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Blogs

 

Can Video Laryngoscopy Improve Trainee Success in Intubation?

Things aren’t the way they used to be.  When I was training, opportunities abounded for opportunities to intubate infants.  Then we did away with intubating vigourous infants born through meconium and now won’t be electively intubating them at all.  Then you can add in the move towards use of non-invasive respiratory support instead of intubating and giving surfactant and voila…you have the perfect barrier for training residents and others how to intubate.  On top of all of this the competition

AllThingsNeonatal

AllThingsNeonatal

 

99nicu Meetups - the previous one and the next one

First of all, my sincere thanks to everyone involved in the 99nicu Meetup, delegates for attending, speakers for giving great lectures, and partners for support! Despite a lower number of delegates than we had planned for (we did not pick the perfect dates for the Meetup...), I think we managed very well. We needed to downsize and slimline a lot, including changing the venue. But, content was king thanks to great lectures, and all interactions and networking. Given the great feedback

Stefan Johansson

Stefan Johansson

 

Scrub but don’t cap the hub to reduce infections in the NICU

I had the pleasure of meeting the author of a paper I am about to comment on this week while at the 99 NICU conference in Stockholm.  Dr. Ohlin from Orebro University in Sweden presented very interesting work on their unit’s “scrub the hub” campaign. As he pointed out, many places attempt to reduce coagulase negative staphylococcal infections by introducing central line bundles but seldom is there one thing that is changed in a bundle that allows for a before and after comparison like his team w

AllThingsNeonatal

AllThingsNeonatal

 

Could a digital stethoscope revolutionize resuscitation of the newborn?

Look around you.  Technology is increasingly becoming pervasive in our everyday lives both at home and at work.  The promise of technology in the home is to make our lives easier.  Automating tasks such as when the lights turn on or what music plays while you eat dinner (all scripted) are offered by several competitors.  In the workplace, technology offers hopes of reducing medical error and thereby enhancing safety and accuracy of patient care.  The electronic health record while being a nuisan

AllThingsNeonatal

AllThingsNeonatal

 

24 hours to go...

There is now only 24 hours until until the 99nicu Meetup starts. The roll-up arrived in time Today, I and @Francesco Cardona are printing and packing delegate folders, preparing USB-sticks and getting snacks for the welcome reception tomorrow night.  We are very excited to meet some of you tomorrow IRL, it will be a great meeting! Now back to our work here in the HQ's!

Stefan Johansson

Stefan Johansson

 

Is it time to (ESC)ape from Neonatal Abstinence

I don’t envy our nurses who care for babies withdrawing from various opiates and other substances.  These assignments are definitely a challenge and require a great deal of patience and depending on the shrillness of an infant’s cry a good set of earplugs. Nonetheless we do our best with these infants to keep them calm and avoid as much stimulation as we can as we attempt to minimize the excitability of their nervous system. Over 40 years ago the Finnegan Neonatal Abstinence scoring syst

AllThingsNeonatal

AllThingsNeonatal

 

Busy HQ before the 99nicu Meetup next week

There's a lot going in at the 99nicu Headquarters right now, as we prepare for the 99nicu Meetup starting on Monday 12/6. USB-sticks and lanyards in preparation Really looking forward to the meeting. Depending on how things run, we may twitter semi-live, and we will also video-record as many lectures as our memory cards allow. It won't be pro-quality but good enough to view and learn. Ciao for now! Stefan

Stefan Johansson

Stefan Johansson

 

Should 24 hour Neonatologist In-House Coverage Be The Rule ?

I have often said that if this came to pass as a mandatory requirement that I would make an announcement shortly thereafter that I was moving on to another career.  I think people thought I was kidding but I can put in writing for all to see that I am serious!  The subject has been discussed for some time as I can recall such talks with colleagues both in my current position and in other centres. The gist of the argument for staying in-house is that continuity is improved over that period and ef

AllThingsNeonatal

AllThingsNeonatal

 

Early Hydrocortisone: Short term gain without long term pain.

Posted on May 7, 2017 by winnineo In our journey as Neonatologists and interdisciplinary teams we are forever seeking to rid or at least reduce the plague of BPD in the patients we care for.  The PREMILOC trial was a double-blind, multicenter, randomized, placebo-controlled trial designed to test just that concept by introducing a low dose of hydrocortisone within 24 hours of birth. They   enrolled infants born between 24 – 26+6 weeks of gestation  and assigned them to receive eithe

AllThingsNeonatal

AllThingsNeonatal

 

Thoughts on future Meetups

During final preparations for the 99nicu Meetup (yes, there are still empty seats, so you can still register ), we have discussed how to think out-of-the-box for future Meetups. Is it really the best idea for us to run by the classic conference format and setup? Given the experience for this years Meetup, maybe not. Especially since regular meetings are connected to larger financial risks, and 99nicu is still an project that runs on philanthropic fuels. One idea is that the 2018 Meetu

Stefan Johansson

Stefan Johansson

 

Why does ETT epinephrine get such a bad rap?

I think my first training in resuscitation began with the principles outlined in the NRP 3rd edition program.  As we have moved through subsequent editions with the current edition being number 7, I can’t help but think about how many changes have occurred over that time.  One such change has been the approach to using medications as part of a resuscitation.  Gone are such things as calcium gluconate, naloxone and sodium bicarbonate but something that has stood the test of time is epinephrine. 

AllThingsNeonatal

AllThingsNeonatal

 

Early low dose hydrocortisone seems to not affect medium term development; PREMILOC outcomes at 22 months.

The PREMILOC trial was a multi-center RCT of hydrocortisone, 0.5mg/kg twice per day for 7 days followed by 0.5 mg/kg per day for 3 days, given starting within 24 hours of age to infants of 24 to less than 28 weeks gestation. Neurological and developmental follow-up has just been published (Baud O, et al. Association between early low-dose hydrocortisone therapy in extremely preterm neonates and neurodevelopmental outcomes at 2 years of age. JAMA. 2017;317(13):1329-37.) There were 523 in

kbarrington

kbarrington

 

A Leap Forward in the Treatment of HIE?

The human body truly is a wondrous thing.  Molecules made from one organ, tissue or cell can have far reaching effects as the products take their journey throughout the body.   As a medical student I remember well the many lectures on the kidney.  How one organ could control elimination of waste, regulate salt and water metabolism, blood pressure and RBC counts was truly thought provoking.  At the turn of the century (last one and not 1999 – 2000) Medical school was about a year in length and as

AllThingsNeonatal

AllThingsNeonatal

 

Rethinking how teams hand over. A better way

This post rings in another new video to add to the series on the All Things Neonatal YouTube channel.  I hope that you have gotten something out of the ones posted so far and that this adds something further to your approach to neonatal care. The Golden Hour Revisited In the last post to the video selections the main thrust of the video was on the use of the Golden Hour approach to starting a baby on CPAP.  Having a standardized checklist based approach to providing care to high risk n

AllThingsNeonatal

AllThingsNeonatal

 

NEC & Anemia: Is the truth out there?

A debate broke out recently at one of our rounds when someone asked whether a recent case of NEC was possibly related to a transfusion that a baby received.  Much has been written about Transfusion Associated Necrotizing Enterocolitis (TANEC) with the pendulum swinging back and forth between it existing as a real entity or simply being an association that is not causative in the least.  Using one of my favourite sources, a retrospective analysis of the Canadian Neonatal Network database found no

AllThingsNeonatal

AllThingsNeonatal

 

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

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