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About this blog

the unofficial 99nicu blog! Thoughts, ideas and opinions piling up while working in the 99nicu HQs

Entries in this blog

First 13 confirmed speakers at our Meetup 2019!

We now have 13 confirmed speakers for the Copenhagen Meetup 7-10 April next year! Generally, we'll stick to the successful format we have had at the previous meetings: 45 min slots split into a 30 min lecture and a 15 min discussion. We'll continue to use the sli.do smartphone app to facilitate the discussion and allow every delegate to share questions and comments. In addition to the lecture program 7-9 April, we are also planning workhops and mini-symposia on the 10th of April. We'll share more info about those soonish, but if you want ONE cliff-hanger... we plan one symposium about the infant microbiome etc-etc   Confirmed topics and speakers Neonatal transports - safe and easy, Morten Breindahl (Sweden) Treating pain in neonates, Karel Allegaert (Belgium) How to improve quality on the NICU, Joseph Kaempf (US) Hyperglycemia - how to manage and why, Kathryn Beardsal (UK) Why we should rehearse simulated scenarios, Ruth Gottstein (UK) Go with the (high) flow, Brett Manley (Australia) News in the updated ESPGHAN guidelines, Nadja Haiden ( Austria) Prevention of BPD, Christian Poets (Germany) The many inotropes - what to use when, Yogen Singh (UK) Cord Clamping, 1.0 and 2.0, Ola Andersson (Sweden) When NEC rates persist , despite everything done “Right”, Ravi Patel (US) Outcomes in infants surviving at the limit of viability, Ulrika Ådén (Sweden) Ethical decision making around the limit of viability, Gorm Greisen (Denmark)

Stefan Johansson

Stefan Johansson

First five confirmed speaker at the 2019 Meetup!

I just want to share some brief news about our next Meetup, 7-10 April 2019 at Rigshospitalet in Copenhagen/Denmark. We (i.e myself, @Francesco Cardona @RasmusR @Christian Heiring , Gorm Greisen and Morten Breindahl) are currently working on the program lectures and workshops. I just want to share the first five confirmed speakers and their topics: Morten Breindahl: Neonatal transports – how to do them safe and easy Ola Andersson: Cord Clamping, 1.0 and 2.0 Ravi Patel: How to explain when NEC rates persist – even when a NICU does everything “Right” Ulrika Ådén: Infants surviving at the limit of viability, what are the outcomes? What shall we do? Gorm Greisen: Ethical decision making around the limit of viability- lessons from Scandinavia I'll update you all with more names and topics as they are confirmed Looking forward to meet up in Copenhagen!

Stefan Johansson

Stefan Johansson

We have become >7000!

I just realized that the 99nicu community has grown to >7000 members. An amazing number for an independent grass-rotish project, that aims to create a virtual space for neonatal staff around the world. Naturally, there are members that registered more than 10 years ago who have completely forgotten about 99nicu. But still, we know that our newsletter is recieved by ~6200 members. Regardless of the exact number,  we have engaged a lot of people over the years, who have been connecting and sharing questions and expertise. And, in my dreams, I see 99nicu reaching its real potential. Let's hope that dream will come true.  

Stefan Johansson

Stefan Johansson

Big Thinking at the Dept of Brilliant Ideas

We are on important missions in the NICU. From time to time, we all sense the strong rewarding feeling that our work mattered a lot. I love the hands-on work in the NICU, but I also believe strongly in pursuing work at the meta-level of things. That we can change care and improve outcomes through research, quality improvement, and taking our professionalism outside the box. And to the web! Naturally, the 99nicu “global village” is one of those meta-level journeys for me. I have shared small bits of information previously about a new project with a really big scope. Together with an EU-based group, I started Neobiomics, an academic startup project that will provide a super-high quality bifidobacterial product requested by neonatologists, “from the community, to the community”. The composition of the product is based on this RCT. Launch is planned in Europe mid-2019, and outside Europe during 2020. Although the product itself is much requested, I personally think that this project has a much wider potential. With access to a highly advanced machinery (literally!) at the production facility, it should be possible to make other compositions (other sets of bacteria, other bacterial numbers, +/- other compounds etc) for some really cool comparative trials. Manufacturing quality is key, but as important in this project is the not-for-profit business models. Naturally, we need to create something sustainable, but taking a perspective of social entrepreneurship enables the largest possible outreach. We are still working mainly behind the scenes in the Neobiomics HQs, but relatively soon, we will step on stage and start creating buzz As part of our communication strategy, we are now collecting Testimonials from neonatologists believing in bringing this product "from the community, to the community". If you share the basic idea behind this project, please consider to click here and share a Testimonial for publication on neobiomics.org And… stay tuned   PS. The project above has nothing and everything to do with the talk below. Creativity is the Power to Act.  

the Global Village(-s) of Neonatology

I must admit that it is a bit exciting to think about that 99nicu.org went live 12 years ago, at a time when Facebook and other “social media” web sites was yet to be invented. (@Zuckerberg, no offense here. Obviously, you created something far greater than 99nicu, still a grass rot project. BTW – could we apply for funding from you Foundation?) When starting 99nicu.org in 2006, we nourished an idea that experiences and expertise should not be hindered by geographical boundaries. In some sense, this was a statement, that we as medical professionals could help each other through other channels than journals and conferences, with inclusive and open mindsets, and new technologies. Back then we knew little about the powerful potential of the Internet. Neither could we foresee how the Internet would change our private and professional lives. We were just a group of young staff in Sweden, wanting to create a web based platform for discussions within a global group of neonatal pro’s. When I read this blog post by @AllThingsNeonatal (on his web site allthingsneonatal.com) where he reflects on how sharing and caring in social media has created a global village, I am struck by the thought - a global village was what we envisioned back in 2006. Coming from a small village myself, I think that also 99nicu.org parallells the village symbolism: a setting with small communication gaps (everyone knows everything about everyone, so we don't need formalities to get in touch and speak out), and where giving and taking advice is a bilateral process that may ultimately lead to “the best solution”. Or simply, that we find out that there are several good solutions for a given problem. Has 99nicu become as global village for neonatal staff on the Internet? Although biased, I’d say YES . Data also supports that. During January through April,  the web site had 18.000 visitors from all over the globe, making 45.200 pageviews. From the Google Analytics dashboard we can all see that 99nicu reaches almost every corner of the world! Our principal idea has always been that the virtual space is where we operate. It is the Internet that creates the possibility to connect and exchange experience as expertise from where we are. However, meeting up IRL is also a powerful way to maintain sustainable networks and that idea is the driving force behind the “99nicu Meetups”. For the 1st and 2nd Meetup conferences in Stockholm and Vienna (in June 2017 and in April 2018), delegates came from 17 and 33 countries, respectively. Let’s hope we can have even a larger geographical representation at our IRL Meetup next year. Stay tuned for dates and location
 

The World will come to Vienna!

As you know, our conference the Future of Neonatal care in Vienna is approaching! When we went through the registrations yesterday, it struck us that delegates will come from all corners of the world. There are already delegates coming from 21 countries! Just to visualize, we marked the countries on the map below. It will be great to meet up with all of you coming! And, although we will represent many different context, I also believe it is a very good example of how a great diversity of people are sharing common questions and problems. My personal reflection is that not only infants are similar around the globe, neonatal staff also share a passion of doing great things for the tiny ones. And yes, we still have vacant chairs in the lecture hall. Be mostly welcome to register for the meeting, regardless if you already have colleagues from your country attending  
 

EBNEO lectures on Youtube!

The Society for Evidence-Based Neonatology (EBNEO) had its 4th International Conference in Hyderabad, India, last November. Although being baised, as the chairman of EBNEO, the conference was a huge success, thanks to that the EBNEO was held in association with Indian Association of Pediatrics Neonatology Chapter. Without the IAP/NEOCON committee led by Dr Srinivas Murki, we would not have managed to set this conference up, that counted many hundreds of national delegates from all regions of India. A set of lectures by Barbara Schmidt, Ashok Deorari, Sourabh Dutta, Courtney Wusthoff, Roger Soll and many others, are now available on Youtube.  You can also view my lecture on Fetal Programming Enjoy!  
 

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 singer. Mother Tongue is a beautifully strong and moving record about parenthood complicated by a preterm delivery, about experiencing a cesarean section far too early ("...this is a riot of blood and steel/bending me open, violently..."), and how a tiny infant still could "weigh more than...the universe, to me". The lyrics, as I interpret, is also about parenthood in a deeper sense. The music itself is so delicate and precise, and yet powerful at the same time. This is a record we should listen to. Get it on CD. Or on vinyl if you still play such records, like I do . And bring it to your next staff meeting. And of course, Mother Tongue is also available on Spotify.

Stefan Johansson

Stefan Johansson

 

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 more equal. The photos are nothing but fantastic! See some below and visit Bävmans web site to see them all here. I touched upon this topic long ago, in a short blog post here in 2012, that "it's not all about motherhood in the maternity wards and NICUs". Our family-centered neonatal care includes all parents, i.e. expect the father to be as present and care-giving as the mother. For myself, being a "Swedish Dad", I never considered NOT taking parental leave when we had our children. When our son was born in 1996, it was more easy as I was a pediatric fellow. But even in 2011 when our daughter was born, going off work during ~6 months was a natural thing to do for me despite being a consultant neonatologist. We work such a lot during our life-time, and we don't have too much ice-cream with our little ones (but it's great when we do )   I am well aware that many countries have less generous systems for parental leave (especially regarding the amount of time funded but welfare systems). But, I strongly recommend all father to take leave with children, and manage the household while the mother is going back to work. It is an investment for life. Have a look at the video about the photo project below and enjoy some of the photos, embedded with permission from Johan Bävman. If you visit Stockholm later this year, the "Swedish Dads" exhibition comes to Galleri Kontrast in Stockholm (30/9 - 29/10).  

Stefan Johansson

Stefan Johansson

 

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 neonatal medicine based on observational data, many of which suffer from major limitations as researchers did not really grasp some basic concepts how to handle their data... In the first video, there is one mistake though - the illustration of confounding is not entirely correct, instead the video illustrates mediation which is different thing. Small mistake though, as the error in the video is rather that the arrow is flipped 180 degrees. See and find out what I mean   The second video is about Big Data, a coming major thing in neonatal research as we get access and collect more and more data. The video is about genetic data, but the same principal idea ("so much data you don't know how to handle it") applies to health register data, and the richness of data that could be tanked down from from our monitors, ventilators etc. Enjoy!    

Stefan Johansson

Stefan Johansson

 

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 we had from delegates, we are committed to continue with this IRL forum for the 99nicu members. Stay tuned for information about the next Meetup, preliminary scheduled for April 2018 in Vienna. Almost all lectures were videorecorded and they will be added over the summer on the Meetup page here: https://99nicu.org/meetup2017/ 
Right now you can see David Sweet lecturing about RDS management and Rebeccah Slater lecturing about pain in preterm infants. The only downside was the financial results, not yet definite but estimated to be a loss of ~5000 USD. Despite "the pain to open the purse" and our original plan to raise funds for IT work for this web site, I believe we shall regard this first meeting as an investment for future Meetups. We will also be trying to crowd-fund to cover some of the deficit. Those who value the videos as a learning experience are able to make a small donation. That was all my reflections for now. Until we meet in Vienna, see you here on 99nicu.org        

Stefan Johansson

Stefan Johansson

 

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

 

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

 

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 Meetup would be a more crowd-sourced event, and much much cheaper, like #FOAMed but IRL. In addition to one or two high-profiled keynote speakers, the program would include lectures by attending delegates, who volunteer to give talks on a subject they suggest themselves. I have heard so many great lectures by fellows and young consultants and believe we should get a fantastic program with a great variety of topics. However, as you know there is no free lunches, a small fee to cover lunches  would still be needed. But without any real budget work, I think a full three day CME-accredited meeting should be possible to run for ~150 euros/USD. Delegates contributing with a lecture should of course be coming free of charge. And naturally, all delegates would need to cover and arrange their own travels and accommodation. Just some thoughts from the 99nicu HQs! Please share feedback below.

Stefan Johansson

Stefan Johansson

 

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, please drop me a PM or an email. PS. The video is cropped... go to here https://www.periscope.tv/w/1ynJOWYbnaWJR to view it with the full width

Stefan Johansson

Stefan Johansson

 

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 in a place that will allow great interactivity! What about our plans to make a web cast of the meeting... well, we plan to use some service like Periscope. Or some other DYI solution. Simple, free! See you in Stockholm!  

Stefan Johansson

Stefan Johansson

 

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 number of seats and to cover the costs for the venue, lunches, speakers' travels etc-etc, we need to charge this fee as the general cost level is this high in Sweden. Further, 99nicu is still a project based on volontary work and without funds (and viable business model, but that's another story...). In other words, we have none backing our budget in case of a deficit, and are pressed to go break-even financially. The better news are though that we plan to video-record all lectures and will make those available through 99nicu.org. Given funding, of course!

Stefan Johansson

Stefan Johansson

 

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

 

Evidence-Based Neonatology

I am waiting to board the flight from Stockholm to Philadelphia, to attend the 3rd Evidence-Based Neonatology (EBNEO) conference. Although being biased (as part of the organizing committee), I think the meeting will be great! You can follow the meeting on www.ebneo.org, on the hashtag #ebneo2015 And, I think the EBNEO Society, the principal organizer of the conference, has an important mission: to increase the knowledge about evidence-based neonatology, and how to apply its principals in neonatal medicine. That also includes understanding of the pitfalls, that "evidence" is not binary, and that we can and need to do much more research and development to further improve care. I recently wrote a column about diagnostic testing in the Swedish Medical Journal (Swe. Läkartidningen).
http://lakartidningen.se/Opinion/Reflexion/2015/09/Simtur-i-diagnostikens-djupa-vatten/#comments I got a comment in English implying that EBM is in conflict with the old-school notion of being a good doctor. That is not the case, def not in neonatal medicine where the caring for babies and families, from a humanistic point of view is central in our daily practise.

Stefan Johansson

Stefan Johansson

 

99nicu - around the world

As Internet is everywhere (sort of), 99nicu.org has become a truly global network!   From Google analytics we could see that people browsing 99nicu the past month (May 9 - June 8) comes from all over the world.   The final goal for our outreach is Greenland and countries in Central Africa.

Stefan Johansson

Stefan Johansson

 

Link to like: Evidence Updates

I know - many of us want less emails... But the emails from Evidence Updates are great! Evidence Updates (a collaboration project by the BMJ Group and McMaster University) assists your reading of new research by grading articles by "Relevance" and "News-worthiness". For example, this trial on D-vitamin supplementation of preterm infants showed up in an email alert, an article I had missed otherwise.   1. You need to Register (here!) 2. Choose your clinical interest ("Pediatric Neonatology", I guess) 3. Set a minimum score for new articles you want to read about (set a higher minimum score to get fewer emails ) 4. Watch your inbox!   Link to like: Evidence Updates.

Stefan Johansson

Stefan Johansson

 

Link to like: Newborn's photo gallery

If you need to show images of common and less common physical findings, the "Link to like" is the photo gallery compiled by MD Janelle Aby, at the Stanford School of medicine. Perfect for teaching of students and fresh fellows.   I used it myself today when we discussed nose deviations of the newborn, and I could illustrate differences between a nose septal dislocation and the much more common septum deviation due to the fetus having the nose "stuck" in the uterine wall.   The photo gallery is "semi-closed": you will be asked to submit your email address to view images, and then await the email with an URL that gives you a 24h access to the photos.   Link to like: Photo gallery, Newborn nursery @ LPCH / Stanford

Stefan Johansson

Stefan Johansson

 

Happy holidays!

I just want to say Happy Holidays to everyone, on behalf of the whole 99nicu Team! We don't share any New Year's promises for 2014, but there are exciting news in the pipeline. Besides polishing corners off the new software, we have plans for at least one educational activity...   Sincere thanks to everyone contributing with questions, expertise and experience in the forums!   Best wishes for the New Year!

Stefan Johansson

Stefan Johansson

 

Link to like: mrineonatalbrain.com

Next in the series "Link to like" is a fantastic web resource by Mary A Rutherford, a pediatric neurologist with 20 years of experience of MRI. She has made her book "MRI of the neonatal brain" available as a free e-book on the web. Sometimes there is a free lunch Link to like: www.mrineonatalbrain.com

Stefan Johansson

Stefan Johansson

 

Tips To Interpret Scientific Claims

Do we not read and talk about research findings more often than we critically discuss methods that led to the findings we discuss? Trained in clinical epidemiology, I often believe we should discuss methods more, especially before we move into processes of changing clinical protocols on treatments and diagnostic methods. EBM! Nature published a very nice article about how to interpret research claims. The idea was rather to aim the article towards non-scientists but I think their advice is worth to high-light for a medical audience. ( and read the article in full text here) The 20 tips are... Chance cause variation (results can be due to chance)
No measurement is exact (as we didn't know)
Bias is rife (it certainly is)
Bigger is usually better for sample size (yes!)
Correlation does not imply causation (we all know this, but we tend to forget that)
Regression to the mean can mislead (it does)
Extrapolating beyond the data is risky (and set patients at risk)
Beware the base-rate fallacy (it is hard to diagnose uncommon conditions)
Controls are important (or rather, they are essential, and it is essential to select controls right)
Randomization avoids bias (or at least reduces bias)
Seek replication, not pseudoreplication (research needs to replicated)
Scientists are human (and therefore im-perfect)
Significance is significant (but confidence intervals are more important than p-values)
Separate no effect from non-significance (abscence of evidence is not evidence of abscence)
Effect size matters (but remember that effects tend to decrease with study size, i.e. the world is not as good as it seems to be in small trials)
Study relevance limits generalizations (i.e. don't generalize findings among 33-weekers to 23-weekers)
Feelings influence risk perception (and that's why we tend to be more afraid in a plane than in a car, despite the higher death risk to drive)
Dependencies change the risks (some factors or events are related, in additive or multiplicative ways)
Data can be dredged or cherry picked (see #12)
Extreme measurements may mislead (and usually do not have a single cause)

Stefan Johansson

Stefan Johansson

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