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  1. Yesterday
  2. @mosarrat we do not use this practise but I don't know why. I searched pubmed but could not find any references on decompression. Anyone else knowing more about this?
  3. Hi Stefan, My question is on the lines of NEC. Is gastric decompression routinely dobe in NEC/suspected NEC cases? If not why not? Some references would be appreciated? We were trained to do it to prevent perforation but some people don't seem to believe in it. Thanks for your feedback Mosarrat Qureshi
  4. Last week
  5. Stefan Johansson

    Follow 99nicu on LinkedIn!

    While we have been sharing updates here on Twitter and Facebook for some time, we finally also have a page on LinkedIn. Also follow 99nicu on LinkedIn The web link is https://www.linkedin.com/company/99nicu/ Best regards from the HQ's!
  6. Wonderful Stefan, Have registered. Just told the way to update on recent evidence. THANKYOU.
  7. prakashmanikoth

    CPAP-related trauma

    To reduce trauma related to frequent nasal suctioning, a noninvasive method of nasopha­ryngeal suctioning has been found to be very effective and without side effects. Sterile 0.9% saline solution is instilled drop wise into one nostril from a 5-mL syringe and suctioned from the other nostril using a Neotech little sucker or De Lee suction catheter, attached to a central vacuum source (suction pressure of 100 mmHg). This results in passage of fluid and sticky secretions from one nostril and nasopharynx to the other nostril which gets aspirated. We have stopped inserting catheters into nostrils for suctioning for over a decade in our unit. See chapter 34 "Nursing Care and Endotracheal Suction in: https://www.amazon.in/Essentials-Neonatal-Ventilation-1st-book-ebook/dp/B07LBTC95N/ref=tmm_kin_title_0?_encoding=UTF8&amp&qid=&amp&sr= Prakash Manikoth, FRCPCH
  8. pHred

    CPAP-related trauma

    Anchoring tubing can be a hazard. When the infant’s head is elevated (as in GERD care), the baby can slide down the mattress and increase pressure on the septum. Occurs most often at night. Tubing should be free to move with the infant.
  9. Thanks Dr Johansson, very useful! It's similar to the amedeo weekly literature newsletters (amedeo.com)
  10. Register for the 99nicu Meetup! In the virtual 99nicu Headquarters, we are now very busy with all preparations for our upcoming Meetup, AKA the Future of Neonatal Care conference. This third conference will take place in Copenhagen, 7-10 April, and we are already thrilled about what to come. Our vision for the 99nicu Community is to offer an Internet platform where neonatal staff from all over the world can share questions, experiences and expertise. Therefore, we are grateful to see, as previous years, that our conference “footprints” our global outreach and attracts a truly international group of delegates. There are currently 130 delegates coming from 30 countries, from East to West, from North to South. Naturally, we have room for You as well! What makes the Future of Neonatal Care conference different from other meetings? First of all, our principal idea is the one of postgraduate learning. To provide evidence-based neonatal care, we all need to refresh and refine our knowledge base. That is pretty obvious, as our work as neonatology professionals gravitates around know-how. IMHO, we can all improve here. Secondly, we believe conferences should be a place to exchange expertise and experience, and give anyone a chance to ask questions. Every 45 minute session typically includes a 30 minute lecture, to give sufficient time for discussion. Participants at our previous conferences especially enjoyed “very good discussions” and “plenty of time for questions”. We use the smartphone app sli.do (https://www.sli.do/) to allow immediate feedback from participants. Through polls and multiple-choice-questions during lectures, delegates learn from each other. Most importantly, lecturers also get an opportunity to comment directly on aspects popping up. Thirdly, we aim to place topics in a forward-facing context, how neonatology will develop in the future. Why do we need to know about cord clamping? How should we support breathing of preterm infants? What inotropes shall we use when? Shall discharge MRIs be standard of care for preterm infants? Why do we need to rehearse simulated scenarios? Great program! We are honored to welcome a great set of Faculty members to Copenhagen. To share a few examples: Barbara Schmidt and Haresh Kirpalani lead a workshop on when evidence should change the standard of care, and how to interpret non-inferiority trials Mortein Breindahl will lecture and lead a workshop on neonatal transports, together with Christian Heiring Victoria Payne will share her expertise on prevention of CLABSI David Edwards will challenge our minds about MRIs in preterm infants Liisa Lethonen and Sari Ahlqvist-Björkroth will, for the third time, run their highly appreciated workshop on Family-based care Brett Manley will tell us if/how to “Go with (high) flow” Gorm Greisen, Ulrika Ådén and Eduard Verhagen will engage in several lectures and a debate on practices and ethics around the border of viability, and parent-participation in decision-making. As you can see, we have lots to look forward to! Join us at the Future of Neonatal Care in Copenhagen 7-10 April! And yes, we will share take-home messages from the Future of Neonatal Care from our Twitter account @99nicu. As previous years, the hashtag will be #99nicuMeetup
  11. Stefan Johansson

    CPAP-related trauma

    CPAP nursing is key. We often rotate between prongs and mask if CPAP is given over longer time periods. We may also protect the skin that is pressured (like around the nostrils and nose tip) with a barrier (softish) tape to avoid direct contact with tubings. And read this paper in PLOS One a few weeks by Srinivas Murki et al in Hyderabad/India: https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0211476
  12. Wojciech Durlak

    CPAP-related trauma

    Could you please share your experience/protocols for preventing CPAP-related nasal trauma? I mean not only possible septal injury but also trauma related to frequent nasal suctioning.
  13. It isn’t often in Neonatology these days that something truly innovative comes along. While the study I will be discussing is certainly small I think it represents the start of something bigger that we will see evolve over the coming years. There is no question that the benefits of mother’s own milk are extensive and include such positive outcomes as improved cognition in preterm infants and reductions in NEC. The benefits come from the immunological properties as well as the microbiome modifying nature of this source of nutrition and have been discussed many times over. Mother’s own milk contains a couple of very special things that form the basis of the reason for the study to be presented. What are neurotrophins and stem cells? Before discussing the study it is important to understand what these two classes of molecules and cells are capable of. Neurotrophins are molecules that have the capability of promoting growth and survival of neural cells. Included in this class are EGF, brain-derived neurotrophic factor, glial derived neurotrophic factor, nerve growth factor, insulin-like growth factor-1, and hepatic growth factor. It turns out that not only are these found in high concentrations in breast milk but that a woman who produces breast milk at early gestational ages has higher amounts of these substances in her milk. Pretty convenient that substances promoting development of the brain and survival of brain cells increase the earlier you deliver! Stem cells are pluripotent cells meaning that they can develop into pretty much any cell type that they need to in the body. This would come in handy for example if you needed some new cells in the brain after a neurological insult. These are also present in mother’s milk and in fact can represent as much as 30% of the population of cells in breast milk. The Nasal Cavity and the Brain Clearly, the distance from the nasal cavity to the brain is relatively short. Without going into exhaustive detail it has been demonstrated in animal models that provision of medications intranasally can reach the brain without traversing the blood stream. This affords the opportunity to provide substances to the neonate through the nasal cavity in the hopes that it will reach the brain and achieve the desired effect. When you think about it, newborns when feeding have contact between the whole nasopharyngeal cavity and milk (as evidenced by milk occasionally dripping out of the nose when feeding) so using an NG as we do in the NICU bypasses this part of the body. Is that a good thing? Intranasal application of breast milk Researchers in Germany led by Dr. Kribs published an early experience with this strategy in their article Intranasal breast milk for premature infants with severe intraventricular hemorrhage—an observation. In this paper the strategy;follows; 2 × 0.1 ml of his or her mother’s milk 3 to 8 times a day (0.6 to 1.6 ml total per day). The breast milk was freshly expressed, which means the milk was used within 2 h after expression. The daily application started within the first 5 days of life and was continued for at least 28 days to a maximum of 105 days. The outcome of interest was whether the severe IVH would improve over time compared to a cohort of infants with severe IVH who did not receive this treatment. Importantly this was not a randomized trial and the numbers are small. A total of 31 infants were included with 16 receiving this treatment and 15 not. The two groups were compared with the results as follows. The results don’t reach statistical significance but there is a trend at the bottom of the table above to having less progressive ventricular dilatation and surgery for the same. Again this is a very small study so take the results with a grain of salt! Is this practice changing? Not yet but it does beg the question of what a properly designed RCT might look like. The authors predict what it might look like with a sham nasal application versus fresh mother’s milk. I do wonder though if it may become a study that would be hard to recruit into as when families are approached and the potential benefit explained it may be hard to get them to say anything other than “Just give my baby the breast milk!” Such is the challenge with RCTs so it may be that a larger retrospective study will have to do first. Regardless, be on the lookout for this research as I suspect we may see more studies such as this coming and soon! * Featured image from the open access paper. (There couldn’t be a better picture of this out there!)
  14. Earlier
  15. bimalc

    Central venous pressure monitoring

    https://lifeinthefastlane.com/ccc/cvp-measurement/ I have mixed feelings in LITFL as they often just make a series of statements and then list some references at the end (as opposed to indicating in the text what evidence there is for each claim) but for this particular discussion, it seems like a reasonable starting point. I could caution that, as we always are, we remain skeptical about the extrapolation of this data to neonates (on the other hand, for many of these issues there is no neonatal data so one must start someplace).
  16. Francesco Cardona

    Central venous pressure monitoring

    @bimalc do you have some literature sources you can point to? would love to read up.
  17. spartacus007

    Glucose gel in preterm babies

    We are using it for 34 weeks and above
  18. bimalc

    Central venous pressure monitoring

    It may or may not be applicable, but if you're setting out to use CVP monitoring in sick neonates, it might also be helpful to think about what things might change the CVP (other than what you're trying to measure). There is a robust literature in adults (and older children) looking at the effects of high PEEP etc. on CVP readings. I haven't looked at it in a number of years, but if I was going to start transducing CVPs regularly and getting calls from nurses or house staff about shifts, I'd probably want to have a mental list of all the iatrogenic things that can and cannot change the value of a CVP reading.
  19. We had a similar issue a number of times. I personally came across children who seemed fine in terms of abdominal symptoms (no distension, good feeding tolerance) but presented with pneumatosis. In cases of massive pneumatosis we would usually start them on NEC protocol. There are also sometimes children with only small number of gas bubbles in the portal vein or superior mesenteric vein. We would observe them closely. Most of these cases resolve spontaneously without sequelae, we sometimes even continue feeds. I remember a preemie approaching discharge in whom the only etiology we could associate portal gas with was cow milk protein allergy. The baby was fine, discharged home with intermittent pneumatosis. On the other hand, very recently I had a term baby who presented with unilateral seizures and was diagnosed with left-sided MCA infarct. On presentation I noticed massive hepatic/portal pneumatosis with gas transfer to IVC via open venous duct and to the systemic circulation via PFO. I was wondering whether air embolism could have been responsible for neurological presentation in that child. Also, pneumatosis usually preceeds other clinical symptoms, like in this case - this baby developed enterocolitis symptoms 24hours later, without any clinical symptoms on the initial presentation. On a different note, couple years back we almost completely eliminated X-ray for assessment of abdominal symptoms. We now rely on ultrasound which provides more data, is obviously not associated with radiation exposure and unlike x-ray allows for continous assessment.
  20. Schumz

    LISA Guideline

    @ali We have recently started using LISA and we had a lot of disussion on what to use as premedication. ...the choices were propofol, fentanyl, morphine etc After much discussion we agreed on Fentanyl! I will have to double check if we give anything else along with it! We have developed a guideline ...which includes which baby, when and how! Only by consultants or under their supervision by senior trainees...Hope that helps.
  21. Schumz

    Central venous pressure monitoring

    @bimalc thanks for your reply. Yes we have the facility to do Echo in our unit but in a sick infant I was wonedring if it is of some use when monitoring continuously. I agree with you trend rather than spot check is required. The normal values for neonates only studied in 2 studies 1992 by Skinner and another one in 1980 which quote a range from 4-6 for healthy term infants. Most (49/62)babies studied by Skinner had a congenital heart disease and rest had RDS..it was an interesting read
  22. Stefan Johansson

    MONIVENT - new Partner of 99nicu

    Check out this video about Monivent!
  23. bimalc

    Central venous pressure monitoring

    In my experience CVP is much more helpful as a trend - if I plug in the transducer and it says 8 vs 6, I'm not sure I know what that means. But if it was 8 all day and now it is 6 or 4, I can go looking for a reason for the change or a consequence of that change. If I'm looking for numbers to target early in the course and I'm worried about preload status, I'd much rather know targeted echo (if available at your facility) and/or pH and lactates.
  24. I'd like to share info about a (possibly) not so well-known Evidence Alert service made available by McMaster University. Visit this link and register for alerts on research papers in any field (like neonatology!): https://plus.mcmaster.ca/EvidenceAlerts/Default.aspx Emails do not come often, like ~1-2 /month. The latest included the following papers: Article Title Discipline Rele- vance News- worthiness Efficacy and Safety of EMLA Cream for Pain Control Due to Venipuncture in Infants: A Meta-analysis. Pediatrics Pediatric Neonatology 6 6 Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial. Lancet Pediatric Neonatology 7 6 Therapeutic hypothermia for mild neonatal encephalopathy: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed Pediatric Neonatology 7 5 Just click on the title to review the abstract and/or PubMed record.
  25. Stefan Johansson

    Evidence Alerts

    DynaMed Plus and McMaster University's Health Information Research Unit are collaborating to provide you with access to current best evidence from research, tailored to your own health care interests, to support evidence-based clinical decisions. This service is unique: all articles (from over 120 premier clinical journals) are pre-rated for quality by highly trained research staff, then rated for clinical relevance and interest by at least 3 members of a worldwide panel of practicing physicians. Here's what we offer: A searchable database of the best evidence from the medical literature An email alerting system Links to selected evidence-based resources
  26. Francesco Cardona

    LISA Guideline

    We perform LISA routinely on all preterms < 28 wks right after birth. We do not use any premedication or analgesia. We use a gastric tube and Magill forceps for application of surfactant intratracheally. We follow a slightly modified version of the original protocol from Cologne (as published here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60986-0/fulltext). You can find our publication on our experience with LISA here: https://www.ncbi.nlm.nih.gov/pubmed/23446061 Let me know if you need any more information.
  27. Guys I need your expertise and knowledge about use of CVP monitoring in a sick neonate... The normal values range in between 4-6 in children (as per the literature...) How much do we rely on this measurement? Are there any normal values in preterm infants or non-immune hydrop babies?
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