This week on social media this seemed to be a hot topic. What should we do to protect ourselves as we start to see more mothers infected or at least suspected of having COVID-19
presenting in labour. Should we be assuming all of these infants are infected and if so should we all don personal protective equipment (PPE) including the N95 mask? Let’s see what we know so far.
The big concern with this began after a report of a 36 hour old newborn in China cont
Dear fellow Ph.D. students, full-time researchers, and other fellow scientists,
please #staythefuckhome. In many grant proposals, we write "this research has the potential to save lives, because... ". Let's face it- most of our research won't save lives (or at least not at once)*. No matter how fantastic our research projects are, science takes time. But what can actually save lives immediately is US STAYING HOME. This way we - the (relatively) young people in big academic campuses- won't b
One of the most common conditions afflicting ex-preterm infants is chronic lung disease. Through advances in antenatal steroids, surfactant and modern ventilation we have done what we can to try and prevent this condition from occurring yet despite our best efforts CLD remains a common problem among those born at less than 1500g as is shown in the 2018 Canadian Neonatal Network data.
Primary prevention is of course the ideal strategy to reduce disease but when you try and your best and an
A article that most struck lately:
This article by Dr. G.Moore et al researchers at the University of Ottawa, accessible #FOAM, give a good thoughtful analysis to whether chest compression & epinephrine cause more harm than good to V.preterm infants using 'principals' as an ethical framework aka the Spanish /French say does 'Encarnecimiento Terapeutico' a concept complex.
As I understand, away to explain it what happens when you go beyond overtreatment? When continuing treatment i
First off I should let you know that we do not do transpyloric feeding for our infants with BPD. Having said that I am aware of some units that do. I suspect the approach is a bit polarizing. A recent survey I posted to twitter revealed the following findings:
I think the data from this small poll reveal that while there is a bias towards NG feeds, there is no universal approach (as with many things in NICU).
Conceptually, units that are using transpyloric feeds would do so bas
Inhaled nitric oxide has been around for some time now. I recall it being called at one point in medical school “endothelial relaxation factor” and then later on identified as nitric oxide. Many years later it finds itself in common usage in NICUs all over the world. Our experience though has been for treatment of pulmonary hypertension and for that it is pretty clear that for those afflicted by that condition it can be lifesaving. Over the years other uses have been looked at including preventi
The new buzz word in health care is “innovation”. Which is a good thing!
I have been in the ecosystem of innovation since 2016 with the startup company Neobiomics and the ProPrems® product, in the Innovation Incubator at Karolinska Institutet (KI DRIVE). There we meet with other startup companies, and we share several of the challenges of operating in the interface between innovation and “traditional” health care.
Here's a few thoughts.
Innovation can only benefit patients throug
The Ortolani and Barlow manouvers are probably the two most requested parts of the physical exam that students ask to be shown. We line up several medical students who take turns applying the steps of abduction and then adduction, testing the stability of the hips. We routinely give oral sucrose, position in kangaroo care or breastfeed while performing other noxious stimuli such as heel lancing but at least in my centre give nothing for manipulating the hips in such a fashion.
How can we
After watching a documentary in ARTE about bacteriophages it made me think about how else is antibiotic resistance in NICU.? It available french / German
Here the story phages was told. First discovered use by Felix Derrel to combat infections in the pre-antibiotics era and was later discredited and forget about in the western world
Historically they worked rather well, so there is an attempt to bring them back in the light of increasing antibiotics resistance.
This rediscovery s
It’s been some time since I last posted here. Many things have changed in my life since then- the most important transition being my decision to move to Finland to work as a research fellow with the Baby-friendly Ventilation Study Group in Turku. The life of a beginning clinical researcher deserves a separate post here (it may even come at some point). To celebrate my first anniversary in Finland I would like to share 3 things I wish somebody had told me before I moved here. Enjoy!
Preterm 32 wks born by NVD. No H/O leaking PV or fever in mother. TLC on day1 was 48000, on day 2 was 62000, on day 5 was 35000. Had about 75% neutrophils, normal platelets, 5% metamyelocytes. Started on Cefotaxime and Amikacin on day 1. LP done on day 4 of life showed cell count of 600, all lymphocytes, protein of 187, sugat of 63mg% ( Pre LP RBS 92 mg%). Would you think of starting Acyclovir or treat as bacterial meningitis. CSF HSV PCR later came out to be negative. LP repeated on day 7 of li
Oral immune therapy (OIT) has really taken off at least in our units. The notion here is that provision of small amounts (0.2 mL intrabucally q2or 24 hours) can prime the immune system. Lymphoid tissue present in the oropharynx and intestine exposed to this liquid gold in theory will give the immune system a boost and increase levels of IgA. Such rises in IgA could help improve the mucosal defence barrier and therefore lessen the incidence of late onset sepsis. Rodriguez et al described this in
This September I had the opportunity to go to BAPM-EBNEO to kept Learning a out Neonatology and hopefully network with the EBNEO, so glad I see lots of you face to face. This kept motivated to finish my PhD as I re-embark in find a new supervisor _only 1.5 yrs to go. I was real hard to let of the clinician in me as , this is my comfort zone. As a budding academic learn I get explore ideas and ways to implement them as bioethicists , as well finding ways to humanize the NIcU via processes. Last
Neurally adjusted ventilatory assistance or NAVA is something that has been around for awhile. Available as a mode on the Maquet ventilator it uses an esophageal probe to sense myoelectrical activity in the diaphragm and provide assistance with postive pressure when detected. This is supposed to be better than the more traditional Graseby capsules or sensing based on airflow. Conceptually then if a preterm infant had a typical mixed apneic event with a component of both central and obstructive a
Glucose metabolism in the newborn can be a tricky thing to manage. Neonates can have significant fluctuation in their serum glucose in the first few days of life which can lead heels to look like pin cushions. How many times have you been asked as a physician if there is anything we can do to reduce the number of pokes? That something may have arrived at least in a feasibility study that could pave the way for this becoming the standard approach to hypo/hyperglycemia in the newborn. This is an i
The story around cord management after birth continues to be an evolving one. I have certainly posted my own thoughts on this before with my most recent post being Delayed cord clamping may get replaced. Time for physiological based cord clamping. While this piece demonstrated that there are benefits to longer times till clamping is done, it also showed that if you go too long hypothermia becomes a real risk and with it possible complications. At least in our centre the standard that we have tri
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
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.
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.
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
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