On June 3, 2020, World Pediatric Project hosted an international videoconference on neonatal care with over fifty participants from seven Caribbean countries and the United States.
Representatives of Antigua & Barbuda, Dominica, Grenada, St. Kitts & Nevis, St. Lucia, St. Vincent and the Grenadines, and Barbados, as well as eight clinicians from St. Louis, participated in two sessions throughout the day.
The first was led by Dr. Justin Josephsen, the lead physician in WPP’s work in Grenada, who described a proposal for a regional quality improvement initiative for improving outcomes for patients with umbilical venous catheters and other central lines. These lines deliver medications and nutrients directly to the main vein leading to the heart. They allow doctors to give a broader range of medications and nutrients, but are prone to potentially dangerous infections without meticulous care. Under the proposed initiative, NICUs in the region would work together to establish protocols, set goals, and monitor progress to reduce the occurrence of bloodstream infections.
The second session covered the use of pulmonary surfactant and led by Dr. Shari-Ann Davis-Andrews of Milton Cato Memorial Hospital in St. Vincent and Dr. Robert Fleming of Cardinal Glennon Children’s Hospital in St. Louis. Surfactant is a naturally occurring chemical in the lungs that helps the air sacs in the lungs (where blood receives oxygen and gets rid of carbon dioxide) stay open. Premature babies are often deficient in surfactant since the lungs do not start producing this chemical in large quantities until the last few weeks of gestation. Without enough surfactant, premature babies can struggle to breathe. Dr. Davis-Andrews presented a case study from the successful administration of surfactant to a newborn in St. Vincent late last year and Dr. Fleming presented indications for surfactant use, particularly in settings where long-term invasive ventilation is not available, and where surfactant itself is costly and hard to come by.
Throughout both sessions, WPP’s Eastern Caribbean Neonatal Consultant Dr. Clyde Cave provided thoughtful questions and perspectives based on his experience as a neonatologist at Queen Elizabeth Hospital in Barbados, a consultant, and an investigator for numerous regional organizations, including Pan American Health Organization and WPP.
Feedback on WPP’s first teleconference was extremely positive. Participants said, “It was a great meeting, I look forward to more!” and “I felt very connected to other islands as we shared our similar challenges and some solutions they’ve found useful.”
In the coming weeks, we will be following up with participants to develop the regional quality improvement initiative and better understand the barriers to surfactant use and how we might address them. We plan to reconvene the entire group towards the end of the summer, in late August or early September.