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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. 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
  4. 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
  5. 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/
    2 points
  6. 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
  7. I find it very interesting but speaking of is not like watching it! For the moment I will not dare do it !
    2 points
  8. 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 t
    2 points
  9. 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
  10. 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
  11. 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
  12. 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
    2 points
  13. Hi.It Seems cutis marmorata where the skin has a pinkish blue mottled or morbeled appearence when exposed to cold stress.
    2 points
  14. 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
  15. 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
  16. Weaning from CPAP is a tricky topic, especially with HFNC available 😅 What is your policy for using HFNC- and do you use as a step-down mode from nCPAP? I am just wondering if our "CPAP-->HFNC--> no support" routine is also practiced elsewhere.
    1 point
  17. I would urge caution in assuming that tight glycemic control improves patient centered outcomes, though certainly, it would appear that if one were to test that hypothesis, it might be worthwhile to test it using such a closed loop system to give the intervention the best chance at success.
    1 point
  18. 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
    1 point
  19. YOU deserve KUDOS!!!
    1 point
  20. One thing to consider about this study (and the other published comparisons between NCH in the USA and UUCH in SWE) is that there are essentially no deliveries at NCH. These babies are born in the community (generally at hospitals with level 3 NICUs) and transported to NCH [I am unsure if the UUCH births were in-born or outborn]. I think the earlier study from Iowa in NEJM already demonstrated fairly convincingly that if you try you get better outcomes than if you don't, and there is a long standing literature on the differential outcomes of inborn vs outborn VLBWs but what remains unclear t
    1 point
  21. 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
  22. 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
  23. congratulation... nice concept of solo speaker conference . We call it CME here though.
    1 point
  24. Thanks for sharing and congratulations to your first talk as a "solo speaker". And the macarons, what a great bonus
    1 point
  25. 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!
    1 point
  26. There is a 00 blade on the market now (https://www.acutronic-medical.ch/products/infantview.html). The Storz (https://www.karlstorz.com/cps/rde/xbcr/karlstorz_assets/ASSETS/2136610.pdf) The Storz product has a "0" blade only but there are claims that it is all that is needed. We are trialing now.
    1 point
  27. 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 ch
    1 point
  28. 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.
    1 point
  29. One for all and all for one I feel that i have many wings all over the world
    1 point
  30. 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 P
    1 point
  31. 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 remov
    1 point
  32. I looken into Youtube and found only videos of LMA placement, this one from the UK-based initiative IMPROVE and @spartacus007
    1 point
  33. 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
    1 point
  34. 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
  35. 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
  36. 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
  37. @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"
    1 point
  38. 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
    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
    1 point
  42. 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 staf
    1 point
  43. 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 outco
    1 point
  44. 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.
    1 point
  45. 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
  46. 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
  47. Thanks for sharing your thoughts here. And I completely agree that we can perform better than today, just by "improving ourselves". We need courage to do it, because we have an obligation to do it.
    1 point
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