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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.

If you like what you see and would like updates to be sent to you as they are published feel free to follow the site by clicking the follow button on the sidebar to the bottom right.  You can also follow both my Twitter (@NICU_Musings) and Facebook feeds for additional content and discussion by clicking the additional links found there.

My Facebook page serves as a better means of expanding dialogue on a variety of topics and posts

https://www.facebook.com/allthingsneonatal

Please share and like to help expand the circle of knowledge

Entries in this blog

 

Mother’s milk and BPD; Every Drop Counts

Producing milk for your newborn and perhaps even more so when you have had a very preterm infant with all the added stress is not easy.  The benefits of human milk have been documented many times over for preterm infants.  In a cochrane review from 2014 use of donor human milk instead of formula was associated with a reduction in necrotizing enterocolitis.  More recently similar reductions have been seen in retinopathy of prematurity. Interestingly with respect to the latter it would appear that

AllThingsNeonatal

AllThingsNeonatal

 

Parents,What Are You Worried About?

Throughout my career one thing has been consistently true.  That is that wherever I was working and regardless of the role I have been an educator.  I imagine the blog to a great extent is related to my interest in this aspect of my work.  In the last few years much has been said about care by parents whether it be a general approach for family centred care or in formalized approaches such as FiCare which has also been formally studied in the research setting.  When we speak of family centred ca

AllThingsNeonatal

AllThingsNeonatal

 

Towards better and safer intubation

We are the victims of our own success.  Over the last decade, the approach to respiratory support of the newborn with respiratory distress has tiled heavily towards non-invasive support with CPAP.  In our own units when we look at our year over year rates of ventilation hours they are decreasing and those for CPAP dramatically increasing.  Make no mistake about it, this is a good thing.  Seeming to overlap this trend is a large increase in demand by learners as we see the numbers of residents, s

AllThingsNeonatal

AllThingsNeonatal

 

Congratulations On The Birth Of Your Preterm Infant! Now Pay It Forward?

It’s World Prematurity Day today and if you are a parent or are caring for a baby who has just entered this world before 37 weeks GA you are now part of a membership that counts 15 million new babies each year according to the WHO’s data.  As I tell most new parents who have a baby admitted to our unit “It’s ok to take some time to adjust to this.  You didn’t plan on being here”.  That is true for most who go into spontaneous labour but of course those who are electively delivered due to materna

AllThingsNeonatal

AllThingsNeonatal

 

A Cure For Neonatal Hypoglycemia

I have probably received more requests for our glucose gel protocol than any other question since I started writing on this blog.  Dextrose gel has been used more and more often for treatment of hypoglycemia such that it is now a key strategy in the management of low blood sugar in ours and many other institutions.  If you are interested in the past analyses of the supporting trials they can be found in these posts; Glucose gel For Managing Hypoglycemia. Can We Afford Not To Use It? and Dextrose

AllThingsNeonatal

AllThingsNeonatal

 

Time To Give Antenatal Steroids After 34 weeks

In April of this year the ALPS trial results were published in the New England Journal of Medicine (Antenatal Betamethasone for Women at Risk for Late Preterm Delivery) and I took the time to review the paper at the time Antenatal Steroids After 34 weeks. Believe the hype?  In the analysis I focused on an issue which was relevant at the time, being a shortage of betamethasone.  In a situation when the drug of choice is in short supply I argued that while the benefits of giving steroid to women a

AllThingsNeonatal

AllThingsNeonatal

 

Nitric oxide & Congenital Diaphragmatic Hernia; not so safe after all?

As a young resident I have a vivid memory of a baby with CDH having saturations of 60 – 65% despite HFOV, paralysis and alkalinization (yes we used to do that).  It was at that time that I pretty much threw my hands in the air and declared there was really nothing left that we could do.  One of my mentors, a very wise Neonatologist Dr. Henrique Rigatto looked at me and said “why don’t we try inhaled nitric oxide?”  Being the resident immersed in the burgeoning field of evidence based medicine I

AllThingsNeonatal

AllThingsNeonatal

 

Free parking to increase parental visitation

This is a title that I hope caught your eye.  In the nearly twenty years I have been in the field of Pediatrics the topic of parking being a barrier to parental visitation has come up again and again.  A few years ago the concern about the cost of parking was so great that I was asked if I could find a pool of donors to purchase parking passes to offset the burden to the family.  The theory of course is based on the idea that if parking were free in the NICU parents would visit more.  If parents

AllThingsNeonatal

AllThingsNeonatal

 

Autopilot Non-Invasive Ventilation

I had a chance recently to drive a Tesla Model S with autopilot. Taking the car out on a fairly deserted road near my home I flicked the lever twice to activate the autopilot feature and put my hands behind my head while the vehicle took me where I wanted to go.  As I cruised down the road with the wheel automatically turning with the curves in the road and the car speeding up or slowing down based on traffic and speed limit notices I couldn’t help but think of how such technology could be appli

AllThingsNeonatal

AllThingsNeonatal

 

Stop guessing when the NICU team is needed at a delivery

The other day I met with some colleagues from Obstetrics and other members from Neonatology to look at a new way of configuring our delivery suites.  The question on the table was which deliveries which were always the domain of the high risk labour floor could be safely done in a lower acuity area.  From a delivery standpoint they would have all the tools they need but issues might arise from a resuscitation point of view if more advanced resuscitation was needed.  Would you have enough space f

AllThingsNeonatal

AllThingsNeonatal

 

Does High Flow Really Have A Place in the NICU At All?

This may sound familiar as I wrote about this topic in the last year but the previous post was restricted to infants who were under 1000g.  High Flow Nasal Cannula be careful out there had a main message that suggested the combined outcome of BPD or death was more prevalent when HFNC is used alone or with CPAP than when CPAP is used alone.  The question remains though whether this applies to larger infants.  Without looking at the evidence for that combined outcome most people would say there is

AllThingsNeonatal

AllThingsNeonatal

 

Informed Refusal at 22 weeks

While we draw the line at 22 5/7 weeks for offering active resuscitation where I work, what does one do when the family requests resuscitation prior to that point.  While I am a clear fan of social media, one consequence of having such widely available information at our fingertips is that families may already know before you come to speak with them that were they only to have been born in another place like Montreal, the cutoff would have been lower.  When faced with such demands what does one

AllThingsNeonatal

AllThingsNeonatal

 

Hold Their Hand

Each day the number of people following these sites grows and at the time of this post, the largest following on Facebook has over 8200 people who receive the feed on a daily basis.  That is nothing short of remarkable and I hope that each of you gets something out of my writings and postings. I recognise that each post may not “light it up” in your mind but if you get at least a few “a ha” moments along the way then I am very happy that you have found these sites! What This Is Not!

AllThingsNeonatal

AllThingsNeonatal

 

Could this be the perfect home apnea monitor?

A question that we are asked from time to time is whether a home apnea monitor should be purchased after discharge from the hospital.  The typical parent is one who has experienced the ups and downs of apnea of prematurity and is faced with the disturbing notion of coming off monitors and going home.  “What if he has an event at home and I don’t know”?  This leads to a search on the web for home monitors which finds numerous options to choose from.  This is where things get interesting from a No

AllThingsNeonatal

AllThingsNeonatal

 

Walk but don’t run to reduce apnea of prematurity

Now that I have caught your attention it is only fair that I explain what I mean by such an absurd title.  If you work with preterm infants, you have dealt with apnea of prematurity.  If you have, then you also have had to manage such infants who seemingly are resistant to everything other than being ventilated.  We have all seen them.  Due to increasing events someone gives a load of methylxanthine and then starts maintenance.  After a couple days a miniload is given and the dose increased with

AllThingsNeonatal

AllThingsNeonatal

 

Can Parental Administered Physiotherapy Lead to Better Outcome in Preemies?

Posted on August 10, 2016 by winnineo I don’t know about your place of work but our centre is busy and by busy I mean our resources and staff are almost always working at full capacity.  There is a shift afoot though in modern Neonatal care to shift some of the responsibility for care to the parents.  You might say it always should have been this way but as with any speciality we grow, learn and evolve over time. The most recent stage of evolution is the development of the F

AllThingsNeonatal

AllThingsNeonatal

 

The Art of Doing Nothing

There may be nothing that is harder in medicine.  We are trained to respond to changes in patients condition with a response that more often than not suggests a new treatment or change in management.  Sometimes the best thing for the patient is in fact to do nothing or at least resist a dramatic response to the issue in front of you.  This may be the most common issue facing the new trainee who is undoubtedly biased towards doing something.  Take for instance the situation in which the trainee w

AllThingsNeonatal

AllThingsNeonatal

 

When should blood be given prior to surgery?

A 28 week preterm infant now two weeks of age develops bilious emesis and abdominal distension.  An x-ray reveals an intestinal perforation and surgery is consulted. Arrangements are made to go to the operating room for a laparotomy and due to apnea and hypotension the baby is both intubated and placed on dopamine.  The resident on service ensures that blood is available in the operating room and an hour after presentation the baby is found to have a HgB of 102 g/L with a HcT of 35%. I d

AllThingsNeonatal

AllThingsNeonatal

 

IV Intermittent Flushing or Continuous Infusions. Which is better for longevity?

As with many things in Neonatology, changes in practice come and go.  Such is the case with how best to manage an IV.  During my career I have seen advocates for both continuous infusions and intermittent flushing.  Sometimes with heparin and at other times none.  The issue at hand is how best to preserve the precious IV.  Based on opinion only I would have said that having a continuous flow through a plastic catheter should help avoid clot formation and prolong the life of an IV but what is the

AllThingsNeonatal

AllThingsNeonatal

 

At the Edge of Viability Does Every Day Count?

Preterm infants born between 22 to 25 weeks gestational age has been a topic covered in this blog before. Winnipeg hospital now resuscitating all infants at 22 weeks! A media led case of broken telephone. Is anything other than “perfect practice” acceptable for resuscitating infants from 22 – 25 weeks? Winnipeg Hospital About to Start Resuscitating Infants at 23 weeks! I think it is safe to say that this topic stirs up emotions on both sides of the argument of how

AllThingsNeonatal

AllThingsNeonatal

 

No more intubating for meconium? Not quite.

After the recent CPS meeting I had a chance to meet with an Obstetrical colleague and old friend in Nova Scotia.  It is easy to get lost in the beauty of the surroundings which we did. Hard to think about Neonatology when visits to places like Peggy’s Cove are possible. Given out mutual interest though in newborns our our conversation eventually meandered along the subject of the new NRP.  What impact would the new recommendations with respect to meconium have on the requirements for providers a

AllThingsNeonatal

AllThingsNeonatal

 

A little cream may go a long way in reducing BPD

Breast milk has many benefits and seems to be in the health care news feeds almost daily.  As the evidence mounts for long term effects of the infant microbiome, more and more centres are insisting on providing human milk to their smallest infants.  Such provision significantly reduces the incidence of NEC, mortality and length of stay.  There is a trade-off though in that donor milk after processing loses some of it’s benefits in terms of nutritional density.  One such study demonstrated nutrit

AllThingsNeonatal

AllThingsNeonatal

 

Parental stress in the NICU; effect of parental presence on rounds.

To many of you the answer is a resounding yes in that it reduces stress.  Why is that though?  Is it because you have had a personal experience that has been favourable, it is the practice in your unit or it just seems to make sense?  It might come as a surprise to you who have followed this blog for some time that I would even ask the question but a social media friend of mine Stefan Johansson who runs 99NICU sent an article my way on this topic. Having participated in the FiCare study I realis

AllThingsNeonatal

AllThingsNeonatal

 

High Flow Nasal Cannula: Be Careful Out There

As the saying goes the devil is in the details.  For some years now many centres worldwide have been publishing trials pertaining to high flow nasal cannulae (HFNC) particularly as a weaning strategy for extubation.  The appeal is no doubt partly in the simplicity of the system and the perception that it is less invasive than CPAP.  Add to this that many centres have found less nasal breakdown with the implementation of HFNC as standard care and you can see where the popularity for this device h

AllThingsNeonatal

AllThingsNeonatal

 

Point of Care Ultrasound: Changing Practice For The Better in NICU

It has been some time since I wrote on the topic of point of care ultrasound (POC). The first post spoke to the benefits of reducing radiation exposure in the NICU but was truly theoretical and also was really at the start of our experience in the evolving area.  Here we are a year later and much has transpired. We purchased an ultrasound for the NICU in one of our level III units and now have two more on the way; one for our other level III and one for our level II unit.  The thrust of

AllThingsNeonatal

AllThingsNeonatal

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