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Popular Content

Showing content with the highest reputation since 04/13/2021 in all areas

  1. On behalf of the 99nicu Team, I would like to invite you to participate in our 2nd Journal Club! The article we chose this time is a review article on "Safe emergency neonatal airway management: current challenges and potential approaches" by Joyce E O'Shea, Alexandra Scrivens, Gemma Edwards, and Charles Christoph Roehr. This artile is not Open Access, but I hope you can get it from your hospital library. The review article examines how to acutely manage the neonatal airway, and the challenges related facemask ventilation and intubation. Some of the key messages in this paper are:
    4 points
  2. Same as you, for the most part. Keys in my view are: 1) Anticipation of risk factors (length of intubation, cuffed tube, lack of leak, parenchymal lung disease which may make the child more prone to struggle with even transient upper airway narrowing, etc) 2) Early recognition/treatment with nebulized Epi and Steroids as well as consideration of heliox as a further temporizing measure until steroids can kick in 3) Shared mental model with frontline staff that re-intubation may be more challenging and/or need to happen fairly expeditiously if the airway cannot be preserved non-in
    4 points
  3. Also there are papers now looking at "cooling outside criteria" which are interesting too e.g. late preterms, stroke..... This RCT was in adults but suggests worse outcomes in adults undergoing therapeutic hypothermia who have bacterial meningitis.....https://pubmed.ncbi.nlm.nih.gov/24105303/ A neonatal study (Jenkins et al 2013) has looked at immunosuppressive impact of cooling. Newer possibilities: cooling in NEC?!? https://pediatrics.aappublications.org/content/125/2/e300.short and lots of work now looking at adjunctive therapies like xenon and erythropoetin..... And perhaps
    4 points
  4. In my units, provider preference, though as far as I am aware we all invite families to remain with the baby. Assuming it is a controlled intubation, I do warn parents that they cannot get in the way of staff and so should remain off to the side, preferably seated, just in case they become faint or ill watching the intubation and I emphasize to them that all our attention will be on the baby and if they think they will become a distraction to the team that they may want to go for a walk or sit in the waiting room instead. I would say 75-80% of families say they'll step out and wait for us to g
    4 points
  5. There has been a lot of thoughts on this in the neonatal Twitter community! is intubation a mandatory competency for trainees in your country? Should it be? How do you as a neonatal physician/ANNP/NNP keep your skills up to date? How many is “enough” to be deemed proficient? 🤔🧐🤓
    3 points
  6. Great idea to have a journal club. Currently although parental presence is encouraged it occurs very seldom in our units.
    3 points
  7. We pause for one week and then check ferritin level; restart if ferritin is <300, otherwise wait 1-2 weeks.
    2 points
  8. hello group, I would like to know how your institutions deal with the administration of iron after transfusion.
    2 points
  9. The point about the VL is an important one. If intubation becomes a high risk/low frequency event, we should take a safety perspective and engineer our systems for safety, not widespread procedural competency with direct laryngoscopy. I am a physician-scientist who primary covers a level IV NICU without a delivery service. The over all number of intubations is relatively low and in most emergency circumstances there is a front line provider (typically NNP), a (very) experienced charge NNP, and a neonatal fellow available for managing the airway while I run the code. I can now count on one hand
    2 points
  10. Precision medicine is a growing field in which genetic factors, environment, metabolism and even lifestyle are taken into account when deciding who should receive a treatment or not. When it comes to bronchopulmonary dysplasia I believe anyone who works in Neonatal care can attest it is a mystery why some infants go on to develop BPD while others don’t. We do know that certain treatment strategies may increase risk such as using excessive volumes or pressure to ventilate and in the last 25 years the notion that your level of cortisol in the blood may make a difference as well. I have written a
    2 points
  11. Parent Session Guest Lecture Parental Experiences at Limits of Viability I would like to invite you all to the session on Thursday the 6th of May from 1400-1530 BST. The session starts with Professor Dominic Wilkinson talking about how we communicate with parents in different situations and cultures and how this changes from prior to birth to after birth. This is followed by a parent session where we will have parents from 3 different countries speaking to us about their experiences in 3 areas How we communicate and what they hear Prognostication and Difficult Conversations
    2 points
  12. In the past, we paused iron supplementation during three days after a blood transfusion. However, we thought this routine did not really make sense as the iron load from a blood transfusion would correspond to ~1 month of iron supplementation In infants with many transfusions, we do check S-Ferritin, and halt iron supplementation if S-Ferritin is >350 μg/L.
    2 points
  13. Dear colleagues, do you see post-extubation stridor regularly at your NICU? We recently had 2 quite severe cases of late preterm babies who at that time already were around 40+0 and that only had been on the ventilator for a few hours (1 for minor surgery and 1 for an MRI). They were treated with nebulized adrenaline and corticosteroids and luckily got better pretty fast. How do you treat it? Do you have any protocol on that and do you have a protocol or guideline on how to prevent it like some of our PICU colleagues (i.e. https://secure.library.leicestershospitals.nhs.uk/PAGL/Shared Do
    2 points
  14. Hi all, I am relaying a message from one PhD Twitter Xavi Jimenez ( PhD student , Neonatal nurse at VallHebron, Barcelona) he reply to my re-tweet of the survey by saying the following In the Delivery room they don’t use humidified air, they mostly central air conditioning. They use the humidified air in the NICU as an extra during the Summer month. Cheers, Jelli
    2 points
  15. Concord Talk with Ronny Knol and Bram Dees was very inspiring, including some amazing video's that show the actual workflow. you can replay the recording of this Concord Talk via: https://concordneonatal.com/concord-talk/
    2 points
  16. Hi, I would like to learn more about hypoxic-ischemic encephalopathy (HIE), can you recommend your favorite articles in the topic? I can totally read some reviews, or also original research papers if you think they are well written and relevant animal studies can also be interesting! Thanks!
    2 points
  17. I have only come across this thread too! We (UK) have 48 hour hang times for vamin, and 24 hour lipid change. The lipids are infused on a separate syringe driver, and the vamin run through different fluid pump. We were looking into using orange light protecting giving sets for the lipid which a different colour to our standard giving sets for bags of fluid. We have standard manufactured bags of PN in stock on the unit, and then we can also get special bespoke bags made via our aseptic pharmacy team if the patient needs fluid restriction or careful electrolyte management. Our nurses chang
    2 points
  18. I think I found an interesting study about antepartum and intrapartum risk factors of neonatal encephalopathy. A bit old, but I think still very relevant when discussing the causes of hypoxic ischemic injury with parents! https://www.bmj.com/content/317/7172/1554.long https://www.bmj.com/content/317/7172/1549.long
    2 points
  19. https://doi.org/10.1186/s12887-020-1958-9 Standardised neonatal parenteral nutrition formulations – Australasian neonatal parenteral nutrition consensus update 2017 I just found this publication in BMC pediatrics from 2017 and it seems obvious we must all shift to 48 hours for parenteral nutrition and consider it for lipids I remembered this discussion and I am sharing this article It contains other interesting informations
    2 points
  20. So many to recommend , vital topics . Agree it a good idea to start with RCT TOBY trial/ Cool Cap Here the latest I viewed. Human umbilical cord mesenchymal stromal cells as an adjunct therapy with therapeutic hypothermia in a piglet model of perinatal asphyxia - ScienceDirect https://www.sciencedirect.com/science/article/pii/S1465324920309300 by one Dr.Nicola Robertson et al who working on this field + 10 yrs.
    2 points
  21. Big topic, and lots of available reads! I would suggest to start off with two review papers, the first one describing long-term outcomes from the key RCTs (like the NICHD and TOBY trials, and the other one about neuroimaging (like a historical overview). https://pubmed.ncbi.nlm.nih.gov/27863707/ https://pubmed.ncbi.nlm.nih.gov/27673422/
    2 points
  22. We have a few replies on twitter on the topic
    2 points
  23. Guest Lecture https://us02web.zoom.us/j/89068687386?pwd=aWtkckI5L04rN2lWV0xsYTB4N2lWdz09 Topic: Outcomes following a comprehensive versus a selective approach for infants born at 22 weeks of gestation Time: Apr 15, 2021 05:00 PM London 0930 PM India UAE 0800PM We would like to invite you for a talk on Outcomes following a comprehensive versus a selective approach for infants born at 22 weeks of gestation Professor Carl Backes Dr Omid Fatih Departments of Pediatrics and Obstetrics & Gynaecology, The Ohio State University Wexner Medical Center, Columbus, Ohio
    2 points
  24. I like the underlying principal, that we shall empower and engage parents. I see the major take-home message as being how few parents were present, something that can certainly be improved. From a methodology perspective, I think there are some major limitations (I know, I take the role as Reviewer #3 now...😞 the cohort is from 2014-7, so the findings may (hopefully!) be outdated, that more parents are present nowadays the association between parental presence and the lack of positive or negative impact on intubation outcomes: this may be baised by differences in who the profession
    2 points
  25. I like the idea, Believe it has benefits, but I am sure it is very disturbing to my staff
    2 points
  26. Dear Colleagues, I hope this email finds you well and in the best of health and good spirits. I would like to thank you for participating in our preterm epidemiology and ethics module. We along with the European foundation for the Care of Newborn Infants are organising a parent led session on 'Shared experiences of Parents at Limits of Viability'. This session is being run on the 06/05/2021 from 1400-1600 British Summer Time with a schedule as follows 1330-1400 Registration and Waiting Room Time: May 6, 2021 02:00 PM London Join Zo
    1 point
  27. We do not pause iron supplementation
    1 point
  28. There are indeed many limitations to this study, as mentioned already. For one, it would take >10 years to get 71 cases of real MAS that required mechanical ventilation in my 89 bed 9000 annual delivery unit. So I wonder about the enrollment issues. Heliox of course can only be effective at low FiO2, so only mild cases would stand to benefit, and they probably would do fine anyway. The graphs show almost parallel improvement in both groups and the SD in most of their data look unusually tight. I would love to see this reproduced somewhere else, because this looks too god to be true....
    1 point
  29. This post is special to me. A redemption of sorts. When I was a fellow in Edmonton in the early 2000s my fellowship project was to see whether heliox (helium/oxygen) given to piglets with meconium aspiration syndrome (MAS) would improve ventilation and measures of pulmonary hypertension vs controls. Why heliox? There had been work done with this gas for other conditions and the lower viscosity of the gas (who hasn’t sucked on a helium balloon to see the effect of helium) means that the flow of the gas in a tube is more linear that regular air. Turbulent flow as with air/oxygen mixtures creates
    1 point
  30. Unfortunately we have seen a few cases, including some that needed further operations by our ENT. We think we see it more often with cuffed tubes we sometimes use (esp. for patients undergoing surgery). We treat if symptoms or if intubation was difficult and we fear swelling, mostly dexamethasone or prednisolone. Most resolves within 6h.
    1 point
  31. May I ask whether anyone has experience with a prolonged hanging time of a parenteral nutrition (PN) bag (incl lipids) of up to 48h? We are probably changing our PN regimen into an all-in-one bag. Since the bag contains >400 mL, it would suffice for most premature infants for 2 days. One strategy could thus be to prolong hang time from 24h to 48h to cut PN costs by half. A recent Australian study (attached) also suggests this would be a feasible approach: https://www.ncbi.nlm.nih.gov/pubmed/23320598 Since our pharmacy will do all additions to the bag in an aseptic env
    1 point
  32. Do you want to know how to stabilize newborns with an intact umbilical cord? Join our Concord Talk on April 6, with Ronny Knol, neonatologist at Erasmus Medical Center. As a special guest, Bram Dees, will share his experience as a parent of his daughter Lara, who was supported on the Concord Birth Trolley. The new ERC guidelines 2021 are now acknowledging the importance cord clamping. Compared to the 2015 guidelines, ERC NLS 2021 recommends that cord clamping should ideally take place after the lungs are aerated. Where adequate thermal care and initial resuscitation interventions can be s
    1 point
  33. In recent years we have moved away from measuring and reporting gastric residuals. Checking volumes and making decisions about whether to continue feeding or not just hasn’t been shown to make any difference to care. If anything it prolongs time to full feeds without any demonstrable benefits in reduction of NEC. This was shown in the last few years by Riskin et al in their paper The Impact of Routine Evaluation of Gastric Residual Volumes on the Time to Achieve Full Enteral Feeding in Preterm Infants. Nonetheless, I doubt there is a unit in the world that has not had the following situation h
    1 point
  34. This study has lot of limitations: retrospective study, more chronic patients with parents obviously familiarized to their preemies problems, with video laryngoscope use and no nasal TI and only 9,4% of parents If we distribute a questionnaire for stress to parents in acute phase immediately after delivery and later we can maybe realize it would be impossible in the first hours to have parents for suurfactant delivery and immediate care
    1 point
  35. On behalf of the 99nicu Team, I would like to invite you to participate in our newest initiative- a Journal Club. The objective of this club is to share and discuss articles of interest to all neonatal healthcare professionals. The article we chose this time (https://fn.bmj.com/content/early/2021/01/20/archdischild-2020-319709) describes the current practice regarding family presence during intubation of their infant in the NICU and examines association with the outcomes (e.g. success rate within the first attempt). Some of the questions we would like to discuss are below. Wha
    1 point
  36. A one day virtual course providing the essential skills to perform and interpret neonatal cranial ultrasound scans on the neonatal unit. This course will cover: · How to use an ultrasound scanner and get the best quality images · Standard images and normal anatomy · Germinal matrix and intraventricular haemorrhage · Linear measurements of ventricular dilatation · Preterm white matter abnormalities · HIE and Doppler measurements · Perinatal stroke Fee: full rate - £50.00 Register here: http://training.ucheducationcentre.org/home/viewcourse/515/
    1 point
  37. Great news! Thank you for all your efforts!
    1 point
  38. 99nicu has taken the step to Instagram! Follow on https://www.instagram.com/99nicu/ This idea was brought up by @piatkat in discussion within the new extended 99nicu Team. Our plan with this new channel... yet to be fully determined, but presence where many others are present is generally a good thing
    1 point
  39. Definitely, it would be great to have a feedback-loop amidst our interested members and guests through the exchange of recent advances along with good old but indispensable pearls in the realm of neonatal cranial ultrasound screening (nCUS) via these shared links in this series. Any relevant nCUS update linking all the 99 nicu enthusiasts would be much appreciated. Courtesy Dr. Taco Geertsma, The Netherlands.
    1 point
  40. We will shortly be changing our standardised lipid infusions from syringes to bags which will have a 48hr hang time. Several units in Ireland have already adapted to a 48hr (over several years) hang time for an aqueous bag and we have not noted any increase in infection. Theoretically it should reduce the risk as you are breaking the central line only once every 48hrs as apposed to every day. Despite initial concerns from the neonatal nurses they have embraced the change and are looking forward to changing the lipids to 48 hours as well. The biggest risk is that when the lipids are infused
    1 point
  41. @Chris van den AkkerI've just found this thread! Seeing you had posted this question some time ago already, I wonder how did it go- have you changed your PN regimen? Please let us know what are your thoughts about it! Any suggestions for units trying to implement this model?
    1 point
  42. 1 point
  43. This is indeed a valid question - I have also thought this myself, We also change every 24 hours BTW. Thanks for sharing that paper, was not aware of it. Would be great to bring this question into a research context (i.e. like large collaborative observational study, presumably with historical controls + some experimental "sham" work). I'd be in such an project
    1 point
  44. Difficult scenario, I must admit have no personal experience. But if I'd get the phone call from the ambulance and asked for advice it would something like this - "Keep the warmer but stop ventilation. Keep everything else as is and we arrange with extubation, catheters out, cleaning/dressing etc when you and the parents has arrived safely here" Warmer and stopped ventilation - I would feel disrespectful towards the infant if he/she got cold and also to keep on ventilating. I would consider the actual death time as is (during transport) but I would feel really bad if the parents
    1 point
  45. @M C Fadous KhalifeWhat about the paper itself? How do you evaluate the evidence there?
    0 points
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