Sharla Rent

Introduction: Perinatal mortality remains high in low‐ and middle‐income countries, with Tanzania bearing one of the greatest burdens. The Three Delays framework is often used to analyze preventable perinatal deaths and includes care seeking, reaching care, and receiving definitive care. This study explores Tanzanian mothers' experiences of perinatal loss, focusing on delays and gaps in care. Methods: This study was conducted at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Fifty women who experienced stillbirth or neonatal death completed intake surveys about their perinatal loss experience. Of these, 40 completed semi‐structured in‐depth interviews 8 weeks post‐loss. Interviews explored barriers in care seeking, access, delivery, and communication. Survey data were analyzed with descriptive statistics. Interview data were thematically coded using a directed content analysis combining a priori codes from the three delays framework and inductive coding. Results: Participants perceived delays in seeking care (50%), receiving care at initial facilities (27.5%), referral processes (12.5%), and care at KCMC (17.5%). Nearly half (45%) reported inadequate communication from healthcare providers. Three key themes emerged: (1) women perceived delays in care at all points along their care trajectory (2) gaps in communication impacted medical care for women and newborns, and hindered healing after perinatal loss; and (3) women emphasized the need for emotional support and compassionate communication following loss. Discussion: While structural, process, and financial barriers persist, informational and relational communication gaps represent an under‐addressed challenge across the perinatal loss care pathway. Rather than being viewed in isolation, efforts to strengthen communication should be integrated into broader health system strategies aimed at reducing delays, improving access to timely and quality care, and supporting families after stillbirth or neonatal death. Strengthening communication within health systems, both as an informational and relational process, has the potential to enhance care experiences, build trust, and support emotional healing after perinatal loss.

Objective: Extreme prematurity results in high mortality and morbidity. Artificial womb technology (AWT) has the potential to revolutionize care for these infants, and first-in-human (FIH) trials are imminent. Our objective was to assess parental acceptability and decision-making regarding AWT. Study Design: Interviews were completed with 30 parents regarding a hypothetical choice for a 23 week gestational age baby between participation in a FIH AWT trial, neonatal intensive care, or comfort care. Result: Most parents (63.3%) indicated that they would participate in a FIH AWT trial. Reasons for participation included: hope for better outcomes, naturalness, comfort, trust in medical progress, and furthering science. The most common reason for not participating was a general hesitancy of FIH trials. Conclusion: AWT may be acceptable to many families facing periviable birth, but that acceptability will depend on transparent counseling about uncertainty, clear communication of preclinical evidence and trial safeguards, and attention to parents’ questions.

Every day, 1900 children die from an injury, with the majority in low-and middle-income countries. In Tanzania, reaching definitive care, or the appropriate final level of care for a child’s injury, often requires referral to a higher level facility. This hierarchical system introduces challenges that may lead to delayed care and, for severely injured children, cause mortality. The aim was to identify patient, healthcare provider, and health system-level barriers to timely referral for pediatric injury patients at the first site of care in order to identify targets for an intervention to reduce time to definitive care. In this mixed-methods study, a pediatric injury registry was established at three health facilities spanning three health system levels in Northern Tanzania. Thirty family caregivers of pediatric injury patients participated in interviews, while healthcare providers participated in four focus group discussions. The Consolidated Framework for Implementation Research framed interview guides and thematic analysis of the qualitative data. Of 782 patients enrolled in the pediatric injury registry from Aug 2024-Aug 2025, 269 were referred. Most visited 1-4 facilities before reaching definitive care (range 1-6). The median time from injury to definitive care was 15.1 hours (IQR 1.8-33). Qualitative data collection with family caregivers and healthcare providers revealed barriers to explain the delays to care in the outer setting (such as non-standardized referral pathways), the inner setting (such as delays in the decision to refer), and individual characteristics (such as inadequate training in pediatric injury care). According to the World Health Organization standards, every child who needs referral should be sent within 2 hours of arrival. To improve the referral delays found in this study, a locally co-designed, multicomponent health systems intervention for healthcare providers at the first site of care must be developed that includes pediatric injury care training and standardized referral decision support. Key Messages: Injuries are important contributors to child morbidity and mortality globally, with low-and middle-income settings like Tanzania disproportionately affected. In Tanzania there is a complex health system where pediatric injury patients present to primary health facilities first, and are referred up the health system until they reach the definitive care that they need. Barriers at the outer setting, inner setting, and individual level of the health system contribute to delays in reaching definitive care. In order to combat these delays and improve child morbidity and mortality, a locally co-designed, multicomponent health systems intervention at the level of the first site of care must be developed that includes standardized referral decision processes.

As artificial womb technology (AWT) nears clinical translation for extreme prematurity, ethical interest has grown. To characterize this ethical landscape, we conducted a scoping review of ethical considerations of AWT searching Medline, Embase, and Web-of-Science through March 2025. Ethical considerations were extracted and organized using thematic analysis. In total, 247 papers were included: 114 (46.2%) focused on AWT for extreme prematurity and 133 (53.8%) on futuristic complete ectogenesis. Most papers were authored by bioethics scholars (157/247, 63.5%), and within this group, the majority addressed complete ectogenesis (98/157, 62.4%). Seven thematic categories were identified: Benefits and Harm; Decision-making; Moral and Legal Status; Justice and Access; Cultural and Societal Perspectives; Research Ethics and Speculative Concerns. Overall, AWT ethics literature is divided between concerns about "complete ectogenesis" and use for extreme prematurity. Insights from clinically focused literature and comprehensive stakeholder engagement are essential for ethical guidance of impending clinical translation of AWT.

Objective Describe the well-being of parents of infants during intensive care unit (ICU) admission through 6 months after discharge. Study design Cohort study of infants with neurological conditions admitted to the ICU between 2018 and 2020 whose parents completed surveys at enrollment, discharge, and 6 months after discharge. Results 40 mothers and 21 fathers of 40 infants were enrolled. Abnormal anxiety scores were most common at enrollment for mothers (58%), and at 6 months post discharge for fathers (71%). Abnormal sleep was most common at enrollment for mothers (75%), and at discharge for fathers (73%). Post traumatic stress disorder (PTSD) scores were abnormal for 47% of mothers and 33% of fathers. Conclusion Parents of infants with neurologic conditions are at risk of poor well-being, including symptoms of anxiety, PTSD, and impaired physical function. Further studies assessing the optimal timing for interventions are needed to improve parental well-being.

In this narrative review, we examine current neurological and neurodevelopmental outcomes associated with extreme prematurity, specifically in infants born between 22 and 24 weeks of gestational age. In addition, we explore the scientific and clinical rationale for the development of artificial womb technology and provide an overview of the current state of the art in preclinical models. For each model, we review and analyze the neurological outcomes, including structural, developmental, and functional outcomes, evaluating their limitations in anticipation of imminent clinical translation.

Objective The Ethiopian Newborn Quality Improvement (EN-QI) Extension for Community Healthcare Outcomes (ECHO) promoted the implementation of Helping Babies Survive training in eight Ethiopian health facilities. The initiative incorporated U.S based Neonatal-Perinatal Medicine (NPM) fellows into the ECHO Expert Hub. This study evaluates the experiences of the NPM fellows. Study design This mixed-methods study incorporated objective data, survey responses, and qualitative focus group analysis from the eight participating fellows. Results Fellows described benefits including mentoring, networking, career development, and quality improvement experience. Their experience would have been improved with more thorough onboarding and clarification of the fellow role at the start of the project. Conclusion This study demonstrates a model for inclusion of fellows in a virtual partnership as a low-cost and high value approach to global health work. This project was well-received and highly valued by fellows as a meaningful training opportunity.

Introduction: Despite overwhelming evidence of the benefits of breastfeeding (BF) and its potential to decrease infant mortality, BF rates are low in many low‐ and middle‐income countries like Ghana. We sought to assess Ghanaian mothers' BF plans and their rationale for these plans. Methods: We conducted a mixed method study via face‐to‐face interviews administered in 2019. We included pregnant or recently delivered maternity ward patients at a tertiary care center in Kumasi, Ghana. Semi‐structured interviews were conducted to collect sociodemographic information, BF plans, and reasons for BF preferences. In accordance with World Health Organization recommendations, optimal BF was defined as 6 months of feeding an infant with breastmilk only (exclusive BF) followed by at least 18 months of feeding an infant the combination of breast milk and supplementary liquids and/or solid foods (complementary BF). Demographic characteristics of the cohort were compared by maternal BF plan using Pearson's chi‐squared and t‐test. Simple thematic analysis was performed to identify reasons for BF preferences. Results: During the study period, 126 participants were enrolled. Forty‐two (33.3%) participants planned to practice optimal BF. Participants who were married were more likely to have optimal BF plans than unmarried participants (OR 0.17; 95% CI 0.04, 0.53). There was no association between optimal BF plans and age, education, religion, and pre‐ or post‐delivery status. Reasons for not practicing optimal BF included concern about the nutritional sufficiency and infants' enjoyment of breastmilk, logistical challenges of optimal BF, milk underproduction, and medical concerns for mother or baby. Conclusions: Only one‐third of our cohort planned to practice optimal BF. Strengthening family support systems and improving patient education may increase optimal BF rates in Ghana.