Day 1 :
Keynote Forum
Rita P Verma
Nassau University Medical Center, USA
Keynote: Early postnatal weight loss in extremely low birth weight infants (ELBW): Clinical determinants and implications in neonatal morbidities
Time : 08:45-09:45
Biography:
Abstract:
We investigated early postnatal weight changes (EPWC) and their clinical implications in morbidities related to fluid metabolism in ELBW infants. As maximum weight loss (MWL) and daily body weight changes from birth weight (D∆ bw) during the ï¬rst 15 days of life, The mothers’ and infants’ demographic and clinical variables relevant to body fluid balance were correlated with MWL and D∆ bw via Pearson's correlation coefficient and Pearson's partial correlation tests. We further assessed effects of MWL graded as low (5-12%) moderate (18.1-12%) and high (18-25%) on these variables. MWL in the cohort (n=102) was 14.2+5.4%. MWL correlated negatively with GA, ANS and pregnancy-associated hypertension (PAH), and positively with BPD28, total days on oxygen, fluid intake, urinary output and the day of life when birth weight was surpassed. All these correlations were lost after controlling for GA except for the day of life when birth weight was surpassed. D∆ bw correlated inversely with GA and was associated with lower risks for BPD28, PDA, and IVH, which persisted after controlling for GA. ANS decreased the volume of D∆ bw. Maternal diabetes mellitus (GDM) and PAH were not noted in mothers in high MWL group, whereas 38% of mothers in low MWL group suffered from the latter.
Conclusion: MWL, governed by maturation, does not promote morbidities within the range of 14.5+4.2% of birth weight. D∆ bw is protective for PDA, BPD, and IVH. ANS, PAH and GDM decrease early postnatal weight losses in ELBW neonates.
Keynote Forum
David V Strider
PROSAMI, USA
Keynote: From pencils and telemedicine lectures to a New Women / Children’s Hospital in the midst of rural Congo: Making a huge health care leap infections in humans
Biography:
David Strider has practiced at the University of Virginia Medical Center as a nurse for 35 years. He obtained his B.S. in Biology from the College of William and Mary and his MSN and Doctors in Nursing Practice from the University of Virginia. He is the president of PROSAMI.
Abstract:
Over the last year PROSAMI, a volunteer organization supporting maternal and infant care in the Democratic Republic of the Congo (DRC) , completed the education for nineteen (19) Congolese nurses, providing them with skills and cognitive resources to function as advanced nurse midwives . PROSAMI has been striving since May, 2009, to develop an educational program that could empower DRC nurses to be trained as advanced practice nurse midwives (ANM), with the expectation that such highly qualified health care practitioners can oversee the prenatal, delivery, and postnatal care of women in rural DRC areas.
Telemedicine support has facilitated the transmission of “cutting edge,” concise maternal / infant health care lectures to the ANM students. Each of the ANM students has received a laptop computer, a copy of the two - volume Sellers manual on nurse midwifery , and an obstetrical kit containing adult stethoscope and blood pressure cuff, fetoscope, scissors, umbilical clamps, and gauze. On March 10th, 2018, PROSAMI finalized the rental of a 1600 square feet stone building that will accommodate the education for and examination of young women prenatally, the space for normal deliveries , and a suite for post partum care of women and infants.
PROSAMI has utilized the Cascade teaching model within the Congo to begin reducing the previous infant mortality rate of 120 /1,000 live births in rural areas, along with the tragically high maternal mortality rate of 693 / 100,000 live births. The Pilot Center will offer comprehensive maternal and infant care services for a three mile radius. Midwives’ clinical services will be provided within a sliding scale matrix that is based on the household gross income. PROSAMI services are blossoming like a beautiful Congolese flower, and the PROSAMI health care model will benefit mothers and babies for many decades.
- Neonatal Research | Neonatal Infectious Diseases & Antibiotics | Midwives in Maternal Care | Midwifery | Neonatal Infectious Diseases & Antibiotics | Neonatal Nutrition Nursing | Perinatal Depression |Women Health
Location: Superior Ballroom C
Chair
Lisa Quinn
Gannon University,USA
Co-Chair
Karen Lumia
Gannon University, USA
Biography:
Abstract:
Is it only a dream to provide accessible, affordable, high quality Health Care to women of childbearing age in a country fraught by Civil War and ongoing human rights violations?
This has been the goal of PROSAMI the past 10 years, with a concerted effort to train Advanced nurse midwives and to establish a clinic for their services and continuing education.
To date, 19 Congolese nurses have received cutting edge, maternal infant Health Care education and are on the home stretch for licensure. In timing which seems providential, a clinic environment has been procured, and a long-awaited Pilot Center is being equipped and ready for opening. This will enable the advanced practice nurse midwives to deliver consistent, high quality Health Care during childbirth and the first year of the infant's life. It will also be a site for continued Education and Training for advanced nurse midwives. A brief overview of the journey includes the initial training of 4 nurses in the US in an intensive course, their return to the DRC where they each mentored four additional nurses in a Cascade training model facilitated through telemedicine, and clinical hours and on-site skills testing in local hospitals rounding out their certification.
Questions for discussion:
How is PROSAMI different from other large philanthropic organizations such as the Red Cross, UNICEF, Doctors Without Borders?
Why is the Cascade training model so important?
What are some of the obstacles encountered by Congolese nurses and PROSAMI members as the program advanced?
Why is it important to tell stories about our successes?
Why were the international conferences important?
Can the PROSAMI model be replicated in other areas of the world?
How can our organization show respect for the Congolese public health system and the local government?
How can PROSAMI best record our patient interventions and publish our data along with success stories?
If we could wind back the clock 9 years, would we have approached the prosami initiatives any differently, in terms of priority and timing?
Karen H Strange
Integrative Resuscitation of the Newborn workshop, USA
Title: Saving a newborn life: The do’s and don’ts of neonatal resuscitation
Biography:
Karen H. Strange is a Certified Professional Midwife (1996), American Academy of Pediatrics/Neonatal
Resuscitation Program Instructor (1992).She is founder of the Integrative Resuscitation of the Newborn workshop, which includes the physiology of newborn transition. She teaches the “when, why and how” of helping newborns that are either not breathing or not breathing well, with incredible clarity. She helps the provider have a sense of what the baby is experiencing which leads to a more appropriate response to newborns in need. Karen has done
over 900+ hours of debrief/case reviews regarding resuscitation. She is an international speaker and has taught over 9,000 people worldwide. There are many neonatal resuscitation instructors but Karen teaches practical neonatal resuscitation, regardless of the place of birth. And her teachings instill a strong sense of confidence and competence in providers, so they can respond in the least traumatic way.
Abstract:
A good birth is such a gift… and a complicated birth is the reason YOU are there. When a baby is born not breathing or not breathing well, it’s the birth practitioners job to step in and help. But that goes beyond just having an NRP card. It takes skill and confidence to breathe for a baby who isn’t yet breathing for themselves. And in that moment fear and panic may be filling your body. Do you know what to do?Each of us had to undergo a transition at birth. We transitioned from intrauterine life to extrauterine life. And in that transition, our lungs went from fluid filled lungs to air filled lungs. We all did it. Most of us made that transition naturally, on our own, but some babies need help clearing that fluid. Some babies need our help.
Karen Strange is teaching the subject that she knows best: neonatal resuscitation and the transition that babies make at birth. While surveying countless midwives and birth attendants through trainings, workshops, case reviews and debriefs, the same mistakes came up time and time again. Karen has gathered birth data from across the globe and has pinpointed the 5 most common mistakes that occur in neonatal resuscitation. In this lecture, Karen breaks down the 5 main failures in neonatal resuscitation and gives you the tips you need for successful resuscitation of the newborn, in the least traumatic way. Learn the most likely complications, what often gets missed by birth practitioners, and the most frequent misunderstandings. You will leave the lecture with a new understanding of the transition that each of us makes at birth. Karen is unlike any other AAP/NRP instructor. She takes the latest updates from NRP, international resuscitation guidelines, and over 900+ debrief hours with experienced birth professionals to create the most cohesive resuscitation trainings available.
Ashlesha Kaushik
UnityPoint Health, USA
Title: Congenital infections and perinatal infection: State of the art diagnosis and management
Biography:
Dr. Ashlesha Kaushik is an American Board certified Pediatric Infectious Diseases Physician and Chief of Pediatric Infectious Diseases at Unity Point Health, and resident preceptor at Siouxland Medical Education Foundation, Sioux City, Iowa, United States. She was the Former Chief, Division of Pediatric Infectious Diseases, University of South Dakota Sanford School of Medicine, Sanford Children’s Specialty Clinic and Hospital, Sioux Falls, South Dakota, United States.
Dr. Kaushik earned her Postdoctoral Fellowship in Pediatric Infectious Diseases at University of Texas Southwestern, Children’s Medical Center of Dallas at Dallas, Texas, United States.
She is certified in Healthcare Epidemiology, Infection Control and Antimicrobial Stewardship by the Society of Healthcare Epidemiology of America (SHEA).
Abstract:
Congenital infectious syndromes can be severe in the neonate with devastating consequences. Knowledge of accurate diagnosis and correct management of congenital infections is essential for neonatal practice and successful patient outcomes. Congenital infections (infections in utero) are defined as infections acquired by the fetus transplacentally from an infected mother. These include toxoplasmosis, rubella, cytomegalovirus (CMV), syphilis, parvovirus, and newly described zikavirus. Perinatal infections are acquired during birth, and include infectious agents like HSV (Herpes simplex virus) and Hepatitis viruses. Clinical manifestations of congenital infections include growth retardation, cataracts, cardiac defects (PDA), blueberry muffin spots, hydrocephalus, generalized intracranial calcifications, chorioretinitis, microcephaly. Different clinical features characterizing the various infections described as “classic associations” have been identified. For diagnosing congenital infections, we should know when to screen the mother and/or the baby. Specific infections need specific diagnostic testing with serology and /or PCR. The main objectives of the presentation would be to distinguish the etiology and clinical features of congenital infections, review the diagnostic modalities for congenital infections, and to review plans of treatment for congenital infections. Knowledge of not only the clinical spectrum and features of congenital infections but the current recommendations for diagnosis and management of these infections including latest advancements is important and beneficial for physicians, specialists and neonatal practitioners. This is especially significant in the era of new and emerging infections.
Biography:
Molly Patterson, Research & Development Midwife at University Hospitals of Leicester NHS Trust. She is a clinical midwife by background for the past 30 years with a passion for clinical research. Her MSc is in Heath Service Research. She has worked in a research role in the NHS since 1997. Currently she manage a team of 10 Research Midwives and 2 Research Support Officers. Together the team undertake both Obstetric and Midwifery clinical research studies on the NIHR portfolio. She has experience with writing research proposals, preparing ethics applications, setting up & running research studies in the NHS and mentoring research midwives through training and development in research.
Abstract:
Background. Repeated epidemiological surveys show no decline in depression although uptake of treatments has grown. Universal depression prevention interventions are effective in schools but untested rigorously in adulthood. Selective prevention programmes have poor uptake. Universal interventions may be more acceptable during routine healthcare contacts for example antenatally. One study within routine postnatal healthcare suggested risk of postnatal depression could be reduced in non-depressed women from 11% to 8% by giving health visitors psychological intervention training. Feasibility and effectiveness in other settings, most notably antenatally, is unknown.
Method. We conducted an external pilot study using a cluster trial design consisting of recruitment and enhanced psychological training of randomly selected clusters of community midwives (CMWs), recruitment of pregnant women of all levels of risk of depression, collection of baseline and outcome data prior to childbirth, allowing time for women ‘at increased risk’ to complete CMW-provided psychological support sessions.
Results. Seventy-nine percent of eligible women approached agreed to take part. Two hundred and ninety-eight women in eight clusters participated and 186 termed ‘at low risk’ for depression, based on an Edinburgh Perinatal Depression Scale (EPDS) score of <12 at 12 weeks gestation, provided baseline and outcome data at 34 weeks gestation. All trial protocol procedures were shown to be feasible. Antenatal effect sizes in women ‘at low risk’ were similar to those previously demonstrated postnatally. Qualitative work confirmed the acceptability of the approach to CMWs and intervention group women.
Conclusion. A fully powered trial testing universal prevention of depression in pregnancy is feasible, acceptable and worth undertaking
Elizabeth Paul
The Children’s Hospital of Philadelphia, USA
Title: Taking baby steps to optimize nutrition
Biography:
Elizabeth completed her undergraduate work in Nutrition and Dietetics at Radford University in Virginia. She went on to complete her dietetic internship at the Medical College of Virginia. Her entire dietetics career so far has been based out of Philadelphia, Pennsylvania. While initially working with the adult population, Elizabeth started working in pediatrics over 10 years ago with exclusive neonatal work for over 8 of those years. She became a dietitian to work with babies and is honored to do so every day.
Abstract:
Nutrition plays a vital role in the life of a neonate, particularly in the Newborn Infant Intensive Care Unit (N/IICU). Early nutrition intervention is of the utmost importance. Inadequate nutrition can place a neonate at risk for poor growth, insufficient brain development, poor bone health and nutrient deficiencies. Initiation of parenteral nutrition may be necessary for high-risk full-term infants and almost always for the preterm population. Human milk is the feeding gold standard for full-term and preterm infants alike, however, human milk alone is typically insufficient to meet the specific nutrient needs of the preterm infant. Therefore, fortification of human milk is necessary. There are a number of commercial fortifiers available to address these specific needs. Furthermore, an infant feeding protocol can help guide when and how to fortify feeds for these infants. The Children’s Hospital of Philadelphia (CHOP) has a preterm infant feeding protocol, a late preterm feeding protocol, and a newborn breastfeeding protocol. The fortification of human milk should ideally take place in a designated space for patient safety. CHOP has a Human Milk Management Center (HMMC) that serves this purpose. This space allows for the storage and preparation of all fortified human milk feeds throughout the hospital. Specially trained technicians fortify and deliver feeds twice daily. Multidisciplinary rounds occur weekly to improve patient safety. While it is acknowledged that such resources are not available everywhere, it is well accepted that optimal nutrition is crucial for the neonate.
Lorraine Shields
California Baptist University, USA
Title: Developmment of an evidence-based family-centered neonatal discharge pathway
Biography:
Lorraine Shields received her Bachelor’s and Master’s degrees at the UCLA School of Nursing and completed her Doctoral work at Vanderbilt University School of Nursing, Nashville Tennessee. She is currently Assistant Professor of Nursing in the graduate nurse practitioner program at California Baptist University College of Nursing in Riverside California. She has 38 years experience in Neonatal Nursing as a bedside nurse, transport nurse, Clinical Nurse Specialist, and Neonatal Nurse Practitioner. She has served many positions in the National Association of Neonatal Nurses. Her passions include neonatal developmental care, family-centered care, and excellence in nursing.
Abstract:
Purpose of the Session: Present the development of an evidence-based neonatal discharge pathway based on the core principles of family-centered care (FCC). The pathway is designed to increase parent participation in care and improve parent readiness and confidence in assuming full care of their high-risk neonate.
Background and Importance of the Topic: Despite the abundance of evidence supporting FCC and comprehensive discharge teaching processes, implementation of FCC practices continues to be a challenge/inconsistencies in discharge teaching processes persist. A neonatal release pathway with particular training progress focuses: gives a more exhaustive release process, incorporates the standards of family-focused care into all care hones, improves the organization between the medical caretaker and the family, and guarantees guardians are included early and all through their baby's NICU travel.
Conclusion
The scientific development of the pathway based on the European Pathway Association’s method for pathway development. The pathway’s teaching topics and transition points for teaching. 3. Integration of Peplau’s Theory of Interpersonal Relations emphasizing the partnership between the nurse and the family. A discussion on how families desire to participate but do not have an understanding of when and how to participate. A family-friendly bedside poster is presented which enables the family and all staff to view and track the infant/family’s progress and readiness toward discharge. A plan for implementation (parent and staff education). Highlights of nursing’s vital contribution to the development of evidence-based practice and to the improvement in patient/family outcomes.
Cheryl DeGraw
Central Carolina Technical College, USA
Title: Birth to discharge: Neonatal simulation clinical experiences
Biography:
Cheryl DeGraw has many years of experience in Maternal-Child nursing care. She is a Neonatal Nurse Practitioner and has provided nursing care at all levels of the Newborn Nursery and NICU, Labor & Delivery, and on Postpartum or Mother-Baby Units. With an Education Specialist degree, she is currently the lead instructor for Family-Centered Nursing Care at a technical college in South Carolina. She developed Maternal/Neonatal Simulation Clinical Experiences (SCEs) to provide alternative clinical rotations to hospital settings and to increase nursing student's understanding of the antepartum, intrapartum, postpartum and newborn nursing care.
Abstract:
With an increase in nursing programs to combat the projected nursing shortage, there is more competition for clinical sites for Maternal-Neonatal clinical rotations. Maternal and Neonatal simulation clinical experiences are being substituted for hospital clinical rotations and for lack of patients during clinical rotations. A technical college in the Southeast is using five-hour simulation clinical experiences, in which Obstetric and Neonatal high-fidelity manikins are utilized, as substitutes for hospital clinical rotations or lack of Maternal-Neonatal patients. Neonatal nursing care is related to the type of disorder the pregnant patient is admitted with to the Antepartum/Intrapartum Simulation Laboratory Hospital Unit. Three patient scenarios are used for the clinical experiences: neonates born to mothers with gestational diabetes, preeclampsia, or preterm labor. Neonatal complications such as hypoglycemia and prematurity are incorporated into the scenarios. Fetal monitoring is used for nursing students to identify fetal complications in order to provide appropriate nursing care to the neonate after delivery. This use of simulation clinical experiences has been endorsed by the National Council of State Boards of Nursing and the National League of Nursing as a substitute for hospital clinical rotations. The significance of using Maternal-Neonatal simulation clinical experiences is increased understanding by nursing students of the entire antepartum through postpartum nursing care and discharge process. Using the high-fidelity manikins and fetal monitoring, nursing students are able to obtain hands-on experience when unable to obtain the clinical experience due to lack of a hospital clinical rotation site or lack of patients during their hospital clinical rotation.