We continue our four-part series “Hot Topics in Neonatology” with Part 2 that explores the latest in neonatology-related research and education with experts from across the United States.
SEGMENT 1: Amniotic fluid is the liquid that surrounds a baby during pregnancy, and it plays a key role in the development of the fetus. According to the March of Dimes, in the early weeks of pregnancy, the amniotic fluid is mostly water that comes from mom. After about 20 weeks, the baby’s urine makes up most of the amniotic fluid. There are instances, however, when there is fetal kidney disease. That means no urine, and no amniotic fluid. That is known as Early Pregnancy Renal Anhydramnios (EPRA), which is almost universally fatal. However, there is a new trial taking place in the U.S. — the RAFT Trial — which provides amniotic fluid replacement. Here to talk about this promising new development is Dr. Jena Miller, who serves as an assistant professor at the Johns Hopkins Center for Fetal Therapy in Baltimore.
SEGMENT 2: According to the NIH, medical simulation allows the acquisition of clinical and non-clinical skills for use in a health care setting through deliberate practice. In simulation, trainees can make mistakes and learn from them without the fear of harming any patients. Dr. Rachel Umoren is a Neonatologist at the University of Washington and Seattle Children’s Hospital where she is the Director of the Neonatal Education and Simulation-Based Training Program. Her research focuses on improving neonatal outcomes globally through simulation-based education, and our wide-ranging conversation includes her work using a Smart-phone-based virtual simulation app to bring training to underresourced areas here and abroad.
Guests:
Jena Miller, MD, Assistant Professor, John Hopkins Center for Fetal Therapy
Rachel Umoren, MD, MS, Director, Neonatal Education and Simulation-Based Training Program, Seattle Children’s Hospital
Host/Producer: Carol Vassar
Explore the Full Series:
Part 1, Episode 50
The NICU View: Mom & Baby
Part 3, Episode 52
Fragile Beginnings: Exploring NEC in Newborns
Part 4, Episode 53
Babies in Crisis: Understanding Neonatal Abstinence
EPISODE 51 TRANSCRIPT
Carol Vassar, podcast host/producer:
Welcome to Well Beyond Medicine: The Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you are here, let’s go.
Welcome to the next in our hot topics in neonatology series. Today we’ll chat with experts about a NICU simulation model that is bringing training to underserved areas of the world.
First though, let’s discuss amniotic fluid. Amniotic fluid is the liquid that surrounds a baby during pregnancy, and it plays a key role in the development of the fetus. According to the March of Dimes, in the early weeks of pregnancy, the amniotic fluid is mostly water that comes from mom. After about 20 weeks, the baby’s urine makes up most of the amniotic fluid. There are instances, however, when there is fetal kidney disease. That means no urine and no amniotic fluid. This is known as early pregnancy renal anhydramnios, or EPRA. EPRA happens in about one in every 2000 pregnancies each year, affecting about 1500 families in the US. It’s almost universally fatal. However, there is a new trial taking place in the US. It’s called the RAFT trial, which provides amniotic fluid replacement. Here to talk about this promising new development is Dr. Jena Miller. Dr. Miller leads the RAFT trial and also serves as an assistant professor at the Johns Hopkins Center for Fetal Therapy, in Baltimore. We begin our conversation with a refresher on the role amniotic fluid plays in the development of the fetus. Here’s Dr. Jena Miller.
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
The amniotic fluid maintains fluid and space around the baby so the baby can move freely. It’s also really important for lung development because what it does is it creates some back pressure on the lungs. So lung fluid is made on the inside of the lungs, and normally, moves outward into the amniotic fluid. With the back pressure present from amniotic fluid, when the fetal trachea and the vocal cords open and close, it allows some of the fluid to remain in the lungs. And so that they continue to grow and expand during the pregnancy.
Carol Vassar, podcast host/producer:
So when we’re talking about a baby that is born too early, too early, in your estimation, 32 weeks or younger?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, I guess any baby born less than 37 weeks is technically preterm.
Carol Vassar, podcast host/producer:
Fair enough. What happens to their lungs if they don’t have enough amniotic fluid?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, the critical time period for amniotic fluid development is really in that mid second trimester. So any baby without amniotic fluid earlier than 22 weeks is prone to have something called pulmonary hypoplasia, where the lungs just don’t have the opportunity to expand and develop sufficiently so that they can exchange air when the baby is born.
Carol Vassar, podcast host/producer:
So if a baby does not have enough amniotic fluid, the mother does not have enough amniotic fluid, lung growth is stunted. Right?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Exactly. And it doesn’t matter then how old a baby is in gestation if the lungs are underdeveloped to the degree that they never have the opportunity or capacity to exchange oxygen, in order to support the baby. So the lungs are small, they’re underdeveloped, and they’re compressed also from the lack of fluid around the baby and from the uterine wall.
Carol Vassar, podcast host/producer:
Do we know what causes this?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
The most common and serious cause of this is from bilateral renal agenesis. And so for babies that have no kidneys, they don’t make any urine. And so the baby continues to drink the urine, and in the mid second trimester of pregnancy, the biggest contributor to amniotic fluid is fetal urine.
Carol Vassar, podcast host/producer:
So fetal urine, amniotic fluid, lack of production leads to what? What would happen to a baby without enough amniotic fluid.
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
So this is a condition we consider uniformly fatal. So a baby who has no amniotic fluid during the critical phase of lung development throughout pregnancy, that is considered to be a uniformly lethal disease.
Carol Vassar, podcast host/producer:
So lethal. We want to prevent lethal. You are studying a way of replacing the amniotic fluid, which to me sounds like the most logical thing to do. You are part of a trial that is called RAFT. What does that stand for?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
RAFT stands for the Renal Anhydramnios Fetal Therapy trial, and the aim is to infuse fluid into the amniotic space by a procedure called serial amnioinfusions. So it’s just replacing fluid with a needle, accessing the amniotic cavity. And that begins in that time period of critical lung development and extends through the duration of the pregnancy.
Carol Vassar, podcast host/producer:
Where does this replacement serial amniotic fluid come from?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, it’s just normal saline. So just the normal isotonic fluid that we infuse in veins and in IV fluids. It’s just isotonic with some sodium.
Carol Vassar, podcast host/producer:
Has this been tried before?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, there have been very few small case series, in some case reports, of attempting this intervention, targeting replacement of amniotic fluid. But this is the first trial that really assesses the effectiveness of this intervention on a bigger scale.
Carol Vassar, podcast host/producer:
Talk about the trial. Have you had any results from the trial as of yet?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Right. So yes. So this is a trial that’s been enacted in nine fetal therapy centers around the country that have significant expertise in fetal interventions of all types. Importantly, all of the RAFT sites not only have the maternal and fetal interventionalists, but they also have all the pediatric subspecialists that are capable to actually do the newborn care when a baby is born, and support these children that not only might have prematurity when they’re born, but also need dialysis and renal replacement therapy.
Carol Vassar, podcast host/producer:
Have you had any success stories? I know that this issue is universally fatal, as you said. But this sounds like it’s giving great hope. Have any babies made it through the RAFT program into birth and what happens to them thereafter?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Sure. So our babies are still young. Those that have been enrolled in the RAFT trial, none of them have reached the final outcome measure of transplantation. There are some case reports of babies getting all the way through that process and being long-term survivors and reaching that endpoint of transplantation. A major focus of the RAFT trial is for us to assess what is the likelihood, big picture, of getting that outcome. And so that’s one of the big questions that we have.
Carol Vassar, podcast host/producer:
What’s your theory? What would happen to them?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, we know early pregnancy, renal anhydramnios in the context of bilateral renal agenesis is a very complicated condition. Because with bilateral renal agenesis, we actually have two problems. So we have first, we have the lung under development that comes from lack of amniotic fluid. But then a child that’s born has no kidneys, and so they are obligated to need renal replacement therapy from the time of birth. So what we actually have is a whole new group of babies that we’ve never actually cared for before. So that’s really our bigger question moving forward. But in order to figure that out, we had to get over this first step of even just can we support the lungs to get to that point where these children can be cared for.
Carol Vassar, podcast host/producer:
When you say renal replacement therapy, that’s the transplantation you’re referring to?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
That’s the long-term strategy. So initially, babies need dialysis. In order to receive a transplant, they have to be about at least two years of age, they have to weigh at least 10 kilograms. So we have to bridge that time period from birth up until transplantation, typically with dialysis.
Carol Vassar, podcast host/producer:
Have you been able to get babies to the birth process and are they born alive?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Yes. So what we’ve learned from the RAFT trial is for our cohort of 18 babies that we report in the bilateral renal agenesis cohort, 94% of them were born live. We had one baby that had a fetal demise in utero. And then our primary outcome was survival to 14 days in placement of dialysis access. And that was just used as a surrogate marker to say that amnioinfusions were able to mitigate pulmonary hypoplasia, or lung underdevelopment, and allow these newborns to have the opportunity for treatment of having lack of kidneys.
Carol Vassar, podcast host/producer:
Let’s talk about the moms. I know this is a saline solution. Fairly simple, as you talked about earlier, intravenous, it’s done all the time. How does this treatment affect them?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, it’s a massive commitment, for the mothers, for the families. Many of our families had to relocate to a RAFT site in order to undergo this treatment. So it requires a huge resource among the families. But for the mothers, they have to undergo this procedure to get that fluid inside, every few days. From when we start before 26 weeks, we are doing those infusions about on a weekly basis. And the whole goal is just to maintain normal fluid as closely as possible throughout the duration of the pregnancy. But closer to the third trimester, pregnant individuals may be undergoing this intervention one to three times a week using local anesthesia, but it’s putting a needle through the abdomen and into the uterus, frequently.
Carol Vassar, podcast host/producer:
Does that put them and the baby at risk of their premature birth or death at that point, anytime you put a needle in?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, these are the safety concerns that we were collecting along the course of this trial. All of the safety events that we were recording were maternal, for specifically this reason. So every time that you enter the amniotic cavity, we have the potential for introducing infection. The membranes don’t heal, so we have the possibility of rupturing the membranes and leading to preterm labor and preterm birth. So in our cohort, all of the babies were born preterm, and on average, our median gestational age at delivery was 32 weeks and four days.
Carol Vassar, podcast host/producer:
These are medically complicated cases and babies, when they are born at 32 weeks, which is preterm. What are the complications? I know kidney replacement therapy is going to be needed. But what else? What other issues are you seeing? What other issues concern you about these young babies?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, a number of things. First of all, issues with pediatric dialysis in neonates is challenging. There has been significant development in pediatric dialysis techniques over the course of the trial. And so we have a lot of questions about that and how to manage these children optimally. And our neonatology work group has been extremely committed to figuring that out along the way as well. And issues with pediatric dialysis catheters, sepsis, is a major issue for these children. And one of the big concerns that we have observed is some children have things that can be really significant, like stroke. And so understanding how that outcome can impact these children long-term is another really important question.
Carol Vassar, podcast host/producer:
What kinds of supports are put in place with these really medically complicated babies? I’m sure this is unfortunately, very common in a NICU. For the families, the moms, the dads, the siblings to be able to cope with all of this. This is a major change, right?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
It’s so important before undertaking this type of intervention for this condition that it really remains in the context of strong multidisciplinary care teams in settings that can provide all of the care that maternal fetal pairs may need from the beginning, during pregnancy, and through that initial care transition. That is paramount, as well as the importance of that multi-specialty counseling and the inclusion of palliative care teams. Because even when we come from a place of hope, it’s certainly possible that there may be times that we need to redirect care and we need to support our families through that process and give them the agency to make the decisions for their families and their child.
Carol Vassar, podcast host/producer:
How soon until you get the first baby to that kidney transplant stage?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
So a few of our long-term survivors are in that process, so being evaluated for transplant. Our oldest children in the BRA arm are just up to about two years of age, and so we are waiting for the outcomes for them.
Carol Vassar, podcast host/producer:
And the kidney transplant, I know kidneys are a little bit easier to find than say livers or hearts. Do those come from family donors? Are they from unknown donors?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
They absolutely can be. And so that is one of the topics that’s addressed with our nephrology colleagues and our transplant surgery colleagues prenatally as well, and the consideration of living donor options within families. Because the other consideration is that a child born with no kidneys may need more than one transplant throughout their life to sustain them.
Carol Vassar, podcast host/producer:
What other long-term issues do you see facing these children who do make it to transplant stage?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, we can expect that these children have a long road. We can expect that they might need multiple admissions and intensive care admissions. And so our biggest questions really revolve around what is the big picture, neurodevelopment, what does life look like for these children? And that is some of the information that we’re still collecting and gathering in the ongoing part of the trial. And a big focus of our group is to understand, from a qualitative perspective, for the families who have gone through this process, how did they perceive this, how did impact them and how do they assess that degree of burden or not?
Carol Vassar, podcast host/producer:
Has the trial identified any racial or ethnic disparities? And if so, what are some of the solutions to overcome those?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
It actually did highlight a number of racial and economic disparities. When we look at the difference between our screen population, for the families that came for evaluation for participation in the RAFT trial, it was much more balanced and representative of our population. When we look at the enrolled participants within RAFT, 94% of them are white, 11% are Hispanic or Latina. So it really does uncover some significant disparities in resource, socioeconomic barriers, insurance coverage, timeliness of being able to access care early enough to be able to have the opportunity to enroll. So this certainly uncovers a number of issues that require more work from maternal and childcare perspective.
Carol Vassar, podcast host/producer:
There’s still a lot of unknowns with this process and this treatment. Do you see it scaling to other facilities? I know it’s at eight different facilities across the nation, from Johns Hopkins all the way out to California, Minnesota, Texas. When could we possibly see it in more institutions?
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
Well, we are in the process of onboarding four additional clinical sites to complete the recruitment for the fetal renal failure arm of the trial, and we’re hopeful that that will increase access to get us through our recruitment goals. The next phase is we still really have a lot of questions on the pediatric side and what is the right strategy, how to manage these children in order to improve and optimize these outcomes. They’re a whole new group, and so we really rely on the strong consortium that we’ve built to learn from each other’s experience.
Carol Vassar, podcast host/producer:
More to come.
Dr. Jena Miller, Johns Hopkins Center for Fetal Therapy:
More to come.
Carol Vassar, podcast host/producer:
Dr. Jena Miller is an assistant professor at the Johns Hopkins Center for Fetal Therapy, at Johns Hopkins University in Baltimore.
MUSIC
Carol Vassar, podcast host/producer:
According to the NIH, medical simulation allows the acquisition of clinical and nonclinical skills for use in a healthcare setting through deliberate practice. That is not just observing what’s happening during training, but participating in it directly. Simulation tools serve as an alternative to real patients. A trainee can make mistakes and learn from them without the fear of harming the patient. Dr. Rachel Umoren is a neonatologist at the University of Washington and Seattle Children’s Hospital where she is the Director of the Neonatal Education and Simulation-Based Training Program. Her research focuses on improving neonatal outcomes globally through simulation-based education, and our wide-ranging conversation includes her work using a smartphone-based virtual simulation app to bring training to under-resourced areas here and abroad. We begin though with a question. Can healthcare simulation training expand to teach softer skills such as communication, leadership, and teamwork? Here’s Dr. Rachel Umoren.
Dr. Rachel Umoren, Seattle Children’s Hospital:
Absolutely. And the way we do this is we’ve come to find that it’s really important for health professionals to learn how to work together in teams. And so even though we might teach the skills that you described, procedural skills independently, in some cases, we try to bring teams together to put all these independent skills together because they need to be able to practice together in order to work efficiently in delivering care in the clinical setting.
So when they come together in those more scenario-based training episodes, we have them practice their leadership skills, their communication skills, things like what we call closed loop communication, which means that if you’re making a request, you want to know that someone has heard that request to give a medication and is doing it and confirms that it’s been done. So that’s just an example of one of the kinds of leadership and communication skills that we can teach during simulation. Others are what we call brief, which means that before you actually start caring for the patient, you’re talking together as a team about the plan. And we also do debriefs, which means that we’re learning from everything that happens in the hospital, whether good or bad. We’re talking about how to identify any gaps and make improvements for the next time.
Carol Vassar, podcast host/producer:
It’s really an opportunity, it sounds like, to solidify the team itself and to engender trust. Talk about that.
Dr. Rachel Umoren, Seattle Children’s Hospital:
Yes, absolutely. So the teams that we work in the hospital are often thrown together in the sense that we work with each other in the capacity of our roles and our knowledge base. So there will be a doctor, a nurse, and a respiratory therapist, or a nutritionist or pharmacist. And because there have to be different people on different shifts, you may not have ever worked with that person before in that role. But everyone knows what their role is supposed to do. And so when we come together, even if we’ve never worked together before, if we’ve had the opportunity to simulate what our role does, then we can fall into those roles.
Carol Vassar, podcast host/producer:
Does simulation kind of take the stress off? Because when you’re with a real patient, a real life human being whose life you’re trying to save, there’s a lot of stress in that, isn’t there?
Dr. Rachel Umoren, Seattle Children’s Hospital:
Oh, absolutely, there can be a lot of stress. But if you’ve done it before in a simulated setting, then you can bring those skills to practice. It gives you a muscle memory so you can automatically do what needs to be done without having to think a lot about it. The stress element, I think, always remains. Some people are actually more stressed in simulation than they are in the live situation.
Carol Vassar, podcast host/producer:
Really?
Dr. Rachel Umoren, Seattle Children’s Hospital:
Yes, yes. Because sometimes people encounter performance-based anxiety. But what we try to do as simulation educators is we tell everyone that not being judged, this is confidential, we’re not going to talk about this case outside of what happened here because this is a learning environment and a safe space. And so we set that standard as we start simulations so that everyone can be assured that this is a place to learn and make mistakes so that we don’t make those mistakes on a live patient.
Carol Vassar, podcast host/producer:
Talk about how simulation-based education can influence and even hopefully improve outcomes in the NICU.
Dr. Rachel Umoren, Seattle Children’s Hospital:
Well, there are a couple of ways in which I think that can happen, and I’ve seen it. So one of the ways is to actually conduct those simulations in a NICU or in a clinical setting, what we call inside in situ based simulation. And what that does is it opens up the possibility of identifying gaps, what we call latent safety threats. Meaning that the equipment’s not in the right place for us to find it, or there’s a possibility of making an error in how we give the medication because of how it gets drawn up, or how the label might be similar to other medication labels that are located in the same space. So because we’re not doing a simulation outside of the clinical setting, we can actually identify those gaps and resolve them right away. And that’s one of the real benefits of simulation, particularly simulation right in the space where we work.
Carol Vassar, podcast host/producer:
Now, you’ve been working on some simulation settings in low resource countries. Talk about that.
Dr. Rachel Umoren, Seattle Children’s Hospital:
I’m very excited about this work because what we’re trying to do is we’re taking what evidence-based education, all the new things that we’ve learned about how to resuscitate newborns and how to care for newborns, in that early first couple days to a week of life, and we’re putting them into a scenario that learners can do on their own device, so on their mobile phone or tablet. And it’s called a virtual simulation, but it has a lot of elements of what we would do with a mannequin except that the baby or virtual baby is on their phone and they can interact with it. They can use their eyes and they can use their hands to make selections and to move things around in the environment. They can have a virtual dialogue with the mother, and they can actually go through all the steps of resuscitation.
In settings where it’s not possible for learners to readily access a mannequin or to have an instructor who can show them what to do or tell them what they’re doing wrong, having a virtual simulation that gives automatic feedback and allows them to practice over and over becomes increasingly important.
The other thing that we’ve done with this simulation, which we’re calling virtual essential newborn care, is it can run offline. So once they have it on their phone or on their tablet, they don’t need to have internet access. It makes it so easy for them to practice anytime they want to.
Carol Vassar, podcast host/producer:
Where’s this being used?
Dr. Rachel Umoren, Seattle Children’s Hospital:
So we’ve piloted it in Nigeria, which is in West Africa, and we’ve also done another study in Kenya. We did that in 2019. So we’ve been working on designing new ways to create these virtual simulations for about five years now.
Carol Vassar, podcast host/producer:
What is the importance of having this kind of technology being used in under-resourced countries and being available to clinicians in those areas?
Dr. Rachel Umoren, Seattle Children’s Hospital:
I can’t understate or overstate the importance of having this technology available because in Nigeria alone, there are 450,000 babies who die in the neonatal period or are stillbirths every single year. If we can save even one of those lives, it would make a big difference. And we can do so much more through this technology. There’s so much turnover and so few resources for training that instructors and educators are stretched so thin by clinical demands, by how many patients that they have to care for every day, that even inserting a little bit of extra support for training through these modalities can make a huge difference. This is such a compelling exercise for them. They’ve translated it into practice because in our simulation, we have a virtual baby crying. And so they said, “I want to just keep helping this baby, the real life baby, until it starts crying,” like the virtual baby in this scenario.
Carol Vassar, podcast host/producer:
So it’s engaging.
Dr. Rachel Umoren, Seattle Children’s Hospital:
It’s engaging. They remember what they did in the virtual scenario, and they are mentally rehearsing it and following it step-by-step, in that live situation. They find it to be something they can really engage in and do over and over again because they enjoy it. It’s better than reading a book and better than listening to a lecture.
Carol Vassar, podcast host/producer:
It exercises that memory muscle that we were talking about earlier and really reinforces what they need to do in those situations.
Dr. Rachel Umoren, Seattle Children’s Hospital:
Absolutely.
Carol Vassar, podcast host/producer:
Any results? This is a pilot project that you’re doing in both, I think Nigeria and Kenya you said. Any results from these pilots?
Dr. Rachel Umoren, Seattle Children’s Hospital:
Yes, absolutely. So we did a study with our original application, which we at that time called electronic Helping Babies Breathe. It was a randomized controlled trial in Nigeria and Kenya. Involved 274 nurses and midwives from many facilities in both of those countries. And we found that it was able to help sustain their knowledge and skills over time. And then as the curriculum evolved, we developed the virtual ENC application, which I just spoke about, and expanded it to include 12 scenarios, to have a range of babies, term babies, preterm babies, and a range of needs for those babies in the scenarios, from early resuscitation all the way through early care. And either discharge home if the baby was healthy or referral for advanced care.
And we studied this new version again, in Nigeria, with 70 nurses and midwives from 23 facilities. And these facilities were primary, secondary, and tertiary facilities. So we wanted to see how it would work with nurses and midwives that were practicing at a very high level of care, but also a very low level of care. And we found that after their initial training and using this application and practicing with it over the course of six months, they were actually able to perform in a simulation based evaluation at an even higher level than they did when they completed their more conventional training. So this really helped to solidify their skills and to give them more confidence and better performance over time, as compared to what we would’ve expected, which is for people to forget over time they were learning.
Carol Vassar, podcast host/producer:
Which is what you’re looking for, right?
Dr. Rachel Umoren, Seattle Children’s Hospital:
Yes, yes. We absolutely want people, especially those who are tasked with caring for our precious little babies, to really have that ability and that performance and that skill that only gets better over time.
Carol Vassar, podcast host/producer:
What’s next with this application?
Dr. Rachel Umoren, Seattle Children’s Hospital:
Well, we’re very excited to share this and test it in other settings. We recognize that different countries may have different needs. We recognize that there’s potentially benefit to some parts of the US for using this type of training. And so we are talking with various partners and various groups about having this available for free for their nurses, midwives, and other health professionals who care for newborns.
Carol Vassar, podcast host/producer:
I’m thinking rural parts of the US might benefit from this tremendously.
Dr. Rachel Umoren, Seattle Children’s Hospital:
Absolutely. Absolutely. Particularly facilities that don’t take a lot of deliveries. So our critical access facilities, nurses who are practicing or midwives who are practicing in those areas may use this to maintain their skills so that they’re ready if there happens to be a baby who’s born and doesn’t breathe right away, or a baby who’s on smaller side so they can recognize those danger signs and refer as needed.
Carol Vassar, podcast host/producer:
Dr. Rachel Umoren is a neonatologist at the University of Washington and Seattle Children’s Hospital, where she is the Director of the Neonatal Education and Simulation-Based Training Program.
Music:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
What’s hot in neonatology from your perspective? Leave us a voicemail at nemourswellbeyond.org. That’s nemourswellbeyond.org. There, you will also find our previous episodes. You can subscribe to the podcast and leave a review. Our production team for this episode includes Che Parker, Susan Masucci, Cheryl Mann, and Yari Payne.
Our hot topics in neonatology series continues next time as we talk with experts on how to save lives through evidence-based bedside protocol bundles for the most common and serious intestinal disease among premature babies. I’m Carol Vassar. Until next time, remember, we can change children’s health for good, well beyond medicine.
