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  4. We measure axillary temps (most often parents do it )
  5. Thank you all for your answers! In our unit this is a nursing decision as well. I feel like we use manipulation a lot and wonder about the implications on short and long term. What temperature method do you use as standard of care?
  6. We also practise some manipulation in preterm infants but only if otherwise well (preterm infants with functional GI problems) - if we suspect NEC, manipulation is a no-no. This practise is usually not a doctor's decision, usually nursing staff decide to do this if they believe it helps.
  7. Who is working with the interfaces for CPAP of STEFAN? Many users in Germany? NICU level 3? Although we are working with the Flexitrunk and the VYGON at two different locations, we might be looking for a new system, hoping to find experience in this CPAP interface. https://www.stephan-gmbh.com/en/products/easyflow-ncpap/
  8. Hello Antoine, As above, in the VUMC Amsterdam we use, binasal Vygon. The pressure is measured at the end of the F@P tubing with a pressure-tube connected to the ventilator. We hardly give more than PEEP 8 (flow 8 liter) We use it for NCPAP en NIPPV. When suction is needed we remove one tube from a nostril, put a knot in it, so O2 (and some PEEEP?) is delivered; suction with catheter or with a Tendernose. With loads of secretion the tape will come lose sometimes, but overall no problems and no skin trauma. You can also insert one Vygon-tube, connected to your T-piece and let O2 and air flow, before extubating. With weeks/months of nCPAP the kids do get irritated by placing the tubes, no different than with mask/prongs. There is offcourse a resistance, especially with the smallest size. But in clinical practice we don't see that. We have used this with the Leoni ventilator and now with the Fabian ventilator. If you are in Amsterdam, you're welcome to come and visit
  9. To Ingrid de Jong Which device do you use to provide cpap (and where is the delivered pressure maesured)? Do you use it for nasal ventilation ? How do you manage secretions/nasal succioning with the tape? Don't you have skin trauma with the tape. I'll be more than happy to try this way of delivering cpap
  10. Because they relied on nurse charting of changes in vital signs, there was almost certainly non-differential misclassification leading to significant bias of effects towards the null. Nurse charting of events like desaturations is notoriously uneven relative to continuously measured data from monitors (this is one of the rationales for using SpO2 histograms to drive management instead of 'event counts'). A trial with continuous VS capture would best resolve the issue.
  11. This September I had the opportunity to go to BAPM-EBNEO to kept Learning a out Neonatology and hopefully network with the EBNEO, so glad I was to see peeps face to face. This kept motivated to finish my PhD as I re-embark in find a new supervisor _only 1.5 yrs to go. I was real hard to let of the clinician in me as , this is my comfort zone. As a budding academic I get explore ideas and ways to implement them. Last year, I took a small detour as jr.posdoc and spent time studying system thinking, process and how to improve health using design thinking. An important fact , I beat my fear of being back in UK .I had mild anxious feeling about going to bapm but Northerners are such lovely folks. Those at the Conference where quite welcoming. ----------- Product Reviews: Review BAPM. Probiotics Pro-prems finally available in individual sachets pre-dose sachets that in my opinion provide a higher security and is more practical. Only maltodextrin . Need mixing with 3 ml in H20. This has more of a track record as it collaboration with a company who been working bio culture for a long time pharmaceuticals grade certified. Vegan alternative for well babies is Labinic drop available liquid bottle comes in 5mls flask_recommended dose 0.2ml( a syringe is needed). Ideally given with maternal milk ( EBM ). * free off dairy, soya, sweetener, presevatives. Good for neonates with intolerances. Both have different formula of microbiota but have a 1 bifidobacterium probiotic in common. Amount of bacteria are specified in the ingredientes list of of proprems on the box. Nëo from ant neuro aEEG The most distinctive item to provide EEG monitoring to Neonate at the bed side. It features a user friendly screen, allowing NICU professionals easy access to interpret resulting brain waves. Electrode are applied through a cap, as I understand help to give a clearer signal. Bliss finally got to nicu mile stone card which are such lovely way to involve parents and make progress. Favorite is parent centered care poster. Bili bluelight . Compared to the standard it is small portable and easily stored . complement comes with a stand.Practical and can carried around, easily stored in the unit. Li-lac As one who had to deal a lot of of documentation I found Li-lac EBM labeling, sorting and tracking useful from quality & safety point of view. I found quite easy to use and track on a smartphone,and it builds an audit trail.Not sure how easy the set up is . Especial mention to SHED/S/upport & H/elp for E/very D/ad : providing specific support for dad whose babies are admitted to NICU. Disclaimer: I have no ties to any of companies. Review Health devices enthusiasts academic. Permission for all pics .
  12. The use of probiotic Bifidobacterium breve M-16 v has been in use for a fairly long time in Australia for preterms with very positive study reports especially by Dr. Sanjay Patole et al. We in India are currently using the same for the last few months with good results so far
  13. nice question we do practice rectal stimulation by feeding tube or sometimes glycerine suppositories or rectal wash out by NS
  14. apathak

    INDIA EBUS

    Very worthwhile effort!
  15. Go through the equipment check . I start checking incubator follow the step but their a mal function. Instead of declare a failure have a second look it, they usually can a fresh look. When I worked for transport we simulate equipment check to at night to avoid equipment failure when tired and hungry. Here have a novice go through the new protocol steps , this way you can find bumps and pit falls. Hope it helps.
  16. Hola , Some time ago I read this really good article by Petra Hüppi who performed an RCT on use EPO in sinergie with HiE. Also Dr.Nicola Roberston who quite a bit of work on this area.
  17. Neurally adjusted ventilatory assistance or NAVA is something that has been around for awhile. Available as a mode on the Maquet ventilator it uses an esophageal probe to sense myoelectrical activity in the diaphragm and provide assistance with postive pressure when detected. This is supposed to be better than the more traditional Graseby capsules or sensing based on airflow. Conceptually then if a preterm infant had a typical mixed apneic event with a component of both central and obstructive apnea this technology could sense an attempt to breath and assist the infant with positive pressure when the diaphragm indicates it is time for a breath. Such support should work to maintain functional residual capacity. A better ventilated lung could lead to less systemic oxygen desaturation and bradycardia correct? Retrospective review in Virginia Tabacaru CR et al just published NAVA—synchronized compared to nonsynchronized noninvasive ventilation for apnea, bradycardia, and desaturation events in VLBW infants. This is a retrospective study and non randomized looking at a single centres experience in 108 VLBW infants in which the attending providers were free to choose the type of respiratory support infants received after extubation. The authors from this group examined 61 epochs of time on niNAVA compared to 103 for the non invasive positive pressue ventilation nIPPV group. niNAVA patients received an initial level (the factor by which the electric diaphragmatic signal intensity (edi) is multiplied) of 1.0 and a PEEP of 5 to 6 cm H2O. NIPPV was initiated at a positive inspiratory prrssure (PI)P of 14 to 16 cm H2O, PEEP of 5 to 6 cm H2O and a rate of 20 breaths per minute. Adjustments were dictated by oxygenation and blood gases and were not described as protocolized but rather left up to clinicians. All events were recorded manually by nursing. What impact did niNAVA have on apnea and bradycardia? There were no significant differences noted between the two study groups including such important parameters as birthweight, day of life of extubation, sepsis or whether they needed to be reintubated. All of these could be markers of worse lungs in one group or the other so at least them seem pretty much the same. What about the effect on apnea and bradycardia? The bold numbers in the table indicate that only the number of bradycardias per day differed between the groups. Whether patients desaturation events or not was not affected. Also not effected was whether or not patients had apnea. Why might these results make sense? First off since the study was not randomized and is small there is always the possibility that these results are not real and occurred just by chance. There could be variables for example that we are not taking into account to explain why some patients were chosen for one modality or the other than affect the outcomes here. Having said that let’s look at the three outcomes. Apnea – why would this be different at all? Both modalities provide support when needed. If the infant decides to stop breathing I would see the lack of neural output not being affected by either modality so perhaps if the primary issue is lack of respiratory drive for most we wouldn’t expect a difference. Desaturation – if pulmonary reserve is kept about the same with both approaches it seems reasonable that we might not see a difference here either. Bradycardia – here there was a difference. Can this be explained as something plausible. I think there might be something here. Use of NAVA just might have a faster and more accurate response time than nIPPV that relies on airflow. Due to leaks around the prongs or mask it is possible that while background pressures are relatively maintained, not all needed positive pressure helping breaths are received in as timely a fashion as when they are detected via electrical activity. The ability of niNAVA to help the infant overcome the obstructive component of breathing might be reason why bradycardia is reduced. The interruption of ventilation is briefer with less reflexive bradycardia. What is needed of course next is a randomized prospective controlled trial. Who knows when that will come but for the infants that we see with seeminly methylxanthine resistant apnea might niNAVA be the path to avoiding reintubations? Time will tell
  18. Hi all, I'm very interested in the role rectal manipulations like rectal thermometry and the use of rectal tubes play in the development of constipation and NEC in the preterm infant. Would you like to share your protocols/guidelines/experiences with me? Do you use rectal thermometers in daily care? Do you use rectal tubes in daily care for air/stool relieve in (extreme) preterm infants? Do you experience constipation in the preterms? Thank you for sharing!
  19. I am one of the co-site PI's on a RCT called PAEAN (https://clinicaltrials.gov/ct2/show/NCT03079167). It is a multi centre, RCT looking at the use of EPO in babies with moderate or severe HIE that receiving therapeutic hypothermia. We are approximately 2/3 through recruiting for this study and hopefully these results can answer your question! Sorry, no answers but thought I would share that!
  20. In Linköping we have developed a structure on how to do this in deliveryroom on ELBW less than GW28. It works pretty well if you manage to deal well with the logistic. Receive on the foot-end of deliverybed between the legs of the mother, put the baby in a nest covered by plastic, using a mobile Neopuff with humidified warm gas, Starting with CPAP only awaiting the respond of heartrate and spontaneous breathing, ventilating only if bradycardia, delayed cordclamping. Incubator Close to the bed, connected to mobile CPAP/Ventilator. If intubation immediate Surfactant instillation. We have planned to enhance it into all Babies less than GW32 (33?). Working on a video on it. Apart from a mobile neopuff, an incubator in Place and a mobile CPAP/ventilator you don´t need any extra equippment. But a well trained team and clear logistic is crucial (protocol). /Per
  21. Currently we never cut the ETT, as per the new ventilator technology will enable us to read all necessary parameters required to monitor our ventilation settings and the baby adaptation to MV.
  22. We used to cut and stop because the repositioned problems. Never cut in HFO.
  23. Hi @olamedmac Do you know if there is a protocol for delayed cord clamping available online? I have looked into the ressource you recommended at the 99nicu meetup in Copenhagen this year, [https://www.frontiersin.org/articles/10.3389/fped.2018.00372/full] but I havent found answers for the following questions: * best way to keep infants warm during DCC born by caesarean? * is the infant placed on or next to the mother during DCC? Thanks! Francesco
  24. until

    Anyone else coming to jENS? I am coming and would be great to meet up with other 99nicu members! I will mostly be in the "startup"-part of the exhibition (with Neobiomics) - come by and we make a plan!
  25. Rola alzir

    Withdrawal

    Why do we call it NAS not drug withdrawal syndrome in neonatal age group ?
  26. I would urge caution in assuming that tight glycemic control improves patient centered outcomes, though certainly, it would appear that if one were to test that hypothesis, it might be worthwhile to test it using such a closed loop system to give the intervention the best chance at success.
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    • We measure axillary temps (most often parents do it  )
    • Thank you all for your answers! In our unit this is a nursing decision as well. I feel like we use manipulation a lot and wonder about the implications on short and long term. What temperature method do you use as standard of care?
    • We also practise some manipulation in preterm infants but only if otherwise well (preterm infants with functional GI problems) - if we suspect NEC, manipulation is a no-no. This practise is usually not a doctor's decision, usually nursing staff decide to do this if they believe it helps.
    • Who is working with the interfaces for CPAP of STEFAN?                                                                                                                                                                                                                                                            Many users in Germany? NICU level 3? Although we are working with the Flexitrunk and the VYGON at two different locations, we might be looking for a new system, hoping to find experience in this CPAP interface.  https://www.stephan-gmbh.com/en/products/easyflow-ncpap/
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