Brochure | Midwifery and Neonatal Care | Child Birth

Mattresses releasing dangerous chemicals in children's bedrooms: Studies

2025-04-15 - 2025-04

Invisible chemicals rising from children's mattresses may be harming their brains and bodies. That's according to a pair of studies published Tuesday, which found troubling levels of plastic-like "phthalate" chemicals and flame retardants in the bedrooms of children under 4. "Parents should be able to lay their children down for sleep knowing they are safe and snug," co-author Arlene Blum, executive director of the Green Science Policy Institute, said in a statement. While there are some steps that parents can take to help keep their kids safe, the problem is pervasive, researchers argued.
The Canadian scientists found that the weight and temperature of the sleeping child helped create a plume of trace chemicals that filled the bedroom. These chemicals can harm the nervous and reproductive system. They also mimic and interfere with systems of hormones, or chemical messengers that help control virtually all bodily functions. The researchers from the University of Toronto argued that much of the responsibility lies with manufacturers and policymakers. Decades-long campaigns have sought to ban phthalates and plasticizers in children's toys and furniture, with limited success. Even where these efforts have been successful, manufacturers don't always follow them, and government regulators often don't enforce them. Tuesday's study found several mattresses containing chemicals that were banned in Canada - suggesting manufacturers weren't testing for compounds known to be harmful. This controversy is particularly fierce around flame retardants, which Blum noted "have a long history of harming our children's cognitive function and ability to learn." Similar chemicals are required by law in the interior of cars - where a 2024 study found that they increased cancer risks for tens of millions of commuters. Those requirements remain despite repeated findings that so-called flame retardants do little to slow the spread of fire. They do, however, make those fires "smokier and more toxic," as a spokesperson from the International Association of Fire Fighters said last year. Mattresses across North America may pose a similar threat, Tuesday's findings found. Despite some benefits in reducing flammability, federal research from the National Institute of Environmental Health Sciences (NIEHS) has found flame retardant chemicals cause widespread, insidious harms as they slough off mattresses and furniture. These include links to impaired attention, cognition and fine motor skills in school-age children. And for phthalates, which are used to make plastic-derived compounds more supple, researchers have found that there may be no safe level of exposure. Phthalates alone caused nearly $70 billion in added health costs just in 2018, a 2024 study found. Copious research has found that exposure to phthalates and flame retardants is harmful to people of all ages. But the NIEHS notes that the risk is particularly stark for children. That's because children breathe up to 10 times faster than adults - allowing them to take in far more airborne contaminants. Their skin is also more permeable to toxins than adults' skin, and they frequently put potentially toxic objects from their homes into their mouths. In Tuesday's findings, scientists focused on manufacturers and North American governments, which they said had to do more to ban dangerous plasticizers and flame retardants from mattresses and toys. But there are some things that parents and caregivers can do, they said. First, wash and change a child's sheets and blankets frequently, because these offer the best shield against the mattress. Second, they continued, declutter the sleeping area by removing excess blankets and toys - which are likely sources of contamination themselves. Finally, they advised avoiding bright-colored sheets and blankets, which often include chemicals meant to block the assault of ultraviolet light - compounds that pose an additional threat. But the researchers emphasized that this was not a problem parents could solve for themselves. The study is "a wake-up call for manufacturers and policymakers to ensure our children's beds are safe," co-author Miriam Diamond of the University of Toronto said in a statement.

VR training for birth emergencies developed in Australia

2025-04-17 - 2025-04

A virtual reality training program has been developed to help paramedics and ambulance officers prepare for unplanned out-of-hospital births.
The training program called NEONATE features a 30 to 40-minute VR simulation of neonatal care scenarios during birth emergencies. These include temperature management, respiratory distress, cardiopulmonary resuscitation, and one-minute Apgar score assessment.
The VR program, which can serve as a standalone or supplement to existing training programs, is designed for paramedics, volunteer ambulance officers, paramedic students, and nursing and midwifery students. It also includes an introduction to VR for users who are unfamiliar with the technology.
WHY IT MATTERS
An Edith Cowan University researcher created the VR program after finding from their previous study that many volunteer paramedics and ambulance officers are ill-equipped to handle out-of-hospital births, which are rare events they are less exposed to.
Such cases create high-pressure situations, "where immediate, skilled intervention is required," according to Michella Hill, who is a PhD candidate at ECU.
It also does not help, she said, that traditional training for volunteer paramedics and ambulance officers provides "less time for obstetric and neonatal emergency preparation."
"With VR, they can actually see the baby move and hear realistic breathing sounds, which significantly enhances engagement and skill retention," Hill said, explaining the benefits of VR-based training.
She added that the VR program is highly accessible, unlike traditional training that requires coordination, significant resources, and rural volunteers travelling long distances.
Trials of this program, which has received grant funding from the Women and Infant Research Foundation, are currently underway. The training package is expected to be launched officially in early 2026.
THE LARGER TREND
In recent years, many hospitals and healthcare providers in Australia have integrated VR into their training programs, especially in critical care. Tertiary hospitals, including Fiona Stanley Hospital, Royal Prince Alfred Hospital, Westmead Hospital and Nepean Hospital, worked with Vantari VR, a known technology provider in this space, to introduce VR into their ICU training program. Gippsland-based trauma centre Latrobe Regional Hospital also adopted the same VR platform for its medical training.
Government agencies have also supported the integration of VR into healthcare training. The Australian Department of Defence, for example, has supported the development of a VR training module called Virtual Tactical Combat Care to train combat medics. The New South Wales government's Agency for Clinical Innovation, together with the University of Newcastle, has also backed the creation of a VR program called TACTICS VR, which trains emergency nurses to administer stroke care.

Advanced Maternal Age: Risks And Realities Of Delayed Childbearing – Analysis

2025-04-08 - 2025-04

The trend of delayed childbearing and advanced maternal age (AMA) has become more prominent globally, with India following a similar trajectory. This shift represents progress in terms of women’s autonomy and prevents health hazards associated with early pregnancy and inadequate spacing between pregnancies. However, delaying having children is associated with several risks as growing evidence indicates that advanced maternal age is linked to an increased likelihood of both maternal and neonatal health complications. While India has made progress in reducing maternal and perinatal mortality rates, these figures continue to remain high.
As India strives to achieve its Sustainable Development Goal (SDG) target of reducing maternal mortality to below 70 deaths per 100,000 live births by 2030, the impact of delayed childbearing must not be overlooked in maternal health policies.
Impact of Delayed Childbearing
Fertility declines with increasing maternal age, particularly after the age of 35. According to the American College of Obstetricians and Gynaecologists, AMA is thus traditionally defined as pregnancy occurring in women aged 35 or older. Women over 35 have a higher pregnancy risk and are more likely to require C-sections. The chances of ectopic pregnancy, preeclampsia, placental complications and developing chronic conditions such as hypertension, diabetes, and cardiovascular diseases increase as well, associated with a higher risk of death during childbirth. In India, 17 percent of women give birth after 35 years. India accounts for nearly 12 percent of global maternal deaths, which amounts to an estimated 1.3 million maternal deaths in the past two decades, with the majority stemming from direct medical causes that increase with age.
Additionally, high-risk pregnancies (HRP) contribute to 75 percent of perinatal deaths in the country. According to research, pregnancies in older age are associated with risks of chromosomal abnormalities such as Down syndrome, structural defects, particularly heart defects, limb malformations, and abnormalities in the urinary or digestive systems. With age, the chances of miscarriage also rise, with women over 40 2.4 times more likely to experience miscarriage than those under 35. Babies born to older mothers are at a higher risk of being premature or having a low birth weight, leading to potential development challenges.
As indicated in Figure 1, while non-live births in India have declined over the years for mothers aged 15-19, they have increased for women over the age of 35. Table 1 shows the significantly higher rates for childhood mortality among women aged 40-49, approximately double the childhood mortality rates among mothers aged 20-29. This disproportionately high burden among older mothers highlights the importance of policy intervention to adequately support them in a world of changing reproductive trends.
Way Forward
Indian public health policy primarily focuses on age at first childbirth, overlooking the age at subsequent birth which also significantly determines maternal and child health outcomes. As childbearing shifts to later ages, the risks accumulate over successive pregnancies. Nevertheless, a World Health Organisation (WHO) study finds that when managed by modern obstetric methods and delivered in modern healthcare centres, older women can have good pregnancy outcomes, highlighting the need for a shift in focus in maternal health policies to build a system that can accommodate the changing reproductive landscape. In an ageing reproductive cycle, targeted interventions in antenatal care (ANC), risk screening—particularly, second-trimester anomaly scans, routine foetal aneuploidy testing, and specialised maternal support for older expectant mothers are important to mitigate these risks.
A meta-analysis indicates that women who postponed childbearing were often unaware of the associated risks of delayed childbirth. India’s public health information and education communication programs predominantly focus on early pregnancy risks, with inadequate counselling on the impact of delayed pregnancy. By implementing programmes for raising community awareness, integrating fertility education into family planning services, and training healthcare workers to communicate risks effectively, women can make better decisions.
Conclusion
While delaying the birth of the first child is important, the median age at subsequent childbirths is also vital to the overall health and survival of women and children. India has come a long way in improving the outcomes of the former, but the latter remains overlooked in the child and maternal health policy discourse. India must redefine its maternal healthcare priorities to be better tailored to an evolving reproductive landscape. Additional research and targeted interventions can help mitigate the risks faced by mothers aged over 35, reducing the likelihood of high-risk pregnancies, and further empowering them to balance their aspirations with motherhood. Delayed childbearing and advanced maternal age are no longer the exceptions but the reality of modern reproductive trends, calling for a system that is prepared to provide adequate support for all mothers and children.

Advanced Maternal Age: Risks and Realities of Delayed Childbearing

2025-04-06 - 2025-04

Delayed childbearing and advanced maternal age are now common trends. India must adapt its maternal healthcare priorities to reflect this shift.
The trend of delayed childbearing and advanced maternal age (AMA) has become more prominent globally, with India following a similar trajectory. This shift represents progress in terms of women’s autonomy and prevents health hazards associated with early pregnancy and inadequate spacing between pregnancies. However, delaying having children is associated with several risks as growing evidence indicates that advanced maternal age is linked to an increased likelihood of both maternal and neonatal health complications. While India has made progress in reducing maternal and perinatal mortality rates, these figures continue to remain high.
As India strives to achieve its Sustainable Development Goal (SDG) target of reducing maternal mortality to below 70 deaths per 100,000 live births by 2030, the impact of delayed childbearing must not be overlooked in maternal health policies.
Impact of Delayed Childbearing
Fertility declines with increasing maternal age, particularly after the age of 35. According to the American College of Obstetricians and Gynaecologists, AMA is thus traditionally defined as pregnancy occurring in women aged 35 or older. Women over 35 have a higher pregnancy risk and are more likely to require C-sections. The chances of ectopic pregnancy, preeclampsia, placental complications and developing chronic conditions such as hypertension, diabetes, and cardiovascular diseases increase as well, associated with a higher risk of death during childbirth. In India, 17 percent of women give birth after 35 years. India accounts for nearly 12 percent of global maternal deaths, which amounts to an estimated 1.3 million maternal deaths in the past two decades, with the majority stemming from direct medical causes that increase with age.
Additionally, high-risk pregnancies (HRP) contribute to 75 percent of perinatal deaths in the country. According to research, pregnancies in older age are associated with risks of chromosomal abnormalities such as Down syndrome, structural defects, particularly heart defects, limb malformations, and abnormalities in the urinary or digestive systems. With age, the chances of miscarriage also rise, with women over 40 2.4 times more likely to experience miscarriage than those under 35. Babies born to older mothers are at a higher risk of being premature or having a low birth weight, leading to potential development challenges.
Conclusion
While delaying the birth of the first child is important, the median age at subsequent childbirths is also vital to the overall health and survival of women and children. India has come a long way in improving the outcomes of the former, but the latter remains overlooked in the child and maternal health policy discourse. India must redefine its maternal healthcare priorities to be better tailored to an evolving reproductive landscape. Additional research and targeted interventions can help mitigate the risks faced by mothers aged over 35, reducing the likelihood of high-risk pregnancies, and further empowering them to balance their aspirations with motherhood. Delayed childbearing and advanced maternal age are no longer the exceptions but the reality of modern reproductive trends, calling for a system that is prepared to provide adequate support for all mothers and children.

Real-Time Adaptive Dosing in Critical Care and How AI Contributes

2025-04-03 - 2025-04

The complexities of individualized medication dosing for critically ill patients, particularly those in intensive care units (ICUs), present significant challenges for clinicians. Sharmeen Roy, PharmD, BCPS, chief strategy and science officer at DoseMe, highlights the need for real-time adaptive dosing models that integrate patient data to optimize care.
Critically ill patients experience rapid physiological changes, which can significantly impact drug metabolism and clearance,“You and I can be given the same medication, such as a beta-lactam antibiotic, and our bodies would process it differently due to physiological differences,” Roy explained. “This variability is even more pronounced in ICU patients, where factors such as kidney function and drug absorption can change from hour to hour.”
To address this, DoseMe is developing models that continuously adapt to a patient’s clinical status by integrating real-time patient data. This approach aims to ensure that dosing decisions are tailored to the individual rather than relying on population-based estimates, which may not account for diverse patient conditions.
Limitations of Clinical Trials and the Importance of Real-World Evidence
One of the key barriers to individualized dosing is the reliance on clinical trial data. Roy notes that while FDA-approved medications undergo extensive testing, clinical trials often exclude diverse patient populations, limiting the generalizability of their findings.
“In clinical trials, patients are carefully selected based on inclusion and exclusion criteria, which means real-world patients, such as pediatric populations, elderly individuals, and those on extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT) may not be represented,” Roy says.
Without robust data on how medications behave in these populations, clinicians are left with limited guidance for individualized dosing. Real-time adaptive models aim to bridge this gap by providing personalized dosing recommendations based on real-world patient data rather than solely relying on controlled trial results.
AI and the Future of Individualized Dosing
Artificial intelligence (AI) is playing an increasing role in healthcare, particularly in clinical decision support systems. Roy acknowledges both the potential and the challenges of integrating AI into real-time dosing models.
“AI can help support clinicians by analyzing large datasets and identifying patterns that would be difficult to discern manually,” Roy explained. “However, in healthcare, patient data privacy and compliance are paramount. The integration of AI must be transparent and controlled, ensuring that clinicians understand the recommendations being made and that clinical judgment remains central to the decision-making process.”
The role of AI in antimicrobial stewardship is another important aspect, particularly in the fight against AMR. By optimizing dosing strategies, AI-driven models can help ensure that antibiotics are used effectively, reducing the risk of resistance development. Roy emphasized that AI should not function as an autonomous system but rather as a tool that enhances clinical decision-making while maintaining necessary safety parameters.
“We need to avoid the ‘black box’ problem, where clinicians are unsure how AI-generated recommendations are made,” Roy said. “AI in dosing should be implemented in a way that provides transparency and allows for continuous monitoring and clinician oversight.”

Menthol in E-Cigarettes during pregnancy May Harm Developing Babies, suggests study

2025-04-02 - 2025-04

Research suggests that menthol, a common flavor chemical in electronic cigarettes, could pose risks to fetal development. Exposure during pregnancy may impact a baby's growth and health, raising concerns about vaping while expecting.
Vaping during pregnancy is becoming more common, but its impact on early human development is not well understood. A new study by scientists at the University of California, Riverside, now reports that the flavor chemical menthol used in electronic cigarettes could pose risks to a developing baby.
The study, published in STEM CELLS Translational Medicine, used human embryonic stem cells, or hESCs, to characterize early stages of embryonic development and examined how low concentrations of menthol affect important cellular processes.
The researchers found the concentration of menthol in the blood of pregnant women who vape is enough to activate stress-related channels called Transient Receptor Potential channels in the hESCs.
“This activation led to inhibition of cell growth, increased cell death, and abnormal cell movement in the hESCs,” said Shabnam Etemadi, first author of the research paper and a bioengineering graduate student who works with Prue Talbot, a professor of the graduate division. “These changes could interfere with a critical stage of development called gastrulation, potentially increasing the risk of birth defects.”
Transient Receptor Potential channels are a large family of ion channels located in the membranes of many different cell types, including in reproductive tissues and embryos. They are involved in a wide range of sensory and physiological processes, including detecting heat, cold, pain, pressure, taste, and smell.
The researchers found that one of the channels, the TRPA1 channel, was activated by nanomolar concentrations of menthol, which their exposure model predicts would be in the blood of pregnant women who vape and would reach the embryo.
Etemadi explained that gastrulation involves movement of epiblast cells-cells that can differentiate into any cell type in the body-to form the definitive endoderm and the mesoderm. Gastrulation is considered a critical stage of development because it is the process where the three primary germ layers-the ectoderm, mesoderm, and endoderm-are formed during the third or fourth week of development, she said.
“These germ layers serve as the building blocks for all future organs and tissues in the embryo; any disruption during this stage can lead to significant structural birth defects due to the misallocation of cells destined for specific tissues and organs,” she added.
Talbot, the senior author of the research paper, said the findings highlight the need for more research on how vaping during pregnancy may harm embryonic and fetal development and point to possible dangers of using mentholated electronic cigarettes.
“The use of e-cigarettes by pregnant women should be discourag.ed until the effects on their embryos of flavor chemicals, such as menthol, are fully understood,” she said.

AI Model Can Optimize, Standardize Total Parenteral Nutrition Formulas

2025-04-02 - 2025-04

An artificial intelligence (AI) approach identified total parenteral nutrition (TPN) formulas that increase safety and potentially reduce costs for neonates admitted to neonatal intensive care units, according to a study published online March 25 in Nature Medicine.
Thanaphong Phongpreecha, from Stanford University in California, and colleagues developed TPN2.0, a data-driven approach that optimizes and standardizes TPN using information obtained from electronic health records. To train TPN2.0, TPN compositions from a decade were assembled (79,790 orders; 5,913 patients). The model was also validated in an external cohort (63,273 orders; 3,417 patients) from a second hospital.
The researchers identified 15 TPN formulas that can enable a precision-medicine approach using the algorithm (Pearson’s R = 0.94 compared to experts), which increased safety and potentially reduced costs. In a blinded study of 192 neonates, TPN2.0 was rated higher than current best practice by physicians. In patients with high disagreement between actual prescriptions and TPN2.0, increased morbidities were seen in association with standard prescriptions (e.g., odds ratio 3.33 for necrotizing enterocolitis), while a reduced risk was seen with TPN2.0 recommendations. Guideline-adhering, physician-in-the-loop recommendations were enabled by TPN2.0 employing a transformer architecture, allowing collaboration between the care team and AI.
“Taken together, TPN2.0 demonstrates the potential of AI to go beyond predictive diagnosis and guide a key therapeutic decision for newborns in the most vulnerable time of their lives,” the authors write.
Several authors disclosed ties to the biopharmaceutical industry; the methods described in this study are covered in a U.S. provisional patent.

Doula care linked to improved maternal health outcomes

2025-04-02 - 2025-04

Introduction
The rate of vaginal birth after cesarean delivery (VBAC) is increased by doula care, according to a recent study published in the American Journal of Obstetrics & Gynecology.1
A widening disparity in maternal morbidity and mortality has been reported in the United States, with a 2.6-fold increased risk of maternal death reported among Black patients vs White patients in 2021.2 This has led to the use of doula support to improve outcomes. Benefits include reduced cesarean delivery and preterm birth rates.1
“Although doulas are posited to have a significant impact on numerous maternal and neonatal outcomes and to decrease racial disparities, research that quantifies these effects is limited,” wrote investigators.
Study design and methods
The study was conducted to determine the impact of doula care on a range of obstetrical and neonatal outcomes. Live births at the Magee-Womens Hospital between January 2021 and December 2022 receiving prenatal care from the University of Pittsburgh Medical Center (UPMC) health system were included in the analysis.
Exclusion criteria included gestational ages under 16 or over 44 weeks and receiving care from a doula outside the study program. Doula care was provided through referral or direct outreach and was free for the patient. UPMC’s Clinical Data Warehouse stored exposure, outcome, and covariate data.
Doula exposure was determined by at least 1 encounter with a doula both prenatally and during the delivery admission. Doula care only during the prenatal period was assessed in secondary analyses.
Key outcomes
Outcomes included cesarean delivery, cesarean delivery of nulliparous, term, singleton, vertex infants, successful VBAC, gestational hypertension after 20 weeks’ gestation, preeclampsia after 20 weeks’ gestation, postpartum emergency department (ED) visit, readmission, and postpartum office visit.
These outcomes were recorded at delivery or within 6 weeks after delivery. Neonatal outcomes such as neonatal intensive care unit admission, unexpected complications in term newborns, breastfeeding, preterm delivery, and intrauterine growth restriction were also reported.
Study findings
There were 17,831 deliveries included in the final analysis, with 486 receiving doula care. A median of 5 doula encounters was reported, most of which occurred during the prenatal period.
Patients receiving doula care were more often Black, insured by Medicaid, living in a disadvantaged neighborhood, diagnosed with gestational hypertension early in pregnancy, visited the ED, and underwent prenatal admission. These patients also had increased rates of VBACs at delivery vs those without care, at 34.4% and 18.8%, respectively.
Preterm, early preterm, and indicated preterm delivery rates were reduced among patients receiving doula care, with rates of 7.2%, 1.2%, and 3.3%, respectively, vs 10.8%, 3.3%, and 5.5%, respectively, among those without care. Exclusive breastfeeding was reported in 44.7% of patients receiving care and 37.1% not receiving care.
An office visit within 6 weeks was reported in 83.1% vs 78.2%, respectively. The data indicated an additional 5.4% to 6.8% adherence among patients receiving doula care, along with an increase from 15.6% to 34.2% in VBACs for every 100 patients receiving care.
Conclusion
Significant improvements following doula care were reported for exclusive breastfeeding and preterm
birth. However, other neonatal outcomes were not significantly associated with doula care. Overall, the data highlighted VBAC, postpartum office visit, and exclusive breastfeeding odds as benefits associated with doula care.
“Although our findings reaffirm the possibility of benefit of doula care for delivering persons with public insurance that were presented in previous studies, in addition, they demonstrated additional benefits and that those also extend to commercially insured patients,” wrote investigators.

Case Study: How A 560g Miracle Preterm Baby Overcame A Two-Month-Long NICU Battle

2025-04-02 - 2025-04

It was a difficult pregnancy for the mother from the beginning. The survival of the baby girl was a medical miracle. Read on to know more about the case and the timely treatment provided by doctors.
In Noida, a preterm baby miraculously survived after being born at 28 weeks of gestation period, with a birth weight of 560 grams only. The baby had to stay in the neonatal intensive care unit (NICU) for two months, where she overcame many life-threatening complications before being discharged as a healthy baby. Read on to know more about this medical case, which highlights the importance of timely intervention and preventive pregnancy care.
Hailing from Varanasi, the baby's mother had a difficult pregnancy. It started with mild bleeding in the initial five weeks of gestation, which continued till the 14th week. At 5 weeks of pregnancy, she was diagnosed with gestational diabetes mellitus (GDM) during a routine antenatal test, with an 'alarmingly high' HBA1C levels of 11. Naturally, doctors tried to stabilise her. Dr Prerna Sharma, a consultant-obstetrician and gynecologist at Noida's Motherhood Hospital initiated treatment involving medications, dietary adjustments, and regular monitoring. Everything was fine until around week 20 of pregnancy. While all blood tests and ultrasounds turned out to be normal, the mother started to experience high blood pressure that was managed with medication.
The situation started to get complicated when a 26-week ultrasound revealed 'impaired fetal growth', 'mild oligohydramnios' (low amniotic fluid levels), and 'slight abnormalities' in the Doppler flow study, prompting the administration of medications to enhance blood flow and support the baby's development. Even after treatment, however, the Doppler growth showed little improvement.
The mother's condition worsened, and the Doppler readings indicated reduced supply of blood to the baby, severely low amniotic fluid levels, and extreme growth restriction at 28 weeks. It posed a health risk to both the mother and her baby, necessitating an emergency C-section surgery to save the unborn baby's life.
"Managing such a high-risk pregnancy required meticulous care and constant vigilance. The mother's condition was critical. Despite the challenges, the timely interventions ensured the best possible outcome for both the mother and her child. This case is a testament to the power of early detection and comprehensive care," Dr Sharma was mentioned as saying in a statement made by the hospital.
This case was handled by a team of experts led by Dr Amit Gupta. Dr Nishant Bansal and Dr Navina Desai provided advanced NICU care. The baby was placed on a ventilator and given surfactant therapy to support lung maturity, the doctors stated, adding that there were some improvements that allowed her to transition to CPAP support and later to independent breathing.
Unfortunately, during her NICU stay, the baby also suffered from sepsis and jaundice, which were successfully treated with antibiotics and phototherapy.
Dr Gupta, a senior consultant-paediatrician and neonatologist said that each day in the NICU was a 'step toward recovery', requiring careful attention to every detail -- from respiratory support to nutritional needs. "This baby's remarkable journey showcases the strength of modern neonatal care and the resilience of life itself."
Dr Bansal, a senior consultant-paediatrician and neonatologist added that the baby girl suffered from severe respiratory distress with underdeveloped organs, which required immediate and sustained intervention. "Surfactant therapy and ventilator support were crucial in the early days, followed by CPAP for several weeks. Kangaroo mother care also played a vital role in promoting her growth and stability."
When she was discharged, the baby weighed 1.6 kg. She continues to grow and develop in a healthy manner, achieving milestones appropriate for her age. Regular follow-ups are ensuring her continued progress and well-being.

Study examines how to protect the breastfeeding relationship for patients admitted into ICU after birth

2025-04-02 - 2025-04

It can happen in an instant—a mother experiences a medical emergency during delivery that requires intensive care.
Meanwhile, her newborn infant is sent to the neonatal intensive care unit.
This early separation can greatly disrupt the establishment of adequate milk supply for those who want to breastfeed.
Recent research from the University of Michigan reveals that simple awareness on the part of the care team can help protect the breastfeeding relationship for patients in the ICU.
The work was spearheaded by Kayla Kolbe, M.D., clinical assistant professor of Pulmonary and Critical Care Medicine, who notes a dearth of research around lactation in critical care, as unprecedented numbers of pregnant people were admitted to the ICU during the COVID pandemic.
"Part of the background of this project was to look at charts and describe what actions we were taking to support lactating patients, as well as to identify potential barriers," she said.
She and her research team reviewed medical charts for adult pregnant and postpartum patients within six months of delivery who were admitted to the ICU at U-M Health over a period of six years from January 2018 to January 2024.
They found that 85% of postpartum-initiated lactation in the ICU, aligning with the national average for initiation of lactation in the general population.
Just over 63% of patients had clearly documented pre-delivery lactation plans in their charts, with an association between having a specific plan to lactate and the initiation of lactation after delivery.
For the 47 patients who lactated in the study who received mechanical ventilation, 17% didn't undergo milk expression while intubated.
Limited documentation and delays during mechanical ventilation seem to be barriers to lactation in the ICU.
"What I've learned through talking to nurses and going around on the units and asking and interviewing people is we don't consistently talk about lactation on rounds. Our ICU teams are so thoughtful, and I think more awareness could really make a difference. We think supporting patients' lactation goals can be empowering, offering them a way to connect with their separated infant. We think that when much is going wrong, this is something that can go right," said Kolbe.
"We have found that many people simply don't know where to start. There is no defined process by which lactation is initiated in the ICU, so we have been working on ways to make this clearer."
To that end, the team is developing an algorithm and guideline that walks people through the process of lactation, starting with communicating with the patient and documenting their wishes, then consulting lactation consultants, and practical steps that explain how to help a patient continue their lactation journey even beyond hospital discharge.

Maternal diet in late pregnancy linked to infant mental health

2025-04-02 - 2025-04

Study overview
The study assessed child behavioral outcomes based on maternal diet in both the second and third trimester. Results indicated shifts in infant temperament and behavioral trajectories from the consumption of foods that rapidly increase blood sugar level during pregnancy.
"These findings highlight opportunities to enhance nutrition during pregnancy and improve offspring outcomes by providing specific dietary targets and timepoints that can make a difference in infant behavioral health," said Elizabeth Wood, PhD, lead author and assistant professor of psychiatry in the OHSU School of Medicine.
Research objectives and methodology
The study was conducted to determine the impact of prenatal maternal diet, dietary glycemic index (GI), adiposity, and insulin resistance on infant negative affect (NA), with NA defined as a range of negative emotions.2 Data was obtained from an ongoing longitudinal study evaluating the impact of perinatal nutrition on infant neurodevelopment.
Exposure data included participant-reported dietary intake, an in-laboratory body composition assessment, and second- and third-trimester fasting blood samples. Infant temperament was reported through questionnaires completed by caregivers 6 months after birth. Emotional regulation, including NA, was also observed.
Study population and measurements
Pregnancies between 2018 and 2021 were included in the final analysis, with mothers reporting prenatal dietary intake during 6 unannounced recalls in the second and third trimester. These recalls were performed across a 2-week period, and daily GI values were calculated using the Nutrition Data System for Research software (NDSR, versions 2018–2020).
Body fat during the second and third trimester were assessed using the BodPod Body Composition tracking system (Life Measurement, Inc.). Participants were instructed not to fast and to avoid exercising in the 3 hours prior to testing.
Venipuncture was utilized to collect fasting blood samples, which were assayed for plasma glucose and insulin. Insulin resistance was reported as the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).
The Still-Face Paradigm (SFP) measure was used to assess infant NA, while the Infant Behavior Questionnaire-Revised (IBQ-R) was used to assess maternal reports of infant NA. Covariates included maternal age, parity, race and ethnicity, prenatal stress, synthetic insulin use, prenatal vitamin use, and socioeconomic status.
Key findings
Significantly increased adiposity, dietary GI, and HOMA-IR values were observed in patients with gestational diabetes mellitus vs their nondiabetic counterparts. Additionally, these factors were higher in patients using synthetic insulin vs those not using synthetic insulin.
A positive association was reported between second-trimester HOMA-IR and infant NA at 6 months, alongside an association with infant fear from the IBQ-R rated by a caregiver. Additionally, a link was reported between caregiver rated infant sadness from the IBQ-R and increased third-trimester GI.
No other measures of infant NA were linked to second-trimester HOMA-IR, nor was second-trimester adiposity linked to infant NA. However, a significant association was reported between third-trimester dietary GI and observer-rated NA at 6 months.
Third-trimester dietary GI was also linked to infant sadness at 6 months based on caregiver report. However, an association with caregiver-reported infant fear was not found.
Implications for maternal nutrition
There was also no significant association between third-trimester adiposity or HOMA-IR with infant NA, showing third-trimester dietary GI as the factor most strongly influencing outcomes. These results indicated an impact from maternal dietary quality during pregnancy, especially the third trimester, on infant neurodevelopment.
"Developing targeted dietary interventions that involve exchanging high-GI foods for lower-GI replacements may be a feasible means of enhancing infant neurodevelopmental health and well-being," investigators concluded.

Research Explores Lactation in Critically Ill Patients

2025-04-02 - 2025-04

It can happen in an instant - a mother experiences a medical emergency during delivery that requires intensive care.
Meanwhile, her newborn infant is sent to the neonatal intensive care unit.
This early separation can greatly disrupt the establishment of adequate milk supply for those who want to breastfeed.
Recent research from the University of Michigan reveals that simple awareness on the part of the care team can help protect the breastfeeding relationship for patients in the ICU.
The work was spearheaded by Kayla Kolbe, M.D., clinical assistant professor of Pulmonary and Critical Care Medicine, who notes a dearth of research around lactation in critical care, as unprecedented numbers of pregnant people were admitted to the ICU during the COVID pandemic.
"Part of the background of this project was to look at charts and describe what actions we were taking to support lactating patients, as well as to identify potential barriers," she said.
She and her research team reviewed medical charts for adult pregnant and postpartum patients within six months of delivery who were admitted to the ICU at U-M Health over a period of six years from January 2018 to January 2024.
They found that 85% of postpartum-initiated lactation in the ICU, aligning with the national average for initiation of lactation in the general population.
Just over 63% of patients had clearly documented pre-delivery lactation plans in their charts, with an association between having a specific plan to lactate and the initiation of lactation after delivery.
For the 47 patients who lactated in the study who received mechanical ventilation, 17% didn't undergo milk expression while intubated.
Limited documentation and delays during mechanical ventilation seem to be barriers to lactation in the ICU.
"What I've learned through talking to nurses and going around on the units and asking and interviewing people is we don't consistently talk about lactation on rounds. Our ICU teams are so thoughtful, and I think more awareness could really make a difference. We think supporting patients' lactation goals can be empowering, offering them a way to connect with their separated infant. We think that when much is going wrong, this is something that can go right," said Kolbe.
"We have found that many people simply don't know where to start. There is no defined process by which lactation is initiated in the ICU, so we have been working on ways to make this clearer."
To that end, the team is developing an algorithm and guideline that walks people through the process of lactation, starting with communicating with the patient and documenting their wishes, then consulting lactation consultants, and practical steps that explain how to help a patient continue their lactation journey even beyond hospital discharge.

AI used to ID abnormalities in unborn babies

2025-03-31 - 2025-04

The use of an AI tool could speed up the time it takes to do pregnancy scans by almost half and it is still able to identify any abnormalities in the fetus, researchers found. Results from a study showed the AI tool used to assist with 20-week pregnancy scans reduced the scan length by more than 40% and still maintained the same accuracy and reliability of diagnoses.

Study Reveals Babies Can Store Memories

2025-03-30 - 2025-03

Most people's first memory comes from when they were around 3 to 4 years old and experienced an emotionally important or mildly traumatic event, like the birth of a sibling or a dog bite. This kind of autobiographical memory is the primary way that we, as adults, tell others about our lives. In psychology, theories of memory development in our earliest years tend to focus on the first reportable episodic memory, defined as a unique personal experience that can be retrieved from long-term memory. Even though episodic memory does not show up for years after birth, babies still learn an incredible amount of information in their first days, weeks, and months - after all, everything in the world is new to a newborn. As this period is critical for understanding how memory matures, developmental psychologists have long speculated on why we, as adults, cannot remember our first years alive. The typical explanation is grounded in an infant's brain development or lack thereof. However, a new research finding has suggested that it may not be that simple. A Yale study, titled "Hippocampal encoding of memories in human infants," was first published on March 20 in Science, the peer-reviewed academic journal of the American Association for the Advancement of Science (AAAS). It was supervised by Nick B. Turk-Brown, a professor at Yale, and led by Tristan S. Yates. Yates, then a graduate student, has since gotten her Ph.D. in cognitive psychology at Yale and is now conducting postdoctoral research at Columbia. The study had 26 subjects, from 4.2 to 24.9 months old - half were younger than 1 year of age and half were older. A previous study by the same team suggested that during statistical learning, a type of memory that involves repeated patterns, the hippocampus is active around 3 months of age - this study aimed to see if infants, at any age, could consistently encode and recall new visual stimuli, and evaluate how their brains behaved while doing so.Like many aspects of modern psychology, the popularization of infant amnesia can be attributed to Sigmund Freud, although the phenomenon was first described by Caroline Miles in 1893. She conducted a survey study design consisting of a series of personal questions, with the 11th item asking "What is the earliest thing you are sure you can remember?" followed by "How old were you?" Receiving 97 responses, Miles found that "the preponderant direction of the mind of the child is shown by the fact that seventy show attention to the outside world and only twenty-seven to self … he is more apt to regard himself as a victim of sensations than as an agent in bringing things to pass." The most commonly reported first memories involved a birth (or death) in the family, being frightened, or some form of injury. Among the responses, the average age of first episodic memory was 3.04 years.
Freud expanded on the idea in his "Three Essays on the Theory of Sexuality," published in 1905. The second of the trio describes "the peculiar amnesia which, in the case of most people, though by no means all, hides the earliest beginnings of their childhood up to their sixth or eighth year." In true Freudian fashion, he explains this mass forgetting as the "repression of the impressions of childhood" which conceals children from "the beginnings of [their] own sexual life." The Yale study was motivated to discover the biological basis of why people don't remember their infancies. The study included two main elements - a subsequent memory paradigm and awake fMRI data. The first is a category of memory test where subjects view a series of images or words only once, and then complete a recognition test. This study's sequence involved three types of stimuli - faces, objects, and scene photographs - placed on a dynamic, relatively trippy green background. This green screen also served as the interstimulus interval, showing for 2, 4, or 6 seconds before the next photograph was revealed. From the moment the encoding trial was completed, a variable lag between 20 and 100 seconds occurred before the recognition task. The test trial involved two images, one previously encoded and one, as yet, unseen - if the infant looked more at the old image, it indicated that the infant remembered the image from the prior encoding trial. The core behavioral mechanism behind the study design, familiarity preference, is when people, in this case, infants, tend to look more at an old, previously seen item than a novel one. This preference is typically associated with incomplete encoding - the infants haven't had time to learn the whole image yet, so they want to keep looking. The familiarity preference is in contrast to the novelty preference, which tends to happen after infants habituate to a stimulus - essentially, once they get bored of it after multiple exposures. As children age, they tend to present the novelty preference more than the familiarity preference as a display of memory. This study's design (particularly interleaving the encoding and test trials, quick pacing, the number and complexity of items, and the delay between encoding and retrieval) helped elicit the familiarity preference in the infants - allowing them to recognize the image, but not memorize it immediately. Throughout the sequence, the infants' brains were monitored through functional magnetic resonance imaging (fMRI). Specifically, the fMRIs were focused on hippocampal activity, and they found that the "trial-wise variance in memory behavior relates to brain activity during encoding." The study used the blood oxygenation level-dependent (BOLD) fMRI technique, which measures oxygenated hemoglobin and blood flow in the anterior and posterior hippocampus. Several individual participants showed familiarity preference across trials - predicting that these infants would have the strongest hippocampal effect, the team split the participants along the median average familiarity preference. They found that the hippocampal activity in infants with better behavioral memory was "robust," as opposed to the "unreliable" below-the-median group.

Doula Care Boosts Vaginal Birth Success Rates and Postpartum Follow-Ups

2025-03-27 - 2025-03

TOPLINE:
Doula care was associated with 15-34 more vaginal births after cesarean per 100 deliveries and increased exclusive breastfeeding rates by 20%. Support from doulas also reduced preterm births by 3-4 cases per 100 deliveries, with benefits consistent across race and insurance status.
METHODOLOGY:
Researchers conducted a retrospective cohort study of 17,831 deliveries from January 2021 to December 2022 at a single institution, analyzing outcomes for 486 patients who received doula care compared with 17,345 patients who did not.
Analysis included maternal outcomes (cesarean delivery, vaginal birth after cesarean, gestational hypertension, preeclampsia, or postpartum emergency department visits) and neonatal outcomes (neonatal intensive care unit admission, breastfeeding, or preterm delivery).
Investigators used multiple methods including multivariate logistic regression and conditional regressions with propensity scores to generate appropriate comparison populations, accounting for targeted outreach to high-risk patients.
TAKEAWAY:
Patients receiving doula care showed significantly higher rates of vaginal birth after cesarean (adjusted risk difference [ARD], 15.6; 95% CI, 3.8-27.4) and increased postpartum office visit attendance (ARD, 5.4; 95% CI, 1.4-9.5).
Exclusive breastfeeding rates were 22% higher among patients with doula support (adjusted risk ratio, 1.22; 95% CI, 1.07-1.38).
Doula care was associated with fewer preterm births (ARD, 3.8; 95% CI, 6.1 to 1.5) per 100 deliveries.
Benefits of doula support remained consistent regardless of patient race or insurance status, as demonstrated across multiple analytical approaches.
IN PRACTICE:
"Although doulas are posited to have a significant impact on numerous maternal and neonatal outcomes and to decrease racial disparities, research that quantifies these effects is limited…The impact of doula support on the general population and the influence of race and payor status have been largely unexplored," wrote the authors of the study.

AI can help doctors give intravenous nutrition to premature babies, study finds

2025-03-26 - 2025-03

Artificial intelligence (AI) can improve intravenous (IV) nutrition for premature babies, new research has found.
The study is among the first to demonstrate how AI can aid doctors in clinical decisions for sick newborns.
The algorithm analyses preemies' electronic medical records to predict their nutritional needs.
Trained on nearly 80,000 past IV nutrition prescriptions linked to patient outcomes, it could reduce medical errors, save time and money, and improve care in low-resource settings.
IV nutrition, or total parenteral nutrition (TPN), is essential for preemies whose digestive systems aren't mature enough to absorb nutrients.
"Right now, we come up with a TPN prescription for each baby, individually, every day. We make it from scratch," said senior study author Nima Aghaeepour, PhD.
"Total parenteral nutrition is the single largest source of medical error in neonatal intensive care units."
Doctors struggle to determine if preemies receive the right nutrients.
Unlike full-term babies, they don't show hunger or satiety cues, and there's no blood test to measure daily caloric intake.
"Nutrition is one of the areas of neonatal intensive care where we are weakest," said study coauthor David Stevenson, MD."We can't approximate what the placenta is doing."
About 10 per cent of babies are born prematurely, and those arriving more than eight weeks early often require IV feeding.
Currently, each prescription is created daily based on factors like weight, development stage, and lab results.
It involves six experts: a neonatologist or pharmacist writes the prescription, a dietitian checks nutrients, a second pharmacist verifies safety, and a compounding pharmacy prepares the formula before nurses administer and double-check it.
"It's a high-risk drug because it is a mixture of many different things," said study co-author Shabnam Gaskari, PharmD.
She noted that ready-to-use TPNs would improve safety.
The researchers trained their AI model on 10 years of neonatal intensive care unit data, including 79,790 prescriptions from 5,913 preemies.
The AI identified patterns linking nutrient levels to health outcomes and grouped similar prescriptions, determining that 15 standard IV formulas could meet all patients' needs.
"What if we make three standard formulas, or 10, or 100?" Aghaeepour said.
"It turns out that with 15 distinct formulas, what you are recommending is pretty similar to what physicians, pharmacists, and dietitians would have done anyway."
The AI also predicts which formula each baby needs and adjusts recommendations daily as the patient grows.
In a test, 10 neonatologists compared real prescriptions with AI-generated ones-doctors consistently preferred the AI versions.
The researchers validated the model using data from the University of California, San Francisco (63,273 prescriptions from 3,417 patients), confirming its accuracy.
They also found that babies whose prescriptions deviated from AI recommendations had higher risks of mortality, sepsis, and bowel disease.
Next Steps
A clinical trial will compare AI-generated prescriptions to manually created ones.
Doctors and pharmacists will still review recommendations to ensure accuracy.
Standardised AI-driven formulas could make IV nutrition more accessible and affordable, benefiting hospitals in low-resource settings.
"This reflects our hope for AI in medicine," Stevenson said.
"It will make doctors better and top-notch care more accessible."

Milk as medicine: Researchers study the effects of breast milk on children of mothers with gestational diabetes

2025-03-26 - 2025-03

In 2010, University of Oklahoma researcher David Fields, Ph.D., was poring over research data when he discovered something he thought was odd: his data showed that at 6 months of age, formula-fed babies born of mothers who were categorized as medically obese weighed about 5% units less fat than breastfed babies in the same dataset.
That discovery struck him as unusual and led him on a research journey to better understand breast milk. Now, he's studying the connections between maternal gestational diabetes, breastfeeding and infant health.
Fields is part of the research team behind a study in JAMA Network Open that examines the effects of breast milk on the children of mothers with gestational diabetes.
"Gestational diabetes is a big deal," said Fields, an associate professor of pediatrics in the OU College of Medicine. "It's bad for the mother because, while it goes away after giving birth, it usually portends that, later in life, the mother will get diabetes."
Fields and his colleagues began studying mother-infant pairs with gestational diabetes in 2019, as part of his 2015 project with University of Minnesota researcher Ellen Demerath, Ph.D., called the Mothers and Infants LinKed for Health Growth (MILK) study, one of the largest and longest-running studies on breastfeeding in the country.
At that time, Fields suspected the breast milk composition of mothers with gestational diabetes would be different from mothers without the disease. When they began digging into the compositional differences between breast milk for mothers with and without gestational diabetes, the results told an unexpected story.
While nine differences existed between the breast milk of mothers with gestational diabetes and those without, three were significantly associated with growth and body composition. Those differences benefited the children of mothers with gestational diabetes.
Babies of mothers with gestational diabetes had faster linear growth: they were longer and growing faster. They also had a lower fat percentage in one month to three months.
"They weren't putting on fat as much, which is totally opposite of what we would think. We thought that these babies would be gaining more fat, but they're not," Fields said.
When the MILK study began, very little was known about the composition of breast milk. "We didn't know much beyond macronutrients, simply how much fat and how much protein is in the milk," he said.
And while there is still more to learn about the differences between formula and breast milk, and their effects on children, Fields and his team are at the forefront of making those discoveries.
"Our ultimate take-home message is milk is medicine. Milk is the interface between the baby and the mother. What a mother eats and how they live, either good or bad, is being signaled and transferred to the infant," Fields said.

Atosiban for Preterm Birth: Prolongs labour but not Neonatal outcomes, finds study

2025-03-24 - 2025-03

Researchers have found that while the tocolytic drug atosiban prolonged labor in cases of threatened preterm birth beyond 30 weeks, it did not improve neonatal outcomes compared to a placebo. They questioned its effectiveness as a treatment, as reported in The Lancet.
Tocolytics are recommended in international guidelines as a treatment for threatened preterm birth. Atosiban, an oxytocin receptor antagonist, is a registered tocolytic drug specifically indicated for the treatment of threatened preterm birth. Although tocolytics have been shown to delay birth, benefits on neonatal outcomes have not been demonstrated. In the APOSTEL 8 trial we aimed to assess the superiority of tocolysis with atosiban compared with placebo in threatened preterm birth from 30 weeks and 0 days (30+0 weeks) to 33+6 weeks of gestation in improving neonatal morbidity and mortality.
This was an international, multicentre, randomised, double-blind, superiority trial conducted in 26 hospitals in the Netherlands, England, and Ireland. After written informed consent, women aged 18 years or older with a singleton or twin pregnancy with threatened preterm birth from 30+0 to 33+6 weeks of gestation were randomly assigned (stratified by centre, 1:1 ratio) to intravenous atosiban or placebo. The primary outcome was a composite of perinatal mortality (stillbirth and death until 28 days postpartum) and six severe neonatal morbidities. Analysis was by intention-to-treat. Treatment effect was estimated as relative risk (RR) with 95% CI. This trial was prospectively registered at EudraCT (2017-001007-72) and the Netherlands Trial Registry (NL-OMON54673), and is complete. Findings: Between Dec 4, 2017, and July 24, 2023, a total of 755 participants were randomly assigned, of whom 752 were included in the intention-to-treat analysis (atosiban n=375, placebo n=377). The primary outcome occurred in 37 (8%) of 449 infants in the atosiban group and 40 (9%) of 435 in the placebo group (RR 0·90 [95% CI 0·58-1·40]). There were three (0·7%) and four (0·9%) infants who died, respectively (RR 0·73 [0·16-3·23]); all deaths were deemed unlikely to be related to the study drug. Maternal adverse events did not differ between groups, and there were no maternal deaths. They did not demonstrate superiority of atosiban over placebo in improving neonatal outcomes as treatment for threatened preterm birth from 30+0 to 33+6 weeks of gestation. As the primary goal of tocolysis should be improvement of neonatal outcomes, our outcomes question the standardised use of atosiban as treatment for threatened preterm birth from 30+0 to 33+6 weeks of gestation. Our findings should reduce practice variation across countries and will contribute to evidence-based treatment for patients with threatened preterm birth.

Stanford Report: Study Finds Foreign Aid Sanctions Set Back Decades of Progress on Maternal and Child Mortality

2025-03-23 - 2025-03

Researchers analyzed three decades of sanctions on foreign aid to assess their impact on health. They hope the work can help government officials better understand and address how foreign policy decisions affect the well-being of local populations.
By Beth Duff-Brown, Jamie Hansen - Reductions in official development assistance can lead to a significant increase in death among mothers, children, and infants, according to a new Stanford-led study that reviewed three decades of sanctions on foreign aid. The researchers estimate that aid sanctions to low-resource countries lasting five years or more can negate 64% of progress against maternal mortality, 29% of the progress for infants, and 26% for children under 5.
The study, which began in 2022, is the first of its kind to assess the global impact of aid sanctions on human health – particularly maternal and child health. The authors hope government officials can use the findings to better understand how foreign policy decisions impact the health of local populations, then take steps to minimize unintended humanitarian harm, including waivers for lifesaving programs.
“Foreign policy can be strategic in advancing national interests while also protecting the health of mothers and children,” said lead author Ruth Gibson, a postdoctoral fellow at Stanford Health Policy and, by courtesy, the Center for International Security and Cooperation. “We used cutting-edge analytic methods to assess the impact of this targeted geopolitical tool so we could make clear policy recommendations for governments considering foreign aid sanctions or cuts to foreign aid.”
The study published in The Lancet Global Health contributes to a growing foreign policy conversation about the use of foreign aid restrictions. The U.S. Congress has been considering ways to minimize the negative impacts of aid sanctions, while the shutdown of USAID has sparked additional debate on the removal of foreign aid and its impact on health.
Assembling and examining decades of data
After more than a decade working on maternal and child health for foreign health ministries and humanitarian organizations, Gibson was struck by the serious toll that sanctioning foreign assistance took on the health and lives of women and children. In 2022, she set out to systematically study their impact as a postdoctoral scholar at the Stanford Center for Innovation in Global Health.
Gibson and a multidisciplinary team from Stanford, Drexel University, and the University of Washington developed a study that analyzed the extent to which past aid sanctions affected maternal and child mortality between 1990 and 2019.
Using population health metrics from multiple databases, as well as assembling a new aid sanctions dataset for this study, the authors examined the relationship between aid sanctions, official development assistance for health, and measures of infant mortality, child, and maternal mortality. They found sanctions to foreign aid reduced roughly 2.4% of a country’s total health care spending through decreases to development assistance for health. This led to increases in mortality of 6.4% for mothers, 3.6% for children under 5, and 3.1% for infants – negating much of the progress made against maternal and child mortality in these countries over the last three decades.
Controlling for diverse variables
The team took particular care to address concerns related to other factors that could impact mortality in countries experiencing aid sanctions, such as changes in gross domestic product, battle-related deaths, and other sanctions. Using state-of-the-art econometric analysis designed to prove causal relationships, they took numerous steps to control for variables that could confound the results and compared sanctioned countries with those that have never been sanctioned. They have provided open-source files so that their methods can be tested, replicated, and used to study the impacts of other foreign policies.
“We believe our work stands out for its careful application of econometric methods and use of novel data,” said senior author and lead economist on this project, Sebastien Bradley, an associate professor of economics at Drexel University. “We take seriously the concern that the set of conditions that precipitate the imposition of aid sanctions may affect mortality directly, so we implemented a variety of modeling techniques to avoid conflating this effect with the true effect of sanctions themselves.”
Life-saving policy interventions recommended
The researchers also recommended policy interventions to reduce the impact of aid sanctions on maternal and child health while ensuring national interests and security.
They outlined, for example, health-related questions for any legislative body considering strategic changes in foreign aid commitments. They also proposed an additional fragility assessment for nations in conflict, such as food insecurity and displacement.
“In a world where disease knows no borders, our national interests are well served by maintaining the health and stability of people in other nations,” said Michele Barry, Stanford’s senior associate dean of global health and a study author. “This new research shows that we can shape foreign aid in strategic ways that advance national interests while also minimizing harm to vulnerable populations.”

Midwives' failure over basic care led to baby's death, coroner says

2025-03-21 - 2025-03

A baby girl died after midwives failed to provide basic medical care as she struggled to breathe in the first minutes of her life, a coroner has found.
Ida Lock suffered a serious brain injury due to a lack of oxygen following her delivery at Royal Lancaster infirmary in November 2019.
She was subsequently moved to intensive care at Royal Preston hospital's neonatal unit, where she died a week later.
The Lancaster coroner, Dr James Adeley, concluded that a gross failure by midwives to provide rudimentary medical care cost Ida her life.
Among a catalogue of failures identified were the 'wholly incompetent' efforts of the lead midwife to resuscitate Ida during the first three-and-half minutes of her life, which contributed to the infant's brain damage.
'Ida was a normal child whose death was caused by a lack of oxygen during her delivery that occurred due to the gross failure of the three midwives attending her to provide basic medical care to deliver Ida urgently when it was apparent she was in distress,' said Dr Adeley.
Midwives also failed to identify an abnormally slow foetal heart rate after Ida's mother, Sarah Robinson, attended in early labour.
A report from the independent Healthcare Safety Investigation Branch in April 2020 highlighted numerous failings in the care of Ida that contributed to her death, a hearing at County Hall, Preston, previously heard.
But an internal 'root cause analysis' by the hospital in January 2020 found no issues and praised the 'great cohesion and communication' shown by staff in the delivery suite.
The trust was the subject of a damning report in 2015 that found a 'lethal mix' of problems at another of its maternity units, at Furness general hospital, led to the unnecessary deaths of 11 babies and one mother between 2004 and 2013.
Declaring that a prevention of further deaths order would be sent to the health secretary, Dr Adeley identified eight missed opportunities by midwives to save Ida's life, adding that she could have survived had she been born six and a half minutes earlier.
'We went to the hospital hoping that within hours or days we would be bringing [our daughter] home to complete our family,' Mr Lock said after the hearing. 'Words truly cannot express how heartbreaking it was to lose Ida and there is not a single moment when we do not think about her and what she may have become.
'The coroner found there was a litany of lamentable failures which led to the death of our beautiful baby girl. We have been casting around in the dark to try to understand what had happened. We have still not received a response to our letter.
'The coroner has reached a verdict of neglect. There has been systemic failings at the trust. Why did we have to endure this? As a family we have only wanted answers as to what happened to Ida.
'We still do not know why the trust were not open, why they were not candid. Hopefully Ida is no longer a hospital number, but her name will be used to implement change and help parents understand what happened to their child.'
The Morecambe Bay investigation, chaired by Dr Bill Kirkup, uncovered a series of failures 'at every level', from the unit itself to those responsible for regulating and monitoring the trust.
'Clinical governance is a framework through which NHS organisations and their staff are accountable for continuously improving the quality and safety of patient care,' said Dr Adeley.
'Clinical governance is also intended to ensure that healthcare professionals adhere to the highest standards of care and that the appropriate systems and processes are in place to monitor clinical practice.'
Taking aim at the trust's failure to respond to the letter from Ida's parents seeking an explanation of how their daughter died, Dr Adeley spoke of 'a lack of compassion and honesty'.
'Ida's death and subsequent investigation is a damning indictment of an ineffective, dysfunctional and callous system that has failed this family at every opportunity presented to it,' he said.
Mr Lock added: 'The answers today will not bring our daughter back, but hopefully will stop another family going through what our family has been through.
'This should not be a test of endurance for bereaved and bewildered parents to work out what happened to their child. Hopefully today we can start healing and we can grieve differently.'

Pre-pregnancy obesity lifts risk of delayed child development: study

2025-03-21 - 2025-03

Being overweight or obese before pregnancy has been confirmed to increase the risk of delayed physical and cognitive behavioral development in children.
Konkuk University Medical Center said Friday that a research team led by Professor Shin Jin-young of the Department of Family Medicine, Professor Park Hye-won of the Department of Pediatrics, and Professor Kim Tae-eun of the Department of Clinical Pharmacology conducted the first large-scale study in Korea to combine the results of the National Health Insurance Service's National Health Examination with the Korean Developmental Screening Test (K-DST) administered at infant checkups.
The researchers analyzed data from about 258,400 infants (11 percent) born between 2014 and 2021.
The results showed that a pre-pregnancy body mass index (BMI) of 25 or higher was associated with increased risk factors for further evaluation in the areas of large muscle, small muscle, social, self-care, cognitive, and language development, and a BMI of 30 or higher was associated with an even higher risk of developmental delay.
In comparison, low pre-pregnancy weight (BMI <18.5) was associated with developmental delays up to two years of age. Still, developmental gains tended to recover after birth with catch-up growth.
Previous studies have shown that obesity during pregnancy affects children's physical and cognitive development through perinatal complications or gestational conditions, including gestational diabetes and hypertension.
However, the new study suggests that obesity itself is likely a direct risk factor for delayed infant and toddler development and that these effects may persist beyond the neonatal period and into early childhood.
This month, the team won the Best Oral Presentation Award at the 61st spring meeting of the Korean Society for the Study of Obesity.
"Proper weight management in women of childbearing age is essential for the healthy development of their children," the researchers said. "We plan to propose more specific prevention and management strategies in future studies."

No Link Between COVID Vaccine During Pregnancy And Birth Defects, Study Says

2025-03-17 - 2025-03

Pregnant women can get the COVID-19 vaccine without any fear of causing birth defects in their unborn child, a new study says.
Researchers found no link between COVID vaccination in early pregnancy and birth defects, results show.
There were also no differences in birth defect risk between either the Moderna and the Pfizer/BioNTech vaccines, researchers reported in the journal Pediatrics.
"These results support the safety of COVID-19 vaccination in early pregnancy," concluded the research team led by Stacey Rowe, a postdoctoral fellow in infectious diseases at the University of California-San Francisco.
The vaccine is recommended for pregnant women, because COVID infection during pregnancy has been linked to an increased risk of preterm birth, stillbirth and new-borns requiring care in a neonatal intensive care unit, researchers said in background notes.
However, some resistance to the vaccine has been reported due to concerns that it might cause birth defects, researchers noted.
For the new study, researchers examined more than 78,000 pregnancies detailed in claims data from public and private health insurance providers.
In all, 1,248 birth defects were noted among unvaccinated people and 199 among vaccinated folks, results show.
Overall, there were no significant differences between birth defects in vaccinated and unvaccinated women.
There were a little more than 160 birth defects per 10,000 live births among the unvaccinated, compared with 156 per 10,000 for women who were vaccinated, results show.
The rate of birth defects didn't change even if pregnant women received other recommended vaccines, such as the influenza or whooping cough shots, researchers said.
The same was true if a pregnant woman caught COVID during pregnancy, researchers said.
"The study's findings are consistent with a growing body of literature supporting the safety of COVID-19 vaccines and their use in pregnancy, including in early periods of gestation," researchers concluded.
"Vaccine safety is a common concern for patients considering vaccination," they wrote. "Provider recommendations are the most important predictors of person's decision to vaccinate during pregnancy, even for those who have previously declined."
"Our findings can strengthen provider-to-patient discussions relating to the safety of COVID-19 vaccines during pregnancy," the report continued. "Providers across all clinical and public health settings should recommend COVID-19 vaccination for their pregnant patients at any period of gestation."

Uterine Rupture Rates Rise Among Trial of Labor After Cesarean Patients

2025-03-14 - 2025-03

National rates of uterine rupture in trial of labor after cesarean (TOLAC) increased from 0.20% in 2010 to 0.37% in 2022, with an annual percentage increase of 6.2%. Among 1,016,073 deliveries analyzed, 2888 uterine ruptures occurred, representing 0.28% of cases.
METHODOLOGY:
Researchers conducted a repeated cross-sectional analysis using natality files from the National Vital Statistics System, examining data from 2010 to 2022.
Analysis included 1,016,073 singleton, cephalic, term pregnancies with one or two prior cesarean deliveries undertaking TOLAC.
Primary outcome measure was uterine rupture, defined as a ruptured uterus recorded for maternal morbidity on the birth certificate.
Secondary outcomes encompassed unplanned hysterectomy, maternal blood transfusion, maternal intensive care unit admission (available from 2015), neonatal intensive care unit admission, and neonatal death.
TAKEAWAY:
Uterine rupture rates showed a significant increase over the study period (average annual percent change, 6.2%; 95% CI, 4.3%-8.7%).
Maternal blood transfusion rates demonstrated an upward trend (annual percentage change, 7.17%; 95% CI, 6.31%-8.02%).
Maternal intensive care unit admission rates increased (annual percentage change, 3.32%; 95% CI, 1.89%-4.79%).
Neonatal death rates decreased over time (annual percentage change, -6.4%; 95% CI, -8.5% to -3.8%), while neonatal intensive care unit admission rates increased (average annual percent change, 1.8%; 95% CI, 1.3%-2.2%)
IN PRACTICE:
"The uterine rupture rate (0.28%) is lower than that found in prior studies but is aligned with other recent data. Similarly, rates of maternal ICU admission, NICU admission, and transfusion increased, whereas the rate of neonatal death decreased. These findings extend our understanding of risks related to undertaking TOLAC in the modern era," wrote the authors of the study.

Interpregnancy Intervals of 24-29 Months Reduce Preterm Birth Risk, finds study

2025-03-13 - 2025-03

A new study published in BMC Pregnancy and Childbirth found that the interpregnancy interval (IPI) of 24-29 months decreases the risk of preterm birth, making it a crucial factor to consider in family planning and clinical guidance. This study was conducted by Xueheng and fellow researchers.
Systematic literature search was done in PubMed, Cochrane, Web of Science, and Embase through June 2, 2023. Studies included IPI and preterm birth outcomes data, with quality assessment based on the Newcastle-Ottawa Scale (NOS). A Bayesian network meta-analysis was carried out to establish the relationship between IPI length and risk of preterm birth. The meta-analysis comprised 34 studies involving data from 8,646,679 individuals, one of the largest reviews conducted so far on this issue.
Key Findin

• An IPI of 24-29 months was found to be the ideal interval with the least risk of preterm birth.

• Compared with IPIs of < 5 months, a 24-29 month IPI reduced the risk of preterm birth at:

• Less than 32 weeks of gestation (OR = 0.55; 95% CI: 0.50 - 0.62)

• Preterm birth less than 37 weeks of gestation (OR = 0.61; 95% CI: 0.59 - 0.63)

• Brief IPIs, particularly those of less than 5 months, were linked with a higher risk of preterm birth.

• The results highlight the need for spacing pregnancies to reduce unfavorable birth outcomes.
Intervals of less than 5 months are associated with a high risk of preterm birth, further supporting the importance of adequate counseling and advice for pregnant women. Best IPI guidelines should be incorporated by medical practitioners in prenatal and postnatal care to improve fetal and maternal health outcomes.
The study authors establish that 24-29 months of interpregnancy interval significantly decrease the risk of preterm birth, and it gives very important information for family planning and guidelines on maternal health. Birth spacing should be encouraged by healthcare professionals in order to avoid poor pregnancy outcomes and enhance neonatal well-being.

Nursing boss calls for community to tackle Norovirus spread

2025-03-12 - 2025-03

Another wave of norovirus is circulating in our communities and we must do all we can to help prevent the spread.
It is very important that we follow hygiene guidelines such as cleaning our hands as this will help keep those who are most vulnerable and my colleagues safe.
Hand hygiene is one of the most effective ways of preventing the spread of infection, not just during winter but all year round. This is to protect all of those in our hospitals and the community.
If you are visiting our hospitals, could I please remind you to help keep our patients and colleagues safe by: Always cleaning your hands using soap and water before and after contact with a patient; and not visiting if you have flu-like symptoms (cough, fever, cold), if you know you have COVID-19 or flu, or any other infections and diarrhoea and/or vomiting within the last two days.
Please ensure that you stay hydrated if you do get norovirus and also stay home for at least 48 hours after symptoms stop to prevent spreading it to others.
Staying as active as possible whilst patients get better from illness or injury in hospital is very important and can reduce recovery time.
We do all we can to help our patients get moving and I would like to thank all those who took part in a pilot study looking at improving mobility and strength to reduce the falls risk of our patients.
The three-month study 'Supporting Health Through Movement' took place on Ward 27 at Royal Shrewsbury Hospital.
Colleagues worked with Energize Shropshire, Telford & Wrekin, a charity which is part of the Active Partnerships Network and works with others to support people to have an active lifestyle, on the study which focused on patient mobility.
Patients took part in bed, chair and standing exercises and they were also provided with hand putty to help strengthen their dexterity along with resistance bands to promote strength.
It also means that when they go home or into the community if patients learn from what they have been shown in hospital they are less likely to be readmitted.

Early-life gut microbes may protect against diabetes, research in mice suggests

2025-03-06 - 2025-03

The microbiome shapes development of insulin-producing cells in infancy, leading to long-term changes in metabolism and diabetes risk, new research in mice has found.
The results could ultimately help doctors reduce the risk of type 1 diabetes -- or potentially even restore lost metabolic function in adulthood -- by providing specific gut microbes that help the pancreas grow and heal.
The critical window
Mice that are exposed to broad-spectrum antibiotics in early life have worse metabolic health in the long term, the researchers found. If the mice received antibiotics during a 10-day window shortly after birth, they developed fewer beta cells -- insulin-producing cells in the pancreas that regulate blood sugar. The antibiotic-treated mice also had higher levels of blood sugar and lower levels of insulin in adulthood.
"This, to me, was shocking and a bit scary," says June Round, PhD, professor of pathology at University of Utah Health and one of the senior authors on the study. "It showed how important the microbiota is during this very short early period of development."
By testing a variety of antibiotics that affect different types of microbes, the researchers pinpointed several specific microbes that increased the amount of insulin-producing tissue and the level of insulin in the blood. Intriguingly, one of these metabolism-boosting microbes is a largely unstudied fungus called Candida dubliniensis, which isn't found in healthy human adults but may be more common in infants.
Crucially, C. dubliniensis exposure in early life also dramatically reduced the risk of type 1 diabetes for at-risk male mice. When male mice that were genetically predisposed to develop type 1 diabetes were colonized by a metabolically "neutral" microbe in infancy, they developed the disease 90% of the time. Their compatriots that were colonized with the fungus developed diabetes less than 15% of the time.
Exposure to C. dubliniensis could even help a damaged pancreas recover, the researchers found. When researchers introduced the fungus to adult mice whose insulin-producing cells had been killed off, the insulin-producing cells regenerated and metabolic function improved. The researchers emphasize that this is highly unusual: this kind of cell normally doesn't grow during adulthood.
"One possibility in the far future is that maybe signals like these could be harnessed not only as a preventative but also as a therapeutic to help later in life," says Jennifer Hill, PhD, first author on the study, who led the research as a postdoctoral scientist in the Round Lab at the U. Hill is now an assistant professor in molecular, cellular, and developmental biology at University of Colorado Boulder.
If the benefits seen in mice hold true in humans, microbe-derived molecules might eventually help restore pancreatic function in people with diabetes. But Hill cautions that treatments that help beta cells regenerate in mice historically have not led to improvements for human health.
An immune system boost
The C. dubliniensis fungus appears to support insulin-producing cells via its effects on the immune system. Previous research had shown that immune cells in the pancreas can promote the development of their insulin-producing neighbors. The researchers found that mice without a microbiome have fewer immune cells in the pancreas and worse metabolic function in adulthood.
When such mice get a booster of C. dubliniensis in early life, both their pancreatic immune cells and their metabolic function are back to normal. And C. dubliniensis can only promote the growth of insulin-producing cells in mice that have macrophages, showing that the fungus promotes metabolic health by affecting the immune system.
The researchers emphasize that there are probably other microbes that confer similar benefits as C. dubliniensis. Their new findings could provide a foot in the door for understanding how similar health cues from other microbes might function. "We don't know a lot about how the microbiome is impacting early-life health," Hill says. "But we're finding that these early-life signals do impact early development, and then, on top of that, have long-term consequences for metabolic health."
Round adds that understanding how the microbiome impacts metabolism could potentially lead to microbe-based treatments to prevent type 1 diabetes. "What I hope will eventually happen is that we're going to identify these important microbes," she says, "and we'll be able to give them to infants so that we can perhaps prevent this disease from happening altogether."

New study finds alarming reason many babies are admitted to NICUs: 'Risks even at the low exposure levels'

2025-03-06 - 2025-03

Exposure to air pollution late in pregnancy dramatically increases the likelihood of newborns needing intensive care, according to a new study.
What's happening?
A U.S.-based research team linked the 2018 National Birth Registry neonatal intensive care unit (NICU) admission data for one-baby pregnancies to satellite and modeled air pollution levels in the months leading up to the births.
The team found that higher ambient levels of two common traffic-related pollutants, nitrogen dioxide and fine particulate matter, increased the likelihood of NICU admissions significantly - by 30-35% for nitrogen dioxide and by 11-22% for fine particulate matter.
"A major strength of our study was that we conducted a comprehensive population-based examination of exposure to air pollutants across seasons for the entire U.S. with approximately 3.6 million singleton births in 2018," the study's authors said. "Compared with global levels, the U.S. has relatively low air pollution, but the enhanced resolution of our exposure assessment allowed us to demonstrate risks even at the low exposure levels experienced."
Why is this study important?
This study adds to a growing body of research examining how different pollutants affect pregnant women and their babies.
For instance, U.S. Right to Know, a nonprofit public health research group that summarized the newest study, pointed out that another 2019 paper discovered that exposure to fine particulate matter (PM2.5) in the week before birth was linked to a 16% to 147% higher risk of the babies having to stay longer in the NICU.
Likewise, a recent global study found that exposure to airborne toxic particles during pregnancy increases the risk of newborns being underweight. The researchers also identified "stark regional variations" regarding the impacts of pollutants on fetal development.
Meanwhile, several other studies have revealed that exposure to microplastics also threatens healthy pregnancies. For instance, one research team discovered a possible correlation between the ingestion of these tiny plastic particles and gestational diabetes mellitus.
What's being done about air pollution?
Reducing the amount of gas-guzzling cars on the road can help, as they produce pollutants like nitrogen dioxide, carbon monoxide, carbon dioxide, hydrocarbons, benzene, and formaldehyde, according to Washington's Department of Ecology. This tactic can also help us curb the overheating of our planet, as carbon dioxide is a major contributor to climate change.
Plenty of places around the world are working on such tactics. Wales is already working to reduce roadway traffic by banning most new roadway projects. Meanwhile, Scotland is turning many urban neighborhoods into "20-minute cities" to give residents better access to public transit. One New York City law will require all Lyfts and Ubers to be EVs by 2030.
You can make a difference by changing how you get around, too. Try cycling more, using public transit when available, or walking.

Fathers Engagement in Surgical NICU and Support Strategies

2025-03-05 - 2025-03

Previous studies on fathers' involvement in the neonatal intensive care unit (NICU) care focused on qualitative methods, which are time- and resource-intensive.

Researchers conducted a prospective study to assess fathers' involvement in a surgical NICU using a novel tool, identifying key facilitators and barriers to their participation.

They conducted a single-center prospective cohort study at a surgical NICU using the Fathers' Involvement Questionnaire: Neonatal Intensive Care Unit (FIQ:NICU) with four sections. They collected data via REDCap and reported involvement scores for individual items, subscales (Physical Contact, Verbal Interaction, During Procedures, Cares/Feeding, Participation in Rounds), and total score (0-92). They analyzed associations between subscales, total FIQ scores, and confidence levels using bivariate correlation (Pearson's r).
The results showed that 32 fathers participated, with total FIQ: NICU scores ranging from 20 to 74 (M = 55.1, 95% CI 49.9-60.2, SD = 14.24). Involvement was highest in 'During Procedures' (M = 2.88, SD = 1.00) and lowest in 'Cares/Feeding' (M = 1.67, SD = 0.83). All fathers (100%) reported partner support as a facilitator, followed by nurses (71.9%). The most reported barriers were lines and tubes (46.9%), followed by work commitments (34.4%).
Investigators found that support from healthcare professionals, psychologists, and peers increased fathers' involvement in their neonate's care in SNICU.

Oman achieves historic conjoined twin separation

2025-03-04 - 2025-03

Muscat: The Sultanate of Oman has achieved a significant medical milestone by successfully performing the first separation of Omphaloischiopagus conjoined twins. This rare condition involves twins sharing a pelvic region, with connections in their intestines, urinary system, and blood vessels. The complex operation, lasting 19 hours, represents a triumph of medical expertise and collaboration. The Omani twins are now receiving intensive medical care, and their health is steadily improving.
The operation was conducted under the direct supervision of His Excellency Dr. Hilal bin Ali Al Sabti, the Minister of Health. A highly skilled medical team, comprising specialists from various fields, including surgeons and medical personnel from the Royal Hospital, Khoula Hospital, the Medical City Hospital for Military and Security Services, and Nizwa Hospital, 1 worked in close coordination. Their efforts were guided by an advanced medical plan designed to ensure the best possible outcome. This operation required a comprehensive and integrated approach, drawing upon the expertise of specialised Omani teams across numerous surgical and supportive medical disciplines. This achievement reflects the advancement of healthcare services within the Sultanate of Oman. The procedure involved delicate stages, beginning with thorough assessments and surgical preparations, followed by the separation and tissue reconstruction, and concluding with post-operative care and intensive medical monitoring to ensure the twins' recovery and stability. This medical success marks a landmark moment for Oman's health sector, demonstrating the capability of Omani professionals to perform highly complex surgical procedures to international standards, thereby enhancing Oman's standing in the field of advanced surgery.
Dr. Mohammed Jaafar Al-Sajwani, Senior Consultant Paediatric Surgeon at the Royal Hospital and head of the Siamese twin separation team, emphasised the rarity of conjoined twins, noting that many children do not survive due to congenital abnormalities. He highlighted the particular complexity of pelvic conjoined twins, especially in girls, due to the intricate network of organs in this area. The team had been monitoring the case throughout the pregnancy and decided to undertake the operation within Oman. The birth proceeded smoothly, and the twins were transferred to the neonatal intensive care unit. Over the preceding 11 months, the team addressed numerous challenges through meticulous preparations, including detailed meetings and imaging studies to map the twins' shared anatomy. Dr. Al-Sajwani attributed the success of the 7th February operation to the expertise and skills of Omani specialists.

Call for public consultation: Target product profile for tests of neonatal sepsis and possible serious bacterial infections in newborns and young infants

2025-02-19 - 2025-03

Infections among young infants (0-59 days old) including newborns (0-28 days old) are a major cause of mortality and must be identified and treated quickly and adequately to ensure survival and minimize morbidity. An estimated 2.3 million newborns die each year. Low- and middle-income countries bear the greatest mortality burden, with neonatal sepsis being a major contributor in these settings. In 2018, an estimated 15% of all newborn deaths globally were due to sepsis, a common outcome of unmanaged possible serious bacterial infections. Due to the need for early intervention and the lack of diagnostic tools, empirical antibiotic therapy is commonly included in sepsis protocols and results in the overuse of antibiotics. Inappropriate use of antimicrobials is a major contributor to rising antimicrobial resistance globally.

The aim of this target product profile (TPP) is to provide guidance for the development of tests that will enable early and accurate detection of sepsis or exclusion thereof, to ensure appropriate management and antibiotics administration in young infants, including newborns, with the aim of improving patient outcomes, decreasing health-care costs, and supporting antimicrobial stewardship.

Research suggests common viral infection worsens deadly condition among premature babies

2025-02-24 - 2025-03

Researchers say they found that infection with a common virus that can be transmitted from mother to fetus before birth significantly worsens an often-fatal complication of premature birth called necrotizing enterocolitis (NEC) in experiments with mice.
The research team, led by Johns Hopkins Children's Center investigators and funded by the National Institutes of Health, says the new findings advance the search for better treatments for NEC -- a relatively rare condition, but still the most common emergency intestinal complication in preemies.
A report on the study published Feb. 13 in Cellular and Molecular Gastroenterology and Hepatology.
"NEC is the most important disease that most people have probably never heard of. The impact of this disease on premature infants and their families is great, and is made worse by the fact that people often hear about NEC for the first time only after their loved one is diagnosed with it. Surprisingly, we often don't actually know what causes NEC in the first place. By identifying its connection with cytomegalovirus infection, we have now identified an important trigger for NEC, which could save the lives of premature infants who develop this condition," says David Hackam, M.D., Ph.D., Garrett Family Professor of Pediatric Surgery at the Johns Hopkins University School of Medicine and surgeon-in-chief and co-director of Johns Hopkins Children's Center.
Up to nearly 10% of premature infants develop NEC, a disease characterized by severe inflammation of the intestinal lining that ultimately kills this tissue. About a third of babies with NEC ultimately die from it, and survival rates have remained unchanged over the past three decades.
Recent research in animals, Hackam says, has shown that NEC's trademark inflammation is at least partly due to a persistent uptick in an immune protein called toll-like receptor 4 (TLR4), which becomes activated by the abnormal accumulation of specific intestinal bacteria that tend to overgrow in the digestive tract of premature infants. But why NEC is more severe in some babies and tends to be spreadable has been a mystery.
That led to CMV as a suspect, Hackam says.
An estimated 40% to 80% of people worldwide are chronically infected with cytomegalovirus, a virus in the herpes family that doesn't usually cause symptoms in healthy people but is a common cause of hearing loss and other organ-damaging birth defects when transmitted from mother to fetus during pregnancy. Fetuses acquire CMV from infected mothers during gestation in 30%-50% of cases.Suspecting a connection between CMV and NEC severity, Hackam and his colleagues developed a neonatal mouse model of NEC with CMV. When they compared the intestines of the rodents with and without CMV infection, they found that mice harboring CMV had significantly worse tissue damage and higher mortality rates compared to those without this virus.
Searching for a molecular mechanism for this outcome, the researchers compared gene activity in the intestines of the two groups of mice. They found that CMV infection triggered genetic pathways that encouraged inflammation, disrupted metabolism and prompted cells to make more TLR4.
A closer look showed that CMV also damaged mitochondria, organelles that serve as cells' energy factories. The damage significantly decreased mitochondrial production of adenosine triphosphate (ATP), a molecule that cells use for fuel. Further experiments with mouse tissue, Hackam noted, showed that TLR4 was necessary for each of these effects. Mice genetically altered to produce no TLR4 in their intestines, for example, had significantly lower NEC severity even with CMV infection, suggesting that this protein could be a good target for developing drugs against NEC. If animal and human studies confirm the CMV-NEC connection, another treatment option might be to administer adenosine, Hackam explains, a precursor for ATP that's commonly sold as a dietary supplement. When the researchers gave mice with NEC and CMV adenosine, it significantly reduced NEC severity. The team plans to investigate these ideas in future studies.

What Have Been Some Recent Advancements In Neonatal Care? Know From A Doctor

2025-02-27 - 2025-02

Neonatal care: Neonatal care is a specialised care offered to sick or premature babies in a hospital's neonatal unit. It has seemingly undergone significant changes in recent years, leading to remarkable improvements in the survival rates of full-term and premature infants. In this article, we discuss the treatment options and technologies that have been transforming the landscape of neonatal care, ultimately saving the lives of millions of babies with serious health complications after birth. According to Dr Anish Pillai, lead consultant-neonatology and paediatrics, Motherhood Hospitals, Kharghar, Navi Mumbai, the integration of advanced medical technologies has become a relieving factor for both parents and care providers. Neonatologists are now better-equipped to ensure that infants with various ailments at birth recover effectively and achieve developmental milestones according to their age.
Understanding The Advancements In Neonatal Care
Advanced Antenatal Care
Dr Pillai states that improvement in antenatal care during pregnancy, along with regular high-quality scans can detect most congenital defects prior to delivery. This prepares the family and medical team to anticipate and treat complications in a more comprehensive manner. Timely identification and management of risk factors during pregnancy can also reduce the burden of prematurity.
Delivery Room Advances
Recent evidence has shown that for all stable term and preterm babies, umbilical cord clamping after birth should be delayed for 60-120 seconds. This provides some vital extra blood to the newborn baby, thus reducing the chances of anaemia later in childhood. Keeping the baby on the mother's chest soon after birth will improve the baby's temperature regulation, breastmilk supply and keep the baby comfortable. Skin-to-skin contact colonises the newborn baby with 'friendly' bacteria, which is helpful for the immune response.
Advanced Respiratory Support
Many premature babies are born with respiratory issues and require immediate ventilation management. Innovations like high-frequency oscillatory ventilation and advanced non-invasive techniques have significantly improved respiratory support strategies; enhancing outcomes for neonates with breathing difficulty.
Nutrition Innovations
Adequate nutrition is vital for the healthy growth and development of premature infants. Innovations such as breast milk banks and human milk-based fortifiers cater specifically to their nutritional needs, ensuring that every infant receives the best possible start in life. Even babies who are too sick to tolerate mother's milk can be given parenteral nutrition using umbilical lines and infusion pumps. Growth monitoring tools in mobile apps have made tracking of baby's growth and development easy.
Telemedicine
Telemedicine has transformed neonatal care by allowing healthcare professionals to monitor the health of premature infants remotely. Parents can seek expert help conveniently, reducing the need for long-distance travel and enabling timely interventions.
Family-Centred Neonatal Intensive Care Unit (NICU)
The NICU model emphasises family-integrated care, recognising the importance of parental involvement in the baby's healing process. This approach creates a nurturing environment for infants, incorporates rigorous protocols, and enhances infection control measures, leading to better neonatal outcomes. Family centered care improves the baby's stability, weight gain and breastmilk feeding. It also reduces parental stress and anxiety.
Advanced Diagnostics
Recognising medical conditions in a timely manner provides prompt treatment to the babies. With the availability of PCR-based tests and genetic panels, paediatricians have more options to improve the diagnosis and treatment of sick neonates, the doctor explains.
Parental Support Programs
The expert adds that recognising the emotional toll of having a sick or premature infant, many neonatal care units are incorporating mental health support services for parents, providing counseling and resources to help them cope. Various national and international parent support groups are also available for parents needing such support.
Long-Term Follow-Up Care
Enhanced follow-up care programs are being established to monitor the neurodevelopment and health of infants after discharge from the NICU, ensuring any issues are addressed early. The neurodevelopmental program involves a multi-disciplinary team including paediatrician, pediatric neurologist, physiotherapist, occupational and speech therapist. Their systematic approach ensures the holistic well-being of the newborn throughout their childhood.

Cold treatment does not appear to protect preterm infants from disability or death caused by oxygen loss

2025-02-25 - 2025-02

Lowering the body temperature of preterm infants (born at 33 to 35 weeks of pregnancy) with hypoxic ischemic encephalopathy (HIE) -- a type of brain damage caused by oxygen loss -- offers no benefits over standard care, according to a study funded by the National Institutes of Health (NIH). Previous studies of near-term and term infants (born after 36 weeks) with HIE found that this cooling treatment, which lowers body temperature to about 92 degrees Fahrenheit, significantly reduced the risk of death or disability by age 18 months (corrected for prematurity). However, the current findings show that such benefits are not observed for preterm infants with HIE. The authors noted that use of the cooling treatment in preterm infants has increased, despite little research on its effectiveness in this age group.

Bottling a mouse 'superpower' may heal lungs damaged by premature birth

2025-02-24 - 2025-02

Understanding resilience -- the ability of injured lung tissue to heal and regenerate -- may be key to advancing the treatment and prevention of life-threatening lung disease that occurs in extremely premature babies, a new study suggests.
Using a four-dimensional microscopy technique, researchers at Vanderbilt University and Vanderbilt University Medical Center have created 3D video images of mouse lung tissue grown in the laboratory. What they have learned has been nothing short of groundbreaking.
"For the first time, we've been able to live-image the lung as it forms, and quantify and measure those cellular movements that come together to make an organ with a surface area large enough for gas exchange," said Jennifer Sucre, MD, associate professor of Pediatrics and Cell and Developmental Biology.
The group's findings, published Feb. 24 as the cover article in JCI Insight, the journal of the American Society of Clinical Investigation, represent a significant step toward improved treatment and prevention of bronchopulmonary dysplasia (BPD), which occurs in about 50% of infants born two to four months prematurely.
"If we can understand how the lung forms, then we have a blueprint for how to grow new lungs after injury," said the paper's first author, Nick Negretti, PhD, a senior post-doctoral fellow in the Sucre lab who co-led the research.
"Mice have an extraordinary ability to repair the lung," said Sucre, the paper's senior author, who directs the Biodevelopmental Origins of Lung Disease (BOLD) Center at VUMC. "I want to give babies the superpower of the mouse."
Premature babies with BPD require oxygen and mechanical ventilation in the early days after birth to help them breathe. Oxygen therapy is a double-edged sword, however, because it also can damage delicate lung tissue. Though many premature babies can be weaned off the ventilator after a few days, they are at increased risk for developing serious breathing problems later in life, including chronic obstructive pulmonary disease.
Respiration -- the exchange of oxygen for carbon dioxide -- occurs in the alveoli of the lungs across a fragile basement membrane between epithelial cells and blood vessels. According to the traditional view of lung development, ingrowing septa (dividers) emerge from a layer of epithelial, endothelial and mesenchymal cells to divide airspaces into the alveoli.
But when the researchers imaged slices of living neonatal mouse lung over three days, a different view emerged, one of a ballooning outgrowth of epithelial cells supported by a ring of myofibroblasts, or cells that promote tissue formation.
The innovative technology implemented by the Sucre lab allows for testing and identification of the specific molecules and pathways that guide this process. It also is a discovery tool for drugs that can promote tissue regeneration after injury.
Sucre said her lab is "keen to understand … what are the pathways in the resilient (mouse) lung that can repair it after infection and injury? How do we bottle that?"

Labor's $8.5 billion Medicare boost to deliver 400 more nursing and midwifery scholarships and bulk-billing for all Australians

2025-02-24 - 2025-02

The Australian Nursing and Midwifery Federation (ANMF) has welcomed the Albanese Government's $8.5 billion Medicare investment, announced yesterday, which will fund 400 extra nursing and midwifery scholarships and increased access to bulk-billing.
If re-elected, Labor will expand its GP bulk-billing incentive payments, currently only applied to children under 16, pensioners, and concession card holders, to all Australians from 1 November 2025. It says this will lead to 9 out of 10 GP visits being bulk-billed by 2030, tripling the current number of fully bulk-billed practices to about 4,800 nationally.
On top of the bulk billing incentive, fully bulk-billing practices will receive an extra 12.5% loading payment on their Medicare rebates.
Altogether, the Bulk Billing Practice Incentive Program will mean that a metropolitan GP clinic that bulk-bills all adults will see their Medicare rebate climb almost two-thirds higher for a standard GP consultation - increasing from $42.85 to $69.56. The same consult at a regional or rural practice will almost double, rising from $42.85 to $84.86, depending on location.
The government says its record Medicare investment will deliver an additional 18 million bulk-billed visits each year and save patients $859 million a year by 2030.
Describing the investment as "the biggest boost to Medicare in its history" at yesterday's announcement in Launceston, Prime Minister Anthony Albanese said the plan would guarantee access to healthcare for all.
"One card guarantees it all. One card covers it all. Not your credit card - your Medicare card," he said.
Labor's $8.5 billion Medicare commitment, which the Coalition has agreed to match, also includes $617 million to produce more nurses and doctors. The investment includes $10.5 million over two years for 400 additional scholarships for nurses and midwives to undertake postgraduate study to extend their skills and qualifications and attain endorsement as a nurse practitioner or endorsed midwife.
"We know that highly skilled nurses and midwives are a critical part of the solution to fix the current problems in our health system and to ensure it can meet the needs of all Australians now and into the future," ANMF Federal Secretary Annie Butler said.
"We continue to call on the government to support the work of nurses and midwives, allowing them to work to their full scope of practice and delivering best health outcomes across the community."
The ANMF welcomed the boost to Medicare amid ever-increasing cost of living pressures, saying that more bulk-billing services will not only save Australians money by enabling them to access timely care when they need it.
"Medicare has been the pillar of universal healthcare for all Australians, but after 40 years it needs renewal to ensure it meets the needs of today's population," Ms Butler said.
"If people can access affordable care when they need it they will be less likely to end up in already overstretched emergency departments, helping to take pressure off our health system."

New blood test accurately predicts preeclampsia

2025-02-12 - 2025-02

"The placenta is not something we can biopsy during pregnancy, but we believe it is integral to developing preeclampsia," said Dr. Swati Shree, a UW Medicine OB-GYN and co-corresponding author of the paper. "Doctors do look at clinical risk factors, which can work reasonably well, but it still misses a fair amount of people."
Preeclampsia is a pregnancy complication characterized by high blood pressure (hypertension) or organ dysfunction. It typically occurs in the third trimester. The condition's exact cause is unknown, but doctors suspect it is related to an abnormal interaction between the placenta and the mother's blood vessels.
Traditionally, doctors tried to discern a pregnant woman's risk based on her patient history. Risk factors for preeclampsia include first pregnancy, history of preeclampsia, history of hypertension or chronic kidney disease or both. Sometimes, however, preeclampsia develops in the absence of any of these pre-existing conditions.
Researchers have known for at least two decades that the placenta sheds DNA into maternal blood. Labs have been able to extract cell-free DNA, sequence it and use the sample to screen for fetal abnormalities such as Down syndrome.
Earlier, this testing was shipped to outside labs for processing, but in 2017, UW Medicine started doing these tests in house, one of the first healthcare systems to do so, Shree added. UW Medicine and Fred Hutch Cancer Center teams collaborated in developing the idea to use cell-free DNA sequence data to screen for pre-eclampsia, Shree said.
Over the past two years, the investigators, led by Shree and co-corresponding author Gavin Ha, a computational biologist at Fred Hutch, used this data, which functions as a liquid biopsy, from the first trimester of pregnancy for over 1,000 pregnant individuals to develop and then validate their test.
"The innovation in this tool reinforces how important it is. Liquid biopsy tests were pioneered in pregnancy health research and is now an emerging research area in oncology," said Ha. "There are similarities in the genes we're looking at in both areas of research, which makes this study a collaboration which bridges both fields."
The samples were collected between 2017-2023. The researchers found that their approach, which uses signals stored within circulating cell-free DNA sequence data, had 80% sensitivity at predicting whether a pregnant individual would experience preterm preeclampsia or not.
Shree said that the next steps would be to improve the training model with more samples, and ultimately to conduct a trial that includes thousands of patients. The researchers hope a test like this could become an early preeclampsia prediction tool that seamlessly integrates into routine early pregnancy screening.
"Although using liquid biopsies for human diseases is largely used in the cancer area, given the frequency at which cell-free DNA screening is performed, prenatal biology truly has incredible opportunities for the discovery and application of innovative tools," she said.

Air pollution exposure late in pregnancy increases NICU admission risk

2025-02-14 - 2025-02

The researchers focused on common pollutants, such as nitrogen dioxide (NO2), which is caused primarily by the burning of fossil fuels in vehicles, industrial processes and power plants, and PM2.5, which refers to fine inhalable particles with diameters that are generally 2.5 micrometers and smaller. They also studied ozone (O3), which is a secondary pollutant that is formed from oxygen and other gases in the presence of sunlight.
The findings, published in January in the Nature journal Scientific Reports, show that newborns exposed in the last month of pregnancy to higher levels of NO2 have a 30-35% higher risk of NICU admission and an 11-22% increased risk associated with PM2.5.
"Our findings highlight the critical impact of air pollution during the final weeks of pregnancy, a time of heightened fetal vulnerability, and emphasize the significance of addressing air pollution exposure, even at lower levels," says the study's first author, Yohane V.A. Phiri, PhD, a postdoctoral research associate in the Department of Epidemiology and Environmental Health in UB's School of Public Health and Health Professions.
Exposure to air pollution during pregnancy has been linked to several adverse neonatal outcomes including birth defects, preterm delivery and altered fetal growth, according to Phiri.
"While our findings are not causal, limiting direct inference, they support local and national initiatives aimed at further reducing air pollution and improving air quality," he said. "Such efforts could ultimately benefit pregnant women by minimizing exposure to harmful pollutants and reducing associated neonatal health risks."
Despite advancements in maternal and child health care, NICU admissions remain high in the U.S., with 8.1% of infants admitted in 2018, the year on which the study is focused. And while the U.S. has relatively low air pollution levels compared to other countries, air pollution's impact on NICU admissions remains an understudied area, according to Phiri.
The study, he adds, was designed to assess the impact of air pollution exposure on NICU admissions across the United States using satellite-derived data, which allows for more comprehensive coverage that can also include areas that lack ground-based monitoring, such as rural parts of the country.
The research team grouped data by regions of the U.S. For example, the Great Plains area saw a lower risk of NICU admissions, a finding that could be attributed to the fact that the risk is underestimated given that infants in more rural parts of the country are transferred to a NICU only for severe complications due to limited access of such units in these areas.Findings varied by pollutants and geographic region.
"We saw the strongest risks with NO2 and intermediate risks with PM2.5," Phiri said, adding that ozone results showed either a protective effect or no difference among groups, except for during the summer.
Geographically, the Midwest and Mid-Atlantic regions had the highest odds of NICU admission due to NO2 exposure. For PM2.5, seasonal variations were noted, with persistent risks along the West Coast and in the Southeast. Summer saw widespread risks, while winter risks were highest in the Northeast, Phiri said.
The research team included senior author Pauline Mendola, PhD, chair and professor, and Jing Nie, PhD, research assistant professor and research scientist, both of the Department of Epidemiology and Environmental Health at UB; and researchers from the University of Maryland and the University of Massachusetts Amherst.

Shaping the future of care - ANMF priorities 2025: Nursing and midwifery workforce reform

2025-02-11 - 2025-02

The Australian Nursing and Midwifery Federation (ANMF) is focused on driving meaningful change in 2025 to ensure better conditions for nurses, midwives, careers, students and to meet the health and aged care needs of the community
Recognizing the critical milestones we have already achieved like wage increases and mandated care minutes, we know progress is possible.
The ANMF's vision is to priorities reforms that support recruitment and retention, empower nurses and midwives to work to their full scope of practice to ensure accessible and affordable healthcare, and deliver improved outcomes for women.
The ANMF remains committed to the development of strategies to: enhance the recruitment of nurses and midwives, especially new graduates; reduce undergraduate attrition; and address workforce retention.
Unsustainable workloads are a key driver of the workforce crisis. The ANMF is advocating for a range of strategies to improve retention, including: increasing nurse practitioner positions, boosting the nursing and midwifery workforce through scholarships, increasing support for continuity of care models, improving clinical placements, and increasing support for RUSON and RUSOM models of care, and exploring financial incentives like allowances.
After years of lobbying by the ANMF, recent introduction of Commonwealth Prac Payments for nursing and midwifery students from 1 July 2025, may help stem undergraduate nursing and midwifery student attrition. The $319.50 a week (means-tested) provides some financial support for students while undertaking their 800 hours unpaid mandatory clinical placement.
The much-awaited National Nursing Workforce Strategy is due to release its report in 2025. The strategy will provide a national approach to shape the future of nurse workforce planning, investment and reform in Australia. The strategy has come out of the Nursing Supply and Demand (2023-2025) study which found unsurprisingly that our supply of nurses will not meet future demand.
Similarly, the Midwifery Futures report, commissioned by the Nursing and Midwifery Board of Australia (NMBA), exposes widespread staffing shortfalls, especially in non-metropolitan areas. The report makes 32 recommendations including in the scale-up of midwifery models of care. This includes to attract, educate, and retain the Aboriginal and Torres Strait Islander midwifery workforce and maintain ongoing initiatives such as Birthing on Country programs.
Both complement other government blueprints including the Nurse Practitioner Workforce Plan, Independent Review of Overseas Health Practitioner Regulatory Settings, and Unleashing the Potential of our Health Workforce (Scope of Practice) Review in how to tackle our critical workforce challenges.

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Shaping the future of care - ANMF priorities 2025: Nursing and midwifery workforce reform