Why we need a new model for parent education

Family-centered care is a model gaining popularity in NICUs across the country.  Traditionally, babies are treated as patients and parents are viewed as visitors while their babies are in the hospital.  But with the family-centered care approach, parents are given unrestricted access to the NICU, are encouraged to be highly involved in their baby’s care and are communicated with regularly about their baby’s condition and treatment.  Many NICUs have rooms where parents can stay the night, or private rooms where parents can more easily engage in activities like breastfeeding and Kangaroo Care.  Some NICUs even go as far as inviting parents to participate in daily rounds in which doctors and nurses discuss and decide on the baby’s treatment plan for the day.

The goal of family-centered care is to strengthen the family unit and to empower parents with the knowledge and support they need to nurture and guide their child’s development, both in the NICU and after the baby comes home.  The benefits of this approach are clear.  A pilot study at a hospital in Canada found that babies cared for through family-centered care were discharged three to five days sooner than babies in traditional programs, gained weight 25% faster, and 80% of them were successfully breastfeeding by the time they went home.

Unfortunately, not all parents are able to participate in family-centered care.  Those who live long distances from the hospital, have other children at home, are teen mothers attending school, are low-income or who need to continue working while their baby is in the NICU are often not available to be highly involved in their baby’s care.  For these parents, other methods of support and education are critical.

Parent education for parents of preemies not only reduces stress and anxiety for parents, but also improves outcomes for the babies.  A study conducted in Norway showed that when parents of premature babies received just 11 hours of training, their children had higher IQ levels and fewer behavioral problems at age 3.  When parents are educated on important warning signs, when to consult a doctor and critical interventions, parent education can also save lives.  The problems is that often the people who need this information the most are typically the ones who are least accessible to receive it.

Pebbles of Hope is working to bridge this gap by providing educational materials for parents of premature babies around the world in a variety of formats, in multiple languages and through digital  platforms that can provide wide distribution.  Our goal is to ensure that all parents of preemies, regardless of where they live or whatever their family or financial situation may be, are empowered to take the steps necessary to ensure the best outcomes for their babies.  To learn more about Pebbles of Hope and our programs, visit our website at www.pebblesofhope.org, find and like us on Facebook or follow us on Twitter.

Parents can help their preemies even before they come home

When a woman gives birth to a child prematurely, it’s often the result of a sudden and unexpected pregnancy complication, leaving parents confused and overwhelmed with the emotional ups and downs that come with having a preemie.   It’s estimated that the cause of at least half of all premature births is unknown, which makes preventing prematurity a challenge.  Most of the time, after a preemie is born, the tiny baby is handed over to team of doctors and nurses who provide intensive care around the clock until the baby is discharged to come home.  During this time, many parents feel helpless, believing that there is little they can do to care for and nurture their newborn child.

In actuality, there are many things a parent can do to help their preemie even if the baby is weak and confined to an incubator.  Although the NICU doctors and nurses may be the primary caregivers to the baby during this time, parents still have a critical role in supporting their baby’s health.  Here are a few specific things parents can do to help their babies along in the journey towards coming home:

Provide breast milk early

While a baby is in the NICU, particularly if the baby is on a ventilator or in an incubator, breastfeeding is difficult and many times impossible.  However, making breast milk available for a preemie as early as possible is one of the best actions a mother can take to help her baby become healthy.  Ideally, if her baby is unable to breastfeed, a mother should begin pumping within an hour of birth to stimulate milk production and give her baby all the nutritional and anti-infection benefits of the early milk.  Research shows that premature babies fed breast milk early in life have a lower risk of infection and higher cognitive function as toddlers.  While fathers are not able to provide breast milk to the baby directly, they can still help this process by supporting the mother and encouraging her to continue pumping until the baby is able to nurse.

It’s no secret that pumping is hard.  Being attached to a machine is impersonal and lacks the physical connection with the baby that a mother gets through breastfeeding.  Plus, pumping is time-consuming and tedious.  But, it’s really the best thing a new mother can do for her premature baby.  Moms who provide breast milk for their preemies are doing something important, something nobody else can do for their little ones.

Talk to your baby

Simply hearing their parents talk and sing to them can have positive effects on preemies.   A recent study shows that premature babies exposed to higher word counts while in the hospital have higher cognitive and language abilities later in life.  Another study found that hearing their mother’s voice helps premature babies develop faster and have shorter hospital stays.  So, just by visiting and talking to your baby in the hospital as much as possible can improve the baby’s health, both in the hospital and later at home.

Provide the healing power of your touch

Babies in general, and preemies in particular, do a lot better when they are held and touched frequently.  Skin-to-skin contact between mother and newborn keeps the baby warm, improves circulation and promotes breastfeeding.  It also appears to improve cognitive function in premature babies throughout childhood.  Even if the baby is in an incubator and can’t be held, simply cupping your hands and placing them gently on the baby’s feet and head can help your baby feel calm and secure.  Once the baby comes home, parents can continue to provide the benefits of their touch through baby massage.  One study found that massaging preemies regularly may boost their immune system and help them gain weight more quickly.

Prepare the home for baby’s arrival

If your preemie is stable and progressing well in the hospital, then it’s time to go out and get the crib, set up the baby’s room and stock up on diapers.  Not only does preparing the home give parents a much needed respite from the stress of the NICU, it gives parents a sense of hope that their baby is indeed coming home.  As new entrants into the world, babies are more sensitive to their environments than adults.  Studies show that babies sense the state of mind of those around them.  A positive attitude, even in the face of what is an extremely stressful situation, can go a long way towards helping the smallest babies find the strength and the will to get better.

A Young Graduate’s Invention: Low-Cost Incubator to Save Thousands of Lives

By Sajib Mannan

James Roberts, a graduate from Loughborough University, won
this year’s James Dyson Award for his life-saving invention, a low-cost incubator called MOM.

James, 23, made this great invention that can save the lives of many babies, especially in places where essential medical facilities are unavailable for newborn children.

The MOM incubator costs less than $400 to manufacture while providing the same benefits as a regular incubator (which costs about $50,000).

James believes that his device will help in a tremendous way to offer necessary treatment to neonates in poorer countries where an average $50,000 incubator is unaffordable to many hospitals.

The incubator is easy to transport, useful and affordable. Because the device is inflatable, it can be collapsed to the size of a briefcase.

MOM is heated using its ceramic heating elements and includes a gauge that shows its temperature and humidity level. The heat and humidity of the unit can be controlled manually and adapted according to the baby’s age. An alarm goes off if there’s a change in temperature. It also includes an optional phototherapy unit to reduce illness caused by jaundice. The unit is collapsible and empowered with intelligent jaundice lightening. Jaundice is a common morbidity among premature babies.

The incubator can run on battery for up to 24 hours in the case of a power shortage, which is a common problem in low-resource areas. This device will play a great role in serving necessary medical services to newborns in hard-to-reach areas such as disaster zones and refugee camps.

James Roberts, who graduated this year with a BSc in product design and technology, was inspired to develop the device after watching a documentary film on newborn babies dying due to lack of incubation in refugee camps in Syria. After watching the documentary, he felt a strong will to develop something to help these and other similar children. Then he became so passionate that ended up selling his car to fund his first model. And that’s not all; he blew out his housemate’s hairdryer to test his device. (She didn’t know about that!)

James says he will be happy when in 10 years’ time he sees kids that have been saved by his invention. As the winner of the James Dyson Award, he will now receive £30,000 in prize money to make a better and low-cost prototype.

His incubator will undergo several extensive tests before it goes into mass production. James plans to travel India and Brazil to launch his life-saving device.

Pebbles of Hope congratulates James Roberts on developing this innovative device that could save thousands of preemie lives!

Premature birth in Bangladesh

By Sajib Mannan

According to a survey conducted by WHO, 26,100 infants die each year in Bangladesh due to premature birth which ranks Bangladesh 7^th amongst the top ten countries with the greatest number of premature births. Everyday, at least 70 premature infants die within 28 days of their birth. According to statistics collected from the Health Ministry of Bangladesh, an estimated 21,900 premature babies die within four weeks of their birth in Bangladesh.

Most of these infants die from diseases that are mostly curable. Mothers who are underweight or are suffering from obesity, diabetes, hypertension and fetal pregnancy complications are more likely to give birth to premature babies. Most of the women here in Bangladesh are not aware of the causes or risk factors that may lead to giving birth to a premature baby. Many of them don’t even consult a gynecologist during their pregnancy.

There aren’t enough medical facilities for the treatment of premature infants in Bangladesh. Officials of health services acknowledge that there are only 13 government hospitals and four medical colleges that have neonatal care units throughout the country. Many parents living in rural areas can’t even find a doctor to provide treatment for their premature babies.

Many of the premature babies in Bangladesh, as in many other parts of the world, suffer from lifelong physical and neurological complications. If more awareness could be raised about life-saving interventions and if proper medical facilities were more accessible, many infants wouldn’t have to lose their lives. Many who do survive could live a normal life and grow into adulthood like most other children.

But brighter days are on the horizon for Bangladesh and a day will come when no infant will die due to lack of medical facilities. The Director of Health Services, Dr. S A J Musa, says that by 2016 more neonatal care facilities will be opened in 29 hospitals and in four medical colleges.

Bangladesh now stands shoulder to shoulder with the world to fight against premature birth and is taking action to reduce its premature birth rate. Last November 17th, World Prematurity Day was observed for the first time in Bangladesh. On that day, ICDDRB ( International Centre for Diarrhoeal Disease Research, Bangladesh), UNICEF, WHO, Bangladesh Neonatal Forum, Bangladesh Perinatal Society, Saving Newborn Lives, USAID and Save The Children jointly organized a seminar where they discussedthe issues surrounding premature birth in Bangladesh. As a result of that seminar, the Ministry of Health and Welfare has promised to develop a strategic plan for program directors to provide steroid injections for women in preterm labor. With this significant step many premature babies can be saved and will have a chance to live a normal life.

How nutrition can help your preemie thrive

Nutrient intake during the first year of life greatly affects a baby’s overall health, growth, development and cognitive ability.  The stomachs of premature babies are smaller than a full-term baby’s, so it’s even more critical to make every drop of nutrition count.  For newborn preemies, breast milk is the best nutrition.  But to achieve the full amount of nutrients and calories they need for optimal growth, many preemies require supplementation with additional vitamins or an enriched formula specifically designed for premature babies.  Even once they advance to solid foods, these babies still typically need more nutrient-rich diets than their full-term counterparts during the early years of life.

Simply being born early puts preemies –even those born just a few weeks before their due date –at risk for health challenges later in life.  But with proper nutrition, most of these babies can thrive.  Here are a few ways in which proper nutrition can give preemies a boost towards a healthy life.

Accelerating growth

Babies born prematurely do not get the benefit of a full nine months in the womb, so they often have to work hard to “catch up” in growth and development after birth.   Without a full store of nutrients in their bodies when they are born, premature babies have a more difficult time achieving a proper nutrient balance.  To make matters worse, their digestive systems are immature and many preemies have underdeveloped muscles and reflexes that make it harder for them to be fed orally.  But, most of the time, preemies do “catch up” to their full-term peers once they are able to receive adequate nutrition.  Parents can help accelerate their preemie’s growth by ensuring their baby receives a balanced set of nutrients and sufficient calories without overfeeding.  This can be achieved by supplementing breast milk with vitamins or providing an enriched formula during the newborn period and providing healthy, nutrient-dense foods during the toddler years.  When these babies do grow appropriately, they become stronger and better equipped to tackle the developmental milestones that help them reach their full potential.

Optimizing brain development

The first three years of life are a period of incredible brain growth.  A child’s brain doubles in size during the first year and achieves 80% of its adult size by the age of three.  Proper nutrition is essential for normal brain development during these critical years.  Shortages of nutrients such as iron, iodine and zinc can impair cognitive and motor development, and these effects are sometimes irreversible.  Premature babies do not get the benefit of a full nine month’s worth of iron stores, so they can often experience iron deficiency after birth.  Many preemies will therefore need iron supplements for several months or even years, and can benefit from more iron-rich foods as toddlers.

Minimizing long-term health challenges

Unhealthy eating during the early years can contribute to health problems like obesity, diabetes and heart disease later in life.  Even during infancy, the foods babies eat can have a significant impact on long-term health.  A healthy nutritional intake during the first few years of life may also reduce the risk of developing food allergies and other noncommunicable diseases later on.  Low-income families, for whom access to healthy, nutritious foods may be limited, face a particularly challenging situation.  Food insecure children are more vulnerable to chronic health conditions, delayed development and are hospitalized more often than their food secure peers.

For these reasons and more, proper nutrition is critical for all babies, and preemies in particular, to help them get the best start in life.  This is why the first module of the Pebbles of Hope Thrive Guide will focus on nutrition.  Stay tuned for more updates on the progress of the Thrive Guide and learn more about ways to help the preemies in your life thrive.

Not all preemies are better off being born in the US

Half a million babies are born prematurely in the US each year. That equates to 1 out of 8, or 12% of all babies born every year. While the preterm birth rate in the US has been declining over the last few years, it still remains high. A 2012 report by the World Health Organization ranks the US 131st in the world in terms of its preterm birth rate, on par with Somalia, Thailand and Turkey.

Despite being the world leader in medical innovation with world class hospitals and state-of-the-art NICUs, the US doesn’t fare any better on infant mortality. This year, in the United States, more than 24,000 babies will take their last breath after only hours, days or months of life. That means 24,000 families will grieve the unfathomable loss of a child. This is what an infant mortality rate of 6 per 1,000 amounts to in a country with approximately 4 million babies born each year. While that may seem like a small number, consider that the US ranks 56th on infant mortality in comparison with other countries. In fact, babies born in the US have a lower chance of surviving their first year of life than babies born in Serbia, Cuba or Belarus. On a state level, Mississippi has an infant mortality rate on par with Botswana and worse than Sri Lanka and Uruguay, making it the state with the worst infant mortality rate in the US. Alabama, Louisiana and Tennessee aren’t much better.

The high infant mortality rate in the US is not because of a lack of specialists or facilities for newborns. On the contrary, America has more neonatologists and neonatal intensive care resources per person than Australia or Canada, but still has lower survival rates for infants of low birth weight. Racial, ethnic and socio-economic disparities in healthcare quality and access play a major role, but that’s only part of the story. While African-Americans have the highest preterm birth (16.5%) and infant mortality rates (11.5 per 1,000 births) of all racial groups, non-Hispanic white babies in the US die at a higher rate than in most other industrialized nations. Still, race and income-level are two of the leading factors that contribute to prematurity and infant mortality. Detroit, whose population is 84% black and where the poverty rate is three times that of the nation, has the highest preterm birth rate (18.2%) of any city in the US and has an infant mortality rate that is more than double the state and national average. The CIA’s latest world rankings indicate that an African-American baby would have a better chance of survival if born in China, Malaysia or Mexico than in the United States.

Why should we care about these statistics?
It is widely known that prematurity is the single largest cause of newborn death, so addressing prematurity could significantly improve our infant mortality figures. If the US could achieve an infant mortality rate at the level of Japan – the country that ranks best on this indicator – we could save more than 16,000 babies each year. For those babies that do survive prematurity, many of them suffer serious medical complications and lifelong challenges that cost the US economy $26 billion each year in medical care, educational costs and lost productivity.

What causes such poor health outcomes for American babies?
Among the factors contributing to these dismal statistics, and the reasons why minority babies are particularly at risk, include disparities in prenatal care, nutritional supplementation for pregnant women, and conditions that lead to unhealthy lifestyle choices such as smoking or unhealthy eating. Another factor is access to health insurance. Pregnant women without health insurance are less likely to receive prenatal care, and those who do not receive adequate prenatal care are more likely to suffer pregnancy complications, deliver preterm and have adverse outcomes after birth. In Mississippi, one of 26 states that have rejected the Medicaid expansion, 13% of its population is left without health insurance, and the majority of those affected are poor or are single mothers.

But, other factors beyond lifestyle choices and healthcare access also play a major role. These include education level, income, job security, working conditions, food insecurity, housing and the social safety net. Higher levels of stress for lower-income and minority women contribute to poor pregnancy outcomes, and for communities with high rates of teen pregnancy, preterm birth and infant mortality rates increase as well.

How can these outcomes be improved?
Some of the necessary changes are obvious. Increase access to early prenatal care, expand insurance coverage to the most vulnerable populations, and ensure mechanisms are in place to quickly get high-risk babies to the best medical facilities available with the proper resources and trained personnel to provide adequate care. All of these things are the role of governments and institutions to take care of. But, there are many things parents can do as well. Even in the most impoverished conditions, parents can ensure that their babies receive proper nutrition, that they keep their homes clean and free of smoke, that they practice safe sleep practices and that they learn how to recognize warning signs so that their babies can get the medical help they need in a timely manner.

That’s where Pebbles of Hope can help. We are developing multi-media materials to educate parents in low-resource areas on how to properly care for their preterm and low birth weight babies and to provide them with the information they need to make positive health choices for themselves and their children. As the wealthiest nation in the world, it’s our moral imperative to do more for our youngest citizens. All babies, regardless of where they are born, deserve a chance at a healthy life.

Simple interventions could save hundreds of thousands of babies

Premature birth is the world’s largest killer of newborn babies. Each year, more than 1 million preemies die, yet, 75% could be saved–without expensive, high technology care. In developed countries like the US and the UK, many people associate premature babies with high-tech neonatal intensive care units (NICUs), where specialized equipment, highly trained doctors and round-the-clock care help save the tiniest babies, some born as early as 23 weeks gestation. As a result, the mortality rate for premature babies in the developed world has declined dramatically over the last few decades. Read More