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Showing content with the highest reputation since 10/21/2013 in Blog Comments

  1. 3 points
    This finding seems to be "livedo reticularis" . You can interpret that as "exagerated cutis marmaratus". Did you investigate in terms of antiphosholipid syndrome? If this finding occured on DOL 4, how could he be discharged ? I saw this finding in babies who were suddenly developed vasomotor spasm (whatever the reason is). In this situation, If it could be removed the reason and secured the circulation, the problem would ended up.
  2. 2 points
    Please also see the results that we have in this matter in Vietnam in journal of antibiotics https://www.sciencedirect.com/science/article/pii/S2213716519301456 and in Plos one and help suggest strategies for how to manage the high rates of colonized children/neonates in South east Asia before it is spread to other parts of the globe.
  3. 2 points
    Here are some answers on @AllThingsNeonatal blog above; Dear Michael, thanks for posting your thoughts on our paper: https://rdcu.be/bP2Ew Regarding < 1 minute compared to > 3 minutes we had the same criteria in our RCT on 540 healthy newborns with 12 months follow-up, showing reduced anemia (http://dx.doi.org/10.1001/jamapediatrics.2016.3971) and improved development assessed by ASQ (http://dx.doi.org/10.1159/000491994). Most major studies on DCC in term infants define DCC as 2-3 min or more. Regarding outcomes in the above mentioned study (https://doi.org/10.1186/s40748-019-0103-y) I can only regret that we didn´t include the important data on temperature and NICU admittance; for you and your readers, here they are. Temperature Celcius: DCC 36.3 (0.5) vs ECC 36.3 (0.5), p=0.05, Mean difference -0.05 (-0.11 – 0.00) Fahrenheit: DCC 97.3 (0.9) vs ECC 97.4 (0.8), DCC 36.3 (0.5), ECC 36.3 (0.5), p=0.05, Mean difference -0.05 (-0.11 – 0.00) Measured at (minutes after birth): DCC 17.1 (8.9) vs ECC 16.7 (1.6), p=0.38, Mean difference 0.4 (-0.3 – 1.1) NICU admittance, N (%): DCC 5 (0.8%) vc ECC 5 (0.7%), p>0.99. As I hope you´ve noticed, we published a study last week on intact cord resuscitation where we included data on temperature and admittance to the NICU: https://doi.org/10.1186/s40748-019-0110-z Kind regards, Ola Andersson
  4. 2 points
    I actually think the potential benefit in the bigger preemies is a major selling point. In regionalized NICU systems, need for intubation is a common trigger for neonatal transport. I could see nebulizer surfactant being very attractive to level 2+ NICUs in the US wanting to keep such babies closer to mom.
  5. 2 points
    I find it very interesting but speaking of is not like watching it! For the moment I will not dare do it !
  6. 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.
  7. 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.
  8. 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.
  9. 2 points
    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
  10. 2 points
    I looken into Youtube and found only videos of LMA placement, this one from the UK-based initiative IMPROVE and @spartacus007
  11. 2 points
  12. 2 points
    Thanks for a great post! I have this specific question (Apgar=0 at 10 min) as a research project that I am applying funding for. Here in Sweden, we have a lot of data in health care register (national coverage) and my plan is to link data (on an individual level using the the "personal id number") from 1992 and onwards, to explore the clinical (ICD-coded) outcomes of Apgar10=0-babies that did survive. Our clinical guidelines has also been to do full resusc until the baby is 15 min, and stop then if the baby is still asystolic. Just need some funding for it.... but I think it would be good study - especially since the time frame would also cover the intro of hypothermia.
  13. 2 points
    Hi.It Seems cutis marmorata where the skin has a pinkish blue mottled or morbeled appearence when exposed to cold stress.
  14. 2 points
    As this rash came and disappeared in 20 minutes it looks like urticarial reaction I didnt see the picture but cutis mormorata can occur in cold stress and once the baby temp improved the rash disappeared
  15. 1 point
    I cannot access the full text from home, but it strikes me that intermittent hypoxia is, at best, a surrogate for the clinical indication I and my colleagues have done trials of post-pyloric feeding in this patient population. As you say, practices vary, so perhaps I'm an outlier, but I use post-pyloric feeding for the very specific subpopulation of BPD patients for whom I am trying to modulate the mode of support (eg wean the baby who is 'stuck' on a low level of CPAP or a HFNC from positive pressure to a low flow canula that can be weaned on an outpatient basis). These trials of post-pyloric feeding typically run ~1 - 2 weeks and the outcomes we follow are (in order from least to most important): intermittent hypoxemia, baseline FiO2 changes, changes in level of support. I agree that those who seldom or never resort to transpyloric feedings need not change their practice based on this study, but I'm not sure this trial addresses the way transpyloric feeding is used in my part of the world.
  16. 1 point
    I am a fan of HFNC, but agree that patient selection is important. I see it working less favorably in the bigger babies (in weight and gestation). In my practice, although there may be a negligible increase in HFNC days, this is not with ongoing supplemental oxygen requirement. Lesser nasal trauma, more comfortable baby and definitely a more positive engagement / involvement from parents when on HFNC makes me lean towards its’ use. But of course, there is always the faithful CPAP to fall back to when things don’t work. This study has highlighted 2 things to me: when a baby is < 1 kg, start with 6L/min flow. When weaning below 4L/min, be mindful of CO2 retention, work of breathing and possible increment in oxygen requirement, which might indicate atelectasis.
  17. 1 point
    And if you havent seen Ola Andersson's lecture from the 99nicu meetup, go and check it out here:
  18. 1 point
    Apologies as I forget to embed it. https://www.ncbi.nlm.nih.gov/m/pubmed/30353079/
  19. 1 point
    neonatologa of San Luis PotosÍ MÉxico, we have a thesis about the weight to which we can thermoregulate to the low weight RN we compared 1500g vs 1600g and we did not find differences between the two groups but if we observe that there is a decrease of days stay when they are put to thermoregulatory early. I will publish it soon Dra Carolina Villegas Alvarez
  20. 1 point
    According to our (Dräger) experience weaning from the incubator varies a lot. There are many different weaning protocols around. In order to wean babies faster from the incubator a new automatic Weaning Mode has been developed for the Babyleo IncuWarmer. The Weaning Mode is designed to support different weaning strategies. It reduces the air temperature in controlled steps and intervals while monitoring the skin temperature to automatically wean the baby off the incubator.
  21. 1 point
    congratulation... nice concept of solo speaker conference . We call it CME here though.
  22. 1 point
  23. 1 point
    Thanks for sharing and congratulations to your first talk as a "solo speaker". And the macarons, what a great bonus
  24. 1 point
    Thanks for a thoughtful post. The idea sounds very good for, I think we (staff) underestimate how parents feel about going home, it is a bigger step than we often believe. Kotiloma FTW And below I embedded a comment posted on FB!
  25. 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 ; >
  26. 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.
  27. 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.
  28. 1 point
    One for all and all for one I feel that i have many wings all over the world
  29. 1 point
    I work in units with colorimetric verification and it is often exactly as you describe, particularly when a trainee performs the intubation and the HR is lingering, the colorimeter is not changing and then neonatologist has the trainee remove the ETT and the patient is reintubated. Earlier in my career I just assumed these were esophageal intubations by me (in the role of a junior trainee). Now, at the end of my fellowship, I have multiple experiences with this phenomenon where I have no doubt that I have seen the tube pass through the cords under a grade 1 view. We pull the tube, provide PPV (presumably further establishing FRC) and reintubate with more rapid CO2 detection on the second attempt.
  30. 1 point
    Glad you presented this issue. It has been festering in me for over 45 years. The BVM has been in the delivery room and at the bedside even before neonatologists existed. The standard approach to a distressed infant was to vigorously “bag him up” to relieve immediate symptoms. The original Baby Bird ventilators had a resuscitation bag incorporated within the ventilator circuit to allow for “bagging up” the infant whenever heart rate dropped or desaturation seemed likely (prior to pulse oximetry). An unacceptably high rate of pneumothoraces and associated barotrauma prompted Bird to remove the resuscitation bag from subsequent Baby Bird models. There is ample evidence to support the notion that the BVM may be the sole cause of infant CLD. Certainly there are contributing factors that predispose the immature lung to be susceptible to overdistension. Other than congenital emphysema, however, one would be hard pressed to document a case of CLD in which the infant had not received BVM ventilation. Columbia Presbyterian neonatal unit has shown an unusually low incidence of CLD as compared to most other hospitals. The practice of adopting Dr Wung’s “bubble CPAP” and low pressure and/or low volume ventilation has led to improvement in neonatal outcomes in many hospitals, but matching Columbia Presbyterian’s results has been an elusive goal for most. A possible reason is that others have failed to adopt the delivery room and neonatal unit discipline instilled by Dr Wung that accompanies the practices they’ve adopted. “Give the baby a chance” is Dr Wung’s mantra. The first apgar is at one minute, not at 20 seconds. This simple act reduces unnecessary interventions and subsequent iatrogenic actions. Outcomes improve. Immediate CPAP application to premature infants is a second action rather than resorting to BVM “rescue”. Again, “Give the baby a chance”. Refer to Dr Jobe at Cincinnati Children’s article, “Don’t just do something, stand there!” Follow-up care in the NICU is equally fraught with iatrogenic actions prompted by good intentions. Infants receiving mechanical ventilation are routinely “bagged up” for desaturation or bradycardia episodes. Again, the immature lung is subjected to stresses it simply cannot tolerate. There are few, if any, studies on how often and to what extent BVM interventions happen. Virtually every study of neonatal mechanical ventilation is skewed by this glaring oversight. Until the role of BVM is thoroughly investigated and quantified, progress in neonatal CLD will continue to be elusive.
  31. 1 point
    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
  32. 1 point
    Besides from death, neonatal morbidities in VLBW (benchmarking with the Spanish network SEN1500), we also use Temperature on admission and nutricional z scores (weight, lenght and cephalic circumference) at discharge. And use of breast milk at discharge.
  33. 1 point
    When I read this publication with my clinical epidemiology-glasses, I wonder if the results (and conclusions) are just an example of the cohort effect. @AllThingsNeonatal you are very nicely referring to that possibility, when you discuss the possibility of a changing distribution of gestational age over time, and mortality differences over time (that probably reflect change in care over time).
  34. 1 point
  35. 1 point
    Thanks for a great post! I agree very much about the discussions in the NICU about BPD, in our unit not so much about the definition but how to manage it. As we tend to increase the saturation targets, and BPD is defined by oxygen supplementation at a certain time point, we likely increase the incidence of BPD only by setting a higher saturation target. Naturally, babies with bad lungs are at risk of doing less well in developmental terms. But the lungs or the BPD-definition may not the problem itself, more a proxy for a high-risk scenario. Related to this blog post, I started a discussion in the lung forum about saturation targeting, find it below
  36. 1 point
    Thanks for a great post! I nourish plans to add a "Procedures" category in our eHandbook (i.e. together with the Pharmacopedia)- would it be ok to embed your Youtube channel videos there, in this case in a "Chest tube insertion" post?
  37. 1 point
    @AllThingsNeonatal Got this link on LinkedIn https://www.thewomens.org.au/news/gentler-breathing-support-can-help-premature-babies/ Nice example on the art of marketing , on how to turn something inferior to something "promising"
  38. 1 point
    Great post - and thanks for high-lighting an important study. I fully agree with your conclusions as well. I was trained before the HFNC days and learned how to use CPAP and low-flow oxygen (if oxygen suppl was needed for a baby). I think we developed a nicely working model in that unit. Nowadays, the HFNC machines are just everywhere without us knowing why and how we should use them. Many says that babies, parents, staff and doctors "love" HFNC. I "like" is a bit, it seems to be a option for some babies. But, my feeling is def that we seem to overtreat babies with respiratory support from this device, some infants not needing oxygen (FiO2 0.21) are kept on HFNC "just because". A more critical view on HFNC is something we need, it is not proven to be a magic bullet.
  39. 1 point
    Thank you for the very practical question that we are facing in every day practice For last couple of days i had this list neonate with hemoglobin 9.8 shifted for coarctation repair we resreved blood for him and shifted to the surgical centre Another one initially with gastroschiesis jeujonostomy and ileostomy done for him and went to OR for stoma closure his Hb was 8 we gave him PRBCs before OR Hydrocephalus for VP shunt shifted to OR with Hb 13 Fresh newborn D2 MMC repair Sooooooo I agree with you some babies need to be transfused before OR specially we do not know how much of blood they will lose during OR Really i like this topic we need a clear guidline for that
  40. 1 point
    BPD existed and was described in 1967 many years prior to the use of surfactant. There is some evidence that surfactant exerts or down regulates many cytokines associated with inflammation.
  41. 1 point
    Being polite transforms the working atmosphere. It makes the communications easier with the parent.
  42. 1 point
    Thanks, Keith, for this careful commentary. Just a few words to say that some may think that parents' approval of a trial is sufficient for being ethical; it's an error: parents should only shield babies from stress and from every risk, they aren't allowed to permit any type of harm to their babies (even when this harm seems minimal or transitory… and it isn’t). Thanks for pointing out the possibilities of analgesia during eye observations: according to authors' conclusions in both reviews you quote, we considered these approaches insufficient as "screening remains a painful procedure" and "pain scores remained consistently high". I hope journals and IRB will consider these data. Carlo Bellieni
  43. 1 point
    Excellent blog. Rude behaviour is detrimental to patient safety and to patient outcome. It builds obstacles in effective communication within the NICU team. I think we have to take lessons from the airline industry about communication strategies. Crew Resource Management and removing hierarchy while communicating is very important. http://psnet.ahrq.gov/public/02-dunn.pdf Motivated staff are a great resource for achieving optimal patient outcomes .http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/implement/teamwork.pptx Rude staff are usually disruptive to the NICU staff. Staff with attitude issues should initially be politely counseled. If still no change in behavior will necessitate disciplinary action and ultimately removal for the team. A single rude disruptive person is enough to upset the whole NICU team.
  44. 1 point
    I don't think there are any large trials published, there are 5 or 6 trials registered, but most are fewer than 200 patients total. Arne Ohlsson and Prakesh Shah just published an updated Cochrane review. They were able to include 2 randomized trials, both of oral therapy, and with a total of 250 patients. They showed no real difference in efficacy or in long term outcomes. We certainly do need a good trial now, I think there are enough data to support such a trial, if paracetamol works equally well, but maybe has fewer effects of fluid balance (for example) that might lead to better outcomes, if we do the studies right.
  45. 1 point
    In addition to the 3 cases of probiotics associated bacteremia published by the team from Zürich (http://www.karger.com/Article/Abstract/367985), we recently identified 2 cases of probiotics-associated sepsis in very preterm newborns (http://cid.oxfordjournals.org/content/60/6/924.long). Interestingly, all 5 cases come from the same country (Switzerland) and occured in patients treated with the same probiotic preparation (Infloran).
  46. 1 point
    RenewLife don't produce the probiotic organisms themselves, they are produced by a company called Harmonium International, who have their facilities in Mirabel just north of Montreal. In fact there are only a few manufacturers of these organisms in the world, and unfortunately in many parts of the world a company selling a probiotic preparation to the public, can change suppliers, change formulation and which strains are involved, without changing the packaging or informing consumers. One of the advantages of the Canadian Natural Products Number system, is to put a stop to that. in order to maintain their NPN, companies have to stick with all the details that are on file with Health Canada. It is certainly important that a safe product is given to our tiny babies, a discussion with manufacturers and regulatory authorities may help you to know what the situation si in your own country.
  47. 1 point
    Thanks for a very thoughtful post. And I agree! Families do have impact on their children's health and less priviliged families have less possibilities to promote health of their preterm infants. At least that is my impression, even is a socio-economically "flat" country like Sweden.
  48. 1 point
    If the baby had or had had an umbilical artery line, I would guess "cath toes"- perfusion issue related to arteriospasm.
  49. 1 point
    No treatment was given as the skin rash disappeared within 20 mint. Only part of history to be added is the baby was just shifted from incubator care to cot and the temp was 36.3 ? I put diagnosis of vascular Immaturity as the diagnosis ?
  50. 1 point
    Looks strange! Bulleaous skin changes or flat? Erythematoues (compressable)? History sounds like some kind of Harlequin phenomena but the images does not really look like it I think.
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