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I’d love to hear from the 99NICU community about your go-to references.A few years ago, our team cared for a remarkable mother whose story reminded us how much nuance—and teamwork—breastfeeding counseling can require. She had undergone a liver transplant as a teenager and remained on lifelong anti-rejection medications. Years later, she delivered a healthy full-term baby and had a strong, heartfelt wish to breastfeed.As you can imagine, her medications raised questions about safety and infant exposure. Instead of defaulting to “no,” our team—neonatologist, clinical pharmacist, and the mother’s own transplant specialist—reviewed each drug carefully. We dove deep into pharmacokinetics and pharmacodynamics, half-lives, peak serum times, and milk-plasma ratios. The goal was to adapt the medication schedule to support breastfeeding, rather than ask her to give up breastfeeding because of the medications.Together, we developed a practical plan:• She could directly breastfeed from 7 AM to 7 PM.• She would take her immunosuppressive dose immediately after 7 PM and avoid breastfeeding until 7 AM the next morning.• She would pump at least twice overnight to maintain supply, but this milk would be discarded.• Her baby would receive formula as needed during the nighttime window.With this tailored approach, she was able to partially breastfeed her baby for eight months, which meant the world to her. For us, it was a powerful reminder that with the right information—and interprofessional collaboration—we can often make breastfeeding possible even in complex medical situations. This case was one that helped me shape my personal practice when it comes to breastfeeding support and orientation. It also highlighted how important it is to have trustworthy, up-to-date resources on medication safety in lactation.So I’m curious: what resources do you rely on to check whether a medication is compatible with breastfeeding?Have you managed similar cases you would like to share, and what tools or references were most helpful (e.g., online databases, institutional guidelines, books, lactation pharmacology experts)?Would love to learn from your experience!

I suppose many of you already know and follow the Tiny Baby Collaborative, and international research group dedicated to improving the lives of children born at ≤23 weeks’ gestation and their families.They do excellent educational webinars about this niche population of preterm infants.You find them all on their site here -> https://www.tinybabycollaborative.org/webinarsCheck out the latest below:

Welcome to the MPROvE Academy YouTube channel. Over 300 videos covering Neonatal procedures, Point of Care US, Neonatal and Perinatal Ethics, Human factors Training, Quality MPROvEment and much moreWe have added 50 new videos on point of care US in neonatologyFree to watch and lots of new topics coveredhttps://m.youtube.com/%40mprove-multiprofessionalne4091?fbclid=IwVERDUAN6Z7RleHRuA2FlbQIxMABzcnRjBmFwcF9pZAwzNTA2ODU1MzE3MjgAAR6I8xSCw_v-LjD1N9sryNQGTJu055JcfIgzScqZAVSrhMaKbUmGfiBd9MsqtQ_aem_jy3ORcH9qqT2W9XdtU0FeQ

Preterm, severe RDS, ventilated, tension pneumothorax resolved with chest drain, no reaccumulation for >24 hours, low MAP, FiO2 25%, off iNO. Which you would do first - extubate or remove chest drain?

Hi everybody! We are conducting a survey to assess the perceptions and/or use of autologous cord blood transfusion for neonatal cardiac surgery. Please, all of you working with congenital heat disease, help us out! It will only take 5 minutes. Thank you so much!https://forms.office.com/e/PU1Z0pexXN

IntroductionYou receive an urgent call to evaluate a term newborn whose mother had gestational diabetes on insulin. The baby appeared normal at birth but has become increasingly lethargic and jittery in the first few hours of life, with poor feeding reported by nursing staff.This case challenges your ability to quickly recognize and manage a common but potentially serious metabolic complication in infants of diabetic mothers. Can you identify the underlying problem and implement appropriate treatment before neurological damage occurs?Important Notes:You must log in to take this quiz and all future quizzesEach question builds on information from previous questionsThis quiz has mainly ONE right answer, in case of MULTIPLE right answers you will be notified by "Select all that apply".The case follows a realistic clinical progression with laboratory findings and management decisionsDISCLAIMER: We do not guarantee that the "correct answer" in a quiz is 100% correct. Never base your clinical decisions on a quiz!Quiz Authors: Eliska Mikeskova @Eli, Victoria Payne @Vicky Payne , Katarzyna Piatek @piatkatExpert Revision by: Stefan Johansson @Stefan Johansson and Mariana Oliveira @Mariana OliveiraThis educational quiz is based on review papers:https://bmjmedicine.bmj.com/content/bmjmed/3/1/e000544.full.pdfhttps://publications.aap.org/neoreviews/article-abstract/22/4/e230/180672/Congenital-Hyperinsulinism?redirectedFrom=fulltext

Mahmoud Abdelreheem & Hassanein Moustafa from UK review the paper 'Li Y, Wisnowski JL and Chalak L, et al. Mild hypoxic-ischemic encephalopathy (HIE): timing and pattern of MRI brain injury. Pediatr Res. 2022 Dec;92(6):1731-1736. doi: 10.1038/s41390-022-02026-7. Epub 2022 Mar 30. PMID: 35354930; PMCID: PMC9771796.' for EbNeo.Read Here!ACTA Commentary:Acta Paediatrica - 2025 - Abdelreheem - EBNEO Commentary Mild Hypoxic Ischemic Encephalopathy HIE Timing and Pattern of.pdf"Neonatal hypoxic-ischaemic encephalopathy (HIE) remains one of the leading causes of neonatal mortality and long-term disability worldwide. Infants with mild HIE, representing 50% of all HIE cases, are often perceived as low risk, with excellent prognosis and no long-term disability. However, recent studies have shown that one-quarter of infants with mild HIE have abnormal outcomes defined as death, motor impairment, or developmental delay at follow-up up to 18 months [1].This study examines the evolution and spatial distribution of brain injuries on MRI in neonates with mild HIE. It addresses a significant gap in literature and has important implications for early diagnosis, prognosis, and treatment strategies. Brain parenchymal injury was present in 87 (61%) infants, and intracranial hemorrhage was observed in 60 (42%) infants.The authors recruited 142 neonates, although only 125 were included in certain analyses, likely due to incomplete imaging. This transparent reporting enhances the credibility of the findings by ensuring that the data analyzed were of high quality. This study highlights how subtle brain injuries evolve over time, confirming that early detection may allow for timely interventions [2, 3]. Moreover, this study explores brain injury patterns, revealing that even mild HIE can cause noticeable changes in brain structure. Identifying these patterns is vital, as it helps clinicians differentiate HIE-related changes from other neonatal brain pathologies. This informs clinical decisions, including whether to consider therapeutic hypothermia (TH) in borderline cases [4]. Additionally, the study’s use of advanced MRI techniques underscores the potential of neuroimaging as both a diagnostic and prognostic tool in neonatal care.However, the study has limitations, notably the small number of infants who did not receive TH, which may limit the generalizability of the findings. The authors also acknowledge variability in MRI protocols across institutions, the lack of EEG data, and potential selection bias toward initiating TH in more severely affected infants within the mild HIE spectrum. Notably, there have been no randomized controlled trials evaluating the efficacy of TH in mild HIE, and many centers continue to question its utility in this population.Clinically, the implications of this work are twofold. First, it emphasizes the need to monitor neonates with mild HIE, as subtle injuries may have long-term neurodevelopmental consequences. Second, it supports incorporating MRI into routine evaluation, facilitating identification of infants who could benefit from neuroprotective interventions. The findings also advocate for further studies to evaluate the efficacy of TH and other therapeutic agents, leading to individualized management strategies for affected infants [5, 6].In summary, this study delivers a well-designed investigation that enhances our understanding of mild HIE. It lays the groundwork for future research aimed at optimizing the timing of neuroimaging and improving outcomes through early intervention. The study serves as a reminder that even mild insults to the neonatal brain warrant careful attention due to their potential to impact long-term development [7]. Future studies with larger cohorts and standardized imaging protocols are needed to confirm these observations and refine MRI timing in mild HIE cases."

Hello everyone! I'd love to hear your thoughts on the management of hemodynamically significant patent ductus arteriosus (PDA). This new article and its recommendations have left me with many questions. before the releae of these news recommendation , in our service, we only treat hemodynamically significant PDA within the first 7 days of life, primarily in patients under 28 weeks' gestational age. We know that the efficacy of medical treatment drops significantly after this age. Our approach is to opt for surgery only if the PDA doesn't close after two series of medical treatment, and we try not to delay the surgical intervention too much.I'm very interested in learning about your management strategies.jamapediatrics_buvaneswarran_2025_oi_250021_1747406474.87605.pdf

Dear colleagues,I would love to read your thoughts on how you manage moderate/late preterm infants admitted in the NICU who do not have enough mother's milk. How do you feed them? Do you prefer to keep them on IV fluids/PN until MOM is available? Do you have unlimited donor milk to use for every baby? How is your level of concern about cow's milk allergy (CMA)?I work in a teaching hospital in South Brazil and I'm an enthusiast (aren't we all?) on improving breastfeeding rates in the NICU.How things work here: we have a limited resource of human donor milk, so we prioritize it to newborns under 32 weeks (when MOM is not available, of course). For babies older than that, when MOM is not available, we are using hydrolyzed formula in the first 24 hours - as an intention to try to avoid early exposure to cow's milk protein. I am very aware that we don't have good evidence for that. In the ESPGHAN position paper on CMA (https://www.espghan.org/knowledge-center/publications/Gastroenterology/2024-Diagnois-and-Management-of-Cows-Milk-Alergy), it might seem OK to give hydrolyzed formula, and I like the thoughts on how offering this different type of formula might help parents to see it as something temporary. The thing is sometimes babies keep on receiving hydrolyzed formula for longer than 24 hours, and we also do not have enough of that. New thoughts on CMA prevention seem to go on a way that probably continue exposure to CMP might help prevent allergies. So, probably, offering hydrolyzed formula to babies who will stay longer in NICU might not be a good idea. Maybe later on I'll start a new topic on CMA in NICU too :)

Test your diagnostic and management skills with our newest quiz: "Critical Care Challenge: Unexpected Complications in a Premature Infant" - can you navigate the complex clinical course of a preterm neonate with multiple emerging complications?

I wanted to share a few Journal Clubs that @EBNEO did a few years back, great educational videos that are published on their Youtube account.I suggest that one watches them in the order as embedded below!P-values - should it be this simple?Interpreting effectsNetwork meta-analyses

How long can a Umbilical Artery line and an Umbilical Venous Line be used in an ELBW neonate when PICC line is not available. Various centers follow different protocols. Your views please

Early bird registration closes soon!
Are you a clinician looking to advance your neonatal ultrasound skills? Join us for the Neonatal Hemodynamics and POCUS Course, happening May 21–23, 2025, in Gothenburg, Sweden.
Register by February 28 to take advantage of the early bird rate. After that, prices go up.
This hands-on course covers key neonatal ultrasound applications:
• Neonatal Hemodynamics – Understanding cardiovascular physiology and management
• Targeted Neonatal Echocardiography (TnEcho/NPE) – Developing skills for bedside cardiac assessment
• Vascular Access POCUS – Mastering ultrasound-guided line placement
• Lung Ultrasound – Enhancing respiratory diagnostics and management
Expect expert-led sessions, practical case-based learning, and valuable networking opportunities. We’ve also organized optional social events to make the experience even better.
Sign up now and secure your spot: https://neonataltraining.org/registration
Know someone who shouldn’t miss this? Tag them in the comments.
#Neonatology #POCUS #MedicalEducation #NICU #NeonatalHemodynamics #TnEcho #VascularAccess #LungUltrasound #PointOfCareUltrasound #EarlyBirdDiscount

Hello everyone, I am a third-year medical student from Brazil and we recently discussed an insightful retrospective study published in the Journal of Perinatology titled Don't Wait, Vaccinate. It compared the incidence of cardiorespiratory events in preterm infants receiving all routine 2-month vaccines on a single day versus on multiple days. The study found no significant difference in events like prolonged apnea or bradycardia between the groups. Single-day administration, however, reduced schedule interruptions, improving adherence to vaccination timelines. I'd like to hear your thoughts: Have you observed differences in outcomes with single-day vs. multi-day vaccination schedules? What factors should guide this decision in the NICU? Looking forward to your insights! Ep43_vaccine.pdf

How do you start and progress with enteral feeds in near term/term infants in the NICU?