Campaign for a Moral, Balanced Immigration Overhaul (CAMBIO), Strategic Review

In March 2014, Campaign for an Accountable, Moral, and Balanced Immigration Reform (CAMBIO) commissioned us to conduct an external review of the CAMBIO campaign. This report summarizes findings based on data gathered during an in-person focus group conducted with members of the CAMBIO Steering Committee in May 2014; a review of approximately 20 CAMBIO corporate documents and 36 internal meeting minutes; and 41 semi-structured telephone interviews conducted principally in June and July 2014

Editorial: Recent advances in our understanding of NEC pathogenesis, diagnosis, and treatment

Necrotizing enterocolitis is a leading cause of death among premature infants, and despite research spanning over six decades, the pathogenesis is still not completely understood. The onset of NEC can be rapid and unpredictable, with clinical signs such as abdominal distension and bloody stools, progressing to fulminant bowel necrosis and death within hours. Even though the clinical and pathological descriptions of NEC were first described many decades ago, the management options have not progressed significantly and continue to be supportive care, such as cessation of feedings, intravenous fluids, antibiotic administration, and, in some cases, surgical bowel resection. Although treatment options for NEC remain limited, one effective preventative strategy is the administration of human milk. Recent advances in identifying the precise nutrients in human milk shed light on its bioactive components and their impact on the intestine. In recent years, several studies have highlighted the benefit of using prebiotics and probiotics as additional preventative options for NEC. Clinical studies focused on diagnostic tools such as using serum biomarkers or big data and artificial intelligence may pave the way for earlier detection to minimize disease progression, avoid the negative impact on other organ systems, and improve the poor neurodevelopmental outcomes associated with NEC. The primary objectives for this topic were to focus on recent advances in our understanding of NEC pathogenesis, new diagnostic strategies such as biomarkers and artificial intelligence, and explore new therapeutic options for treating this devastating disease

Experience of fathers with babies admitted to neonatal care units: A review of the literature

There is a growing understanding of the role and place of men in maternity care generally and for fathers of babies in neonatal care in particular. This review offers a systematic narrative review on issues affecting fathers, whose babies are admitted to neonatal units. Twenty-seven papers in the review highlighted four key themes: stress & anxiety; information; gender roles and emotions

Effects of storage practices on long-chain polyunsaturated fatty acids and lipid peroxidation of preterm formula milk.

BACKGROUND: Preterm formula milk (FM) is often prepared in advance, potentially affecting nutritional quality. Long-chain polyunsaturated fatty acids (LCPUFAs), important for brain and immune system function, are prone to lipid peroxidation, which correlates with comorbidities of prematurity. The effects of clinical storage practices on LCPUFA content and lipid peroxidation of preterm FM were investigated. METHODS: UK liquid and powder preterm FM (2017) (from two manufacturers) were subjected to routine storage conditions (liquid: refrigeration ≤10 h; powder: weekly preparation in accordance with the manufacturer's instructions and refrigeration ≤24 h for 4 weeks). LCPUFA content, thiobarbituric acid reactive substances and 4-hydroxy-2-nonenal (HNE) content were analysed. RESULTS: Storage did not significantly decrease LCPUFA content. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition recommended LCPUFA intake, whereas in utero accretion rates could not be achieved with both FM brands (liquid and powder). Lipid peroxidation was evident on opening, with 6× higher levels in powder. No effect of ≤10-h refrigeration on peroxidation was seen in liquid FM. In powder FM, it increased over refrigeration (HNE opening: 6.5-9.7 µg mL-1 versus day 28, 24 h: 16.6-36.5 µg mL-1 ) with a significant interaction between storage time and refrigeration (P = 0.015), with higher HNE at 4 h on days 0, 7, 14 and 21 (all P < 0.05). CONCLUSIONS: The results suggest that preterm FM and storage conditions do not support in utero accretion rates for LCPUFAs. Although the results suggest different susceptibility of liquid and powder FM to peroxidation upon refrigeration, they are too preliminary to make specific recommendations. We suggest minimising storage time of fresh and prepared powder FM, wherever possible

Racial Disparities in Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is a serious disease of the intestinal tract affecting 5-10% of pre-term infants with up to 50% mortality in those that require surgery. There is wide variation in the rates and outcomes of NEC by race and ethnicity, and the reasons for this disparity are poorly understood. In this article, we review the epidemiology and discuss possible explanations for racial and ethnic differences in NEC. Most of the current evidence investigating the role of race in NEC comes from North America and suggests that Hispanic ethnicity and non-Hispanic Black race are associated with higher risk of NEC compared to non-Hispanic White populations. Differences in pre-term births, breastfeeding rates, and various sociodemographic factors does not fully account for the observed disparities in NEC incidence and outcomes. While genetic studies are beginning to identify candidate genes that may increase or decrease risk for NEC among racial populations, current data remain limited by small sample sizes and lack of validation. Complex interactions between social and biological determinants likely underly the differences in NEC outcomes among racial groups. Larger datasets with detailed social, phenotypic, and genotypic information, coupled with advanced bioinformatics techniques are needed to comprehensively understand racial disparities in NEC

Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis.

Necrotising enterocolitis (NEC) is a serious inflammatory bowel disease of prematurity with potentially devastating complications and remains a leading cause of morbidity and mortality among premature infants. In recent years, there has been accumulating data regarding benefits of using bowel ultrasound (BUS) in the diagnosis and management of NEC. Despite this, adoption of robust BUS programmes into clinical practice has been slow. As BUS is a relatively new technique, many barriers to implementation exist, namely lack of education and training for sonographers and radiologists, low case volume and unfamiliarity by clinicians regarding how to use the information provided. The aim of this manuscript is to provide a framework and a roadmap for units to implement BUS in day-to-day practice for NEC diagnosis and management

A Proposed Machine Learning Based Collective Disease Model to Enable Predictive Diagnostics in Necrotising Enterocolitis

© 2018 IEEE. Despite 60 years of research into necrotising enterocolitis (NEC), our understanding of the disease has not improved enough to achieve better outcomes. Even though NEC has remained the leading cause of death and poor outcomes in preterm infants, there remain vital questions on how to define, differentiate and detect the condition. Numerous international groups have recently highlighted NEC as a research priority and called for broader engagement of the scientific community to move the field forward. The three foremost barriers at present are lack of suitable definition(s), lack of clean datasets and consequently a lack of scope to gain sufficient insights from data. This research paper proposes a new direction of travel to advance neonatal gastro-intestinal monitoring and strengthen our efforts to gain better insights from global databases. An integrated machine learning based model is recommended to produce a comprehensive disease model to manage the complexity of this multi-variate disease. This intelligent disease model would be used in the daily neonatal settings to help aggregate data to support clinical decision making, better capture the complexity of each patient to enrich global datasets to create bigger and better data. This paper reviews current machine learning and CAD technologies in neonatology and suggests an innovative approach for an NEC disease model

COVID-19 restrictions and psychological well-being of fathers with infants admitted to NICU—An exploratory cross-sectional study

Aim To describe the impact of the COVID-19 restrictions on the caregiving activities and psychological well-being of fathers with infants admitted to neonatal units. Methods Cross-sectional study using adapted COPE-IS and COPE-IU tools. Participants\u27 recruitment occurred online via social media and parents\u27 associations. Online survey in English, French and Italian were distributed and promoted via websites and social media platforms of parent\u27s associations. The study was undertaken across 12 countries in Asia, Australia, Africa and Europe. Results A total of 108 fathers of NICU infants completed the survey. COVID-19 related restrictions were categorised into 3 types: no restrictions, partial and severe restrictions. Fathers who experienced partial restrictions reported more involvement in caregiving activities but high levels of emotional difficulties and sleeping problems compared to those who experienced full or no restrictions. Conclusion Given the impact on the psychological well-being of fathers, restrictions should be avoided as much as possible in the neonatal unit and fathers given free access to their infants if they follow appropriate infection control precautions

Long‐Chain Polyunsaturated Fatty Acids and Lipid Peroxidation Products in Donor Human Milk in the United Kingdom: Results From the LIMIT 2‐Centre Cross‐Sectional Study

Background: Donor human milk is increasingly used as alternative to mother’s own milk to feed preterm infants, however, it may provide less long-chain polyunsaturated fatty acid (LCPUFA), and more oxidised lipids, which may be detrimental for preterm infant health and development. Levels have not been reported for donor human milk in the U.K. Methods: Donor human milk (n=19) from two neonatal units, milk from preterm mothers from a neonatal unit (n=10), and term mothers from the community (n=11) were analysed for fatty acid, malondialdehyde, 4-hydroxy-2-nonenal, and hexanal content. Study registration: NCT03573531 Results: Donor human milk had significantly lower absolute LCPUFA content compared to term milk (P<0.001) and significantly lower omega-3 PUFAs than preterm milk (P<0.05), although relative LCPUFA composition did not differ. Exclusive donor human milk feeding leads to significantly lower fat (3.7 vs. 6.7 g/d) and LCPUFA (DHA: 10.6 vs. 16.8 mg/d; ARA: 17.4 vs. 25.2 mg/d) intake than recommended by ESPGHAN, and provides only 17.3% and 43.1% of the in utero accreted ARA and DHA. Donor human milk also had the highest proportion of lipid peroxidation. Conclusions: This study confirms that donor human milk in the U.K. has insufficient levels of LCPUFAs for preterm infants. It demonstrates for the first time that donor human milk has the highest level of lipid peroxidation, compared to preterm or term milk. This has important implications for preterm infant nutrition, as exclusive donor human milk feeding might not be suitable long-term, and may contribute to the development of major preterm neonatal morbidities

COVID-19 restrictions and fathers of infants in neonatal care.

This is a letter without an abstract