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Hydrocortisone after birth may benefit the smallest preemies the most!

This must be one of my favourite topics as I have been following the story of early hydrocortisone to reduce BPD for quite some time. It becomes even more enticing when I have met the authors of the studies previously  and can see how passionate they are about the possibilities. The PREMILOC study was covered on my site twice now, with the first post being A Shocking Change in Position. Postnatal steroids for ALL microprems? and the second reviewing the 22 month outcome afterwards /2017/05/07/ea

AllThingsNeonatal

AllThingsNeonatal

Can’t intubate to give surfactant? Maybe try this!

Intubation is not an easy skill to maintain with the declining opportunities that exist as we move more and more to supporting neonates with CPAP.  In the tertiary centres this is true and even more so in rural centres or non academic sites where the number of deliveries are lower and the number of infants born before 37 weeks gestational age even smaller.  If you are a practitioner working in such a centre you may relate to the following scenario.  A woman comes in unexpectedly at 33 weeks gest

AllThingsNeonatal

AllThingsNeonatal

An Old Drug Finds A New Home In The Treatment of BPD.

What is old is new again as the saying goes.  I continue to hope that at some point in my lifetime a “cure” will be found for BPD and is likely to centre around preventing the disease from occurring.  Will it be the artificial placenta that will allow this feat to be accomplished or something else?  Until that day we unfortunately are stuck with having to treat the condition once it is developing and hope that we can minimize the damage.  When one thinks of treating BPD we typically think of pos

AllThingsNeonatal

AllThingsNeonatal

Stubborn PDAs despite prophylactic indomethacin!

As time goes by, I find myself gravitating to reviews of Canadian research more and more.  We have a lot of great research happening in this country of ours and especially when I see an author or two I know personally I find it compelling to review such papers.  Today is one of those days as the lead author for a paper is my colleague Dr. Louis here in Winnipeg.  Let me put his mind at ease in case he reads this by saying that what follows is not a skewering of the paper he just published using

AllThingsNeonatal

AllThingsNeonatal

Continuous glucose monitoring in NICU may be around the corner

We sure do poke a lot of babies to test their blood glucose levels.  Some of these babies don’t have so much blood to spare either so checking sugars multiple times a day can drain the body of that precious blood they so need for other functions.  Taking too much can always be addressed with a blood transfusion but that as I see it may be avoidable so shouldn’t we do what we can to cut down on blood work? Those with diabetes will be familiar with a continuous glucose monitor (CGM) which is impla

AllThingsNeonatal

AllThingsNeonatal

Resuscitating before 22 weeks. It’s happening.

Given that today is world prematurity day  it seems fitting to talk about prematurity at the absolute extreme of it. It has been some time since as a regional program we came to accept that we would offer resuscitation to preterm infants born as early as 23 weeks gestational age.  This is perhaps a little later in the game that other centers but it took time to digest the idea that the rate of intact survival was high enough to warrant a trial of resuscitation.  This of course is not a u

AllThingsNeonatal

AllThingsNeonatal

Delayed Cord Clamping for the Premature Infant?

The APTS (Australian placental transfusion study) trial has just appeared on line. This was a high-quality multicenter, international RCT of immediate cord clamping (less than 10 seconds) compared to delayed clamping (60 seconds) for babies born less than 32 weeks gestation. (Tarnow-Mordi W, et al. Delayed versus Immediate Cord Clamping in Preterm Infants. the FPNEJM 2017.) Another trial arriving almost simultaneously is a smaller trial from the UK, which compared cord clamping at less than

kbarrington

kbarrington

Guidelines to help parents who have lost one of twins

The group in Newcastle in the UK has studied parents who suffered the loss of a twin. This is an unfortunately common experience in the NICU, twins and higher order multiples are much more likely to be born prematurely (for triplets it is actually quite rare to be born at full term), and for one twin to die, while the other is still being cared for in the NICU, happens frequently. Richards J, et al. Mothers' perspectives on the perinatal loss of a co-twin: a qualitative study. BMC Pregnancy

kbarrington

kbarrington

In the Opioid Crisis is Burprenorphine The Answer?

It would seem that the Opioid crisis is continuing to be front and centre in the news.  Just today the President of the United States declared an Opioid Epidemic Emergency. Of course he was speaking primarily about the damage these drugs do on the family unit and those around them, the impact on the unborn child is significant as well.  If this sounds familiar it is because I have written about this topic recently and in the past in the posts A Magic Bullet to Reduce Duration of Treatment and Ho

AllThingsNeonatal

AllThingsNeonatal

Looking for a place to happen

This past week, Canada lost a rock icon in Gord Downie of the Tragically Hip.  My late high school, university and medical school days seem to have him and the band forever enmeshed in memories from that time.  In honour of his passing I thought it suitable to pay tribute to him by using one of the band’s famous song titles as the title for this post.  No this isn’t a post about the band but rather a controversial ventilation strategy.  While CPAP has been around for some time to support our inf

AllThingsNeonatal

AllThingsNeonatal

Can a chest x-ray predict the future?

If you work in Neonatology then chances are you have ordered or assisted with obtaining many chest x-rays in your time.  If you look at home many chest x-rays some of our patients get, especially the ones who are with us the longest it can be in the hundreds. I am happy to say the tide though is changing as we move more and more to using other imaging modalities such as ultrasound to replace some instances in which we would have ordered a chest x-ray.  This has been covered before on this site a

AllThingsNeonatal

AllThingsNeonatal

Automated control of FiO2; one step closer

It has been over two years since I have written on this subject and it continues to be something that I get excited about whenever a publication comes my way on the topic.  The last time I looked at this topic it was after the publication of a randomized trial comparing in which one arm was provided automated FiO2 adjustments while on ventilatory support and the other by manual change.  Automated adjustments of FiO2. Ready for prime time? In this post I concluded that the technology was promisin

AllThingsNeonatal

AllThingsNeonatal

Maybe we shouldn’t be in such a rush to stop caffeine.

Given that many preterm infants as they near term equivalent age are ready to go home it is common practice to discontinue caffeine sometime between 33-34 weeks PMA.  We do this as we try to time the readiness for discharge in terms of feeding, to the desire to see how infants fare off caffeine.  In general, most units I believe try to send babies home without caffeine so we do our best to judge the right timing in stopping this medication.  After a period of 5-7 days we generally declare the in

AllThingsNeonatal

AllThingsNeonatal

Mother Tongue by Rebekka Karijord - a record we all should listen to

Our every-day job is to meet parents and their preterm infants. We have our professionalism, skills and family-centered care strategies. But how do we understand the large gap those families need to bridge, and how parenthood evolves when a child arrives too early? For myself, music has always been important (even essential!) in my own reflections about wider scopes. When it comes to parenthood, I can strongly recommend the record Mother Tongue by Rebekka Karijord, a Norwegian composer and

Stefan Johansson

Stefan Johansson

A Magic Bullet to Reduce Duration of Treatment and Hospital Stays for Newborns With NAS

As someone with an interest in neonatal abstinence (NAS) I am surprised that I missed this study back in May.  Anyone who says they aren’t interested in NAS research must be turning a blind eye to the North American epidemic of patients filling neonatal units or postpartum wards in need of treatment for the same.  News feeds such as CNN have covered this story many times with concerning articles such as this published “Opioid Crisis Fast Facts” even the Trump White House has  officially declared

AllThingsNeonatal

AllThingsNeonatal

Is expired CO2 the key to making sustained inflation a standard in resuscitation?

We can always learn and we can always do better.  At least that is something that I believe in.  In our approach to resuscitating newborns one simple rule is clear.  Fluid must be replaced by air after birth and the way to oxygenate and remove CO2 is to establish a functional residual capacity.  The functional residual capacity is the volume of air left in the lung after a tidal volume of air is expelled in a spontaneously breathing infant and is shown in the figure. Traditionally, to establish

AllThingsNeonatal

AllThingsNeonatal

Swedish Dads FTW!

The photographer Johan Bävman is touring around the world with a photo exhibition about "Swedish Dads". The exhibition shows fathers on parental leave.  Swedish newspapers recently wrote about the reactions in Sydney, Australia (see exhibition before 26/9).  A (female) columnist in Sydney Morning Herald referred to the exhibition like "porn for stressed moms". I wouldn't agree on that headline but the column itself is interesting, and the reasoning about how the society could/should become

Stefan Johansson

Stefan Johansson

Is our approach to ventilation really harming babies?

A grenade was thrown this week with the publication of the Australian experience comparing three epochs of 1991-92, 1997 and 2005 in terms of long term respiratory outcomes. The paper was published in the prestigious New England Journal of Medicine; Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years. This journal alone gives “street cred” to any publication and it didn’t take long for other news agencies to notice such as Med Page Today. The claim of the paper is that t

AllThingsNeonatal

AllThingsNeonatal

Hesham Tawakol

3rd International Neonatal Multispecialty Conferecne Abu Dhabi 16th-18th November 2017 http://www.abudhabinms.com/ 3rd Abu Dhabi Neonatal Conference .pdf 3rd Abu Dhabi Neonatal Conference .pdf

htawakol

htawakol

Exclusive human milk diets in infants < 1250g as a rescue approach. The Winnipeg Experience

Exclusive human milk (EHM) diets using either mother’s own milk or donor milk plus a human based human milk fortifier have been the subject of many papers over the last few years. Such papers have demonstrated reductions is such outcomes as NEC, length of stay, days of TPN and number of times feedings are held due to feeding intolerance to name just a few outcomes. There is little argument that a diet for a human child composed of human milk makes a great deal of sense. Although we have come to

AllThingsNeonatal

AllThingsNeonatal

Life, and Medicine, with a Disability

I met the author of this article at a CPS meeting a few years ago, she immediately impressed me with her unique perspective. Paige is a developmental pediatrician who does long-term follow-up of preterms, and is involved in developmental evaluation and intervention of children with other challenges, including Spina Bifida. Church P. A personal perspective on disability: Between the words. JAMA Pediatrics. 2017. As you will see if you read the article, Paige has a form of Spina Bifida h

kbarrington

kbarrington

It’s possible! Resuscitation with volume ventilation after delivery.

I know how to bag a baby.  At least I think I do.  Providing PPV with a bag-valve mask is something that you are taught in NRP and is likely one of the first skills you learned in the NICU.  We are told to squeeze the bag at a rate of 40-60 breaths a minute.  According to the Laerdal website, the volume of the preterm silicone bag that we typically use is 240 mL.  Imagine then that you are wanting to ventilate a baby who is 1 kg.  How much should you compress the bag if you wish to delivery 5 mL

AllThingsNeonatal

AllThingsNeonatal

Science Showcase

I subscribe to the small Youtube channel Science Showcase curated by Andrew Maynard, a very enthusiastic researcher! Science Showcase collect video clips with scientific content aimed for a broader (public) audience. There is a contest going on and the best video will win 2000 USD. Just wanted share two interesting clips that are sort of relevant for neonatal staff. The first video is about epidemiology and its basic concepts. As you know, there are tons of clinical studies in neonata

Stefan Johansson

Stefan Johansson

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