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Showing content with the highest reputation since 10/15/2019 in all areas

  1. 5 points
    For those of you having follow-up clinics with children born preterm and affected by BPD, check out these European guidelines. A very thorough document. In short, most recommendations (screen shot below) are graded as low or even very low evidence. So there are lots of room for good research! Find the full document here (and yes, it is available as open-access): http://doi.org/10.1183/13993003.00788-2019
  2. 4 points
    It’s been some time since I last posted here. Many things have changed in my life since then- the most important transition being my decision to move to Finland to work as a research fellow with the Baby-friendly Ventilation Study Group in Turku. The life of a beginning clinical researcher deserves a separate post here (it may even come at some point). To celebrate my first anniversary in Finland I would like to share 3 things I wish somebody had told me before I moved here. Enjoy! 1.Get nylon pants. The weather in Finland is truly whimsical. We have had a kind spring, warm summer, and lovely, colorful autumn. I was able to enjoy each of these seasons, biking in the Archipelago, watching sun that never sets, traveling north to see ruska, and finally seeing Northern Lights for the first time in my life. My only concern here is rain. It doesn’t follow laws of gravity AT ALL. How is that possible, that those raindrops are not falling DOWN from the sky, but they are literally attacking you from every direction? It took me some time to overcome my frustration and find a solution. I have closely observed (relatively) happy Finns and discovered that the most important clothing item here is… nylon waterproof pants. The trick is they have to be big enough that you can pull them over your regular pants to keep you dry and warm when it rains. This small thing has definitely improved my comfort here. It has also created that precious feeling of belongingness- I could finally proudly join the rustling and swishing sisterhood of waterproof pants. 2. Drop in the fertility rate is a real thing. Ok, I am a doctor and I KNOW it is a real thing. I know that statistics don’t lie. I know. But I kind of didn’t want to acknowledge that it may actually impact my study. We have had a fairly good start of the patient recruitment, which had kept me busy in spring. But then summer had arrived, and the recruitment slowed down. I kept thinking that maybe it’s just because of the summertime in general (like preemies would be able to pick a season when they want to arrive early, right?). But then autumn has come, and it was time to face the music- I have a problem. In order to recruit the desired number of infants, I may either stay here forever OR I need to come up with a clever solution very soon. Thankfully, I have amazingly supportive supervisors here and we decided- we are expanding! That means more traveling for me (and possibly more blog posts for you)! 3. Compulsive talking about 99nicu may help you to dance more salsa. That statement may seem rather weird, but there is a logical explanation. Very recently I’ve had a chance to attend a regional neonatal meeting in Finland. I was asked to present highlights from the 99nicu Meetup in Copenhagen. Since I like the whole concept of 99nicu.org and loved two conferences I had attended, I took that task very seriously- meticulously prepared my PowerPoint presentation and practiced my performance out loud at home. I decided to tell participants about lectures I remembered the best- neonatal transports, simulations in the NICU and infants surviving at the limit of viability. You may argue that there were more important lectures there, but those were the ones that still “spark joy” after all these months. Do you remember that sim scenario of postpartum seizures in a birthing pool that Ruth Gottstein talked about? I’ve discussed it with so many people in so many places already, that it might have become my favorite topic of random conversations with strangers. Anyways, I think the presentation went well- participants awarded me the prize for the best presentation of the evening! I received a gift card that I can use for cultural or fitness activities in Turku- including more salsa classes in my favorite dance school. Voila! Thank you 99nicu!
  3. 3 points
    Oral immune therapy (OIT) has really taken off at least in our units. The notion here is that provision of small amounts (0.2 mL intrabucally q2or 24 hours) can prime the immune system. Lymphoid tissue present in the oropharynx and intestine exposed to this liquid gold in theory will give the immune system a boost and increase levels of IgA. Such rises in IgA could help improve the mucosal defence barrier and therefore lessen the incidence of late onset sepsis. Rodriguez et al described this in their paper Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives in 2009. They followed it up the next year with a pilot study demonstrating how to actually administer such therapy. The fact that this approach has been adopted so quickly I think speaks to the principle that this kind of therapy falls into the category of “can’t hurt and might help”. The real question though is does it actually make a difference? Recently, authors from Brazil presented their findings from a single centre double blind RCT entitled Randomized Controlled Trial of Oropharyngeal Colostrum Administration in Very-low-birth-weight Preterm Infants. This authors are commended for studying this practice in such a fashion and included infants <34 weeks who were <1500g at birth to receive the above mentioned intervention. These infants were compared to placebo who received the same intervention except instead of mother’s own colostrum they were given sterile water. In total there were 149 infants randomized with 81 receiving OIT vs 68 who received a placebo. The primary outcome of interest on which a power calculation was performed was the incidence of late onset sepsis. Other typical outcomes including NEC, ROP, BPD, IVH and death were also followed. Did they find a difference? Sadly to many of you I am sure they did not as is shown in the table below. Surprisingly the authors also looked at levels of IgA in infants in both arms and also found no difference. There is a big problem with this study however that no doubt will lead to a repeat version at some point. While the authors enrolled the numbers above, the numbers that were analyzed in the table are 34 lower in the OIT arm and only 2 lower in the placebo group. In essence, a large number of mothers after enrollment were not able to provide the colostrum that was needed for the study. The study called for 48 applications over a 48 hour period and a little more than half of the mothers were able to do it. Do not be dismayed then that no difference was found here. There is no need to “throw the baby out with the bathwater” and abandon OIT based on this one study. I think what is needed in the future though is a study that enrolls far more than needed to account for attrition due to loss of mothers who can complete the study. Without another study I think the practice will continue but does it really make a difference to rates of sepsis? Who knows but there is no doubt it helps parents who are feeling that they have lost control of a pregnancy that has gone wrong, a positive experience and the feeling that they are doing something for their child.
  4. 2 points
    After watching a documentary in ARTE about bacteriophages it made me think about how else is antibiotic resistance in NICU.? It available french / German Here the story phages was told. First discovered use by Felix Derrel to combat infections in the pre-antibiotics era and was later discredited and forget about in the western world Historically they worked rather well, so there is an attempt to bring them back in the light of increasing antibiotics resistance. This rediscovery started with lab study that showed that the phages were effective at clearing infection in rats population sample. Phagoburn Recently, a French team took it to human and show it feasible despite the many challenges. This study was a RCT which a specific process approval and protocols were established. The aim in *Phagoburn*was to see if phages could be useful using to fight infection in burn victims. It was lead by Dr. Patrick Jault and large team .Jerôme Gabbard head Start up tells Pherecydes provided the synthesis of phages. control got standard treatment {silver salts +antiobiotics} and othe got phages.This got published in nature. The was a reduction in the infection rate in phage group, a loading dosing issue among other practical things. Researchers in france say that there a scaling issue to produce larger amounts, as well a regulatory framework. From bioethical point of view it is possible, a more detail informed consent will be necessary.These days research still going a la Croix de Lion Hospital, France. University Hospital ~CHU Lyon~. ( initial used - discovered @pasteur Institute) https://www.arte.tv/fr/videos/078693-000-A/l-incroyable-histoire-des-tueurs-de-bacteries/ Thus what do think any future of phage in NICU?
  5. 2 points
  6. 2 points
    I found this link, have not looked at it in detail but maybe a starting point, and with a video https://www.jove.com/video/58990/protocol-guidelines-for-point-care-lung-ultrasound-diagnosing
  7. 2 points
    Dear Colleagues, I am attaching a link to the website for the European Neonatal Ethics Conference here. We now have the final programme There are still a few places left and you can register on https://www.eventbee.com/v/neonatalethicsconference#/tickets 250 registrations from 44 countries 20 International Speakers 12 Workshops #ENEC2019 Debates Round Tables 50 Abstracts Every Continent ENEC 2019 Final Programme.pdf
  8. 2 points
    Many of you already know about my engagement in Neobiomics, a startup company now launching ProPrems® in Europe. I was asked recently if there was a specific event that made me committed to close the gap between need and availability of a safe way to support the intestinal microbiota. Yes, there was a “Tipping Point” that I can share a few words about, without disclosing patient data. The photo below shows the place in my NICU where a preterm infant stayed some years back, being well on full feeds and expected to have an easy journey with us. When things went into new and unfortunate directions. Although difficulties and suffering is part of what we work with, this event made me feel that I did not provide the best care for my patients. I mean, compared to all interventions we make every other day, and the lack of good evidence for many of them, probiotics supplementation was already in 2014 a no-brainer from an EBM perspective. So, I set off to find a suitable product. But became increasingly frustrated. I thought that manufacturing probiotics could not be rocket science but I experienced that no company could provide what I was looking for. Specifically, when it came to documentation around quality. I discussed this matter with colleagues and realized that I shared my concerns with others. An idea came to my mind that maybe we should just work out a solution ourselves, within the neonatal community. Philipp Novak, a life-science entrepreneur in Austria, was brave enough to get convinced and off we went. Backed by a group of clinicians and researchers. In 2016 we founded the startup company Neobiomics and initiated our collaboration with Chr.Hansen, world-leading manufacturer of bacterial cultures. And now, after 1000s of work hours (pro bono BTW) and with very limited funds, we have now reached the first goal. With ProPrems® there is now a premium product available, with manufacturing quality as we want it (single-dose-packaging, 2y stability in room temp, tested against an extended panel of contaminants, no risk of antibiotic resistance gene transfer). What’s next? To speak in symbols, our plane is on the takeoff strip at full throttle while we are still putting the wings together. So times are both hectic and thrilling. But like when standing in front of a very ill infant in the NICU, I feel that this is something we can manage by systematic and hard work. But of course, ProPrems® needs to find the way out to NICUs. Without a costly "old-school" organization of sales rep’s etc, this may seem challenging. But given the collegial feedback so far, we feel confident our project will sustain. If you get interested to learn more, find more in the attached folder. You can also visit the web sites neobiomics.eu and proprems.eu, or get in touch with me directly at stefan@neobiomics.eu. But please note that ProPrems® will be only available in Europe (that’s why access to ProPrems.eu is restricted from non-EU countries). ProPrems_Folder.pdf
  9. 2 points
    In Linköping we have developed a structure on how to do this in deliveryroom on ELBW less than GW28. It works pretty well if you manage to deal well with the logistic. Receive on the foot-end of deliverybed between the legs of the mother, put the baby in a nest covered by plastic, using a mobile Neopuff with humidified warm gas, Starting with CPAP only awaiting the respond of heartrate and spontaneous breathing, ventilating only if bradycardia, delayed cordclamping. Incubator Close to the bed, connected to mobile CPAP/Ventilator. If intubation immediate Surfactant instillation. We have planned to enhance it into all Babies less than GW32 (33?). Working on a video on it. Apart from a mobile neopuff, an incubator in Place and a mobile CPAP/ventilator you don´t need any extra equippment. But a well trained team and clear logistic is crucial (protocol). /Per
  10. 1 point
    @cB23 we dont use Morfin since quite some years but fentanyl as analgetic during intub. even for LISA we give a small dose to reduce assumed pain of the laryngoskopy
  11. 1 point
    @nashwa Would be great to hear the experience by for example @Francesco Cardona , I work in a NICU with ≥28w infants now. As I understand from level3 colleagues, nCPAP with relatively high pressures is the primary mode of respiratory support, and LISA the method to give surfactant, while nCPAP is ongoing. This is said to be a successful strategy for a surprisingly large proportion of the very immature infants (also ~24-25wk), but I don't have numbers or first-hand experience myself. I have even heard discussions that staff worry about intubation skills, and how those skills are trained/kept when only a minority of ELBW infants needs intubation and invasive ventilation. A new world!
  12. 1 point
    Hello. We use Insure on ELBW children. And we extubate them just after putting surfactant into lungs. We wait a little bit untis surf. is absorbed (by stetoscope). But it takes just little of time. If baby is breathing, extubate and put nCPAP. It all takes maybe 5 min.
  13. 1 point
    In this case just pull the line 1 cm. It's worse when you insert the UV line shortly after birth, and when the baby develops distension after a day or two, the tip will be pulled to the level below diaphragm. It happened to me several times. For that reason I try to place the tip rather at T8 then T9. If the tip gets pulled to the level below diaphragm on the AP XR, you may still be able to salvage the line by getting a cross table lateral XR which will show more precisely the position of the tip in relation to the posterior diaphragm, and if you are lucky it may be still positioned above it.
  14. 1 point
    We use gastral tubes with 5ml/KG NaCl0,9% rectally in the second day of life if a premie (《1500g) to stimulate mekonium release (because changings of enteral feeding regimes depending on mek rel). With this procedere we stimulate bowelmovment. It works most everytime. We don't wait for problems. I believe most Effect depends to the distending fluid As long as premies stay in incubator temp is measured with rectal probe. Later with Thermometer (without plastic wrap). We do no Stimulation. For Colic gas seldom we use small airwaytube 3 cm inserted for 30 min.
  15. 1 point
    I practice in two very different ICU environments, one delivery and one which is more of a med-surg ICU closer to a PICU than a NICU in many ways. I think the data are clear and many of the previous respondents concur that NaHCO3 in the delivery setting is at best useless. For the ELBW with anticipated renal losses NaHCO3 should almost never be needed because these losses can be anticipated and should be incorporated into nutrition to avoid the biochemical inevitabilities noted in the articles Stefan cited. I suppose I might use bicarb in the preemie population if I had metabolic acidosis and evidence it was effecting cardiac output and even then I probably would not correct past 7.2. However, in the case of the older child or the med-surg patient where some specific pathologic perturbation has led to rapid collapse and I suspect part of that mechanism is bicarb deficit, I would have no hesitation to rapid correct the pH. I have several times done this and watched the EKG improve in real time.
  16. 1 point
    I find this web and app resource from Cincinnati Hospital extremely useful to teach students/ trainees and during parent consultations to explain the condition in 3D (saves me the embarrassment from drawing!) Weblink Link to play store to download the Android version.
  17. 1 point
    Whatever side we take...the most important point to remember is that ventilation should be excellent when using Bicarbonate...if ventilation is not optimal...then the CO2 released from Bicarb in vivo goes nowhere and paradoxically leads to increased acidosis !!!
  18. 1 point
    According to ERC guidelines of resuscitation in the delivery room the aim of administering sodium bicarbonate during resuscitation is not to correct the blood acidosis in general but only to elevate the pH level as close to the heart as possible to make the epinephrine receptors more "reactive" to it.
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