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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

 

Just Text Me! Enhancing Communication With Families

When you mention electronic medical records to some physicians you get mixed responses.  Some love them and some…well not so much.  These tech heavy platforms promise to streamline workflows and reduce error with drop down menus, some degree of artificial intelligence in providing warnings when you stray too far from acceptable practice but for some who are not so tech savvy they are more of a pain.  I have to admit I am in the camp of believing they are a good thing for patient care as I work i

AllThingsNeonatal

AllThingsNeonatal

 

How many preterm infants can we safely care for at once?

We have been seemingly under siege over the last year or so by a relentless flow of preterm infants through our units in the city.  Peaks and valleys for patient census come and go for the most part but this almost unwavering tendency to be filled to the rafters so to speak is unusual.  Much has been said and will continue to be acknowledged that we are all doing incredible work, that we are dedicated and putting patients first but where is the breaking point?  When does fatigue lead to errors n

AllThingsNeonatal

AllThingsNeonatal

 

Is It Time To Use Sustained Lung Inflation In NRP?

As I was preparing to settle in tonight I received a question from a reader on my Linkedin page  in regards to the use of sustained inflation (SI) in our units.  We don't use it and I think the reasons behind it might be of interest to others.  The concept of SI is that by providing a high opening pressure of 20 - 30 cm H2O for anywhere from 5 to 15 seconds one may be able to open the "stiff" lung of a preterm infant with RDS and establish an adequate functional residual capacity.  Once the lung

AllThingsNeonatal

AllThingsNeonatal

 

What if we criminalized drug use in pregnancy?

I don't know if you missed it but I did until tonight.  We don't have this in Canada but there have been some US states that have been doing so for the past while.  You may find the following link very interesting that explains the positions of each state in regards to drug use in pregnancy. The intentions were good to protect the unborn child but the consequences to mother's who tested positive were of great concern. As this article from March 4th indicates the practice has been ongoing in

AllThingsNeonatal

AllThingsNeonatal

 

Detecting Congenital Heart Defects After Home Birth

As evidence mounts for the use of pulse-ox screening to detect congenital heart defects a few key points have arisen.  The evidence comes from many publications but one of the best which summarizes the body of evidence is the systematic review by  Thangaratinam S which included over 200000 asymptomatic newborns.  The key here is to note that as this is a screening test if there are symptoms of congenital heart disease one should be referring to a specialist to rule out a significant CHD rather t
 

Why do we keep treating reflux in preemies?

Choosing wisely is an initiative to “identify tests or procedures commonly used whose necessity should be questioned and discussed with patients. The goal of the campaign is to reduce waste in the health care system and avoid risks associated with unnecessary treatment.” The AAP Section on Perinatal Pediatrics puts the following forth as one of their recommendations. “Avoid routine use of anti-reflux medications for treatment of symptomatic gastroesophageal reflux disease (GERD) or for

AllThingsNeonatal

AllThingsNeonatal

 

Has the Magic Bullet to Prevent Kernicterus Been (Re)Discovered?

As the saying goes "What is old is new again" and that may be applicable here when talking about prevention of kernicterus.  In the 1990s there was a great interest in a class of drugs called mesoporphyrins in the management of hyperbilirubinemia.  The focus of treatment for many years had been elimination of bilirubin through the use of phototherapy but this shifted with the recognition that one could work on the other side of the equation.  That is to prevent the production of bilirubin in the

AllThingsNeonatal

AllThingsNeonatal

 

Skin-to-skin fad blamed for deaths of babies!

As the practice seems to be winning the world over you can imagine that a headline entitled, 'Skin-to-skin' fad blamed for deaths of babies would get some attention.  This article was sent to me by a colleague after being published last month on Yahoo news service.  The claim is based on the experience of a hospital in Perth that has seen some cases of neonatal suffocation after mothers who were performing skin to skin care fell asleep and rolled onto their newborn.  This "fad" they sa

AllThingsNeonatal

AllThingsNeonatal

 

Micropreemie Lives Matter

It seems the expression "(insert a group) lives matter" is present everywhere these days so I thought I would join in after a moving experience I had today.  For those of you who have been with the blog since the beginning you would have seen a number of posts that if you follow them in time, provide a glimpse into the transformation that Winnipeg has seen over the last year or so. Prior to that point, 24 weeks was a cutoff for resuscitation that had been in place for some time and after a

AllThingsNeonatal

AllThingsNeonatal

 

Believe it or not? Injections For ROP Causing Brain Damage.

The media loves a good story and when a medication that has been given to children may have a link to "brain damage" you better believe it will gain some traction. Ever since the first reports began emerging suggesting laser treatment for ROP may have an alternative in Avastin (bevicizumab) skeptics have abounded.  After the link was established between high vascular endothelial growth factor (VEGF) and ROP it was not long before the thought of using Bevicizumab to reduce abnormal vessel pr

AllThingsNeonatal

AllThingsNeonatal

 

Are Antibiotics Really Necessary For Meconium Aspiration Syndrome?

We live in a world at the moment where the public has become increasingly aware of the dangers of antibiotic overuse.  Parents are more than ever requesting no erythromycin for the eyes after birth, and even on occasion questioning the need for antibiotics after delivery for the infant with risk factors for sepsis.  The media has latched on to the debate as well by publishing the sensational articles about superbugs and medicine running out of the last lines of defence such as this article from

AllThingsNeonatal

AllThingsNeonatal

 

A Shocking Change in Position. Postnatal steroids for ALL microprems?

It seems like a sensational title I know but it may not be as far fetched as you may think. The pendulum certainly has swung from the days of liberal post natal dexamethasone use in the 1990s to the near banishment of them from the clinical armamentarium after Keith Barrington published an article entitled The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs in BMC Pediatrics in 2011. This article heralded in the steroid free epoch of t

AllThingsNeonatal

AllThingsNeonatal

 

Breastfeeding...who says it's not natural?!

I woke up this morning and as I do everyday, scanned the media outlets for news that would be of interest to you the reader.  Most of the time I am searching for items of interest that I hope will get people thinking about ways to improve care but once in awhile I come across something that elicits a strong emotional reaction and today was the day. CNN released the following article today entitled Are there unintended consequences to calling breast-feeding 'natural'? The premise o

AllThingsNeonatal

AllThingsNeonatal

 

Antenatal steroids may well benefit near term infants. Time for a global rethink?

What a hard topic to resist commenting on.  This was all over twitter and the general media this week after the New England Journal published the following paper; Antenatal Betamethasone for Women at Risk for Late Preterm Delivery.  The fact that it is the NEJM publishing such a paper in and of itself suggests this is a top notch study...or does it? In case the idea of giving antenatal steroids after 34 weeks sounds familiar it may be so as I wrote about the use of such an approach prior to

AllThingsNeonatal

AllThingsNeonatal

 

All Things Neonatal Anniversary Edition

It is hard to believe but All Things Neonatal is a year old.  When I started this little concept I had no idea what was to come but am delighted with where it has gone.  While the Blog site itself has about 200 followers, the Facebook page is home to nearly 4200 followers with twitter accounting for over 500 more.  What began as a forum for me to get some thoughts off my chest about neonatal topics or articles of interest has morphed into a place to create change.  As I look back over the last y

AllThingsNeonatal

AllThingsNeonatal

 

Building a better mask for positive pressure ventilation

Ask almost anyone who has worked in the field of Neonatology for some time and they will tell you that babies are not as sick as they once were. We can give a lot of credit to better antenatal steroid use, maternal nutrition and general management during pregnancy.  Additionally, after birth we now rush to place infants on CPAP and achieve adequate expansion of the lungs which in many cases staves off intubation. The downside to our success though is that the opportunities to provide positi

AllThingsNeonatal

AllThingsNeonatal

 

Non-sterile gloves to reduce NICU infections. Back to the Future?

I don't know about you but I have deeply rooted memories from the 1990s of donning a yellow gown and gloves before examining each and every patient on my list before rounds.  This was done as we firmly believed such precautions were needed to prevent the spread of infections in the NICU.  As time went on though the gowns were removed and not long after so went the gloves as priority was placed on performance of good hand hygiene to reduce rates of infection in our units. You can imagine tha

AllThingsNeonatal

AllThingsNeonatal

 

The Eyes Have It. No Not Really

Every now and then I come across an instance when I discover that something that I have known for some time truly is not as well appreciated as I might think. Twice in my career I have come across the following situation which has been generalized to eliminate any specific details about a patient.  In essence this is a fictional story but the conclusions are quite real. Case of the Flat Baby A mother arrives at the hospital with severe abdominal pain and in short order is diagnose

AllThingsNeonatal

AllThingsNeonatal

 

Is there really a place for standard phototherapy in the NICU anymore?

I have been mulling over this piece for some time.  In my own practice I have long questioned the role for standard phototherapy (the equivalent of a single light source) vs intensive phototherapy (delivering >30 microwatts/cm2/nm and usually two light sources) when treating jaundice for all patients. I have bolded that last part to emphasize that I am not just talking about newborns with severe hyperbilirubinemia but rather all infants with treatable jaundice based on local treatment curves

AllThingsNeonatal

AllThingsNeonatal

 

Is Cannabis To Blame For The Rise In Rates of Gastroschisis?

Gastroschisis, a condition in which the bowel herniates out of the abdomen during fetal development, is on the rise.  The rising incidence which occurs about 2000 times a year in the US caught the interest of CNN in a piece on their site this week.  Canada is no different with rates seeming to increase steadily over the last decade or so and many of us who care for these infants are left scratching our heads as to why. What Causes Gastroschisis to Occur Interestingly, the site of herni

AllThingsNeonatal

AllThingsNeonatal

 

High frequency nasal ventilation: Ready for prime time?

I will admit it.  I resist change at times just like many others.  This may come as a surprise to some of you who have worked with me and accused me of bringing too much change at times to the units.  The truth though is that when one understands something and is enthusiastic about implementation the change does not seem so difficult.  When it isn't your idea though we may find ourselves a little uneasy about adopting this unfamiliar practice. Such has been my experience with nasal HFOV.  I

AllThingsNeonatal

AllThingsNeonatal

 

Advice for Parents Regarding Hemangiomas: Time to change our approach in Pediatrics?

The story is typical.  A family notices a small red spot in the weeks following delivery which enlarges over the next month.  They present to their family doctor or Pediatrician who identifies the most common skin lesion in childhood; a hemangioma affecting about 3-10% of all children depending on the population observed.  As a resident I was given the following advice regarding hemangiomas; "As long as the hemangioma is not of cosmetic concern, sight threatening, multiple in number or causing a

AllThingsNeonatal

AllThingsNeonatal

 

Giving surfactant through an LMA. Time to ditch the endotracheal tube?

In the spirit of full disclosure I have to admit I have never placed a laryngeal mask airway (LMA) in a newborn of any gestational age.  I have played with them in simulated environments and on many occasion mentioned that they are a great alternative to an ETT especially in those situations where intubation may not be possible due to the skill of the provider or the difficulty of the airway in the setting of micrognathia for example. In recent years though we have heard of examples of surf

AllThingsNeonatal

AllThingsNeonatal

 

A New Years Wish. Are We Up to It?

I have been at this writing thing for almost a year and as I was approaching the end of 2015 my thoughts turned to asking myself what I have learned.  There have been so many posts, in fact so many between the blog and Facebook posts that I have truly lost count.  Having said that the posts have generally fallen into two dominant categories; those promoting a therapy or diagnostic tool and those suggesting that we should avoid certain practices. If I had to have one wish though it would be

AllThingsNeonatal

AllThingsNeonatal

 

Dextrose gel for hypoglycemia: Safe in the long run?

The Sugar Babies trial was the subject of a post earlier this year as the largest trial to date examining the effects of using dextrose gel to treat hypoglycemia.  For an analysis of the use of gel in this situation please see the original post Glucose Gel For Neonatal Hypoglycemia: Can We Afford Not To Use It? In summary though, the trial involved 118 infants who received 40% dextrose gel vs 119 who received a placebo gel. All of the infants in this study were selected based on risk factor

AllThingsNeonatal

AllThingsNeonatal

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