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As CNN anchor Alisyn Camerota remembers, it was just another day at work. Until it wasn’t.  A routine prenatal check-up for Alisyn, then 30 weeks pregnant with twins, turned life changing when her doctor announced that she’d need to deliver her daughters within 48 hours. A rare condition was preventing one baby from receiving enough nutrition through the umbilical cord.  

 
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As Camerota explained during her keynote address at the fifth annual Infant Health Policy Summit, this was just one of the challenges she faced.  Before her pregnancy, Camerota had struggled with infertility. After her daughters were both safely delivered and in the NICU, she faced breastfeeding challenges.   

Camerota described attempting to pump breastmilk for days with no results.  When she told her doctor she was ready to give up, he advised, “Give it one more day.”  The next day, Camerota recalled, she produced her first drops of milk. The NICU nurses – “angels on Earth” – immediately put it into her newborn daughter’s feeding tube.  

Camerota’s experiences resonated with the advocates, clinicians, patients and policymakers attending the summit.  And the day’s lineup of interviews and panel discussions echoed themes from her story, especially the struggles and the triumphs of meeting infants’ needs. 

Breastfeeding & Human Milk

Describing the value of human milk as a “cornerstone issue” for the National Coalition for Infant Health, Medical Director Mitchell Goldstein, MD, moderated a discussion of how human milk benefits the human microbiome.  Human milk doesn’t just promote “good” gut bacteria but can reduce the risk in lower respiratory infections by 50%, explained Cynethia Bethel-Jaiteh, DNP, of the University of Louisville School of Nursing, and lower the risk of GI infections by 59%.  It can also reduce the risk of necrotizing enterocolitis, explained Victoria Niklas, MD, of Prolacta Bioscience.

 
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Deb Discenza of PreemieWorld recalled her own challenges pumping breastmilk for her premature daughter, born at 30 weeks gestation, while the hospital intended to give her daughter formula. 

Vaccine Hesitancy

Incongruity between parents’ and health care providers’ intentions also came up during a panel discussion of preventable diseases and vaccine hesitancy in the United States.  Daniel Salmon, PhD, of Johns Hopkins School of Medicine and Mary Koslap-Petraco, DNP, of Stony Brook University School of Nursing debunked widespread myths that have led to a rise in vaccine exemptions – and fueled outbreaks of preventable diseases.  Topics included autism links, government overreach and misinformation about vaccine ingredients.  

 
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Both Salmon and Koslap-Petraco emphasized the importance of empathizing with parents and educating about the potential impact of vaccine-preventable diseases like measles, rubella and hepatitis B.

NICU Disparities 

Good communication with parents of young children was also a central theme in a panel discussion about how to build patient-centered NICUs.  DeShay Rice-Clansy, MSW, of Atlanta’s Grady Health System and Brigit M. Carter, PhD, RN, of Duke University School of Nursing described how the different demographics being served by NICUs can present strikingly different needs.  One mother delivering her baby at Grady Hospital, Rice-Clansy recalled, had only a second-grade education.  Other families faced challenges as stark as homelessness, mental health issues, substance abuse and sex trafficking.  

 
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These hospitals and their NICUs must meet families where they are, explained Suzanne Staebler, DNP, of Emory University.  That includes staffing the hospital with diverse health care providers. But that’s not always easy. As Bridget Carter, PhD, of Duke University School of Nursing explained, the rate of diverse providers is “phenomenally low.”  

Innovation for Neonates

Getting infants and their families what they need also requires effective public policies.  In an interview with Amy Akers of the National Perinatal Association, the FDA’s Susan McCune, MD, described the strides that research and regulatory policy have made for neonates.  She noted that safety efforts have come a long way, describing morphine-laced “syrup” promoted in the early 1900s for babies with colic or teething pains.  Legislative policies are increasingly designed to promote the development of drugs specifically tested and designed for infants, Dr. McCune explained. She noted the impact of bills like the “Best Pharmaceuticals for Children Act” in 2002, which incentivizes the development of drugs for infants.  

 
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But the process is rife with challenges. Only about 40% of studies of pediatric drugs are successful, McCune noted.  She emphasized the role of partnership, encouraging nonprofits and other stakeholders to join alongside regulators and researchers to improve options for treating infants.    

Respiratory Care

Respiratory care is one area where continued policy progress is needed.  In a conversation with Ashley Darcy Mahoney, PhD, of The George Washington University School of Nursing, Donald Null, MD, of UC Davis Children’s Hospital, described the improvement he’s seen during the course of his career.  It can take “a long time” for advances to make their way through, Null noted, and even then, policy often lags behind.  

 
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Erin Thatcher of PPROM Foundation knows that all too well.  The mother of fraternal twins born prematurely, Thatcher described the impact of respiratory syncytial virus on her daughter, now 7, who still battles asthma-like symptoms from the disease.  The effects of RSV “can last for years,” Dr. Null explained.     

The panel spoke to the Academy of American Pediatrics Committee on Infectious Disease guidelines from 2014 that effectively reduced the number of infants who receive RSV prophylaxis.  Of those guidelines, Thatcher noted, “I wish they’d look at long-term outcome…the policies are not taking into account what’s happening to families.” 

Tubing Safety & Maternal Nutrition

Infant health, safety and guidance also came to light in updates provided by National Coalition for Infant Health Executive Director Susan Hepworth.  On the topic of tubing and connector systems used in NICUs, Hepworth alluded to hospitals’ being pressured to incorporate a tubing connector system known as ENFit, which can present safety challenges for infants.  Hepworth emphasized the importance of thoughtful consideration by hospital systems and NICUs, which should make decisions based on what’s best for their patients.

 
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Hepworth also addressed new guidelines on pregnant mothers and fish consumption.  Recently revised FDA advice could, Hepworth noted, “help pregnant women confidently add more seafood to their diet, with the goal to have pregnant women eat, on average, as much as 6 times more seafood than they currently do.” 

See footage of the event from Facebook Live and explore photos and online activity from the day using #InfantSummit19.

Report

Click below to read the Summit report.

Photos

 

 

 
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Advocates cannot reach every infant or every family, acknowledged National Coalition for Infant Health Medical Director Mitchell Goldstein, MD, as he welcomed attendees to the fourth annual infant health policy summit on Thursday.  But, he emphasized, “We can impact policy.”

 
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The daylong event brought together health care providers, parents, advocates and congressional staff in Washington, DC, to consider how policy can address the challenges facing infants and their families. But as the day’s discussion made evident, those challenges can be staggering.

Congenital Heart Disease

Congenital heart disease, for instance, loomed large during the summit.  Katie Mooshian of Mended Little Hearts described her son Charlie’s experience with single-ventrical physiology, whereby only one of the heart’s two ventricles pumps blood as it should.

 
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Of Charlie’s birth, Mooshian recalled, “I handed over a vulnerable, tiny infant to have his heart stopped, to be put on bypass, and hopefully to be given back to me.”  Katie’s son Charlie ultimately survived multiple surgeries.  Meeting the challenges of congenital heart disease, Mooshian emphasized, requires providing infants and their familes with “continued support, advocacy and intervention.”

Beyond those measures, another factor plays an important role in the lives of infants with congenital heart disease: nutrition.  In a panel discussion, Jodi Lemacks of Mended Little Hearts, described struggling to breastfeed her infant son Joshua, who was born with congenital heart disease.  “Feeding your child is the one way you know your child’s going to be nourished, that your child’s going to survive,” Lemacks explained.  Ultimately, Lemacks noted, breastmilk helped Joshua gain weight and boost his immunity.

 
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Clinical research is underway to more closely examine the benefits of human milk for infants like Joshua.

David Rechtman, MD, of Prolacta Bioscience explained that human milk – whether breastmilk, donor milk or human milk-based fortifier – has been shown to help protect premature infants from deadly intestinal conditions.  Now researchers hope to confirm that human milk also provides benefits for infants born with congenital heart disease.   “If you give them more calories and more protein, they’re going to grow better,” Dr.  Rechtman noted.

Respiratory Syncytial Virus

Another struggle also generated vigorous discussion: Respiratory syncytial virus, or RSV.  Suzanne Staebler, DNP, of Emory University presented results from the National Coalition for Infant Health’s national survey on awareness of RSV.  The virus is the leading cause of hospitalization in children under one year of age.  The survey revealed that parents have high levels of concern about RSV but feel unprepared to protect their young children.  Specialty health care providers such as neonatologists and NICU nurses, meanwhile, reported seeing RSV cases regularly and proactively monitoring patients for the disease.

 
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Blogger and former television news anchor Shanisty Ireland brought that research to life by describing her own family’s battle with the disease in a panel discussion on RSV.  Ireland recalled taking her son Adam to the hospital after he exhibited signs of distress, explaining, “I still didn’t know how close he was to dying.”

“I asked people, ‘Pray for him.  He has RSV,’” Ireland recalled, adding, “Not a single person had ever heard of it.”

 
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Neonatologist Mitchell Goldstein, MD, acknowledged widespread misinformation about the potential severity of the disease.  Ireland recalled thinking of it as something akin to the common cold. “For some babies,” Dr. Goldstein explained, “it’s a whole lot more.”

The experience turned Ireland into an advocate. “RSV had a hold on my baby,” Ireland explained, “but now I feel like I have a hold on RSV.”

Support for Families

Ireland wasn’t the only event speaker who turned adversity into advocacy.

Keynote speakers Stephen Bowen, former NFL player, and his wife Tiffany Bowen, PhD, lost their premature infant son Skyler to intestinal infection just days after his birth at 24 weeks.  In the face of overwhelming grief, the couple persevered – “staying strong” for Skyler’s surviving twin brother and the couple’s older daughter.

 
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Stephen’s strength under stress led him to receive the Ed Block Courage Award.  Tiffany earned her doctorate and came through post-traumatic stress disorder to create Skyler’s Gift Foundation along with her husband.  The nonprofit aids unprepared families in paying for the funerals of premature infants who don’t survive.  The organization also provides funding for those families’ grief counseling.

In recalling the loss of young Stephen, the couple reflected upon the worry and grief they felt – but also the dedication of their sons’ health care providers.  People who work in the NICU “are heroes,” Tiffany emphasized.

NICU Safety

Those heroes face challenges of their own.  Just consider the issue of hospital tubing.  Addressing the summit audience, Rebekah Thacker, MSN, of the University of Arkansas Medical Center described concerns about the use of tubing connectors known as ENFit in NICUs.  As described in a 2017 video from the National Coalition for Infant Health, liquid can “hide” in the reservoir at the tip of the connector – potentially dosing tiny infants with more medication than intended.

Thacker described her efforts to push back against industry’s drive for ENFit adoption.  “Nobody knows the neonatal population like a neonatal nurse,” Thacker insisted.

“Still a Preemie”

And that population is broader than one might expect.  The National Coalition for Infant Health released at the summit a new video emphasizing the full spectrum of prematurity.  “Still a Preemie,” explains that preemies don’t always conform to stereotype.  Late-preterm infants born from 34 through 36 weeks’ gestation, or those who are born premature but at a “normal” birthweight, can still struggle with feeding issues, jaundice, respiratory conditions and development delays.  And their parents can feel the effects too.

Just ask Kelli Kelly of the parents support organization Hand to Hold.  When Kelly’s daughter Lauren was born at 34 weeks, she “looked good, looked healthy” Kelly recalled in an address to summit attendees.  But the appearance was deceiving.  Lauren required NICU care, so Kelly left the hospital “with empty arms.”  She recalled waking during the nights to pump breastmilk for her daughter, whose developmental challenges made it impossible to breastfeed.  Kelly suffered emotionally.  “It’s hard to bond with a baby that’s in a glass box,” she recalled.

 
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Meanwhile, medical bills rolled in.  Because of baby Lauren’s size, she didn’t qualify for Medicaid coverage.

Several organizations are working to improve conditions for families like Kelly’s.  The Association of Women’s Health, Obstetric and Neonatal Nurses has developed evidence-based clinical practice guidelines for late preterm infants.  Meanwhile, the National Perinatal Association has published a similar document that also reaches parents, social workers, therapists and lactation consultants, among others.

In a discussion moderated by Sue Ludwig of the National Association of Neonatal Therapists, the group explored the challenges of infants born late-preterm. “Every organ in the body is premature,” emphasized Raylene Philips, MD, of the National Perinatal Association.

 
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Jean Salera-Vieira, MS, of the Association of Women’s Health, Obstetric and Neonatal Nurses, noted the importance of support for these infants’ parents.  Nurseries for infants born after 32 weeks’ gestation “don’t have same level of parent support that a NICU might,” she explained.

Congressional Action

Another opportunity for policy change lies with Congress’ PREEMIE Reauthorization Act of 2018.  Staff representing the bill’s authors, Senator Lamar Alexander (R-Tenn.) and Senator Michael Bennet (D-Colo.), explained that the bill would reauthorize pivotal Centers for Disease Control and Prevention research on preterm births. The bill also includes screening measures and services for pregnancy depression and substance abuse treatment.

 
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Introduced earlier this year, the PREEMIE Reauthorization Act passed the full Senate over the summer.  Rep. Anna Eshoo (D-Calif.) and Rep. Leonard Lance (R-NJ) are working to advance the bill in the House of Representatives.

See photos and social media highlights from the day at the National Coalition for Infant Health’s Facebook page.

 
 
 
 
 
 
 
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For the third year in a row, the Institute for Patient Access and National Coalition for Infant Health hosted the 2017 Infant Health Policy Summit in Washington, DC on October 26. 

Health care providers, patient advocates, and policy makers gathered to discuss patient access issues facing vulnerable infants and their families.

Vertical Transmission: A New Wave of Hepatitis C Carriers

Vertical Transmission: A New Wave of Hepatitis C Carriers

Safety in the NICU: New Tubes, New Problems?

Safety in the NICU: New Tubes, New Problems?

Expert panels explored how the opioid crisis is bringing a baby boomer disease to pregnant women and how an attempt to fix hospital tubing mix-ups could endanger preemies in a new way. Other discussions centered on how existing problems, such as preemies’ inability to access preventive treatment for a deadly seasonal virus or human donor milk for optimal nutrition, continue to pose risks.

Milk Matters: Diversity, Quality & Safety

Milk Matters: Diversity, Quality & Safety

The RSV Story: When Treatment is Out of Reach But Not Out of Mind

The RSV Story: When Treatment is Out of Reach But Not Out of Mind

The summit’s keynote address featured Adam Busby, star of TLC’s “OutDaughtered.” The show chronicles the life of he and his wife, Danielle, as parents of all-girl quintuplets. Earlier this year, during the show’s third season, Adam came public with his experience of paternal postpartum depression.

Adam Busby, star of TLC’s “OutDaughtered” and paternal postpartrum depression advocate

Adam Busby, star of TLC’s “OutDaughtered” and paternal postpartrum depression advocate

Adam and Danielle Busby pose with summit attendees

Adam and Danielle Busby pose with summit attendees

Attendees also heard from Andrew Rosenberg, director of the Newborn Health Initiative. Once a preemie himself, Rosenberg advocates for medicines that are designed for and tested on infants. There has not been a new drug approved to improve survival and outcomes in premature infants in over 25 years.


 
 
 
 

The Institute for Patient Access and the National Coalition for Infant Health hosted the 2016 Infant Health Policy Summit in Washington, DC on September 15. 

Health care providers, patient advocates, parents, and policy makers gathered to discuss patient access issues facing vulnerable infants and their families.

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   Representative Katherine Clark (D-MA)   

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   Kelley French, Author, Juniper: The Girl Who Was Born Too Soon

Kelley French, Author, Juniper: The Girl Who Was Born Too Soon

Representative Katherine Clark (D-MA), for the second year in a row, addressed attendees about congress’ work in infant and maternal health. Kelley French, an award-winning journalist, Pulitzer Prize finalist, author, and mother of a premature infant born at 23 weeks served as the keynote speaker. 

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   The “Gap Baby”: How Preemies Are Unprotected From RSV

The “Gap Baby”: How Preemies Are Unprotected From RSV

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   Preemie Nutrition: A Discussion About Human Milk Quality & Safety

Preemie Nutrition: A Discussion About Human Milk Quality & Safety

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   PPD & PTSD: Impact Of The NICU On Parents, Families, And Staff