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Question solved? Why HFNC appears to be inferior to nCPAP for preemies.

To be sure there are fans of both HFNC and CPAP out there. I have often heard from other Neonatologists that they use HFNC and find positive results while other centres refuse to use it in favour of the tried and true CPAP. Turning to the literature you will find some conflicting results with some studies suggesting equity and others more recently favouring CPAP. There has been speculation as to why one would be superior to the other and now we appear to have some answers as to where the differe

Aerosolized surfactant. Can we finally do away with intubation?

I have written about non-traditional methods of providing surfactant to newborns previously. The practice of intubating a preterm infant to administer surfactant and leaving the endotracheal tube in with a slow wean of ventilation is mostly a thing of the past (at least in my units). Strategies have evolved and have seen the development of the INSURE technique, LISA methods, use of an LMA to delivery surfactant and even simple deposition into the pharynx all with variable success. The Holy

High tidal volume during PPV for infants <29 weeks GA linked to IVH

Just about all of our preterm infants born at <29 weeks start life out the same in terms of neurological injury.  There are of course some infants who may have suffered ischemic injury in utero or an IVH but most are born with their story yet to be told.  I think intuitively we have known for some time that the way we resuscitate matters.  Establishing an FRC by inflating the lungs of these infants after delivery is a must but as the saying goes the devil is in the details. The Edmonton
Review on ethics around decision-making - compulsary reading for all NICU staff

Review on ethics around decision-making - compulsary reading for all NICU staff

If you are to read one paper on neonatal ethics this year, I'd argue that this is the one. Late last year, John Lantos, pediatrician and a leading medical ethicist, published a review in NEJM on the ethics around decision-making in the NICU. The paper is not open-access... but you can surely get it from within your hospital intranet or your university/hospital library. We have a fantastic toolbox in the NICU. We can provide live-saving treatments and support. Most newborns in the NICU

Developmental outcomes for extreme preemies after delivery room CPR.

We have all been there.  After an uneventful pregnancy a mother presents to the labour floor in active labour.  The families world is turned upside down and she goes on to deliver an infant at 27 weeks.  If the infant is well and receives minimal resuscitation and is on CPAP we provide reassurance and have an optimistic tone.  If however their infant is born apneic and bradycardic and goes on to receive chest compressions +/- epinephrine what do we tell them?  This infant obviously is much sicke

Exclusive human milk diets may overcome programming for the metabolic syndrome

The metabolic syndrome describes the development as an adult of centripetal obesity, high blood pressure, high triglycerides, elevated blood sugar and low HDL cholesterol. These constellation of problems significantly increase the risk of cardiovascular disease, stroke and diabetes. The origins of this syndrome may begin in the newborn period as previous research has noted an association with infants who are born SGA and development of insulin resistance later in life as in the paper Insuli
Sim Devices for teaching NLS & ALS:Day @EMS2019

Sim Devices for teaching NLS & ALS:Day @EMS2019

Last month I got a chance to day pass at ems2019 to get an update on hospital tranfer#picu by la paz and update on  ilcor peadiatric resus by Dr Maconochiel who gave us an insight into how guidelines are elaborated -quite complex.I also the tech lover and intetact  resus decives. The   Mechanical for compression in for fevices look impressive , and fumctional .I was suprised to see many there are available to date x adult use only. My NLS Top medical devices -tried and tested Moniven

Can we reduce severe IVH with elevated midline head positioning for ELBWs?

Recently the practice of keeping ELBW infants with a midline head position for the first three days of life has been recommended to reduce IVH as part of a bundle in many units.  The evidence that this helps to reduce IVH has been somewhat circumstantial thus far.  Studies finding that decreased sagittal sinus blood flow, increased cerebral blood volume with increased intracranial pressure all occur after head turns would theoretically increase the risk of IVH.  Raising the head of the bed would
Neobiomics provides ProPrems® - You know why

Neobiomics provides ProPrems® - You know why

Since 2016, I have been working “off-radar” with a group of dedicated people in the startup company Neobiomics. I think we have pushed boundaries for thinking and working outside-the-box, and with only small financial support from ALMI and Karolinska Institutet Innovations. As you are aware, the intestinal microbiota is a hot topic in the neonatal community. For several years I was frustrated about the lack of a high-quality bacterial product. I shared this frustration within my closer netw

Intratracheal instillation of steroids to prevent BPD

Choosing to provide postnatal systemic steroids to preterm infants for treatment of evolving BPD has given many to pause before choosing to administer them. Ever since K Barrington published his systematic review The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs. and found a 186% increase in risk of CP among those who received these treatments, efforts have been made to minimize risk when these are given.  Such efforts have included

Keeping up with the Kardashians: Should you eat your placenta after delivery?

The medical term for this is placentophagy and it is a real thing. If you follow the lay press you may have seen that originally this was promoted by Kourtney Kardashian who did this herself and then by Kim who planned on doing the same after delivery. See Did Kourtney Kardashian Eat Her Placenta? This is not completely without basis as many readers will be thinking already that they have heard about the health benefits of doing the same. Reports of improved mood and reductions in the ba

🎶🎹 Music Therapy in the NICU 🎶🎻

Several tweet posted on the subject of music therap­y, namely by Fiona Lawson and Dr. Michae­l Narvey. It prompted me to share  paper on the on the Music therapy(MT) in NICU as I was abl­e to research for my posgrad as a way of­ humanizing NICU experience. I had a top­ic on my mind for a while since I used t­o work in the NICU. I First heard of this kind of therapy  from a french television TV5. Here I saw how music was used in a neurological ward for its appeasing edge.    Music therapy i­n Med

Jelli KA

Jelli KA


What secrets are hiding in your patient monitor?

This post is very exciting to me.  All of us in the field of Neonatology are used to staring at patient monitors.  With each version of whatever product we are using there seems to be a new feature that is added to soothe our appetites for more data.  The real estate on the screen is becoming more and more precious as various devices such as ventilators, NIRS and other machines become capable of displaying their information in a centralized place.  The issue though is that there is only so much

Can topical breast milk cure teenage and adult acne?

A recent post on the intranasal application of breast milk Can intranasal application of breastmilk cure severe IVH? garnered a lot of attention and importantly comments.  Many of the comments were related to other uses for breast milk (almost all of which I had no idea about).  A quick search by google uncovered MANY articles from the lay press on such uses from treating ear infections to diaper dermatitis.  One such article 6 Surprising Natural Uses For Breast Milk certainly makes this liquid
Do you know what’s in your tube of glucose gel?

Do you know what’s in your tube of glucose gel?

Hypoglycemia has been a frequent topic of posts over the last few years. Specifically, the use of dextrose gels to avoid admission for hypoglycemia and evidence that such a strategy in not associated with adverse outcomes in childhood. What we know is that dextrose gels work and for those centres that have embraced this strategy a reduction in IV treatment with dextrose has been noted as well. Dextrose gels however in the trials were designed to test the hypothesis that use of 0.5 mL/kg
The Future of Neonatal Care will happen in Copenhagen

The Future of Neonatal Care will happen in Copenhagen

Register for the 99nicu Meetup! In the virtual 99nicu Headquarters, we are now very busy with all preparations for our upcoming Meetup, AKA the Future of Neonatal Care conference. This third conference will take place in Copenhagen, 7-10 April, and we are already thrilled about what to come. Our vision for the 99nicu Community is to offer an Internet platform where neonatal staff from all over the world can share questions, experiences and expertise. Therefore, we are grateful to see,

Stefan Johansson

Stefan Johansson


Can intranasal application of breastmilk cure severe IVH?

It isn’t often in Neonatology these days that something truly innovative comes along. While the study I will be discussing is certainly small I think it represents the start of something bigger that we will see evolve over the coming years. There is no question that the benefits of mother’s own milk are extensive and include such positive outcomes as improved cognition in preterm infants and reductions in NEC. The benefits come from the immunological properties as well as the microbiome

Less Invasive Surfactant Administration with High Volume Surfactant

InSurE (Intubate, Surfactant, Extubate) has been the standard approach for some time when it comes to treating RDS.  Less Invasive Surfactant Administration (LISA) or Minimally Invasive Surfactant Administration (MIST) have been growing in popularity as an alternative technique.  More than just popular, the techniques have been shown to reduce some important short term and possibly long term outcomes when used instead of the InSurE approach.  Aldana-Aquirre et al published the most recent system

Was resetting the threshold for hypoglycaemia a good thing?

In 2015 the Pediatric Endocrine Society (PES) published new recommendations for defining and managing hypoglycaemia in the newborn. A colleague of mine and I discussed the changes and came to the conclusion that the changes suggested were reasonable with some “tweaks”. The PES suggested a change from 2.6 mmol/L (47 mg/dL) at 48 hours of age as a minimum goal glucose to 3.3 mmol/L (60 mg/dL) as the big change in approach. The arguments for this change was largely based on data from normal preterm

Caffeine. Give it and give it early.

Use of caffeine in the NICU as a treatment for apnea of prematurity is a topic that has certainly seen it’s fair share of coverage on this blog. Just when you think there is an aspect of treatment with caffeine that hasn’t been covered before, along comes a new paper to change my mind. The Caffeine for Apnea of Prematurity study or CAP, demonstrated that caffeine given between 3-10 days of age reduced the incidence of BPD in those treated compared to those receiving placebo. As an added ben

At 22 weeks of gestation does your faith matter most to outcome?

Recent statements by the American Academy of Pediatric’s, NICHD, the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and recommend selective approaches to mothers presenting between 22 0/7 to 22 6/7 weeks. The decision to provide antenatal steroids is only recommended if delivery is expected after 23 weeks. Furthermore the decision to resuscitate is based on an examination of a number of factors including a shared decision with the fami



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