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TL;DR: What's Changed and WhyReading full discussions now requires login. Questions remain visible to everyone, but replies and expert responses are members-only.Why? Our members share knowledge under their real identities. We believe readers should be part of the community too. Registration is free, takes under a minute, and unlocks 20 years of peer-to-peer neonatal knowledge.Key points:Homepage and news stay openQuestions are visible; answers require loginYour profile is visible to members — be thoughtful about what you shareNever include patient-identifying information in discussionsThe platform grows when you participate — share your experienceBottom line: The questions are open. The expert knowledge is for members. If you're not registered yet, join us — it's free, quick, and connects you to neonatal colleagues in 75+ countries.You might have noticed while browsing 99nicu recently: reading the full discussions now requires you to be logged in.The first post of any thread remain visible to everyone, like the news updates and feeds. But to read replies and join the conversation, you'll need to log in as a member.We know this adds a step. Here's why we're doing it, and how we're working to make it worthwhile.________________________________________Why This Matters?For 20 years, 99nicu is built on professional exchange by NICU staff. When you contribute here, you're part of a community where many members use their real names and affiliations when sharing their clinical experience, knowledge, and personal insights. Our members are willing to be known, and we believe the readers should be, too.________________________________________What You Need to KnowRegistration is free and always will be. No fees, no paywalls, no corporate gatekeeping. Just a basic account, that takes one minute to register for, and then you just need to await our manual approval of your account (usually within 24 hours).Homepage News , Blogs and Calendar remain open. Many sections remain open/public for browsing without logging in, including the Homepage, the Latest Research feed.Discussion Forum Topics are visible to everyone. You can see the first post in all Discussions, what colleagues are asking, but to read answers and expert responses, you need to log in.Posting and commenting requires login. Only members can contribute to discussions.We don't verify institutional emails. You can register with any email address. We trust you to be part of this professional community in good faith, but please remember to be thoughtful about what and how you post. Your profile information is visible to other members.Be mindful when sharing patient-related information. While clinical discussions are essential to our community, you must respect patient confidentiality and integrity. Never include information that could potentially identify a patient or family. When discussing specific cases, parental consent is recommended. You are responsible for ensuring your posts comply with your national laws and regulations regarding patient privacy. See our [privacy policy] and [registration terms] for details.Stay logged in with the 99nicu app. Available for iOS and Android, the app keeps you connected without needing to sign in every time. If you visit us with your mobile browser, you'll see a prompt: "View in the app: a better way to browse." It's a simple, browser-style app that lets you keep 99nicu on your phone homescreen — no notifications, no instant messages. Just at the reach of your tap when you want to browse and interact.________________________________________The Platform Grows When Your Activity Grows99nicu thrives when you participate!The value of this community isn't just in what you can read — the value is built from people sharing their questions, comments and expertise. Therefore we encourage you to ask questions and share your experiences.Remember: what seems like a "basic, normal thing" to you might be genuinely eye-opening for another clinician somewhere else in the world. We all have unique perspectives shaped by the context where we work, what we've seen, and who we've learned from. So don't hold back!________________________________________Help Us Get This RightWe want to make this transition as smooth as possible. So we're asking:What can we do to make logging in easier for you? Is the registration process clear? Do you have any issues recovering your password?Let us know in the comments, or send us a message- we're here for you!See you inside!Kat from the 99nicu Team

We are pleased to announce that the 99NICU Community has become an official partner of the CEPAS Conference, 28-31 Oct 2026.CEPAS is an international conference dedicated to advancing knowledge and collaboration in neonatal and pediatric care, a new biennial meeting of the European Academy of Paediatrics (EAP) and the European Society for Paediatric Research (ESPR). In addition, the Global Foundation for the Care of Newborn Infants (GFCNI) is co-organiser.Through this partnership, 99NICU will help amplify the reach and discussions of CEPAS within our global neonatal community.In the lead-up to the conference, 99NICU will promote CEPAS across our social media channels to help spread awareness and encourage participation. During the conference, members of the 99NICU team will be present on site, host a dedicated 99NICU session, and provide live coverage of selected sessions through social media, sharing insights and key takeaways with the wider community.We look forward to working together with the CEPAS team to support collaboration, learning, and innovation in neonatal care.Learn more about the conference at cepas.org.

Dear colleagues,I was wondering what your practice is regarding preparation of drugs for intravenous administration in the NICU? Are your units employing an individualized approach, whereby each drug is prepared for each infant in the prescribed dose and thus administered, or a 'standard concentration' approach, whereby a drug solution is prepared in a fixed concentration and the volume to be administered is calculated from that concentration?In our unit we employ the latter approach, as can be observed in the attached figure. The doctor prescribes a weight-based dose, the pharmacist prepares a standard concentration solution in sufficient volume to account for dose and tubing, and the nurse calculates the volume that would provide the precise prescribed dose and sets the syringe pump to deliver that dose.I am interested to know of other units working this way, as well as other approaches. Please share for everyone's benefit!

The N3 Neonatal Nutrition Network, are pleased to announce our spring webinar focused on research updates is now open for registration. The event will be held online (via Zoom) between 13:15 - 17:00, on Thu 26 Mar 2026.Topics include:Probiotics in Neonatal CareNutrition at the Limits of Viability: Feeding the Extremely Preterm InfantCultural and Religious Considerations in Neonatal Nutrition and LactationAnthropometry in Neonates: Measuring Length as a Marker of GrowthThe FEED 1 Trial and Its ImplicationsMore info: https://neonatalnutritionnetwork.org/registration-now-open-for-the-spring-webinar/For any administrative enquiries please contact uclh.educationevents@nhs.netN3 Spring 2026 Meeting Programme.pdf

Dear 99nicu friends,Some of you might have already noticed our 99nicu page has been going through small improvements. We keep thinking about how to make this page more friendly for you, our users. What would it take to make us a page you visit often, or maybe even your starting page?Last week I implemented an RSS feed with the newest papers in neonatal medicine. As 99nicu, we cannot guarantee you access to full texts, but at least we can show you new research being published every single day—for the betterment of neonatal care. Living in Europe and communicating in English almost everywhere, I never even considered that 99nicu might not be accessible enough for people who simply don't use English. I'm thankful to our dear @Mariana Oliveira who opened my eyes and encouraged me to find solutions to make our page more accessible for non-English speakers.So, first of all—in the bottom right corner, you will find a blue "Translate" button. This is a whole page translation powered by Google Translate that will allow you to browse the page in any language you choose. Roam around and explore our content in the language you feel most comfortable with—you're welcome.Second—underneath each post and reply to a post, you will find a button "Translate", which will give you an opportunity to choose a language. This will translate that post to your chosen language. This way, you can participate in the conversation in any language you feel comfortable with, and other users can translate your post to their language of preference. Right now the languages to choose from are limited to 12 (Spanish, French, German, Italian, Portuguese, Dutch, Polish, Russian, Japanese, Chinese, Arabic and English), but we can add as many as you like—just let us know.We're doing our best here, without an army of social media, IT and marketing experts—but honestly, it's been fun figuring out these improvements for you. I'd love to hear your feedback: what else can we do to make 99nicu work better for you? Drop your ideas in the comments or send me a message. You can help us in this mission by visiting our page, being an active part of our community, and telling us what you need. And if you like what we do, you can become a 99nicu Society Member (https://99nicu.org/subscriptions/) for 10 EUR/year to keep our servers alive.All the best,Kat

We are approaching the 20 year anniversary of 99NICU and while thinking about our journey, we also came to explore the wider scope, including the feeling of a lost online neonatal community.When I first helped build 99NICU in 2006, it came from a very simple need: a safe place to talk about neonatal care with other health care professionals. Not just to exchange information, like over email, but create a community space to think, question and learn together from real clinical experience. At the time, those kinds of conversations were harder to find online, due to the immature technology. Today, that challenge feels even more familiar, but for other reasons.Many of us now rely on large social media platforms for professional connection. They’re convenient, fast, and always there. But they were never designed for careful clinical discussion. Algorithms decide what gets seen, conversations disappear as quickly as they appear, and the focus is often on confirmation and engagement (likes!) rather than substance. For neonatal care, where nuance, trust, and context matter, that model simply doesn’t work very well.99NICU was created as an alternative to that. From the beginning, it has been built by neonatal professionals, for neonatal professionals, with no commercial agenda driving the conversations. We have a non-profit structure because independence matters.What makes me most proud, all these years later, is not the platform itself, but the community behind it. Moderators, developers, and contributors are all volunteering NICU staff, colleagues who care deeply about neonatal care and about maintaining an online space where knowledge grow over time.99NICU is not “social media” in the usual sense. It is a professional community reclaimed — a shared space we collectively own and shape.Last but not least, being independent implies that we need support in a crowd-funding way. Please consider to donate 10 EUR per year to keep our servers running, visit this page to do it today!

Dear NICU health care professional,  You are invited to participate in the survey: Stress Management for Newborns and their Parents at the Neonatal Intensive Care Unit. The aim of this survey is to explore current practices, challenges, and opportunities to reduce stress for premature and term newborns and their parents during NICU admission. Your input will help shape recommendations for clinical practice. The survey takes approximately 10-15 minutes to complete. At the end, you may choose to provide your contact details if you wish to join the study group, which will be included in the scientific publication. Link to the survey: https://esurvey.erasmusmc.nl/servicebedrijf/ls/index.php?r=survey/index&sid=342415  Kind regards, Famke van Erkel, MD, PhD candidate Gerbrich van den Bosch, MD, PhD, Consultant Neonatologist Sinno Simons, MD, PhD, Consultant Neonatologist Sophia Children’s Hospital, Erasmus University Medical Center Rotterdam, The Netherlands 

what is your guidelines in giving Rota virus vaccine inside NICU in due time

OverviewA 31-week preterm infant does well in the NICU, gains weight appropriately, and goes home at 36 weeks postmenstrual age. But within days, the parents are back with concerns: minimal weight gain, episodes of hypothermia, and brief apneas. A 24-hour observation shows the baby is fine—gaining weight, no problems. Sent home again... and the same thing happens.What's going on? Why does this infant thrive in one place but struggle in another?Work through this case with seven questions that will challenge your diagnostic reasoning and remind you why sometimes the most important clues come from the simplest questions.Important Notes:You must log in to take this quiz and all future quizzesEach question builds on information from previous questionsThe 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: Katarzyna Piatek @piatkatExpert Revision by: @Stefan JohanssonThis educational quiz is based on case reports and clinical recommendations:Nobel L, Johansson S, Lundberg B. Growth faltering in a preterm infant associated with inaccurate formula preparation by an automated formula dispenser. BMJ Case Rep. 2025 Dec 23;18(12):e268301. doi: 10.1136/bcr-2025-268301. PMID: 41436211.Lucas C, Panko L. Failure to Thrive: A Modern Recipe for Success. Clinical Pediatrics. 2022;62(6):655-657.Embleton, N.D., Jennifer Moltu, S., Lapillonne, A., van den Akker, C.H.P., Carnielli, V., Fusch, C., Gerasimidis, K., van Goudoever, J.B., Haiden, N., Iacobelli, S., Johnson, M.J., Meyer, S., Mihatsch, W., de Pipaon, M.S., Rigo, J., Zachariassen, G., Bronsky, J., Indrio, F., Köglmeier, J., de Koning, B., Norsa, L., Verduci, E. and Domellöf, M. (2023), Enteral Nutrition in Preterm Infants (2022). Journal of Pediatric Gastroenterology and Nutrition, 76: 248-268. https://doi.org/10.1097/MPG.0000000000003642

Hi everybody.Which drugs/ doses/ rotation of sedatives do you use in extremely preterm infants on prolonged mechanical ventilation. We commonly use non-pharmacological strategies, fentanyl and dexmedetomidine, but after 1-2 weeks, they trend to tolerate them and need a progressive increase... We're managing now a 24weeker on HFOV wiht a severe pulmonary emphysema (after RDS and pulmonary hemorrhage on firts days), The weaning is not possible, and she is needing high doses of fentanyl and dexmedetomidine + extra bolus of fentanyl.Would anybody use benzodiacepines? Or rotate to morphine sulfate?

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?