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Greetings from the 99nicu HQs

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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

Stefan Johansson

As I wrote in a previous blog post, I am involved in a very exciting, sort of a medical underground project, about providing GMP-produced probiotics for preterm infants.

The non-profit company Neobiomics will provide a probiotics product in early 2018, fulfilling specific needs for preterm infants. Non-profit refers to that any potential revenue is re-invested in next generation products or leads to a price reduction. The idea is to have a self-propelling business, without commercial interests.

Due to rigorous quality standards (GMP + "Infant grade") and small production batch size we estimate a price of 3 euros per stickpack, i.e. the monthly cost will be around 90 euros/infant. Given larger batches (more people use the product), we expect the price to drop in the future.  

To make the final internal decision on setting up the production line and produce the first batch, we need to gather information on potential use of this product.

If you are interested to use the Neobiomics Probiotics product, “from the community – to the community”, please respond to a few upcoming questions that you find on this URL: https://www.surveymonkey.com/r/neobiomics

It takes about 1-2 minutes to respond.

Stefan Johansson

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

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

I would like to open a secret box of mine :)

Like many others, I have been trying to get hold on a probiotics product for the preterm infants I care for. For years.

I discussed the lack of a suitable probiotics product with Philipp Novak, founder of the orphan drug start-up company Orphanix, and together we set out on a mission - to provide a probiotics product specifically designed for preterm infants. In a non-profit business model, "from the community - to the community"

Since early 2016, we have been working with this project, framed within Neobiomics AB, our non-profit company registered in Sweden.

Thanks to our supportive CSR partners, we have reached the final stages of the project. The product will go into production according to GMP and in an FDA-approved facility during Q4-2017.

Stay tuned...!



Stefan Johansson

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

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

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).

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.

My point is not that EBM should replace the humanistic side of medicine. I believe that our caring for patients, from a humanistic perspective, operates on another scale than the issues of accuracy and efficacy of diagnostics and therapies. And, unless we learn to question those latter domains of medicine, we will be lurking around in the same muddy waters as during the 19th century, even if we are committed, empathic etc. In other words, we can still be good doctors and treat patients well, and at the same time develop our skills to offer patients things that work. And, those most educated patients, they are probably most easy to convince that "doing everything" is sometimes a waste of their time and resources.

Stefan Johansson


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

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

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

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

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...

  1. Chance cause variation (results can be due to chance)
  2. No measurement is exact (as we didn't know)
  3. Bias is rife (it certainly is)
  4. Bigger is usually better for sample size (yes!)
  5. Correlation does not imply causation (we all know this, but we tend to forget that)
  6. Regression to the mean can mislead (it does)
  7. Extrapolating beyond the data is risky (and set patients at risk)
  8. Beware the base-rate fallacy (it is hard to diagnose uncommon conditions)
  9. Controls are important (or rather, they are essential, and it is essential to select controls right)
  10. Randomization avoids bias (or at least reduces bias)
  11. Seek replication, not pseudoreplication (research needs to replicated)
  12. Scientists are human (and therefore im-perfect)
  13. Significance is significant (but confidence intervals are more important than p-values)
  14. Separate no effect from non-significance (abscence of evidence is not evidence of abscence)
  15. 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)
  16. Study relevance limits generalizations (i.e. don't generalize findings among 33-weekers to 23-weekers)
  17. 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)
  18. Dependencies change the risks (some factors or events are related, in additive or multiplicative ways)
  19. Data can be dredged or cherry picked (see #12)
  20. Extreme measurements may mislead (and usually do not have a single cause)
Stefan Johansson

Back in the early Internet days, Portals with link collections were hot and big business. Today, we use search engines and "google" whatever we need to know. And, we have learned the URLs to the sites we use most often by heart.


But, there are still a some really good web based resources that is worth to be promoted and high-lighted. That's my idea with a series of posts with "Links to like"


First out is neonatalresearch.org, a professional and yet personal blog by professor Keith J. Barrington, neonatologist and clinical researcher in Canada.


Keith J. Barrington is writing about and commenting neonatal research. By subscribing to his new posts* on the or following the blog on Twitter, you will feel up-to-date and enlightened.


Link to like... http://neonatalresearch.org :)


*how to subscribe: visit the web site and submit your email address in the "subscribe" widget in the left sidebar


Stefan Johansson

Although there are still things to polish on 99nicu.org, I am relieved that the web site is back on-line again.


With time, the technology became out-dated and we came to a point where we had to do something to vitalize and update 99nicu.


I am certain that the new software we use for 99nicu will improve your experience.

However, as content is king, the vitality of 99nicu will rely on activity by all members making up this community.


Our move to a more solid ground, technology-wise, will be followed by other initiatives too. For example, we plan some educational activities, new EBNEO conferences, and new collaborations with other professional partners.

For a bright future of 99nicu, we also need look into a models for funding of maintenance and development.


That's all for now :)


Stefan Johansson

Take a moment and visit www.neoknowledge.org, a freshly new web site with neonatology content.

On of the 99nicu members, associate professor Gautham Suresh, working at Dartmouth Hitchcock Medical Center in Lebanon/NH, USA, started this e-resource. It has only been online for a few months but already contains lots of useful information.

The web site is principally a portal. One of the great features it the collection of educational videos. The video clip on endotracheal intubation of newborns is among others very useful for doctors in training.


We wish the best of luck with this project!


Stefan Johansson

I write this while waiting at the Istanbul airport, on my way home to Stockholm.

Still full of impressions from the 2nd EBNEO conference that ended earlier today.


The conference was originally planned to be held in Cairo, Egypt, but in the last minute we took the decision to change to a venue in Istanbul. We worried about that the current social and political instability in Egypt could interfere with the conference. Although such a risk was probably very small I think most speakers and delegates had understanding for our precautions.


The venue for 2nd EBNEO was the Gonan Hotel in Istanbul, a very nice hotel close to the Ataturk international airport.


During 2.5 intense days, we could hear in lectures covering a wide range of topics. Naturally, the focus of the conference was evidence-based clinical care of newborn infants, but we also learned more about the basic science of preterm brain damage and got new insights the fetal-neoantal transition. Importantly, we also heard about follow-up care and long-term outcomes of high-risk infants. As we put so much efforts and resources after delivery, we have an equally strong obligation to put efforts and resources in follow-up care.


The 2nd EBNEO conference was not broadcasted on the web as the 1st conference (still available here), but we did our best to live-tweet the most important content. Take a look at the @ebneo twitter feed!


Before I finish (and board the plane to Stockholm) I would like to, on behalf of the EBNEO Founding Board, to thank:



  • Hesham Abdel-Hady and Abdel-Rahman El-Mashad, for being President and Secretary General for the 2nd EBNEO conference
  • ICC, the conference agency, for all practical work and not the least for taking a great financial responsibility for all arrangements
  • all speakers and all delegates for coming and for sharing expertise, comments and questions



The EBNEO project will now travel across the Atlantic. Professor Haresh Kirpalani will be the president for the 3rd EBNEO conference, and it will be held in Sept 2015 in Philadelphia/USA. I am already confident that the 3rd EBNEO will be as succesful as this conference in Istanbul.


Subscribe to get future updates about the details of the 3rd EBNEO conference!


Stefan Johansson

I am on the way to the 2nd EBNEO conference, waiting in the airport to board. :D

As you probably know, the 2nd EBNEO conference was scheduled in Cairo/Egypt. Due to current circumstances, the conference was moved in the last minute to Istanbul/Turkey.

I am very glad and grateful towards the conference president Hesham Abdel-Hady (aka hehady here at 99nicu). It is really a major achievement to make EBNEO happen a 2nd time!

There will be no webcast this time, but you will be able to follow the symposias on Twitter

@pubneo or @EbNeo or the hash-tag #ebneo2013

PS. BTW, the 3rd EBNEO is taking form too. Unless we meet in Istanbul over the next coming days, let's hope that we meet 14-15 September 2015 in.... Philadelphia/USA.

Stefan Johansson

I have a week off clinical duties for research. After the weather forecast yesterday, I brought my laptop and dataset home, as I realized it could be difficult to get to work.

So, now I sit here analysing the effect of maternal BMI on infant health (more to be read in journals near you in 2013...), with a great snow storm outside our house.

It's winter, and a very good one :)!

Almost as good as the exciting odds ratios coming up on my laptop screen!


Stefan Johansson

@24weekers started to follow our twitter account @99nicu - which draw my attention to "24weekers" - a film project by the journalist/film producer Alan Entwistle who became the father of a baby born at 24 weeks gestation. A film that "affirms the value of life".

The project seeks crowd-sourced funding through Kickstarter (here!).

Moved by the trailer, I really hope that enough people will contribute. This movie would be important document, for the public, for health care professionals, for politicians and not the least for the many-many thousands of those who became parents far too early to the tiny ones, cared for in NICUs around the world.

Click here to read more about what Alan Entwistle and his team want to achieve.

Stefan Johansson


Sweden is a good country for parents and when it comes to becoming a father, I think our society is becoming more and more "inclusive".

Illustrated by the welcoming photo outside the maternity ward, an infant - with the father in the background.

In our Karolinska NICUs we are "rooming-in" parents in family rooms, where the baby is taken care of by the parents as much as possible.

We promote the presence of both parents. When only one parent is staying over, it is not uncommon that the father is the one doing that.

Still, we, i.e. fathers in Sweden, have more to work on, before we can say that we equally share all family commitments and responsibilities for our children.


Stefan Johansson

I am just reading the yet unofficial and near-final programme for the 2nd EBNEO-conference, scheduled 13-16 March 2013 in Egypt.

Topics will (probably) include:

  • Mode of delivery and morbidity in the preterm infant?

  • Developing a cheap surfactant for the third world – planning stages of a large RCT
  • Survival without disability to age 5 years after neonatal caffeine therapy for apnea of prematurity
  • Resuscitation of the preterm infant
  • Implementation of evidence based neonatology - the EPICE project
  • Economic outcomes of prematurity
  • Follow up of high-risk infants

Stay tuned :)

the conference web site (where you can also register): www.ebneo2013.com