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  4. Learn Neonatal Brain Ultrasound on Youtube!

    Thank you!
  5. 2nd Neonatal Neurology Conference, UK

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    2ND NEONATAL NEUROLOGY CONFERENCE Neonatal neurology is ever evolving and new knowledge is always emerging. Assessment techniques have become more advanced. Newer imaging modalities are increasingly used to help map the extent of brain injury and its implications for neurodevelopment. This meeting lines up exciting talks from experts in the field. More info on: https://www.lutonneocon.co.uk/fom-neurology
  6. Hi Francesco, Thanks for the information. What a pity. Maybe the measurements are similar but than the blade is too long. For a skilled person it will be possible doing the intubation but this is not the classic procedure (different angel etc). This means (IMHO ) that the C-Mac can not be used for teaching intubation in infants below about 1200g. Have a nice weekend Dirk
  7. Video Assisted Intubation using a C-Mac

    We had contact with the company last week, they said they are not planning on a smaller blade than the Miller 0, because their Macintosh 0 is thinner and measures similarly to most Miller 00.
  8. The 24 hour countdown for Early Birds is starting! If you want to join us at the discounted rate, register no later than January 15. Sign up today https://99nicu.org/meetup/registration Why come to the Future of Neonatal Care? Reason #1 Interactivity We believe conferences should be a place to exchange knowledge and give anyone a chance to ask questions. Participants at our last conference especially enjoyed “very good discussions” and “plenty of time for questions”. We use an app to allow for immediate feedback from participants. Additionally, we will have workshops on current important issues of neonatology like parent-centered care, best practice in applying surfactant and simulation training in neonatology. Reason #2 Future Our topics are focused on how neonatology will develop in the future. What skills will the neonatologist need to perform best practice neonatology (echo, LISA)? How can we identify infants that are in risk of deteriorating? What tools will help us treat our infants on the neonatal ward (ultrasound, aEEG, NIRS, MRI)? How should we design our neonatal wards ideally? And how can we work together with parents for optimal outcomes?
  9. Future of Neonatal Care, Vienna, Austria

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    Me too
  10. Future of Neonatal Care, Vienna, Austria

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    I will be there!
  11. Early Bird Weekend :)

    The "Future of Neonatal Care", our upcoming meeting in Vienna 9-12 April 2018, is now only three months away. This weekend is the last chance for you to sign up for the discounted Early Bird Rate. Click here to register This meeting is an IRL event for bringing the neonatal community together, for staff sharing a passion to provide the best neonatal care. While our vision is to promote evidence-based neonatal care, and acknowledge the limitations thereof, we focus on the learning experience by creating a friendly and interactive context. The conference will span over a wide range of topics, for example the Golden Hour, LISA, hypoglycemia, NICU design, follow-up of preterm infants, hypothermia, functional echo, lung ultrasound, and palliative care. There will also be workshops on LISA, PICC line placement, family-based care and simulation. See You in Vienna!
  12. Can’t intubate to give surfactant? Maybe try this!

    thanks for video.
  13. Can’t intubate to give surfactant? Maybe try this!

    I think that the statement "Roughly 25% of the infants were found to have not received any surfactant,..." is an understandable misinterpretation of a long sentence in the manuscript. The text says that upon gastric aspiration post-treatment, 26% had no surfactant... (... in the stomach), suggesting that those babies actually had the full dose of surfactant delivered to the lungs. It is implausible that surfactant could be delivered via an LMA without any of it being aspirated into the lungs. Both animal and clinical evidence indicate that surfactant delivery via an LMA is quite efficient - though the specific techniques that maximize efficiency still need to be studied.
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  15. This is part 2 in a Neonatal Brain Ultrasound tutorial on Youtube.! Also check out the first video below on Anatomy and Protocol https://www.youtube.com/watch?v=kJq8eXf41nI
  16. Learn Neonatal Brain Ultrasound on Youtube!

    One of our fellows showed me these two videos on Youtube, on how to learn brain ultrasound. Both videos are very good! Enjoy Part 1 - anatomy and protocol Part 2 - IVH and PVL
  17. Neonatal Brain Ultrasound is an indispensible tool for evaluating preterm and term neonates for intracranial pathology. It is readily available, portable, relatively inexpensive and safe. This video is a great learning tool! Also check out the second video below on IVH and PVL on https://www.youtube.com/watch?v=hiRt8UiXRag
  18. I have recently posted a series of short "educational" webinars addressing infant oral feeding issues. They can be found at www.chantallau.com or  on YouTube (https://www.youtube.com/channel/UC1a-zNccdoHt3BJJuZ62sig/featured),

    Please feel free to share, if of interest, with colleagues.

     

     

  19. Join the Future of Neonatal Care, in Vienna 9-12 April 2018

    Dont forget - cheaper early bird rates for the conference are only available until Jan 15!
  20. Can’t intubate to give surfactant? Maybe try this!

    I looken into Youtube and found only videos of LMA placement, this one from the UK-based initiative IMPROVE and @spartacus007
  21. Can’t intubate to give surfactant? Maybe try this!

    hi,do you have any video for Surfactant Administration Through and Laryngeal Mask Airway (LMA)?
  22. @Stefan Johansson it sounds greatt with this news. we havebeen giving probiotics with three starins but we are not gettting good results so hopefully it will be agreat option for us.
  23. As 2017 comes to an end, I'd like to post an update on the probiotics project. You may have read previous blog posts about Neobiomics (here and here), a not-for-profit project that will provide probiotics specifically manufactured for preterm infants, “from the community, to the community”. Launch is planned for Q1 2019. The probiotics will fulfill specific needs: three bacterial strains documented in a large clinical trial (i.e. the ProPrems trial) manufactured according to GMP, fulfilling the highest possible quality grade (21 CFR Part 106, “Infant Formula grade”) freeze-dried bacterias with superior stability and long shelf-life single dose units (aluminium foil stickpack) to virtually eradicate the risk of contamination If you would be interested to use this probiotics product in your NICU, visit this page and submit the form to ensure yourself to learn when this product will become available. That's all for now about this exciting project
  24. Intubation is not an easy skill to maintain with the declining opportunities that exist as we move more and more to supporting neonates with CPAP. In the tertiary centres this is true and even more so in rural centres or non academic sites where the number of deliveries are lower and the number of infants born before 37 weeks gestational age even smaller. If you are a practitioner working in such a centre you may relate to the following scenario. A woman comes in unexpectedly at 33 weeks gestational age and is in active labour. She is assessed and found to be 8 cm and is too far along to transport. The provider calls for support but there will be an estimated two hours for a team to arrive to retrieve the infant who is about to be born. The baby is born 30 minutes later and develops significant respiratory distress. There is a t-piece resuscitator available but despite application the baby needs 40% oxygen and continues to work hard to breathe. A call is made to the transport team who asks if you can intubate and give surfactant. Your reply is that you haven’t intubated in quite some time and aren’t sure if you can do it. It is in this scenario that the following strategy might be helpful. Surfactant Administration Through and Laryngeal Mask Airway (LMA) Use of an LMA has been taught for years in NRP now as a good choice to support ventilation when one can’t intubate. The device is easy enough to insert and given that it has a central lumen through which gases are exchanged it provides a means by which surfactant could be instilled through a catheter placed down the lumen of the device. Roberts KD et al published an interesting unmasked but randomized study on this topic Laryngeal Mask Airway for Surfactant Administration in Neonates: A Randomized, Controlled Trial. Due to size limitations (ELBWs are too small to use this in using LMA devices) the eligible infants included those from 28 0/7 to 35 6/7 weeks and ≥1250 g. The infants needed to all be on CPAP +6 first and then fell into one of two treatment groups based on the following inclusion criteria: age ≤36 hours, (FiO2) 0.30-0.40 for ≥30 minutes (target SpO2 88% and 92%), and chest radiograph and clinical presentation consistent with RDS. Exclusion criteria included prior mechanical ventilation or surfactant administration, major congenital anomalies, abnormality of the airway, respiratory distress because of an etiology other than RDS, or an Apgar score <5 at 5 minutes of age. Procedure & Primary Outcome After the LMA was placed a y-connector was attached to the proximal end. On one side a CO2 detector was placed and then a bag valve mask in order to provide manual breaths and confirm placement over the airway. The other port was used to advance a catheter and administer curosurf in 2 mL aliquots. Prior to and then at the conclusion of the procedure the stomach contents were aspirated and the amount of surfactant determined to provide an estimate of how much surfactant was delivered to the lungs. The primary outcome was treatment failure necessitating intubation and mechanical ventilation in the first 7 days of life. Treatment failure was defined upfront and required 2 of the following: (1) FiO2 >0.40 for >30 minutes (to maintain SpO2 between 88% and 92%), (2) PCO2 >65 mmHg on arterial or capillary blood gas or >70 on venous blood gas, or (3) pH <7.22 or 1 of the following: (1) recurrent or severe apnea, (2) hemodynamic instability requiring pressors, (3) repeat surfactant dose, or (4) deemed necessary by medical provider. Did it work? It actually did. Of the 103 patients enrolled (50 LMA and 53 control) 38% required intubation in the LMA group vs 64% in the control arm. The authors did not reach their desired enrollment based on their power calculation but that is ok given that they found a difference. What is really interesting is that they found a difference in the clinical end point despite many infants clearly not receiving a full dose of surfactant as measured by gastric aspirate. Roughly 25% of the infants were found to have not received any surfactant, 20% had >50% of the dose in the stomach and the other 50+% had < 10% of the dose in the stomach meaning that the majority was in fact deposited in the lungs. I suppose it shouldn’t come as a surprise that among the secondary outcomes the duration length of mechanical ventilation did not differ between two groups which I presume occurred due to the babies needing intubation being similar. If you needed it you needed it so to speak. Further evidence though of the effectiveness of the therapy was that the average FiO2 30 minutes after being treated was significantly lower in the group with the LMA treatment 27 vs 35%. What would have been interesting to see is if you excluded the patients who received little or no surfactant, how did the ones treated with intratracheal deposition of the dose fare? One nice thing to see though was the lack of harm as evidenced by no increased rate of pneumothorax, prolonged ventilation or higher oxygen. Should we do this routinely? There was a 26% reduction in intubations in te LMA group which if we take this as the absolute risk reduction means that for every 4 patients treated with an LMA surfactant approach, one patient will avoid intubation. That is pretty darn good! If we also take into account that in the real world, if we thought that little of the surfactant entered the lung we would reapply the mask and try the treatment again. Even if we didn’t do it right away we might do it hours later. In a tertiary care centre, this approach may not be needed as a primary method. If you fail to intubate though for surfactant this might well be a safe approach to try while waiting for a more definitive airway. Importantly this won’t help you below 28 weeks or 1250g as the LMA is too small but with smaller LMAs might this be possible. Stay tuned as I suspect this is not the last we will hear of this strategy!
  25. An Old Drug Finds A New Home In The Treatment of BPD.

    Short version - not much experience at all. We have tested it in some selected infants with severe BPD (longterm CPAP) - no control group...
  26. Happy Holidays!

    I would like to wish Happy Holidays to all members and web site visitors! Thanks for all posts and comments, and all direct communication through messages and emails during 2017. It was also such a great pleasure to meet some of you at the 99nicu Meetup, in Stockholm, last June. For 2018, I hope that 99nicu will become an even more busy community. Most importantly, we have a new chance to meet up at the conference in April in Vienna. Join the "Future of Neonatal Care" 9-12 April in Vienna Best Holiday Wishes from the Headquarters!
  27. An Old Drug Finds A New Home In The Treatment of BPD.

    Hello.The use of montelukast for BPD is a great idea but,the main concern is the short and long-term side effects of this drug in neonates. Do you have any experience with this?
  28. Quizzes FTW!

    The 99nicu community is much about engagement, how we can learn from interacting with each other, sharing experience and expertise. Along those lines, we have started launched a Quizzes section. To date, there are only two quizzes online, one about neonatal encephalopathy and one about RDS management. The idea is that we post quizzes based on a specific document, like an original research paper, a meta-analysis, or a review article. The purpose is to make us all read, and learn from what we read. Doing a quizz is also a very learning experience, and therefore we invite all members to help us prepare quizzes. All you need to do is to email us on info@99nicu.org with a suggestion and we then guide you how to do a quiz
  29. An Old Drug Finds A New Home In The Treatment of BPD.

    Interesting post! Some colleagues tend to use it for more severe BPD-patients (although on CPAP etc), but I just have not felt convinced myself, which was why I posted this topic some time ago. Will read up on the reference you gave (but I tend to agree that there could a whole lot of observer bias there...) PS. BTW, I fixed the images, I copied & pasted the image URLs from allthingsneonatal. com
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