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Another dogma bites the dust? Two vs three hour feeding intervals for VLBW infants.

This could turn into a book one day I suppose but I have become interested in chalenging some of my long held beliefs these days. Recently I had the honour of presenting a webinar on “Dogmas of Neonatology” for the Indian Academy of Pediatrics which examined a few practices that I have called into question (which you can watch in link). Today I turn my attention to a practice that I have been following for at least twenty years. I have to also admit it is something I have never really questioned

Reducing severe IVH/PVL through exclusive human milk diets. Is this the real thing?

Anyone who works in the NICU is more than familiar with the sad moment when you find out an infant has suffered a severe IVH (either grade III or IV) and the disclosure to the family. The family is in a state of shock with the fear of ventricular drainage a reality that will likely come to pass.  We have spent many years trying to find ways to reduce this risk and antenatal steroids and delayed cord clamping are two relatively recent interventions that have had a real impact.  Unfortunately we h

How much feeding voume can a preterm baby really take? It’s likely more than you think!

Since the dawn of my time in Neonatology there has been cibophobia! What is this you ask? It is the fear of food and with some flexibility in the definition I would apply this to large volumes of milk rather than the fear of food itself. Most units in the world seem to use a volume range of about 135 – 165 mL/kg/d as a range considered to mean “at full feeds”. As I was discussing this on rounds today I was quick to point out though that babies with neonatal opioid withdrawal syndrome (NOWS) freq

Nasal High Frequency Oscillatory Ventilation For Preventing Intubation

I have reviewed many articles on this site in the last few years. My favourite pieces are ones in which I know the authors and I have to say my ultimate favourite is when I know the authors as colleagues. Such is the case this time around and it pertains to a topic that is not without controversy. Nasal High Frequency Oscillatory Ventilation or NHFOV for short is a form of non-invasive ventilation that claims to be able to prevent reintubation whether used prophylactically (extubation directly t

AllThingsNeonatal

AllThingsNeonatal in Intubation

Premedication for Intubation: Take a pass on propofol

The Canadian Pediatric Society has a statement on the use of premedication before non-emergent intubation which was written in 2011 and reaffirmed in 2018. After reviewing available medications for use the recommended strategy was atropine, fentanyl and succinylcholine. This combination does involve three different medications, the first being to prevent bradycardia, the second to sedate and the third to paralyze. With the use of three medications however there is always room for error so it is

AllThingsNeonatal

AllThingsNeonatal in Intubation

Say what!? Applying a mask to resuscitate preterm infants causes apnea.

Let me start off by giving thanks to John Minski for this article and in fact for many others that have been reviewed on this blog. John is a registered respiratory therapist in Winnipeg with a passion for respiratory care like no other. John frequently sends articles my way to think about for our unit and this one was quite sensational to me. As readers of this blog I thought you might find it pretty interesting as well. Why Would A Mask Cause Apnea To begin with this seems coun

Dark green gastric residuals are gross but may be part of a systemic logical fallacy in Neonatology

In recent years we have moved away from measuring and reporting gastric residuals. Checking volumes and making decisions about whether to continue feeding or not just hasn’t been shown to make any difference to care. If anything it prolongs time to full feeds without any demonstrable benefits in reduction of NEC. This was shown in the last few years by Riskin et al in their paper The Impact of Routine Evaluation of Gastric Residual Volumes on the Time to Achieve Full Enteral Feeding in Preterm I

Surfactant and inhaled nitric oxide make beautiful music together

If you work in Neonatology you no doubt have listened to people talk in rounds or at other educational sessions about the importance of opening the lung. Many units in the past were what you might call “peepaphobic” but over time and with improvements in technology many centers are adopting an attitude that you use enough PEEP to open the lung. There are some caveats to this of course such as there being upper limits to what units are comfortable and not just relying on PEEP but adding in surfac

AllThingsNeonatal

AllThingsNeonatal in PPHN

Cows milk, the gut & starvation of oxygen. Why even the fortifier used may contribute to NEC.

It seems so simple doesn’t it. Shouldn’t we just be able to feed milk whether it be from humans or cows and our preemies will just adapt? I have often written about human milk diets vs those with bovine but this week an intriguing article came my way that really gave me some pause to say hmmm. Human milk diets have been shown to reduce the risk of necrotizing enterocolitis (NEC) compared to use of formula. The use of bovine human milk fortifiers falls somewhere in the middle I suppose as the die

AllThingsNeonatal

AllThingsNeonatal in *

Humanizing Care NICU : Management with Compassion

Today I sharing ‘tis post from HUGES a great. Organization dedicated to humanizing care in intensive care settings and emergency services. I particularly by this webinar on humanize. Management starting with leading with empathy, simply things that can be hard to achieve, but make us think Speakers suggests a few things to start with :   J. Carlos March - Profesor  EASP {Escuela Salud Publica- Public Health Institute of Andalucia}  Director of School of patient.

Jelli KA

Jelli KA

Time to say goodbye to INSurE and hello to IN-REC-SUR-E?

Intubate-Surfactant- Extubate or INSURE has been around for awhile. The concept is to place an ETT while an infant is first on CPAP and then after pushing surfactant in quickly remove the ETT and put back on CPAP. This does not always go as planned though. If after surfactant the FiO2 remains above 30% many people would keep the ETT in place as they would surmise that the infant would fail if the tube was removed. They would probably be right. Sustained inflations have fallen out of favo

AllThingsNeonatal

AllThingsNeonatal

What’s in your nose makes you more or less susceptible to COVID19

I recently had the honour of being asked to present grand rounds at the University of Manitoba. My former Department Head during the question period stumped me when he asked me what role angiotensin converting enzyme 2 receptor (ACE2) has in pediatric COVID19. Like all great teachers, after I floundered and had to confess that while I was aware there is a role in COVID19 I wasn’t sure of the answer, he sent me a paper on the subject. The reality is that a very small percentage of COVID19 illness

AllThingsNeonatal

AllThingsNeonatal

Seizure control. Tried and true or the new kid on the block?

Phenobarbital at least where I work has been first line treatment for seizure control for as long as I can recall. We dabbled with using phenytoin and fos-phenytoin in the past but the go to tried and true has been phenobarbital for some time. The use of this drug though has not been without trepidation. Animal studies have linked phenobarbital to increases rates of cerebral apoptosis. Additionally, in a retrospective comparison of outcomes between seizures controlled with phenobarbital vs Levet

AllThingsNeonatal

AllThingsNeonatal

Put me in! Care provider workload reduced when parents are present for resuscitations.

It’s Father’s Day so why not put out a post about a role for father’s in resuscitation. Given that we are talking about a parent being present for resuscitation after delivery and the mother will have just delivered, what follows is a discussion about having the other parent present at the ensuing resuscitation if needed. This will of course not always be a father as in female same sex parenting so what follows could apply to any situation in which there are two parents present and one has just

AllThingsNeonatal

AllThingsNeonatal

Is Vasopressin the near perfect inotrope?

It isn’t often I have had the pleasure of reviewing a paper from my own center (maybe because I have been reticient to critique my colleagues) but this paper I couldn’t resist. If my colleagues are reading this then I will provide a spoiler alert that I am not planning on trashing the paper. A few years ago my colleague Dr. Yasser El Sayed (who many of you will know from his work on targeted echocardiography and ultrasound and most recently on www.pocusneo.ca) began touting the benefits of vasop

AllThingsNeonatal

AllThingsNeonatal

Why health care professionals are fitted for the #startup universe

I like projects outside my clinical and academic work. 99nicu was the first big project that came out in public from my "Department of Brilliant Ideas". Since several years, I have devoted a lot of work for a project that eventually led to the startup Neobiomics, since 2019 under the wings of the Karolinska Innovations AB. Neobiomics provides ProPrems®, a high-quality multi-strain food supplement. Entering the startup universe has been like embarking a rollercoaster journey. In many wa

Stefan Johansson

Stefan Johansson in startup

SARS-CoV-2 Just Might Be In Breastmilk After All

After several reports providing reassurance to breastfeeding mothers, two very recent reports are giving me reason to pause. The Canadian Pediatric Society has been recommending breastfeeding if a mother has COVID19 with precautions in place; Breastfeeding when mothers have suspected or proven COVID-19. It would be heresy to suggest that a mother not be permitted to breastfeed her infant but what follows are two reports that at the very least may need to enter the discussion when a COVID19 posit

AllThingsNeonatal

AllThingsNeonatal

All Things Neonatal Facebook Site Has Moved!

After developing a community of over 23000 people unfortunately I had to close my Facebook site due to concerns over a hack. Not to worry as I have created a new independent site to share information daily in Neonatology. I look forward to building an audience at this site and working to continue the dialogue I have come to enjoy with all the followers. I look forward to seeing you there! The New Site is at: https://www.facebook.com/allthingsneonatal2  

AllThingsNeonatal

AllThingsNeonatal

Improve your success rate in weaning from CPAP.

I doubt there is a unit in the world where at least once a day a discussion ensues about whether an infant is ready to wean or come off their CPAP. For many years we have made the decision based on a variety of markers. Some people would comment on the work of breathing, others on the FiO2 or what the oxygen saturations are at the moment as we round on the patient. Our unit has been pulling oxygen histograms off the patient monitor for years now to provide a more objective measurement to determi

AllThingsNeonatal

AllThingsNeonatal

COVID19 Questions and Hopefully Answers!

Good morning or evening everyone! As we move thorough these turbulent times everyone has questions about how this story will end.  My experience with social media has been one that has been evolving for some time.  Recently with so many questions about COVID19 I opted for setting up Facebook Live video sessions and although they aren't a visual question and answer session they do allow for people who are watching to make comments.  One of my favourite sessions so far has been with Stefan fr

Is it possible to smell NEC coming?

You might think this title is a joke but it is actually quite serious. Volatile organic carbons (VOCs) are what give stool it’s characteristic and often very malodorous scent. These same VOCs though could serve as biomarkers for preemies at risk of NEC. In fact previous research using an artificial nose has suggested as much. In 2015 de Meij TGJ et al published a study looking at VOCs entitled Early detection of necrotizing enterocolitis by fecal volatile organic compounds analysis. They used an

AllThingsNeonatal

AllThingsNeonatal

What Is Driving The Desire For N95 Masks For Newborn Resuscitation?

I had the pleasure of being asked to speak to a Canadian audience of people working with newborns yesterday about the new CPS practice points for managing deliveries and newborns with suspected or proven COVID-19. Something fascinating happened over the course of the discussion and that was that we are a country divided. It didn’t help that the week prior to the CPS releasing their practice points the American Academy of Pediatrics released the following position: “Precautions for birth

AllThingsNeonatal

AllThingsNeonatal

Is it safe to use my breast milk if I have COVID-19?

This is another hot topic out there as centers around the world struggle to determine how best to manage the mother who has contracted COVID-19 in pregnancy. There are resources out there already such as the CDC which states the following. The World Health Organization also has this to say as of yesterday. The question though is where do these recommendations come from? How strong is the evidence? Let’s begin with another Coronavirus Do you remember SARS? This

AllThingsNeonatal

AllThingsNeonatal

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