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    The awaited probiotics UK-trial is now published, and the results are showing that a single bacteria (Bifidobacterium breve BBG-001 in very preterm infants) does not reduce the risk of NEC, late-onset sepsis, or mortality. In short, a negative trial of good quality methodologically.
    However, the results contrasts against the ProPrems trial, similarly powered and well-designed, but the probiotics in that trial included a 3-strain preparation. Also, the Cochrane review from last year expressed strong recommendations that probiotics should be offered to preterm infants.
    We have started a new 99nicu Poll about probiotic use in the NICU.
    Please go there, vote, and share your experience and expertise.
    Here's the URL: http://99nicu.org/forums/topic/1901-probiotics-in-very-preterm-infants-how-do-you-do-now/
    So, our first JC ever is over. Three people from Sweden, India and Iran met up to discuss two papers on PDA. Despite the small group, I think it was a great experience to sort-of meet IRL, although there is room for improvements, also on the technical side.
    I add a transcript from the Chat room below.
    Stefan Johansson
    ** getting ready **
    Welcome to the 1st 99nicu Journal Club
    Tonight we are going to discuss a paper previously publ in ADC: http://fn.bmj.com/content/100/1/F55.full.pdf+html 
    on the "Natural evolution of patent ductus arteriosus in the extremely preterm infant"
    ** patiently awaiting others to join... **
    Stefan Johansson
    Hi Selvan! How are you?
    @Selvan - seems that we are not attracting a crowd
    @amirmasoud2012! Welcome here!
    yes stefan .it is day one . wait for sometime
    Stefan Johansson
    Shall we start? Did you read the ADC paper on spontaneous PDA closure? If so, what was your general impression?
    yes. paper questions the need for treatment to close pda since around 70% pda close on their own
    It was interesting ... the more we were treated ....     
    Stefan Johansson           
    PDA's are a tricky business. Interesting that the unit (in the study) did not treat PDA's at all (with drugs)
    But I think the rate of spontaneous closure is a mistake... they should have included all infants "at risk", i.e. also those who died, in the denominator.
    But still, the spont closure rate would be around 55-60% if all infants were included               
    What is your practises regarding PDA therapy?
    yes stefan you are correct .they have excluded babies who died.and within 72 hrs . but still 55-60 good number               
    we treat if they are symptamatic           
    Stefan Johansson               
    We do the same. But I think our general view has changed - to a more conservative approach                     
    Better if we treat the unstable situation ...                 
    modrate to large size pda 18:26
    Stefan Johansson               
    @amir - I agree. A major difficulty with PDA's is that some tiny babies are severly affected (say a 24w on mech ventilation), while other more mature preterm do just fine without tx (like a 31w on CPAP)    
    i heard from my friend who has worked in cardiff saying they have used it very rarely.            
    can you accept the risk of no treatment?                     
    Stefan Johansson               
    I would be very hesitant NOT to give a significant shunt.          
    I am a PDA-believer
    Did you manage to get hold on the other paper in JAMA - about early echo and its benefits? 
    In fact - that paper oppose the ADC paper - that there are benefits with early investigation (less lung bleeds for example)                   
    i just read the abstract. as you said it is for early echo!                    
    i could not get full paper   18:33
    I remember I do not have to search again                   
    Stefan Johansson               
    But it is a bit strange (the JAMA paper) - because they use timing of echo as a proxy for treatment.
    It will be difficult for me to keep my hands tied when you see a significant pda          
    Stefan Johansson               
    Actually, I have heard know of plans in the US (within the NICHD trial network) that they will make a placebo-controlled (blinded) RCT. Meaning they will give NSAID or placebo to treat a duct...
    Very difficult trial, and complicated with cross-overs in case a baby really need to close the duct                 
    An early PDA is not always a benign entity- did you read the rapid response?      

    An early PDA is not always a benign entity
    Martin R Kluckow, Neonatologist Nick Evans, Sydney University
    We read with interest the article by Rolland et al regarding a retrospective natural history study of the PDA in a cohort of preterm infants in a unit which conservatively managed the presence of a PDA after 24 hours(1). We have concerns about the data analysis and the conclusions drawn. In particular we question the decision to exclude...
    Stefan Johansson               
    Nick Evans is my principal mentor in PDA-thinking
    This is a good conclusion! "Concluding from the data presented that the exposure to the risk of therapeutic intervention to close a PDA is not warranted based on spontaneous closure rates of a selected surviving sub-group is not justified."              
    Nice argument                   
    Stefan Johansson               
    In short, I think Kluckow and Evans want to say that the ADC study is crap
    yes stefan

    what do feel is a best model to study the natural evolution of pda 
    Stefan Johansson               
    I think the best way would be to make serial echos on a prospective cohort. In fact I think Kluckow and Evans have done that
    and showing that severe early shunts is associated with lung bleeds and IVH (really significant and bad things)              
    Our third day we echo
    And before the third day if not treated pda .               
    Stefan Johansson               
    @amir - generally do the same, but in very instable babies our guidelines is echo typically on 1-2 day of life
    Stefan Johansson               
    @amir and @selvan - my time is out now
    it was great chatting with you despite some techn problems        
    thanks stefan                     
    good idea    
    thanks amir 
    Stefan Johansson               
    I think we need to think about how we use                 
    the chat room in the future                     
    i.e. the technical side. I hope we meet again here    
    can we have offline postings?               
    Keep going in the future    
    Stefan Johansson               
    @selvan - I will try to copy & paste the conversation into a word doc and then add it on the web site
    yes . hoping for the best   
    Stefan Johansson               
    We keep in touch! Ciao!
    17 November is World Prematurity Day, a day to bring light on the public arena to the world-wide burden of preterm birth.
    With advances in combatting infections, complications of preterm birth is now the main cause of mortality among children before 5 years of age. Of 6 millions estimated deaths among children <5y, preterm birth and its complications account for about 1 million.
    In many countries, there are events set up by health care providers, parent organisations, charities and organisations.
    In addition to your own local channels, we would like to promote a few web sites with information about the World Prematurity Day:
    March of Dimes EFCNI The WPD Facebook group And, additionally, find tweets using the hashtag #WorldPrematurityDay (https://twitter.com/hashtag/worldprematurityday)
    Finally, a video produced for March of Dimes, feel free to share it.

    Finally, the first 99nicu Journal Club is scheduled, on Tuesday the 24th of November, 5 PM (GMT).
    The JC will be held in the Chat room on 99nicu.org. To attend, you need to log in with your membership credentials (username/password), and then you find the "Chat" in the navigation menu above.
    Our current software license enables up to 20 people to attend, so there is a risk that some may not get in. If the discussions will be attracting lots of people, we could upgrade the license to allow more people in the Chat room (although that means a higher license cost).
    the Topic
    of the first JC is ductal shunting, and the natural evolution of the PDA and the great chance of spontaneous closure. The paper was published in ADC some time ago. A complementing paper is the findings from Epipage2, published in JAMA this summer, about the benefits of early echocardiography.
    Find the papers here:
    the JC Discussion
    will be semi-structured. The aim is to dissect the paper and get a feeling whether the paper is good (research-wise) and relevant (clinical-wise).
    Please have a look at this poster from Elsevier about how to read a paper

    Now you can tweak your signature by adding your country flag!
    The flag will be displayed before your name, like the Swedish flag is seen before my name.
    Just login, and in the right upper corner, choose "Account settings", and click on the "Country" tab there.

    After a long sleep, I have re-launched NeonatalStaff.com, a dedicated the job board for NICU professionals! For recruiters to advertise vacant job positions related to neonatal care.
    The web site is developed and maintained by myself, and any revenue is directly granted 99nicu and its maintenance and development. In other words, NeonatalStaff.com is a sort of charity project for 99nicu
    It is free to post vacancies there, but it is also possible to feature jobs. Featured vacancies are cross-posted to 99nicu and its social channels.
    There is an big and relevant topic started in the forums, about how to avoid that malnutrition develops in infants with congenital heart disease.
    @Aymen Eshene works in a NICU in Libya and often see that infants with congenital heart disease is becoming malnourished.
    He searches for input on strategies and interventions how to reduce the risks of malnutrition. If anyone has experience or knowledge within this field, please post in the thread here: