Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org
  • entries
    136
  • comments
    106
  • views
    38,733

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

 

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

 

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

×
×
  • Create New...