99nicu... Your Forum in Neonatology!

Welcome to 99nicu, the web community for staff in neonatal medicine!

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    The 99nicu Pharmacopedia project is taking form! The goal is to make the web's best resource on pharmacological treatment in the NICU. The Pharmacopeia is discretely opened but there is yet only two drugs listed, Furosemide and Caffeine. Please note that guest access to 99nicu.org is somewhat restricted - for full access to everything, the Pharmacopedia included - just login (and tick "Remember" to stay logged in).
    If you would like to contribute and write up short summaries of drugs used in the NICU - please email stefan.johansson@99nicu.org and you will get instructions and the standardized template for writing such summaries.You find the Pharmacopeia under "Browse -> Pharmacopedia"
    The editorial board formed around this project includes:
    Stefan Johansson, Sweden Yurii Korzhynskyy, Ukraine Tarek Kotb, Saudi Arabia André M. Graça , Portugal Thorben Kracht, Germany Ravi Agarwal, United Kingdom Jasim Shihab, United Kingdom Marcio Fossati, Brazil  
    We have decided to restrict site access for temporary visitors. From now on it is possible to read only a few articles and posts without logging in.
    We have taken this step to increase the number of members who are logging in. It is as easy to log in here as to log in on Facebook  
    If you have a membership but need help to login, first try to reset your password. If you need more assistance - please email info@99nicu.org and we will assist you further.
    If you are not a member but work in the context of neonatal medicine or research, sign up for a membership. It is free of charge!
    Stefan Johansson
    Believe it or not - but on the 11th of May it is exactly 10 years ago since 99nicu opened its doors on the web!
    My best greetings to everyone who has contributed to the first ten years!
    I'd wished I could telegram you all a piece of the virtual birthday cake  
    PS. If you would like to give a 10y Anniversary Contribution to keep this ship afloat for another 10y, have a look here!
    Stefan Johansson
    I would like to high-light a request in the forums.
    Input is wanted for a strategic review conducted by the Department of Maternal, Newborn, Child and Adolescent Health of the World Health Organization. The objective is to conduct a rapid, high-level assessment of diagnostic and treatment guidelines used at hospitals, in frontline health facilities, and by community health workers.
    The posting member @axf10 seeks for pediatricians/neonatologists with practical experience in low and middle income countries to complete this survey. 
    Read more here on the link below how contribute to this survey.

    Stefan Johansson
    We have been online for 10 years now! Help us to keep going for another 10 years!
    On May 11 2006, I proudly posted that 99nicu was online after a few months of preparation.  

    Since then, we have achieved many good things. Most importantly, we have grown into a large community that is well-known for independence and a friendly atmosphere. While I have personally invested tons of time and money into this project, our bright future for a coming 10 years depends on a sustainable business model.
    My personal opinion is that crowd-funding would be a great way to add funds into our system, as I have myself experience from contributing to other projects this way.
    That's way I opened up a possibility to share a 10y Anniversary Donation!
    Please consider to make a small donation, just click here! 
    All donations are managed through Paypal, either you can use your account there or use your card. 99nicu.org is technically owned and funded by my company AB Epikris (VAT nb SE556961370501), therefore all donations will be addressed to AB Epikris.
    Stefan Johansson
    There is an ongoing discussion in the Virtual NICU about a term infant with a rash and what the likely diagnosis could be.
    I think this discussion is a great illustration about what 99nicu should be like - a place were neonatal staff could share issues and have input from people all around the world. And where tricky questions can be get directions where to find the right answers
    Although general questions about neonatal care and its challenges can be posted in the open forums, clinical cases should only be posted in the Virtual NICU where only logged-in members have access.
    If you are a member, log in and follow this particular discussion here.
    Stefan Johansson
    As you probably know, 99nicu is a project run with enthusiasm and for the good cause. For almost 10 years  
    However, we feel that we need to re-vitalize the 99nicu community, and our strategy is to involve more people in the Team behind 99nicu.org. We search for people that would like to act as "moderators", and people that are willing to start up a 99nicu Pharmacopedia, like a dictionary of short but informative posts of commonly used medications in the NICU. 
    Do you want to get involved as a 99nicu moderator, i.e. work a bit behind the scenes and participate in site moderation and development? Do you want to get involved in planning and setting up of Pharmacopedia? Click on the post below to read more about the principal idea, (but note that you need to be logged-in to read this topic as it is posted in the Lounge, a members-only forum)  Interested?! Then I look forward to an email on stefan.johansson@99nicu.org
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    • Persistent pulmonary hemorrhage in a preterm
      Dear members, I would like to discuss a case concerning pulmonary hemorrhage in a preterm of 26+2 weeks of gestational age.
      This little fellow had to be intubated at day 2 after CPAP due to increasing oxygen requirements and dyspnea, he received one dose of surfactant and responded pretty good. During very gentle ventilation he encountered a pulmonary hemorrhage and needed transfusion of erythrocytes and thrombocytes (min. 100/nl). He got vitamin K at the very beginning, blood clotting was unsuspicious, no signs of infection. We treated him with Terlipressin intratracheal and put him on high-frequency oscillation. Despite our efforts the bleeding recurred a couple of times. He still does´t need to much oxygen (about 30%) and HFO ventilation is still moderate. additionally he has a PDA of hemodynamic significance which I would like to start treating with indomethacin, but i am in doubt because of the enduring pulmonary bleeding. Any suggestions in this case??? Would you start treating the PDA?? Any other therapy options?   Thanks! Mahatma
    • Five Inflation Breaths
      ...very interesting  clinical trial on sustained inflation by professor Plavka from NICU in Prague   Medical Faculty of Charles University (extremly premature infants )
    • Five Inflation Breaths
      See this great blog post by @AllThingsNeonatal  
    • Weaning of postnatal steroids
      Our unit uses the DART regimen (with dexamethasone sodium phosphate) when starting postnatal steroids to facilitate extubation or they are sometimes started in cases where the baby is in extremis and receiving maximal other supportive care with respect to respiratory and cardiovascular support. This is the dosing regimen we use: 75 micrograms/kg/dose 12 hourly for 3 days*
      50 micrograms/kg/dose 12 hourly for 3 days*
      25 micrograms/kg/dose 12 hourly for 2 days*
      10 micrograms/kg/dose 12 hourly for 2 days*
      *Dose based on working weight of patient on Day 1 of regimen. Total of 10 days of steroids. Can be given IV or PO. We do not increases or decrease the dose outside of these regimens irrespective of any change in clinical practice. We aim to extubate babies between D3 and D5 of the steroid course in order that there is still a "tail-off" period of weaning steroid cover while they are on non-invasive respiratory support. We do counsel parents prior to starting steroids about both the short-term and perceived long-term side effects of the steroid use. We very rarely do back-to-back steroid courses. If we are unable to extubate the baby on the 1st course of steroids we will generally ensure optimisation of nutrition and ensure adequate growth, treat anaemia and any associated VAP before trying another course of steroids several weeks later if they are still unable to be extubated with the above. I hope that helps. Kind regards
    • HFOV noninvasive
      HFNC 2.0 indeed.. 😆😆
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