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Blogs

 

99nicu Meetup and the Periscope test run

For the 99nicu Meetup, not only the venue but also the budget is down-sized  So, there won't be funding for the kind of web cast we originally planned.  Instead we plan to use Periscope, the live streaming service that (I think) is a Twitter-owned service. It seems from the Periscope test run below, that the image quality from using a smartphone is not superb (despite having the latest model!) but if you plan coming to the 99nicu Meetup and are experienced with Periscope Producer, plea

Stefan Johansson

Stefan Johansson

 

A Golden Opportunity For Your NICU Team!

I have written about respectful communication before in Kill them with kindness. The importance of collaborating in a respectful manner cannot be overemphasized, as a calm and well prepared team can handle just about anything thrown their way.  This past week I finally had the opportunity to take the 7th ed NRP instructor course.  What struck me most about the new version of the course was not the approach to the actual resuscitation but the preparation that was emphasized before you ev

AllThingsNeonatal

AllThingsNeonatal

 

99nicu Meetup, the same great program in a down-sized venue

Maybe we were a bit too optimistic about the 99nicu Meetup, when we booked a big and fancy venue However, we will not be 200 people on the meeting, or at least, we cannot take the risk NOT becoming 200 people. While you will still be able to book accommodation at the Clarion Hotel, we will run the conference in a smaller aula for 80 people at "my hospital". The aula (i.e. our hospital) is within 1200 meter walking distance from Clarion Hotel. So, in short, the same great program i

Stefan Johansson

Stefan Johansson

 

Donor Milk; Falling like DOMINOs?

The rise of donor milk banks and depots in recent years has been a welcome addition to the care of preterm infants.  We have known for many years that “breast is best” and advocate for mother’s own milk whenever possible.  When this is not possible we previously turned to formula but with the availability of pooled pasteurized donor milk many hospitals have focused on expanding the indications for use.  Through personal communications in Canada we are a bit all over the map in terms of indicatio

AllThingsNeonatal

AllThingsNeonatal

 

The Rugged Individualist Neonatal Blogger

Rather excited this week as Biomed Central picked up a blog post that I wrote on social media.  The post is found here.  It is based though on a larger version that I have included below and really delves into the impact of social media and how one uses it.  A big thank you to Kristy Wittmeier for all of her help in writing the post. Original Piece I read with great interest the article by Campbell et al entitled Social media use by physicians: a qualitative study of the new fron

AllThingsNeonatal

AllThingsNeonatal

 

Healthy at risk infants failing the infant car seat challenge. Cause for concern?

The infant car seat challenge(ICSC) is a test which most definitely fits the definition of a battleground issue in Neonatology.  After publishing the Canadian Pediatric Practice point on the same topic I received interesting feedback through the various social media forums that I frequent.  While some were celebrating the consensus of the statement as verification that a centres’ non practice of the test was acceptable, others seriously questioned the validity of the position.  The naysayers wou

AllThingsNeonatal

AllThingsNeonatal

 

The New BPD That Matters

As a Neonatologist I doubt there are many topics discussed over coffee more than BPD.  It is our metric by which we tend to judge our performance as a team and centre possibly more than any other.  This shouldn't be that surprising.  The dawn of Neonatology was exemplified by the development of ventilators capable of allowing those with RDS to have a chance at survival.  As John F Kennedy discovered when his son Patrick was born at 34 weeks, without such technology available there just wasn't mu

AllThingsNeonatal

AllThingsNeonatal

 

Premature labour changes a mother's brain, and her baby's

In this rather weird, but interesting study from Italy, 10 mothers of preterm babies (less than 32 weeks or less than 1500 grams) without ultrasound brain injury or severe retinopathy, and 11 mothers of full term babies were shown photos of their own baby or photos of an unknown baby (from one of the other mothers) while they had their head in an MRI magnet. (Montirosso R, et al. Greater brain response to emotional expressions of their own children in mothers of preterm infants: an fMRI study. J

kbarrington

kbarrington

 

New Publication: Does fluid restriction improve the clinical status of babies with BPD?

I have never been convinced that fluid restriction is a good thing for kids with BPD. I think the common practice came about because of the short-term improvements in lung function that sometimes follow if you start diuretics. The idea being that if diuretics improve lung function, then giving less fluid will also. But this is a false equivalency, diuretics cause sodium depletion, and therefore decrease total body water, and probably lung water content also. Fluid restriction in contrast le

kbarrington

kbarrington

 

Has permissive hypercapnia failed to deliver?

Positive pressure ventilation puts infants at risk of developing chronic lung disease (CLD). Chronic lung disease in turn has been linked many times over, as a risk for long term impacts on development.  So if one could reduce the amount of positive pressure breaths administered to a neonate over the course of their hospital stay, that should reduce the risk of CLD and by extension developmental impairment.  At least that is the theory.  Around the start of my career in Neonatology one publicati

AllThingsNeonatal

AllThingsNeonatal

 

You don’t plan to fail. You fail to plan

I am fortunate to work with a group of inter-professionals who strive for perfection.  When you connect such people with those with skills in multimedia you create the opportunity for education.  I can’t say enough about the power of education and moreover the ability to improve patient outcomes when it is done well. With this post I am going to be starting to share a collection of videos that I will release from time to time.  The hope with any release like this is that you the reader w

AllThingsNeonatal

AllThingsNeonatal

 

Just how safe is feeding while on CPAP?

This is becoming “all the rage” as they say.  I first heard about the strategy of feeding while on CPAP from colleagues in Calgary.  They had created the SINC (Safe Individualized Feeding Competence) program to provide an approach to safely introducing feeding to those who were still requiring CPAP.  As news of this approach spread a great deal of excitement ensued as one can only imagine that in these days when attainment of oral feeding is a common reason for delaying discharge, could getting

AllThingsNeonatal

AllThingsNeonatal

 

Why the 99nicu Meetup is priced at ~630 USD, and how we aim to release it for free

As you may have noticed, we have opened the registration for the 99nicu Meetup 12-15 June. I hope many of you will be able to come! Click here for more infor! We got some feedback from a member in an African country about the fee for the meeting, which is 5600 SEK (excl VAT) corresponding to ~630 USD, and whether we had plans to add a differentiated lower fee for members coming from middle- and low-income countries. I really wished we could offer a reduced fee but to with a limited num

Stefan Johansson

Stefan Johansson

 

The Hidden Pathogen Of Late Onset Sepsis

If you work in the NICU then you have seen your fair share of septic workups for late onset sepsis.  Sepsis is such a common diagnosis that if I had to guess I would say that at least 50% of all discharge summaries would include this in a list of final diagnoses for any VLBW infant.  If you were to look through the chart though you would find that while workups are common, the recovery of a pathogenic bacterium is not as much.  This is in part due to the low threshold that many people have for d

AllThingsNeonatal

AllThingsNeonatal

 

Too Small To Extubate?

This is something that I continue to hear from time to time even in 2016 and I imagine I will continue to hear rumblings about this in 2017.  Certainly, there are physical limitations when a baby is born at less than 500g.  Have you tried fitting a mask to deliver NIPPV or CPAP to a baby this small?  I have and it didn’t work.  The mask was simply too big to provide a seal and while I am all for INSURE and emerging minimally invasive surfactant techniques they still require transitioning to a fo

AllThingsNeonatal

AllThingsNeonatal

 

First registrations filed to the Meetup in June

As planned before the end of 2016, we have completed the program for the 99nicu Meetup in June 2017. You can find the program on this page, where we will also post the registration link around the 20th of January 2017. However, we have already the first two members registered who wanted to spend remains of educational funds for 2016   I look forward very much to this meeting, the program is great and it will be a joy to meet you IRL!

Stefan Johansson

Stefan Johansson

 

What do body builders and preemies have in common?

A strange title perhaps but not when you consider that both are in much need of increasing muscle mass.  Muscle takes protein to build and a global market exists in the adult world to achieve this goal.  For the preterm infant human milk fortifiers provide added protein and when the amounts remain suboptimal there are either powdered or liquid protein fortifiers that can be added to the strategy to achieve growth.  When it comes to the preterm infant we rely on nutritional science to guide us. H

AllThingsNeonatal

AllThingsNeonatal

 

Mother’s milk and BPD; Every Drop Counts

Producing milk for your newborn and perhaps even more so when you have had a very preterm infant with all the added stress is not easy.  The benefits of human milk have been documented many times over for preterm infants.  In a cochrane review from 2014 use of donor human milk instead of formula was associated with a reduction in necrotizing enterocolitis.  More recently similar reductions have been seen in retinopathy of prematurity. Interestingly with respect to the latter it would appear that

AllThingsNeonatal

AllThingsNeonatal

 

Parents,What Are You Worried About?

Throughout my career one thing has been consistently true.  That is that wherever I was working and regardless of the role I have been an educator.  I imagine the blog to a great extent is related to my interest in this aspect of my work.  In the last few years much has been said about care by parents whether it be a general approach for family centred care or in formalized approaches such as FiCare which has also been formally studied in the research setting.  When we speak of family centred ca

AllThingsNeonatal

AllThingsNeonatal

 

Towards better and safer intubation

We are the victims of our own success.  Over the last decade, the approach to respiratory support of the newborn with respiratory distress has tiled heavily towards non-invasive support with CPAP.  In our own units when we look at our year over year rates of ventilation hours they are decreasing and those for CPAP dramatically increasing.  Make no mistake about it, this is a good thing.  Seeming to overlap this trend is a large increase in demand by learners as we see the numbers of residents, s

AllThingsNeonatal

AllThingsNeonatal

 

Neonatal Sepsis after Chorioamnionitis, what to do about healthy appearing newborns

In 2007, when I was chair of the CPS Fetus and Newborn Committee, we published a guideline regarding the approach to term and late preterm infants with perinatal risk factors for sepsis. Obviously any infant with clinical signs consistent with sepsis needs immediate work up and antibiotics, but the management of infants with risk factors for sepsis and no clinical signs evident was the focus of that guideline. This is what we said about chorioamnionitis, based on what we thought was the mos

kbarrington

kbarrington

 

Teaching clinicians to evaluate encephalopathy

I hope this link stays active for ever as it is a great resource... Courtney Wusthoff from Stanford has developed a web-based educational tool, designed initially, I think, for medical (pediatric) residents. Their team has evaluated whether or not this works by showing pediatric residents videos of actual examinations of asphyxiated newborn infants, and asking them to identify whether the babies were normal or had encephalopathy that was either mild moderate or severe. They repeated the process

kbarrington

kbarrington

 

Maternal complications of extremely preterm delivery

When there is a threatened delivery in the periviable period, one of the decisions that have to be made is about the mode of delivery. In my opinion (IMHO, I think those young'uns say) we should consider the different parts of the decision-making to be linked but separate. A decision to give antenatal steroids, for example, does not mandate a cesarean delivery or intensive care of the baby. A decision to not perform a cesarean does not mean that fetal heart rate monitoring should not be performe

kbarrington

kbarrington

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