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About this blog
I am a Neonatologist trained in Winnipeg, Manitoba and Edmonton, Alberta. My current position is Section Head of Neonatology in Manitoba and over my career my interests have meandered from time to time. I have been a past Program Director of Neonatology and Medical Director for a level II Intensive Care Unit prior to relocating to Winnipeg become a Section Head.
Welcome to my blog which I hope will provide a forum for discussion on topics that are of interest to Neonatologists, trainees, all health care professionals and in some cases parents of those we care for. My intent is to post opinions and analysis on both items from the media and literature that pertain to neonates. While I have many interests, my particular motivation is to find ways to reduce discomfort for the patients that we care for. Whether it is through the use of non-invasive testing or finding a way to improve the patient experience this is where I find myself most energized.
I chose the picture for this site as since the inception of this site there is hardly a country that has not had an individual or many people view posts. Moreover I have received comments from many people from so many different countries that have inspired me to think not just about the impact of these posts in North America but more globally as well.
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Entries in this blog
Could a digital stethoscope revolutionize resuscitation of the newborn?
Is it time to (ESC)ape from Neonatal Abstinence
Should 24 hour Neonatologist In-House Coverage Be The Rule ?
Early Hydrocortisone: Short term gain without long term pain.
Why does ETT epinephrine get such a bad rap?
A Leap Forward in the Treatment of HIE?
Rethinking how teams hand over. A better way
NEC & Anemia: Is the truth out there?
A Golden Opportunity For Your NICU Team!
Donor Milk; Falling like DOMINOs?
in terms of the latter outcome no difference was observed between the two groups. The Bayley III findings were quite similar at 18 months which on the surface may cause everyone’s shoulders to sag as the benefit everyone hoped for did not transpire. Additionally, linear growth, head circumference and weight gain were not different between groups. This may simply reflect that protein and caloric intakes were indeed matched between groups whereas in the past, the lack of protein fortification led to delays in growth in the donor milk groups. At the risk of sounding like the end of a Cochrane review I am not sure this is the final word on donor milk and outcome. Larger studies may be needed to get at the real truth. This was not a pure sample of donor milk vs formula as a significant percentage (over 20% in both groups) received purely mother’s own milk. Furthermore, in those that received supplements there was still a significant percentage that received some of mother’s own milk. The authors suggest that a larger sample size would unlikely have detected a difference and that may be the case but is it so due to where the study was done. What if the study were done in a centre with a very low rate of breastfeeding? I am concerned that the lack of response in outcome may reflect a dilution of the impact of the strategy by having such a successful rate of providing mother’s own milk. All Is Not Lost Using a glass is half full view, I think it is worth pointing out that this study should also provide some comfort for those centres that use formula as a supplement. Clearly the higher rate of NEC is not comforting to anyone but for those who survive to discharge the neurodevelopmental outcome is promising. Formula in some circles has taken on a view as almost a toxic substance but I often remind residents and fellows that while we prefer breast milk, formula has been used in NICUs for decades and not every patient who receives it will develop NEC. Yes it is a risk factor for NEC and when you don’t have an alternative it is an acceptable form of nutrition to use. What I think may be lost in the DOMINO study is that if you are a centre that uses formula as there is no access to DBM this should help provide reassurance to the families you care for. All is not lost after the DOMINO study. Every cloud has a silver lining and fear not this will not be the last study to test this hypothesis. At the moment it is just the best we have and this is not the last we will hear on this topic.