Jump to content


Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org


Popular Content

Showing content with the highest reputation since 05/25/2018 in all areas

  1. 4 points
    We proudly present Paul Crossley, founder of 1in10, as our new blog writer! "Hello Everybody! – My name is Paul and I am a NICU Dad on a mission to create a global (if I can take it that far) support community for families who have spent time or who are currently spending time on NICU with their child/children. My Son Oliver was born in September 2016 at 29+2 weeks gestation at 2.2lbs and suffered a unilateral Grade 3 IVH prior to being born, during his time in NICU we tackled Hydrocephalus, 2 Brain Surgeries, hernia surgery and almost fatal pneumonia. The idea for 1in10.org.uk came when I was searching for other parents going through something similar but unfortunately, I could not find anything, professionally I am a web developer, so I used my skills and knowledge to create what I needed when I was in NICU, for other families who might still be there now looking for the same thing as I was. I look forward to telling you more about my experiences soon! Paul Crossley" Since the parental perspective is so central to NICU care, we feel honoured that Paul connected with us and wanted to share reflections in a blog format. @Paul looking forward to read your posts here! The link to the 1in10 web site is https://1in10.org.uk/ - feel free to share it to parents in your NICUs!
  2. 3 points
    I had an amazing opportunity to visit NICU in the Turku University Hospital in 2016. They admit around 550 problematic newborns per year. About 10% of them are born below 30 weeks of gestation. The whole unit is practically based on 11 family rooms (single family rooms when possible) and additionally one larger room for 4 patients. The larger room is usually used for babies who are admitted due to transient issues (tachypnea, hypoglycemia, hyperbilirubinemia etc). Single family rooms are equipped with an incubator/open warmer bed/cot, one adult bed, one reclining armchair and a nappy changing station. There is also a breast pump and a refrigerator for breast milk in the room. Parents are constantly involved in the care of their preterm baby and are welcome to stay and care for their child all day and night. That’s the theory. So what is the reality? Entering the unit for the first time, the word that came to my mind was „serenity”. The unit welcomes you with knitted octopuses and tiny socks everywhere. The whole design of the unit is somehow soft, warm and calming. Each family room is „protected” by a closed door with a window in them - and the window is also covered with a pastel-color quilt. If you want to enter the room, or you’re just looking for your co-worker, you can just „peek in” and check without disturbing the family much. Then you can knock on the door and enter the room. This way you are giving the family the maximum privacy we can offer in those special circumstances. Well, you have those tiny, „problematic” children in those private family rooms, with their parents being their primary caretakers, guardians and gate-keepers. Yet, nobody feels that their access to the patient is limited. How is that even possible? Maybe this is what we call „the change of the caring culture”? When you’re „letting go” of some of your duties and delegating them to the parents, you also learn to trust them with your little patient. After all, we all have the same goal- and the parents are personally and emotionally interested in their own child’s well-being, so they have even stronger motivation to perform well. Visiting you patient in the single family room feels like visiting your friends, who had just brought their newborn back from the hospital. Imagine the situation, that you’re paying them that first visit, with a little gift wrapped in a pink paper and a big pink balloon. What will you expect? I think it’s quite normal that their room will be a bit messy and everybody will be whispering around the sleeping baby. It’s normal that the mother will be breastfeeding (or pumping milk) in your presence. And again- it’s normal that parents will be touching and cuddling the baby. I’ve visited several neonatal intensive care units around the Europe. They all announce proudly, that they are „family centered units”. They all know that skin-to-skin care is a recommended, good and beneficial procedure. Yet in the same time, they actually treat it like a medical procedure - which is time-limited and full of exclusion criteria. That procedure also seems to be quite stressful for the medical staff, because they feel like they can’t access their patient anymore. What if something happens, what if we need to react, how to save that baby when the baby is outside the cot? How can we be medical professionals, when the patient is out of reach? It comes straight to the question: what exactly is skin-to-skin care for you? Is it a medical procedure, which is performed once or twice a week, for one hour, when the baby (and the parent!) is fully dressed? Or do you consider mother’s and father’s bare chest as a new space of care for your patient? A safe surrounding, stabilizing baby’s body temperature, breathing and heart rate? And what do you consider a contraindication for skin-to-skin care? Recently I’ve heard from my friend that in their NICU (highest reference centre) kangaroo care is performed only after the baby reaches 1600g. In other place, I’ve seen a healthy 31-weeker in his second week of life, on full enteral feeds, happily kicking in a closed incubator, who couldn’t be kangarooed or even touched by his parents, just because there was a PICC-line placed in his arm. I still remember those sad parents, wearing plastic gowns, standing by that closed incubator, not being able to even touch their own baby, just because it was a preemie. Prematurity is a diagnosis, but it’s not a sentence! If we are treating similar babies with similar equipment and similarly trained staff - why does our practice differ so much? Leave your comment and join the discussion!
  3. 3 points
    Thank you for your interest in NRP courses, For the NRP Instructor course in Saudi Arabia we have a Saudi Neonatal resuscitation program which is in accordance with the standards of the American Academy of Pediatrics and American heart association, To be eligible for the instructor you should fulfill the following criteria 1- Physicians, registered nurses, registered midwives, or respiratory therapists 2- The individual should have relevant experience in neonatal care/ delivery room experiences 3- The individual should have a sponsoring institution/hospitals that normally provides NRP courses. 4- Recommendation letter from the center where you completed your provider course Pre-requisites: 1-Successful completion of an NRP Provider course within 6 months prior to the Instructor course; 2- must have your own NRP 7th Edition Provider Manual 3- must have Knowledge of current NRP updates, recommendations, and changes. Instructor training : 1: Successfully complete the NRP Online exam/ provider course (provide your Instructor Trainer with 2: Successfully complete an NRP instructor bundle and Instructor course . 3: Successfully “team teach” at least 2 NRP Provider course, supervised by an NRP Instructor Trainer (IT) within six months of the Instructor course. 4: once completed, Instructors will receive ID number and card. The renewal date will begin on the date of your last completed “team teach.” The instructor course is a 2 days course. The Instructor Course bundle provides you with the key changes in the 7th Edition; it will also help you to prepare and to teach the NRP 7th Edition Provider Course. During the Instructor course, you will share in teaching a practice skill station and evaluate a candidate in an integrated skill station as well as conducting a Simulation Debriefing Station. at the end of the course, the candidates will have a structured evaluation. For the provider course It is one day course the contents of the training adhere to the recommended Neonatal Resuscitation Course teaching guidelines. The course material (NRP Provider manual) will be sent to the participants at least one month prior to the course . Online exam should be done prior to the course at least 2 -3weeks . The practical test (Simulation) should administered at the end of the course We are currently have no courses for Ramadan and Eid holiday m we will start again on August (depends on candidates and their location, it can be done in Jeddah or Riyadh The course fees for the providers course ( including the manual / online exam / cards /certificates / coffee breaks/lunch) The course fees for the instructor course 2 days ( including the manual / online exam / cards /certificates / coffee breaks/lunch)..our instructor will be contribute to run courses a cross the Kingdome The course fees given by dr Tariq is only for Ministry of health in Saudi Arabia which is supported financially by Ministry of health ( the fees above excluding the provider manual and fee of the online exam and cards and certificates ) so, its not applicable for other For further details , please do not hesitates to email us at : SaudiNRP@gamil.com I hope I answer your questions , best regards Jubara Alallah
  4. 2 points
    I find it very interesting but speaking of is not like watching it! For the moment I will not dare do it !
  5. 2 points
    Sounds like pushing the skin-to-skin care to its boundaries! Personally, I think it is not a bad idea as such, I guess one just needs to get used to it. However, it is not uncommon that intubation is not just something isolated, but part of a stabilizing efforts that includes more procedures/medications etc. In other words, I am not sure skin-skin-care is the right thing to do in an infant with respiratory failure, whatever its cause. My personal experience is that I have used parents to comfort the infant (holding support) on the open bed while intubating, i.e. including them in the team doing the stabilization.
  6. 2 points
    If I look back on my career there have been many things I have been passionate about but the one that sticks out as the most longstanding is premedicating newborns prior to non-emergent intubation. The bolded words in the last sentence are meant to reinforce that in the setting of a newborn who is deteriorating rapidly it would be inappropriate to wait for medications to be drawn up if the infant is already experiencing severe oxygen desaturation and/or bradycardia. The CPS Fetus and Newborn committee of which I am a member has a statement on the use of premedication which seems as relevant today as when it was first developed. In this statement the suggested cocktail of atropine, fentanyl and succinylcholine is recommended and having used it in our centre I can confirm that it is effective. In spite of this recommendation by our national organization there remain those who are skeptical of the need for this altogether and then there are others who continue to search for a better cocktail. Since I am at the annual conference for the CPS in Quebec city I thought it would be appropriate to provide a few comments on this topic. Three concerns with rapid sequence induction (RSI) for premedication before intubation 1. "I don't need it. I don't have any trouble intubating a newborn" - This is perhaps the most common reason I hear naysayers raise. There is no question that an 60-90 kg practitioner can overpower a < 5kg infant and in particular an ELBW infant weighing < 1 kg. This misses the point though. Premedicating has been shown to increase success on the first attempt and shorten times to intubation. Dempsey 2006, Roberts 2006, Carbajal 2007, Lemyre 2009 2. "I usually get in on the first attempt and am very slick so risk of injury is less." Not really true overall. No doubt there are those individuals who are highly successful but overall the risk of adverse events is reduced with premedication. (Marshall 1984, Lemyre 2009). I would also proudly add another Canadian study from Edmonton by Dr. Byrne and Dr. Barrington who performed 249 consecutive intubations with predication and noted minimal side effects but high success rates at first pass. 3. "Intubation is not a painful procedure". This one is somewhat tough to obtain a true answer for as the neonate of course cannot speak to this. There is evidence available again from Canadian colleagues in 1984 and 1989 that would suggest that infants at the very least experience discomfort or show physiologic signs of stress when intubated using an "awake" approach. In 1984 Kelly and Finer in Edmonton published Nasotracheal intubation in the neonate: physiologic responses and effects of atropine and pancuronium. This randomized study of atropine with or without pancuronium vs control demonstrated intracranial hypertension only in those infants in the control arm with premedication ameliorating this finding. Similarly, in 1989 Barrington, Finer and the late Phil Etches also in Edmonton published Succinylcholine and atropine for premedication of the newborn infant before nasotracheal intubation: a randomized, controlled trial. This small study of 20 infants demonstrated the same finding of elimination of intracranial hypertension with premedication. At the very least I would suggest that having a laryngoscope blade put in your oral cavity while awake must be uncomfortable. If you still doubt that statement ask yourself whether you would want sedation if you needed to be intubated? Still feel the same way about babies not needing any? 4. What if I sedate and paralyze and there is a critical airway? Well this one may be something to consider. If one knows there is a large mass such as a cystic hygroma it may be best to leave the sedation or at least the paralysis out. The concern though that there might be an internal mass or obstruction that we just don't know about seems a little unfounded as a justification for avoiding medications though. Do we have the right cocktail? The short answer is "I don't know". What I do know is that the use of atropine, an opioid and a muscle relaxant seems to provide good conditions for intubating newborns. We are in the era of refinement though and as a recent paper suggests, there could be alternatives to consider;Effect of Atropine With Propofol vs Atropine With Atracurium and Sufentanil on Oxygen Desaturation in Neonates Requiring Nonemergency IntubationA Randomized Clinical Trial. I personally like the idea of a two drug combination for intubating vs.. three as it leaves one less drug to worry about a medication error with. There are many papers out there looking at different drug combinations. This one though didn't find a difference between the two combinations in terms of prolonged desaturations between the two groups which was the primary outcome. Interestingly though the process of intubating was longer with atropine and propofol. Given some peoples reluctance to use RSI at all, any drug combination which adds time to the the procedure is unlikely to go over well. Stay tuned though as I am sure there will be many other combinations over the next few years to try out!
  7. 2 points
    One of the benefits of operating this site is that I often learn from the people reading these posts as they share their perspectives. On a recent trip I was reunited with Boubou Halberg a Neonatologist from Sweden whom I hadn’t seen in many years. I missed him on my last trip to Stockholm as I couldn’t make it to Karolinska University but we managed to meet each other in the end. As we caught up and he learned that I operated this site he passed along a paper of his that left an impact on me and I thought I would share with you. When we think about treating an infant with a medicinal product, we often think about getting the right drug, right dose and right administration (IV, IM or oral) for maximum benefit to the patient. When it comes to nutrition we have certainly come a long way and have come to rely on registered dieticians where I work to handle a lot of the planning when it comes to getting the right prescription for our patients. We seem comfortable though making some assumptions when it comes to nutrition that we would never make with respect to their drug counterparts. More on that later… A Swedish Journey to Ponder Westin R and colleagues (one of whom is my above acquaintance) published a seven year retrospective nutritional journey in 2017 from Stockholm entitled Improved nutrition for extremely preterm infants: A population based observational study. After recognizing that over this seven year period they had made some significant changes to the way they approached nutrition, they chose to see what effect this had on growth of their infants from 22 0/7 to 26 6/7 weeks over this time by examining four epochs (2004-5, 2006-7, 2008-9 and 2010-11. What were these changes? They are summarized beautifully in the following figure. Not included in the figure was a progressive change as well to a more aggressive position of early nutrition in the first few days of life using higher protein, fat and calories as well as changes to the type of lipid provided being initially soy based and then changing to one primarily derived from olive oil. Protein targets in the first days to weeks climbed from the low 2s to the mid 3s in gram/kg/d while provision of lipid as an example doubled from the first epoch to the last ending with a median lipid provision in the first three days of just over 2 g/kg/d. While figure 3 from the paper demonstrates that regardless of time period there were declines in growth across all three measurements compared to expected growth patterns, when one compares the first epoch in 2004-2005 with the last 2010-11 there were significant protective effects of the nutritional strategy in place. The anticipated growth used as a standard was based on the Fenton growth curves. What this tells us of course is that we have improved but still have work to do. Some of the nutritional sources as well were donor breast milk and based on comments coming back from this years Pediatric Academic Society meeting we may need to improve how that is prepared as growth failure is being noted in babies who are receiving donated rather than fresh mother’s own milk. I suspect there will be more on that as time goes by. Knowing where you started is likely critical! One advantage they have in Sweden is that they know what is actually in the breast milk they provide. Since 1998 the babies represented in this paper have had their nutritional support directed by analyzing what is in the milk provided by an analyzer. Knowing the caloric density and content of protein, carbohydrates and fats goes a long way to providing a nutritional prescription for individual infants. This is very much personalized medicine and it would appear the Swedes are ahead of the curve when it comes to this. in our units we have long assumed a caloric density of about 68 cal/100mL. What if a mother is producing milk akin to “skim milk” while another is producing a “milkshake”. This likely explains why some babies despite us being told they should be getting enough calories just seem to fail to thrive. I can only speculate what the growth curves shown above would look like if we did the same study in units that actually take a best guess as to the nutritional content of the milk they provide. This paper gives me hope that when it comes to nutrition we are indeed moving in the right direction as most units become more aggressive with time. What we need to do though is think about nutrition no different than writing prescriptions for the drugs we use and use as much information as we can to get the dosing right for the individual patient!
  8. 2 points
    good questions. we keep our 1000gms-1100 gms babies in the room with the parents and not in nicu after their medical conditions are stabilised . All relatives are taught KMC.
  9. 2 points
    Thank you very much. unfortunately, family centered care is still far away from our hands. I hope one day it will thanks a lot and keep the good work up.
  10. 2 points
    I must admit that it is a bit exciting to think about that 99nicu.org went live 12 years ago, at a time when Facebook and other “social media” web sites was yet to be invented. (@Zuckerberg, no offense here. Obviously, you created something far greater than 99nicu, still a grass rot project. BTW – could we apply for funding from you Foundation?) When starting 99nicu.org in 2006, we nourished an idea that experiences and expertise should not be hindered by geographical boundaries. In some sense, this was a statement, that we as medical professionals could help each other through other channels than journals and conferences, with inclusive and open mindsets, and new technologies. Back then we knew little about the powerful potential of the Internet. Neither could we foresee how the Internet would change our private and professional lives. We were just a group of young staff in Sweden, wanting to create a web based platform for discussions within a global group of neonatal pro’s. When I read this blog post by @AllThingsNeonatal (on his web site allthingsneonatal.com) where he reflects on how sharing and caring in social media has created a global village, I am struck by the thought - a global village was what we envisioned back in 2006. Coming from a small village myself, I think that also 99nicu.org parallells the village symbolism: a setting with small communication gaps (everyone knows everything about everyone, so we don't need formalities to get in touch and speak out), and where giving and taking advice is a bilateral process that may ultimately lead to “the best solution”. Or simply, that we find out that there are several good solutions for a given problem. Has 99nicu become as global village for neonatal staff on the Internet? Although biased, I’d say YES . Data also supports that. During January through April, the web site had 18.000 visitors from all over the globe, making 45.200 pageviews. From the Google Analytics dashboard we can all see that 99nicu reaches almost every corner of the world! Our principal idea has always been that the virtual space is where we operate. It is the Internet that creates the possibility to connect and exchange experience as expertise from where we are. However, meeting up IRL is also a powerful way to maintain sustainable networks and that idea is the driving force behind the “99nicu Meetups”. For the 1st and 2nd Meetup conferences in Stockholm and Vienna (in June 2017 and in April 2018), delegates came from 17 and 33 countries, respectively. Let’s hope we can have even a larger geographical representation at our IRL Meetup next year. Stay tuned for dates and location
  11. 2 points
    Thanks @mahmoud very informative This is another article taking about Advances in Diagnosis and Management of Hemodynamic instability in Neonatal Shock https://files.acrobat.com/a/preview/1d78eae5-940a-407d-970a-7461f06d4629
  12. 2 points
    This is great! Thanks so much. I was in Toronto for the NeoHemodynamics 2018 Conference and Workshop and one of the main take-home messages was that both transitional hemodynamics and knowledge of its physiology are key to tailoring therapeutic interventions both in preemies and term babies. The slides from the talks are available at neohemodynamics.com
  13. 1 point
    Much has been written about methylxanthines over the years with the main questions initially being, “should we use them?”, “how big a dose should we use” and of course “theophylline vs caffeine”. At least in our units and in most others I know of caffeine seems to reign supreme and while there remains some discussion about whether dosing for maintenance of 2.5 -5 mg/kg/d of caffeine base or 5 – 10 mg/kg/d is the right way to go I think most favour the lower dose. We also know from the CAP study that not only does caffeine work to treat apnea of prematurity but it also appears to reduce the risk of BPD, PDA and duration of oxygen therapy to name a few benefits. Although initially promising as providing a benefit by improving neurodevelopmental outcomes in those who received it, by 5 and 11 years these benefits seem to disappear with only mild motor differences being seen. Turning to a new question The new query though is how long to treat? Many units will typically stop caffeine somewhere between 33-35 weeks PMA on the grounds that most babies by then should have outgrown their irregular respiration patterns and have enough pulmonary reserve to withstand a little periodic breathing. Certainly there are those who prove that they truly still need their caffeine and on occasion I have sent some babies home with caffeine when they are fully fed and otherwise able to go home but just can’t seem to stabilize their breathing enough to be off a monitor without caffeine. Then there is also more recent data suggesting that due to intermittent hypoxic episodes in the smallest of infants at term equivalent age, a longer duration of therapy might be advisable for these ELBWs. What really hasn’t been looked at well though is what duration of caffeine might be associated with the best neurodevelopmental outcomes. While I would love to see a prospective study to tackle this question for now we will have to do with one that while retrospective does an admirable job of searching for an answer. The Calgary Neonatal Group May Have The Answer Lodha A et al recently published the paper Does duration of caffeine therapy in preterm infants born ≤1250 g at birth influence neurodevelopmental (ND) outcomes at 3 years of age? This retrospective study looked at infants under 1250g at birth who were treated within one week of age with caffeine and divided them into three categories based on duration of caffeine therapy. The groups were as follows, early cessation of caffeine ≤ 14 days (ECC), intermediate cessation of caffeine 15–30 days (ICC), and late cessation of caffeine >30 days (LCC). In total there were 508 eligible infants with 448 (88%) seen at 3 years CA at follow-up. ECC (n = 139), ICC (n = 122) and LCC (n = 187). The primary outcome here was ND at 3 years of age while a host of secondary outcomes were also examined such as RDS, PDA, BPD, ROP as typical morbidities. It made sense to look at these since provision of caffeine had previously been shown to modify such outcomes. Did they find a benefit? Sadly there did not appear to be any benefit regardless of which group infants fell in with respect to duration of caffeine when it came to ND. When looking at secondary outcomes there were a few key differences found which favoured the ICC group. These infants had the lowest days of supplemental oxygen, hospital stay ROP and total days of ventilation. This middle group also had a median GA 1 week older at 27 weeks than the other two groups. The authors however did a logistic regression and ruled out the improvement based on the advanced GA. The group with the lowest use of caffeine had higher number of days on supplemental oxygen and higher days of ventilation on average than the middle but not the high caffeine group. It is tempting to blame the result for the longer caffeine group on these being babies that were just sicker and therefore needed caffeine longer. On the other hand the babies that were treated with caffeine for less than two weeks appear to have likely needed it longer as they needed longer durations of oxygen and were ventilated longer so perhaps were under treated. What is fair to say though is that the short and long groups having longer median days of ventilation were more likey to have morbidities associated with that being worse ROP and need for O2. In short they likely had more lung damage. What is really puzzling to me is that with a median GA of 27-28 weeks some of these kids were off caffeine before 30 weeks PMA and in the middle group for the most part before 32 weeks! If they were in need of O2 and ventilation for at least two weeks maybe they needed more caffeine or perhaps the babies in these groups were just less sick? What is missing? There is another potential answer to why the middle group did the best. In the methods section the authors acknowledge that for each infant caffeine was loaded at 10 mg/kg/d. What we don’t know though is what the cumulative dose was for the different groups. The range of dosing was from 2.5-5 mg/kg/d for maintenance. Lets say there was an over representation of babies on 2.5 mg/kg/d in the short and long duration groups compared to the middle group. Could this actually be the reason behind the difference in outcomes? If for example the dosing on average was lower in these two groups might it be that with less respiratory drive the babies in those groups needed faster ventilator rates with longer durations of support leading to more lung damage and with it the rest of the morbidities that followed? It would be interesting to see such data to determine if the two groups were indeed dosed on average lower by looking at median doses and total cumulative doses including miniloads along the way. We know that duration may need to be prolonged in some patients but we also know that dose matters and without knowing this piece of information it is tough to come to a conclusion about how long exactly to treat. What this study does though is beg for a prospective study to determine when one should stop caffeine as that answer eludes us!
  14. 1 point
    When it comes to inserting tubes, NICU staff is probably the most experienced in the world. Intubation is one of the first procedures we learn as young doctors in NICU. Some of us perform it through nose, some through mouth. But who performs it on mother’s or father’s chest? Well, I’ve seen it only once or twice, but that is a practice in Uppsala University Hospital. What do you need to perform it? An intubation set. A baby, that actually needs that intubation. It can be a planned or an acute one. And then you need that special thing- a parent (or a caregiver), that is willing to help you with the procedure. When I came back from Sweden, I shared this crazy idea with one neonatal nurse. She told me, that it must be extremely stressful for the parent and that she considers it inhumane to push parents to do that. Well, I can say that I partly agree with her, giving the specification of the unit she worked in at that time. It was a medium size NICU of the highest reference, where parents were welcome to visit the baby, but there were no beds for them, and the chairs for the kangaroo care were each time brought in for that short „session” of skin-to-skin care. LET’S TALK ABOUT SPONTANEITY THERE! But in Uppsala University Hospital this procedure is possible, because you have parents there all the time. They basically never leave the unit. If they are not doing skin-to-skin with their baby (watching a movie on a little player approved by the unit or reading a book), they are cooking or eating in the parent’s area or taking shower in their bathroom. They are not patients there, but they are staying there overnight, so in the morning you can see some of them sneaking out to the bathroom in their pyjamas. So in that situation, you don’t just have a scared parent, who is there from time to time, smiling nervously to his or her child through the plastic incubator. You have a semi-professional companion, who knows his or her baby’s needs best and who is there to care for their own infant. So back to the main topic. Intubation on parent’s chest. Ok, you may say- that sounds okay, but what are the benefits? Why should we risk intubating on an unstable ground? I asked Erik Normann, the Head of the Department of Neonatology in Akademiska Hospital in Uppsala the same question. His opinion is, that in that way child stays in it’s preferred care site during this stressful moment. And in case of spontaneous extubation during skin-to-skin care, you don’t have to move the child back to the incubator to place the tube, so this is quicker. And that skin-to-skin care just continues after the procedure. There’s no special technique or limitations for that procedure, but he admits, that it creates some logistic problems with the staff position around the bed. Also, bending over parent’s chest is not the most optimal working position (especially for taller doctors 😉). But what you get in return for that effort is a happier baby, supported and stabilized by their parents hands. I’m not sure if all of us are „there yet”. What is the more important, is that we are heading in that direction- to this mental NICUland, where parents are there for the baby all the time, to offer warmth of their skin and delicacy of their touch, and where medical staff is ready to accept their help and presence. Together we can do more! So hands up guys- who does that too in their unit? Who would like to try?✋✋✋
  15. 1 point
    I am interested in management of well term infants who fall into the algorithm for Chorio treatment with 48 hours of abx pending negative cultures. I work in a Level I nursery and we have been contemplating 24 hours in the nursery on the monitor then out to the Mom's room saline locked getting their last day of meds in the Mom's room. does anyone have a protocol.
  16. 1 point
    @Stefan Johansson I think that pushing the boundaries would be to intubate an infant on mothers chest during primary stabilization in the delivery room 😉I haven't heard about anybody doing that YET, but I'm watching carefully NINO Birth and Nils Bergman, they are very into KMC ; >
  17. 1 point
    We are on important missions in the NICU. From time to time, we all sense the strong rewarding feeling that our work mattered a lot. I love the hands-on work in the NICU, but I also believe strongly in pursuing work at the meta-level of things. That we can change care and improve outcomes through research, quality improvement, and taking our professionalism outside the box. And to the web! Naturally, the 99nicu “global village” is one of those meta-level journeys for me. I have shared small bits of information previously about a new project with a really big scope. Together with an EU-based group, I started Neobiomics, an academic startup project that will provide a super-high quality bifidobacterial product requested by neonatologists, “from the community, to the community”. The composition of the product is based on this RCT. Launch is planned in Europe mid-2019, and outside Europe during 2020. Although the product itself is much requested, I personally think that this project has a much wider potential. With access to a highly advanced machinery (literally!) at the production facility, it should be possible to make other compositions (other sets of bacteria, other bacterial numbers, +/- other compounds etc) for some really cool comparative trials. Manufacturing quality is key, but as important in this project is the not-for-profit business models. Naturally, we need to create something sustainable, but taking a perspective of social entrepreneurship enables the largest possible outreach. We are still working mainly behind the scenes in the Neobiomics HQs, but relatively soon, we will step on stage and start creating buzz As part of our communication strategy, we are now collecting Testimonials from neonatologists believing in bringing this product "from the community, to the community". If you share the basic idea behind this project, please consider to click here and share a Testimonial for publication on neobiomics.org And… stay tuned PS. The project above has nothing and everything to do with the talk below. Creativity is the Power to Act.
  18. 1 point
    Thank for your encouraging comments @Aymen Eshene and @M C Fadous Khalife! I think that if the situation is stressful for the medical staff, it's probably also stressful for the baby and the parents. In those situations they could probably use even more of each other's support than when the baby is doing well. But I agree, we need to gather more information and tips from units like Turku, especially about how to cope with that stress around parents:) They do that every day for some years now! When it comes to space issues, it is a big problem. But I will try to show you, that the change starts with the attitude, and the architectural change will follow.
  19. 1 point
    Some cases are so stressfull that we will not be able to work easily with presence of parents ! But when baby is good , parents’ participation is essential. Our only limitation is the lack of space in our NICU.
  20. 1 point
    I'm not sure, but I think that in @Francesco Cardona's unit they use Thompson score for monitoring HIE, right?
  21. 1 point
    Neonatal Hemodynamics: From Developmental Physiology to Comprehensive Monitoring https://www.frontiersin.org/articles/10.3389/fped.2018.00087/full?
  22. 1 point
    @Dr Jubara Alallah She is my boss in Saudi NRP Welcome Dr Jubara in 99nicu
  23. 1 point
    Thank you for the compliment and congratulations to all that you have accomplished on 99NICU. The classroom is now virtual and your site reflects the needs of the adult learner to absorb information at their own speed and indeed on the topics they are most interested in
  24. 1 point
    Hi Ayman, Dividing your question to EOS and LOS EOS: -Concerning your first question please visit the Management of term infants at increased risk for early onset bacterial sepsishttps://www.cps.ca/en/documents/position/management-infant-sepsis -Concerning your second question: In our practice, we would NOT include tracheal aspirate to routine septic workup. - Antifungal for prophylaxis in ELBWI (in Japan 3 times/week) unless we have a positive culture or suspected skin rash we switch to a therapeutic regimen. - Antiviral eg HSV (acyclovir) given in the following scenarios: The CPS statement on prevention and management of HSV infection in this link: https://www.cps.ca/en/documents/position/prevention-management-neonatal-herpes-simplex-virus-infections 1- If symptomatic for signs and symptoms of neonatal HSV regardless and/or without knowing maternal history. (symptoms eg: vesicular skin lesion, seizures, DIC, unexplained thrombocytopenia, elevates liver enzymes with or without resp. distress) 2- If asymptomatic newborn plus (A) +ve maternal history WITH active genital herpes lesion and delivered by CS (in primary genital herpes) or CS/VD (in recurrent genital herpes) --> collect surface swabs within 24hrs of age for HSV PCR (eye, throat, umbilicus) if PCR results are +ve or neonate become unwell take CSF sample via lumbar puncture (LP) for HSV PCR and start acyclovir. (B) +ve maternal history of primary genital herpes WITH active genital herpes lesion and delivered by VD --> take swabs + LP + start acyclovir. (C) +ve maternal history primary or recurrent genital herpes WITHOUT active genital herpes lesion--> Observation If develops any symptoms of neonatal HSV as above --> take swabs + LP + start acyclovir. LOS: once clinical suspected we take cultures (Bl, urine and CSF) start antibiotics (the type of antibiotics depends on your units policy eg in Japan: mostly Gentamycine and ampicillin, in Canada: Vancomycin and tobramycin). Results in 48hr If cultures + , take another culture and switch antibiotics according to sensitivity if not sensitive to the initially given. Duration of treatment after obtaining a -ve culture depends on the organisms type and whether or not CSF sample was +ve. We use meningitic dose from the start if suspected meningitis (eg seizure). until CSF results. Antifungal if cultures are +ve for fungus. Rarely would we take a tracheal aspirate, however, if there is a lot of secretions in an intubated infant and received a septic workup and bl cultures are -ve after 48hrs and still secretions are a lot, then we may consider taking a tubal aspirate for culture.
  25. 1 point
    In Kwa Zulu Natal South Africa we are advocating that well at risk term babies are monitored (and if necessary receive antibiotics via short line-hep locked) in skin to skin care with their mother in post natal and are only admitted to the neonatal unit if they develop problems.
This leaderboard is set to Stockholm/GMT+02:00