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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

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

Jelli KA

Jelli KA

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

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

AllThingsNeonatal

AllThingsNeonatal

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

AllThingsNeonatal

AllThingsNeonatal

🎶🎹 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

AllThingsNeonatal

AllThingsNeonatal

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

AllThingsNeonatal

AllThingsNeonatal

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

AllThingsNeonatal

AllThingsNeonatal

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

AllThingsNeonatal

AllThingsNeonatal

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

AllThingsNeonatal

AllThingsNeonatal

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

AllThingsNeonatal

AllThingsNeonatal

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

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 :)

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

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

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