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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

Is this for real?!

I would consider myself fairly open minded when it comes to care in the NICU.  I wouldn’t call myself a maverick or careless but I certainly am open to new techniques or technologies that may offer a better level of care for the babies in our unit.  When it comes to “non-Western” concepts though such as therapeutic touch, chiropractic manipulations of infants and acupuncture (needle or otherwise) I have generally been a skeptic.  I have written about such topics before with the most popular post

AllThingsNeonatal

AllThingsNeonatal

How reliable are capillary refill and blood pressure in determination of hemodynamic compromise?

When I think back to my early days as a medical student, one of the first lessons on the physical exam involves checking central and peripheral perfusion as part of the cardiac exam.  In the newborn to assess the hemodynamic status I have often taught that while the blood pressure is a nice number to have it is important to remember that it is a number that is the product of two important factors; resistance and flow.  It is possible then that a newborn with a low blood pressure could have good

AllThingsNeonatal

AllThingsNeonatal

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

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