlight

Maternal Hypertension Remote Patient Monitoring Project

Using remote patient monitoring (RPM) technology, the University of Mississippi Medical Center, a HRSA-funded Telehealth Center of Excellence, is monitoring women who are at high risk for hypertension during their pregnancy. A nurse coordinator will assist the mothers in coordinating care including connecting them to community and health resources to support a healthy pregnancy. The program also provides maternal child and chronic disease management support and virtual consultations with an obstetrician in the home.

Learn more about the University of Mississippi Medical Center’s Maternal Hypertension RPM project .

YouTube  Child Mind Institute  Apr 27, 2023

Building Resilience: Taking Charge of Your Well-Being

Navigating life as a young person today can feel like an obstacle course of challenges, from school pressures to social expectations and the quest for personal goals. But each of these experiences is also a chance to build something powerful: resilience. Resilience is the ability to bounce back from setbacks and keep going even when the going gets tough. And the good news? It’s a skill anyone can develop with a little practice.

Set Your Own Pace
Life is not a race, despite how it sometimes feels. Take a moment to step back, breathe, and check in with yourself. How do you feel? Are you pushing too hard or not hard enough? Finding your balance is key. Try setting small, achievable goals each week that help you get closer to your bigger dreams. Remember, it’s the consistent, small steps that lead to big changes.

The Power of Positive Self-Talk
Your mind can be a powerful cheerleader—or a tough critic. What you say to yourself impacts how you feel and act, so practice kindness in your self-talk. When a mistake happens, instead of thinking, “I can’t believe I messed up,” try, “I learned something valuable here. I’ll do better next time.” Resilience isn’t about never feeling down; it’s about how you lift yourself back up.

Find Your Outlet
Everyone needs an outlet to decompress and recharge. For some, that’s going for a jog or hitting the gym. For others, it’s creating art, cooking, or simply enjoying a quiet walk. Whatever brings you joy, make time for it. Life can be demanding, but even a few minutes a day spent doing what you love will help you keep your energy up and your stress down.

Celebrate Your Wins
Often, we’re so focused on what we haven’t done that we forget to celebrate what we have achieved. Did you ace that exam, complete a project, or make a new friend? Each accomplishment is worth recognizing. Celebrating even the small victories gives you the confidence to tackle the next big thing with resilience and courage.

Building resilience takes time, patience, and practice. But with each step forward, you’re creating a stronger foundation to support you through whatever life brings your way. Keep going, believe in yourself, and know that every challenge you overcome makes you that much stronger.

Mylemarks

Stress Management Tips for Kids and Teens!

Sep 3, 2020

Today, we will be learning all about stress! You’ll learn the definition of stress, how it affects you, and FIVE helpful ways of coping!

Mental Health Center Kids

Coping Skills For Kids – Managing Feelings & Emotions For Elementary-Middle School | Self-Regulation

Nov 6, 2022

Help children and teens learn how to manage big emotions. Emotional regulation for anger management, stress management, anxiety, depression, and coping strategies for many more mental health struggles. Provide a good foundation of coping skills for elementary and middle school students, and the same concepts can be applied to teenagers or high school students. Three Steps To Manage Emotions: 1) Notice And Identify Your Feelings 2) Think About Coping Skills You Can Use To Feel Better 3) Take Action By Practicing One Or More Coping Skill

        Gravedad Zero

De Colombia para el mundo. Los mejores exponentes del surf local se unieron a tres surfistas explosivos: la campeona mundial de stand up paddle Izzi Gómez, su hermano Giorgio y el panameño Oli Camarena. Dirección y Producción: Germán Bertasio. Edición: Fede Maicas. Comercial: Martín Méndez Pasquali. Productora: Mundo Zero Producciones.

EXCEPTIONAL ACTS, PERSPECTIVES, TRANSFORMING HEALTHCARE

Honduras, officially the Republic of Honduras, is a country in Central America. It is bordered to the west by Guatemala, to the southwest by El Salvador, to the southeast by Nicaragua, to the south by the Pacific Ocean at the Gulf of Fonseca, and to the north by the Gulf of Honduras, a large inlet of the Caribbean Sea. Its capital and largest city is Tegucigalpa.

The nation’s economy is primarily agricultural, making it especially vulnerable to natural disasters such as Hurricane Mitch in 1998. The lower class is primarily agriculturally based while wealth is concentrated in the country’s urban centers. Honduras has a Human Development Index of 0.625, classifying it as a nation with medium development. When adjusted for income inequality, its Inequality-adjusted Human Development Index is 0.443.

The health system consists of a public and a private sector. The former includes the Ministry of Health and the Honduras Social Security Institute . The Ministry serves the entire population in its own facilities staffed by its own physicians and nurses, but it is estimated that only 50%-60% of Hondurans regularly use these services. The Institute covers 40% of employed economically active individuals and their dependents, using its own and contracted facilities. The private sector serves some 10%-15% of the population: those who can afford to pay or are covered by private insurance. An estimated 17% of Hondurans do not have regular access to health services. 

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

Evelyn Lee, PhD1,2Deborah Schofield, PhD2Mithilesh Dronavalli, MPhil3Kate Lawler, BSc(Med)Hons4Hannah Uebel, MD4,5Lucinda Burns, PhD7Barbara Bajuk, MPH8Andrew Page, PhD3Yuanyuan Gu, PhD6John Eastwood, MBChB, PhD9,10,11,12,13,14Michelle Dickson, PhD15Charles Green, PhD16Lauren Dicair, MSW17Ju Lee Oei, MD4,18,19

JAMA Pediatr. Published online July 22, 2024. doi:10.1001/jamapediatrics.2024.2281

Key Points

Question  Does the increase in health care needs among children exposed to substance use during pregnancy vary by engagement in out-of-home care?

Findings  In this cohort study, children exposed to substance use during pregnancy with or without neonatal abstinence syndrome were at higher risk of adverse birth outcomes and long-term costs than children who were not exposed but a reduction in cost was associated with any out-of-home care contact.

Meaning  Increased support and timely access to services could mitigate the higher readmission risk and cost associated with substance use during pregnancy.

Abstract

Importance  

Children exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain.

Objective  

To evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years.

Design, Setting, and Participants  

This was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n = 5946) and intrauterine exposure to drugs of addiction (n = 1260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n = 202 098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n = 1 611 351). Data were analyzed from July 2001 to December 2021.

Main Outcomes  

Main outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care.

Results  

Of the 1 820 655 live births, 935 807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1 = A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90 433/209 304 [43.4%] vs 616 425/1 611 351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02.

Conclusion and Relevance

Children who were exposed to substance use during pregnancy incurred more hospital costs than children who were not exposed up to 20 years of age, but this was reduced in association with any contact with out-of-home care. This provides insights into possible strategies for reducing health and financial burdens associated with exposure to substance use during pregnancy for children.

Source:https://jamanetwork.com/journals/jamapediatrics/fullarticle/2821473

Ashley D. Osborne, MD; Diana Worsley, MPH; Catherine Cullen, MD; Ashley Martin, MPH; Lori Christ, MD

May 08 2024

BACKGROUND

Moderately preterm infants (MPTI) comprise a large proportion of NICU admissions and are an understudied population. The unique experience of families with MPTIs has yet to be examined in the literature. Describing MPTI parent needs and preferences may inform interventions to improve care and outcomes for this population.

METHODS

Semi-structured qualitative interviews were performed with English-speaking birth parents of infants born between 32 and 34 weeks gestation to describe their NICU experience and identify areas for improvement specifically surrounding care team inclusion, education, discharge, and communication. Interviews were recorded, transcribed, and analyzed using directed content analysis. Enrollment ceased when the data reached thematic saturation.

RESULTS

Sixteen birth parents participated. Four themes emerged around parent-medical team connectedness, parental confusion, discharge readiness, and the desire for a use of a mix of in-person and electronic communication methods (e-mail, texting, apps, etc.) for communication. MPTI parents valued a strong connection with the medical team; however, they described a lack of knowledge regarding the reasons for admission and ongoing management. Near discharge, parents desired more information regarding feeding, reflux, and breathing patterns. Parents preferred in-person discussions but described a role for electronic methods to improve their understanding of their infant and discharge readiness.

CONCLUSIONS

From the MPTI parent perspective, clinicians can focus improvement efforts on communication, specifically around reasons for admission, discharge planning, and anticipatory guidance. These results may serve as a foundation for initiatives to improve the MPTI parent experience and potentially parent and MPTI outcomes.

Source: https://publications.aap.org/pediatrics/article-abstract/153/6/e2023064419/197249/Enhancing-NICU-Care-and-Communication-Perspectives?redirectedFrom=fulltext

Apr 28, 2023 #NFL #AmericanFootball #Football

Auburn’s Derick Hall survives the near-death experience of being born four months premature, rising to become one of the best defensive ends in the nation – and making a transformational impact on his Gulf Coast community.

Nicolle Fernández Dyess, MD, MEd; Perspectives| September 01 2024

Shetal Shah, MD  Neoreviews (2024) 25 (9): e531–e536.https://doi.org/10.1542/neo.25-9-e531

The modern neonate differs greatly from newborns cared for a half-century ago, when the neonatal-perinatal medicine certification examination was first offered by the American Board of Pediatrics. Delivery room resuscitation and neonatal care are constantly evolving, as is the neonatal workforce. Similarly, the Accreditation Council for Graduate Medical Education review committees revise the requirements for graduate medical education programs every 10 years, and the modern pediatric medical trainee is also constantly evolving. Delivery room resuscitation, neonatal care, and pediatric residency training are codependent; changes in one affect the other and subsequently influence neonatal outcomes. In this educational perspective, we explore this relationship and outline strategies to mitigate the impact of decreased residency training in neonatal-perinatal medicine.

Source:https://publications.aap.org/neoreviews/article-abstract/25/9/e531/199058/The-Relationship-between-Pediatric-Medical?redirectedFrom=fulltext

Dudding, Katherine M. PhD, RN, RNC-NIC, CNE; Assistant Professor

Advances in Neonatal Care 24(5):p 389-390, October 2024.

A couple of months ago, I had a conversation with a Director of Nursing Professional Development from a potential hospital site which to conduct my research. I was asked if I would consider having a couple of nurses help with my study. Without hesitation, I replied “yes, I would be happy to mentor a couple of nurses to assist me with my study.” Initially, I thought this was an odd request because I feel like that is one of my professional responsibilities as a nurse. Upon further thinking, I realized maybe others do not share the same opinion and how unfortunate this would be for our future neonatal nurses, practitioners, educators, and researchers.

According to the American Nurses Association (ANA), 18% of nurses are leaving the profession after 1 year though other sources reported even higher rates of attrition. The nursing workforce dilemma continues to be problematic with nurse turnovers and an alarming rate of nurses leaving the profession after 1 year. While other sourcesreported rates as high as 30%, education and the healthcare systems are establishing strategic interventions to retain nurses. One of these interventions is mentoring. Specifically, peer nurse to nurse mentoring is beneficial when matched into a positive mentored relationship.

MENTORING

Nurses experiencing positive mentorships are associated with intent to remain at their current positions. There is nothing like the support of a mentor when you begin your nursing career. It was the kindness of mentors that taught us and encouraged us to become the best possible nurses and achieve our dreams. The knowledge we gained from our mentors are incorporated into our everyday professional lives. There is not one of us who was not impacted by a mentor and their influence (see Supplemental Figure 1, available at https://links.lww.com/ANC/A292). Many of us will have several distinct types of mentors throughout our nursing careers.

Each mentor serves a purpose and may be time limited. There may be mentors that are experts in clinical practice, education, research, or leadership. You might even have a mentor, whose sole purpose, is your sounding board for difficult decisions. However, there will be a handful of phenomenal nurses who will become lifetime mentors. Those are the special ones that we strive to emulate.

NURSING

When nurses feel supported by administration and mentors, they remain in their jobs. Being mentored gives us the opportunity to grow our skill sets or learn new processes under the guidance of our mentor. The mentor provides the safety net when learning and a resource to ask our never-ending questions without judgment.

We all can remember the hesitation we felt the first time we attempted our first IV. Moreover, we remember the happiness we felt when we successfully started our first IV. This was, in part, due to our mentor’s willingness to mentor us and invest their time and talent into our success. Our mentors believed in us.

It does not take long before these skills in essence become second nature. Our confidence level begins to increase with more successes than failures. We are becoming competent and independent nurses. These achievements cannot help but to spill over into our own interactions with patients, our students with teaching, and our participants in research. Good mentorship also benefits those we serve whether it be our patients, our students we teach or participants in research. Why would we not pay this forward when mentoring results in the best possible outcomes for all?

As our skills are honed, this cultivates our confidence, not only as a competent nurse, but as a valuable team member. Lyu et al states that competence and being integrated into a team is correlated with retention. As a supported team member, we are unstoppable to what we can accomplish in nursing. Eventually, this often leads the nurse mentee to now becoming the mentor.

GROWING THROUGH MENTORSHIP

Being a mentor is frequently the catalyst for endless opportunities for growth and the development of a leader. This may be a leadership opportunity within your respective work environment such as a charge nurse, manager, and director. Your sphere of influence, as a leader, has the ability change practice within the nursing. Moreover, this may motivate a broader impact by earning an advanced degree to become nurse practitioners, educators, and researchers.

What a privilege it is to mentor nurses and leave a lasting impact on the nursing profession. Today’s nursing graduates are tomorrow’s nursing leaders. We have a responsibility to present and future nurses to mentor them. I, personally, will forever be grateful to all my mentors. I am truly standing on the shoulders of giants by kindness that has and continues to be given to me. This act of kindness and giving of oneself through mentoring is invaluable.

In conclusion, there is only one question that remains, “will you step up to mentor the next generation of nurses?”

—Katherine M. Dudding, PhD, RN, RNC-NIC, CNE Assistant Professor The University of Alabama kmdudding@ua.edu

Source:https://journals.lww.com/advancesinneonatalcare/fulltext/2024/10000/peer_nurse_to_nurse_mentoring__an_exceptional_act.1.aspx

July 19, 2023     Sathvik Namburar

In a May 6, 2016 photo, medical residents Dr. Wes Penn, right, and Dr. Cameron Collier, center, walk with medical students down a hallway during their daily rounding at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana. (Gerald Herbert/AP)This article is more than 1 year old.

July marks a time of change in hospitals across the country. It marks the beginning of the academic year for medical residents and fellows, with new physicians starting their training. As I begin the second year of my medical residency this month, I have been thinking about Libby Zion and Nakita Mortimer.

The former was briefly a household name in the 1980s. Libby Zion was a college student who sought care at New York Hospital (now New York-Presbyterian) with a fever in March 1984, only to pass away after her doctors missed a crucial medication interaction. Her distraught parents believed that overworked resident physicians were to blame and drove efforts to institute work-hour caps for residents.

The latter is tragically less known. Dr. Nakita Mortimer was a resident physician at Montefiore Medical Center, and she died by suicide in May 2023. My colleagues and I became aware of her untimely passing almost immediately, as this news spread rapidly through the medical world. (As with all suicides, it will remain unclear specifically why Dr. Mortimer took her own life.)

My colleagues and I reacted to Dr. Mortimer’s death with shock but not surprise. As one of the senior resident physicians in my program put it, “Residency can unmoor even the best of us.”

All of us in the medical profession know classmates or colleagues who were unable to complete their training, overburdened by the demands of the profession. Studies show that upwards of 50% of physicians report feeling burnout.

Residency is a key contributor to these issues. Usually lasting between three and seven years depending on subspecialty, resident physicians have completed medical school but are still undergoing training and cannot independently practice medicine.

Being a resident means working long hours for little pay (the average first-year resident makes about $60,000 a year). Many residency programs continue to require residents to work 28-hour shifts out of a belief that these long hours enhance continuity of care and resident learning.

But by the end of 28-hour shifts, residents are so sleep-deprived that they have the equivalent of blood alcohol contents of 0.1%, above the threshold for being legally drunk. The resident physicians who were taking care of Libby Zion were in the midst of a 28-hour-plus shift and were also responsible for 40 other patients on the night she died.

Often forgotten in the Libby Zion case is that her death led her parents to push not only for reforms in the medical residency system, but also the consideration of legal charges against the resident physicians and the threat of revocation of their licenses to practice medicine. Therefore, to my co-residents and me, her passing is both a clarion call and a warning, that even if we are tired, we must be perfect or else lose our livelihoods. Of course, with the desire for perfection comes incredible mental stress.

With the desire for perfection comes incredible mental stress.

We resident physicians recognize that our profession has societal responsibilities. It is our duty to learn and take care of patients, and we do not and should not expect to work regular 9 a.m. to 5 p.m. hours during our training. My goal is to maximize my learning opportunities so that when I complete residency, I can practice medicine independently and competently.

Physicians take an oath to “Do no harm” and try to live up to this credo. But no one can always be perfect.

Some residency programs have been implementing further reforms to protect resident physicians and patients. Over the past year, I have only had to complete one 28-hour shift, compared to my friends in other residency programs who have had to do dozens of such shifts. My residency also has a dedicated wellness curriculum, peer listening programs and access to mental health professionals.

Still, there is more to do. Residents in programs around the country are forming unions and demanding better working conditions and more pay. After 26 years of stagnation, in 2022, Congress finally approved an increase in the number of residency spots, which would decrease the work burden on residents. Our patients should support these efforts and push for further changes because well-rested, better-paid residents are more likely to provide adequate health care.

Few other jobs place physical and mental demands on employees like residency does, and few other jobs come with the awesome responsibility that being a physician has. Continuing reforms will help prevent deaths like those of Libby Zion and Dr. Mortimer. We owe it to all resident physicians and our patients to ensure that such reforms are enacted.

Editor’s note: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline (call or text) at 1-877-870-HOPE (4673). Call2Talk can be accessed by calling Massachusetts 211 or 508-532-2255 (or text c2t to 741741).

Source:https://www.wbur.org/cognoscenti/2023/07/19/medical-residency-long-shifts-libby-zion-nakita-mortimer-sathvik-namburar

A Million Little Miracles       Premiered May 22, 2024

Feeling lost on how to advocate for your preemie in the hospital? NICU grad mom Alexis shares practical tips to help you become your baby’s champion!

Shalece was 30 weeks pregnant when she went to UPMC Magee-Womens Hospital for a follow-up sonogram. At a routine prenatal appointment the week before, doctors felt the baby was smaller than he should be, so they asked her to come back for a second look.

She told her husband, Dion, not to bother calling off work; convinced that there was no danger, she brought her aunt instead, and the two women made plans to go for lunch after the appointment.

“When I got down there, they did the first sonogram. I could tell by their reaction that something was wrong, but they didn’t want to alarm me,” she recalled. “They said, ‘We’re going to send you upstairs for a uterine sonogram and a monitor.’”

Her older son, Dion 2nd, was born at full term 11 years earlier with no complications. So while her aunt panicked, Shalece — a former nursing assistant — remained calm: “I’m not a person who panics a whole lot,” she said, adding that throughout the process, she was thinking, “It’s only 30 weeks. I’m not having this baby today.”

And then the doctor on duty came in and said that, in fact, she was. The blood in the umbilical cord was flowing backward, preventing the baby from getting vital nutrients. She would have to undergo an emergency Cesarian section.

According to Dr. Yoel Sadovsky, MD, executive director of Magee-Womens Research Institute, the reversal of blood flow in the umbilical cord is usually caused by a dysfunction in the placenta — a complication Dr. Sadovsky and other researchers at the institute study.

In such cases, delivery is induced in an effort to save the baby’s life, he noted: “If you don’t deliver someone who has these kinds of findings, some babies don’t even make it.”

But at that moment, Shalece was in denial, even though the staff advised her to call her husband and get him to the hospital.

“I was absolutely not going for it,” she recalled. “In my mind, it wasn’t happening to me; it was happening around me.”

Finally, her aunt called her husband, who arrived in time for the emergency delivery. Their son was born at 1:33 p.m., but Shalece’s blood pressure skyrocketed, so she only glimpsed him before he went to the neonatal intensive care unit (NICU).

Once she stabilized, the staff wheeled her, still in her hospital bed, to meet her tiny son.

“There were more cords and plugs than baby,” she said. “I was able to see him, really see him. From there, it was me and him.”

Little Shea spent two months and three days in the NICU. After seeing her older son on the school bus in the morning, Shalece traveled back to the hospital, where she would sing to Shea, read to him from the Game of Thrones series, and talk.

“I told him, ‘You’re a squatter in this NICU. You’re coming home,’” she said. “I willed this baby into coming home.”

Of the 380,000 babies born prematurely in the United States each year, rates are up to 50 percent higher among women of color, according to the March of Dimes. Black children face an infant mortality rate that is more than twice as high as other infants, according to the U.S. Centers for Disease Control, making prematurity the largest contributor to infant mortality disparities.

Shea spent the first few hours of his life on oxygen and was treated with bilirubin lights for jaundice. He went through several blood transfusions and experienced a brain bleed, but no surgery was required. He also had retinopathy of prematurity, an eye disorder caused by abnormal blood vessel growth in the retina of premature infants, and wears glasses now. He also undergoes physical therapy for mild cerebral palsy.

About a quarter to a third of preterm births are medically induced, Dr. Sadovsky said. Less than 5 percent of all babies need to have a medically-induced preterm delivery for growth restriction, and in the majority of these cases, the placenta is the cause.

“This is a typical case of what we’re studying in our lab,” Dr. Sadovsky said. “One of the major goals of our research is better diagnosis, and importantly, prevention of these kinds of stories.”

Despite the long odds, Shea is now in preschool, and most people don’t realize he has had difficulty walking or climbing steps in the past. He adores sports and superheroes, and he looks up to his big brother.

“He’s your average 4-year-old boy. He is loud. He is fast,” said Shalece.

She knows his premature birth will always influence other parts of his life; she’ll have to be careful about his participation in sports because of his early brain bleeds, and she pays attention to how he learns things, or even how he holds a pencil.

“Once a preemie, always a preemie. You are always on high alert,” she said. She belongs to a support group for mothers of premature infants, where she both draws and offers encouragement.

Asked what advice she would offer to a new mother of a preemie, Shalece said: “Take it one day at a time. Don’t hesitate to cry; crying is good. Don’t feel bad, and reach out for help.”

She remembers how worried she was, and looks at her 4-year-old son riding a bike and realizes how far he has come.

“You have to try a little harder as a parent,” she said, but added, “Being born premature doesn’t mean they aren’t going to be the kid you thought they were going to be.”

Jul 9, 2024 #swaddling #babytips #preemiebaby

Was your baby born more than 3 weeks early? Premature development differs from full-term, but there’s no need to worry! Let’s explore effective ways to understand and support your baby’s growth and milestones. Premature babies are often born with more extended (straight) positions, while full-term babies get a curled up (flexed) feeling from being in the womb longer. Babies need both flexion and extension to help their motor skill development. Try these activities to aid your preemie’s physical growth and work on their flexion. Always consult your healthcare provider for personalized advice.

Medically Reviewed by Amita Shroff, MD on July 30, 2023 Written by R. Morgan Griffin

By the time they’re 2, your preemie has come a long way. It may be hard to believe that your child — maybe a noisy, strong-willed toddler already — is the same person as that tiny, fragile baby you anxiously watched over in the hospital.

What comes next? As they grow, most preemies become healthy children. But some continue to have health issues. And even kids that do well generally may have lasting health effects years and even decades later.

There’s no way to know exactly how your child will grow and develop. In general, the earlier your child was born, the more likely they are to have lasting health issues. Watch out for signs of problems so you can get your child the care and treatment they need.

Your Preemie’s Long-Term Health

If your child was born prematurely, they have a higher chance of some of these health concerns:

Growth problem: Kids who were born at less than 32 weeks of pregnancy — what doctors call “very premature” — are likely to be shorter and weigh less than other kids.

Learning disabilities.Some preemies have lasting problems with how they think and learn. About 1 in 3 kids born prematurely need special school services at some point.

Behavior problems: As they grow up, preemies may be more likely to have attention deficit hyperactivity disorder (ADHD) than full-term babies. They’re also more likely to be shy or anxious.

Breathing problems and asthma:.Lots of preemies need help breathing when they’re born, since their lungs aren’t ready yet. While these issues often go away, some babies born prematurely have lasting asthma or similar problems.

Other health conditions:Some preemies have more serious long-term complications. One example is cerebral palsy, which causes problems with movement and balance. There’s no cure, but it can be managed with treatment. Other kids may have lasting problems with their vision, hearing, and digestive system.

Remember, your child may not develop any of these problems or may outgrow them. But being aware that they have a higher chance of having them is important. If you notice signs, you can get help from your child’s doctor. The faster your child gets treatment for any problems, the better.

Your Preemie in Early Childhood

While your child might have been treated for lots of health problems in the hospital when they were born — like apnea, reflux, and jaundice — most if not all of those should be gone by now. Experts say that in terms of growth, most preemies are more or less caught up to full-term babies by age 3.

When your child is still young you can:

Keep track of your baby’s developmental milestones. Milestones are skills your child will learn, like riding a tricycle or walking up the stairs on their own. They’re often linked with the average age kids are able to do them. When preemies are young, doctors use their “corrected age” — based on their original due date — instead of their birthdate when checking milestones. But by age 2, most preemies have caught up enough that you can start using their actual age.

Remember that milestones are just rough averages. All kids develop differently, whether they’re full-term or premature. It’s not a big deal if your child doesn’t meet a milestone exactly on schedule.

Get help if you need it. If you do notice your child seems to be lagging behind, talk to their doctor. Make sure to ask about a state program called Early Intervention. It offers special services to help babies up to age 3 who have higher odds of developmental delays or disabilities. Some of these services are free. Other options include referral to private therapies such as physical therapy, occupational therapy, feeding therapy, and speech therapy.

Getting Your Child Ready for School

Watching your child go off to school is exciting — and stressful, too. To help make the transition smoother and give your child support, you can:

Get in touch with the school early. Before your child starts school, talk to the staff — like their teacher or the principal — about their health issues and concerns you have. Ask questions about the school’s special education programs. If your child’s teachers understand their needs, they’ll be better able to help them succeed.

Be alert for any new problems. Sometimes, learning disabilities or behavior problems only show up once a child starts school. If your child seems to be struggling, work with their teacher — and make sure your youngster gets special services if they need them.

Gradually give your child more independence. After you spend so much time caring for your child, it can be hard to let them go off on their own. But you have to find a balance between protecting them when they need it and giving them the freedom they need to grow.

As Your Preemie Grows Up

Will the effects of being born premature last into your child’s adulthood? It’s possible. Some studies have linked being a preemie with a higher chance of getting conditions like diabeteshigh blood pressure, and lung and vision problems in adults.

But again, remember that your child only has a higher risk of these problems. They may not develop any of them. You can look at being born premature as another factor that may raise your risk of developing health issues, like a person’s genes, habits, home life and environment. After all, plenty of adults who weren’t born prematurely develop the same health conditions.

The most important need for a child who was born prematurely is to get good, consistent care — both as a child and an adult. Being a preemie can create barriers to your child’s development. But with the help of the right experts — doctors, specialists, therapists, and others — you can often find ways to work around them.

Source: https://www.webmd.com/children/preemies-growth-development-age-two-up

University of Colorado Anschutz Medical Campus    Apr 9, 2024

While a recent explosion in AI technology has exposed its possibilities to the public with online systems such as ChatGPT and Dall·E, researchers at the University of Colorado Anschutz Medical Campus have been exploring the rapidly evolving technology for years and are beginning to harness its problem-solving powers to change healthcare.

Interprofessional Education (IPE) is more than sitting passively in a classroom together. It is integrative, experiential, and about learning and practicing the skills needed to function effectively as a highly collaborative team. Interprofessional collaborative practice makes care safer, more patient-centered, and it leads to lower burnout and higher job satisfaction amongst health professionals. Explore below to learn more about the opportunities to grow your skills in collaboration.

Interprofessional Education (IPE) is an approach to teaching and learning that brings together students from two or more professions to learn about, from, and with each other in service of enabling effective collaboration. The goal of IPE is to improve health outcomes through the education of a practice-ready health care team that is prepared to respond to local health needs (WHO, 2010).

Interprofessional Collaborative Practice (IPCP), or “Practice Transformation,” in health care occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across setting (WHO, 2010). The Interprofessional Education Collaborative (IPEC) states that, “interprofessional collaborative practice drives safe, high-quality, accessible, person-centered care and improved health outcomes” (2019).

Source:https://collaborate.uw.edu/about-us/defining-ipe-and-ipcp/

Anna Baranowska-Rataj, Kieron Barclay, Joan Costa-Font,Mikko Myrskylä, Berkay Özcan

Population Studies/ Research Article

A Journal of Demography – Volume 77, 2023 – Issue 3

Abstract

Although preterm birth is the leading cause of perinatal morbidity and mortality in advanced economies, evidence about the consequences of prematurity in later life is limited. Using Swedish registers for cohorts born 1982–94 (N  =  1,087,750), we examine the effects of preterm birth on school grades at age 16 using sibling fixed effects models. We further examine how school grades are affected by degree of prematurity and the compensating roles of family socio-economic resources and characteristics of school districts. Our results show that the negative effects of preterm birth are observed mostly among children born extremely preterm (<28 weeks); children born moderately preterm (32–<37 weeks) suffer no ill effects. We do not find any evidence for a moderating effect of parental socio-economic resources. Children born extremely preterm and in the top decile of school districts achieve as good grades as children born at full term in an average school district.                                   

Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2022.2080247.

As a micro-preemie, my early days were filled with challenges, but the encouragement from my mother to engage in sports became a pivotal part of my development. Growing up, I was introduced to various physical activities, from swimming to basketball, which not only helped me build strength but also instilled a sense of confidence that was essential for my growth. Research has shown that early engagement in sports can significantly benefit the physical and emotional development of children, particularly those with a history of premature birth. According to a study published in the Journal of Pediatrics, participation in physical activities helps improve motor skills and overall health, which are critical areas of development for preemies.

The benefits of sports extend beyond physical health; they also foster social skills and emotional resilience. Engaging in team sports allowed me to develop friendships and learn the value of teamwork. These experiences helped me navigate social dynamics and build a support network that would prove invaluable throughout my life. A report by the American Academy of Pediatrics emphasizes that participation in sports can promote social interactions and enhance communication skills, which are crucial for preemie survivors as they transition into adulthood. My mother’s encouragement to embrace sports created opportunities for me to thrive socially, fostering connections with peers who understood my unique journey.

Moreover, sports provided an essential outlet for stress relief and emotional expression. As I faced the lingering effects of my premature birth, participating in physical activities became a healthy way to cope with anxiety and build self-esteem. Studies have indicated that regular physical activity can reduce symptoms of anxiety and depression, particularly in children who may feel different or face health-related challenges. This therapeutic aspect of sports not only aided in my emotional well-being but also reinforced my belief in the importance of maintaining a healthy lifestyle, which I carry into adulthood.

Reflecting on my journey, I am grateful for my mother’s unwavering support and encouragement to engage in sports. The lessons I learned and the resilience I built through these experiences have shaped who I am today. For other preemie families, I encourage you to explore the world of sports and other physical activities you and they may prefer. The benefits are profound and can lead to a brighter, healthier future for your little ones.

Mid-Atlantic ADA Center 453 views May 30, 2023

Dr. Anjali Forber-Pratt, Director of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and two-time Paralympian, talks about the importance of adaptive and inclusive sports and recreation for people with disabilities.

5,773 views Nov 14, 2017

David Kyle explains in his talk about his journey from discovering his disabilities and being depressed to a life full of challenges, mobility and opportunity for success as an athlete. David is the director of the UAH Ability Sport Network, which is a program that encourages participation among people with physical disabilities in adapted physical activity. In addition, he is a lecturer in the Department of Kinesiology of UAH’s College of Education. David holds a master’s degree in Health and Physical Education and will complete his doctoral degree in Kinesiology in 2019. He is also a Certified Exercise Physiologist and Disability Sport Specialist. David is a member of the USA Triathlon National Paratriathlon Committee, and competed internationally for 10 years with the USA Elite Paratriathlon Team in triathlon, duathlon, and XTERRA off-road events winning multiple world and national titles in each discipline.

Miss Rosie’s Storytime   Jun 15, 2019

Froggy Plays Soccer By: Jonathan London & Frank Remkiewicz It’s the day of the big game, and Froggy is ready. His soccer team is playing the Wild Things for the City Cup. All Froggy has to do is remember the rule: “Head it! Boot it! Knee it! Shoot it! BUT DON’T USE YOUR HANDS!” But Froggy’s busy doing cartwheels and picking daisies. Uh oh, Froggy! Here comes the ball! Budding soccer players and Froggy’s many fans will welcome Froggy’s latest hilarious adventure.

2020 started off as a big kiting year. About a week after I got back from the Grenadines as buddy called saying he’d organized a trip to a little known kite spot in Honduras called Roatan. Everyone scrambled to move things around, and at the last minute it all came together.

Guides, Patterns, Stewardship

Scotland is a country that is part of the United Kingdom. It contains nearly one-third of the United Kingdom’s land area, consisting of the northern part of the island of Great Britain and more than 790 adjacent islands, principally in the archipelagos of the Hebrides and the Northern Isles. To the south-east, Scotland has its only land border, which is 96 miles (154 km) long and shared with England; the country is surrounded by the Atlantic Ocean to the north and west, the North Sea to the north-east and east, and the Irish Sea to the south. The population in 2022 was 5,439,842 and accounts for 8% of the population of the UK. Edinburgh is the capital and Glasgow is the largest of the cities of Scotland.

NHS Scotland sometimes styled NHSScotland, is the publicly–funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland, supported by seven special non-geographic health boards, and Public Health Scotland.

At the founding of the National Health Service in the United Kingdom, three separate institutions were created in Scotland, England and Wales and Northern Ireland.

https://en.wikipedia.org/wiki/Scotland#

  • There are an estimated 29 million nurses worldwide and 2.2 million midwives. WHO estimates a shortage of 4.5 million nurses and 0.31 million midwives by the year 2030.
  • That will bring the a global shortage of health workers estimated for 2030 to 4.8 million nurses and midwives, with the greatest gaps found in countries in Africa, South-East Asia and the WHO Eastern Mediterranean Region, as well as some parts of Latin America. 
  • Nurses and midwives play a pivotal role in improving health and contributing to the wider economy. Investing in them is imperative to achieve efficient, effective, resilient and sustainable health systems. They not only provide essential care but also play a critical role in shaping health policies and driving primary health care. Nurses and midwives deliver care in emergency settings and safeguard the sustainability of health systems globally.
  • Globally, 67% of the health and social workforce are women compared to 41% in all employment sectors. Nursing and midwifery occupations represent a significant share of the female workforce.
  • More than 80% of the world’s nurses work in countries that are home to half of the world’s population. And one in every eight nurses practices in a country other than the one where they were born or trained.
  • Higher levels of female nurses are positively correlated with health service coverage, and life expectancy and negatively correlated with infant mortality.

Overview

Nurses and midwives are central to Primary Health Care and are often the first and sometimes the only health professional that people see and the quality of their initial assessment, care and treatment is vital. They are also part of their local community – sharing its culture, strengths and vulnerabilities – and can shape and deliver effective interventions to meet the needs of patients, families and communities.


WHO response

WHO’s work relating to nursing and midwifery is currently directed by World Health Assembly resolution WHA74.15 (2021) which calls on WHO Member States and WHO to strengthen nursing and midwifery through the Global Strategic Directions for Nursing and Midwifery (SDNM) 2021–2025. The SDNM is an interrelated set of policy priorities  that can help countries to ensure that midwives and nurses optimally contribute to achieving universal health coverage (UHC) and other population health goals .

The SDNM comprises four policy focus areas: education, jobs, leadership, and service delivery Each area has a “strategic direction” articulating a goal for the five-year period, and includes between two and four policy priorities If enacted and sustained, these policy priorities can support advancement along the four strategic directions: 1) educating enough midwives and nurses with competencies to meet population health needs; 2) creating jobs, managing migration, and recruiting and retaining midwives and nurses where they are most needed; 3) strengthening nursing and midwifery leadership throughout health and academic systems; and 4) ensuring midwives and nurses are supported, respected, protected, motivated and equipped to safely and optimally contribute in their service delivery settings.

WHO engages ministries of health, the Government Chief Nurses and Midwives (GCNMOs) and other relevant stakeholders to enable effective planning, coordination and management of nursing and midwifery programmes in countries. The Global Forum for the Government Chief Nurses and Midwives, established in 2004, is organized by WHO and meets every two years. It is a Forum for senior nursing and midwifery officials to develop and inform areas of shared interest. WHO also engages with academic institutions specialised in nursing and midwifery. Forty-seven academic centres are designated as Collaborating Centres for Nursing and Midwifery with WHO. The academic centres are affiliated to the Global Network of WHO Collaborating Centres for Nursing and Midwifery.

WHO has established a Nursing and Midwifery Global Community of Practice (NMGCoP). This is  a virtual network created to provide a forum for nurses and midwives around the world to collaborate and network with each other, with WHO and with other key stakeholders (e.g WHO collaborating centres for nursing and midwifery, WHO Academy, Nursing and Midwifery Associations and Institutions.) The network will provide discussion forums, a live lecture programme, opportunities to develop and share policies, WHO documents and tools, and facilitated innovation workshops, masterclasses and webinars.

The Nursing and Midwifery Global Community of Practice is free to join and available to nurses and midwives everywhere.

From May 2022 it will be possible to access the virtual community via a smartphone, by downloading the Nursing and Midwifery Global Community of Practice App Nurses Beyond the Bedside_WHO_CSW66 Side Event available for Android and IOS system via the APP store.

A 2017 Report on the history of nursing and midwifery in the World Health Organization 1948 –2017, demonstrates how WHO, since its inception, has given this workforce a voice, and highlights the critical role nurses and midwives play in improving health outcomes across the world.

Feb 8, 2024

Watch this amazing Scottish artist sing Yellow by Coldplay with me! @AndrewDuncan

Mary A. Short MSN, RN – Volumn19/Issue 5 May 24

Critical Path Institute (C-Path) announces the launch of Bridging the GAP: Empowering Neonatal Nurses in Drug Development for Neonates, a comprehensive series covering the history of neonatal drug development, approaches to promote drug development for neonates, pharmaceutical industry decision-making processes, and strategies for advocating neonatal needs. Developed in collaboration between its International Neonatal Consortium (INC) and the National Association of Neonatal Nurses (NANN), this series aims to empower neonatal nurses and interested neonatal health care professionals with the knowledge needed to actively participate in research and ensure better outcomes for our tiniest patients.

“As an organization committed to advancing neonatal research and care, we recognize the vital role nurses and clinicians play in the hospital setting,” said INC Executive Director Kanwaljit Singh, MD, MPH. “This collaboration with NANN represents a pivotal step forward in our mission to support and empower neonatal nurses and clinicians. By engaging them in developing these educational modules, we aim to enhance their understanding and involvement in neonatal clinical trials and drug development.”

The modules aim to provide foundational knowledge on innovative, regulated medicines development for neonates, including pipeline decision-making factors and addressing neonatal needs within the current environment. Upon completion of the presentations and activity evaluations, participants can earn up to 4.5 FREE CE credits and 2.56 FREE pharmacology credits. NANN is an accredited provider of nursing continuing professional development recognized by the American Nurses Credentialing Center’s Commission on Accreditation. The content is appropriate for AMA PRA Category 2 Credit. The presenters reflect the diversity of neonatal stakeholders, as illustrated in Figure 1, which outlines the module titles and the presenters involved.

Background:

Neonates are therapeutic orphans, underserved by the drug development community, and lag in the development of new, safe, and effective therapies. Most NICU drugs are off-label, impacting their safety and efficacy evaluation.  Nurses play a vital role in administering medications and monitoring their effects but often lack a comprehensive understanding of clinical trials and drug development processes in the NICU. Critical Path Institute (C-Path) is an independent nonprofit established in 2005 as a public-private partnership in response to the FDA’s Critical Path Initiative. C-Path’s mission is to lead collaborations that advance better treatments for people worldwide. Globally recognized as a pioneer in accelerating drug development, C-Path has established numerous international consortia, programs, and initiatives that currently include more than 1,600 scientists and representatives from government and regulatory agencies, academia, patient organizations, including parent/family advocates, nursing organizations, disease foundations, and pharmaceutical and biotech companies. INC, established in 2015 as a public-private partnership within the construct of C-Path, advances the unmet drug development needs in the neonatal population.

INC conducted a multistakeholder (neonatologists, neonatal nurses, parents) survey to explore communication practices and stakeholders’ perceptions and knowledge regarding the conduct of clinical trials in the NICU. Survey results indicated that most neonatologists (82%) responded that medications are insufficient to meet the needs of critically ill neonates and identified a knowledge gap for nurses regarding drug development. Degl et al. conclude that the engagement of nurses at all stages of neonatal research is suboptimal and indicates a need for nurses to be educated about research. Beauman et al. report additional findings specific to nurse respondents from the multistakeholder survey. Nurses expressed a learning need because they historically lacked effective education to prepare them for competent participation in neonatal research, especially in informing study design. The authors recommend leveraging neonatal nurses’ unique and essential role as key stakeholders from the onset of the study design to enhance the conduct of neonatal clinical research and improve care for premature and sick neonates.

To address the survey findings, industry representatives held an education workshop on Pharmaceutical Drug Development for Neonates at the 2019 INC Annual meeting intended for all neonatal stakeholders, including academics, clinicians, and regulators. The INC Communication Workgroup updated the content for the recently launched education modules, emphasizing the significance of the information for nurses, but the content remains relevant to other neonatal healthcare professionals.

Product Description:

“Consistent with our mission to elevate and transform neonatal care, NANN is grateful to bring forth this important collaboration with INC and give all neonatal nurses access to these outcome improving modules,” said NANN Executive Director Molly Anderson. “We know neonatal nurses have the expertise and knowledge to play an essential role in drug development that benefits their patients. NANN seeks out partnerships with organizations like INC that allow us to empower deepened nurse involvement with all aspects of care throughout their careers.”

The series includes access to seven on-demand video modules related to nurse-informed neonatal study design for drug development to provide context for the importance and implications for neonatal nurses. The NANN iLEARN site provides a platform for open access. Share the product flyer with colleagues to provide the QR code for access.

Jan 31, 2021       Kay Lloyd

Free patterns. Great for a beginner or just someone who wants to make for local maternity/neo natal hospital.

A Call to Action

Zukowsky, Ksenia PhD, CRNP, NNP-BC; Editorial Board Member; Savin, Michele Kacmarcik DNP, APRN, NNP-BC, CNE, FAWHONN; Assistant Professor Director; Manning, Mary Lou PhD, CRNP, CIC, FAPIC, FSHEA, FAAN; Professor Director

Advances in Neonatal Care 24(3):p 209-211, June 2024. | DOI: 10.1097/ANC.0000000000001168

Metrics

Antibiotics are life-saving drugs and essential for the treatment of many serious infections, but widespread inappropriate use is now common and has become a major contributor to the development of antibiotic resistance (ABR). ABR is an urgent global public health and socio-economic threat, generating calls for actions from the World Health Organization and the US Centers for Disease Control and Prevention (CDC). Left unchecked, ABR is poised to reverse a century of medical progress, rendering antibiotics ineffective in treating even the most common infectious diseases. Infants admitted to neonatal intensive care units (NICUs) are at high risk for the development and transmission of multidrug-resistant pathogens, particularly where hospital stays are prolonged because of prematurity or congenital anomalies.3 Worldwide, sepsis is the third leading cause of neonatal mortality, with antibiotic resistant pathogens responsible for approximately 30% of deaths.

Antibiotics are the most common medication prescribed in NICUs, with wide variability in use, regardless of the level of care or complexity of patients.5 On any given day, 40% of infants admitted to a NICU are prescribed antibiotics, with an estimated 90% exposed to antibiotics over the duration of their NICU stay. A recent study published in The Lancet Regional Health-Southeast Asia found that the most commonly prescribed antibiotics in Southeast Asia are now only 50% effective at treating sepsis and meningitis in newborns. Furthermore, there is increasing evidence that preterm infant antibiotic exposure is associated adverse outcomes including alteration in the intestinal microbiome, necrotizing enterocolitis, invasive fungal infections, retinopathy, and late-onset sepsis.5 Early life antibiotic exposure is also associated with future health problems including childhood obesity, asthma, allergic disorders, and inflammatory bowel disease. Therefore, it is important to find strategies to reduce antibiotic use in the NICU patient population.

ANTIBIOTIC STEWARDSHIP

According to the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society, the major objective of antibiotic stewardship (AS) is to achieve the best clinical outcomes related to antibiotic use while minimizing toxicity and other adverse events, thereby limiting the emergence of ABR bacterial strains. AS – a core strategy to combat ABR – is intended to ensure patient safety through the implementation of combined, coordinated interprofessional interventions to optimize how antibiotics are used. Studies indicate that the implementation of AS initiatives in NICUs is associated with a significant decrease in the overall days of therapy and reduction in use of broad-spectrum antibiotics, such as cephalosporins, without adverse issues. However, significant gaps exist between CDC recommendations to improve antibiotic use and antibiotic practices during the neonatal and newborn period. Until recently, AS interventions focused primarily on improving clinician antibiotic prescribing practices through formulary restriction and prospective audit with feedback. However, with more nurses in the frontline of healthcare than any other healthcare profession, the CDC, the American Nurses Association (ANA), the International Council of Nurses and The Joint Commission, have endorsed nurses’ active participation in AS activities to expand the reach and impact of stewardship programs. A recent survey of NICU nurses found that most were familiar with the term AS, yet over half reported administering an antibiotic to a patient who they thought was an inappropriate choice and most reported not questioning the treating provider about antibiotic choice, dose or route of administration.

THE ROLE OF NEONATAL NURSES AND NEONATAL NURSE PRACTITIONER IN ANTIBIOTIC STEWARDSHIP

As trusted professionals, expert clinicians, and advocates for their patient’s health, neonatal nurses and neonatal NPs are well qualified to make significant contributions to the reduction of ABR through active engagement in AS. There are multiple AS activities to consider now.

  • Advance your knowledge. Read the articles cited in this editorial. Participate in educational opportunities (eg, grand rounds, seminars, webinars) to advance your antibiotic, ABR and AS knowledge. Learn with and from others by starting an interprofessional AS journal club or lunch-and-learn at your practice setting. Contact the National Association of Neonatal Nurses and encourage them to provide state-of-the-science ABR and AS educational sessions specific to neonatal care and evidence-based antibiotic prescribing.
  • Advocate for the adoption and evaluation of at least one nurse driven AS recommended action in your practice setting. Many preterm infants who do not have infections receive antibiotic treatment in the setting of negative cultures. Consider implementing daily antibiotic timeouts.
  •  Antibiotic time-outs involve a daily formal antibiotic review, often conducted during clinical rounds, to determine if a modification or discontinuation of a patient’s antibiotic therapy is warranted. The time-out approach is in keeping with nurse engagement in prevention of central line-associated bloodstream infections, which includes a daily formal review of central line necessity. Bedside neonatal nurses are well positioned to lead reassessment of antibiotic treatment for they know how long a patient has been receiving antibiotic(s) and when diagnostic test results become available. For additional examples of nursing interventions that may have an important impact on promoting nurse engagement, read the recommendations from the ANA/CDC Workgroup and an article providing a framework to guide AS nursing practice.
  • Become an antibiotic stewardship champion. Neonates are entitled to receive antibiotic therapy that is based on evidence and best practice, but might be overlooked in hospital AS programs. Build and strengthen partnerships and facilitate communication between the NICU clinical staff and your organization’s AS team (physicians, clinical pharmacists, clinical laboratory personnel). Reach out to the AS team to learn about the overall AS program and specific AS NICU strategies. Engage and educate NICU staff about AS to increase their buy-in and awareness of nursing-related AS practices. Consider AS within the tenets of patient safety, and promote local-level “stewarding” behaviors that tap into the interprofessional NICU team’s collective knowledge, expertise, relationships and wisdom.15 NICU AS nursing practices should be intentionally selected, and strategically align with the organization’s AS program, giving ample consideration to the local context and tailored to the needs and resources of the NICU patients and clinical setting.
  • Monitor your antibiotic prescribing practices. A core AS strategy is tracking and reporting of provider antibiotic prescribing. Audit and feedback, includes analyzing antibiotic prescribing data and providing feedback to clinicians aimed at helping them understand their antibiotic prescribing habits. These data are most effective when individual results are compared to other clinicians in the clinician’s area and/or specialty (e.g., NNP peer comparisons). If you are a prescriber and are not receiving peer comparison audit and feedback data, work closely with your practice colleagues to develop a process to audit patterns of antibiotic prescribing to gauge appropriateness.
  • Use evidence-based clinical decision support systems. Clinical decision support systems are electronic tools or software that provide guidance to providers in making both diagnostic and therapeutic choices for patients.16 Applications range from pop-up reminders during a patient encounter, to automated order entry, to electronic guides, including dynamic interactive programs that tailor guidelines to specific patients. Such systems can be particularly useful when applied to antibiotic prescribing. Engage and partner with the NICU clinical team to identify the most useful systems to enhance clinical guideline adherence, decrease antibiotic consumption, or narrow the spectrum of antibiotic usage.

ABR has been aptly described as a subtle, slow moving catastrophe. AS programs aim to optimize antibiotic use to prevent the emergence of resistant pathogens and protect patients from the adverse effects of unnecessary antibiotics. We posit that all NICU nurses have a central role to play in the safe and responsible use of antibiotics and suggest several strategies for NICU nurses to engage in preventing unnecessary antibiotic exposure in this highly vulnerable population. We encourage you to seize the moment and become active, engaged stewards!

https://journals.lww.com/advancesinneonatalcare/fulltext/2024/06000/neonatal_nurse_and_nurse_practitioner_engagement.1.aspx

First Day of Neonatology

Dr. Glaucomflecken

Jennifer Degl, MS, Deb Discenza, MA, Mitchell Goldstein, MD, MBA, CML

In contemporary healthcare settings, the role of a Neonatal Intensive Care Unit (NICU) Volunteer Coordinator is indispensable, as it embodies the essence of compassionate care and community support for families navigating the challenges of premature births and neonatal health complications. While volunteer coordinators are often relied upon to fulfill this critical role, it is imperative to recognize the value they bring to the table and advocate for establishing a paid position dedicated to this noble cause.

Parents experience trauma regardless of what level NICU their baby is in and no matter the length of their NICU stay, and so it is vital that we push for a national campaign to address the inequity in order to help families bond and start the healing process before discharge. Not doing so can lead to trauma-related family issues at home. Currently, we largely focus on preparing parents for discharge across all things involving care of the infant. Why would we leave out the important topic of mental health Not addressing this important issue is tantamount to failure for that infant’s long term outcome, not to mention the outcome of the family unit as well. A NICU Volunteer Services Coordinator can alter that trajectory.

The NICU Volunteer Services Coordinator serves as a beacon of hope and support for families enduring the emotional rollercoaster of having their newborn hospitalized. This position encompasses a myriad of responsibilities aimed at fostering a nurturing environment within the NICU, where families feel empowered and supported throughout their journey. From recruiting additional NICU graduate parents to serve as volunteers to organizing crucial training sessions on mental health first aid and active listening, the coordinator plays a pivotal role in equipping volunteers with the necessary skills to provide invaluable support to NICU families.

 Furthermore, the coordinator is a liaison between volunteers, nursing staff, and physicians, ensuring seamless communication and collaboration for improving patient care. Facilitating regular meetings and educational events creates opportunities for peer to-peer support among parents and disseminates vital information on neonatal care practices, empowering families to make informed decisions regarding their child’s healthcare journey.

The significance of celebrating milestones and raising awareness cannot be overstated in the NICU setting. The coordinator spearheads initiatives such as NICU Awareness Month/Day and World Prematurity Month/Day, fostering community and solidarity among NICU families and staff. Moreover, their involvement n fundraising activities and grant writing endeavors ensures continued access to resources and services that benefit NICU babies and their families, underscoring their dedication to enhancing the quality of care provided.

Regarding qualifications and working conditions, the NICU Volunteer Services Coordinator must possess a unique blend of empathy, organizational acumen, and leadership skills. While a post-secondary education degree serves as a foundation, firsthand experience as a parent of a NICU graduate and previous involvement in peer mentoring or emotional support roles are invaluable assets. The flexible nature of the position, with a combination of on-site and remote work, accommodates the dynamic needs of NICU families while ensuring that the coordinator remains accessible and responsive to their concerns.

Crucially, advocating for a paid position for the NICU Volunteer Services Coordinator acknowledges the intrinsic value of their role and underscores the commitment of healthcare institutions to prioritize patient-centered care and community engagement. By investing in this position, hospitals enhance the support provided to NICU families and cultivate a culture of compassion and collaboration that is essential for fostering positive health outcomes.

In conclusion, establishing a paid position for the NICU Volunteer Services Coordinator is not merely a bureaucratic formality but a testament to the unwavering commitment of healthcare institutions to uphold the highest standards of patient care and support. By recognizing the invaluable contributions of these dedicated individuals, we affirm our collective responsibility to ensure that every NICU family receives the compassion, guidance, and support they deserve during their journey toward healing and hope. And in the end, the hospital, as a whole, wins substantially through quality improvement scores and community appreciation. It is worth the investment because the benefits are tenfold.

August 15, 2023 – by Robert Forman

Midwife care can improve pregnancy outcomes for mothers and babies, says new “Expert Review” from Yale faculty

The practice of midwifery is less common in the United States than in other countries and other cultures, which is a shame because adding care by midwives generally improves childbirth outcomes, according to two Yale faculty members who have published an “Expert Review” in the American Journal of Obstetrics & Gynecology. Holly Powell Kennedy PhD, MSN,CNM, the Helen Varney Professor of Midwifery, and  Joan Combellick, PhD, MPH,CNM, assistant professor of nursing, along with their colleagues, examined the scientific literature related to midwifery and childbirth, and conclude that many measures of successful pregnancy are elevated when midwives play a central role.

They cite the approach to midwifery that is standard in other countries, especially in wealthy European nations, where women have as much as seven times the access to midwives that they do in the United States. They report that midwifery care has improved outcomes by 56 different measures—including lower morbidity and mortality among mothers and newborns, fewer preterm births and low birthweight infants, and reduced interventions in labor.

The authors acknowledge that differences in those countries’ overall health systems make a substantial contribution to good outcomes, but say it’s the integral role of midwives that matters most. “In other countries, midwives make up the basic maternity care provider workforce, and then, obstetricians are used as the specialists that they are, surgeons who are there to handle complications,” says Combellick. “[Midwives] are the experts in normal childbirth, which happens the majority of the time.” Combellick adds that midwives also extend their care beyond pregnancy. “We also do well-person preventive care, across the lifespan from teenagers through postmenopausal people, so it isn’t only pregnancy-related.”

The Value of Midwives at the Baby’s Arrival

But the continuum of pregnancy, birth, and postnatal care is what midwives are best known for, and where the contribution of midwives can differ sharply from what is often considered standard care. Kennedy says a very basic way that outcomes can improve is because prenatal care by midwives is not squeezed into appointments of a set duration, where the provider may not have the time to fully answer the patient’s questions. Kennedy notes that in some settings, midwives caring for a woman throughout the pregnancy bring continuity and can structure longer appointments. Having more time permits building better rapport with a mother-to-be and helps her feel more respected, which often translates into a smoother pregnancy.

“In our paper, we discuss some of the research done about respect. It’s true for any kind of health care, but particularly in prenatal care,” says Kennedy. “It can amount to being highly disrespected and simply having to wait two hours for a very short prenatal visit. If people aren’t feeling respected or safe, they’re less likely to keep coming in for prenatal care.” Combellick adds that this can be especially true for women of color, for whom the cumulative race-based disrespect they endure in their daily lives can make the pressures of pregnancy more intense.

When the time for delivery arrives, a few statistics are especially striking. First-time mothers giving birth at medical centers where midwives were on their care team were 74% less likely to have their labor induced, 75% less likely to receive oxytocin augmentation, and 12% less likely to deliver by cesarean than their counterparts at medical centers without midwives in attendance.

Midwives and Ob/gyns Collaborate During Childbirth

Combellick says that on a collaborative team, the pregnant person is at the center of care, with everyone contributing their particular expertise. Whether to wait and allow labor to continue at its own pace, to induce, or to perform a cesarean can generally be a shared decision that involves patient understanding and consent. “We are collaborators,” says Combellick. “We work in conjunction with physicians. To have two viewpoints thinking about one person is a really strong style of care.”

At Yale, Kennedy and Combellick contribute to the midwifery faculty practice supporting student midwives as they learn. Faculty practice midwives are also active with obstetricians-in-training. “We contribute to the resident training program,” Combellick says. “So the residents, when they first come, are assigned to follow a midwife. Around the country, midwives often play a role in demonstrating ‘here’s what normal physiologic birth looks like,’ and that occurs at Yale.”

Hugh S. Taylor, MD, chair and Anita O’Keeffe Young Professor of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine, says this collaboration has been good for all involved. “It’s important that all of our practitioners get exposure and training on the collaborative practice model. The trainees participate in these teams and get a living example of how collaboration results in outstanding care. It was very important to establish that program—not only for patient care but for our residents and students.”

Taylor says that both for prenatal care and during deliveries, the presence of midwives on the care team can be invaluable. “Most of the prenatal care in our collaborative practice is delivered by midwives, with appropriate escalation and/or referral when things get complicated. If somebody develops diabetes or high blood pressure in pregnancy, we get the physician involved. However, for routine prenatal care or uncomplicated deliveries, we try to keep the physician in the background.”

Kennedy and Combellick both hope that the profile of midwifery in this country will rise, both through growing what Combellick now calls a “relatively small midwifery workforce” that attends only 10 to 12% of births in the United States, and by reforming practices related to health care delivery at large. “It’s not a simple, magical thing about the midwife,” Kennedy concludes, “but really about the model of care: that it’s accessible, it’s available, it’s respectful.” Those changes for the better, they say, would be nothing short of radical, and they are doing their part to gather the available evidence and advocate for change to happen.

https://medicine.yale.edu/news-article/the-value-of-midwives-during-prenatal-care-and-birth/

 UpToDate – Free

Find clinical answers at the point of care or anywhere you need them! Now you can access UpToDate’s current, synthesized clinical information — including evidence-based recommendations — quickly and easily on your iPad, iPhone, or iPod touch.

Notes: To use the mobile app you must first create an UpToDate account. Use this link on the WCMC-Q network to create an account.

 First Consult – FREE

Do you need evidence-based answers to clinical questions at the point of care? The First Consult iPhone/iPad app is your solution. The app allows First Consult’s trusted answers to be stored on your iPhone, iPad, or iPod touch. A data connection is required for the initial content download and content updates, but is not required to use the app itself.

Notes: Log in with your ClinicalKey account created from a WCMC-networked computer.

               DynaMed Plus – Free

DynaMed Plus™ is the clinical reference tool that physicians go to for answers to clinical questions. Content is written by a world-class team of physicians and researchers who synthesize the evidence and provide objective analysis. DynaMed Plus topics are always based on clinical evidence and the content is updated multiple times each day to ensure physicians have the information they need to make decisions at the point of care.


Note: To use this app begin by clicking on the “Get the DynaMed Plus Mobile App” link on the DynaMed Plus homepage. See this link for more information.

Touch Surgery, Surgical Simulator – Free

Touch Surgery is an interactive mobile surgical simulator that guides you step-by-step through every part of an operation, and every decision that’s made along the way. It’s the OR in your pocket.

Preop Eval – Free

Preop Eval organizes and presents much of the guidance that one needs in order to evaluate and prepare adult patients for non-cardiac surgery. It is based upon the guidelines on this topic from the American College of Cardiology of 2014, the European Society of Anaesthesiology of 2011, , and more. The app contains 1 algorithm and 3 resources: the cardiac evaluation algorithm, guidance on starting and stopping key medications in the perioperative period, guidance on timing of surgery after cardiac events, and guidance on preoperative testing. It also contains a review of preoperative evaluation mainly for students and residents.

AO Surgery Reference – Free

AO Surgery Reference is an online repository for surgical knowledge. It describes the complete surgical management process from diagnosis to aftercare for all fractures of a given anatomical region, and also assembles relevant material that the AO has published before.

drawMD General Surgery – Free

drawMD General Surgery’s content was developed by physicians and clinical practitioners to facilitate discussion of the most common conditions and procedures. The drawMD platform allows you to easily annotate any condition on our pertinent medical illustration or you can easily upload your own images.

*** This site also has All-Purpose Clinical APPs:

https://hslib-guides.qatar-weill.cornell.edu/c.php?g=364087&p=4181702

In Scotland, we believe that parenting is one of the most important jobs in the world. The work we do preparing our children for the future will ultimately shape our world in the years to come. With that in mind, we want to make sure that Scotland was the best place in the world to grow up in. That’s why, in 2017, we launched the Baby Box initiative, which is designed to give every single baby in Scotland an equal start in life.

Scottish Government   Jun 29, 2022

New babies need a surprising amount of stuff! Scotland’s Baby Box is packed full of clothes, bedding and lots of other useful things to help give your baby the best possible start in life

https://www.scotland.org/live-in-scotland/progressive-scotland/baby-box

by Eduardo Gonzalez-Moreira, Thalía Harmony, Manuel Hinojosa-Rodríguez, Cristina Carrillo-Prado,María Elena Juárez-Colín,Claudia Calipso Gutiérrez-Hernández, María Elizabeth Mónica Carlier, Lourdes Cubero-Rego, Susana A. Castro-Chavira, and Thalía Fernández / Published: 2 May 2023

Abstract

Background: Preterm birth is one of the world’s critical health problems, with an incidence of 5% to 18% of living newborns according to various countries. White matter injuries due to preoligodendrocytes deficits cause hypomyelination in children born preterm. Preterm infants also have multiple neurodevelopmental sequelae due to prenatal and perinatal risk factors for brain damage. The purpose of this work was to explore the effects of the brain risk factors and MRI volumes and abnormalities on the posterior motor and cognitive development at 3 years of age. Methods: A total of 166 preterm infants were examined before 4 months and clinical and MRI evaluations were performed. MRI showed abnormal findings in 89% of the infants. Parents of all infants were invited to receive the Katona neurohabilitation treatment. The parents of 128 infants accepted and received Katona’s neurohabilitation treatment. The remaining 38 infants did not receive treatment for a variety of reasons. At the three-year follow-up, Bayley’s II Mental Developmental Index (MDI) and the Psychomotor Developmental Index (PDI) were compared between treated and untreated subjects. Results: The treated children had higher values of both indices than the untreated. Linear regression showed that the antecedents of placenta disorders and sepsis as well as volumes of the corpus callosum and of the left lateral ventricle significantly predicted both MDI and PDI, while Apgar < 7 and volume of the right lateral ventricle predicted the PDI. Conclusions:  The results indicate that preterm infants who received Katona’s neurohabilitation procedure exhibited significantly better outcomes at 3 years of age compared to those who did not receive the treatment.  The presence of sepsis and the volumes of the corpus callosum and lateral ventricles at 3–4 months were significant predictors of the outcome at 3 years of age.

OPEN ACCESS ARTICLE HERE: Brain Sci. 2023, 13(5), 753; https://doi.org/10.3390/brainsci13050753 ; https://www.mdpi.com/2076-3425/13/5/753

Ryan Jaslow – Program Director, External Communications – Research, Mass General Brigham- rjaslow@mgb.org

06/05/24

Key Takeaways

  • A new clinical trial in Shanghai, China, in partnership with Mass Eye and Ear researchers, demonstrated the restoration of hearing in both ears in five children born with autosomal deafness caused by mutations in the OTOF gene.
  • All children gained ability to determine locations that sounds came from and improved speech perception in noisy environments.
  • The trial is the first to provide gene therapy for this form of inherited deafness to children in both ears, and the researchers hope to expand this work internationally.

Boston, Mass. — A novel gene therapy designed to target a form of inherited deafness restored hearing function in five children who were treated in both ears. The children also experienced better speech perception and gained the ability to localize and determine the position of sound. The study, the world’s first clinical trial to administer a gene therapy to both ears (bilaterally), demonstrates additional benefits than what were observed in the first phase of this trial, published earlier this year, when children were treated in one ear. The research was led by investigators from Mass Eye and Ear (a member of the Mass General Brigham healthcare system) and Eye & ENT Hospital of Fudan University in Shanghai, and findings were published June 5th in Nature Medicine.

“The results from these studies are astounding,” said study co-senior author Zheng-Yi Chen, DPhil, an associate scientist in the Eaton-Peabody Laboratories at Mass Eye and Ear. “We continue to see the hearing ability of treated children dramatically progress and the new study shows added benefits of the gene therapy when administrated to both ears, including the ability for sound source localization and improvements in speech recognition in noisy environments.”

The researchers noted their team’s goal was always to treat children in both ears to achieve the ability to hear sound in three dimensions, a capability important for communication and common daily tasks such as driving.

“Restoring hearing in both ears of children who are born deaf can maximize the benefits of hearing recovery,” said lead study author Yilai Shu MD, PhD, professor, director of Diagnosis and Treatment Center of Genetic Hearing Loss affiliated with the Eye & ENT Hospital of Fudan University in Shanghai, “These new results show this approach holds great promise and warrant larger international trials.

Over 430 million people around the world are affected by disabling hearing loss, of which congenital deafness constitutes about 26 million of them. Up to 60 percent of childhood deafness is caused by genetic factors. Children with DFNB9 are born with mutations in the OTOF gene that prevent the production of functioning otoferlin protein, which is necessary for the auditory and neural mechanisms underlying hearing.

This new study is the first clinical trial to use bilateral ear gene therapy for treating DFNB9. The new research presents an interim analysis of a single-arm trial of five children with DFNB9 who were observed over either a 13-week or 26-week period at the Eye & ENT Hospital of Fudan University in Shanghai, China. Shu injected functioning copies of the human OTOF transgene carried by adeno-associated virus (AAV) into the inner ears of patients through a specialized, minimally invasive surgery. The first case of bilateral treatment was conducted in July 2023. During follow-up, 36 adverse events were observed, but no dose-limiting toxicity or serious events occurred. All five children showed hearing recovery in both ears, with dramatic improvements in speech perception and sound localization. Two of the children gained an ability to appreciate music, a more complex auditory signal, and were observed dancing to music in videos captured for the study. The trial remains ongoing with participants continuing to be monitored.

In 2022, this research team delivered the first gene therapy in the world for DFNB9 as part of a trial of six patients in China treated in one ear. That trial, which had results published in The Lancet in January 2024, showed five of six children gained improvements in hearing and speech. Shu initially presented the data at the 30th annual congress of European Society of Gene and Cell Therapy (ESGCT) in Brussels, Belgium in October 2023, becoming the first in the world to report clinical data on using gene therapy to restore hearing.

“These results confirm the efficacy of the treatment that we previously reported on and represent a major step in gene therapy for genetic hearing loss,” said Shu. Shu trained under Chen for four years as a postdoctoral fellow at Mass Eye and Ear, with their collaboration continuing for more than a decade since he returned to Shanghai.

“Our study strongly supports treating children with DFNB9 in both ears, and our hope is this trial can expand and this approach can also be looked at for deafness caused by other genes or non-genetic causes,” added Chen, who is also an associate professor of Otolaryngology–Head and Neck Surgery at Harvard Medical School. “Our ultimate goal is to help people regain hearing no matter how their hearing loss was caused.”

Currently, there are no drugs available to treat hereditary deafness, which has made room for novel interventions like gene therapies.

Mass General Brigham’s Gene and Cell Therapy Institute is helping to translate scientific discoveries made by researchers into first-in-human clinical trials. Chen and his colleagues are working with the Institute to develop platforms and vectors with good manufacturing practice standards that would enable his team to more easily test this therapeutic approach with other genes in the future.

The authors note that more work is needed to further study and refine the therapy. The bilateral study requires more consideration compared to the unilateral (one-ear) study as operations in both ears, in the course of one surgery, doubles the surgical time. Furthermore, by injecting double doses of AAVs into the body, the immune response is likely to be stronger and the potential for adverse effects could be greater. Looking ahead, more patients as well as a longer follow-up duration are necessary, and continued analysis of gene therapies and cochlear implants in larger randomized trials will be valuable.

Paper cited: Wang, H et al. “Bilateral gene therapy in children with autosomal recessive

HEALTHMEDICAL SCIENCES 11 MAR 2024

The Neuroimaging Group, at the Department of Paediatrics, in collaboration with Bliss, the charity for babies born premature or sick, has launched a new suite of information resources for parents of neonates, designed to make them feel more confident about being involved in the care of their babies.

While evidence demonstrates that parents can play a positive role in comforting their baby during painful procedures, practice in the UK lags far behind. However new research by the Neuroimaging Group, published in the Lancet Child & Adolescent Health and Pain has brought further proof of the positive impact that being involved in their baby’s care has on parents.

The Parental touch trial (Petal) aimed to assess whether parental touch at a speed of approximately 3 cm/s to optimally activate C-tactile nerve fibres, provides effective pain relief during a heel-prick procedure. While there was no difference in the babies’ brain, behavioural or heart rate response to pain regardless of whether the parent touched their baby before or after the painful procedure, the findings did demonstrate that the majority of parents had positive emotions when involved in their child’s care – such as feeling useful and reassured – and an overall decrease in parental anxiety after their participation.

These new resources, a combination of beautifully curated and informative videos, FAQs and online information content, have been developed in light of the collaboration with parents and healthcare professionals. They are free to access online and set out in detail the many ways that parents can touch and comfort babies of all gestations during painful procedures on the neonatal unit, including skin-to-skin care.

Commenting on the research in an accompanying Lancet Child and Adolescent Health editorial, Ruth Guinsburg, said: ‘This study is an example of excellence in research. The trial was carefully designed with a clear question, strict inclusion and exclusion criteria, a well-designed and reproducible intervention based on biological plausibility, and defined outcomes, with the strength of using an objective rather than a subjective measure of pain. Only with trials like this might we transform faith in scienceand test the efficacy of traditional aspects of parental care in order to incorporate them, or not, in bundles to alleviate the pain in neonates.’

Dr. Rebeccah Slater, Professor of Paediatric Neuroscience and Senior Wellcome Fellow at the Neuroimaging Group, said: ‘Working with parents, babies and healthcare professionals to better understand how we can support premature and sick babies during painful procedures has been a highlight of my career. Developing these resources with Bliss has placed families at the heart of all the research we do, and has directly improved our engagement with families and the quality of our research. We will continue to find new ways to support parents and their babies when painful procedures form an essential component of neonatal care.’

Dr. Roshni Mansfield, a Paediatrics trainee and NIHR Academic Clinical Fellow in the Paediatric Neuroimaging Group said: ‘The Petal trial has highlighted the importance of involving parents in the provision of care and comfort for relieving their child’s pain. Future studies can build upon the insights gained from this trial including the positive parental experiences observed in this study. Prospective research might, for example, exercise a more spontaneous approach to delivering the gentle touch, such as allowing parents to stroke their child at their own pace, for as long as they need to calm and comfort their child, rather than a more mechanical and precise application.’

Dr. Maria Cobo, a postdoctoral researcher who managed the trial, added: ‘Another positive aspect of the study was the high degree of involvement by both fathers (35%) and mothers (65%) in delivering the parental touch to their babies. This contrasts with many studies, where only mothers’ opinions and involvement have been sought.’

 Caroline Lee-Davey, Chief Executive of Bliss, said: ‘We are thrilled to have worked alongside the amazing team of researchers at the University of Oxford to further our understanding on the importance of parental involvement in their babies’ neonatal care. We know that babies have the best chance of survival and quality of life when their parents are empowered to be partners in their care but, sadly, we hear all too often that parents are not informed about their babies’ procedures or the role that they can have in comforting their baby. The outcomes of this research have directly shaped a new suite of Bliss information for parents and healthcare professionals which will help to validate what families often instinctively know to be true – that no matter how unexpected or strange the neonatal environment can feel, they are still their baby’s parent and they have a vital role to play in their comfort and care.’ 

Additional funding from the Wellcome Trust enabled Bliss to develop these valuable resources for families, including new information, video content filmed at John Radcliffe Hospital’s neonatal unit giving precious insight into neonatal care, as well as translated flyers for neonatal units and a webinar for healthcare professionals on how to support parents to be involved in their babies’ procedures. These resources were created in collaboration with parents and healthcare professionals, and included a listening event with the Raham Project, a CIC supporting ethnic minority families, where four mothers shared their neonatal stories.

  https://www.ox.ac.uk/news/2024-03-11-research-shows-comforting-babies-eases-parental-stress-painful-procedures

Empowering the Unsung Heroes: Siblings of NICU Warriors

When a baby is born prematurely or with critical health needs, the entire family is thrust into a world of uncertainty and emotional upheaval. While much attention is rightfully focused on the newborn and parents, siblings often navigate this journey with a unique blend of resilience and vulnerability. These brave siblings of preemie babies deserve recognition and support for the vital role they play in the family’s NICU journey.

Siblings of NICU babies often experience a whirlwind of emotions, from fear and confusion to jealousy and isolation. It’s essential to create an environment where their feelings are acknowledged, and their contributions celebrated. Simple actions, like involving them in care routines or creating special sibling-only times, can foster a sense of inclusion and importance. Encouraging open conversations about their fears and questions can also help them feel more connected and less isolated.

Educational resources tailored to siblings can also be beneficial. Books, videos, and activities that explain the NICU environment in age-appropriate terms can demystify the experience and reduce anxiety. These resources help siblings understand the medical aspects of their baby brother or sister’s care, making the hospital environment less intimidating. Providing clear and accessible information empowers siblings by giving them a sense of control and understanding in an otherwise overwhelming situation. Resources such as Hand to Hold, Bliss, Miracle Babies Foundation, and Canadian Premature Babies Foundation, offer valuable insights and practical tips for supporting siblings during this challenging time.

Recognizing the importance of supporting siblings of NICU babies is essential for fostering a positive family dynamic and ensuring the emotional health of all children involved. By acknowledging their unique experiences and providing targeted support, parents and caregivers can help these strong siblings navigate the complex emotions and challenges they face, contributing to the overall resilience and well-being of the entire family navigating the NICU journey.

These resources provide valuable insights and practical tips to help siblings navigate the complex emotions and experiences associated with having a brother or sister in the NICU:

Hand to Hold: Sibling Support

Hand to Hold provides comprehensive resources to support siblings of NICU babies, including tips for preparing siblings for NICU visits and strategies for making them feel included in their baby brother or sister’s care.

https://handtohold.org/resources/siblings

Bliss (UK): Support for Siblings

Bliss is a UK-based charity that provides comprehensive support for families of premature and sick babies. They offer resources and guidance specifically designed for siblings, including advice on how to involve them in the care process and ways to help them understand and cope with the NICU environment.

https://www.bliss.org.uk/parents/support/siblings

Miracle Babies Foundation (Australia): Sibling Support

Miracle Babies Foundation is an Australian organization dedicated to supporting premature and sick newborns, their families, and the hospitals that care for them. They provide resources tailored for siblings, helping them navigate the emotional and practical challenges of having a brother or sister in the NICU.

https://www.miraclebabies.org.au/parents-and-families/sibling-support/

Canadian Premature Babies Foundation Sibling Support

The Canadian Premature Babies Foundation (CPBF) offers a range of resources to support families of premature babies across Canada. They provide specific guidance and materials for siblings, including educational resources and support groups to help them cope with their sibling’s NICU stay.

https://www.cpbf-fbpc.org/sibling-support

Boy’s Heart Melts As He Meets Baby Sister After NICU Stay

Sep 11, 2023

 A three-year-old boy who could not meet “his” baby sister while she spent her first days in the NICU lit up when he was finally able to hold her for the first time. Dominic “Dommy” Voso, from Rome, Georgia, told his parents the newborn would be “his” baby, having asked mom and dad for a sibling for a long time, proudly telling others when his mom was pregnant. But unfortunately for Dommy, mom Chrissy, 30, had preeclampsia during her pregnancy, which meant that Mia had be delivered at 35 weeks and four days. Mia then had trouble breathing, which caused her to spend her first 12 days in the NICU. This period was extremely tough for Dommy, as he had been desperate to meet his newborn sister, but only adults and siblings over 13 years of age could enter the NICU. Added to this difficulty, Chrissy had to spend an extra eight days in hospital, too, so Dommy couldn’t understand why he could see his mom but not his little sister. But that all changed on July 4 when Dommy sat in his family’s home and Chrissy came in holding Mia. When Dommy was then presented with his little sister, he immediately beamed with joy, holding her before bringing toys and books to share with her.

This inspiring video  highlights the experiences and resilience of siblings of Preemie Warriors:

                                 Let’s Travel!      #scotland #travelchannel #scotlandtravel

Surfing Scotland, Thurso, surf trip UK, Surfing scotland West Coast, Surfing Scotland East Coast, Surfing Dunbar, Moray firth, December surf!

Lifelines, Redirection, Neurocritical Care

Yemen, officially the Republic of Yemen, is a country in West Asia. It is located in the southern end of the Arabian Peninsula, bordering Saudi Arabia to the north and Oman to the northeast. It shares maritime borders with EritreaDjibouti and Somalia. Covering 530,000 square kilometres (204,634 square miles) and having a coastline of approximately 2,000 kilometres (1,200 miles), Yemen is the second-largest Arab sovereign state on the Arabian Peninsula.Sanaa is its constitutionally stated capital and largest city. The country’s population is estimated to be 34.7 million as of 2023. Yemen is a member of the Arab League, the United Nations, the Non-Aligned Movement and the Organisation of Islamic Cooperation.

Since 2011, Yemen has been facing a political crisis, marked by street protests against poverty, unemployment, corruption, and President Saleh’s plan to amend Yemen’s constitution and eliminate the presidential term limit. Subsequently, the country has been engulfed in a civil war with multiple entities vying for governance, including the government of President Hadi (later the Presidential Leadership Council), the Houthi movement‘s Supreme Political Council, and the separatist Southern Movement’s Southern Transitional Council. This ongoing conflict has led to a severe humanitarian crisis and received widespread criticism for its devastating impact on Yemen’s people.

The ongoing humanitarian crisis and conflict has received widespread criticism for having a dramatic worsening effect on Yemen’s humanitarian situation, that some say has reached the level of a “humanitarian disaster”. Yemen is one of the least developed countries in the world, facing significant obstacles to sustainable development and is one of the poorest countries in the Middle East and North Africa region. The United Nations reported in 2019 that Yemen had the highest number of people in need of humanitarian aid, amounting to about 24 million individuals, which is nearly 75% of its population.

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

  • GLOBAL PRETERM BIRTH RATES YEMEN
  • Estimated # of preterm births: UNKNOWN per 100 live births
  • (Global Average: 10.6)
  • Source- WHO Yemen – Healthy Newborn Network 6.8% preterm birth rate, 39% of infant mortality

Highlights

  • Despite expert knowledge and expertise, nurses often do not write for publication.
  • Barriers to writing for publication are commonly reported by nurses.
  • A virtual, Writing for Publication Program was convened to overcome these barriers.
  • The group of clinical and academic nurses successfully published a manuscript.
  • Recommendations for overcoming writing for publication barriers provided.

Abstract

Nurses have valuable knowledge and expertise to share. Yet, for a variety of reasons, many nurses do not write for publication. Members in one Sigma Theta Tau International chapter requested information about publishing so a writing for publication program (WPP) was convened. Ten nurses from diverse clinical and academic backgrounds participated. The goal of the WPP was to support a small group of nurses to advance knowledge and develop practical skills through the development of a manuscript with mentorship from doctorally-prepared nurses with publishing experience. The anticipated effect was that participants would share what they learned with colleagues or mentor others to publish in the future. Beginning with informational sessions to lay the foundation for writing and publishing, the WPP included biweekly, two-hour online sessions over a seven-month period whereby individual and group writing with embedded peer and WPP leader feedback occurred. WPP participants gained proficiency in searching online databases, synthesizing published literature, and working as a member of a writing team. The group successfully published a manuscript based on a topic of interest. This current article describes the structured support and mentorship provided during the WPP with recommendations for overcoming publication barriers commonly described in the literature.

Background

Barriers to writing for publication are widely reported in nursing literature. Writing barriers are described as situational or personal (Tivis & Meyer, 2018) and internal or external (Oman et al., 2016). Situational and external barriers to writing for publication include a lack of time, family commitments, lack of resources, inadequate access to technology, insufficient organizational support, or a workplace culture that does not value writing and dissemination (Ansryan et al., 2019; Oman et

Forming the group

In August 2021, the annual general membership meeting for one chapter of Sigma Theta Tau International (Sigma) was held. Based on member requests, the educational focus of the general membership meeting, held online via the chapter’s discussion board, was writing for publication. Over the three-day meeting, those with publication experience were encouraged to share insights related to publishing. Members without publication experience reflected on publishing myths and barriers to writing for

Developing the manuscript

The goal of the WPP was to train a small cohort of nurses on how to write a single manuscript on a topic of interest and submit it to a peer-reviewed nursing journal. Wood (2018) and Bourgault (2023) note that some of the earliest decisions should be selecting the topic of the manuscript, identifying the intended audience, and selecting the journal the manuscript should be submitted. Oman et al. (2016) concur that successfully writing a manuscript is enhanced when the topic relates to lived

Reflections from group members

Two months after the second manuscript was accepted for publication, participants were asked to complete an anonymous survey to ascertain perspectives about the WPP. All ten members completed the survey. Resoundingly participants believed the WPP was a ‘well run,’ ‘helpful,’ and a ‘worthwhile’ experience. WPP leaders were ‘well prepared’ and ‘professional and skilled in guiding the process.’

The topics that members were already familiar with before participating in the WPP were writing

Lessoned learned with recommendations

Reflection by WPP leaders yielded several lessons learned with recommendations for overcoming known barriers to writing for publication. Insufficient time is frequently cited as a barrier to writing for publication (Ansryan et al., 2019). The structure of the WPP program was feasible to accomplish personal and collective goals. Two-hour, bimonthly meetings allowed sufficient time to complete the session agenda without burdening participants who may have competing work and family demands.

Conclusion

Writing for publication is an expectation of all nurses because it improves the quality of patient care to achieve optimal outcomes while also advancing the nursing profession. An innovative, virtual WPP successfully guided 10 academic and clinical nurses to publish a manuscript in a respected, peer-reviewed journal (Chargualaf et al., 2023). Participants largely reported feeling more confident in their own ability to publish in the future. Thus, the goal of the WPP was met. 

Source:https://www.sciencedirect.com/science/article/abs/pii/S8755722324000267

FROM THE AMERICAN ACADEMY OF PEDIATRICS| FEBRUARY 26 2024

American Academy of Pediatrics https://doi.org/10.1542/peds.2023-065582Board of Directors  Pediatrics (2024) 153 (3): e2023065582.

The violence, suffering, and death from the terrorist attack on Israel and the Israel-Hamas War weigh on us all. Pediatricians—who are called to care for children and keep them safe and healthy—have been reaching out to the American Academy of Pediatrics expressing anguish, outrage, and a deep desire to help stop the killing, ease the suffering, and protect all children from harm.

We are shaken and pained by what is happening in Israel and Gaza, and we are also alarmed by the increasing acts of violence and intimidation we’ve been witnessing in this country toward Jews, Muslims, and those with ties to Israel or Palestine. Many pediatricians and the families they care for have experienced such incidents.

As antisemitic and anti-Palestinian hate speech have been surging on social media, acts of hate have also been increasing in the United States and around the world. There has been an unprecedented rise in incidents of antisemitism, Islamophobia, and anti-Palestinian racism in this country according to data from the Anti-Defamation League and the Council on American-Islamic Relations. And reports of violent hate crimes targeting Jews, Muslims, and Arabs have risen steeply across the United States.

As people at home and abroad confront these issues and as world leaders debate how to move forward, one thing is certain: all children affected deserve our unconditional support.

It will always be the mission of the American Academy of Pediatrics (AAP) to advocate for children’s protection, health, and safety, no matter what, no matter where—be it in the United States, Israel, Gaza, the West Bank, Ukraine, South Sudan, Armenia, Syria, Yemen, Myanmar, Ethiopia, Democratic Republic Congo, or other conflict-torn areas that receive less media attention.

As pediatricians, pediatric medical subspecialists, and pediatric surgical specialists, we understand that the profound cost of any war is measured in children’s lives—those lost to violence and those forever changed by it. We know that what happens to these children today and what we do for them will help determine what becomes of this generation tomorrow.

In 2018, the Academy published a policy statement and accompanying technical report, “The Effects of Armed Conflict on Children,” which began with the following statistic: 1 in 10 children are affected by armed conflict. By 2021, 1 in 6—or about 449 million children worldwide—were living in a conflict zone. Africa had the highest overall number of children impacted by conflict (180 million), followed by Asia (152 million), and the Americas (64 million). Today, that figure is tragically even higher.

Our policy details both the acute and long-term effects of armed conflict on child health and well-being and uses a children’s rights-based approach as a framework for the AAP, child health professionals, and national and international partners to respond in the domains of clinical care, systems development, and policy formulation.

Our policy calls on governments to safeguard children and for pediatricians and health organizations to be involved both in preventing and responding to armed conflict. It advocates for integrating core human rights principles set forth in the United Nations Convention on the Rights of the Child (UNCRC) treaty into US policy.

To fulfill these rights, the policy lays out a number of detailed recommendations for mitigating the harms of child conflict both in clinical practice and in social systems serving children. This includes ensuring child health professionals who care for children affected by armed conflict have access to training in trauma-informed care, which involves recognizing and mitigating the harmful effects of these experiences. And it highlights opportunities for public policy advocacy, which include:

  • Ending the participation of children younger than 18 years of age in armed conflict and ensuring all children are protected from torture and deprivation of liberty, including extended or arbitrary detention;
  • Upholding the Geneva Conventions with respect to maintaining the sanctity of safe places for children, ensuring medical and educational neutrality, and allowing children fleeing armed conflict to petition for asylum and be screened for evidence of human trafficking;
  • Ensuring that children are not separated from their families during displacement and resettlement, and in the event of separation, prioritizing family reunification;
  • Protecting children from landmines, unexploded ordnances, small arms, and light weapons through effective clearing efforts and strict control on their sale, ownership, and safe storage;
  • Affording children a voice in creating policy and programs that prevent and mitigate harmful effects of armed conflict; and
  • Providing children affected by armed conflict access to educational opportunities as part of an environment conducive to their reintegration into society.
2023 AAP Board of Directors2024 AAP Board of Directors
Sandy L. Chung, MD, FAAP Benjamin D. Hoffman, MD, FAAP 
Benjamin D. Hoffman, MD, FAAP Susan J. Kressly, MD, FAAP 
Moira A. Szilagyi, MD, FAAP Sandy L. Chung, MD, FAAP 
Dennis M. Cooley MD, FAAP Margaret C. Fisher, MD, FAAP 
Patricia Flanagan, MD, FAAP Patricia Flanagan, MD, FAAP 
Warren M. Seigel, MD, FAAP Jeffrey Kaczorowski, MD, FAAP 
Margaret C. Fisher, MD, FAAP Patricia Purcell, MD, MBA, FAAP 
Michelle D. Fiscus, MD, FAAP Jeannette “Lia” Gaggino, MD, FAAP 
Jeannette “Lia” Gaggino, MD, FAAP Dennis M. Cooley, MD, FAAP 
Gary W. Floyd, MD, FAAP Susan Buttross, MD, FAAP 
Martha C. Middlemist, MD, FAAP Greg Blaschke, MD, MPH, FAAP 
Yasuko Fukuda, MD, FAAP Yasuko Fukuda, MD, FAAP 
Madeline M. Joseph, MD, FAAP Madeline M. Joseph, MD, FAAP 
Charles G. Macias, MD, FAAP Angela M. Ellison, MD, MSc, FAAP 
Constance S. Houck, MD, FAAP Kristina W. Rosbe, MD, FAAP 
Joelle N. Simpson, MD, FAAP Joelle N. Simpson, MD, FAAP 

In examining the entire policy in light of the Israel-Hamas War, we determined it was missing important elements to emphasize the protection of children during war and the Academy’s opposition to religious persecution of any kind. We voted unanimously to add the following to the policy statement:

  • Children should never be harmed because of the religious, cultural, and other beliefs and values of the child and/or their family;
  • Harm to children should never be used as a tool or tactic of war or conflict; and
  • Children should be protected from the direct effects of armed conflicts and their food, housing, health, and other basic needs safeguarded.

With the magnitude of the suffering and so many children hurting at home and abroad, this is a distressing time to work in pediatrics. The pain of our members is palpable; both the urgent desire to do all we can to protect children in Israel and Gaza and the fear and concern we are experiencing as acts of hate proliferate in the United States. Yet our common mission and the outpouring of support and solidarity among our member pediatricians reminds us there is light in the darkness.

We use our platform as the world’s largest pediatric organization to speak out against violence, hate, antisemitism, Islamophobia, and enmity toward Jews, Muslims, Israelis, and Palestinians and to speak up on behalf of all children suffering in armed conflict. We stand with everyone in the pediatric profession in these times of tragedy as we continue our work of healing, protecting, and caring for the world’s children.

Source:https://publications.aap.org/pediatrics/article/153/3/e2023065582/196273/Protecting-Children-and-Condemning-Hate-During-a?autologincheck=redirected

Jane E. Brumbaugh, MD1Carla M. Bann, PhD2Edward F. Bell, MD3; et alColm P. Travers, MD4Betty R. Vohr, MD5Elisabeth C. McGowan, MD5Heidi M. Harmon, MD, MS3Waldemar A. Carlo, MD4Susan R. Hintz, MD, MS Epi6Andrea F. Duncan, MD, MS7; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network- 03/11/24

Key Points

Question  How are maternal social determinants of health associated with discussions and decisions surrounding redirection of care for infants born extremely preterm?

Findings  In this cohort study of 15 629 infants born extremely preterm, Black mother-infant dyads were significantly less likely to have redirection of care discussions than White mother-infant dyads, and Hispanic mother-infant dyads were significantly less likely to have redirection of care discussions than non-Hispanic mother-infant dyads.

Meaning  Research is needed to understand the possible reasons and solutions for differences in redirection of care discussions for critically ill infants by race and ethnicity.

Abstract

Importance  Redirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding.

Objective  To examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm.

Design, Setting, and Participants  This is a retrospective analysis of a prospective cohort of infants born at less than 29 weeks’ gestation between April 2011 and December 2020 at 19 National Institute of Child Health and Human Development Neonatal Research Network centers in the US. Follow-up occurred between January 2013 and October 2023. Included infants received active treatment at birth and had mothers who identified as Black or White. Race was limited to Black and White based on service disparities between these groups and limited sample size for other races. Maternal social determinant of health exposures were education level (high school nongraduate or graduate), insurance type (public/none or private), race (Black or White), and ethnicity (Hispanic or non-Hispanic).

Main Outcomes and Measures  The primary outcome was documented discussion about redirection of infant care. Secondary outcomes included subsequent redirection of care occurrence and, for those born at less than 27 weeks’ gestation, death and neurodevelopmental impairment at 22 to 26 months’ corrected age.

Results  Of the 15 629 infants (mean [SD] gestational age, 26 [2] weeks; 7961 [51%] male) from 13 643 mothers, 2324 (15%) had documented redirection of care discussions. In unadjusted comparisons, there was no significant difference in the percentage of infants with redirection of care discussions by race (Black, 1004/6793 [15%]; White, 1320/8836 [15%]) or ethnicity (Hispanic, 291/2105 [14%]; non-Hispanic, 2020/13 408 [15%]). However, after controlling for maternal and neonatal factors, infants whose mothers identified as Black or as Hispanic were less likely to have documented redirection of care discussions than infants whose mothers identified as White (Black vs White adjusted odds ratio [aOR], 0.84; 95% CI, 0.75-0.96) or as non-Hispanic (Hispanic vs non-Hispanic aOR, 0.72; 95% CI, 0.60-0.87). Redirection of care discussion occurrence did not differ by maternal education level or insurance type.

Conclusions and Relevance  For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants. It is important to explore the possible reasons underlying these differences.

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By Alisha Haridasani Gupta     Published Feb. 8, 2024Updated Feb. 14, 2024

Premature births, after years of steady decline, rose sharply in the U.S. between 2014 and 2022, according to recently published data from the Centers for Disease Control and Prevention. Experts said the shift might be partly the result of a growing prevalence of health complications among mothers.

“I’m not too surprised that these are the changes we’re seeing,” said Dr. Nahida Chakhtoura, chief of the pregnancy and perinatology department at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. “We know that maternal complications have been on the rise for the same time period.”

Births before 37 weeks of gestation increased by 12 percent, though there were fluctuations during the pandemic years, with slight decreases in 2020 and 2022. Deliveries at or after week 40 declined during the study period. Increases in premature birth rates were similar across races and age groups, but the largest jump was among mothers aged 30 and above.

It is a reversal of promising trends before 2014, when premature births had been steadily declining and full-term deliveries were on the rise. Though the latest report doesn’t delve into the causes, it is “concerning,” Dr. Chakhtoura said, particularly because premature babies generally face increased risks for health complications.

One of the reasons for the rise might be that women are having babies later in life, said Dr. Vanessa Torbenson, an obstetrician and gynecologist at the Mayo Clinic in Minnesota. Older maternal age, she added, presents an increased risk of health complications that may require an early induction. Overall rates of high blood pressure in particular have been on the rise in recent years. According to the C.D.C., almost 16 percent of women who delivered in hospitals had some kind of hypertensive disorder in 2019, and those issues were most common among women 35 and older. Rates of gestational diabetes have also grown, especially among older mothers.

Generally, “the further along you go in pregnancy, the higher the chance of survival” for the baby, said Dr. Dawnette Lewis, director of Northwell Health’s Center for Maternal Health and a maternal fetal medicine specialist. Studies have found that a baby delivered at 23 weeks, for example, has a roughly 55 percent chance of survival, with chances increasing each week after that, Dr. Lewis said. The American College of Obstetricians and Gynecologists recommends inducing labor at or before 37 weeks when medically necessary.

The latest C.D.C. data is “skimming the surface,” Dr. Lewis said. One of the many unanswered questions is why there were few differences in premature birthrates across races, given that research consistently shows that rates of pre-eclampsia and hypertension are disproportionately higher among Black women. Understanding who was induced and why might shed some light on that question, she added.

Despite the concerns around later maternal age, many of the health risks can be managed, Dr. Lewis said. “Anyone who’s considering a pregnancy, regardless of their age, should see a health care practitioner so that they can be evaluated and, in case that they do have any medical conditions, that they can get those under control before attempting a pregnancy.”

Source:https://www.nytimes.com/2024/02/08/well/family/premature-births-maternal-age.html

By  Cathy Cassata  Published on May 03, 2022   Medically reviewed by Steven Gans, MD

There’s no doubt early in the pandemic, healthcare workers were pushed to their limits. Crowded hospitals required doctors and nurses to work long hours caring for patients suffering from an unprecedented and unpredictable COVID-19 virus. The pressure and demands of the situation put a physical and mental strain on those seeing patients.

According to a 2021 survey published in the Journal of General Internal Medicine of more than 500 healthcare workers and first responders, a substantial majority of respondents reported experiencing clinically significant psychiatric symptoms, including:1

  • anxiety (75%)
  • depression (74%)
  • post-traumatic stress disorder (38%)
  • recent thoughts of suicide or self-harm (15%) 

To support healthcare workers’ mental health during the pandemic, many people were inspired to establish organizations. Below are three that sprung up over the past few years and continue to make a difference in the lives of doctors, nurses, and other frontline workers bearing the brunt of caring for the public during the ebb and flow of the pandemic. 

Dr. Lorna Breen Heroes Foundation

Lorna Breen, MD, was a seasoned emergency room physician at New York Presbyterian Hospital in Manhattan when the COVID-19 crisis hit. In a period of three weeks, Breen treated COVID patients, contracted COVID herself, and returned to an overwhelming number of critically sick patients. At the peak of COVID, she worked 15 to 18-hour shifts with limited PPE, insufficient supplies, and not enough equipment to care for patients; some of who were dying in the hallways. 

When Breen called her sister Jennifer to share that she was overwhelmed and exhausted to the point that she couldn’t get out of her chair, Jennifer and her husband Corey Feist went to Manhattan and took Breen to a mental health hospital, where she stayed for 10 days, receiving the first mental health treatment of her lifetime. A few days into her stay, Breen called her sister to express concern that her career as a physician was ruined because she was receiving mental health treatment. 

When Breen returned to work on April 1, 2020, her fear continued, as she worried her colleagues would notice she couldn’t keep up. Breen died by suicide on April 26, 2020. 

What Lorna was feeling is felt by doctors and nurses across the country today. The average person can ask for help, but not healthcare workers; in [several] states, they can lose their license for seeking [treatment for mental health]. That’s unacceptable.

According to a 2022 Medscape report, when physicians were asked why they have not sought help for burnout or depression, their top reasons were:2

  • I can deal with this without help from a professional (49%)
  • Don’t want to risk disclosure to medical board (43%)
  • Concerned about it being on my insurance record (32%)
  • Concerned about my colleagues finding out (22%) 

After Breen’s death, the Feists went on the “Today” show to spread awareness about the mental health strain healthcare workers faced during the pandemic. After the show, they received an outpouring of support from the healthcare workforce, thanking them for sharing Breen’s story. One sentiment they heard often was the need for change when it comes to questions on licensure applications and hospital credentialing applications that ask about a person’s prior mental health
history. 

The responses moved them to establish the Dr. Lorna Breen Heroes Foundation, which aims to reduce burnout of healthcare professionals and safeguard their well-being and job satisfaction by: 

  1. Advising the health care industry to implement well-being initiatives
  2. Building awareness of these issues to reduce the stigma; and
  3. Funding research and programs that will reduce health care professional burnout and improve provider well-being. 

“While Lorna is our beacon and inspiration, we started the organization because we heard from the
healthcare force (hundreds) after she died that something needed to change,” said Feist. “Now, what we have is a huge subsection of our healthcare workforce who has experienced repetitive trauma for two years. For some of them, this has been 9/11 every day for two years, and because of their fear of repercussions to continue working, they are going to suffer in silence.”

On March 18, 2022, the foundation’s work helped pass the Dr. Lorna Breen Health Care Provider Protection Act, which establishes grants and requires other activities to improve mental and behavioral health among healthcare providers.

The more we talk about mental health, the more we normalize it and give others permission to speak. Lorna was the toughest person I knew in the world and she was a seasoned physician in New York. She worked through Ebola in New York and other crises. This wasn’t about being tough.

He added that many solutions to the problem are complex, but that small actions can help. 

“[Like] someone being vulnerable and recognizing the need for self-care, and peer support (recognizing a colleague who needs support) that don’t cost money. We need to make it clear that you care for yourself and colleagues just as you would your patients,” he said. 

The foundation’s next mission is to raise awareness among medical licensing boards, nursing boards, and hospital systems about the impact of including mental health questions on applications. They hope licensing boards will change questions to reflect current mental health impairment and exclude past ones. 

“We are asking all hospitals in this country to simply publish to their workforce that they can
get mental health support without repercussions, which can be a life-saving opportunity for all of the healthcare community,” said Feist. 

The Emotional PPE Project

In March 2020, Ariel Brown, PhD, neuroscientist, was talking to her neighbor and friend Daniel Saddawi-Konefka, MD, critical care physician and anesthesiologist at Massachusetts General Hospital, when she was moved to help with the COVID crisis. 

“Dr. Dan…is responsible for directing [about] 100 anesthesiology residents and was struggling with the best way to support them during the onslaught of COVID,” said Brown. “I wanted to help and so I put out a call on social media to see if any of the therapists in my network wanted to volunteer some of their time to help these folks who were fighting on the frontline of the pandemic.” 

The therapists raised their hands in droves to offer free therapy to healthcare workers. When
Brown passed on their contact information to the residents, many reached out to therapists for help
at a no-cost, no-insurance, streamlined option for healthcare workers to seek mental health care. 

Because of the goodwill of the mental health provider community and because of the great need in the healthcare worker community, things grew very quickly. I put together a team, which I led to set up to be able to scale. Two years later, we are a national nonprofit organization that has over 700 volunteer therapists and has served over 2,000 healthcare workers across the nation.

Over the course of the pandemic, she has learned that healthcare workers face significant barriers to getting support for their mental health. The Emotional PPE Project is designed to streamline mental health service by lifting barriers, including: 

  • Financial: Facilitating services at no cost and with no insurance.
  • Access: A streamlined process to connect with therapists
  • Stigma: Remaining 100 percent confidential and unaffiliated with any organization that employs healthcare workers

“Overall, we seek to take away every barrier that we can so that the folks experiencing unprecedented stress and trauma can have a streamlined connection with someone that can help,” said Brown. 

The Emotional PPE Project is also involved in research and advocacy work similar to that of the Dr. Lorna Breen Heroes Foundation, including working to reform licensing practices to protect the mental health of physicians

  • Healthcare workers, find a therapist in The Emotional PPE Project directory
  • Licensed therapists, sign up to volunteer your time
  • Anyone, support the organization by making a tax-deductible donation

Therapy Aid Coalition

As the world started to shut down due to COVID-19 in March of 2020, Jennifer Silacci, LCSW, psychotherapist, felt grateful she could work from home and shelter in place although anxious about the virus. 

I wondered, if those of us at home felt so overwhelmed, how were those on the frontlines coping? How were they processing the anxiety around constant exposure to a potentially deadly virus? And what could I do to help them?

She decided to offer free and low-cost therapy sessions to healthcare workers and asked her colleagues if they would join her. Word spread, and before she knew it, thousands of volunteer therapists from across the country joined Silacci. 

“Quite honestly, I had no idea how to manage this new, growing network of volunteers, or the thousands of emails pouring into my inbox, so I asked everyone I could think of for help. Childhood friends and even some kids I babysat (now adults) stepped up. A friend connected us with her law firm, and soon we were a fully formed 501(c)(3) public charity,” she said. 

Within months of putting out the initial call, Silacci established the Therapy Aid Coalition,
now made up of over 3,000 licensed therapists, who offered free and low-cost online therapy to essential workers in the United States. 

Because confidentiality is a concern for many healthcare professionals, and many do not want to utilize employee assistance programs (EAPs), health insurance, or support and resources from their hospitals and clinics, Silacci said her service offers them the opportunity to connect with a therapist anonymously. Over the past two years, the program has served thousands of essential workers throughout the country. 

“I think the pandemic and the amazing work of so many nonprofits…have shed light on the need for mental health support, destigmatization, and advocacy for mental wellness within the healthcare professions,” she said. 

Because the Therapy Aid Coalition continues to receive hundreds of requests monthly, Silacci said, normalizing the fact that healthcare professionals “while perhaps heroic in their actions—are still painfully and beautifully human” needs to become more understood. 

“We all have a breaking point. It is my belief that individuals that have been on the frontlines may not even fully realize the impact of their experience just yet. Some are still running on adrenaline. Some are still numb and just trying to make it through another shift,” she said. “I believe we will see a greater need for mental health support among frontline workers in the next year or two, as they finally come up for air, and have the time and space to unthaw, and digest all that has unfolded.”

Those affected also include mental health professionals, Silacci added, and taking care of therapists is also one of her objectives. While the Therapy Aid Coalition currently offers free and low-cost services, it plans to pay therapists via stipends as it accumulates grants. 

Those affected also include mental health professionals, Silacci added, and taking care of therapists is also one of her objectives. While the Therapy Aid Coalition currently offers free and low-cost services, it plans to pay therapists via stipends as it accumulates grants. 

“We want services to be free to essential workers, but we also believe it is absolutely not fair to ask therapists to continue to offer pro-bono sessions two years into the pandemic,” she said. “[Therapists] are essential workers, and also qualify for free short-term sessions with us!” 

Source:https://www.verywellmind.com/3-organizations-providing-a-free-lifeline-for-healthcare-workers-5222435

Bernard Marr/Contributor

The roles of professionals in society are shifting thanks to the development of truly useful and powerful generative artificial intelligence. Every industry will be impacted, but we have already seen that healthcare, with its heavy use of data and technology, will be disrupted more than most.

Generative AI has the potential to revolutionize the way we treat disease, develop new medicines and personalize treatments to fit individual patients. It will also fundamentally change both the day-to-day working lives of doctors, nurses and other clinical health professionals and even the way they are seen by society. As a result, they will find they are more reliant than ever on the human qualities like compassion, communication and the instinct that many who fill these jobs have for providing care.

So here’s my overview of some of the most dramatic and meaningful transformations we can expect to see in the near future, as well as some of the practical and ethical challenges that will have to be overcome.

AI As A Diagnostic Assistant

Generative AI helps with diagnosing conditions by interpreting data and providing clear, in-depth insights into what is known about the patient. It can be used to examine hundreds of X-ray, MRI and CT scans and quickly give a statistical summary of its findings. This will lead to more accurate, data-driven diagnosis of many common or not-so-common conditions.

This communication can then be fine-tuned depending on the role of the healthcare professional who is using it, whether a doctor, nurse, consultant or specialist. Communicating only the insights relevant to them means there will be less noise between the professional and the specific information they need.

The World Economic Forum has also predicted that generative AI will lead to improved outcomes as it becomes able to efficiently extract data from the many disparate and siloed sources that have traditionally existed across healthcare.

It will also increasingly be used to create synthetic data, which is artificially generated to resemble real-world information. This is particularly useful for situations with limited training data, such as with rare conditions and diseases. It can also reduce the security and data protection measures that healthcare professionals must take when working with real patients’ personal data. Synthetic data can also be used to simulate healthcare scenarios like pandemics or the emergence of antibiotic-resistant organisms that could cause a global healthcare crisis.

Automating Routine And Administrative Tasks

It will become increasingly common for medical professionals to use generative AI to automate many of the repetitive and routine administrative tasks they carry out every day. This will free up their time to focus on directly providing care, as well as continuing their training and learning.

From managing and updating patient records to scheduling appointments, healthcare professionals engage in many time-consuming tasks that can be streamlined or even entirely taken over by AI. According to one study, doctors spend half of their working day on tasks involving maintaining electronic health records.

Generative AI can drive more efficient EHR management by intelligently organizing doctors’ notes, test results and medical imaging. It can then provide quick summaries of individual patients, highlighting aspects of their health that are a concern and generating reports for other professionals. Automating many of these tasks is likely to also have the effect of reducing errors that could impact quality of care and patient outcomes.

Generative AI In Drug Discovery

The same capabilities that allow generative AI to create text and writing can also be used to develop new candidate medicines and vaccines for clinical trials. This means that researchers can speed up the lengthy process of shortlisting potential candidates.

Last year, Oxford-based biotech firm Etcembly produced the first immunotherapy drug created with the help of generative AI.

The process promises to speed the transition of potentially lifesaving new treatments from lab to patient, ultimately leading to better patient outcomes. This indicates that just like doctors and nurses, healthcare researchers and scientists will also have powerful generative AI tools to enable them to work more quickly and efficiently.

Ethical Consideration: The Human Touch

Clearly, however, integrating generative AI into healthcare in this way creates a long list of ethical challenges that can’t be ignored. This is because most use cases revolve around the use of personal data. This means that safeguarding against data leaks, losses and breaches is of paramount importance.

It’s also essential that AI algorithms make decisions that are transparent and explainable—this will be crucial for building the public trust essential for these systems’ potential to be realized.

The damage that can be caused by bias in data is also more pronounced than in nearly any other field. Its been shown that generative AI models can amplify bias present in training data. We know that women and people from minority ethnic backgrounds are more frequently diagnosed due to their underrepresentation in medical studies, and this issue could scale as AI becomes more widely used.

Data, models and outcomes must all be continually monitored and updated in order to mitigate these biases, which could otherwise further perpetuate inequalities.

Like many other professionals, those in healthcare will find themselves required to learn the skillset of the AI ethicist. This means developing the capability to evaluate potential use cases in order to determine whether applying AI is likely to cause damage, risk or danger, and ensuring adequate guardrails are in place at all times.

The Future Of Doctors And Healthcare Workers

Doctors, nurses and other clinical healthcare professionals are probably more insulated than many from the risks of being replaced by AI. Their jobs require them to function at an advanced level across many human skills that machines will not replicate any time soon. Intuition and experience all play a role, and that isn’t going to change.

AI does, however, offer the opportunity for these professionals to redefine the way they work and even their role in wider society. Shifting to models of work that allow them to spend more time with patients will also mean more time to continue their ongoing education and develop their own medical expertise.

This is likely to lead to new specializations as the need grows for clinical staff focused on AI-enhanced diagnoses, data-driven medicine and ethical AI, as well as helping patients navigate the range of new AI-assisted treatment options that will become available.

With AI handling routine analysis, record keeping and interpretation of scans, imaging and other data, doctors and nurses will spend more time getting to the bottom of more complex and nuanced patient issues.

Ultimately, the essence of providing healthcare will continue to revolve around empathy, compassion and the human touch. Generative AI creates the opportunity to augment these qualities in ways that will make professionals in this field even more essential to society. Those who are able to embrace this paradigm shift will find they are able to use their skills and training to cure sickness and improve patient lives in ever more rewarding ways.

Source:https://www.forbes.com/sites/bernardmarr/2024/03/13/how-generative-ai-will-change-the-jobs-of-doctors-and-healthcare-professionals/?sh=58f34eef974a

Dec 15, 2023

Title: Neonatal Neurocritical Care: Past, Present and Future Speaker: Fernando Gonzalez, MD Co-Director, UCSF Neuro-Intensive Care Nursery Director, Residency Molecular Medicine Track Co-Leader, SPR Pediatrician-Scientist Development Professor of Pediatrics, University of California, San Francisco Presented by leading researchers from UCSF Pediatrics, from other departments at UCSF and outside institutions, Frontiers in Child Health Research is an interactive series meant to facilitate scientific exchange and stimulate new ideas.

Front. Pediatr., 20 March 2024 Meline M’Rini* Loïc De Doncker Emilie Huet Céline Rochez Dorottya Kele Neonatal Department, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium

Objective: Immediate skin-to-skin contact (SSC) is already standard care for healthy term newborns, but its use for term or preterm newborns requiring admission to neonatal intensive care unit (NICU) with or without respiratory support is challenging. This study aimed to assess the safety and feasibility of SSC during the transfer of newborn infants, using a new purpose-built mobile shuttle care-station, called “Tandem”.

Material and methods: A monocentric prospective observational study was conducted at the tertiary referral center of the Université libre de Bruxelles in Brussels, Belgium after ethical approval by Hopital Erasme’s Ethics Committee (ClinicalTrials.gov ID: NCT06198478). Infants born with a birth weight above 1,500 g were included. Following initial stabilization, infants were placed in SSC with one of their parents and transferred to the NICU using the Tandem.

Results: Out of 65 infants initially included, 64 (98.5%) were successfully transported via SSC using the Tandem. One transfer was not successful due to last minute parental consent withdrawal. The median (range) duration of continuous skin-to-skin contact after birth was 120 min (10–360). SSC transfers were associated with gradually decreasing heart rate (HR) values, stable oxygen saturation levels (SpO2), and no increase in median fraction of inspired oxygen (FiO2). Heatloss was predominantly observed during initial setup of SSC. There was no significant difference in the occurrence of tachycardia, desaturation or hypothermia between preterm and term neonates. No equipment failures compromising the transfer were recorded.

Conclusion: Skin-to-skin transfer of infants with a birthweight of equal or above 1,500 g using the Tandem shuttle is feasible and associated with stable physiological parameters. This method facilitates early bonding and satisfies parents.

Clinical Trial Registration: ClinicalTrials.gov (NCT06198478).https://www.frontiersin.org/articles/10.3389/fped.2024.1379763/full

© Pexels/Hussein Altameemi

POSTED ON 18 MARCH 2024

Fasting during Ramadan is a valuable experience for Muslims all over the world. Even though it is not compulsory for pregnant women to participate in fasting, many choose to do so. However, the question arises as to whether abstaining from food and water throughout the day could have an impact on the well-being of the unborn child. To answer this question, fourteen studies from seven countries were reviewed, involving more than 2,800 expectant mothers. The results show that Ramadan fasting influences neonatal weight and other parameters of foetal health. However, most of the effects, including the risk for preterm birth, were found to be non-significant. This indicates that fasting during Ramadan is not harmful for the baby overall, and that the decision to participate in Ramadan fasting should therefore be left to the mother.

Ramadan is a month focusing on prayer, community, and reflection for all Muslims around the world. Central to this is the Ramadan fasting (RF), which is a form of intermittent fasting in which no food or water is consumed from sunrise to sunset. The abstinence from water during the fasting period makes RF more intense compared to other forms of intermittent fasting. While RF is obligatory for healthy Muslims, breastfeeding mothers and pregnant women are exempt from fasting and can decide for themselves whether they feel fit enough to participate or not. The Muslim population makes about ¼ of the world’s population, and accordingly many pregnant women face the question if they can participate in RF without harming the foetus. This concern arises from the fact that an adequate supply of nutrients is important to meet the needs of both mother and foetus, and neonatal weight is a direct indicator of the foetus’ wellbeing.

A total of 14 studies from seven countries examined the topic and the results were analysed in an overall review. The 2,889 participating mothers lived in Turkey, Iran, Lebanon, Pakistan, the UK, the Netherlands, and Saudi Arabia.

Ramadan fasting has a significant influence on birth weight

Several different measurements indicate foetal health and can be used to analyse the effects of RF on the unborn child. One indicator is neonatal weight. The findings varied in the different studies examined, but the overall effect showed a significantly lower birth weight in fasting mothers. The amniotic fluid index (AFI), a standardised indicator of foetal well-being, also showed a significant effect. The combination of dehydration during RF, longer daytimes, and temperatures above 36°C led to a reduction of the AFI in fasting mothers. Further significant correlations were found between RF and foetal femur length and RF and lower biparietal diameter assessing foetal size in fasting mothers.

The results on gestational age at delivery were contradictory but insignificant altogether. When analysing the impact on preterm birth (PTB), only one study showed a slightly increased incidence of PTB when the mother was fasting. The increase was not statistically significant and all other studies that examined PTB reported no association, leading to the redeeming conclusion that RF has no effect on the likelihood of PTB.

Various other measures showed no significant impact of RF on foetal health, including foetal body weight, length, head circumference, and abdominal circumference of the infant. The biophysical profile also did not change for fasting mothers, nor did the foetal movements, breathing movements, tone, amniotic fluid volume or the Apgar Score.

 Fasting for expectant mothers is not harmful to neonatal health overall

Although RF affects foetal growth, it is not associated with poorer neonatal health. The negative associations between fasting and foetal well-being were stronger when the mother fasted during the second or third trimester of her pregnancy. Furthermore, all associations between RF and reduced health were predominantly found in lower quality studies, which supports the evidence that fasting is safe for pregnant women. Thereafter, current scientific evidence shows that fasting during Ramadan is not harmful to the foetus and can be practiced by pregnant women. The decision to fast should therefore be made by the pregnant woman herself, in consultation with her doctor, who will take her individual health status into account. The wellbeing of the foetus depends more on the type of food the mother eats during the fast-breaking period of Ramadan.

Source:https://www.efcni.org/news/does-ramadan-fasting-influence-risk-for-ptb/

In adulthood, these children “are more vulnerable to stress-related health outcomes, like diabetes, and mental health issues, addiction and obesity,” one expert says

By Katie C. Reilly – March 20, 2022

Are infants too young to experience and remember painful emotions or traumatic events? A growing body of research suggests no, and researchers believe that if left untreated, trauma experienced in infancy can sometimes result in lifelong health consequences.

Beyond such obvious triggers as war and terrorism, exposure to domestic violence, natural disasters such as a house fire, physical abuse and community violence are examples of experienced events that can be traumatic for infants, experts say.

Experts in infant mental health, which goes from the prenatal period up to age 3, say that babies and very young children who experience such things have higher incidences of anxiety disorders or depression that can persist into adulthood if left untreated.

“It is easy to assume that babies don’t remember trauma because they express their experiences differently,” Tessa Chesher, an clinical assistant professor of psychiatry and behavioral sciences at Oklahoma State University who specializes in infant and early childhood mental health, says in an email. “At [8 to 12] weeks of age, babies have stored enough memories that [the babies] start to anticipate their caregiver’s behavior based on previous behaviors. They start to respond based on the experiences they have had.”

‘Vulnerable to stress-related illnesses’

Evelyn Wotherspoon, a social worker specializing in infant mental health, said that as they reach adulthood “infants and very young children who have had early exposure to trauma and chronic stress … are more vulnerable to stress-related health outcomes, like diabetes, and mental health issues, addiction and obesity. These children are much more vulnerable to all of these stress-related illnesses, and their brain may not develop the way it should.”

Although infants and young children are just developing, experts in infant mental health say they can experience a wide range of feelings that includes negative emotions, sadness or anxiety. A report by the American Academy of Pediatrics found that, by age 16, more than 2 in 3 children had said they had experienced a traumatic event.

According to a Report of the Task Force of the World Association for Infant Mental Health, rates of mental health disorders in infancy (which generally includes birth to age 3) are comparable to that of older children and adolescents. And one small study of 1-year-olds found that 44 percent of those who had witnessed severe violence against their mother by an intimate partner showed symptoms of trauma afterward, such as increased arousal, increased aggression or an interference with normal infant development. Infants and young children (under age 4) can develop post-traumatic stress disorders after events, according to a study in the Journal of the American Academy of Child & Adolescent Psychiatry.

Kathleen Mulrooney, a counselor who is also program director for the Infant and Early Childhood Mental Health Program for Zero to Three, a nonprofit organization dedicated to improving the lives of babies and toddlers, said it’s important to note that not every infant who experiences a trauma will be traumatized. As with adults, it depends on the infant, “because what is traumatic for one person is not for someone else,” Mulrooney says.

“To be traumatized, one must be severely frightened,” says Charles Zeanah, a psychiatrist and the executive director of the Institute of Infant and Early Childhood Mental Health at Tulane University School of Medicine. Infants under 12 months may not always be aware that a particular situation is actually dangerous, which can potentially protect them from trauma, he says.

Caregivers can be key

In this context, caregivers can be key in buffering small children from the effects of trauma by how they react. “The ability of parents or key caregivers to provide protection, to have a co-regulating role when it comes to the stress response is critical,” Mulrooney said in an email.

If a child has a significant trauma before age 2 but following the trauma “the baby has the powerful protective factors of consistent safety, love and security; there is a decreased likelihood of having mental health problems,” Chesher says in an email. “That doesn’t mean the baby didn’t suffer or that their body doesn’t remember that trauma, it means that there were protective factors around to mitigate the effects of the trauma.”

Regina Sullivan, a developmental behavioral neuroscientist and professor of psychiatry at NYU Grossman School of Medicine, says that while a primary caregiver cannot “buffer a small child from trauma in the environment — it’s called social buffering because the child’s fear response and stress hormone response is reduced — more recently, we have shown that the caregiver is actually blocking neural activity in the amygdala, the brain area responsible for fear.”

Trauma in infancy can physically alter the developing architecture of the brain, according to the American Academy of Pediatrics. Toxic stress — strong, frequent or prolonged adversity — has been shown in various studies to harm learning capabilities, memory and executive functioning.

“Many brain areas in infants and small children are physically altered and the ability of those brain areas to talk to one another is also modified by trauma,” said Sullivan.

Trauma can be difficult to recognize

Yet trauma in infancy can be difficult to recognize given that infants are not yet verbal and rely on their caregivers to respond to their needs, which means a caregiver would have to be attuned to symptoms and seek help.

“A baby can’t just go up to you and say, ‘Hey this happened yesterday, I’m scared,’ Chesher says. “And so really learning the language of the babies is important and then educating people on how to read that language. And so, if we don’t know the red flags, then we are not identifying trauma and we can have longer term effects on the brain.”

Experts say some red flags of trauma for babies younger than 12 months are: feeding or sleep problems and not being able to be comforted by their caregiver. A toddler (between ages 1 and 3) can express themselves more verbally and physically than a baby. Some red flags of trauma in that age group can involve repeating traumatic events in their play or becoming aggressive, Chesher says.

“One of the issues is how that child expresses trauma might be through disruptive sleep or being a bit fussier,” Sullivan says, “things that occur in normal children for a host of many reasons, which makes it difficult to identify which child is going to respond to the trauma in a way that will be long lasting and damaging.”

If a parent or other caregiver is concerned, based on a child’s behavior and experiences, they should “ask to be referred to an infant and early childhood mental health specialist,” Chesher says.

Experts will look at a variety of factors, with the most critical being the relationship between the baby and their primary caregiver. In addition to observing that interaction, mental health experts may also look at “pregnancy history, birth history, medical history, development history, safety screeners, perinatal depression screener [for both parents], how the infant eats and how the infant sleeps,” Chesher says.

Different interventions

Depending on a child’s age, different interventions are available, including child-parent psychotherapy.

“It is essential that the parents or … their caregivers … are involved in a major way in the treatment because it is really through relationships with caregiving adults that infants thrive and do well,” Zeanah says.

To recover, an infant needs a caregiver in their life who can accurately read their cues and respond in a nurturing, patient manner, Wotherspoon says. “One of the most powerful therapeutic tools that we have is the relationship a child has with a nurturing caregiver and they only need one and it doesn’t have to be perfect. … An infant who gets that fairly early on can recover beautifully from trauma,” Wotherspoon says.

Increasing awareness about infant and early childhood mental health among both parents and medical practitioners is critical, experts say. But it’s also important for parents to understand what trauma is — and is not. A child “getting distressed is different than being traumatized,” Zeanah says.

“It’s important to distinguish from everyday events that might scare the child and are important in the child learning how to regulate their emotions and physiology versus trauma from horrible events such as a tornado or a parent who is repeatedly traumatizing the child unnecessarily through verbal or physical assaults,” Sullivan says.

“We want parents to enjoy this time in their life and not be fearful that they are going to traumatize their child by making them eat vegetables or get vaccinated,” she adds. “Those are normal experiences in life that the child needs to experience as part of [the] current world.”

Source:https://www.washingtonpost.com/health/2022/03/20/infant-trauma-stress-mental-health/

August 28, 2023 

DeKalb, IL – Technology developed by NIU Electrical Engineering Professor Lichuan Liu and designed to prevent hearing loss in the most vulnerable of newborns could soon find its way into hospital neonatal intensive care units, or NICUs

NICUs can be noisy. The care units are louder than most home or office environments and have sound levels that often exceed the maximum levels recommended by the American Academy of Pediatrics. Hearing impairment is diagnosed in 2% to 10% of preterm infants, versus 0.1% of the general pediatric population.

Aiming to put her electrical engineering expertise to use to benefit others, Professor Liu invented an apparatus, system and method to significantly reduce harmful noises while maintaining communication between the newborns and their parents or caregivers.

In 2014, NIU began a partnership with Invictus Medical, a Texas-based medical device company, to commercialize the technology. NIU licensed its related patents to Invictus, while the company has continued to refine the incubator-based active noise control (ANC) device, now known as the Neoasis®.

In July, Invictus announced that the company had received a U.S. Food and Drug Administration (FDA) clearance-for-use declaration for the device.

The control unit front face and home screen on the Invictus Medical Neoasis® incubator-based active noise control (ANC) device. Photo courtesy of Invictus Medical

“With this clearance for use, Invictus has made a huge step towards deploying the Neoasis® ANC device in neonatal intensive care units,” said George Hutchinson, Ph.D., Invictus Medical’s chief executive officer. “It is well documented that a quieter environment has a positive impact, including improved sleep hygiene and weight gain in infants where both are critical for development.

“The NIU team has been a pleasure to work with,” Dr. Hutchinson added. “The Office of Innovation has been a great teammate throughout the entire process.”

The Neoasis® ANC device utilizes a proprietary, innovative active noise control (ANC) system to attenuate noise with canceling sound wave technology. At the same time, it allows a parent’s voice to be directed to the infant, which can also be beneficial for cognitive development. Invictus is currently exploring relationships with strategic partners to get the Neoasis® ANC device into NICUs—now possible with the FDA clearance.

While universities and researchers can realize typically modest financial benefits from technology transfer, the primary intent is to broaden the potential impact of research through the creation of innovative products and services for public benefit, said Karinne Bredberg, director of NIU’s Office of Innovation. The office has guided Liu through the partnership, patent processes and licensing.

“This is a big deal for Dr. Liu and for NIU,” Bredberg said.

“NIU research has produced other patents and licenses, but we believe this is the first NIU-licensed technology to be incorporated into a device that has an FDA clearance-for-use declaration,” Bredberg said.

Mark Hankins, NIU’s assistant director for technology transfer, credited the ingenuity of Professor Liu, as well as a great working relationship with Invictus Medical.

“Dr. Hutchinson in particular was very diligent in trying to move this technology forward and persevered through a number of roadblocks,” Hankins said.

Professor Liu said it was about a decade ago when President Lisa C. Freeman, then serving as NIU’s vice president for Research and Innovation Partnerships, brought Liu together with Invictus Medical. While Liu developed an initial prototype, the company refined the device, making the it more commercially accommodating for NICU environments.

“It’s a little different working with industry, as opposed to academia,” Professor Liu said. “It was a learning curve for me, but Invictus Medial has been very professional and easy to work with.”

NIU Professor Lichuan Liu is now conducting research on an artificial-intelligence algorithm that can detect the meaning behind babies’ cries.

Over the years, the commercialization process received funding support from the NIU Foundation and a National Science Foundation’s (NSF) Small Business Technology Transfer grant. Liu, herself a mother of two, is excited at the prospect of hospitals using the Neoasis® ANC device.

“I think this is fantastic,” Liu said. “I kept working on this project and thought someday there would be payback.

“I have a passion or motivation to work to benefit others,” Liu added. “As a mom, I think this device is really something important. As an engineer, I’m happy to make an impact.”

Liu said her current research includes other ways to use noise cancellation. She is working on a pillow that would cancel out the racket of snoring, and she and NIU Nursing Professor Jie Chen are working on a system for adult intensive care units.

Additionally, Liu is working on an artificial intelligence algorithm that can listen to infant cries and determine whether they are normal or abnormal to potentially indicate a severe or chronic illness. Invictus might incorporate the technology into future versions of its Neoasis® ANC device.

Source:https://newsroom.niu.edu/niu-researchers-innovation-helps-lead-to-device-to-prevent-hearing-loss-in-nicu-infants/

Carla Madeleine Cuya1* Carlos Barriga2 Maria del Carmen Graf3 Mirta Cardeña1 María del Pilar Borja1 Richard Condori4 Moises Azocar5 Carlos Cuya4

Introduction: In a significant number of NICUs, mothers are unable to provide enough maternal milk to feed their premature babies, so healthcare workers rely on human milk banks. Unfortunately, this service is not available in many countries, such as Peru, where premature infants receive formula. The aim of this study was to determine the effectiveness of multisensory stimulation on mother’s own milk production.

Methods: Participants in this study were postpartum mothers of preterm infants 27–37 weeks gestational age. The participants were assigned to three groups: (1) audiovisual stimulation (SAV) (n = 17), (2) audiovisual and olfactory stimulation (SAVO) (n = 17), and (3) control (n = 16). A questionnaire was used to collect demographic and obstetric data, including a record of mother’s own milk volume.

Results: There was no significant difference between the SAV, SAVO and control groups regarding age, marital status, education level, occupation, number of children, mode of delivery, Apgar and birth weight. On the other hand, a significant difference was observed between the SAV and SAVO groups regarding the amount of milk produced, with higher production between the fourth and seventh day (Tukey p < 0.05). Similarly, milk volume was significantly greater in the SAVO group compared to the SAV and control groups (OR = 1.032, 95% CI = 1.0036–1.062, p < 0.027).

Conclusion: Multisensory stimulation in postpartum mothers of preterm infants caused an increase in the volume of mother’s own milk production. However, more research is needed to explain the findings presented in this study.

Front. Pediatr., 14 March 2024
Volume 12 – 2024 | https://doi.org/10.3389/fped.2024.1331310

Jennifer Arnold, Niranjan Vijayakumar, Philip Levy

Abstract

Advances in modeling and imaging have resulted in realistic tools that can be applied to education and training, and even direct patient care. These include point-of-care ultrasound (POCUS), 3-dimensional and digital anatomic modeling, and extended reality. These technologies have been used for the preparation of complex patient care through simulation-based clinical rehearsals, direct patient care such as the creation of patient devices and implants, and for simulation-based education and training for health professionals, patients and families. In this section, we discuss these emerging technologies and describe how they can be utilized to improve patient care.

Introduction

Simulation is a powerful tool for improving education, patient safety, and innovation in any field of medicine.1 In neonatology, the opportunity to create realistic simulations to help prepare clinicians for high risk care of vulnerable patients is paramount.2 As the field of healthcare simulation advances, technologies for simulation are diversifying. With advances in modeling and imaging, broader and more realistic tools for education and training, and even opportunities to improve direct patient care are emerging. These include realistic models for preprocedural planning and clinical rehearsals, and innovative, bespoke patient specific devices and healthcare tools to use in clinical care. Current advances in specific technologies have allowed for this expansion, including point-of-care-ultrasound (POCUS), three dimensional (3D) and digital anatomic modeling, and extended reality technologies that are immersive digital recreations of reality, such as virtual reality (VR), augmented reality (AR), and mixed reality (beyond the scope of this article). In this article we review the types of imaging and modeling technologies available and how they can be applied to improve neonatal patient care and outcomes through healthcare simulation-based education (SbE), clinical rehearsals(SbCR), and more.

Section snippets:

Point-of-care ultrasound (POCUS)

POCUS, which is ultrasound performed and interpreted in real time by bedside clinicians, has been used by adult and pediatric specialties for many decades, with recognition that this technology may enhance quality of care and improve patient outcomes.3 Pediatric anesthesiology and adult emergency medicine were early adopters of POCUS, and pediatric critical care has increasingly utilized POCUS for central line placement and diagnostic imaging.4 POCUS has more recently been utilized in

Applications of imaging and modeling

The types of imaging and modeling described above are emerging tools now available in healthcare that can be applied in three specific ways: preparation for complex patient care through SbCRs, direct application for patient care, and simulation-based education and training.

Patient specific simulation-based clinical rehearsal (SbCR)

Simulation-based Clinical Rehearsal (SbCR) refers to the practice and rehearsal by clinicians to prepare for a patient-specific procedure or complex care process before providing direct patient care. These are typically rehearsed using physical 3DP or virtual models. SbCRs can be patient-specific (utilizing the patient’s exact anatomical data to create a model for rehearsal, such as practicing a specific congenital heart disease [CHD] repair on a 3DAM before operating on the patient) or

Imaging and modeling in direct patient care

While using immersive technologies as a part of the preparation for patient care is exceedingly valuable, there are additional applications as part of healthcare services provided directly to patients. In the next section we describe how 3DP, POCUS, and virtual modeling improve care delivery in neonatology and other fields of medicine.

Imaging and modeling in simulation-based education and training

Imaging, modeling and other emerging technologies are used in the education of healthcare professionals and patients, families, and other home caregivers. 3DAMs have been shown to improve performance and promote competency-based education. The benefits of 3DP in education include on demand reproducibility, the possibility to model different physiologic and pathologic anatomy from an endless dataset of images, and the possibility to share 3D models among different institutions.56 3DP has

Conclusion

In conclusion, imaging and modeling technologies have significantly advanced healthcare, including neonatal care. These technologies have enhanced education and training for all levels and types of learners, enabled better preparation and rehearsal for complex care, augmented diagnosis and applications of personalized treatment plans, and improved patient outcomes. From ultrasound to physical models to sophisticated virtual models, these tools provide invaluable insights into the delicate care.

Source:https://www.sciencedirect.com/science/article/abs/pii/S0146000523001283?via%3Dihub

Casey Insights

Mar 7, 2023 VIENNA

MRI can be a powerful tool for diagnosing problems in newborns, but transferring infants to the radiology department for scanning creates a number of issues. Aspect Imaging has developed Embrace, a 1-telsa MRI scanner that can be installed in the neonatal intensive care unit (NICU) to enable MRI to be used at the bedside. Aspect Imaging demonstrated the Embrace scanner at the 2023 European Congress of Radiology (ECR) meeting.

Innovation and Comfort in the NICU: Enhancing the Neonatal Experience:

In the fast-paced world of neonatal care, where infants face immense challenges from their earliest moments, a wave of innovation is transforming the NICU into a place of both healing and joy. Amidst the beeping monitors and hushed whispers, new technologies and thoughtful touches are bringing smiles to the faces of families and healthcare professionals alike.

Imagine, for a moment, the introduction of point-of-care MRI machines, compact enough to fit beside a newborn’s crib yet powerful enough to provide detailed images without the need for transport. Picture tiny headphones delicately placed on the ears of our smallest patients, playing gentle melodies to soothe and comfort them during procedures. In these small yet significant advancements, the NICU transcends its clinical setting, becoming a sanctuary of warmth and reassurance.

But the innovation doesn’t end there. Enter virtual reality (VR), once reserved for gaming enthusiasts, now offering parents a momentary escape to tranquil beaches or serene forests, providing a much-needed respite from the sterile surroundings. Meanwhile, specialized mobile apps empower parents to track their baby’s progress, celebrate milestones, and inject a touch of whimsy into their daily routines with photo filters that adorn their infants with superhero capes or astronaut helmets.

This harmonious blend of technology and compassionate care paints a future where laughter and joy are as integral to the NICU experience as medical treatment. It’s a future where parents find solace and moments of levity amidst the uncertainty, and where our smallest patients are given every opportunity not just to survive, but to thrive.

As we embrace these innovations, we usher in a new era of neonatal care—one filled with hope, imagination, and the promise of brighter beginnings for our tiniest heroes and their families.

By Yi-Jin Yu – February 19, 2024

An Indiana mother was inspired to change careers after her second child was diagnosed with congenital heart defects and spent nearly two months in a neonatal intensive care unit.

With February being Heart Month, Calley Burnett is sharing her personal story to raise awareness about congenital heart defects, something she had no idea her son Spencer would have when he was born on July 26, 2016.

Burnett, who previously worked for a family business, is now a NICU nurse at Riley Hospital for Children in Indianapolis, the same hospital where Spencer was sent for further care days after his birth.

Calley Burnett was inspired to become a nurse after her second son, Spencer, was born with congenital heart defects.

Burnett’s positive experience with the Riley nurses and doctors who cared for Spencer left an indelible mark on her and in 2019, the mom of two decided to go back to nursing school and become a registered nurse.

“Spencer was born with congenital heart defects and that led my way into the nursing program after just being bedside for several weeks with Spencer at Riley,” the 39-year-old told “Good Morning America.”

Recent Stories from GMA

Burnett said even though it was a “very scary” time for her while Spencer was in the NICU, she and her family had a team of caring health providers who were dedicated to helping Spencer through his many treatments and hurdles.

Spencer had to spend nearly two months in the neonatal intensive care unit at Riley Hospital for Children in Indiananpolis, Indiana.

Spencer had to be treated for multiple heart defects, including coarctation of the aorta, ventricular septal defect, and patent ductus arteriosus. This meant a part of Spencer’s aorta was narrower than usual, he had an unclosed hole in his aorta and he also had a hole in the wall separating the two ventricles of his heart.

According to Burnett, Spencer needed to have a closed-heart surgery in August 2016 before he was discharged. Nearly a year later, the boy also had an open-heart surgery in July 2017, all to treat the various heart issues he was born with.

“We had just phenomenal nurses there that I still talk to today … Their bedside manner and how they made me feel and the trust that I had and the bond that we had, it just opened my eyes to say, ‘You know what, I think that this is something that I would love to do,'” Burnett explained.

It took Burnett, who had to take prerequisite classes, about two years to complete nursing school. The working mom said although it was “tough,” the sacrifices and the hard work were “very well worth it.”

After graduating, Burnett first took a job at another hospital but she knew she wanted to return to Riley, where the staff meant so much to her and Spencer.

“I knew immediately that I wanted to be with the babies. There’s just something about being at Riley and being with kids and tiny little infants that I just knew that’s where my heart was going to be as soon as I hit nursing school,” Burnett said.

Today, Spencer is an active second grader who plays basketball and soccer.

“He is a very spunky 7-year-old. He’s very athletic. He’s always on the go, always making me laugh. He is just loving life,” his mother told “GMA.”

Burnett says she’s staying on her toes as a NICU nurse at Riley, which she said “feels like home.”

“It’s a phenomenal feeling to be able to help the parents because I feel like I’ve been there. I can tell these moms and dads, ‘Hey, I’ve been where you are and I understand.’ And I just love it,” she said.

For others inspired to take a turn in their own careers or to go into nursing themselves, Burnett said she encourages them to take the leap.

“If that is your passion. I would 100% follow [it]. It’s worth it,” she said. ‘The journey is worth it. It’s tough. But what you get back from it is a hundred times better.”

Source: https://www.goodmorningamerica.com/living/story/mom-inspired-become-nurse-after-sons-diagnosis-heart-107269214

Mama Sing My Song  715 views Jan 19, 2024

“My Little Fighter – NICU Baby Song” by @mamasingmysong AS SEEN ON SHARK TANK! https://www.mamasingmysong.com

🦸‍♂️💜Children’s Book Read Aloud: SUPREEMIE: KYLO’S JOURNEY THROUGH THE NICU by Nico Avery + Shanel

nightyniteswithneli

On this episode of Nighty Nights with Miss Neli, we join our friend Kylo on his journey to grow big and strong so that he can go home with his family from the NICU. Book Description: This book takes readers on a journey with a micro premature baby named Kylo. Born weighing just 1 pound 3 ounces, Kylo may be small but that doesn’t stop him from being super. He’ll have to stay in the NICU (Neonatal Intensive Care Unit), which is way different from mommy’s belly until he’s big and strong enough to go home. But adventure and growth await him during his hospital stay. This story follows Kylo on his journey to grow stronger and bigger. SUPREEMIE KYLO’S JOURNEY THROUGH THE NICU

NOVA | Performance Paragliders Oct 28, 2014 #FLYnova #parapente #paragliding

A group of professional test pilots explore the remote and rarely visited Island of Socotra off the coast of Yemen in the heart of the Middle East. Join them as they thermal up to 1000m over the Indian Ocean, battle 40 km/h winds, and fly from the longest caves in the orient. A 37 minute documentary including spectacular aerial footage from one of the few remaining flying secrets left on earth. #NOVAparagliders #NOVAwings #FLYnova #Gleitschirm #paragliding #parapente #parapendio #paragleiter #ForgottenIsland

MATE, TRAUMA, WAR, CALMER

Syria.1

 

 

 

 

 

 

SYRIA

Rate: 10.9%      Rank: 76

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

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

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

health.syriaImpacts of attacks on healthcare in Syria

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

COMMUNITY

NIH

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

Thursday, September 12, 2019

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

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

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

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

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

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

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

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

NIH…Turning Discovery Into Health®

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

 

 

HEALTH CARE PARTNERS

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New model mimics persistent interneuron loss seen in prematurity

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

 

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UWMed GME Wellness Service (SEATTLE)

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

Resources for residents and fellow wellness.

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

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

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

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

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

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

Easy online scheduling

We have made it super easy to book counseling appointments.

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

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

Referrals

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

Psychiatric consultation

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

Learning consultation

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

Community providers

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

Other wellness services and resources

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

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

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

Self-Screening Tools

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

SELF-SCREENING TOOLS: 

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

 

Forward Motion Mindfulness in the Medical Community

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

 

INNOVATIONS

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Scientists designed a robot to reduce pain for premature babies

Posted April 2, 2019  tech                                                         

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

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

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

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

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

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

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

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Source: UBC – Video –  A Robot called Calmer

 

 

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

Posted September 9, 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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PREEMIE FAMILY PARTNERS

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Stable home lives improve prospects for preemies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Barbara Melotto – “I JUST WAIT FOR YOUR LIFE”

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

 

 

 

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

Q: How can these difficulties be avoided?

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

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

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

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

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

 

WARRIORS:   

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

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

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

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

scotACE-Aware Scotland- Published on Jul 18, 2019

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

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

 

Kat’s Corner- 

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

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How Syrian Refugee Ali Kassem Found Solace Through Surfing

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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Scars…what do they mean?

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SCAR=Strength Courageous Actualized Resilience-Kat Campos

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

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

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

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

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

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

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