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  3. Learn Neonatal Brain Ultrasound on Youtube!

    This is awesome for training !!! simply great.
  4. LactMed

    Need to know more about drugs/supplements and breastfeeding? LactMed can help! Find information about maternal and infant drug levels, possible effects on lactation and on breastfed infants, and alternative drugs to consider. The LactMed database by NHS (UK) contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific literature and fully referenced. A peer review panel reviews the data to assure scientific validity and currency. The smartphone app is available both for iOS and Android.
  5. This must be one of my favourite topics as I have been following the story of early hydrocortisone to reduce BPD for quite some time. It becomes even more enticing when I have met the authors of the studies previously and can see how passionate they are about the possibilities. The PREMILOC study was covered on my site twice now, with the first post being A Shocking Change in Position. Postnatal steroids for ALL microprems? and the second reviewing the 22 month outcome afterwards /2017/05/07/early-hydrocortisone-short-term-gain-without-long-term-pain/. The intervention here was that within 24 hours of birth babies born between 24-27 weeks gestational age were randomized to receive placebo or hydrocortisone 1 mg/kg/d divided q12h for one week followed by 0.5 mg/kg/d for three days. The primary outcome was rate of survival without BPD at 36 weeks PMA. The finding was a positive one with a 9% reduction in this outcome with the use of this strategy. Following these results were the two year follow-up which reported no evidence of harm but the planned analysis by gestational age groupings of 24-25 and 26-27 weeks was not reported at that time but it has just been released this month. Is there a benefit? Of the original cohort the authors are to be commended here as they were able to follow-up 93% of all infants studied at a mean age of 22 months. The methods of assessing their neurological status have been discussed previously but essentially comprised standardized questionnaires for parents, assessment tools and physical examinations. Let’s start off with what they didn’t find. There was no difference between those who received placebo vs hydrocortisone in the 26-27 week group but where it perhaps matters most there was. The infants born at 24-25 weeks are certainly some of our highest risk infants in the NICU. It is in this group that the use of hydrocortisone translated into a statistically significant reduction in the rate of neurodevelopmental impairment. The Global Neurological Assessement scores demonstrated a significant improvement in the hydrocortisone group with a p value of 0.02. Specifically moderate to severe disability was noted in 18% compared to 2% in the group receiving hydrocortisone.They did not find a difference in the neurological exam but that may reflect the lack of physical abnormalities with cognitive deficit remaining. It could also be explained perhaps by the physical examination not being sensitive enough to capture subtle differences. Why might this be? Adding an anti-inflammatory agent into the early phase of a preemies life might spare the brain from white matter damage. Inflammation is well known to inflict injury upon the developing brain and other organs (think BPD, ROP) so dampening these factors in the first ten days of life could bring about such results via a mechanism such as that. When you look at the original findings of the study though, a couple other factors also pop up that likely contribute to these findings as well. Infants in the hydrocortisone group had a statistical reduction in the rate of BPD and PDA ligations. Both of these outcomes have been independently linked to adverse neurodevelopmental outcome so it stands to reason that reducing each of these outcomes in the most vulnerable infants could have a benefit. In fact when you add everything up, is there much reason not to try this approach? Ten days of hydrocortisone has now been shown to reduce BPD, decrease PDA ligations and importantly in the most vulnerable of our infants improve their developmental outcome. I think with this information at our fingertips it becomes increasingly difficult to ignore this approach. Do I think this will become adopted widely? I suspect there will be those who take the Cochrane approach to this and will ask for more well designed RCTs to be done in order to replicate these results or at least confirm a direction of effect which can then be studied as part of a systematic review. There will be those early adopters though who may well take this on. It will be interesting to see as these centres in turn report their before and after comparisons in the literature what the real world impact of this approach might be. Stay tuned as I am sure this is not the last we will hear on this topic!
  6. Barnveckan 2018

    Barnveckan 2018 i Västerås 23-26 april Aros congress center Inom neonatologi bl.a. inledningstalare och föreläsare Professor Lex Doyle, Australien samt Edward Shepherd, MD, USA BPD-specialist Ta en titt på det preliminära programmet på www.barnveckan.se och följ på Instagram: barnveckan2018
  7. Barnveckan 2018

    Barnveckan 2018 i Västerås Neonatologiprogram med bl.a. inledningstalare samt föreläsare Professor Lex Doyle, Australien samt Edward Shepherd, MD, USA om Ohio-modellen/BPD se det preliminära programmet på www.barnveckan.se och följ på instagram: barnveckan2018
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  9. Learn Neonatal Brain Ultrasound on Youtube!

    Thank you!
  10. 2nd Neonatal Neurology Conference, UK

    2ND NEONATAL NEUROLOGY CONFERENCE Neonatal neurology is ever evolving and new knowledge is always emerging. Assessment techniques have become more advanced. Newer imaging modalities are increasingly used to help map the extent of brain injury and its implications for neurodevelopment. This meeting lines up exciting talks from experts in the field. More info on: https://www.lutonneocon.co.uk/fom-neurology
  11. Hi Francesco, Thanks for the information. What a pity. Maybe the measurements are similar but than the blade is too long. For a skilled person it will be possible doing the intubation but this is not the classic procedure (different angel etc). This means (IMHO ) that the C-Mac can not be used for teaching intubation in infants below about 1200g. Have a nice weekend Dirk
  12. Video Assisted Intubation using a C-Mac

    We had contact with the company last week, they said they are not planning on a smaller blade than the Miller 0, because their Macintosh 0 is thinner and measures similarly to most Miller 00.
  13. The 24 hour countdown for Early Birds is starting! If you want to join us at the discounted rate, register no later than January 15. Sign up today https://99nicu.org/meetup/registration Why come to the Future of Neonatal Care? Reason #1 Interactivity We believe conferences should be a place to exchange knowledge and give anyone a chance to ask questions. Participants at our last conference especially enjoyed “very good discussions” and “plenty of time for questions”. We use an app to allow for immediate feedback from participants. Additionally, we will have workshops on current important issues of neonatology like parent-centered care, best practice in applying surfactant and simulation training in neonatology. Reason #2 Future Our topics are focused on how neonatology will develop in the future. What skills will the neonatologist need to perform best practice neonatology (echo, LISA)? How can we identify infants that are in risk of deteriorating? What tools will help us treat our infants on the neonatal ward (ultrasound, aEEG, NIRS, MRI)? How should we design our neonatal wards ideally? And how can we work together with parents for optimal outcomes?
  14. Future of Neonatal Care, Vienna, Austria


    Me too
  15. Future of Neonatal Care, Vienna, Austria


    I will be there!
  16. Early Bird Weekend :)

    The "Future of Neonatal Care", our upcoming meeting in Vienna 9-12 April 2018, is now only three months away. This weekend is the last chance for you to sign up for the discounted Early Bird Rate. Click here to register This meeting is an IRL event for bringing the neonatal community together, for staff sharing a passion to provide the best neonatal care. While our vision is to promote evidence-based neonatal care, and acknowledge the limitations thereof, we focus on the learning experience by creating a friendly and interactive context. The conference will span over a wide range of topics, for example the Golden Hour, LISA, hypoglycemia, NICU design, follow-up of preterm infants, hypothermia, functional echo, lung ultrasound, and palliative care. There will also be workshops on LISA, PICC line placement, family-based care and simulation. See You in Vienna!
  17. Can’t intubate to give surfactant? Maybe try this!

    thanks for video.
  18. Can’t intubate to give surfactant? Maybe try this!

    I think that the statement "Roughly 25% of the infants were found to have not received any surfactant,..." is an understandable misinterpretation of a long sentence in the manuscript. The text says that upon gastric aspiration post-treatment, 26% had no surfactant... (... in the stomach), suggesting that those babies actually had the full dose of surfactant delivered to the lungs. It is implausible that surfactant could be delivered via an LMA without any of it being aspirated into the lungs. Both animal and clinical evidence indicate that surfactant delivery via an LMA is quite efficient - though the specific techniques that maximize efficiency still need to be studied.
  19. This is part 2 in a Neonatal Brain Ultrasound tutorial on Youtube.! Also check out the first video below on Anatomy and Protocol https://www.youtube.com/watch?v=kJq8eXf41nI
  20. Learn Neonatal Brain Ultrasound on Youtube!

    One of our fellows showed me these two videos on Youtube, on how to learn brain ultrasound. Both videos are very good! Enjoy Part 1 - anatomy and protocol Part 2 - IVH and PVL
  21. Neonatal Brain Ultrasound is an indispensible tool for evaluating preterm and term neonates for intracranial pathology. It is readily available, portable, relatively inexpensive and safe. This video is a great learning tool! Also check out the second video below on IVH and PVL on https://www.youtube.com/watch?v=hiRt8UiXRag
  22. I have recently posted a series of short "educational" webinars addressing infant oral feeding issues. They can be found at www.chantallau.com or  on YouTube (https://www.youtube.com/channel/UC1a-zNccdoHt3BJJuZ62sig/featured),

    Please feel free to share, if of interest, with colleagues.



  23. Join the Future of Neonatal Care, in Vienna 9-12 April 2018

    Dont forget - cheaper early bird rates for the conference are only available until Jan 15!
  24. Can’t intubate to give surfactant? Maybe try this!

    I looken into Youtube and found only videos of LMA placement, this one from the UK-based initiative IMPROVE and @spartacus007
  25. Can’t intubate to give surfactant? Maybe try this!

    hi,do you have any video for Surfactant Administration Through and Laryngeal Mask Airway (LMA)?
  26. @Stefan Johansson it sounds greatt with this news. we havebeen giving probiotics with three starins but we are not gettting good results so hopefully it will be agreat option for us.
  27. As 2017 comes to an end, I'd like to post an update on the probiotics project. You may have read previous blog posts about Neobiomics (here and here), a not-for-profit project that will provide probiotics specifically manufactured for preterm infants, “from the community, to the community”. Launch is planned for Q1 2019. The probiotics will fulfill specific needs: three bacterial strains documented in a large clinical trial (i.e. the ProPrems trial) manufactured according to GMP, fulfilling the highest possible quality grade (21 CFR Part 106, “Infant Formula grade”) freeze-dried bacterias with superior stability and long shelf-life single dose units (aluminium foil stickpack) to virtually eradicate the risk of contamination If you would be interested to use this probiotics product in your NICU, visit this page and submit the form to ensure yourself to learn when this product will become available. That's all for now about this exciting project
  28. Intubation is not an easy skill to maintain with the declining opportunities that exist as we move more and more to supporting neonates with CPAP. In the tertiary centres this is true and even more so in rural centres or non academic sites where the number of deliveries are lower and the number of infants born before 37 weeks gestational age even smaller. If you are a practitioner working in such a centre you may relate to the following scenario. A woman comes in unexpectedly at 33 weeks gestational age and is in active labour. She is assessed and found to be 8 cm and is too far along to transport. The provider calls for support but there will be an estimated two hours for a team to arrive to retrieve the infant who is about to be born. The baby is born 30 minutes later and develops significant respiratory distress. There is a t-piece resuscitator available but despite application the baby needs 40% oxygen and continues to work hard to breathe. A call is made to the transport team who asks if you can intubate and give surfactant. Your reply is that you haven’t intubated in quite some time and aren’t sure if you can do it. It is in this scenario that the following strategy might be helpful. Surfactant Administration Through and Laryngeal Mask Airway (LMA) Use of an LMA has been taught for years in NRP now as a good choice to support ventilation when one can’t intubate. The device is easy enough to insert and given that it has a central lumen through which gases are exchanged it provides a means by which surfactant could be instilled through a catheter placed down the lumen of the device. Roberts KD et al published an interesting unmasked but randomized study on this topic Laryngeal Mask Airway for Surfactant Administration in Neonates: A Randomized, Controlled Trial. Due to size limitations (ELBWs are too small to use this in using LMA devices) the eligible infants included those from 28 0/7 to 35 6/7 weeks and ≥1250 g. The infants needed to all be on CPAP +6 first and then fell into one of two treatment groups based on the following inclusion criteria: age ≤36 hours, (FiO2) 0.30-0.40 for ≥30 minutes (target SpO2 88% and 92%), and chest radiograph and clinical presentation consistent with RDS. Exclusion criteria included prior mechanical ventilation or surfactant administration, major congenital anomalies, abnormality of the airway, respiratory distress because of an etiology other than RDS, or an Apgar score <5 at 5 minutes of age. Procedure & Primary Outcome After the LMA was placed a y-connector was attached to the proximal end. On one side a CO2 detector was placed and then a bag valve mask in order to provide manual breaths and confirm placement over the airway. The other port was used to advance a catheter and administer curosurf in 2 mL aliquots. Prior to and then at the conclusion of the procedure the stomach contents were aspirated and the amount of surfactant determined to provide an estimate of how much surfactant was delivered to the lungs. The primary outcome was treatment failure necessitating intubation and mechanical ventilation in the first 7 days of life. Treatment failure was defined upfront and required 2 of the following: (1) FiO2 >0.40 for >30 minutes (to maintain SpO2 between 88% and 92%), (2) PCO2 >65 mmHg on arterial or capillary blood gas or >70 on venous blood gas, or (3) pH <7.22 or 1 of the following: (1) recurrent or severe apnea, (2) hemodynamic instability requiring pressors, (3) repeat surfactant dose, or (4) deemed necessary by medical provider. Did it work? It actually did. Of the 103 patients enrolled (50 LMA and 53 control) 38% required intubation in the LMA group vs 64% in the control arm. The authors did not reach their desired enrollment based on their power calculation but that is ok given that they found a difference. What is really interesting is that they found a difference in the clinical end point despite many infants clearly not receiving a full dose of surfactant as measured by gastric aspirate. Roughly 25% of the infants were found to have not received any surfactant, 20% had >50% of the dose in the stomach and the other 50+% had < 10% of the dose in the stomach meaning that the majority was in fact deposited in the lungs. I suppose it shouldn’t come as a surprise that among the secondary outcomes the duration length of mechanical ventilation did not differ between two groups which I presume occurred due to the babies needing intubation being similar. If you needed it you needed it so to speak. Further evidence though of the effectiveness of the therapy was that the average FiO2 30 minutes after being treated was significantly lower in the group with the LMA treatment 27 vs 35%. What would have been interesting to see is if you excluded the patients who received little or no surfactant, how did the ones treated with intratracheal deposition of the dose fare? One nice thing to see though was the lack of harm as evidenced by no increased rate of pneumothorax, prolonged ventilation or higher oxygen. Should we do this routinely? There was a 26% reduction in intubations in te LMA group which if we take this as the absolute risk reduction means that for every 4 patients treated with an LMA surfactant approach, one patient will avoid intubation. That is pretty darn good! If we also take into account that in the real world, if we thought that little of the surfactant entered the lung we would reapply the mask and try the treatment again. Even if we didn’t do it right away we might do it hours later. In a tertiary care centre, this approach may not be needed as a primary method. If you fail to intubate though for surfactant this might well be a safe approach to try while waiting for a more definitive airway. Importantly this won’t help you below 28 weeks or 1250g as the LMA is too small but with smaller LMAs might this be possible. Stay tuned as I suspect this is not the last we will hear of this strategy!
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