After the software upgrade 3 Aug, the membership registration did not work. This error is now fixed.

If you have any questions on how to register or log in, please email info@99nicu.org

Jump to content

99nicu... Your Forum in Neonatology!

Welcome to 99nicu, the web community for staff in neonatal medicine!

Become a member for full access to all features: get and give advice in the forums, start your own blog and enjoy benefits! Registration is free :) - click here to register!

Greetings from the 99nicu HQs

  • What's on 99nicu

    Browse the latest updates below! You can also browse the sidebar for latest topics, blog posts and articles!

All Activity

This stream auto-updates     

  1. Yesterday
  2. Although we have not yet nailed the venue or date for the next 99nicu Meetup (April 2018, in Vienna!), we want to start to crowdsource the program In short, we are searching for topics YOU want to see in the program! No matter how controversial, evidence-based, or big or small, we want your input on topics that help you perform better in the NICU, thereby improving long-term outcomes infants you care for. Also share your dream team of speakers from any corner of the world, who are dedicated, engaging and know how to convey take-home messages! Of note, we are not only looking for superstars. We also want to offer the 99nicu Meetup stage for raising stars. Maybe YOU should come and give a talk
  3. All videos from the 99nicu Meetup is now available!

    At last, all video recordings* of the Meetup lectures are now posted on Youtube! Sorry about the DIY quality Next year we hope to have budget for more professional recordings, but I hope that you will find the lectures good enough. If you value the videos as a good learning experience, please consider to make a small donation here. No matter how small, all donations are mostly welcome to help us fund IT-costs for the 99nicu web site. And here - the 99nicu Meetup playlist! Click on the symbol in the upper left corner to switch/change to another video. *not all videos are included as not the recording failed in a few instances
  4. Difficult Neonatal Airway Videos

    Great thanks
  5. Last week
  6. Work-Life Balance as a Neonatologist

    Hello, I am a 3rd year medical student interested in neonatology, but have heard that the work-life balance is pretty difficult and it can be hard to be a good husband/father (or wife/mother) because of the schedule. Most of the practices that I have seen or heard about generally have doctors work ten 24hr shifts per month, which is a 24hr shift every 3 days so you're either on call, post-call, or pre-call all the time. I have talked with a handful of neonatologists about this but I was wondering if I could get a broader perspective on this topic? Thank you!
  7. Life, and Medicine, with a Disability

    @kbarrington Thanks for sharing this great post here (saw it on your blog last week), and great you enlighten everyone about the paywall-thing
  8. I met the author of this article at a CPS meeting a few years ago, she immediately impressed me with her unique perspective. Paige is a developmental pediatrician who does long-term follow-up of preterms, and is involved in developmental evaluation and intervention of children with other challenges, including Spina Bifida. Church P. A personal perspective on disability: Between the words. JAMA Pediatrics. 2017. As you will see if you read the article, Paige has a form of Spina Bifida herself, a Lipomyelomeningocele, with a neurogenic bladder and neurogenic bowel, requiring life-long interventions. She discusses the poor tolerance many medical people have of disability, and such how things are often discussed as black or white, whereas having a profound personal experience of disability has made her much more nuanced. She recounts being involved in a discussion regarding a "selective reduction" of a twin pregnancy where the twin being considered for "reduction", i.e. abortion, had a similar lesion to her own. That is an experience that I can barely understand: how would I react if a family was considering terminating a pregnancy because of a condition that I had? Paige recounts the episode with tact and humanity. I can imagine, as I have heard them many times, the words of the other physicians involved in such a decision, I am sure they talked about handicaps and limitations, poor quality of life, pain, and restrictions on family life. Most of which is said with good intentions but with no real knowledge of the literature, or of the range of experiences of families living with the challenges. Just as with similar discussions regarding extreme preterm infants, a list of complications, interventions, disabilities, and long-term problems is often presented, but with no similar list of benefits, achievements, abilities, long-term adaptation, and happiness. Near the end of her moving piece Paige writes: Like most things in life, and medicine, disability is sharp, painful, humbling, as well as tremendous, giving, awe-inspiring. It is human. It is not easily distilled to an all or none discussion. Medicine sets the tone for this discussion and, to date, has done a miserable job. More is needed to appreciate the incredible opportunities that disability poses. More education is needed to provide the counselling families deserve: balanced, sensitive, thoughtful, and individualized rather than “objective.” I sincerely hope that this piece by Paige will be part of a new discussion about these issues. (Of note, even though the article is behind a paywall, JAMA lets you see the first page of the article before buying, in this case there is only one page, so you can read the whole thing for free!)
  9. hi .. i want to know if any one have a job description for neonatal intensive care unit physicians and nurse ??? please send if you have
  10. I know how to bag a baby. At least I think I do. Providing PPV with a bag-valve mask is something that you are taught in NRP and is likely one of the first skills you learned in the NICU. We are told to squeeze the bag at a rate of 40-60 breaths a minute. According to the Laerdal website, the volume of the preterm silicone bag that we typically use is 240 mL. Imagine then that you are wanting to ventilate a baby who is 1 kg. How much should you compress the bag if you wish to delivery 5 mL/kg. Five ml out of a 240 mL bag is not a lot of squeeze is it? Think about that the next time you find yourself squeezing one. You might then say but what about a t-piece resuscitator? A good choice option as well but how much volume are you delivering if you set the initial pressures at 20/5 for example? That would depend on the compliance of the lung of course. The greater the compliance the more volume would go in. Would it be 5 mL, 10 ml or even 2.5 mL based on the initial setting? Hard to say as it really depends on your seal and the compliance of the lung at the pressure you have chosen. If only we had a device that could deliver a preset volume just like on a ventilator with a volume guarantee setting! Why is this holy grail so important? It has been over 30 years since the importance of volutrauma was demonstrated in a rabbit model. Hernandez LA et al published Chest wall restriction limits high airway pressure-induced lung injury in young rabbits. The study used three models to demonstrate the impact of volume as opposed to pressure on injuring the lung of preterm rabbits. Group 1 were rabbit ventilated at pressures of 15/30/45 cm H2O for one hour, group 2 rabbits with a cast around their thorax to limit volume expansion and group 3 sets of excised lungs with no restriction to distension based on the applied pressures. As you might expect, limitation of over distension by the plaster cast led the greatest reduction in injury (measured as microvascular permeability) with the excised lungs being the worst. In doing this study the authors demonstrated the importance of over distension and made the case for controlling volume more than pressure when delivering breaths to avoid excessive tidal volume and resultant lung injury. The “Next Step” Volume Ventilator BVM Perhaps I am becoming a fan of the Edmonton group. In 2015 they published A Novel Prototype Neonatal Resuscitator That Controls Tidal Volume and Ventilation Rate: A Comparative Study of Mask Ventilation in a Newborn Manikin. The device is tablet based and as described, rather than setting a PIP to deliver a Vt, a rate is set along with a volume to be delivered with a peep in this case set at +5. This study compared 5 different methods of delivering PPV to a 1 kg preterm manikin. The first was a standard self inflating bag, the next three different t-piece resuscitators and then the Next Step. For the first four the goal was to deliver a pressure of 20/5 at a rate of 40-60 breaths per minute. A test lung was connected to the manikin such that each device was used for a one minute period at three different levels of compliance (0.5 ml/cmH2O, 1.0 ml/cmH2O and then 2.0 ml/cm H2O representing increasing compliance. The goal of the study was to compare the methods in terms of delivering a volume of 5 mL to this 1 kg model lung. The order in which the devices were used was randomized for the 25 participants in the study who were all certified in NRP and included some Neonatologists. Some Concerning Findings As I said at the beginning, we all like to think we know how to ventilate a newborn with BVM. The results though suggest that as compliance increases our ability to control how much volume we deliver to a lung based on a best guess for pressures needed is lacking. One caveat here is that the pressures set on the t-piece resucitators were unchanged during the 1 minute trials but then again how often during one minute would we change settings from a starting point of 20/5? Vt (mL) 0.5 mL/cmH20 1.0 mL/cmH20 2.0mL/cmH20 Self inflating 11.4 17.6 23.5 Neo-Tee 5.6 11.2 19.3 Neopuff 6.1 10 21.3 Giraffe 5.7 10.9 19.8 Next Step 3.7 4.9 4.5 Without putting in all the confidence intervals I can tell you that the Next Step was the tightest. What you notice immediately (or at least I did) was that no matter what the compliance, the self inflating bag delivers quite an excessive volume even in experienced hands regardless of compliance. At low compliance the t-piece resuscitators do an admirable job as 5-6 ml/kg of delivered Vt is reasonable but as compliance improves the volumes increase substantially. It is worth pointing out that at low compliance the Next Step was unable to deliver the prescribed Vt but knowing that if you had a baby who wasn’t responding to ventilation I would imagine you would then try a setting of 6 ml/kg to compensate much like you would increase the pressure on a typical device. How might these devices do in a 29 week infant for example with better compliance than say a 24 week infant? You can’t help but wonder how many babies are given minutes of excessive Vt after birth during PPV with the traditional pressure limited BVM setup and then down the road how many have BPD in part because of that exposure. I wanted to share this piece as I think volume resuscitation will be the future. This is just a prototype or at least back then it was. Interestingly in terms of satisfaction of use, the Next Step was rated by the participants in the study as being the easiest and most comfortable to use of all the devices studied. Adding this finding to the accuracy of the delivered volume and I think we could have a winner.
  11. Earlier
  12. Port Said Eighth Neonatology Conference

    until
    ort Said Neonatology Society is honored to invite you to its Eighth Neonatology Conference 18-21 October 2017 Venue: Al Fayrouz resort Port Said Six Pre -conference workshops: Wednesday 18th & Friday 20th of October Conference sessions: Thursday 19th & Friday 20th of October Registration linkConference website
  13. Port Said Neonatology Society is honored to invite you to its Eighth Neonatology Conference 18-21 October 2017 Venue: Al Fayrouz resort Port Said Six Pre -conference workshops: Wednesday 18th & Friday 20th of October Conference sessions: Thursday 19th & Friday 20th of October Registration link
  14. Orphanet

    Orphanet is a web portal for rare diseases and orphan drugs. Orphanet was established in France in 1997 at the advent of the internet in order to gather scarce knowledge on rare diseases so as to improve the diagnosis, care and treatment of patients with rare diseases. This initiative became a European endeavour from 2000, supported by grants from the European Commission: Orphanet has gradually grown to a Consortium of 40 countries, within Europe and across the globe. Over the past 20 years, Orphanet has become the reference source of information on rare diseases. As such, Orphanet is committed to meeting new challenges arise from a rapidly evolving political, scientific, and informatics landscape. In particular, it is crucial to help all audiences access quality information amongst the plethora of information available online, to provide the means to identify rare disease patients and to contribute to generating knowledge by producing massive, computable, re-usable scientific data.
  15. until
    3rd Abu Dhabi International Neonatal Multi Specialty Conference t Abu Dhabi from 16 -18 November , 2017 - Ritz Carlton Hotel - Abu Dhabi – UAE http://www.abudhabinms.com/
  16. Science Showcase

    I subscribe to the small Youtube channel Science Showcase curated by Andrew Maynard, a very enthusiastic researcher! Science Showcase collect video clips with scientific content aimed for a broader (public) audience. There is a contest going on and the best video will win 2000 USD. Just wanted share two interesting clips that are sort of relevant for neonatal staff. The first video is about epidemiology and its basic concepts. As you know, there are tons of clinical studies in neonatal medicine based on observational data, many of which suffer from major limitations as researchers did not really grasp some basic concepts how to handle their data... In the first video, there is one mistake though - the illustration of confounding is not entirely correct, instead the video illustrates mediation which is different thing. Small mistake though, as the error in the video is rather that the arrow is flipped 180 degrees. See and find out what I mean The second video is about Big Data, a coming major thing in neonatal research as we get access and collect more and more data. The video is about genetic data, but the same principal idea ("so much data you don't know how to handle it") applies to health register data, and the richness of data that could be tanked down from from our monitors, ventilators etc. Enjoy!
  17. 4th EBNEO conference

    until
    Welcome to the 4th international Conference for Evidence-Based Neonatology, 10-12 November 2017, in Hyderabad India! As the number of articles world-wide in the medical press explodes, the importance of understanding and disseminating the principles of Evidence Based Medicine becomes greater. This is a central focus of the Society of EBNEO. At this Fourth international meeting of our young society, as in prior meetings – we include talks with both neonatal contents and clinical epidemiological methodology. We hope that this meeting will facilitate an international on-going collaboration and interchange. This meeting will be in association with Indian Association of Pediatrics Neonatology Chapter. There are two organizational features that are new at this year’s meeting. Firstly, we will have two workshops: one on advanced methods for meta-analysis. Secondly a workshop on running randomized controlled trials in the less well-resourced countries. In addition we have now almost 2 years after having launched the “EBNEO Journal Club”. The intent of this was to provide a structured synopsis of studies to allow a quick methodologically based over-view. It follows the model of the American College of Physicians Journal Club – which has proven an effective leaning and dissemination tool. These are now being published with pubmed referencing at Acta Paediatrica. In all of these ventures – there is ample opportunity for all neonatologists interested in methodologically based Neonatal care – to participate – from the ground level! Register to the conference by following the instructions below. We hope to see you at this exciting venture! Dr. Srinivas Murki and Dr. Vasudeva Murli on behalf of IAP Neochap Associate professor Stefan Johansson, professor Haresh Kirpalani, professor Mikael Norman and associate Professor Clyde Wright; on behalf of EBNEO Conference folder and program Click here to download the conference folder with general information. Click here to download the preliminary program.
  18. Welcome to the 4th international Conference for Evidence-Based Neonatology, 10-12 November 2017, in Hyderabad India! As the number of articles world-wide in the medical press explodes, the importance of understanding and disseminating the principles of Evidence Based Medicine becomes greater. This is a central focus of the Society of EBNEO. At this Fourth international meeting of our young society, as in prior meetings – we include talks with both neonatal contents and clinical epidemiological methodology. We hope that this meeting will facilitate an international on-going collaboration and interchange. This meeting will be in association with Indian Association of Pediatrics Neonatology Chapter. There are two organizational features that are new at this year’s meeting. Firstly, we will have two workshops: one on advanced methods for meta-analysis. Secondly a workshop on running randomized controlled trials in the less well-resourced countries. In addition we have now almost 2 years after having launched the “EBNEO Journal Club”. The intent of this was to provide a structured synopsis of studies to allow a quick methodologically based over-view. It follows the model of the American College of Physicians Journal Club – which has proven an effective leaning and dissemination tool. These are now being published with pubmed referencing at Acta Paediatrica. In all of these ventures – there is ample opportunity for all neonatologists interested in methodologically based Neonatal care – to participate – from the ground level! Register to the conference by following the instructions below. We hope to see you at this exciting venture! Dr. Srinivas Murki and Dr. Vasudeva Murli on behalf of IAP Neochap Associate professor Stefan Johansson, professor Haresh Kirpalani, professor Mikael Norman and associate Professor Clyde Wright; on behalf of EBNEO Conference folder and program Click here to download the conference folder with general information. Click here to download the preliminary program.
  19. Is this for real?!

    I would consider myself fairly open minded when it comes to care in the NICU. I wouldn’t call myself a maverick or careless but I certainly am open to new techniques or technologies that may offer a better level of care for the babies in our unit. When it comes to “non-Western” concepts though such as therapeutic touch, chiropractic manipulations of infants and acupuncture (needle or otherwise) I have generally been a skeptic. I have written about such topics before with the most popular post being Laser acupuncture for neonatal abstinence syndrome. My conclusion there was that I was not a fan of the strategy but perhaps I could be more open to non traditional therapies. Magnetic Acupuncture This would appear to be the newest and perhaps strangest (to me at least) approach to pain relief that I have seen. I do love name of this study; the MAGNIFIC trial consisted of a pilot study on the use of auricular magnetic acupuncture to alleviate pain in the NICU from heel lances. The study was published in Acta Paediatrica this month; Magnetic Non-Invasive Acupuncture for Infant Comfort (MAGNIFIC) – A single-blinded randomized controlled pilot trial. The goal here was to measure pain scores using the PIPP scoring system for pain in the neonate before during and after a painful experience (heel lance) in the NICU. Being a pilot study it was small with only 20 needed per arm based on the power calculation to detect a 20% difference in scores. The intervention used small magnets placed at specific locations on the ear of the infant at least two hours before the heel lance was to occur. Before I get into the results, the authors of the study provide references to explain how the therapy works. Looking at the references I have to admit I was not able to obtain complete papers but the evidence is generally it would appear from adult patients. The explanation has to do with the magnetic field increasing blood flow to the area the magnet is applied to and in addition another reference suggests that there are affects the orbitofrontal and limbic regions which then impacts neurohormonal responses as seen in functional MRI. The evidence to support this is I would have thought would be pretty sparse but I was surprised to find a literature review on the subject that looked at 42 studies on the topic. The finding was that 88% of the studies reported a therapeutic effect. The conclusion though of the review was that the quality of the included studies was a bit sketchy for the most part so was not able to find that this should be a recommended therapy. So what were the results? Despite my clear skepticism what this study did well was that aside from the magnets, the intervention was the same. Twenty one babies received the magnetic treatments vs 19 placebo. There was a difference in the gestational ages of the babies with the magnet treated infants being about two weeks older (35 vs 33 weeks). What difference that might in and of itself have on the PIPPs scoring I am not sure. The stickers were applied to the ears with and without magnets in a randomized fashion and the nurses instructed to score them using the PIPP scoring system. Interestingly, as per their unit policy all babies received sucrose as well before the intervention of a heel lance so I suppose the information gleaned here would be the use of magnets as an adjunctive treatment. No difference was noted in the two groups before and after the heel lance but during the procedure the magnet treated infants had a difference in means (SD): 5.9 (3.7) v 8.3 (4.7), p=0.04). No differences were found in secondary measures such as HR or saturation and no adverse effects were noted. The authors conclusions were that it was feasible and appears safe and as with most pilot studies warrants further larger studies to verify the results. Should we run out and buy it? One of the issues I have with the study is that in the introduction they mention that this treatment might be useful where kangaroo care (KC) is not such as a critically ill infant. Having placed infants who are quite sick in KC and watched wonderful stability arise I am not sure if the unit in question under utilizes this important modality for comfort. The second and perhaps biggest issue I have here is that although the primary outcome was reached it does seem that there was some fishing going on here. By that I mean there were three PIPP scores examined (before, during and after) and one barely reached statistical significance. My hunch is that indeed this was reached by chance rather than it being a real difference. The last concern is that while the intervention was done in a blinded and randomized fashion, the evidence supporting the use of this in the first place is not strong. Taking this into account and adding the previous concern in as well and I have strong doubts that this is indeed “for real”. I doubt this will be the last we will hear about it and while my skepticism continues I have to admit if a larger study is produced I will be willing and interested to read it.
  20. Three new videos from the Meetup!

    There is now three more videos from the 99nicu Meetup posted on the "Meetup17" page about: NAVA-ventilation Probiotics Perinatal care differences in EU Find the Meetup17 page in the navigation bar above. Enjoy !
  21. Neonatal Ethics and Difficult Situations Course

    Sounds like a very interesting programme!
  22. Dear Colleagues We are organising the next Neonatal Ethics and Difficult Situations Course 2017 in Southampton. There are a host of excellent topics which include 1. Disagreement between teams -Achieving Consensus 2. Disagreement with Parents-When consensus is not possible? 3. Parental decision making in End of Life Care 4. The Law and End of Life Care: Land Mark Decisions Influencing Management 5. Simulated scenarios with professional actors 6. Neonatal death and Surrogacy 7. Ethical Cases A programme is attached. For more information go to http://www.wonepedu.com/Products.html To register go to https://www.surveymonkey.com/r/NEOETHICCOURSE An over view of how we conduct the simulations is provided here Best Wishes Dr Alok Sharma Consultant Neonatologist Princess Anne Hospital Southampton United Kingdom Email wonepedu@gmail.com NEDS6.pdf
  23. Dear Colleagues We are organising the next Neonatal Ethics and Difficult Situations Course 2017 in Southampton. There are a host of excellent topics which include 1. Disagreement between teams -Achieving Consensus 2. Disagreement with Parents-When consensus is not possible? 3. Parental decision making in End of Life Care 4. The Law and End of Life Care: Land Mark Decisions Influencing Management 5. Simulated scenarios with professional actors 6. Neonatal death and Surrogacy 7. Ethical Cases A programme is attached. For more information go to http://www.wonepedu.com/Products.html To register go to https://www.surveymonkey.com/r/NEOETHICCOURSE An over view of how we conduct the simulations is provided here Best Wishes Dr Alok Sharma Consultant Neonatologist Princess Anne Hospital Southampton United Kingdom Email wonepedu@gmail.com NEDS6.pdf
  24. Rare diseases

    The database of rare diseases, like congenital syndromes, by the National Board of Health, Sweden. the database is in English
  25. This paper was recently published in J of Pediatr, read it Thanks to @EBNEO that promoted it in this tweet. The headline and study question are both great, but I am sceptical to the design: SGA infant with brain sparing was (as I See it from my vacation balcony in Greece ) compared with a small group of term AGA infants. (96 + 32 infants) Not surprisingly, this small study found mostly no differences. but as you know - abscense of evidence is not evidence of abscense. would have been better if SGA infants with brain sparing had been compared with SGA infants without it (or study whether degree of SGA would be associated with outcomes). Not supernew (has been done before if I recall it correctly) but still relevant to replicate Below - URL to the paper in J of Pediatr www.jpeds.com/article/S0022-3476(17)30781-3/
  1. Load more activity
×