Reducing Infant / Neonate Morbidity and Mortality

Issa Trust Foundation (ITF) approach to medical education and training related reducing neonate & infant morbidity and mortality.

ITF takes a multifaceted approach when working with hospitals and healthcare providers to address infant morbidity and mortality.  We recognize that success in this area can only be achieved by a sustained, interactive and multidisciplinary approach. Our approach encompasses:

1. Identification of specific needs at each hospital as they related to current capabilities, population served, and achievable goals.  Input from providers/administrators at each hospital is vital to accurately identify these needs
2. Provision of medical equipment, achieved through partnerships with Welch-Allyn, Heart-to-Heart, DirectAid, just to name a few.
3. Provision of consumable medical supplies, and disposables such as catheters, feeding tubes, pharmaceuticals, achieved through partnerships with
4. Provision of initial and on-going training related to equipment provided, particularly those designed for respiratory support (ventilators, CPAP devices)
5. Ongoing education directed at specific areas of neonatal medical care, including, but not limited to infant feeding and nutrition, respiratory disease, fluid and electrolyte therapy, prevention of risk for neonatal morbidities such as chronic lung disease, necrotizing enterocolitis, retinopathy of prematurity.
6. Ongoing education focused on neonatal nursing care, including physical assessment, feeding practices, securing of respiratory devices (endotracheal tubes), thermoregulatory support, and infant positioning.
7. Ongoing biomedical engineering support for equipment donated by ITF (ie ventilators) as well as equipment already present within hospitals (radiology devices).

With regards to medical/nursing education and training, our model encompasses a number of formats. 

1. Physicians, nurses and respiratory therapists working with ITF provide structured neonatal education courses directed towards Jamaican physicians, midwives and nurses.  A curriculum is developed to address a range on topics, including but not limited to neonatal resuscitation and stabilization, preparation for transport, achieving intravenous access, invasive and non-invasive respiratory support, fluid and electrolyte management, neonatal hemodynamics, renal function and acute kidney injury, hypoxic-ischemic injury, transitional physiology, neonatal hematology and infant nutrition.  These courses, which are 3-5 days in length, include opportunity for hands-on experiences, use of simulation scenarios and open-ended questions sessions.  We also allow ample time to address needs and questions of participants that are not addressed in the structured curriculum.  These courses could be provided approximately every 4-6 months.
2. On-site, side-by-side training of physicians and nurses.  By physically being present in the special care nursery, and rounding with the team providing care to neonates, our physician and nurse educators are able to identify areas to focus teaching and provide immediate input relative to issues of individual patients. Additionally, we are able to identify and address technical problems with medical equipment being used, such as ventilators, infant incubators, warmer beds and cardiopulmonary monitors.  On-site training could be provided every 3-4 months.
3. Provision of relevant protocols, checklists and system-based approaches that can be incorporated into the workflow in special care nurseries.  For example, we developed a feeding protocol for preterm infants based upon gestational age and chronological age that is designed to optimize nutrition in this vulnerable population.  A number of additional resources developed by faculty and staff at the University of Iowa Children’s Hospital are available through open access websites. These resources, which we acknowledge are not entirely relevant to the Jamaican population, include the Iowa Neonatology Handbook (URL:  https://www.uichildrens.org/iowa-neonatology-handbook) and the Iowa Guidelines for Perinatal Care (appendix) (URL: https://www.idph.state.ia.us/hpcdp/common/pdf/2013_appendicies.pdf). 
4. We continue to work towards developing a functioning, inexpensive and user-friendly platform for telemedicine.  Incorporation of electronic provider-to-provider communication, either scheduled or immediate access as needed, will provide opportunity for direct input into patient care as well as ongoing education. 
5. Direct provider-to-provider communication via email.  Healthcare providers associated with ITF, including physicians, nurses and respiratory therapists, are continuously interested and available to address any questions or issues shared with us by our Jamaican partners.