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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

AllThingsNeonatal

AllThingsNeonatal

 

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

AllThingsNeonatal

AllThingsNeonatal

Survive and thrive - the WHO take on transforming care for every small and sick newborn

Survive and thrive - the WHO take on transforming care for every small and sick newborn

I would just like to share a new document by the World Health Organization, WHO. In a report that come out the other week, WHO present its key findings from an upcoming publication "Survive and thrive: transforming care for every small and sick newborn." While we commonly think about neonatal care and preterm infants in high-resource settings, there is really a lot of public health work to be done when it comes to improve neonatal care in low-/mid-resource contexts. In fact, the world

Stefan Johansson

Stefan Johansson

Great thesis on telomeres, immune development and oxidative stress in preterm infants. And a funny card :)

Great thesis on telomeres, immune development and oxidative stress in preterm infants. And a funny card :)

My colleague Ewa Henckel defended her thesis at Karolinska Institutet on "Cellular consequences of preterm birth : telomere biology, immune development and oxidative stress" last week, including four projects on  telomere length, inflammation and lung function viral respiratory infections and cellular aging  immune system development and environmental exposures hyperoxia-induced lung damage and the capacity to counter-act surfactant inactivation with a novel antioxidan

Stefan Johansson

Stefan Johansson

 

Does size really matter when weaning from an incubator?

Look around an NICU and you will see many infants living in incubators. All will eventually graduate to a bassinet or crib but the question always is when should that happen? The decision is usually left to nursing but I find myself often asking if a baby can be taken out. My motivation is fairly simple. Parents can more easily see and interact with their baby when they are out of the incubator. Removing the sense of “don’t touch” that exists for babies in the incubators might have the psycholog

AllThingsNeonatal

AllThingsNeonatal

 

Every drop counts

As a Neonatologist, there is no question that I am supportive of breast milk for preterm infants.  When I first meet a family I ask the question “are you planning on breastfeeding” and know that other members of our team do the same.  Before I get into the rest of this post, I realize that while breast milk may be optimal for these infants there are mother’s who can’t or won’t for a variety of reasons produce enough breast milk for their infants.  Fortunately in Manitoba and many other places in

AllThingsNeonatal

AllThingsNeonatal

 

Delayed cord clamping may get replaced. Time for physiological-based cord clamping?

Much has been written on the topic of cord clamping.  There is delayed cord clamping of course but institutions differ on the recommended duration.  Thirty seconds, one minute or two or even sometimes three have been advocated for but in the end do we really know what is right?  Then there is also the possibility of cord milking which has gained variable traction over the years.  A recent review was published here. Take the Guessing Out of the Picture?

AllThingsNeonatal

AllThingsNeonatal

 

Using the printed word to treat apnea of prematurity

As the saying goes, sometimes less is more.  In recent years there has been a move towards this in NICUs as the benefits of family centred care have been shown time and time again.  Hi tech and new pharmaceutical products continue to develop but getting back to the basics of skin to skin care for many hours and presence of families as an integral team member have become promoted for their benefits.  The fetus is a captive audience and hears the mother's heart beat and voice after the development

AllThingsNeonatal

AllThingsNeonatal

99nicu – a Forum with a Future

99nicu – a Forum with a Future

Since the October issue of Neonatology Today, I and @Francesco Cardona will alternate in writing a column where we will share bits and pieces from the 99nicu community, mixed with more general reflections. This column is the start of a extended partnership between 99nicu and Neonatology Today.  In case you don't know, Neonatology Today is a peer-reviewed monthly newsletter that is available free of charge, and has a mission to provide timely news and information the care of newborns and the

Stefan Johansson

Stefan Johansson

 

Don’t let the cord gas fool you

It has to be one of the most common questions you will hear uttered in the NICU.  What were the cord gases?  You have a sick infant in front of you and because we are human and like everything to fit into a nicely packaged box we feel a sense of relief when we are told the cord gases are indeed poor.  The congruence fits with our expectation and that makes us feel as if we understand how this baby in front of us looks the way they do. Take the following case though and think about how yo

AllThingsNeonatal

AllThingsNeonatal

First 13 confirmed speakers at our Meetup 2019!

First 13 confirmed speakers at our Meetup 2019!

We now have 13 confirmed speakers for the Copenhagen Meetup 7-10 April next year! Generally, we'll stick to the successful format we have had at the previous meetings: 45 min slots split into a 30 min lecture and a 15 min discussion. We'll continue to use the sli.do smartphone app to facilitate the discussion and allow every delegate to share questions and comments. In addition to the lecture program 7-9 April, we are also planning workhops and mini-symposia on the 10th of April. We'll

Stefan Johansson

Stefan Johansson

First five confirmed speaker at the 2019 Meetup!

First five confirmed speaker at the 2019 Meetup!

I just want to share some brief news about our next Meetup, 7-10 April 2019 at Rigshospitalet in Copenhagen/Denmark. We (i.e myself, @Francesco Cardona @RasmusR @Christian Heiring , Gorm Greisen and Morten Breindahl) are currently working on the program lectures and workshops. I just want to share the first five confirmed speakers and their topics: Morten Breindahl: Neonatal transports – how to do them safe and easy Ola Andersson: Cord Clamping, 1.0 and 2.0 Ravi Pat

Stefan Johansson

Stefan Johansson

 

The days of the Apgar score may be numbered

One of the first things a student of any discipline caring for newborns is how to calculate the apgar score at birth.  Over 60 years ago Virginia Apgar created this score as a means of giving care providers a consistent snapshot of what an infant was like in the first minute then fifth and if needed 10, 15 and so on if resuscitation was ongoing.  For sure it has served a useful purpose as an apgar score of 0 and 0 gives one cause for real worry.  What about a baby with an apgar of 3 and 7 or 4 a

AllThingsNeonatal

AllThingsNeonatal

 

1st Solo Speaker Conference ,Noisy le Grand France

Excited for my first speaker oportunity to a peds audience.We a small group of about 20 I did expect a litlle more. The good Things and not so good that needed improving here. The conference wad set to be the first consist of primary care topics & community health. The second was solid peads with a special section of neonatology talks in the afternoon. The was also a poster competition in the mix. Lets start with the good I really enjoyed the networking oportunity over a nice healt

Jelli KA

Jelli KA

We have become >7000!

We have become >7000!

I just realized that the 99nicu community has grown to >7000 members. An amazing number for an independent grass-rotish project, that aims to create a virtual space for neonatal staff around the world. Naturally, there are members that registered more than 10 years ago who have completely forgotten about 99nicu. But still, we know that our newsletter is recieved by ~6200 members. Regardless of the exact number,  we have engaged a lot of people over the years, who have been conn

Stefan Johansson

Stefan Johansson

 

This Vitamin Could Save A Babies Life

It has been a few months now that I have been serving as Chair of the Fetus and Newborn Committee for the Canadian Pediatric Society. Certain statements that we release resonate strongly with me and the one just released this week is certainly one of them. Guidelines for vitamin K prophylaxis in newborns is an important statement about a condition that thankfully so few people ever experience.  To read the statement on the CPS website click here. Similar story to vaccinations Pri

AllThingsNeonatal

AllThingsNeonatal

Kotiloma means "vacation at home"

Kotiloma means "vacation at home"

July was very eventful for me and that had caused my on-line silence. I had a chance to visit again my beloved Finland and now I'm back with fresh thoughts and ideas (and also hundreds of photos). Enjoy! Kotiloma is a word in Finnish that means „vacation at home”. But in some NICUs around Finland it has grown into a bit different meaning. Kotiloma is a practice of arranging a little vacation at home for NICU patients before their final discharge.  The routine is quite simple. On the ko

cathfriday

cathfriday

 

Intubating to give surfactant is so 2017!

A catchy title for sure and also an exaggeration as I don’t see us abandoning the endotracheal tube just yet.  There has been a lot of talk about less invasive means of giving surfactant and the last few years have seen several papers relating to giving surfactant via a catheter placed in the trachea (MIST or LISA techniques as examples).  There may be a new kid on the block so to speak and that is aerosolized surfactant.  This has been talked about for some time as well but the challenge had be

AllThingsNeonatal

AllThingsNeonatal

 

Can video laryngoscopes reduce risk of harm from intubation?

The modern NICU is one that is full of patients on CPAP these days. As I have mentioned before, the opportunity to intubate is therefore becoming more and more rare is non-invasive pressure support becomes the mainstay of therapy. Even for those with established skills in placing an endotracheal tube, the number of times one gets to do this per year is certainly becoming fewer and fewer. Coming to the rescue is the promise of easier intubations by being able to visualize an airway on a screen us

AllThingsNeonatal

AllThingsNeonatal

 

Was adding placement of EKG leads to NRP a good idea after all?

It is hard to believe but it has been almost 3 years since I wrote a piece entitled A 200 year old invention that remains king of all tech in newborn resuscitation. In the post I shared a recent story of a situation in which the EKG leads told a different story that what our ears and fingers would want us to believe. The concept of the piece was that in the setting of pulseless electrical activity (where there is electrical conductance in the myocardium but lack of contraction leaves no blood fl

AllThingsNeonatal

AllThingsNeonatal

 

⏰Alarms in the NICU🔕

Alarms in NICU are part of the environment  and with more advanced model appear to be more present.  As one walks through the unit one is going off, creating annoyance to staff.Thus, raising the issue have reached a 'fatigue alarm'. Among I and some of the NICU professionals in my twitter Community belief. An article by Belteki and Morley give some answers. COPYRIGHTED THE Child &Fetal Archives Here the link below : https://bmj.altmetric.com/details/28352250

Jelli KA

Jelli KA

 

Is paralysis for intubation really needed?

A few weeks back I wrote about the topic of intubations and whether premedication is really needed (Still performing awake intubations in newborns? Maybe this will change your mind.) I was clear in my belief that it is and offered reasons why. There is another group of practitioners though that generally agree that premedication is beneficial but have a different question. Many believe that analgesia or sedation is needed but question the need for paralysis. The usual argument is that if the int

AllThingsNeonatal

AllThingsNeonatal

 

Hospital or Home Based Therapy For Neonatal Abstinence?

This post is very timely as the CPS Fetus and Newborn committee has just released a new practice point: Managing infants born to mothers who have used opioids during pregnancy Have a look at discharge considerations as that section in the statement speaks to this topic as well! As bed pressures mount seemingly everywhere and “patient flow” becomes the catch-word of the day, wouldn’t it be nice to manage NAS patients in their homes?  In many centres, such patients if hospi

AllThingsNeonatal

AllThingsNeonatal

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