tag:theconversation.com,2011:/us/topics/premature-babies-29382/articlesPremature babies – The Conversation2024-02-08T13:38:26Ztag:theconversation.com,2011:article/2145432024-02-08T13:38:26Z2024-02-08T13:38:26ZBreastfeeding benefits mothers as much as babies, but public health messaging often only tells half of the story<figure><img src="https://images.theconversation.com/files/558172/original/file-20231107-19-cjfj8i.jpg?ixlib=rb-1.1.0&rect=23%2C23%2C7961%2C5303&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breastfeeding lowers the risk of diabetes as well as breast and ovarian cancers for mothers.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/smiling-mom-holding-her-baby-boy-in-her-arms-while-royalty-free-image/1370476365?phrase=black+mothers+breastfeeding&adppopup=true">Goodboy Picture Company/E+ via Getty Images</a></span></figcaption></figure><p>Four babies are born <a href="https://www.theworldcounts.com/populations/world/births">every second in the world</a>, and there are only two options for their first food at birth: human milk or formula. </p>
<p>Global and U.S. health authorities agree, however, that human milk provides the optimal nutrition for infants. The World Health Organization and the American Academy of Pediatrics <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommend exclusive breastfeeding</a> for the <a href="https://doi.org/10.1542/peds.2022-057988">first six months of an infant’s life</a>. Following the introduction of solid foods, these organizations recommend continued breastfeeding up to two years and beyond. </p>
<p>Human milk can be given to infants directly through breastfeeding or by pumping or expressing human milk into a cup or bottle. The health benefits of breastfeeding and human milk for infants stem from its composition, which includes <a href="https://www.aap.org/en/patient-care/newborn-and-infant-nutrition/newborn-and-infant-breastfeeding/">vitamins, minerals and antibodies</a> that can prompt its composition to change over time to meet the growing infant’s needs. The dynamic nature of human milk leads to commonly known benefits, such as <a href="https://doi.org/10.1111/apa.13151">lower risks of ear</a> and <a href="https://doi.org/10.1111/apt.14291">gastrointestinal infections among infants</a> who are breastfed. </p>
<p>However, there are other benefits for infants that many people aren’t aware of, as well as for the breastfeeding mother and society.</p>
<p>We are women’s health scholars with combined professional expertise in <a href="https://sc.edu/study/colleges_schools/nursing/faculty-staff/riversj.php">maternal obstetrics nursing</a> and <a href="https://sc.edu/study/colleges_schools/nursing/faculty-staff/feldert.php">public health</a>. Together, we co-founded <a href="https://www.instagram.com/mochamamasmilk/">Mocha Mamas Milk</a>, a research and support initiative focused on improving <a href="https://doi.org/10.1177/01939459211045431">breastfeeding among Black families in South Carolina</a>, a <a href="https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a3.htm">state where just 55.1% of Black infants are breastfed</a>, compared with 75.2% of white infants. </p>
<p>Human milk is personalized medicine that can benefit both the mother and infant. We are personally and professionally passionate about this because many people are not aware that some of these benefits can save lives and reduce persistent health disparities.</p>
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<figcaption><span class="caption">Breast milk provides benefits to the infant that no other food source can.</span></figcaption>
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<h2>Lesser-known benefits of breastfeeding for infants</h2>
<p>One significant benefit of breastfeeding not widely known by the public is its ability to lower the risk of <a href="https://www.childrenshospital.org/conditions/sudden-infant-death-syndrome-sids#">sudden infant death syndrome</a>, or SIDS. SIDS, sometimes referred to as “crib death,” is the unexplained death of a baby, usually under 1 year of age. </p>
<p>Some risk factors include stomach- or side-lying sleep, low birth weight, sleeping on a soft surface or overheating. A large analysis of studies found that infants who received any human milk for at least two months had nearly a <a href="https://doi.org/10.1542/peds.2017-1324">50% lower risk of SIDS</a>. </p>
<p>This reduction is notable for two reasons. First, the reduction in risk occurs about 60 days following birth, which is several months before the six-month exclusive breastfeeding guideline is met. Second, the protection from SIDS was the same for infants who were exclusively breastfed compared to infants who may have received formula in addition to any breastfeeding. </p>
<p>In addition, breastfeeding can <a href="https://doi.org/10.1016%2Fj.pcl.2012.09.008">significantly protect premature infants</a> – those <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">born before 37 weeks of pregnancy</a> – from developing a condition called <a href="https://www.ncbi.nlm.nih.gov/books/NBK513357/#">necrotizing enterocolitis</a>, an inflammation of the intestines that <a href="https://doi.org/10.3390/nu12051322">can be fatal</a>. While this condition is rare in full-term infants, it <a href="https://doi.org/10.1097%2FNNR.0000000000000483">occurs in 5% to 15% of preterm infants</a>.</p>
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<h2>Benefits for mom, too</h2>
<p>Breastfeeding also provides important benefits for the mother, such as reducing <a href="https://doi.org/10.1001/jama.294.20.2601">risks of diabetes</a> and <a href="https://doi.org/10.1016/s0140-6736(02)09454-0">breast</a> and <a href="https://doi.org/10.1001/jamaoncol.2020.0421">ovarian cancers</a>. Breastfeeding for any length of time compared to never is associated with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855244">10% decrease in hormone receptor-negative breast cancers</a>, which are more common in younger women. These cancers cannot be treated with hormonal therapy and <a href="https://www.cancer.org/cancer/types/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-hormone-receptor-status.html">often grow faster</a> than the more commonly diagnosed hormone receptor-positive breast cancers. </p>
<p>The reduction in risk from breastfeeding is even greater for Black women, who are more likely to be diagnosed with these hormone receptor-negative breast cancers and <a href="https://doi.org/10.1158/1055-9965.EPI-20-1784">have worse prognoses and fewer treatment options</a>. Any way of reducing the risk for Black women is critically important because, compared to white women, Black women are 40% more likely to die from breast cancer, <a href="https://www.cancer.org/research/acs-research-news/breast-cancer-death-rates-are-highest-for-black-women-again.html">yet 4% less likely to be diagnosed </a> with the disease.</p>
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<figcaption><span class="caption">Tisha Felder explains the vision behind Mocha Mamas Milk to help improve the way that Black mothers think about breastfeeding. Figures presented in the 2021 film were from the National Immunization Survey, 2011–2015.</span></figcaption>
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<p>There is also growing research suggesting the positive impact of breastfeeding on a mother’s mental health. One possible reason for this is that <a href="https://www.yourhormones.info/hormones/oxytocin/">oxytocin</a> – often <a href="https://www.health.harvard.edu/mind-and-mood/oxytocin-the-love-hormone">called the “love hormone” because of its association with bonding</a> – plays a <a href="https://doi.org/10.1016%2Fj.ijnss.2019.09.009">role in the maternal-infant bonding process</a>. </p>
<p>After delivery, the release of oxytocin causes human milk to flow – a process called the <a href="https://www.ncbi.nlm.nih.gov/books/NBK148970/#">letdown reflex</a> – and initiate breastfeeding. This release of milk can satisfy the new baby and leave the mom with “warm and fuzzy” feelings toward her baby. Research also suggests that breastfeeding can <a href="https://doi.org/10.1017/s0033291713001530">reduce the risk of depression </a>. A 2021 study also found that the longer a woman breastfed, <a href="https://doi.org/10.1111/phn.12969">the lower her risk for postpartum depression</a>. </p>
<h2>Closing racial gaps</h2>
<p>Despite the benefits of breastfeeding to both infants and mothers, few U.S. families are able to sustain breastfeeding over time. The Centers for Disease Control and Prevention 2022 Breastfeeding Report Card – the latest data that is currently available – shows that more than 80% of infants start out receiving human milk, yet just over a quarter of them <a href="https://www.cdc.gov/breastfeeding/pdf/2022-Breastfeeding-Report-Card-H.pdf">are exclusively breastfed through six months</a>.</p>
<p>Black infant-mother pairs not only have the lowest breastfeeding rates in South Carolina, but they also have the lowest rates nationally, compared to other U.S. racial and ethnic groups. More recent data from the National Vital Statistics System of U.S. infants born in 2020 and 2021, shows that <a href="https://www.cdc.gov/pcd/issues/2023/23_0199.htm">only 74.5% of Black infants were breastfed</a>, compared with non-Hispanic Asian infants (90.1%), non-Hispanic white infants (84.0%) and Hispanic infants (86.8%), based on analysis of birth records collected by the CDC. </p>
<p>Black infants are also more likely <a href="https://www.ncbi.nlm.nih.gov/books/NBK513376/">to die from SIDS</a> and to be born prematurely. So <a href="https://www.contemporarypediatrics.com/view/breastfeeding-least-2-months-provides-sids-protection">increasing breastfeeding among Black families</a> could lead to saving significantly more Black infant lives. </p>
<p>The Southeast U.S. is where the <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7021a1.htm?s_cid=mm7021a1_w">widest racial gaps in breastfeeding exist</a>. In addition, infants living in Southern states are <a href="https://doi.org/10.1038%2Fs41372-022-01535-x">less likely to achieve national goals for breastfeeding</a> at 6 or 12 months old compared to infants living in other regions of the country.</p>
<h2>Removing barriers to breastfeeding</h2>
<p>Reducing barriers is critical to closing racial and geographic gaps in breastfeeding and allowing U.S. mothers and their infants the opportunity to benefit from the life-saving qualities of human milk. Studies show that addressing work-related barriers by making investments in paid family leave, for example, could <a href="https://doi.org/10.1016/j.ehb.2023.101308">increase exclusive breastfeeding rates by 15%</a>. </p>
<p>The U.S. is one of the only countries in the world that <a href="https://www.worldpolicycenter.org/policies/is-paid-leave-available-for-both-parents-of-infants">does not provide national paid family leave</a>. </p>
<p>Workplaces that support breastfeeding breaks and provide safe and clean spaces for expressing and storing human milk are also <a href="https://www.unicef.org/sites/default/files/2019-07/UNICEF-policy-brief-family-friendly-policies-2019.pdf">important in promoting breastfeeding</a>. Given that U.S. women’s labor force participation rates are <a href="https://www.bls.gov/opub/ted/2023/labor-force-participation-rate-for-people-ages-25-to-54-in-may-2023-highest-since-january-2007.htm">at a record high</a>, the importance of reducing barriers in the workplace cannot be overstated.</p>
<p>The U.S. Agency for International Development estimates that every U.S. dollar invested in breastfeeding <a href="https://www.usaid.gov/global-health/resources/fact-sheets/breastfeeding#">yields $35 in economic returns</a>.</p>
<p>Societal investments in breastfeeding-friendly workplace policies will not only yield cost savings and extend breastfeeding rates, but they will shift the burden of breastfeeding from simply being an individual choice to being a public health priority.</p><img src="https://counter.theconversation.com/content/214543/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tisha Felder receives funding from the Patient Centered Research Outcomes Institute (PCORI) and National Institutes of Health (NIH).</span></em></p><p class="fine-print"><em><span>Joynelle Jackson receives funding from Patient Centered Research Outcomes Institute (PCORI). </span></em></p>Some states, especially in the Southeastern US, have large disparities in breastfeeding among racial groups, making clear the need to lower barriers for breastfeeding in the workplace and elsewhere.Tisha Felder, Associate Professor of Behavioral Sciences, University of South CarolinaJoynelle Jackson, Associate Professor of Nursing, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1640042021-08-18T13:33:12Z2021-08-18T13:33:12ZPremature babies are prone to impaired brain development, but nutrients may reduce the risk<figure><img src="https://images.theconversation.com/files/415310/original/file-20210809-21-1pj2e23.jpg?ixlib=rb-1.1.0&rect=813%2C507%2C5019%2C3375&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Premature babies are at risk of impaired brain development, but adjusting the nutrients in intravenous feeding solutions may help reduce that risk.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Extreme preterm birth is associated with impaired brain development: defective executive function, disruptive behaviours and psychiatric issues are more common among those born preterm than those born at term. This <a href="https://doi.org/10.1213/ANE.0000000000000705">risk is greater at lower gestational ages</a>. </p>
<p>The current <a href="https://doi.org/10.1016/j.bpobgyn.2018.04.003">global incidence of preterm birth</a> is 11 per cent. With advancements in care before and after birth, an increasing number of extreme preterm (below 28 weeks of gestational age) babies survive. However, this increasing survival does not come with a reduction in the impaired brain development associated with premature birth. </p>
<p>As a neuroscience and nutritional biochemistry researcher, my focus is nutrition, neonatal brain development and associated brain disorders. <a href="https://doi.org/10.1542/peds.2017-2169">Optimizing nutrition is a promising avenue</a>: our research suggests that creatine, an energy-providing nutrient, may help mitigate the adverse brain development of these preterm babies. </p>
<h2>Premature babies and nutrition</h2>
<p>Premature infants often have immature digestive systems that aren’t ready to absorb adequate nutrients. As a result, they often depend on nutrients delivered intravenously, bypassing the digestive system. This method of feeding is called <a href="https://doi.org/10.1016/B978-0-12-384947-2.00520-1">parenteral nutrition</a>. </p>
<p><a href="https://doi.org/10.3945/jn.109.105411">Creatine is a natural compound that is produced mainly in the kidneys and liver</a> from three amino acids, the fundamental building blocks of proteins: arginine, glycine and methionine. </p>
<p>Healthy term babies <a href="https://doi.org/10.1017/s000711451300010x">receive nine per cent of their creatine requirements from their mother’s milk</a>. These healthy babies produce the remaining requirement of creatine in their bodies.</p>
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<a href="https://images.theconversation.com/files/416357/original/file-20210816-6755-1rvpzku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infant with an intravenous tube on its wrist." src="https://images.theconversation.com/files/416357/original/file-20210816-6755-1rvpzku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/416357/original/file-20210816-6755-1rvpzku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/416357/original/file-20210816-6755-1rvpzku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/416357/original/file-20210816-6755-1rvpzku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/416357/original/file-20210816-6755-1rvpzku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/416357/original/file-20210816-6755-1rvpzku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/416357/original/file-20210816-6755-1rvpzku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Premature infants often receive parenteral nutrition through an intravenous tube, like the one on this baby’s wrist.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Unlike human milk, newborn parenteral nutrition solutions do not routinely contain creatine, which leaves newborn premature babies dependent on their own production to meet their creatine requirement. </p>
<p>In healthy term babies, the majority of arginine, a building block of creatine, is produced in intestinal cells. However, feeding via the baby’s veins bypasses the intestine, so intravenous feeding interferes with normal arginine production. Because these premature babies cannot make enough arginine, they can’t make their required creatine. </p>
<h2>Creatine and neurodevelopment</h2>
<p>Creatine provides quick, short-term energy to skeletal muscles and heart. Muscle stores most of the body’s creatine (95 per cent), but the brain stores the second-highest amount. The brain is also the body’s second-highest energy user, after muscle. </p>
<p>The brain needs a continuous energy supply, and certain regions of our brains <a href="https://doi.org/10.1111/j.1460-9568.1994.tb00298.x">rely on creatine</a> for energy. In the adult brain, interruption of this energy supply impairs brain function and leads to the <a href="https://doi.org/10.3389/fnmol.2018.00216">progression of neurodegenerative diseases</a> such as Parkinson’s, Alzheimer’s or Huntington’s diseases. </p>
<p>Creatine is also an important modulator of brain neuron systems, making it crucial for babies’ brain development. Babies born with inherited creatine deficiency disorders are not able to produce creatine. These babies experience frequent seizures, significant impairment in cognition, language development, upper or lower limb movements and behaviour problems. These outcomes clearly suggest the <a href="https://www.ncbi.nlm.nih.gov/books/NBK3794/">importance of creatine for normal brain function and development</a>. </p>
<h2>Supplementing creatine in parenteral nutrition solutions</h2>
<p>Human studies provide limited information on the long-term metabolic consequences of the complete absence of creatine in parenteral nutrition solutions. An animal model such as piglets is ideal to study this situation. <a href="https://doi.org/10.1038/pr.2017.208">Our research</a> showed neonatal piglets receiving parenteral nutrition intravenously for two weeks (which represents nine months for a human baby) did not sustain optimal creatine accumulation. </p>
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<a href="https://images.theconversation.com/files/414019/original/file-20210731-32831-4engh3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph comparing parenteral nutrition with and without creatine, and showing levels achieved with mothers' milk." src="https://images.theconversation.com/files/414019/original/file-20210731-32831-4engh3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414019/original/file-20210731-32831-4engh3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=725&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414019/original/file-20210731-32831-4engh3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=725&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414019/original/file-20210731-32831-4engh3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=725&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414019/original/file-20210731-32831-4engh3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=910&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414019/original/file-20210731-32831-4engh3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=910&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414019/original/file-20210731-32831-4engh3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=910&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Piglets receiving parenteral nutrition supplemented with creatine accumulated similar creatine levels as those seen in piglets fed mothers’ milk.</span>
<span class="attribution"><span class="source">(O. Chandani Dinesh)</span>, <span class="license">Author provided</span></span>
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<p>When creatine was added to the piglets’ parenteral feeding solution, piglets’ creatine accumulation improved.</p>
<p>To address the inadequate arginine production associated with complete intravenous feeding, some premature human infants are fed small amounts of parenteral nutrition solution into their stomachs via a tube. (This is a form of enteral nutrition — enteral means via the digestive tract and parenteral means outside the digestive tract — but similar feeding solutions are sometimes used for both ways of providing nutrition.) The remainder of the parenteral nutrition solution is delivered intravenously. However, because organ levels of creatine cannot be tested in human babies without damaging organs or risking health, human studies are of limited value in assessing this approach. </p>
<p><a href="https://doi.org/10.1093/jn/nxaa369">We fed the parenteral nutrition solution into the stomachs</a> of our piglets. These neonatal piglets were not able to meet normal levels of creatine accretion without pre-made creatine in their parenteral nutrition solutions, even when the parenteral nutrition solution was delivered to their stomachs. </p>
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<a href="https://images.theconversation.com/files/415490/original/file-20210810-23-1q9bgoc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph showing different approaches to raising creatine levels in piglets" src="https://images.theconversation.com/files/415490/original/file-20210810-23-1q9bgoc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415490/original/file-20210810-23-1q9bgoc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=757&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415490/original/file-20210810-23-1q9bgoc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=757&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415490/original/file-20210810-23-1q9bgoc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=757&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415490/original/file-20210810-23-1q9bgoc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=951&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415490/original/file-20210810-23-1q9bgoc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=951&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415490/original/file-20210810-23-1q9bgoc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=951&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Creatine accumulation with and without creatine added to parenteral feeding solution in piglets.</span>
<span class="attribution"><span class="source">(O. Chandani Dinesh)</span>, <span class="license">Author provided</span></span>
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<p>Piglets fed parenteral solution to their stomachs with no pre-made creatine had very low levels of creatine in their blood. However, piglets fed parenteral solution to their stomach with pre-made creatine or extra building blocks (arginine and methionine) improved their creatine levels. These levels were similar to the creatine levels of piglets fed mothers’ milk. </p>
<p>Our findings were supported by a <a href="https://doi.org/10.1007/s00431-021-03950-2">recent review on human babies that concluded that hospital preterm babies</a> need adjustments to nutritional components in order to achieve normal brain development.</p>
<p>Premature babies rely on parenteral and/or enteral nutrition support during their stay at hospital. However, creatine is not a routine component of these newborn parenteral/enteral nutrition solutions. </p>
<p>Supplementing these nutrition solutions with creatine to increase or regulate local energy stores and to regulate neuromodulation may help protect the developing brain. This approach represents a therapeutic tool for reducing the risks of developing abnormal neurological conditions in premature babies. Furthermore this approach may reduce the incidence of neurodegenerative diseases later in life of those born premature.</p><img src="https://counter.theconversation.com/content/164004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olupathage Chandani Dinesh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Premature infants are at risk of impaired brain development. Adding creatine to the intravenous solution used to feed them may lower that risk.Olupathage Chandani Dinesh, Postdoctoral Researcher (Department of Psychology) & Course Instructor (Department of Biochemistry), Memorial University of NewfoundlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1612932021-06-10T14:42:54Z2021-06-10T14:42:54ZMalawi is taking steps to improve care of preterm babies. But gaps remain<figure><img src="https://images.theconversation.com/files/403098/original/file-20210527-22-1tux0a4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mothers need to be introduced to the kangaroo mother care method through counsel and practice, a process that requires patience and ultimately, time. </span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>“Kangaroo mother care” is widely <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002771.pub4/full">acknowledged</a> as a helpful method in caring for small and preterm infants. It makes a vital contribution to their survival, well-being and development. Developed in 1978 by Colombian paediatrician Edgar Ray, kangaroo care involves continuous skin-to-skin contact on the mother’s chest to keep the baby warm, increase breastfeeding frequency, and aid in recognising danger signs of illness.</p>
<p>Preterm births often come with dangerous complications. They are the <a href="https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality">largest cause</a> of neonatal deaths globally – 35% in 2017. In African countries, preterm babies die at a rate of 8.5 per 1,000 live births – much <a href="http://dx.doi.org/10.1136/bmjgh-2020-004760">higher</a> than the 1.3 deaths per 1,000 live births in high income countries.</p>
<p>Malawi has one of the <a href="https://www.who.int/features/2015/malawi-infant-survival/en/#:%7E:text=Malawi%20has%20one%20of%20the%20highest%20rates%20of,are%20the%20single%20largest%20cause%20of%20neonatal%20death.">highest</a> rates of preterm births globally. Figures from 2015 indicated that over 1 in 10 Malawian babies were born prematurely. And its neonatal death <a href="https://dhsprogram.com/pubs/pdf/FR319/FR319.pdf#page=112">rate</a> was 27 per 1,000 births in 2016.</p>
<p>Malawi was one of the early adopters of kangaroo mother care, with a pilot intervention in 1999. By 2005 it had been integrated into national policy for routine care. Yet, even with this low-cost, low-technology solution, Malawi’s neonatal mortality rates <a href="https://dhsprogram.com/pubs/pdf/FR319/FR319.pdf#page=112">remained</a> the same in 2016 as in 2004.</p>
<p>Between May and August 2019, my colleagues and I undertook a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243770">study</a> to explore the perspectives and experiences of health workers who work in newborn health with kangaroo mother care in their facilities. One tertiary-level central hospital and three secondary-level district hospitals in southern Malawi were chosen as the research settings. </p>
<p>Our research revealed that kangaroo mother care is viewed positively and has potential for further routine uptake in striving to eradicate neonatal deaths. But while it is a low-cost intervention, it is far from a no-cost intervention. While it has no direct reliance on technology, resources are still crucial to its practice in hospitals in Malawi. It needs investments in technology, staffing and hospital support in the provision of essential items for preterm infant care.</p>
<h2>What we found</h2>
<p>Our study was carried out under a <a href="https://www.idrc.ca/en/project/integrating-neonatal-healthcare-package-malawi-imcha">project</a> that seeks to integrate neonatal healthcare in Malawi under the auspices of the <a href="http://www.ea-imcha.com/index.php/en/">Innovating for Maternal and Child Health in Africa</a> initiative. Malawi was selected as a focus for newborn health improvements, including low-cost and locally appropriate innovations to improve care at low-resource health facilities.</p>
<p>Based on the limited number of health workers in neonatal units, 5 to 10 health workers per unit were interviewed in order to draw an effective analysis. Of the 27 health workers interviewed, the general perception of kangaroo mother care was positive for a number of reasons. This goes beyond the low-cost advantage of the method. A tertiary hospital nurse put it this way:</p>
<blockquote>
<p>It’s easy for the mother to know whether the baby is sick or not because she has her full attention on her child, and so the baby is protected. </p>
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<p>We also found that only infants who were clinically stable were eligible for kangaroo mother care according to guidelines at the selected health institutions. Thus, critical care was first administered to preterm and low birthweight newborns who experienced complications such as birth asphyxia and respiratory distress, before starting kangaroo mother care. Maternal health, especially after caesarean delivery, was also a factor considered before kangaroo mother care initiation, in keeping with <a href="http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-guideline/en/">best practice</a>. </p>
<p>But the novel method could also be a source of fear, especially for those practising for the first time and had no prior knowledge. Most caregivers <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02443-9">reported</a> minimal previous knowledge of the kangaroo care method. Many only learned about the practice when their low birthweight infants were admitted.</p>
<p>For this reason, some were scared of harming their newborns due to the small size, fragility, or new ways of holding the baby. Caregivers said skin-to-skin contact on the chest was different than the typical practice of carrying children on the back. </p>
<p>Even though health workers described kangaroo mother care as a good practice that helped save the lives of small, vulnerable babies, a few setbacks were revealed. Once preterm infants began care, the health workers prioritised them less in comparison to those in critical care. Kangaroo mother care wards were not monitored regularly and staff expected mothers to call for help if any complications rose.</p>
<p>Further investigation of kangaroo mother care wards uncovered that inadequate resources challenged both initiation and monitoring of the practice. Mothers need to be introduced to the method through counsel and practice, a process that requires patience, follow up and time. </p>
<p>But at the district hospitals, there were limited staff working nights, and even fewer nurses assigned to the critical care nursery. At the tertiary hospital, specific nurses had been assigned to the kangaroo mother care unit. But these were still understaffed at night and with few nurses in the critical care nursery. This affected the staff’s ability to regularly monitor both units.</p>
<p>Some new mothers wanted to leave the hospital a few days after delivery, long before their babies had gained enough weight. This often came about from poor support from hospital staff.</p>
<p>Limited resources also extended to the lack of equipment, such as weighing scales, thermometers and glucometers to monitor vital signs and clinical indicators, as well as wraps to practise kangaroo mother care. This especially affected low-income families who could not afford to purchase and transport the supplies needed by the mother.</p>
<p>Some mothers were isolated from their families, which discouraged them from continuing with kangaroo mother care because they wanted to return home.</p>
<h2>More resources needed</h2>
<p>Though routine uptake of kangaroo mother care was policy for stable low birth-weight and preterm infants in the four hospitals, there were gaps in monitoring and maintenance of practice. While conceptualised as a low-cost intervention, sustainable implementation requires investments in technologies, staffing and hospital provisioning of basic supplies such as food, bedding, and wraps. </p>
<p>Strengthening hospital capacities to support kangaroo mother care is needed as part of a continuum of care for premature infants.</p>
<p><em>Lynette Kamau, a health policy and advocacy specialist and a Senior Policy and Advocacy Officer at African Population and Health Research Center, contributed to the writing of this article.</em></p><img src="https://counter.theconversation.com/content/161293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Malawi was one of the early adopters of kangaroo mother care, with a pilot intervention in 1999.Mai-Lei Woo Kinshella, Global Health Research Coordinator at the Department of Obstetrics and Gynaecology, University of British ColumbiaAlinane Linda Nyondo-Mipando, Lecturer in Health Systems and Policy, University of MalawiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1433532020-07-30T01:39:49Z2020-07-30T01:39:49ZIt’s tempting to believe good news. But are there really fewer premature babies in lockdown? We’re likely clutching at straws<figure><img src="https://images.theconversation.com/files/350066/original/file-20200729-35-1qu7dqh.jpg?ixlib=rb-1.1.0&rect=4%2C5%2C994%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-premature-infant-baby-neonatal-intensive-1138674578">Shutterstock</a></span></figcaption></figure><p>Amid the <a href="https://www.theguardian.com/world/live/2020/jul/27/coronavirus-live-news-us-sees-5000-deaths-in-five-days-as-dr-birx-urges-some-states-to-close-bars">horrific stories</a> of coronavirus deaths and disease around the world, researchers <a href="https://www.nytimes.com/2020/07/19/health/coronavirus-premature-birth.html?referringSource=articleShare">have reported</a> a ray of light.</p>
<p>Almost simultaneously, two independent groups in Europe <a href="https://www.afr.com/policy/health-and-education/far-fewer-premature-babies-during-covid-19-20200721-p55e11">noticed</a> their neonatal intensive care units seemed quieter during the pandemic.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1285238398031028224"}"></div></p>
<p>Was this a coincidence? Or were there actually fewer babies born prematurely who needed intensive care? And if fewer premature babies were being born, why?</p>
<p>So, the researchers studied what was going on to try to get a <a href="https://www.tandfonline.com/doi/full/10.1080/14767058.2020.1781809">fuller picture</a> of how COVID-19 affects pregnant women and their newborns.</p>
<h2>Here’s what they found</h2>
<p>In Denmark, <a href="https://www.medrxiv.org/content/10.1101/2020.05.22.20109793v1">there was</a> a significant drop (around 90%) in the rate of babies born extremely premature (under 28 weeks gestation) during the nationwide lockdown, compared with a stable rate in the previous five years.</p>
<p>However, the researchers did not see a drop in the rate of other preterm babies born (at greater than 28 weeks but under 37 weeks). </p>
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<strong>
Read more:
<a href="https://theconversation.com/coronavirus-while-pregnant-or-giving-birth-heres-what-you-need-to-know-133619">Coronavirus while pregnant or giving birth: here's what you need to know</a>
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<p>Irish researchers thought lockdown was an opportunity to measure whether non-medical, community-based, social factors were associated with a reduction in preterm birth. When they ran a <a href="https://www.medrxiv.org/content/10.1101/2020.06.03.20121442v1">similar study</a> to the Danish team, they found similar results.</p>
<p>Over the past two decades, women were on average 3.77 times more likely to have a very low-birthweight baby (under 1,500g) than during the recent lockdown, in the study region of the Irish study. This was about a 73% reduction in very preterm births. </p>
<h2>What could explain this?</h2>
<p>There is a certain irony about these findings. </p>
<p>Pregnant women are <a href="https://www.today.com/parents/pregnant-women-covid-19-pandemic-feel-lonely-anxious-t187828?cid=sm_npd_nn_tw_ma">sharing stories</a> of increased stress, fear and anxiety during the pandemic. And there’s <a href="https://pubmed.ncbi.nlm.nih.gov/25765470/">strong evidence</a> stress, fear and anxiety during pregnancy is associated with preterm birth.</p>
<p>So we’d potentially see an overall increase in preterm birth, which we’ve yet to measure or see.</p>
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Read more:
<a href="https://theconversation.com/pregnant-in-a-pandemic-if-youre-stressed-theres-help-138825">Pregnant in a pandemic? If you're stressed, there's help</a>
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<p>Yet, pregnant women’s response to lockdown measures may indeed reduce other stressors. They may be spending less time commuting to work and facing stressful workplace dynamics. This may allow them to get more rest and increased access to family support.</p>
<p>Physically demanding work or demanding shiftwork, <a href="https://pubmed.ncbi.nlm.nih.gov/31276631/">known to increase risk of preterm birth</a>, may also have been eliminated or reduced. </p>
<p>Another theory relates to the removal of pregnant women from busy workplaces and community activities, reducing their exposure to pathogens generally.</p>
<p>Inflammation and other immune-related responses are thought to <a href="https://pubmed.ncbi.nlm.nih.gov/32339092/">contribute to the risk of preterm birth</a>. And we know rates of some infectious diseases, including influenza, have <a href="https://wwwnc.cdc.gov/eid/article/26/8/20-1229_article">reduced</a> during the pandemic, as we physically isolate, wash hands and wear masks. </p>
<p>Lockdown has also caused a reduction in <a href="https://www.sciencedirect.com/science/article/pii/S0306987713005719">air pollution</a> said to act together with other biological factors to induce inflammation and influence the duration of pregnancy.</p>
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<strong>
Read more:
<a href="https://theconversation.com/during-covid-19-women-are-opting-for-freebirthing-if-homebirths-arent-available-and-thats-a-worry-142261">During COVID-19, women are opting for 'freebirthing' if homebirths aren't available. And that's a worry</a>
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<h2>Hang on a minute</h2>
<p>Authors from both studies attributed this significant decrease in extreme preterm birth to the sum total of social and environmental changes during lockdown. They did not pinpoint one specific factor.</p>
<p>In fact, their studies were not designed to demonstrate which specific factor caused what, so we need to interpret their findings with caution.</p>
<p>And their studies are “pre-prints”, meaning they have not been formally peer- reviewed.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/researchers-use-pre-prints-to-share-coronavirus-results-quickly-but-that-can-backfire-137501">Researchers use 'pre-prints' to share coronavirus results quickly. But that can backfire</a>
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<p>While these studies offer some interesting discussion points, we have some reservations about how they should inform future work.</p>
<p>Ideally, other researchers would want to replicate a given exposure or intervention to see if they come up with similar results. But how do we ethically replicate the drastic social-environmental change pregnant women have had to face once the pandemic is over?</p>
<p>Can we really expect future pregnant women to stay home, not work so hard on their feet, and limit social interaction so we can see what happens? It may have the exact opposite effect on their well-being.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sad woman sitting on floor staring out window" src="https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Ethically, how could we ever repeat this ‘experiment’ to verify the researchers’ results?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-thoughtful-girl-sit-alone-on-1523325014">from www.shutterstock.com</a></span>
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<p>Some neonatal intensive care units may have seen an increase in preterm births during the pandemic. But this may not have been studied formally, published or reported as news.</p>
<p>We have also peer-reviewed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104131/">published studies</a> showing an increased risk of preterm birth if women are diagnosed with a coronavirus related illness. That’s <a href="https://www.who.int/health-topics/severe-acute-respiratory-syndrome">SARS</a> (severe acute respiratory syndrome), <a href="https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)">MERS</a> (Middle-East respiratory syndrome) or COVID-19.</p>
<p>Once the full impact of this pandemic is revealed, we may well see an overall increase in preterm births related to coronaviruses.</p>
<p>Perhaps we are clasping at straws, trying to visualise some possible benefit to the most significant disruption the world has undergone in recent years. But we are cautious to say we have found it here. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-with-a-baby-what-you-need-to-know-to-prepare-and-respond-133078">Coronavirus with a baby: what you need to know to prepare and respond</a>
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<img src="https://counter.theconversation.com/content/143353/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Kearney receives funding from the Wishlist Health Foundation, Sunshine Coast for a number of specific externally funded research grants. </span></em></p><p class="fine-print"><em><span>Kendall George receives funding from the Wishlist Health Foundation, Sunshine Coast for a number of specific externally funded research grants.</span></em></p>We still don’t know if being in lockdown during the pandemic really does lead to fewer premature babies, as some people report. Maybe we’re trying too hard to find some good news.Lauren Kearney, Senior Lecturer, Nursing and Midwifery, University of the Sunshine CoastKendall George, Lecturer, Nursing and Midwifery and Midwifery Program Leader, University of the Sunshine CoastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1408682020-07-07T13:22:00Z2020-07-07T13:22:00ZBabies born prematurely are at higher risk of heart problems throughout life – new study<figure><img src="https://images.theconversation.com/files/345566/original/file-20200703-33931-8alznn.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C2891%2C1949&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/premature-baby-incubator-chamber-reaching-his-531482251">goodbishop/Shutterstock</a></span></figcaption></figure><p>The weeks and months after a baby is born are a critical time for the growth of the heart of premature babies. This is largely because they are faced with major blood flow changes and increased oxygen demands as they transition to the outside environment during a time where they would normally be developing inside their mother. </p>
<p>A lot of research has identified preterm birth (born before 37 weeks gestation) as a risk factor for developing early heart disease, including <a href="https://www.nhs.uk/conditions/heart-failure/">heart failure</a>. Heart failure is when the heart can’t pump blood around your body as effectively as it should. </p>
<p>Several studies have shown that preterm birth is linked to abnormalities in the structure and function of their heart, yet the extent and evolution of these changes throughout development, from birth to adulthood, are not well defined. However, it’s important that they are defined as <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">one in ten people worldwide</a> are born preterm. </p>
<p>In our <a href="https://pediatrics.aappublications.org/content/early/2020/07/03/peds.2020-0146">latest study</a>, we performed a meta-analysis of data from published studies that compared the heart’s structure and function using echocardiography or cardiovascular magnetic resonance imaging for people born preterm versus those born at term. We included 32 studies in our analysis, with comparisons between groups made in newborns, infants, children, adolescents and young adults. </p>
<p>The results of our study showed that the left and right pumping chambers of the heart, known as the ventricles, are smaller across all developmental stages in people born preterm. Also, the right ventricle’s contractile pump function is impaired across all developmental stages. </p>
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<img alt="" src="https://images.theconversation.com/files/345742/original/file-20200706-4000-1bri0tu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/345742/original/file-20200706-4000-1bri0tu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=515&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345742/original/file-20200706-4000-1bri0tu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=515&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345742/original/file-20200706-4000-1bri0tu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=515&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345742/original/file-20200706-4000-1bri0tu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=647&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345742/original/file-20200706-4000-1bri0tu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=647&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345742/original/file-20200706-4000-1bri0tu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=647&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/anatomy-human-heart-illustration-131979947">BlueRingMedia/Shutterstock</a></span>
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<p>Although the left ventricle’s ability to relax and fill with blood was found to be lower in preterm newborns, this appears to worsen with age. Also, the level of thickening of the left ventricle’s muscle wall from childhood to adulthood is accelerated in people born preterm. Many of these changes were shown to be worse in those born the earliest or most prematurely.</p>
<p>These changes in the hearts of people born preterm have been linked to developing heart disease in later life, but may also put them at more immediate heart disease risk than their term-born peers. Studies show that these physical changes in the heart make people born preterm less able to cope with physiological stress demands, <a href="https://academic.oup.com/ehjcimaging/article/doi/10.1093/ehjci/jeaa060/5821314">such as exercise</a>. </p>
<h2>A lot still to be learned</h2>
<p>The reason for these changes are not known. Work from different animal models of preterm birth, including in sheep, pigs and rats, has shown that a likely reason is <a href="https://academic.oup.com/eurheartj/article/31/16/2058/431785">the early transition from the womb</a>. This is believed to be because the heart undergoes flow and pressure changes around the time of birth, as well as major shifts in oxygen levels (which are much higher outside the womb), causing changes to cells and the shape of the heart. </p>
<p>Ultimately, this results in the heart muscle cells, known as cardiomyocytes, growing differently (switching from rapid division, known as hyperplasia, to increasing cell size, known as hypertrophy) and the structural and functional properties of the heart to change in order to meet the body’s demands. While this is a normal event for all births, the immature preterm heart appears to be less able to cope with these changes, with harm seen at a cellular and structural level.</p>
<p>Given that such a large proportion of the population is born preterm, steps should be put in place to maintain and promote long-term heart health. This includes further research into the best strategies for newborn and infant care to promote healthy heart development, such as early feeding and best practices to support normal lung function, including mechanical ventilation using a machine to move air in and out of the lungs (invasive) and CPAP to provide air through a mask (non-invasive). It also includes lifestyle approaches, such as exercise and nutrition, beginning as early as childhood.</p><img src="https://counter.theconversation.com/content/140868/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Lewandowski receives funding from the British Heart Foundation. </span></em></p>One in ten people are born prematurely.Adam Lewandowski, Research Lecturer, Cardiology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1286072019-12-19T13:50:23Z2019-12-19T13:50:23ZGiving pregnant women antibiotics could harm the lungs of preemies, according to study in mice<figure><img src="https://images.theconversation.com/files/306434/original/file-20191211-95149-1gyrcya.jpg?ixlib=rb-1.1.0&rect=71%2C44%2C5919%2C3943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Premature infants are at higher risk for lung diseases.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-premature-baby-being-held-fathers-580721992">Sarahbean/Shutterstock.com</a></span></figcaption></figure><p>Born after just 23 of the normal 40 weeks of pregnancy, the extremely preterm baby is small enough to fit in the palm of my hand and weighs just one and a quarter pounds. <a href="https://www.researchgate.net/profile/Kent_Willis">I am a neonatologist</a>, a physician that cares for these preterm babies in intensive care. Most of these preterm infants, particularly the smallest and sickest who require oxygen to help them breathe, are at high risk of developing lung inflammation and <a href="http://dx.doi.org/10.1016/S1084-2756(02)00193-8">scarring</a>. </p>
<p>This early damage will lead to a chronic lung disease called <a href="https://www.nhlbi.nih.gov/health-topics/bronchopulmonary-dysplasia">bronchopulmonary dysplasia</a>. Bronchopulmonary dysplasia can be one of the most severe and long-lasting complications of being a preterm baby. Many require oxygen for years and often have severe asthma-like episodes during which they are hospitalized for difficulty breathing. </p>
<p>Bronchopulmonary dysplasia affects many of the tiniest preterm babies that I care for and often leads to severe long-term disability. But it’s tricky to prevent preterm babies from developing bronchopulmonary dysplasia, and the situation is a bit of a Catch-22. That is because oxygen and breathing machines, which are essential for keeping these babies alive, also increase the likelihood of developing bronchopulmonary dysplasia. This dilemma has inspired my research into lung disease in preterm babies to discover new ways of preventing bronchopulmonary dysplasia.</p>
<h2>The gut-lung axis</h2>
<p>In newborns, research into <a href="http://dx.doi.org/10.1126/scitranslmed.aab2271">asthma</a> and <a href="http://dx.doi.org/10.1126/scitranslmed.aaf9412">pneumonia</a> has indicated that the microbial communities, known as the microbiome, that live inside the human gut can influence inflammation – the response of the body to pathogens or cellular damage – in their host. This may happen because of changes in the host immune system, which in turn may shape the course of lung diseases that result from <a href="http://dx.doi.org/10.1016/j.jaci.2014.06.027">inflammation</a>.</p>
<p>This recently discovered connection between the gut microbes and lung health or disease is called the <a href="https://doi.org/10.1513/AnnalsATS.201503-133AW">gut-lung axis</a>, and it may reveal new ways to treat lung diseases.</p>
<p>Over the last several years, neonatologists have done retrospective studies in which they looked back over several years of babies’ records to see if they could identify events that happened to babies who later developed bronchopulmonary dysplasia. These studies were designed to try to identify new exposures that might cause bronchopulmonary dysplasia. </p>
<p>One potential trigger for bronchopulmonary dysplasia was <a href="http://dx.doi.org/10.1016/j.jpeds.2014.09.041">antibiotics</a>. One thing that stood out to researchers, including myself, was a potential link between the mother being exposed to antibiotics and babies who developed <a href="http://dx.doi.org/10.1016/j.jaci.2014.06.027">bronchopulmonary dysplasia</a>. However, because a lot of babies and mothers are given antibiotics, this research wasn’t enough to prove that antibiotic exposure causes bronchopulmonary dysplasia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A premature baby with neonatal infant pulse oximeter.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/premature-baby-legs-neonatal-infant-pulse-1073367044">Kristina Bessolova/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Maternal antibiotic exposure worsens bronchopulmonary dysplasia</h2>
<p>In my <a href="https://doi.org/10.1152/ajplung.00561.2018">latest study</a>, I used mice to test whether there was a causal link between the state of the gut-lung axis and how bronchopulmonary dysplasia develops. </p>
<p>I wanted to investigate how maternal exposure to antibiotics affects the lung development of offspring. I thought this research would not only lead to a better understanding of the gut-lung axis but also identify a new way to potentially prevent bronchopulmonary dysplasia. </p>
<p>My colleagues and I sorted pregnant mice into four groups and exposed the mothers to antibiotics at different points during gestation. </p>
<p>The first group of mother mice was exposed to antibiotics throughout their pregnancy and for the first two weeks of their pups’ life while they nursed. The second group was exposed just during pregnancy, but not after. Group three was exposed just while nursing. The fourth group wasn’t exposed at all. After the pups were born, we also exposed some to oxygen – just as we would do for a premature infant – which triggered bronchopulmonary dysplasia. </p>
<p>At the end of the experiment we looked at the lung structure of the baby mice. All the newborn mice that were exposed to oxygen developed bronchopulmonary dysplasia to some extent, but the mice whose mothers were exposed to antibiotics developed more severe disease. In fact, mice exposed to antibiotics at any stage were more deformed and had a more simplified structure than the animals that were never exposed to antibiotics. </p>
<p>A simplified lung structure, with giant, partially formed air sacs instead of tiny, well-shaped air sacs, is the hallmark of bronchopulmonary dysplasia. The more abnormal the air sac structure, the worse the bronchopulmonary dysplasia. These changes in lung structure are evidence that antibiotic exposure caused more severe bronchopulmonary dysplasia in these mice. </p>
<p>My colleagues and I were also surprised to find that antibiotics given to the mother also increased scarring in the lungs of their babies, abnormal blood vessel structure and more white blood cells in their lung tissue. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Giving antibiotics during pregnancy causes more severe lung damage in the pups. This figure created with the aid of BioRender.</span>
<span class="attribution"><span class="source">Kent Willis</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<h2>Reshaping the gut-lung axis to prevent bronchopulmonary dysplasia</h2>
<p>Finally, to understand what the gut-lung axis had to do with bronchopulmonary dysplasia, we looked at the microbes in the guts of the baby mice during the first two weeks of life. My colleagues and I found that that giving antibiotics to their mothers likely prevented them from acquiring normal bacterial communities like those found in the guts of pups with no antibiotic exposure.</p>
<p>However, the way we administered the antibiotics did not directly affect the pups. Rather, the antibiotics altered the mother’s microbiome. The pups then inherited this altered set of bacteria from her. We also showed that molecules that allow gut microbes to signal to the lungs about the status of the microbial communities in the gut in newborn mice were reduced in newborn mice with abnormal microbial communities.</p>
<p>These experiments imply that the gut-lung axis may be involved in causing bronchopulmonary dysplasia. Because a lot of human mothers and preterm babies are given antibiotics, our research suggests that physicians should consider the risks to the fetus when giving a pregnant mother antibiotics and only do so when there are no other alternatives.</p>
<p>A lot more research needs to be done. First, we would like to test if we can change the microbial communities in newborn mice so that they are more resistant to getting bronchopulmonary dysplasia. Next I plan to investigate what part of the microbial communities alters the gut-lung axis. This may reveal a way to make human preterm babies resistant to developing bronchopulmonary dysplasia.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/128607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kent Willis does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Prenatal and postnatal antibiotic exposure combined with oxygen treatment led to lung inflammation and altered immunity in a study in mice.Kent Willis, Assistant Professor of Neonatology, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1258452019-10-25T10:06:05Z2019-10-25T10:06:05ZLifesaving treatment for babies born at 22 weeks doesn’t mean abortion law should change<figure><img src="https://images.theconversation.com/files/298583/original/file-20191024-170475-98pl0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Recommendation for life support from 22 weeks.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/neonatal-infant-pulse-oximeter-premature-babies-486542008?src=IgZCSlxkZXw5FsDNRMXJBQ-1-0">Kristina Bessolova/Shutterstock</a></span></figcaption></figure><p>When <a href="https://www.bapm.org/resources/80-perinatal-management-of-extreme-preterm-birth-before-27-weeks-of-gestation-2019">new guidance</a> relating to the outcome and medical care of babies born extremely prematurely was recently released, it led some to call for UK abortion law to be revised. </p>
<p>This was because <a href="https://www.bbc.co.uk/news/health-50144741">one of the new recommendations</a> from the British Association of Perinatal Medicine is that it is sometimes appropriate to provide resuscitation and active medical treatment for babies born at 22 weeks gestation (four and a half months before their due date). This is a week earlier than was recommended in the last version of the framework, published in 2008.</p>
<p>The argument goes that the new guidance creates a “contradiction in British law” because extremely premature infants can now be resuscitated before the point in pregnancy where abortion law changes.
A spokesperson for campaign group <a href="https://www.telegraph.co.uk/news/2019/10/22/doctors-should-attempt-save-premature-babies-born-22-weeks-medical/">Right to Life UK said</a>: “In one room of a hospital, doctors could be working to save a baby born alive before 24 weeks whilst in another room a doctor could perform an abortion which would end the life of a baby at the same age. Surely this contradiction needs to end?”</p>
<p><a href="https://www.nhs.uk/conditions/abortion/">Currently, in England, Scotland and Wales</a>, abortion is legally permitted before 24 weeks of a pregnancy as long as two doctors certify that the broad conditions of the <a href="http://www.legislation.gov.uk/ukpga/1967/87/contents">Abortion Act 1967</a> are fulfilled. After 24 weeks, abortion can only take place if a stricter set of conditions apply – for example where the pregnant woman’s life is at risk, or the child would be born with a severe disability. A cut off of 28 weeks was set in the original act, reduced to 24 weeks in 1990. </p>
<p>The question is: given the new UK neonatal guidelines, does the cut off needs to be revised again?</p>
<h2>Nothing has changed</h2>
<p>One reason not to review the law is that the fundamental issues have not changed overnight, or indeed over the last 20 years. It has been possible for more than two decades for extremely premature infants before the 24-week cut off point to survive. </p>
<p>For example, <a href="https://fn.bmj.com/content/78/2/F99">one in ten 23-week infants</a> treated in a UK neonatal unit survived in the early 1990s. <a href="https://www.bmj.com/content/345/bmj.e7976">In 2006</a>, there were 238 babies at 22 and 23 weeks admitted to neonatal intensive care units in England (69 survived) – just under two in ten. </p>
<p>While survival rates have improved for these extremely premature births, most babies born at these gestations still, sadly, do not survive even if intensive care is attempted.</p>
<p>While some claim that the law is contradictory, there is, in fact no inherent contradiction. It is true that doctors will attempt to save the lives of some babies born before 24 weeks, where that is what parents wish. However, the very high risk of mortality or very serious complications means that intensive care treatment is not always provided. If parents do not wish for their baby to receive intensive treatment it is ethical to provide palliative care at delivery, and the revised framework supports this. </p>
<p>This reflects the ethical importance of respecting the wishes of parents when it comes to treatment that is so risky and uncertain. Arguably, if a woman decides not to continue a pregnancy at 22 or 23 weeks’ gestation, and obstetricians support this choice, that is completely consistent with the ethical framework that applies in newborn care.</p>
<h2>Viability</h2>
<p>The important question that underlies all of this is why the law relating to abortion should have a 24-week cut off in the first place. The current law appears to be based on the idea that “viability” changes the ethical considerations around abortion. </p>
<p>It is also often deeply unclear both what is meant by “viable”, and <a href="https://www.jstor.org/stable/3560289">why this is relevant</a> to the ethics of abortion. Is a 22-week foetus/baby viable? They could survive – if their parents want to undergo highly intensive treatment, and if that treatment is available (in most parts of the world it isn’t). However, <a href="https://www.ncbi.nlm.nih.gov/pubmed/30705140">three out of four babies</a> will not survive, even if this is attempted. Some might regard such infants as viable, while others would not.</p>
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<img alt="" src="https://images.theconversation.com/files/298587/original/file-20191024-170475-1e2ujdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/298587/original/file-20191024-170475-1e2ujdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/298587/original/file-20191024-170475-1e2ujdg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/298587/original/file-20191024-170475-1e2ujdg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/298587/original/file-20191024-170475-1e2ujdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/298587/original/file-20191024-170475-1e2ujdg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/298587/original/file-20191024-170475-1e2ujdg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Viability doesn’t affect the ethics of abortion.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/prolife-vs-prochoice-traffic-sign-two-503320492?src=rW6VzV8AUDJeDA6XD3KRwA-2-56">M-Sur/Shutterstock</a></span>
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<p>While pro-life advocates are opposed to termination of pregnancy at 23 weeks, they are also opposed to abortion occurring at 20, 16 or 12 weeks. Viability is of no relevance if you have the view that the foetus has a right to life. On the other hand, those who support women’s right to choose sometimes argue that abortion should be allowed past 24 weeks. The importance of respecting a woman’s autonomy does not change just because a foetus could, in theory, survive if they were born prematurely and actively treated. </p>
<p>On either of the most prominent (and opposing) views, viability does not affect the ethics of abortion.</p>
<h2>Reasons not to change the law</h2>
<p>There are some other good reasons not to change the rules around abortion. The number of women who terminate their pregnancy between 20 and 24 weeks is actually very small (about <a href="https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2018">1% of all terminations</a> in England and Wales in 2018). </p>
<p>Many of those who have abortions after 20 weeks have not learned until a very late stage that they were pregnant. Others have learned on their 18 week ultrasound scan that their foetus has a potentially serious medical condition. It can take several weeks for such women to receive specialist advice on the likelihood of their infant having serious problems and what those would involve. Not all women in such cases choose to terminate their pregnancy, but the decision is one that is often difficult and takes time. If the abortion time limit is reduced it will impair the ability of such women to make informed and considered decisions. </p>
<p>Whatever your view on abortion, that would be a serious problem.</p><img src="https://counter.theconversation.com/content/125845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominic Wilkinson was one of the authors of the BAPM framework. This piece represents his personal view, and not necessarily that of the BAPM.</span></em></p>New guidance recommends lifesaving treatment for extremely premature babies – but what does this mean for an abortion cut off at a similar gestation? An ethicist takes a look.Dominic Wilkinson, Consultant Neonatologist and Professor of Ethics, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1182812019-06-17T11:12:32Z2019-06-17T11:12:32ZMusic therapy improves the health of premature babies and boosts parental bonding<figure><img src="https://images.theconversation.com/files/279158/original/file-20190612-32347-g3c8w7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bonding in a busy hopsital can be tough for new parents and premature babies.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-holding-her-premature-newborn-713505415?src=IgZCSlxkZXw5FsDNR">Brocreative/Shutterstock</a></span></figcaption></figure><p>Singing and playing music to your baby or young child may seem to be a no-brainer. We all have strong associations with nursery rhymes or childhood ditties sung to us by our parents and grandparents. We associate these with feelings of comfort and security, and it seems like the most natural thing in the world that we would sing to our own children as we cuddle and soothe them, or put them to bed.</p>
<p>Imagine, though, that your baby was born earlier than anticipated, and had to spend time in a neonatal unit in a hospital. Perhaps your baby also has serious medical issues and needs to be constantly monitored, being linked up to a frightening array of medical equipment. Hospital staff are constantly moving around the wards checking everything is OK, and there are alarms on ventilators going off, the hiss of oxygen and all sorts of electric lights flashing and beeping. It can’t be easy to bond with a baby when they are being kept in an incubator and need special medical treatment.</p>
<p>Although hospital staff are trained to support families in these situations, it’s often a very traumatic time for parents. Research into parental experiences in neonatal units shows that feelings of anxiety, guilt and even depression are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293875/">all common features</a> for many mums and dads. This can prevent or disrupt the natural bonding process that is so important to the healthy development of the baby, and the happiness of the family unit too.</p>
<p><a href="https://voices.no/index.php/voices/article/view/2315/2070">Recent research</a> has shown, however, that <a href="https://theconversation.com/explainer-what-is-music-therapy-20154">music therapy</a> can offer a way for parents to connect with and develop their relationship with their premature baby while they are in hospital. This consists of a music therapist playing a guitar or other instruments, and singing with parents to their baby on the ward. Using melodies and lullabies that the parents choose – including favourite songs, gentle sounds and simple rhythmic structures – the baby can be soothed while parents hold, rock and, if they wish to, sing or hum to their baby.</p>
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<p>Music therapy does more than just improve bonding. A <a href="https://pediatrics.aappublications.org/content/131/5/902">large study</a> undertaken in 2013 in the US demonstrated other positive effects for babies who receive music therapy in neonatal units. The study showed improved oxygen saturation, better heartbeat regulation, longer periods of sleep, increased weight gain, and, perhaps most importantly, reduced time spent in hospital. These results <a href="https://www.bamt.org/DB/past-journals/vol-31-no-1-2017.html">have been replicated</a> in other studies too. </p>
<h2>Soothing tones</h2>
<p>So why is music therapy such a powerful tool for premature babies? Hearing develops from the age of 24 weeks, meaning that babies are accustomed to hearing their mother’s voice, and that of other family members while still inside the womb. They respond more readily to these voices than those of unknown adults, although even then they show a <a href="https://nypost.com/2016/10/23/how-babies-know-their-mothers-voice-even-in-the-womb/">preference for live voices</a></p>
<p>In addition, researchers think that every baby is born hardwired, as it were, with what has been termed “<a href="http://www.soundconnectionsmt.com/docs/Communicative_Musicality_1999-2000.pdf">communicative musicality</a>”. Put simply, babies respond positively to, and have an appreciation of, simple musical structures, melodies and simple vocal sounds. We are all familiar with “baby talk” – the way we instinctively alter the tone of our voices when we talk to babies and young children. This is very calming and soothing for both baby and parent. It not only helps bonding, but lays down the foundations for later cognitive development such as <a href="https://theconversation.com/why-baby-talk-is-good-for-your-baby-59515">speech and motor skills</a>. </p>
<p>At present music therapy practice is commonly used in neonatal units across the world, including in Australia, the US, Scandinavia, Columbia, and Europe too. UK provision, however, is limited to just a few sites. But, my own preliminary research has found that more and more UK parents are keen to use these techniques, often commenting that “it will give me something to do with my baby”, and “it’s something normal and natural that I can do during this very unnatural beginning to our life together”. </p>
<p>I’ve also found that nurses are also supportive of music therapy. They believe helping parents to explore music with their babies will empower parents and give them the confidence they need to provide the extra attention premature babies require, such as special feeding techniques and potentially administering medication. Consultants are also aware that at the moment, psychological support for parents in neonatal facilities is limited. They believe that the introduction of music therapy will have an important impact on the quality of parental experiences in hospital and the health of the baby.</p>
<p>I am currently part of a team developing a pilot study in South Wales which will offer parents the chance to explore singing to their premature babies. It is hoped that this will be the beginning of an exciting new provision of psychological and medical support for parents and babies in neonatal units in Wales and beyond, but also help ensure these little ones have the best start at life possible.</p><img src="https://counter.theconversation.com/content/118281/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Coombes receives funding from The Music Therapy Charity to support a music therapy study in a Local Neonatal Unit in south Wales.</span></em></p>Soothing babies with song is a natural instinct for some parents, and research has shown just how powerful it can be for premature babies.Elizabeth Coombes, Senior Lecturer in Music Therapy, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/933522018-05-08T10:44:12Z2018-05-08T10:44:12ZReading and singing to preemies helps parents feel comfortable with their fragile babies<figure><img src="https://images.theconversation.com/files/212787/original/file-20180402-189827-mi1cwc.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A mother in the Mother Goose on the Loose program reading to her infant. </span> <span class="attribution"><span class="source">University of Maryland Medical System Foundation</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>One out of 10 babies is <a href="https://www.marchofdimes.org/Peristats/ViewTopic.aspx?reg=99&top=3&lev=0&slev=1">born prematurely in the United States</a>. These babies typically are cared for in neonatal intensive care units, often called NICUs. </p>
<p>Traditional NICUs have an open-bay design where multiple babies are cared for in a large room. More recently, single-family room NICUs have emerged and have led to a variety of <a href="https://www.sciencedirect.com/science/article/pii/S1527336916300046">positive medical, developmental and behavioral outcomes.</a> </p>
<p>However, one study demonstrated an <a href="https://www.ncbi.nlm.nih.gov/pubmed/24139564">unexpected outcome</a>: Babies cared for in these settings had MRI scans showing decreased brain development and lower language scores at two years of age. </p>
<p>This finding highlighted the importance of adult language to the development of vocalizations in preterm babies. Accordingly, we and two colleagues – Dr. Betsy Diamant-Cohen of <a href="http://www.mgol.net">Mother Goose on the Loose</a> and Summer Rosswog of <a href="https://www.portdiscovery.org">Port Discovery Children’s Museum</a> – partnered together to develop, implement and evaluate a literacy program called <a href="https://journals.ala.org/index.php/cal/article/view/6586">Mother Goose on the Loose Goslings</a>.</p>
<p><a href="https://www.youtube.com/watch?v=qVTbNZXeJFk">Goslings</a> is a one-hour interactive early language and literacy program for families with babies in the NICU. It is a revision of <a href="https://journals.ala.org/index.php/cal/article/view/6586">Mother Goose on the Loose</a>, a nationally recognized early literacy program for parents and caregivers with children from birth to age 3. Our team revised it to be appropriate for medically fragile newborns in the NICU.</p>
<p>Families in the NICU at <a href="https://www.umms.org/childrens/health-services/neonatology/neonatal-intensive-care-unit-nicu">University of Maryland Children’s Hospital</a> are participating in this new program designed to help foster their premature baby’s language development, and we are studying the results. </p>
<h2>What’s good for the mother is good for the Goslings?</h2>
<p>As with the original Mother Goose on the Loose program, the Goslings program teaches parents the importance of stimulating their baby’s language development through talking, reading, singing songs and reciting nursery rhymes. </p>
<p>To best meet the needs of these medically fragile babies, Dr. Betsy Diamant-Cohen modified traditional songs and nursery rhymes in two ways: They were revised to address medical needs and concerns of small babies, and they were adapted to enhance parent-baby bonding by using the word “love.” For instance, instead of singing “If you’re happy and you know it, clap your hands,” parents are encouraged to sing, “Since I love you very much, I’ll hold your hand.” </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217096/original/file-20180501-135814-1anohes.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217096/original/file-20180501-135814-1anohes.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217096/original/file-20180501-135814-1anohes.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217096/original/file-20180501-135814-1anohes.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217096/original/file-20180501-135814-1anohes.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217096/original/file-20180501-135814-1anohes.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217096/original/file-20180501-135814-1anohes.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A mother interacting with her premature newborn son.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/premature-baby-boy-delivered-by-caesarean-32776099?src=q6NK_asGR8OPvElMHqj9zA-1-57">Steve Lovegrove/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>A novel aspect of Goslings focuses on teaching parents when it is best to provide this additional stimulation. A traffic light concept is used to teach parents about providing stimulation according to their baby’s medical status. </p>
<p>• Red light: The baby is very medically fragile; interactions should be limited to a quiet voice.</p>
<p>• Yellow light: The baby is medically ready for a little more stimulation; parents can add touch and holding to their voice.</p>
<p>• Green light: The baby is medically ready for all of the items in the Goslings kit, which includes finger puppets, rattles, colored scarves and books.</p>
<p>In addition, parents are taught how “to read” their baby’s signals to know when they are behaviorally ready for these interactions and when they are too overstimulated. A baby who is “happy and ready” for interaction will appear relaxed, look at faces or objects, coo and/or smile. A baby who is “not happy and ready” may look away, frown, grimace, splay their fingers apart and/or cry. </p>
<h2>Parents give seal of approval</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217098/original/file-20180501-135825-kcj5ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217098/original/file-20180501-135825-kcj5ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217098/original/file-20180501-135825-kcj5ik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217098/original/file-20180501-135825-kcj5ik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217098/original/file-20180501-135825-kcj5ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217098/original/file-20180501-135825-kcj5ik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217098/original/file-20180501-135825-kcj5ik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A mother holds the tiny feet of a premature baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-holding-premature-baby-legs-636954517?src=q6NK_asGR8OPvElMHqj9zA-1-2">Kristina Bessalova/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Port Discovery Children’s Museum staff has provided Goslings at the UMCH NICU for two years. We collaborated to evaluate the effectiveness of the Goslings program.</p>
<p>During the first year, the primary questions were whether family members who participated thought the program increased their knowledge of how to interact with their babies. Sixty-six parents and other relatives participated in the evaluation by completing pre- and post-intervention questionnaires about their views of the program. </p>
<p>All 66 parents said they would recommend Goslings to other parents of babies in a NICU and would recommend that the program be implemented again at the UMCH NICU. Parents thought the program had increased their knowledge of how and when to interact with their babies to stimulate their language development.</p>
<p>Almost all the parents also thought they would significantly talk, sing and read more with their babies after completing the intervention.</p>
<p>One significant limitation of these data, however, is that we could not assess whether interactions between parents and their babies increased after the Goslings program. </p>
<p>The evaluation in the second year sought to determine whether parents implemented what they learned from the Goslings program. A new sample of 38 parents and other relatives completed pre- and post-program questionnaires about their views of the program. Ten of these parents also participated in more in-depth interviews one to two weeks after attending Goslings. </p>
<p>The findings were consistent with those during the first year. In addition, parents who participated in the in-depth interviews, reported that they implemented what they learned, particularly in terms of talking and singing with their babies. Some even read and recited nursery rhymes. All parents discussed how the program improved their abilities to understand their babies’ signals of readiness. Those parents who were not reading had babies who were not yet medically or developmentally ready for such interactions; however, these parents reported that they intended to read with their babies once it was more appropriate. </p>
<p>The positive impact of Goslings on parents was further validated by the results of an anonymous survey completed by 37 nurses in the same NICU. Most nurses, 84 percent, reported they observed changes in parents’ behavior. They said parents seemed more aware of their babies’ needs, more understanding of their signals, and more knowledgeable and confident about how to interact appropriately with their babies. Nurses observed these parents reading, singing, and using program materials with their babies. </p>
<p>These results suggest that Goslings may be an important program for fostering language experiences of babies in NICUs. The next step to evaluate the effectiveness of Goslings is to extend the interview process to families who have been home for several months to see if program concepts are still being applied.</p><img src="https://counter.theconversation.com/content/93352/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brenda Hussey-Gardner received funding from PNC Grow Up Great to support her work with Mother Goose on the Loose: Goslings. She is the author of "Understanding My Signals" which is a booklet used in Goslings and published by VORT; she receives royalties on the sales of the booklet.</span></em></p><p class="fine-print"><em><span>Susan Sonnenschein received funding from PNC Bank Growing up Great for conducting the evaluation of the Goslings program.</span></em></p>A new program has been show to help parents of preemies use their voice to foster their premature baby’s language development. The findings are hopeful, the researchers behind the program say.Brenda Hussey-Gardner, Associate Professor, Pediatrics, University of Maryland, BaltimoreSusan Sonnenschein, Professor, Applied Development Psychology, University of Maryland, Baltimore CountyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/816402017-08-16T15:01:17Z2017-08-16T15:01:17ZHere’s looking at you, kid: how webcams help parents bond with premature babies<figure><img src="https://images.theconversation.com/files/182229/original/file-20170816-32632-11b9aq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-premature-baby-swaddles-purple-wrap-580721896">Shutterstock</a></span></figcaption></figure><p>During pregnancy, most parents prepare for the baby’s arrival and look forward to introducing a healthy baby to family and friends soon after the birth. But an <a href="http://www.rcpch.ac.uk/system/files/protected/page/Your%20baby%E2%80%99s%20care%20-%20A%20guide%20to%20the%20National%20Neonatal%20Audit%20Programme%202015%20Annual%20Report.pdf">increasing number of parents</a> (8-12%) find that things do not progress as planned and their hoped-for healthy baby is sick or premature and needs expert neonatal care.</p>
<p>When this happens, joy is replaced by concern about the baby’s immediate and longer-term health and development, and a period of stress and anxiety for the parents often follows. Admission to a neonatal unit also means the parents are separated from their baby for lengthy periods just when they should be establishing bonds. </p>
<p>While the survival and long-term future of babies is improved in a neonatal unit, the separation of parents and children limits opportunities for early bonding. Parents are encouraged to visit the neonatal unit as much as possible; however, there is a need to develop and evaluate interventions to help parents feel closer to their babies when they are physically separated from them. <a href="http://www.explainthatstuff.com/webcams.html">Webcam</a> technology presents a potential solution.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/182238/original/file-20170816-32661-1wxub6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/182238/original/file-20170816-32661-1wxub6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182238/original/file-20170816-32661-1wxub6m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182238/original/file-20170816-32661-1wxub6m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182238/original/file-20170816-32661-1wxub6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182238/original/file-20170816-32661-1wxub6m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182238/original/file-20170816-32661-1wxub6m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Admission to a neonatal unit separates parents from their baby just when they should be establishing close bonds.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/premature-baby-incubator-machine-229937416">Shutterstock</a></span>
</figcaption>
</figure>
<p>Published recently in <a href="https://bmcpediatr.biomedcentral.com/about">BMC Pediatrics</a>, our <a href="http://rdcu.be/t6Al">study</a> is one of a few world-wide to have evaluated the use of webcam technology in neonatal units. This UK-based study represents the first in-depth analysis of parent and professional views on whether webcams can assist the early bonding process.</p>
<p>We interviewed 30 mothers and fathers and 18 professionals, including nurses, midwives, nursery nurses and doctors, in a Scottish hospital over a six-month period.</p>
<h2>The comfort of technology</h2>
<p>Each webcam was placed over an individual cot/incubator in the neonatal unit and transmitted real-time images of the baby, wirelessly and securely, to a linked tablet computer kept by recovering mothers in the postnatal area in the hospital. The camera was switched off when medical/nursing procedures were undertaken to avoid any potential distress on the part of parents, but otherwise it was in constant operation, allowing parents to see their baby whenever they wished.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/BFQqDui8mI8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">YouTube.</span></figcaption>
</figure>
<p>Parent and professional views of the webcam technology were overwhelmingly positive. One of the issues discussed by a number of the parents was that the technology allowed them to “feel that they were with their baby” even during periods of separation. It also meant they were able to be more responsive to their babies’ needs – for example, seeing their baby, helped mothers to produce breast milk. One mother of an eight-week premature baby said: </p>
<blockquote>
<p>When I had my little boy [also admitted to a neonatal unit] I couldn’t see him straightaway, whereas this time having the camera means I can see her constantly, she’s right beside my bed, really. Also, with things like expressing milk, I’ve found that a lot easier.</p>
</blockquote>
<p>Parents also discussed how webcam technology had helped them to “keep more stable emotionally” in the days following the delivery. The mother of a six-week premature baby described the comfort the webcam brought her:</p>
<blockquote>
<p>If I didn’t have the camera, I think I would have cracked up. I’d been waking up during the night and being able to see that she was there and that she was sleeping meant I was able to fall back to asleep again.</p>
</blockquote>
<p>Use of the technology also helped the mothers to “recover physically” following the birth, with issues such as rest, nourishment and the reduction of pain being discussed. One mother stated she would “definitely have got less sleep if I hadn’t been able to see her on the tablet”.</p>
<p>Parents also discussed the benefits that the webcam technology afforded in allowing them to share “real-time” pictures of the baby with their wider family and friends. The mother of a five-week premature baby told us:</p>
<blockquote>
<p>My partner loves it, just being able to see her all the time. And my mum and dad thought it was a fantastic idea. Because our baby’s in neonatal they couldn’t visit her, so it meant they didn’t have to wait to see her.</p>
</blockquote>
<p>Finally, staff in the neonatal care unit stressed the almost “gift-like” quality of webcam technology. A neonatal nurse said:</p>
<blockquote>
<p>You get such a great reaction the minute the baby’s stable. If I took a tablet round, the mum was just so happy. She thought she wasn’t going to see her baby for maybe another 12 hours, and then I appear and say, “Here she is, now you can watch her.”</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/182230/original/file-20170816-32614-1fkgr9m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182230/original/file-20170816-32614-1fkgr9m.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182230/original/file-20170816-32614-1fkgr9m.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182230/original/file-20170816-32614-1fkgr9m.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182230/original/file-20170816-32614-1fkgr9m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182230/original/file-20170816-32614-1fkgr9m.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182230/original/file-20170816-32614-1fkgr9m.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Neonatal professionals have described the comfort webcams bring parents separated from their newborn babies.</span>
<span class="attribution"><a class="source" href="http://www.basildonandthurrock.nhs.uk/wards/childrens-and-maternity/817-neonatal-intensive-care-unit-nicu-2">BUH NICU</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Parental anxieties</h2>
<p>But for a <a href="http://rdcu.be/t6Al">small minority</a> of parents in our study, the ability to see their baby 24/7 appeared to increase rather than decrease their anxiety. Areas of concern included interpreting what was being seen on the screen of the tablet and wondering if it was something to be concerned about. The father of a six-week premature baby said:</p>
<blockquote>
<p>It’s a double-edged sword using the webcam, I would say. You can see what’s happening but you don’t always know what’s happening.</p>
</blockquote>
<p>Another mother of a ten-week premature baby said she got deeply anxious if the camera was not switched on:</p>
<blockquote>
<p>Sometimes they turned the camera off and they’d forget to turn it on again and I had a sense of anxiousness when I couldn’t see him. I didn’t want to make a fuss and be a neurotic mother but I would ask, “Please can you turn it on so I can see he’s okay?”</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/182232/original/file-20170816-32632-bky3bs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182232/original/file-20170816-32632-bky3bs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182232/original/file-20170816-32632-bky3bs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182232/original/file-20170816-32632-bky3bs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182232/original/file-20170816-32632-bky3bs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182232/original/file-20170816-32632-bky3bs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182232/original/file-20170816-32632-bky3bs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Being able to see their baby at any time gives most parents peace of mind, but for some it made them more anxious.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/premature-newborn-baby-girl-hospital-incubator-396467245">Shutterstock</a></span>
</figcaption>
</figure>
<p>With a <a href="http://who.int/pmnch/media/news/2012/preterm_birth_report/en/">current global increase</a> in premature births, webcam technology can offer an important solution to periods of enforced parent-child separation in the early postnatal period. For the majority of parents these benefits meant increased feelings of closeness; enhanced emotional well-being; assisted the mother’s physical recovery, and facilitated the involvement of family and friends.</p>
<p>These benefits appeared to encourage the early bonding process between parents and their babies. Further work is required to assess the cost-effectiveness of webcam technology and also to evaluate its use in the family home following the mother’s discharge from hospital; currently it is only available in the hospital.</p>
<p>While mothers are commonly discharged after a few days, their premature baby may remain in neonatal care for weeks or even months. Webcam access at home could mean the difference between stressful anxiety and peace of mind for new parents.</p><img src="https://counter.theconversation.com/content/81640/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Kerr receives funding from the Digital Health & Care Institute, the National Institute for Health Research (NIHR), the Medical Research Council (MRC), the Chief Scientist Office (Scottish Government), NHS Greater Glasgow & Clyde.
Susan Kerr would like to acknowledge the contribution of her co-authors: Dr Caroline King, School of Health & Life Sciences, Glasgow Caledonian University; Dr Rhona Hogg, formerly NHS Greater Glasgow & Clyde; Dr Kerri McPherson, School of Health & Life Sciences, Glasgow Caledonian University; Dr Janet Hanley, School of Health and Social Care, Edinburgh Napier University; Dr Maggie Brierton, formerly Clinical Psychology Department, Child and Families Speciality, NHS Fife;
Dr Sean Ainsworth, Victoria Hospital, NHS Fife.
The technology (named mylittleone) was developed by Integrated Care 24, England, UK, a not for profit ‘gold’ social enterprise. The setting up, use and evaluation of the technology were facilitated by the Digital Health & Care Institute (DHI), Scotland. The views expressed in the article are those of the authors and do not necessarily reflect those of the funding body.
</span></em></p>Watching their babies via webcams eases parents’ anxiety and helps them connect in the absence of physical contactSusan Kerr, Reader/Lead, Healthy Lives & Relationships Research Group, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/554842017-02-13T14:44:50Z2017-02-13T14:44:50ZHow gum disease in pregnant women poses a risk to their newborns<figure><img src="https://images.theconversation.com/files/156012/original/image-20170208-9133-1nouc0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mothers-to-be must go for dental check-ups early on in their pregnancies to ensure that they don't develop pregnancy gingivitis.
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Women who develop severe mouth infections and suffer from bleeding gums when they are pregnant have a greater chance of delivering their babies preterm if they don’t treat the infection. </p>
<p>Up to 70% of women develop inflammation of the gums, or gingivitis, during their pregnancy. It’s commonly referred to as <a href="https://www.therabreath.com/pregnancy-gingivitis.html">pregnancy gingivitis</a>. This is due to the changes in a mother’s hormone levels during pregnancy. This promotes an inflammatory response which increases the risk of developing periodontal disease. </p>
<p><a href="http://www.colgateprofessional.com/patient-education/articles/what-is-periodontal-disease">Periodontal diseases</a> are infections of the structures around the teeth including the gums, ligaments and bone. They may cause bleeding of the gums and in severe cases, loss of teeth.</p>
<p>The challenge is that not many mothers seek dental treatment for bleeding gums during pregnancy. And antenatal clinics pay little, if any, attention to the mother’s oral health status. As a result, this complication often goes undetected.</p>
<p><a href="http://europepmc.org/abstract/med/19431959">Our research</a> shows that incorporating a rapid point-of-care test into routine antenatal examinations could help diagnose periodontal disease. The test is simple and inexpensive and is widely used as a diagnostic test for periodontal disease. </p>
<p>If the test is set up before the patient is examined, it can deliver a result by the time her examination is complete. This would alert antenatal health care providers of the risk of adverse pregnancy outcomes. Mothers can then be referred to a dental clinic for prompt treatment to reduce their risk. </p>
<h2>Premature babies</h2>
<p>Across the world, about 6.9 million babies die due to prematurity. Many as a result of their birth weight being low. In the US about 7% of babies are born with a low birth weight while in the UK, this figure sits at 6%. </p>
<p>But in Africa up to 12% of babies are born with a low birth weight. In South Africa <a href="http://www.samj.org.za/index.php/samj/article/view/7200/5281">neonatal deaths</a> account for about 40% of all deaths in children under the age of 5. In <a href="http://data.worldbank.org/indicator/SP.DYN.IMRT.IN">Angola and the Central African Republic</a>, close to 100 babies in every 1000 die within the first four weeks of birth. These are the highest known rates of infant death in the world. This compares to the UK and the US where only seven in every 1000 infants die within the first four weeks of life. </p>
<p><a href="https://repository.uwc.ac.za/handle/10566/925">Studies</a> have linked babies born prematurely with a low birth weight to their mothers’ smoking habits, and her ethnicity. Other factors have also played a role such as the mother’s age, whether she previously delivered a baby that had a low birth weight, whether she had pregnancy complications and the type of delivery she had. </p>
<p>Some research found a link between periodontal disease and <a href="http://www.joponline.org/doi/abs/10.1902/jop.2005.76.11-s.2144">adverse pregnancy outcomes</a> but other studies couldn’t establish a conclusive link. None of these studies were in the developing world. </p>
<p>But <a href="http://europepmc.org/abstract/med/19431959">our research</a> in South Africa and <a href="http://www.tandfonline.com/doi/abs/10.4161/viru.1.4.12004">Rwanda</a> has found a link between mothers with periodontal disease that deliver underweight preterm babies. Our study was the first in Africa to link periodontal disease to pre-term delivery. </p>
<h2>What we found</h2>
<p>As part of <a href="http://onlinelibrary.wiley.com/doi/10.1111/idj.12274/abstract">our research</a> we did two studies. One focused on pregnant women during their antenatal visits to maternal obstetric units in Kwazulu-Natal. The other looked at mothers admitted to labour wards in Rwanda’s Butare Hospital.</p>
<p>One study showed there was a strong likelihood that there would be an adverse pregnancy outcome when a mother was clinically diagnosed with periodontal disease. Those who didn’t have periodontal disease were more likely to have normal pregnancy outcomes.</p>
<p>The other study focused on the specifics of the bacteria associated with periodontal disease. </p>
<p>In the immune system there are two sets of proteins called cytokines, which regulate the body’s response to an inflammation. There are pro-inflammatory cytokines and anti-inflammatory cytokines. In normal full term pregnancies, proteins that encourage inflammation in the body are regulated by those that dismiss the inflammation. This prevents the body developing an inflammation and rejecting the fetus.</p>
<p>But our studies confirmed that when a woman had periodontal disease there was an imbalance in these proteins which could create an inflammation in the woman’s body and induce preterm labour. </p>
<h2>Changing testing patterns</h2>
<p>The earlier periodontal disease is diagnosed in pregnant women, the less of a chance it has of having an impact on their delivery. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/24934944">Surveys</a> into practice behaviours of obstetricians in other countries show there’s growing awareness of the link between periodontal disease and adverse pregnancy outcomes. </p>
<p>But not enough is being done to forge the collaboration between the antenatal health care providers and oral health care professionals. </p>
<p>Obstetricians argue that they have no time to perform oral examinations during antenatal consultations. And, they argue, these would be better performed by oral health care workers.</p><img src="https://counter.theconversation.com/content/55484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlene Africa receives funding from National Research Foundation. She is affiliated with University of the Western Cape.
This material is based upon work partially supported financially by the National Research Foundation (NRF) of South Africa. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors, and therefore, the NRF does not accept any liability in regards thereto. </span></em></p>Up to 70% of women develop gingivitis during their pregnancy but not many seek dental treatment for bleeding gums. This could be detrimental for their babies.Charlene Africa, Professor of Medical Biosciences, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/675342016-10-31T18:51:11Z2016-10-31T18:51:11ZThe number of premature baby deaths is still too high. What can be done about it<figure><img src="https://images.theconversation.com/files/143904/original/image-20161031-15793-wnxv7q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A mother holds the foot of her premature baby. Prematurity is the most common cause of neonatal death globally. </span> <span class="attribution"><span class="source">UNICEF Ethiopia/2012/Pudlowski</span></span></figcaption></figure><p>In 2015 just under 6 million children under the age of five died across the globe. Of these, about 2.6 million died within the first month of being born. And more than 60% of these deaths took place in Africa and South Asia. Just over a third of these babies died as a result of complications because they were born premature. </p>
<p>Prematurity is the most common cause of neonatal deaths globally. Babies are considered premature if they are born before the mother reaches 37 weeks of pregnancy.</p>
<p>In developed countries, the main causes of preterm deaths are well known and studied. Some babies develop infections, others have breathing problems such as birth asphyxia or lung immaturity. They also have feeding problems or experience metabolic and electrolyte disturbances and congenital malformations. </p>
<p>But in low resource countries, the causes of preterm deaths is much less understood. Anecdotal evidence from experts and clinicians in neonatal intensive care units is that infections such as neonatal sepsis and asphyxia are common. But there is no data to back this up.</p>
<p>It is therefore critical to identify the most “treatable and preventable” causes of death in low resource settings. These findings would help inform the tools and interventions that must be developed and included in national programmes to reduce neonatal mortality in the developing world.</p>
<h2>Approaches that work</h2>
<p>Reducing the high rates of children under the age of five who die has been a global health priority since the early 1990s. At the time diarrhoea, pneumonia and malaria were the three leading killers of children under the age of five. </p>
<p>To tackle these several interventions were rolled out and since deaths of children under five has <a href="http://www.who.int/mediacentre/factsheets/fs178/en/">more than halved</a>. The interventions were simple: oral rehydration solutions and zinc for diarrhoea, a pneumococcal vaccine and antibiotics for pneumonia and antimalarial medicines and long-lasting insecticide treated nets for malaria. </p>
<p>But these reductions has meant that the proportion of deaths in the neonatal age group has increased. Just under half of all the <a href="http://www.who.int/mediacentre/factsheets/fs178/en/">under-five deaths</a> are due to neonatal mortality. </p>
<p>The thinking behind these interventions is based on the principles of precision medicine where the right solution is delivered to the right population at the right time. </p>
<p>The same approach can be used to deal with neonatal mortality. And these interventions can then be deployed based on the number and type of preterm birth risk factors in particular women. </p>
<h2>Risk factors</h2>
<p>There are four groups of factors that increase the likelihood of a woman having a preterm baby:</p>
<ul>
<li><p>Age: women who fall pregnant under the age of 20 when their bodies are physiologically unable to handle a baby or over the age of 35 when their bodies’ fertility functions start to decline are at risk of having a preterm baby.</p></li>
<li><p>Illness: women who develop diabetes during pregnancy or suffer from chronic illnesses such as hypertension, asthma or heart disease have a higher risk of delivering a preterm baby. In addition, women with tuberculosis, HIV/AIDS, persistent malaria, urinary tract infections and vaginal infections are also at risk.</p></li>
<li><p>Bad habits: smoking and alcohol drinking also contribute. </p></li>
<li><p>Socio-economic conditions: being single, having a low income and low levels of education also have an effect on a baby being born prematurely. This is mainly due to them having a lack of proper nutrition or being overworked.</p></li>
</ul>
<h2>Old and new interventions</h2>
<p>For these risks to be dealt with, health authorities make the best use of existing tools. But in addition to this, they must remain receptive to new approaches. </p>
<p>There are several existing interventions that could reduce preterm deliveries and prevent poor pregnancy outcomes. Some are based on improving the access to preconception packages while others include enhanced care packages for women at higher risk of preterm birth. Women with hypertensive disease, for example, could be identified and treated. </p>
<p>Similarly, teenage girls could be given family planning lessons and all women receive regular antenatal care during pregnancy. Those with infections such as tuberculosis, HIV, syphilis, and urinary tract infections could be treated promptly. </p>
<p>But there are also new interventions that should be explored. For a pregnant young woman working long hours in a remote agricultural area, the intervention package could include prepaid transport to a facility for delivery, decreased working hours as pregnancy progresses as well as nutritional supplements. </p>
<p>For an urban woman with a sedentary desk job in an area where there is a high prevalence of sexually transmitted infections, the intervention package might focus on treating the infection and recommendations for gentle exercise. But in this case transport would not be a priority.</p>
<h2>Defining concrete interventions</h2>
<p>Preterm mortality is a major contributor to overall child mortality.</p>
<p>The challenge is that there is a lack of research to define and prioritise the specific causes of mortality of preterm infants. There is also no research defining concrete interventions that can be scaled up. </p>
<p>The lens of precision thinking can help with this challenge as it can help develop a more focused and targeted intervention package that can be implemented.</p><img src="https://counter.theconversation.com/content/67534/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lulu Mussa Muhe receives funding from Bill and Melinda Gates Foundation. </span></em></p>In developed countries, the main causes of preterm deaths are well known and studied.But in low resource countries, the causes are much less understood.Lulu Mussa Muhe, Professor of Paediatrics, Addis Ababa UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/649352016-09-07T05:51:07Z2016-09-07T05:51:07ZWhy we should aim to deliver most twins at 37 weeks<figure><img src="https://images.theconversation.com/files/136805/original/image-20160906-25237-uao3mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You say tomato, I say potato.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-96938312/stock-photo-adorable-looking-twins-with-curly-hair.html?src=XJSsexz62yZFAwHLX6apvw-1-6">Shutterstock</a></span></figcaption></figure><p>Increasing numbers of mothers are now pregnant <a href="http://www.ncbi.nlm.nih.gov/pubmed/23046551">with twins</a>, mainly due to the use of assisted reproductive techniques such as IVF. These pregnancies can either be monochorionic, where the twins share the same placenta, or dichorionic, where each twin has its own and which is more common.</p>
<p>Twin pregnancies are often complicated by problems related to the placenta, maternal age, obstetric complications, and concerns about the growth of the twins. Complications can often happen in pregnancies near term that have otherwise gone well, with no single cause identified for why this happens.</p>
<p>Twin pregnancies are at high risk of stillbirths compared to mothers carrying just one baby. This <a href="http://www.scirp.org/journal/PaperInformation.aspx?PaperID=27145">risk increases</a> 13-fold if twins share the placenta, and five-fold when they have their own placenta. </p>
<p>Stillbirth risk also increases as the pregnancy advances so mothers are often delivered before their due date. But early delivery poses additional risks to the baby including neonatal death and other complications, often arising from being born prematurely. The optimal time for delivery believed to minimise risk to newborns varies and current national and international guidelines recommend delivery at different time points, with some including <a href="https://www.nice.org.uk/guidance/cg129">the UK</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21277672">France</a> advising delivery as early as 34 weeks if the twins share the placenta – six weeks before the expected date of delivery.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/136807/original/image-20160906-25266-1tidxxw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/136807/original/image-20160906-25266-1tidxxw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136807/original/image-20160906-25266-1tidxxw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136807/original/image-20160906-25266-1tidxxw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136807/original/image-20160906-25266-1tidxxw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136807/original/image-20160906-25266-1tidxxw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136807/original/image-20160906-25266-1tidxxw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Early post.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-259726004/stock-photo-twin-newborns-in-a-basket.html?src=zKq1ukHPhtg5Y1PpjOKe6A-1-1">Shutterstock</a></span>
</figcaption>
</figure>
<p>In a new paper <a href="http://www.bmj.com/content/354/bmj.i4353">published in the BMJ</a>, we identified the optimal time to deliver mothers with twin pregnancies to reduce the risks of both stillbirth and neonatal death. The work involved a team of international research collaborators from the <a href="http://www.ncbi.nlm.nih.gov/pubmed/22893554">Global Obstetric Network</a>. We systematically reviewed all published and unpublished evidence on delivery times for twins, which compared the weekly risks of stillbirth when a pregnancy was continued to the following week, to the risks of neonatal death when delivered at that gestational week. </p>
<p>We identified 32 studies that provided data on about 35,000 twin pregnancies (29,685 dichorionic and 5,486 monochorionic). We found that in twin pregnancies where each has its own placenta, the risks of neonatal death from delivery was more or equal to the risk of stillbirth from continuing the pregnancy. However, when pregnancy was continued from 37 to 38 weeks, the risks of stillbirth appeared to be greater than neonatal death, resulting in 8.8 additional infant deaths per 1,000 pregnancies. </p>
<p>In twin pregnancies that shared the placenta, this risk of stillbirth appeared to be greater than neonatal death when pregnancy was continued from 36 weeks to 37 weeks, resulting in 2.5 additional deaths per 1,000 pregnancies. But this increase was not statistically significant. </p>
<p>We also provided estimates of other complications in twin babies such as respiratory distress syndrome, septicaemia, neonatal seizures, and admission to the neonatal intensive care unit for a complication. </p>
<p>Based on our findings, we recommend that delivery should be offered to mothers with twin pregnancies that have their own placentas (dichorionic) at 37 weeks of pregnancy. We did not find clear evidence to deliver twins with a shared placenta (monochorionic) before 36 weeks of pregnancy – two weeks after some guidelines – and so suggest that delivery should be considered at 36 weeks in these pregnancies.</p><img src="https://counter.theconversation.com/content/64935/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shakila Thangaratinam does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Delivering twins is a balance between preventing pregnancy complications and the dangers of prematurity. New research suggests there is an optimum time.Shakila Thangaratinam, Professor in Maternal and Perinatal Health, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/634042016-08-05T01:21:34Z2016-08-05T01:21:34ZCommon method of preventing early births may be causing more<figure><img src="https://images.theconversation.com/files/133034/original/image-20160804-12192-tj896x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Preterm babies are at significant risk of health and development problems, highlighting the need to get prevention strategies right.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>New research has found a commonly used method of preventing early or preterm birth (delivery of a baby before 37 weeks) may in fact be causing more to occur, and leading to further problems.</p>
<p>The “cervical cerclage” is a surgical procedure involving stitching the neck of the womb (the cervix) closed in pregnancy. The cerclage stitch prevents preterm birth as it provides support to a weakened cervix. </p>
<p>This <a href="http://www.sutureonline.com/wound-closure-manual">prevents the cervix from opening</a> too early in pregnancy, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/12114901">also acts a barrier</a>, protecting the baby from vaginal infection.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=756&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=756&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=756&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=950&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=950&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=950&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The cerclage stitch prevents preterm birth as it provides support to a weakened cervix.</span>
<span class="attribution"><span class="source">Screenshot</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Some two million cervical cerclages are performed annually to prevent preterm birth. Worldwide, 80% of doctors use a tape-like braided suture material for the <a href="http://www.tandfonline.com/doi/abs/10.3109/14767058.2013.870551?journalCode=ijmf20">cerclage stitch</a>. A minority of doctors use a thinner “monofilament” material (like fishing line), although until now there has been no evidence to support this alternate practice.</p>
<p>Our study looked back at pregnancies across ten years at five United Kingdom university hospitals. Comparing the two suture materials, we found rates of stillbirth were three times higher in women who had a braided rather than monofilament cerclage, as were rates of preterm birth – 28% in women with braided suture compared to 17% with monofilament.</p>
<p>While larger studies will be required to replicate our findings, we estimate switching to the thinner monofilament thread for all cerclage procedures in the meantime could prevent 170,000 premature births globally every year, and 172,000 stillbirths across the world.</p>
<h2>What we did</h2>
<p>To investigate why preterm and stillbirth rates were higher in women who had a braided cerclage, vaginal fluid was sampled from high-risk women receiving either a braided or monofilament cerclage in pregnancy. At the same time, ultrasound scans were performed to see how the cervix was affected by the different suture material types. </p>
<p>Using lab-based techniques to assess the bacteria in the birth canal – called the microbiome – we revealed the traditional braided suture material caused a five-fold increase in abnormal and potentially harmful bacteria during pregnancy. </p>
<p>In contrast, the monofilament suture maintained high amounts of good lactobacillus bacteria in the vagina, throughout pregnancy. We also noticed this overgrowth in bad bacteria observed in the braided suture material was associated with an increase in potentially harmful levels of inflammation as well as abnormally early changes to the cervix, detected by ultrasound scan. </p>
<p>There is now strong evidence that infection is an important cause of the cervix opening too early in pregnancy, which results in preterm birth. The cerclage, the thicker woven structure of the braided thread, shown to encourage the growth of dangerous bacteria in our study, may increase the risk of adverse pregnancy outcomes in certain women. </p>
<p>Importantly this study finds this overgrowth of harmful bacteria was not observed in the thinner and simpler structure of the monofilament.</p>
<h2>Why this matters</h2>
<p>Preterm birth affects about <a href="http://www.who.int/bulletin/volumes/88/1/08-062554/en/">7-15% of pregnancies worldwide</a> and affects babies’ breathing, feeding and ability to fight infection. </p>
<p>Preterm babies are therefore at <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2006.01118.x/abstract">significant risk</a> of longer-term brain damage as well as learning difficulties, blindness and deafness. </p>
<p>Some babies are so unwell <a href="http://digital.nhs.uk/hes">they may not survive</a> the stress of prematurity, with preterm birth being the <a href="http://www.who.int/gho/child_health/mortality/causes/en/">largest single cause of death</a> in children under the age of five. </p>
<p>Preterm birth <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa041367">places major strain</a> on families coping with the substantial emotional and financial health care costs of medical problems resulting from being born too early. </p>
<p>Caring for a premature baby in a neonatal intensive care unit <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2005.00577.x/full">costs an estimated</a> GB£317,166 (A$555,000) per night in the UK, and many preterm babies are admitted for weeks and even months. In the United States <a href="http://www.ncbi.nlm.nih.gov/pubmed/21219170">preterm birth is thought to cost</a> more than US$26 billion every year.</p>
<p>Despite a significant increase in research focused on preterm birth over the last 20 years, rates remain largely unchanged. The major priority in tackling this important condition is in understanding how to prevent preterm birth in women at risk.</p><img src="https://counter.theconversation.com/content/63404/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsay Kindinger does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research has found a commonly used method of preventing early or pre-term birth (delivery of a baby before 37 weeks) may in fact be causing more to occur, and leading to further problems.Lindsay Kindinger, Prematurity Clinical research fellow, Imperial College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/625452016-07-18T20:06:30Z2016-07-18T20:06:30ZMums and dads of very preterm babies more likely to be depressed<p>The classic image of a newborn baby happily nestled in the proud parents’ arms is one we are all familiar with. Many of us are lucky enough to have one on the mantelpiece, but some families miss out on taking this photo. </p>
<p>Babies who come too early, often weighing under a kilogram, are rushed away from their parents to the neonatal intensive care nursery in a fight for survival. Babies are classified as preterm when they are born <a href="http://www.who.int/mediacentre/factsheets/fs363/en/">prior to 37 weeks’ gestation</a>. </p>
<p>Within this group, those born prior to 32 weeks are classified as very preterm. In Australia, more than <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129545698">5,000 babies</a> are born very preterm every year, and it is these babies who are at greatest risk for a <a href="http://www.ncbi.nlm.nih.gov/pubmed/12824207">wide range of adverse outcomes</a>. </p>
<p>A new baby is life-changing for all parents, but for those whose babies are born too early, the challenges can be immense. </p>
<p>Our research <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=2532578">published today in JAMA Pediatrics</a> reports concerning levels of psychological distress in both mothers and fathers of very preterm babies. We closely followed these families, assessing parental mental health every two weeks for the first 12 weeks after birth, then again six months later. </p>
<p>In the weeks immediately following the birth of their babies, 40% of mothers and 36% of fathers experienced clinically significant symptoms of depression. This was compared to just 6% of mothers and 5% of fathers of healthy full-term babies.</p>
<p>Rates of anxiety were even higher, at close to half of both mothers and fathers. Thankfully, symptoms improved over the course of the first 12 weeks. When we checked in again with parents six months later, though, 14% of mothers and 19% of fathers were still distressed, compared to 5% of mothers and 6% of fathers of full-term babies. </p>
<p>There was little evidence changes in parental psychological distress were related to medical severity, time of transfer or discharge from hospital, or other family factors. </p>
<p>In many ways, it’s not surprising parents of very preterm infants are at far higher risk of depression and anxiety than parents of healthy, full-term babies. Their experiences are vastly different. </p>
<p>Parents of very preterm babies often describe great fear, shock, feelings of helplessness and unmet expectations, as well as inherent separation from their babies. </p>
<p>On average, the very preterm babies in our study stayed in hospital for about three months – a far cry from the few days following a straightforward birth. A baby’s path through the neonatal intensive care unit is often not smooth, which puts enormous strain on families in a multitude of ways. </p>
<p>There is also the impact of grief – many parents speak of the sense of loss they feel for the pregnancy, the birth and the baby they had imagined. </p>
<h2>Father’s depression often neglected</h2>
<p>Fathers of very preterm babies have been largely neglected in the research to date. This study is the first to our knowledge to look at the mental health of fathers in this way. </p>
<p>We found they were no less susceptible to depression and anxiety than mothers. This differs from rates reported in the general population, which show that <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0">men have lower rates of depression and anxiety than women</a>, regardless of whether they are <a href="http://www.ncbi.nlm.nih.gov/pubmed/20483973">fathers</a> or not.</p>
<p>There are a few potential reasons for this new finding. First, there is no doubt the neonatal intensive care unit experience can be highly stressful for both mothers and fathers. </p>
<p>However, it is important to appreciate that fathers also often have unique pressures. Many men described feeling torn between their partner and their baby, both in need of extra support. They were often going back to work and juggling multiple responsibilities, especially when there are other children at home. </p>
<p>Many also spoke of the challenges of trying to meaningfully engage in an environment where traditionally the focus is on mothers. </p>
<h2>What can be done?</h2>
<p>It’s important for parents to know that, for many people, the distress they feel after having a preterm baby does improve over the first few months. This may represent a period of adjustment. </p>
<p>However, as parents in our study were still showing higher rates than their full-term counterparts six months later, it is also important to be aware the challenges for these families do not end when they leave hospital. </p>
<p>We know from previous research mothers still have higher rates of psychological distress <a href="http://www.ncbi.nlm.nih.gov/pubmed/19955253">two</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24359937">seven</a> years after having a very preterm baby. </p>
<p>It’s important health professionals working with these families closely monitor parents for signs of depression and anxiety at regular intervals during the hospital stay and beyond, and ensure they are receiving appropriate support. This support needs to continue far beyond the traditional postnatal period. </p>
<p>It’s clear we need to be more aware of the well-being of fathers. Many of our fathers said they were surprised we were interested in how they were going, and were grateful for it. </p>
<p>This article talks about the typical nuclear family consisting of a mother and father, but of course there is also much diversity in families. This extra awareness and support must apply to all caregivers and support people involved in the birth of a child. </p>
<p>All parents sometimes need reminding to look after themselves. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/21052833">large body of research</a> shows parental mental health is important for child outcomes. Parents of very preterm babies getting the support they need will not only improve their own well-being, but will go a long way to help protect these vulnerable babies too.</p>
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<p><em>Further information and support for parents of preterm babies can be found at <a href="https://www.lifeslittletreasures.org.au">Life’s Little Treasures</a> or <a href="http://raisingchildren.net.au/premature_babies/premature_babies.html">Raising Children Network</a>.</em></p>
<p><em>For general support you can contact <a href="https://www.lifeline.org.au">Lifeline</a>: 131 114 or <a href="https://www.beyondblue.org.au">Beyond Blue</a>: 1300 22 4636</em></p><img src="https://counter.theconversation.com/content/62545/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carmen Pace does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new baby is life-changing for all parents, but for those whose babies are born too early, the challenges can be immense.Carmen Pace, Clinical Psychologist and Research Fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.