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

  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. 3 points
    We practise pre-med for INSURE (atropin+fentanyl+pento and some use celo) - my experience is good with regards to cardiovasc and respiratory stability. But as @Nathan Sundgren says, we don't premed if we need to do INSURE right after delivery. Around here, the INSURE procedure also means pre-med, while LISA/MIST is the term used when surfactant is given without pre-med. Originally, when LISA/MIST was first done and studied by Angela Kribs and co-workers (https://www.ncbi.nlm.nih.gov/pubmed/17359406; https://www.ncbi.nlm.nih.gov/pubmed/18298776; https://www.ncbi.nlm.nih.gov/pubmed/18298776) I think their idea was to minimize any drug-related impact on the breathing drive. So they tested with no drugs and it worked well for them. I know many share this experience, that surfactant can be instilled without any pre-med. I personally feel concerned about the laryngoscopy as such, I believe atropine and analgesics would still have a place also in LISA/MIST. And for younger colleagues less experienced with laryngoscopy and intubation, I think the procedure may also be more uncomfortable for infants not given analgesia.
  3. 3 points
    Great podcast! In fact, we almost had the interviewed author Joe Kaempf as speaker at this years "Future of Neonatal Care conference (last week in CPH). Let's hope he can come next year
  4. 3 points
    Hi Al, I came across this article only just this morning. It is an interesting read on the subject. I also love this YouTube from the March of Dimes Taking the Evidence Based Case for Kangaroo Care into the Clinical Setting Cheers Trish 2018_Lim_Neonatal nurses perceptions of supportive factors and barriers to the implementation of skin-to-skin care in ELBW.pdf
  5. 3 points
    Thanks for sharing your 24wk`s case. To truly be able to give advice, its better to share the current setting which the baby is on her Sats and transCO2. From your question, she is now on conventional ventilation (AC or SIMV) without VG. You have several ventilation maneuvers you can follow: 1- If the ventilator you are using does not have VG, use PIPs which give you volumes of 4~5.5 ml/kg, however, if you have a big leak around the ET tube, it will be hard to follow volumes and you will depend then on your blood gas CO2 or transcu. Co2 or end tidal CO2 and saturation to give a sufficient PIP. 2- if the ventilator has VG, adjust your volumes as above at 4~5.5 /kg the ventilator will provide PIPs to give your selected volumes. Again if the ET tube has a big leak, VG will not work and then you better switch the VG off and do as in # 1 , Or you can change the ET tube with a wider one. 3- In our unit we keep these ELGANs during the first 3 days of life on A/C (after giving surfactant and if intubated) to lower the risk of IVH, then we switch to HFO for several days using gentle ventilation settings until the MAP drops to 10 or 9 in room air, then we consider switching to A/C again or just go down on the MAP and extubate from HFO. Lastly, you mentioned hypoxic episodes, to decrease that start Caffeine and if you are using SIMV switch to AC. Good luck.
  6. 3 points
    Are you sure it is CDH OR diaphragmatic eventration. Differentiation is not easy ???
  7. 3 points
    Find great to gearbeitet about - preventing NEC - ultrasound of the lung - CMV, pasteurisation yes or No. - Mother Milk Banking, ist it worth
  8. 3 points
    The ProPrems Trial investigated the use of probiotics in very preterm infants. The study has been reported at meetings, but the full article will be published in Pediatrics in December. The primary outcome was late onset sepsis, but the finding given most publicity was reduction of NEC. Keith Barrington, neonatologist in Canada and blogging at neonatalresearch.org, argued that probiotics should now be used as NEC prevention and that future research should focus on refining probiotic therapy, not comparing it with placebo. In the new 99nicu Poll we ask about your practise regarding probiotics as NEC prevention. Please also comment your votes. If you use probiotics, please share your experience.
  9. 2 points
    We use this system on an ongoing basis. Very comfortable and does not damage the nasal septum.
  10. 2 points
    This article in NY Times came on my radar, written by a parent whom is also an obstetrician. Very well written piece and I would really recommend it. Sparkles a lot of thoughts on what we do, what we achieve, and the parental perspective. Find the article here: https://parenting.nytimes.com/newborn/prematurity-baby-burden
  11. 2 points
    every time I check my email and find 99nicu in the list I feel too much excited every time I visit this site I gain new information and add new knowledge thanks @Stefan Johansson and all 99nicu members love you all❤️❤️❤️❤️❤️
  12. 2 points
    In AmsterdamUMC location VUMC, we have no nasal trauma giving nCPAP by VYGON, a silicone double tube, fixated with tape. They come in different sizes, so even for the extreme neonates we use these. https://www.vygon.com/catalog/double-tube_575_00259615 For non-invasive suction we use the Tendernose. The Tendernose, is held in the nostril, coupled to a universal suction hose and the mucus is simply sucked away with the adjustable vacuum. Together with a specialist NICU nurse at the Máxima Medical Center in Veldhoven, Medica-Europe has developed the Tendernose. This unique product is new in Europe and CE certified https://www.medica-europe.com/producten/ic-anesthesie-neonatologie/nasale-uitzuiger-neonaten
  13. 2 points
    Interesting subject. In Vienna, we prime insulin infusion systems before use. The insulin is prepared as ordered, we start off with 0.05-0.1 IE/kg/h. After 30min, the insulin in the infusion system is discarded and the same amount/dilution prepared with the same system before use. Let me know if you need more information @ChantalNICU
  14. 2 points
    we do see these cases, and usually they respond in a week or 10 days time. difficult to say how common but its not very uncommon too.
  15. 2 points
    Hi Bimalc thanks for your reply. This is exactly why I am asking, we do have one center where hyperconcentrated platelets are administered, but need more data if we want to assess their effect on clinical outcomes. So I am hoping to find another 3 or 4 centers in which hyperconcentrated platelets are administered, so we can share our data, analyze the results and hopefully generate more reliable evidence regarding the efficacy of this product in neonates.
  16. 2 points
    We used Protovit for some months when Soluvit wasnt available for us.
  17. 2 points
    Thank you, Stefan, for reminding me of my one major criticism of the PINT trial: They did not include NEC (or at least surgical NEC) in their composite outcome. As for why we, as a profession, continue to worry about TANEC, it is mostly recall bias (we all remember the case of NEC shortly after transfusion but we never stop to think of all the transfusions we have given without NEC appearing) I've often wondered if there isn't already enough data out there to answer these questions (or at least get a start). Supervised learning techniques have advanced sufficient that if you were willing to invest in combining and curating multiple datasets of ELBWs you could probably train a binary classifier to predict risk of NEC with or without transfusion.
  18. 2 points
  19. 2 points
    I could not find any data from newborns, but this study on healthy (young) volonteers showed only a slight diff: https://www.ncbi.nlm.nih.gov/pubmed/11553055 This correlation study in adults in intensive care also suggest a good correlation: http://www.thejh.org/index.php/jh/article/view/231/186 We only take venous blood (or arterial from UAC), but good to keep in mind that capillary hemoglobin levels are ~10% higher than central values.
  20. 2 points
    According to NRP textbook What are the limitations of a laryngeal mask? Laryngeal masks have several limitations to consider during neonatal resuscitation. •The device has not been studied for suctioning secretions from the airway. •If you need to use high ventilation pressures,air may leak through the seal between the pharynx and the mask, resulting in insufficient pressure to inflate the lungs. •Few reports describe the use of a laryngeal mask during chest compressions. However, if endotracheal intubation is unsuccessful, it is reasonable to attempt compressions with the device in place. •There is insufficient evidence to recommend using a laryngeal mask to administer intratracheal medications. Intratracheal medications may leak from the mask into the esophagus and not enter the lung. •Laryngeal masks can not be used in very small newborns. Currently, the smallest laryngeal mask is intended for use in babies who weigh more than approximately 2,000 g. Many reports describe its use in babies who weigh 1,500 to 2,000 g. Some reports have described using the size-1 laryngeal mask successfully in babies who weigh less than 1,500 g. This study by Prof Kary Roberts in USA Laryngeal Mask Airway for Surfactant Administration in Neonates:A Randomized,ControlledTrial
  21. 2 points
  22. 2 points
    Thank you for your detailed comments. The baby did receive surfactant as part of the normal practice. Oxygen requirement was 26% when I got handed over the baby. As mentioned in the first instance ...I couldn't understand those settings at all and thought maybe I do not know the intricacy of HFOV this may be a strategy. But because I was uncomfortable, I read and found out, mostly what that you guys have mentioned above. This has given me so much clarity... cheers to all the gurus' (You all). Much appreciated.
  23. 2 points
    Agree that 6 hz is too slow. Appropriate MAP is key to successfully ventilating and oxygenating. Axiom #1: The best ventilator is the one you have the most expertise with. New (to the user) forms of ventilation open the door for errors of inexperience. Axiom #2: HFOV has a checkered past in many studies. Sun et al demonstrated strongly positive results in VLBW infants receiving HFOV vs pressure support ventilation. Why the discrepancy? Consider the adjunct care. Hypothesis: Whenever an infant is disconnected from an oscillating device, the lungs instantly deflate. Consider that extremely premature infants have little, if any, alveolar surface area.Temporary ventilation is usually provided by a manual resuscitation device that cannot match the oscillator. This act in itself likely contributes to barotrauma and subsequent CLD. Terminal bronchioles are “bubbled up” by attempts to mimic the ventilation we see in term infants. Evidence includes the observation that it can take a half hour after reconnecting the infant to HFOV to fully achieve reinflation. Thus, any interruption in oscillatory MAP can be considered iatrogenic. Axiom#3: The role of manual resuscitation in the development of CLD has not been adequately studied (almost completely ignored). Disconnection from high MAP ventilation is rarely a point of focus. These omissions skew most of the observations and conclusions in neonatal ventilation studies. ref: Sun et al ClinicalTrials.govNCT01496508 Respiratory Care Feb 2014, 59(2) 159- 169
  24. 2 points
    Although we have not yet nailed the venue or date for the next 99nicu Meetup (April 2018, in Vienna!), we want to start to crowdsource the program In short, we are searching for topics YOU want to see in the program! No matter how controversial, evidence-based, or big or small, we want your input on topics that help you perform better in the NICU, thereby improving long-term outcomes infants you care for. Also share your dream team of speakers from any corner of the world, who are dedicated, engaging and know how to convey take-home messages! Of note, we are not only looking for superstars. We also want to offer the 99nicu Meetup stage for raising stars. Maybe YOU should come and give a talk
  25. 2 points
    @Hamed, thanks a lot!. It is a tricky case. CDH wasn't detected prenatally. CPAP was started because of mild RDS and CDH on Xray was somewhat surprising. As the baby was doing well on CPAP we decided do not intubate. Feeding tube was corrected and now CPAP is withdrawn.
  26. 2 points
    @amirmasoud2012 well... not all photos/videos says more than 1000 words
  27. 2 points
    Sorry I cannot share anything valuable about this Have only experience from low-volume strategy on HFO only (but have good experience with HFO for any air leaks incl PIE)
  28. 2 points
    This paper was recently published in J of Pediatr, read it Thanks to @EBNEO that promoted it in this tweet. The headline and study question are both great, but I am sceptical to the design: SGA infant with brain sparing was (as I See it from my vacation balcony in Greece ) compared with a small group of term AGA infants. (96 + 32 infants) Not surprisingly, this small study found mostly no differences. but as you know - abscense of evidence is not evidence of abscense. would have been better if SGA infants with brain sparing had been compared with SGA infants without it (or study whether degree of SGA would be associated with outcomes). Not supernew (has been done before if I recall it correctly) but still relevant to replicate Below - URL to the paper in J of Pediatr www.jpeds.com/article/S0022-3476(17)30781-3/
  29. 2 points
    I like to share this article about neonatal pain management I consider it amazing I hope you will enjoy it Neonatal pain policy.pdf
  30. 2 points
    Dear Colleagues We have produced videos for percutaneous long line, scalp long lines and umbilical venous and arterial line insertion. They are available on the MPROvE website http://www.wonepedu.com/MPROvE.html There are also videos on human factors. Alok
  31. 2 points
    Stefan, Here are a couple of pics using our SimBaby illustrating securing a catheter down to the abdomen. We also suture first (not in pic), & decided on 2 loops because we had traditionally secured 2 loops into our bridge. It seems to work best to have the tail coming out the bottom to the side. This keeps the catheter away from fingers & legs. We also try to catch as much of the catheter at the umbi as possible for safety. If both UA & UVCs we use a bigger op-site looping each a little to the side. Some folks use a skin protectant product such as Duo Derm in addition. The caution with this method is that the Duo Derm holds moisture against the skin which is exaggerated when covered by the op-site, & this has revealed problems when removed. We find the op-site adheres well as long as it is put onto dry skin. It has not caused damage when removed as long as we use the "stretching to break the adhesive" method. I hope this is clear enough. I can get over to the Sim Lab this week for more pics if need be & apologize for the missing cap in the line set up. Best, Gayle
  32. 2 points
    Hello, I don't have a good answer but I think there are some things more important than others. Like Japan we have almost full coverage of antenatal care (free service for all). About 95% of pregnancies are ultrasound-dated, i.e. we have a uniform estimate of gestational age. Obstetric and neonatal services are fairly well "coordinated" and available to all. Level-3 NICU care is centralized to (7?) regional/university hospitals and the vast majority small infants are transferred in utero to their level-3 hospital. And, we have a relatively low proportion of really socially disadvantaged parents. Apart from that we also have a tradition of non-invasive ventilation (nCPAP) also in tiny infants - I am not sure but it is likely this was a strategy that was developed due to less staffing and budgets initially... The National Board of Health issued national guidelines recently on some key topics: those are only available in Swe though.... but here they are: http://www.socialstyrelsen.se/publikationer2014/2014-9-10 However, I think there is a greater room for improvements in Sweden: we don't use probiotics our transportation services are rather regional "initiatives" than a results of a national strategy there are no national consensus whether 22-weekers should be resuscitated we could still "do less" of things that lack evidence but has potential side-effects we need to combat nosocomial infections better Most importantly, despite the structure of care/society that enables really large observational studies (we can track /link individual data from birth to death, data in several national registries), we do hardly no intervention research. Greetings from Sweden
  33. 2 points
    Very practical issue..... We use Vygon UVC as routinely. In case of nonavailability of non affording patient, w use NG tube, same as you do. Practically it is encountered vry often that UVC is not advancing or have resistance. In that case we follow 2 techniques. 1. If we are using Vygon UVC and not advancing, we sometimes switch over to NG tube. Bcs Conventional UVC, including Vygon has opening at tip, while NG tube has blunt tip with side openings. This BLUNT TIP of NG tubes helps to pass through the resistence in LIVER. 2. IF we still have issues with advancing the NG tube, while inserting NG slowly with one hand, we give slight pressure on liver with another hand. The pressure is being given on the skin overlying Liver in downward direction while slowly advancing the NG as UVC. Most of the times, this proves helpful, even with Vygon UVC. Another technique is slowly advancing UVC in cork screw manner, if resistence is felt. But somehow, I have not fount this working. Pressure over Liver, many times has solved problem for us. Hope this proves useful to you. Do let me know for anything else, at manan179@yahoo.com
  34. 2 points
    Hai, can anyone help me to get freely downloadable TPN calculator
  35. 2 points
    Thank you for contacting us. We usually do not give medical advice nor counsel in this forum. However we will try our best to help you and your baby. From your post, I see that your baby has received therapeutic hypothermia which is the current standard practice in neonatology for management of Perinatal Asphyxia cases. Other than supportive care and careful follow-up and early intervention if any neurological sequlae are detected, currently there is no other evidence based therapeutic intervention specific for perinatal asphyxia. Your neonatologist and the pediatric neurologist are the best persons to guide you regarding this matter. If you have any further querries, please do ask us. Though I remind you again that your doctors in your unit are the best persons to answer your querries as they have the case in front of them and know all the case details We wish you and your baby all the best.
  36. 1 point
  37. 1 point
  38. 1 point
    @Francesco Cardona great paper! And reminds me of medical studies when I struggled with the coagulation pathways... (like the embedded image below) @Marina22 Did you have something special in mind?
  39. 1 point
    Certainly I agree with @Stefan Johansson on the exception to the rule stated by @rehman_naveed. I have never done it, but I've at times wondered if I wouldn't give glucose gel a try in a situation where there was some difficulty obtaining access, just to get the sugar up a bit while I put in an umbilical line.
  40. 1 point
    Good Morning, For NICU ET Tube securement the HY-Tape is NOT my first choice. In the humidified environment the tape almost melts, causing a sticky mess with tons of residue on the tape, making further tube securement difficult. Our patients typically will return from the OR with this tape and we change it immediately. I will say it is good for use with the NeoBar ET tube securement device. https://www.neotechproducts.com/product/neobar/ All in all, we've found that tape works best for us in our NICU. We are currently using the MultiPore Tape from 3M. https://www.3m.com/3M/en_US/company-us/all-3m-products/~/3M-Multipore-Dry-Surgical-Tape/?N=5002385+3292186741&rt=rud and Cavilon skin barrier https://www.3m.com/3M/en_US/company-us/all-3m-products/~/3M-Cavilon-No-Sting-Barrier-Film/?N=5002385+3293321921&rt=rud Hope this helps..... Jennifer
  41. 1 point
    We use surfactant bolus but never used surfactant lavage I find the idea only interesting in pulmonary hemorrage ; since we have high mortality , Does anyone have experienced surfactant lavage in pulmonary hemorrage?
  42. 1 point
    @Hamed I am no longer at the level-3 NICU at Karolinska but I cross-checked with @Alexander Rakow : they apply nothing but sodium chloride 0.9% for cleaning the umbilicus for UAC/UVC insertion (meaning only gentle mechanical washing and no chlorhexidin) For diaper change - I did not cross-check but think they use water
  43. 1 point
    To my knowledge, this is not common practise in Sweden. @AllThingsNeonatal @kbarrington - do you have something to share about rewarming?
  44. 1 point
    I guess nothing has changed from a medical point of view, i.e. universal vitamin K prophylaxis is recommended. There is a relatively new position paper by ESPGHAN, here: https://www.ncbi.nlm.nih.gov/pubmed/27050049 ( if you need the paper in full-text, try http://unpaywall.org/ )
  45. 1 point
    Hope for HIE is a worldwide nonprofit organization serving families whose children have been diagnosed with or experienced HIE at birth or sometime during early childhood. We have a comprehensive support network providing much-needed psychosocial support. We are also committed to working with neonatal and postnatal providers to help connect families, participate in any research studies and provide educational materials. If you are interested in receiving our materials (we ship them worldwide!), please submit a request to our Vice President of Professional Outreach at http://www.hopeforhie.org/requestmaterials Please let me know if you have any thoughts of ways you wish to collaborate, or questions that I can answer from this parental perspective. Sincerely, Betsy Pilon, President, Hope for HIE HopeforHIE.org Facebook.com/hopeforhie Consider joining our group for networking professionals: https://www.facebook.com/groups/hopeforhieprofessionals/
  46. 1 point
    Wow! What an impressive NICU design in Richmond! We too just had our new NIC unit built 3years ago. Sad to say, RNs who work every single second in the unit were never asked for inputs in the design. Long story short, we found a lot of flaws, faults and inefficiencies with the design. Too late its already built. So here my two cents of advice, please solicit some inputs from staff who work 24hrs in your Unit, they are actually one of the best available resource you could use.
  47. 1 point
    We give it as a slow bolus, body lying flat and head/nose straight up.
  48. 1 point
    We use a special type of probes whish is soft rubber encircling the whole circumfrenc of the limp we almost never record this type of injury since we start useing it
  49. 1 point
    infant aged now 4 m, he had circular lesion in back of his head 2 cm in diameter, red, with scales on it , hair is preserved is it tinea ???
  50. 1 point
    Dear Stefan It is true most of us are now more and more restrictive on using NaHCo3. I think the next version of NRP will also decrease their role in resuscitation. Personally in our unit we started a restrictive policy about 1 year ago, I do agree the treatment of acidosis should be directed to the cause rather than giving NaHCO3. We do not have tribonat or THAM in our country and I do not have experience in there use. Thanks for this hint from hot topics, would you also elaborate more on therapeutic hypothermia in HIE (hot topics 2008 had a session on this issue)
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