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  1. Yesterday
  2. until
    CALL For ABSTRACT 6TH ANNUAL NATIONAL CONFERENCE MUMBAI THEME: Neonatal Therapy to Strengthen the Maternal-Neonatal Bond 15-17TH NOVEMBER, 2024 Venue: HOTEL TIP TOP PLAZA Workshops Assessments in the NICU - Sanika Gawade Assessment, Intervention, and Transition Home for Feeding in the NICU - Shailaja Jaywant Relationship Based Intervention in the NICU - Hemant Nandgaonkar Newer Trends in the Positioning in the NICU - Geetha M. Arora, Delhi Post Discharge Monitoring the of NICU Graduates - Usha Kasar FOR ALL - EARLY BIRD REGISTRATION TILL 1ST APRIL, 2024 Rs. 5775/- AFTER 1ST APRIL, 2024 MEMBERS - Rs. 5775/- NON MEMEBERS Rs. 7500/- https://www.neonataltherapy.org/
  3. Last week
  4. Thanks for sharing this @chandas - NEC is such a terrible disease but law suits like this one is just a sign of cynism IMHO, lawyers "milking" the system so to say. You raise an important question, would be interesting to hear from US staff about the implications of this law suit.
  5. Adding some links for context: Reckitt charged with $60 million verdict: https://www.reuters.com/legal/reckitt-unit-hit-with-60-million-verdict-enfamil-baby-formula-case-illinois-2024-03-14/ The legal turns: https://www.law.com/2024/03/14/mead-johnson-hit-with-60m-verdict-in-first-nec-trial-over-preterm-infant-formula/?slreturn=20240224133119 As I’ve understood it they are fined for not warning about the increased risk for NEC compared to breast milk. As for breast milk, there are a number of ways to set up programmes for donor breast milk, wouldn’t that be the most reasonable approach?
  6. Earlier
  7. Many colleagues would be aware of the recent lawsuit in Illinois against Mead Johnson alleging Enamel causing NEC in a preterm baby which the US Court found in the family's favour with an award of $60 million. Whilst the allegation that any cow's milk-based formula CAUSES NEC (rather than saying that human milk protects against NEC) may not be widely held view here, I wondered if colleagues are seeing any fallout from this lawsuit. Clearly this would raise parental concerns and the professionals would find it difficult to recommend any cow's milk-based formula for a preterm baby if the mother can not or does not wish to provide her own breast milk.
  8. In our NICU, in the absence of breast or human milk, we use formula for premature babies in extremely preterm babies. There is no support in the literature for the use of partially or extensively hydrolyzed formulas or amino acids. Post-enteritis, the use of an extensively hydrolyzed formula can be considered, but it is not our routine.
  9. Hello everyone! I would like to ask about the choice of milk you do for an extremely premature neonate when there is not human milk or mothermilk. Here, in Greece some NICU's give EHF instead and when the baby achieves full enteral feeding they change it to premature formula. Thanx in advance
  10. We have converted to a webinar to allow more participants to join us. Register on the link below https://us02web.zoom.us/webinar/register/WN_nRDn-K-hQA-7q3lYVZohfQ
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    Objectives IPOKRaTES seminars provide high quality postgraduate education which enables professionals to keep abreast of the most recent developments and offers participants the opportunity to discuss clinical problems or scientific issues personally with international experts. This unique seminar offers an excellent insight into dialog of obstetricians and neonatologists, to provide the best possible start in life - also in special risk situations.
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    Registration is ongoing for the upcoming SIGNEC & NeonatalQI and Innovation Conference! Join global neonatalogists, paediatricians, dieticians, nurses and other professionals for our exceptional 2-day learning experience to explore new concepts, approaches and recent advances in the fields. Register now: https://bit.ly/3TVcR9w The Scientific Committees invites clinicians & scientists to submit their latest research on Necrotizing Enterocolitis and Neonatal Quality Improvement & Innovation to be part of our SIGNEC 2024. The abstract submission deadline ENDS this weekend 17 March, 23:59 CET. Submit now: https://bit.ly/3tEk3Mt Check out the preliminary programme: https://bit.ly/47KHpOx ----- SIGNEC & Neonatal QI and Innovation Conference 18-19 April, 2024 www.signec-conference.com
  13. Dear Colleagues We have a guest speaker session as part of the Lung Ultrasound Course we are running. In it, we will discuss consolidation, atelectasis, and pneumonia. This webinar is being held on the 21st of March via Zoom as a webinar. If you would like to join, please register below. You are invited to a Zoom webinar. When: Mar 21, 2024 08:00 PM Dubai Topic: Lung Ultrasound-Differentiating Consolidation and Atelectasis in Neonates and Clinical Implications Register in advance for this webinar: https://us02web.zoom.us/webinar/register/WN_nRDn-K-hQA-7q3lYVZohfQ After registering, you will receive a confirmation email containing information about joining the webinar.
  14. Rashida Javed and Harsha Gowda from University Hospitals, Birmingham, UK review EbNeo October Article of the Month "Kidman AM, Manley BJ, Boland RA, et al. Higher versus lower nasal continuous positive airway pressure for extubation of extremely preterm infants in Australia (ÉCLAT): a multicentre, randomised, superiority trial. Lancet Child Adolesc Health. 2023 Dec;7(12):844-851. https://doi.org/10.1016/S2352-4642(23)00235-3. Epub 2023 Oct 27. PMID: 38240784." READ HERE! Hear it discussed on the Incubator Podcast! Acta Commentary: Acta Paediatrica - 2024 - Javed - EBNEO Commentary Reducing extubation failure in extreme preterm infants higher vs.pdf Despite advances in non-invasive respiratory support, extremely preterm infants experience extubation failure frequently which can be associated with morbidity and mortality1. The increased risk of extubation failure is due to lung immaturity, poor chest compliance and immature respiratory drive2. Nasal continuous positive airway pressure (nCPAP) or high flow have been the mainstay of post extubation respiratory support3. Following extubation, nCPAP settings vary between centers. Higher set nCPAP levels post extubation may help to maintain end expiratory lung volume and reduce atelectasis. But, a small pilot RCT by Kitsommart et al in 2013 comparing high vs low nCPAP pressures showed no difference in extubation failure rates4. In the ECLAT study, extubating infants less than 28-week gestation to a higher nCPAP of 10cmH2O reduced extubation failure (35% – 24/69 infants) compared to standard nCPAP group (57% – 39/69 infants) with risk difference of -21.7%, 95% CI -38.5% to -3.7%. The number needed to treat was 5 infants meaning five infants needed to receive higher nCPAP to standard nCPAP to prevent one additional extubation failure. Stratification for gestational age subgroups (22-25 and 26-27 completed weeks) also showed a lower extubation failure rate in the nCPAP group receiving higher pressures, especially in the more mature subgroup. However, the study was underpowered for subgroup analysis. The secondary outcomes showed no significant differences between groups which was also underpowered. The most common adverse events, such as pneumothorax, pulmonary interstitial emphysema, spontaneous intestinal perforation, and death were similar in both groups. All infants had exogenous surfactant prior to recruitment which might had contributed to minimal incidence of pneumothorax in higher nCPAP group. 13(19%) infants in standard nCPAP group and 2(3%) in higher nCPAP deviated from protocol to increased nCPAP level above the prescribed level. All these infants were eventually re-intubated within the primary outcome period. Recruitment ceased at 74% of planned sample size due to recurrent pauses during COVID-19 pandemic. Other limitations are clinicians were not blinded and actual distending pressure in alveoli was not measured. Also, there were no standardized criteria for readiness for extubation. Inspite of above limitations, it is a well-designed randomized control trial showing benefits of higher nCPAP reducing extubation failure. Buzzella et al did randomized control trial in 93 infants of less than 30 weeks gestational age to a higher nCPAP of 7-9 cmH2O or a lower nCPAP of 4-6 cmH2O and found a significant reduction in extubation failure in higher nCPAP group5. But in the ECLAT trial, a much higher nCPAP was used and more immature infants were included. All the extubation failure in higher nCPAP group occurred in first 72hours and nil between 73-168 hours compared to 12 in standard nCPAP group. Probably this suggests the importance of high alveoli end expiratory pressure after extubation to prevent later atelectasis and extubation failure. To conclude, the ECLAT study provides evidence for the use of higher nCPAP in infants less than 28 weeks’ gestation to reduce extubation failure compared to standard nCPAP. There was no difference in BPD rates observed, so the benefit of higher nCPAP (9-11 cmH2O) is questionable. Further large RCT adequately powered to compare BPD rates is required to better evaluate the safety and efficacy of higher post-extubation nCPAP levels on outcomes of greater importance to clinicians and families.' References: Razak A, Shah PS, Ye XY, Mukerji A. Post‐extubation use of non‐invasive respiratory support in preterm infants: a network meta‐analysis. Cochrane Database Syst Rev. 2021;2021(10):CD014509. Published 2021 Oct 25. Kidman AM, Manley BJ, Boland RA, Davis PG, Bhatia R. Predictors and outcomes of extubation failure in extremely preterm infants. J Paediatr Child Health. 2021;57(6):913–9. Awanti, Srinivas & Pol, Ramesh & Katti, Arun. (2023). A randomized controlled trial to compare the success rates and efficacy of high flow nasal cannulae versus nasal continuous positive airway pressure in post extubation period in neonates. International Journal of Contemporary Pediatrics. 10. 510-513. 10.18203/2349-3291.ijcp20230728. Kitsommart R, MHSc AK, Al-Saleem N. Levels of nasal CPAP applied during the immediate post- extubation phase. A Randomized Controlled Pilot Trial2013;3:9. Buzzella B, Claure N, D’Ugard C, Bancalari E. A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants. J Pediatr 2014; 164: 46–51.
  15. Vonita Chawla from University of Arkansas for Medical Sciences / Arkansas Children’s Hospital reviews the paper "Motojima Y, Nishimura E, Kabe K, Namba F. Management and outcomes of periviable neonates born at 22 weeks of gestation: a single-center experience in Japan. J Perinatol 2023; 43(11):1385-1391. PMID: 37393397" for EbNeo. READ HERE! Acta Commentary: Acta Paediatrica - 2024 - Chawla - EBNEO Commentary Management and outcomes of periviable neonates born at 22 weeks of.pdf 'In 1991, an amendment to the Eugenic Protection Act lowered the limit of viability to 22 weeks of gestation, in Japan (1). Backed by a robust prenatal care program (2), the Japanese longitudinal experience in caring for neonates born at the cusp of viability has led to improved outcomes (3). Subsequently, active resuscitation is offered to most neonates born at 22 weeks GA, i.e.>80% of these neonates are intubated at birth, according to the year 2020 report of the Neonatal Research Network (NRN) Database, Japan (4) despite a lower rate of antenatal steroid use (~50%). In this study, Motojima et al describe the experience of a single Japanese tertiary center, in caring for periviable neonates born as early as 2013. In this cohort of 29 neonates, overall favorable outcomes are noted with more than 80% survival. Strikingly, only one neonate (5%) in this group developed CP long-term, and only 2 infants (11%) had severe NDI, with the overall greatest impairment seen in the language-social domain. Key maternal/infant characteristics include universal prenatal care, a considerably higher median birth weight of 512 g (compared to median birth weight of 480 g reported by the National Institute of Child Health and Human Development NRN, 2013-2018) (5), use of C-section as the predominant mode of delivery and comparable rates (5) of antenatal steroid administration (34%), both of which are associated with increased survival in this population (6). Maternal illnesses and other prenatal exposures such as smoking and recreational drugs are not listed. Cord milking is practiced commonly, which is currently not standard of care for infants <28 weeks GA, due to an increased risk of IVH (7). Interestingly, in this study, the incidence of severe IVH remained low. Other noteworthy management strategies include early enteral feeding (100% of infants fed by day of life (DOL) 1, despite 90% of these infants requiring some inotropic support), frequent use of neonatologist-performed echocardiograms to inform decisions regarding fluid management, PDA, selection/titration of inotropes/vasopressors, etc., and lung-protective approach to ventilation. All infants are on non-invasive respiratory support by 40 weeks PMA. Postnatal steroid use is not mentioned and a distinction between early vs. late onset sepsis is not made. Probiotics are used as early as DOL 0 in some neonates and phenobarbital is the primary sedative used in the first week of life. Worldwide, several centers have well-established neonatal hemodynamics programs, however, this highly specialized area of neonatology is still evolving and many neonatal intensive care units rely on traditional clinical parameters. This may be one of many reasons for such wide variation in clinical practice and outcomes related to periviable neonates (8). Given the overall improved survival, the American College of Obstetricians and Gynecologists has provided updated recommendations to consider antenatal steroids for GA 22w 0d – 22w 6d (9). Careful consideration should be given to individual patient factors including maternal comorbidities, presence of fetal/neonatal anomalies, inborn versus outborn neonates, resource availability, and most importantly, expectations of the families when choosing active resuscitation for these infants.' References Nishida H, Ishizuka Y. Survival rate of extremely low birth weight infants and its effect on the amendment of the Eugenic Protection Act in Japan. Acta Paediatr Jpn 1992; 34(6):612-6. PMID: 1285508. Kusuda S, Hirano S, Nakamura T. Creating experiences from active treatment towards extremely preterm infants born at less than 25 weeks in Japan. Semin Perinatol 2022; 46(1):151537. PMID: 34862068. Miyazawa T, Arahori H, Ohnishi S, Shoji H, Matsumoto A, Wada YS, et al. Mortality and morbidity of extremely low birth weight infants in Japan, 2015. Pediatr Int 2023; 65(1):e15493. PMID: 36740921. Website for the Neonatal Research Network Database Japan: https://plaza.umin.ac.jp/nrndata/indexe.htm Bell EF, Hintz SR, Hansen NI, Bann CM, Wyckoff MH, DeMauro SB et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA 2022; 327(3):248-263. PMID: 35040888. Vidavalur R, Hussain Z, Hussain N. Association of Survival at 22 Weeks’ Gestation With Use of Antenatal Corticosteroids and Mode of Delivery in the United States. JAMA Pediatr 2023; 177(1):90-93. PMID: 36315137. Katheria A, Reister F, Essers J, Mendler M, Hummler H, Subramaniam A et al. Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants. JAMA. 2019; 322(19):1877-1886. PMID: 31742630. Silva ER, Shukla VV, Tindal R, Carlo WA, Travers CP. Association of Active Postnatal Care With Infant Survival Among Periviable Infants in the US. JAMA Netw Open 2023; 6(1):e2250593. PMID: 36656583 Website for the American College of Obstetricians and Gynecologists: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/09/use-of-antenatal-corticosteroids-at-22-weeks-of-gestation
  16. until
    6th workshop - Update on Neurodevelopmental Care in the NICU VID-20240306-WA0005.mp4
  17. Hello

    I was just wondering if any unit had experience using this product for their PICC's? We currently use Vygon 1Fr and 2Fr catheters but this product has a 1.4Fr and 1.9Fr size catheter with the ability to trim the catheter to length which seems very appealing.

    Very curious to hear of other units experiences with these catheters.

    Thanks

    Footprint Medical PICC's.pdf

  18. Hi @Stefan Johansson & @Gustaf Lernfelt If possible I would very much like a copy of the mentioned VG-region guideline (I´ve sent you an email Stefan). Best, Jesper
  19. until
    Update on Neurodevelopmental Care in NICU This workshop will concentrate on evidence-based therapeutic intervention programmes in the NICU and provide participants with tools, methods, and improved critical problem-solving abilities. An emphasis will be placed on the NICU environment, sensory experience, and feeding routines that best promote developmental care and offer neuroprotection. There will be group activities with practical takeaways for your own NICU. 1. Discuss key concepts of neuroprotection and stress in the NICU and how the neonatal therapist plays a role. 2. Prepare therapeutic interventions and strategies for the environment, positioning, feeding, sleep, and family support. 3. Develop developmental care for your practice with the very low birth weight infant, the late preterm, and infants with HIE. 4. Demonstrate at least 25 strategies learned to create change in the NICU regarding neurodevelopmental care. FOR REGISTRATION
  20. No evidence, but some people use it to wean off from o2
  21. A common and significant problem is the actual delivered dosage. There are too many variables to effectively standardize treatment.
  22. Neurodevelopmental Care in the NICU: Approaches & Resources at Jaipur https://www.neonataltherapy.org/
  23. Many thanks for all your responses, wide variation in approaches. 👍 Ali
  24. until
    The purpose of this workshop is to increase the skills on the use of NAVA ventilation and lung ultrasound (LUS) in the NICUs. This is the first time we combine both modalities to offer the participants two new ways to enlarge their treatment and diagnosis options. Some previous experience and theoretical knowledge of NAVA and LUS as well as suitable equipment is of advantage (Servo-i or Servo-n ventilators, US machine with a LUS compatible probe). The workshop will focus on - interpretation of the Edi signal - interpretation of LUS findings - utilization of the monitoring capabilities - making a diagnosis using LUS - individualization of the treatment - implementation of LUS in the NICU - implementation of NAVA in the NICU We aim to get together a group of NAVA and LUS users at the same level of experience. We encourage you to participate as a team of both doctor and nurse participants. The course includes both theory sessions and bedside teaching with the patients on NAVA ventilation in the NICU. LUS examinations will also be performed with NICU patients. Each participant is invited to present a patient case which has a teaching point on either NAVA or LUS. TIME AND PLACE The course will be held in September 19-20, 2024 in Turku, Finland by Dr Hanna Soukka, Professor Liisa Lehtonen, Dr Frank Fuchs and Dr Nadya Yousef at the Turku University Hospital. REGISTRATION AND ACCOMODATION You can apply for the course by contacting Hanna Soukka at hanna.soukka@utu.fi. The registration fee is 800 € + taxes including the lunches and refreshments during the workshop. The participants are responsible to arrange their travelling and accommodation by themselves at their own expense. For more information, contact Dr Hanna Soukka, hanna.soukka@utu.fi Turku University Hospital Majakkasairaala, Savitehtaankatu 5 Lecture hall Bengtskär, 3rd floor Turku NAVA 2024.pdf
  25. Hello group, someone has it protocolized, could you upload it, or comment on how you do it, nebulize puff dose, time. A local treatment rather than a systemic one proposed by DART would seem interesting.
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  • Latest Posts

    • Thanks for sharing this @chandas - NEC is such a terrible disease but law suits like this one is just a sign of cynism IMHO, lawyers "milking" the system so to say. You raise an important question, would be interesting to hear from US staff about the implications of this law suit.
    • Adding some links for context: Reckitt charged with $60 million verdict: https://www.reuters.com/legal/reckitt-unit-hit-with-60-million-verdict-enfamil-baby-formula-case-illinois-2024-03-14/ The legal turns: https://www.law.com/2024/03/14/mead-johnson-hit-with-60m-verdict-in-first-nec-trial-over-preterm-infant-formula/?slreturn=20240224133119 As I’ve understood it they are fined for not warning about the increased risk for NEC compared to breast milk. As for breast milk, there are a number of ways to set up programmes for donor breast milk, wouldn’t that be the most reasonable approach?    
    • Many colleagues would be aware of the recent lawsuit in Illinois against Mead Johnson alleging Enamel causing NEC in a preterm baby which the US Court found in the family's favour with an award of $60 million. Whilst the allegation that any cow's milk-based formula CAUSES NEC (rather than saying that human milk protects against NEC) may not be widely held view here, I wondered if colleagues are seeing any fallout from this lawsuit. Clearly this would raise parental concerns and the professionals would find it difficult to recommend any cow's milk-based formula for a preterm baby if the mother can not or does not wish to provide her own breast milk.
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