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Abel

PDA: meds/surgery/conservative

Hi there seem to be enough evidence about the lack of beneficial effect of treatment of the PDA! The approach to a hemodinámica significant ductus has changed significantly in the last 10 years.  Years ago we weee so obsessed that indocin prophylaxis was standard in many NICUs and early treatment became standard across the board.  I remember going to Dr Clayman  PDA lecture at PAS where the PDA was seen as a demon many babies had  been exposed to surgical ligation with a known
Bubbly Girl in NICU

Hope x to Neonatal Congenital Heart

Had a chance to attend #TEIBIO -  Transference (of knowledge Entrepreneurship ) & Innovation in Biotech . inspirational talk on rare diseases awareness day and topics were bringing hope to paediatrics #nicu: by address solutions to Neonatal Congenital Heart #CHD ❤️and better tolerance heart transplant. - 💡Crazy scienceco-founder Dr. Beatriz Salvador shows us how her team have found a non-invasive treatment for Congenital Diaphragmatic Hernia.  They were able the hole in C
Department of Brilliant Ideas

Values made me X-it

I don’t need to expand on how Internet and social media have shifted the paradigm for professional discussion. You know this! Painful it is, but I wanted to share that I have decided to close my Twitter/X account. I will miss you tweeps. But... see you soon elsewhere! I started to build a network on Twitter in 2009, exploring this new channel for communication about research and medicine. Twitter was different then, compared to what X has become. In the earlier years, Twitter impersona
spotted: NICU

From Tarrega's Memories of the Alhambra to Sibelius' Tounela Swan: experience of a Spanish neonatologist in Turku

I would like to introduce to you doctor Angela Gregoraci, a Spanish neonatologist, who has just completed a two-month observership in our NICU in Turku, Finland. Our unit here in Turku, is a tertiary center, with single-family rooms and- even more importantly- with families having the possibility to stay with and care for their sick or premature infant throughout the day and night. The objective of this short training was to learn how to facilitate the implementation of family-centered care in d
piatkat

piatkat in Guests

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Bubbly Girl in NICU

Humanize Care Neonatal Transport in Spain.

Fantastic put together webinar by neonatal transport Seneo work neonatal transport group. Here are some  favorite suggestions. 🔷Ear Muffs 🔷Air mattress 🔷Blanky with mum swell  🔷Fuzzy toy. 🔷Thank the Drivers : Be aware of G force driver have take with sudden break.  🔹Consider 🚑 design allow all to have a better transport experience.             From my perspective it was   Interesting the neonatal transport   Landscape is diverse from the pioneering r
All Things Neonatal

Can a couple puffs of albuterol help preemies on mechanical ventilation?

Giving bronchodilators to preemies on a ventilator has certainly been tried before. The major issue to contend with is getting the drug to where it is supposed to be. Anyone reading who has a child with asthma knows that you should use an aerochamber when taking a puff to help with better distribution to the lung. Giving a puff or two without it largely ends up on the back of the throat. Similarly, giving puffs through an endotracheal tuberaises questions about how much of the medication winds u
All Things Neonatal

High CPAP vs NIPPV. Is there a winner?

A couple years back at the Canadian Pediatric Society annual meeting a discussion broke out about extubating infants to higher levels of CPAP. Conventional thinking had been to use levels between 5 – 8 cm H2O typically. I shared with the group the experience we had in Winnipeg (unpublished) of using higher levels from 9 -12 cm H2O with some degree of success in allowing earlier extubation. The group thought it was interesting but pointed out the lack of robust research in the area so were not so
AllThingsNeonatal

AllThingsNeonatal in CPAP

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All Things Neonatal

Can a single serum cortisol target those who should receive prophylactic steroids to reduce BPD?

Precision medicine is a growing field in which genetic factors, environment, metabolism and even lifestyle are taken into account when deciding who should receive a treatment or not. When it comes to bronchopulmonary dysplasia I believe anyone who works in Neonatal care can attest it is a mystery why some infants go on to develop BPD while others don’t. We do know that certain treatment strategies may increase risk such as using excessive volumes or pressure to ventilate and in the last 25 years
AllThingsNeonatal

AllThingsNeonatal in BPD

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All Things Neonatal

Is Heliox A Magic Bullet For Treating Meconium Aspiration Syndrome

This post is special to me. A redemption of sorts. When I was a fellow in Edmonton in the early 2000s my fellowship project was to see whether heliox (helium/oxygen) given to piglets with meconium aspiration syndrome (MAS) would improve ventilation and measures of pulmonary hypertension vs controls. Why heliox? There had been work done with this gas for other conditions and the lower viscosity of the gas (who hasn’t sucked on a helium balloon to see the effect of helium) means that the flow of t
All Things Neonatal

Can transcutaneous auricular vagus nerve stimulation do the impossible and fix the baby who won’t eat?

If you work in NICU you will have seen many babies who have passed through the stages of apnea, weaned off respiratory support and have reached a sufficient weight for discharge but alas will just not feed. Different strategies have been employed to get these infants feeding that rely in many cases on a cue based approach but in the end there are some that just won’t or can’t do it. Many of these babies will be sent home either with NG feedings or if it appears to be a more long term situation a
All Things Neonatal

Should CPAP be weaned or is stopping “cold turkey” the way to go?

With American Thanksgiving coming up this weekend a post about “cold turkey” seemed apropos. You can’t work in Neonatology and not be familiar with CPAP. We have learned much about this modality in the last couple decades as clinicians have moved more and more towards non-invasive support as the preferred strategy for supporting newborns regardless of gestational age. Ask a Neonatologist how they use CPAP and you will find varied opinions about how high to go and how quickly to wean. I have writ
AllThingsNeonatal

AllThingsNeonatal in CPAP

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All Things Neonatal

Another dogma bites the dust? Two vs three hour feeding intervals for VLBW infants.

This could turn into a book one day I suppose but I have become interested in chalenging some of my long held beliefs these days. Recently I had the honour of presenting a webinar on “Dogmas of Neonatology” for the Indian Academy of Pediatrics which examined a few practices that I have called into question (which you can watch in link). Today I turn my attention to a practice that I have been following for at least twenty years. I have to also admit it is something I have never really questioned
All Things Neonatal

Reducing severe IVH/PVL through exclusive human milk diets. Is this the real thing?

Anyone who works in the NICU is more than familiar with the sad moment when you find out an infant has suffered a severe IVH (either grade III or IV) and the disclosure to the family. The family is in a state of shock with the fear of ventricular drainage a reality that will likely come to pass.  We have spent many years trying to find ways to reduce this risk and antenatal steroids and delayed cord clamping are two relatively recent interventions that have had a real impact.  Unfortunately we h
All Things Neonatal

How much feeding voume can a preterm baby really take? It’s likely more than you think!

Since the dawn of my time in Neonatology there has been cibophobia! What is this you ask? It is the fear of food and with some flexibility in the definition I would apply this to large volumes of milk rather than the fear of food itself. Most units in the world seem to use a volume range of about 135 – 165 mL/kg/d as a range considered to mean “at full feeds”. As I was discussing this on rounds today I was quick to point out though that babies with neonatal opioid withdrawal syndrome (NOWS) freq
All Things Neonatal

Nasal High Frequency Oscillatory Ventilation For Preventing Intubation

I have reviewed many articles on this site in the last few years. My favourite pieces are ones in which I know the authors and I have to say my ultimate favourite is when I know the authors as colleagues. Such is the case this time around and it pertains to a topic that is not without controversy. Nasal High Frequency Oscillatory Ventilation or NHFOV for short is a form of non-invasive ventilation that claims to be able to prevent reintubation whether used prophylactically (extubation directly t
AllThingsNeonatal

AllThingsNeonatal in Intubation

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All Things Neonatal

Premedication for Intubation: Take a pass on propofol

The Canadian Pediatric Society has a statement on the use of premedication before non-emergent intubation which was written in 2011 and reaffirmed in 2018. After reviewing available medications for use the recommended strategy was atropine, fentanyl and succinylcholine. This combination does involve three different medications, the first being to prevent bradycardia, the second to sedate and the third to paralyze. With the use of three medications however there is always room for error so it is
AllThingsNeonatal

AllThingsNeonatal in Intubation

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All Things Neonatal

Say what!? Applying a mask to resuscitate preterm infants causes apnea.

Let me start off by giving thanks to John Minski for this article and in fact for many others that have been reviewed on this blog. John is a registered respiratory therapist in Winnipeg with a passion for respiratory care like no other. John frequently sends articles my way to think about for our unit and this one was quite sensational to me. As readers of this blog I thought you might find it pretty interesting as well. Why Would A Mask Cause Apnea To begin with this seems coun
All Things Neonatal

Dark green gastric residuals are gross but may be part of a systemic logical fallacy in Neonatology

In recent years we have moved away from measuring and reporting gastric residuals. Checking volumes and making decisions about whether to continue feeding or not just hasn’t been shown to make any difference to care. If anything it prolongs time to full feeds without any demonstrable benefits in reduction of NEC. This was shown in the last few years by Riskin et al in their paper The Impact of Routine Evaluation of Gastric Residual Volumes on the Time to Achieve Full Enteral Feeding in Preterm I
All Things Neonatal

Surfactant and inhaled nitric oxide make beautiful music together

If you work in Neonatology you no doubt have listened to people talk in rounds or at other educational sessions about the importance of opening the lung. Many units in the past were what you might call “peepaphobic” but over time and with improvements in technology many centers are adopting an attitude that you use enough PEEP to open the lung. There are some caveats to this of course such as there being upper limits to what units are comfortable and not just relying on PEEP but adding in surfac
AllThingsNeonatal

AllThingsNeonatal in PPHN

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All Things Neonatal

Cows milk, the gut & starvation of oxygen. Why even the fortifier used may contribute to NEC.

It seems so simple doesn’t it. Shouldn’t we just be able to feed milk whether it be from humans or cows and our preemies will just adapt? I have often written about human milk diets vs those with bovine but this week an intriguing article came my way that really gave me some pause to say hmmm. Human milk diets have been shown to reduce the risk of necrotizing enterocolitis (NEC) compared to use of formula. The use of bovine human milk fortifiers falls somewhere in the middle I suppose as the die
AllThingsNeonatal

AllThingsNeonatal in *

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Bubbly Girl in NICU

Humanizing Care NICU : Management with Compassion

Today I sharing ‘tis post from HUGES a great. Organization dedicated to humanizing care in intensive care settings and emergency services. I particularly by this webinar on humanize. Management starting with leading with empathy, simply things that can be hard to achieve, but make us think Speakers suggests a few things to start with :   J. Carlos March - Profesor  EASP {Escuela Salud Publica- Public Health Institute of Andalucia}  Director of School of patient.
Jelli KA

Jelli KA

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All Things Neonatal

Time to say goodbye to INSurE and hello to IN-REC-SUR-E?

Intubate-Surfactant- Extubate or INSURE has been around for awhile. The concept is to place an ETT while an infant is first on CPAP and then after pushing surfactant in quickly remove the ETT and put back on CPAP. This does not always go as planned though. If after surfactant the FiO2 remains above 30% many people would keep the ETT in place as they would surmise that the infant would fail if the tube was removed. They would probably be right. Sustained inflations have fallen out of favo
AllThingsNeonatal

AllThingsNeonatal

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