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  1. Stefan Johansson

    Stefan Johansson

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  2. bimalc

    bimalc

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  3. piatkat

    piatkat

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  4. AllThingsNeonatal

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

  1. For months I've been dreaming to have a possibility to work from my sofa in my pyjamas. Now my dreams are coming true 😅 I keep hearing from people "oh but there's nothing you can do about it!" and it just triggers me. We can all contribute to improve the safety of the most fragile citizens by undertaking some measures. At least in this sense we are not completely "powerless"!
    3 points
  2. 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.
    3 points
  3. Thanks for sharing! Looks like plenty of tips to improve the transport experience for families!
    2 points
  4. I agree with your analysis, regarding the obvious limitations of the study and the need for an RCT. The good news is that a pilot of such a study is currently underway and we hope to join. The authors share my conviction that the apparent benefits of NIPPV over CPAP derive from the fact that NIPPV was almost invariably used with higher MAP. The few studies that ensured equal MAP between the two showed no differences. This retrospective study is consistent with that thesis, but as you state, certainly not conclusive To me, the important message from this study is that using CPAP with a higher distending pressure than the traditional 8cmH2O limit appears to be safe. Some of us have been doing that quite a bit, especially after extubation, and find it safe and effective. We presented an abstract at PAS last year that documented no differences in indeces of oxygenation, ventilation, and bradycardia/desaturation events in a shor-term crossover study of CPAP and NIPPV at equal MAP. The next step is to do the prospective trial with well defined criteria. Stay tuned... Martin Keszler MD Brown University, MKeszler@wihri.org
    2 points
  5. https://trends.hms.harvard.edu/2020/03/31/covid-19-separating-infected-mothers-from-newborns-weighing-the-risks-and-benefits/ Melissa Bartick just posted this on the Harvard “trends” blog - weighing risk/benefit similarly
    2 points
  6. 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.
    2 points
  7. 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
    2 points
  8. 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.
    2 points
  9. I find it very interesting but speaking of is not like watching it! For the moment I will not dare do it !
    2 points
  10. 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.
    2 points
  11. 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.
    2 points
  12. 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.
    2 points
  13. 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
    2 points
  14. 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.
    2 points
  15. Hi.It Seems cutis marmorata where the skin has a pinkish blue mottled or morbeled appearence when exposed to cold stress.
    2 points
  16. 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
    2 points
  17. The trouble with using ventilator derived compliance and resistance measurement is that the inspiratory effort of the baby is usually not measured. In spontaneously breathing ventilated infants, the tidal volume is the result of the combined inspiratory effort of the baby and the positive pressure from the ventilator (baby pulling, machine pushing). Only the latter is used in the calculation, unless an esophageal balloon catheter is used to measure inspiratory effort. So, the numbers are bogus. Most people don't seem to realize that. So, unless the babies were paralyzed or intentionally hyperventilated to stop them from breathing, I am not buying... Martin Keszler, Brown University
    1 point
  18. I’ve had these exact thoughts myself! Thank you for sharing! I’ve never understood the logic in throwing away gastric content no matter what colour. (In contrast , I’d say an atresia goes with green vomits and not just green aspirates)
    1 point
  19. Great post! And I admit I had to Google that hashtag ... and found https://staythefuckhome.com/
    1 point
  20. 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.
    1 point
  21. 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.
    1 point
  22. @bhushan I share your concern about the BPD/CLD rates. We have no hard data but my def impression is that we keep HFNC for longer times. On the other hand, if infants are more comfortable and (as we use HF) the HF is used without oxygen (for ”stability”), maybe the BPD definition is the problem, not the resp support mode.
    1 point
  23. YOU deserve KUDOS!!!
    1 point
  24. Apologies as I forget to embed it. https://www.ncbi.nlm.nih.gov/m/pubmed/30353079/
    1 point
  25. 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
    1 point
  26. 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.
    1 point
  27. Thanks for sharing and congratulations to your first talk as a "solo speaker". And the macarons, what a great bonus
    1 point
  28. I have only had access down to size 0 (as PICU bought the VL set up there was no urgency to get a 00 blade and many of my colleagues in NICU were of the attitude that they could intubate anything with a pulse so why budget for such an item). I will admit that with just a size 0 blade there were instances where you could get a decent view but simply ran out of real estate in a small oropharynx using the VL 0 blade and were unable to actually pass the ET tube. Even in those cases, though, the broader field of view made subsequent DL significantly easier.
    1 point
  29. I agree that the data is not convincing, but what bothers me the most is that nobody ever talks about the experience and expertise of the "intubator", I know I can intubate a baby in a few seconds without a problem, been doing it for 40 years, and our group of RT's have been trained carefully and extensively to do the same. Some centers, especially academic centers, allow first year residents to do it with not such good results. I have never used intubation and in the majority of cases nor sedation. I an appropriate intubation, the baby thanks you immediately!!!
    1 point
  30. 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.
    1 point
  31. One for all and all for one I feel that i have many wings all over the world
    1 point
  32. thank you for such an insightful comment and refreshing all of our memories regarding Dr. Wung's incredible results
    1 point
  33. I looken into Youtube and found only videos of LMA placement, this one from the UK-based initiative IMPROVE and @spartacus007
    1 point
  34. Hello.The use of montelukast for BPD is a great idea but,the main concern is the short and long-term side effects of this drug in neonates. Do you have any experience with this?
    1 point
  35. 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.
    1 point
  36. 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).
    1 point
  37. 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
    1 point
  38. 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?
    1 point
  39. 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.
    1 point
  40. Being polite transforms the working atmosphere. It makes the communications easier with the parent.
    1 point
  41. In response to Jannfos. The answer to that is yes, it is still unethical. If you are going to research a painful intervention and decide that no intervention is the appropriate comparison then you have to do multiple unethical things. You have to state to the IRB that there is clinical equipoise, which would be lying to them. You then have to lie to parents and tell them that there is real uncertainty whether treating pain is effective. Most importantly you have to purposefully expose babies to more pain than they should have, so that you can get a paper published. This is why, not only should IRBs not approve such studies, journals should never publish them. If no pain intervention is the usual practice in a particular setting the only ethically appropriate response is to change that practice. For all the babies, not just a randomly selected 50%! No-one is perfect with pain control in babies, in my NICU sometimes the sucrose is forgotten, or the nurse is busy with another patient when the lab technician arrives. The ethically appropriate response to that is to improve our procedures, to simplify administration, to allow parents and lab techs to give sucrose, to unsure that it is always available at the bedside etc, and to work towards 100% It is like hand-washing. In very good NICUs, compliance with hand washing is still less than perfect. I don't think you could pass an RCT of washing hands compared to no hand hygiene! Comparing different methods if hygiene would certainly be acceptable.
    1 point
  42. 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
    1 point
  43. 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.
    1 point
  44. 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.
    1 point
  45. Thanks Stefan, this Photo gallery is FANTASTIC . Excellent learning and teaching tool. Love it !!!!
    1 point
  46. 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 ?
    1 point
  47. 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.
    1 point
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