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Showing content with the highest reputation since 09/18/2020 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: Intubation success rates are low, especially for inexperienced trainees Universal intubation competency for all pediatric and neonatal trainees and consultants may no longer be possible Videolaryngoscopy can help increase rates The laryngeal mask airway (LMA) is a promising alternative to intubation Some of the questions we would like to discuss are: What is current practice in your department? How to do you manage the airways and who is doing what? What do you think are the strengths of this review article? What do you think are some of the limitations? Will this review have an impact in your department? If no - why? If yes, how? We are looking forward to hearing your thoughts and opinions! UPDATE: More information on the virtual journal club on June 9th here: https://99nicu.org/99nicu-news/join-our-virtual-journal-club-meetup-on-neonatal-airway-management-9-june-1630-1715-cet-r124/
    7 points
  2. A series of free, online guest lectures in pulmonology, courtesy of the NOTE and ESPR collaboration. I have added these dates into the calendar, but you can sign up for these by contacting noteteam20@gmail.com. All times are in CEST.
    5 points
  3. We do, in our unit. No specific guidelines though. We generally encourage cuddles at every opportunity, including in the delivery room. Sent from my iPhone using Tapatalk
    5 points
  4. https://www.neonatalconversations.com Neonatal Conversations is another NICU dedicated podcast, based out of Sydney, Australia. The first episode, conversation with Nick Evans around use of inotropes is terrific.
    5 points
  5. 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 as a separate infusion errors can occur when setting the infusion rates unless there are robust systems in place for checking, prompts on the pumps etc. Unfortunately we have discovered that no one is manufacturing a light protected IV administration set in any colour other than shades of yellow which would help clearly distinguish each infusion. Therefore labelling the lines will be important both before and after the pump, two -person checks at each change of infusion and subsequent infusion rate changes, hourly checking set rate and volume infused and checks at each shift changeover. Another suggestion following an error in the UK is to consider having dedicated pumps for Lipid infusions only.
    5 points
  6. From prof Takeshi Arimitsu, invited speaker at our previously planned Meetup in April 2020 (but cancelled due to Covid), I got an email about an interesting case report from their large neonatal center in Tokyo. They have published about a 268 gram 24-weeker with intact survival. I share the last sentences of the summary below. The publication is available open-access and in full-text here: https://www.frontiersin.org/articles/10.3389/fped.2020.628362/full Looking fw to follow the discussion about this extraordinary case.
    5 points
  7. Time really flies, and it now 15 years ago since we started to plan for the 99nicu forums, opening in May 2006. In many ways, this project has been a key part throughout my own neonatology carrier. I have learnt so much about the diversity of how to practise neonatology, and I have also learned to know many people around the world. I had not get to know you without this virtual platform. But with time comes age and I have started to think about how to future-proof the operation and development of 99nicu. I, @Francesco Cardona and @Vicky Payne have started to think about where to go from here. what do you like with 99nicu? how does it benefit your work? what can we do better? what are you missing? Please share what you think!
    5 points
  8. This looks unusual indeed, have not seen this before. I would recommend an echocardiography and a regular ultrasound of the abdominal organs to start with, to look for any apparent anomalies in the "venous geography". If those investigations turns out to be normal, I really don't know. I suppose we would offer clinical followup and wait and see. Will follow this topic with great interest!
    4 points
  9. This might be useful to some, covers paediatrics and some neonates. "Waiting until 48 hours to stop antibiotic therapy in all children is an outdated approach. Research shows that 90% of bacteria will have grown by 24 hours and 95% by 36 hours. In children with low BSI suspicion, stopping antibiotics at 24–36 hours with good safety-netting advice avoids unnecessary hospitalisation without jeopardising patient safety" https://ep.bmj.com/content/edpract/106/4/244.full.pdf Just for fun.......anyone stopping at 24 hours?
    4 points
  10. It is now possible to bookmark 99nicu.org on your smartphone browser (Safari for Iphone users, Chrome for Android users) and place the bookmark on your mobile phone screen. When you then tap on the "bookmark", browsing 99nicu looks and feels like using an app If you have an Android phone, you can get push notifications when topics you follow are updated etc, just go to your notification settings in your profile to active such push notifications. As of now, Iphone users cannot get push notifications yet. Instead, you need to rely on the notifications given on 99nicu (on my screen shot below, the nb "6" in the right upper corner) This technology is called Progressive Web Application (PWA). IMHO is works so well that I will mostly access 99nicu.org from my phone now!
    4 points
  11. Saw this and thought of this thread!! Might be worth trying to link up with the researchers about this!
    4 points
  12. Recently I've participated in a small scientific meeting with the neonatal team from Uppsala, Sweden, and from what I understand they are trying to involve parents in a more meaningful way to care for their infants during therapeutic hypothermia. I know that so far they have published this qualitative study https://onlinelibrary.wiley.com/doi/10.1111/apa.15431 and a bit earlier this study https://pubmed.ncbi.nlm.nih.gov/31084824/ :"Being unable to hold the infant skin-to-skin during HT has been shown to be stressful [10], and although skin-to-skin contact has to be limited due to thermoregulatory constraints, infant holding is indeed feasible [23]." I hope this gives you some fresh perspective I have no idea if we have anybody from Uppsala here, @Stefan Johanssondo you maybe know?
    4 points
  13. We looked for evidence regarding safety and temperature stability and found one study of 10 infants (no intubated infants) held for 30 minutes on 2nd or 3rd day. There were no adverse events (stable VS, temp, no displacement of umbilical lines or EEG wires) and positive feelings of bonding and connection from moms and nurses Craig A, Deerwester K, Fox L, Jacobs J, Evans S. Maternal holding during therapeutic hypothermia for infants with neonatal encephalopathy is feasible. Acta Paediatr. 2019 Sep;108(9):1597-1602. doi: 10.1111/apa.14743. Epub 2019 Mar 5. PMID: 30721531; PMCID: PMC6682469. We are looking for expert opinions from various centers and plan to do a QI study Kathrynlm what are your criteria?
    4 points
  14. The Neonatal Department at the Karolinska Unviversity Hospital, Stockholm, Sweden is advertising 3 senior and 3 junior Consultant Posts in Neonatal Medicine. With 48 cots on three sites we are one of the largest neonatal unit in northern Europe and still expanding. We work in close collaboration with Obstetrics and Fetal Medicine teams as well as Cardiology, Surgery, Nutrition, ENT, Ophthalmology, Neurology, and Neurosurgery. We also host neonatal transport with a commitment for land, and air based transport. There are about 28000 deliveries each year in the Stockholm where about 22000 deliveries are in-house at the Karolinska University Hospitals at Dandery, Huddinge and Solna. Activity levels for ITU/HDU are very high and this is one of the busiest units in the whole of Scandinavia. Enthusiastic and highly motivated clinicians are invited to submit an application for a substantive Consultant Neonatologist post. In order to be appointed you must have completed specialist training in Paediatrics and Neonatology as by European standards and hold a license to practice with the Swedish Board of Health and Welfare (Socialstyrelsen). For the senior Consultant job an academic degree as PhD or higher is mandatory. The Swedish Board of Health and Welfare requires all medical staff to speak Swedish at C1 university level. https://candidate.hr-manager.net/ApplicationInit.aspx?cid=1354&ProjectId=177100&DepartmentId=61951&MediaId=5 Application closing date 30-06-2021 For further details and information please contact: Alexander Rakow MD PhD Överläkare, Sektionschef ME Neonatologi Solna Consultant, Clinical Director Neonatal Unit Solna Karolinska University Hospital, Solna, Stockholm, Sweden +46 725968444 alexander.rakow@sll.se // alexander.rakow@ki.se
    4 points
  15. @Stefan Johanssonshal we make a folder "Podcasts" in our Links directory?
    4 points
  16. I loved it! Here’s a little compilation of podcasts that I’d shared with my staff Sent from my iPhone using Tapatalk
    4 points
  17. During the development of our Premature Baby Manikins (first the 28/29 week gestation and then the more recent 22/23 week gestation) we have observed a lack of suitably sized DL & VL equipment designed to deal with these extremely low birth weight babies (i.e. the blade sizes are simply too big!). It would be interesting to share what DL & VL devices you are using as we see a fairly high proportion of failed intubations (or at best too much force being applied to achieve intubation) in the training / simulation setting. While the cause, in part, can be associated with variances in an individuals technique, it is not helped by the seeming lack of suitable equipment. As the 'gestation / viability window' has come down over time, has equipment design kept pace with this and do you use different protocols (including different devices) for different gestations?
    4 points
  18. 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? 🤔🧐🤓
    4 points
  19. 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.
    4 points
  20. 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-invasively
    4 points
  21. 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 a topic for a separate discussion thread....and I think topical to practice (in UK) cooling in mild HIE?!? https://fn.bmj.com/content/105/2/225.abstract?casa_token=urlRBLGeNVgAAAAA:mpPfBX_gPwzVlNLIpUYO9ETpCgdI20zJNzxhuJ2EoqU-hcqW3NGeoqpYXAH9GN-6fZrhsSx-mRk
    4 points
  22. 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 get them, the rest choose to stay. It has never particularly bothered me, but I've had parents watch me perform intubation since I was an intern so it is all I've ever known.
    4 points
  23. Useful resources on managing a difficult airway developed from the British Association of Perinatal Medicine....practical flow charts and equipment to have to hand! https://www.bapm.org/resources/199-managing-the-difficult-airway-in-the-neonate
    4 points
  24. I am treating umbilical granulomas with common salt application at my place for >25 years with excellent results. This can be done by mother or grandmother by applying small piece of rock common salt over the granuloma ( preferably after feeds so that it stays there for at least 3 hours) and fixing it with a plater. I advice twice a day application for a week. It's just a home care remedy for umbilical granulomas.
    4 points
  25. Thank you for your response. I try to reduce unnecessary examinations and treatments and perform only those that are necessary. In addition, I try to avoid treatments with low evidence levels and to include treatments for which new evidence has been shown. I am personally interested in circulatory management immediately after birth, early extubation, infection control, and factors that improve long-term prognosis, and so on. I would also like to promote more family involvement in our NICU. This is because it is the safest treatment with no side effects and has evidence that shows its benefit.
    4 points
  26. In our March Concord Talk, Prof. Arjan te Pas will educate us what the key success factors are when incorporating cord clamping into stabilisation of preterm infants and share the experiences of his clinic in practicing physiological-based cord clamping for over 4 years. March 2nd at 15:00u (CET). Register via: https://concordneonatal.com/concord-talk/
    4 points
  27. Genetics may have something to play a role. Worldwide, survival rates are increasing and complication rates are decreasing. I believe that tomorrow's outcomes will be better than today's as a result of advances in treatment. I am studying publications written by all of you, and I am implementing what I have learned every day in my practice.
    4 points
  28. Join Concord Talk by Professor Stuart Hooper on February 2nd at 10:00am CET. Don't cut the cord until the baby is ready, the science behind umbilical cord management. Professor Stuart Hooper is professor of physiology in fetal and neonatal health. He is the Director of Research at the Department of Obstetrics and Gynecology at Monash University and is Center Head of the Ritchie Centre. In this Talk, Prof. Hooper will educate us on the physiology of transition and the science behind the timing of umbilical cord clamping, built on research performed by his institute and completed with everyday case studies of neonates in need of support. Sign up, together with your colleagues, to join the conversation: https://concordneonatal.com/concord-talk/ If you are not able to attend, please also register to receive the recording.
    4 points
  29. We are doing MIST/LISA from 24 weeks onwards. We use sucrose en facilitated tucking, wich works fine in most of the cases, and, if necessary (rarely), atropine. We do not use any other premedication except caffeine, of course. But it remains an issue. If a baby is too vigoruous we switch to INSURE with propofol sedation. The colleagues in Leiden use propofol, 0,5-1 mg/kg I think. They published a paper in 2018: https://pubmed.ncbi.nlm.nih.gov/30068669/
    4 points
  30. Hi, I did MS in Neonatology with the University of Southampton, it is an excellent experience. I am a better neonatologist after completing each module, this is the bottom line. Of course, the degree depends hugely on self learning, but who and how can motivate you, that is the essence of how effective that kind of learning. Each module is divided into 3 parts: 1- online discussion about a subject , the tutor starts a thread and stimulate the participants to engage in the discussion and show your expertise, your knowledge and your efforts to search new evidence. So it is not about a lecture you read and retain some information and forget them later. There is a mark for online contribution in the discussions (quality and quantity) 2- mcq exam at the end . 3- Assignment. Four years after completing the haemodynamics module, as an example, I am still on the track , at a higher level of knowledge and understanding. Ironically most of NICUs are adopting traditions and dogmas for managing hypotension and PPHN, and it is so challenging to change, but maintaining up-to-date insightful knowledge, you will be capable of implementing improvements. A great advantage of the degree us that you will gain a huge experience in academic writing , through the online discussions and the assignments. Evidence based practice, this degree is the real chance to understand, practice and be capable to teach EBP. Money wise , yes costly, but there is a chance to do modules as CPD , with less expensive fees. Time and convenience, even if u do one module per year, that is very good. If you do Neonatal nutrition in 3 and half months then work on teaching and improving practice in your unit , for the rest of the year then move to another module. This is how it should work, not just a line in my CV , it is a way of life as a good neonatologist It is convenient, yes a hard work but generally convenient. Good luck Omayma Hemida
    4 points
  31. Hello Everyone, A shout out to any Units that utilise a Neuro Care Bundle for your extreme premmies and/or HIE. Would you be kind enough to share or send me a PM on your approach please? Many thanks Alistair
    3 points
  32. I would love to, but we mostly work per the outdated approach
    3 points
  33. We have only had one infant held so far and it went well—no temperature or vital sign instability. The baby was pretty stable and not on a vent but had umbilical lines. There didn’t seem to be a problem with the vEEG wires. We don’t have an actual protocol for this but with our project, the baby must be stable and is held for 30 minutes with vital signs and temperature from the monitor recorded every 5 minutes. It was the father who got to hold as the mother was still at the birth hospital after a C section. We are a children’s hospital so all of our babies are transported in, a definite disadvantage for C/S moms though they can see their babies 24/7 with the bedside camera and sometimes get a pass to visit day or 2 after birth.
    3 points
  34. Sidestream is highly accurate in optimal conditions (homogene lung perfusion, no leakage, evident end-tidal plateau,...) so from technological point of view it is very good. But there are some limitations and you have to do a lot of training to increase knowledge in your hole team to work with it. The numbers are worthless without looking for other parameters to interpret them ;-). So we use it regularly and do in the beginning a bloods sample. We use standard ventilation mode SIPPV+Vg so the situation should be stable and we follow the trend. If trend follows our expectations we don't do routine bloods check. If we see changes we first look on the flow curve and percentage leak before interpreting the number. Then we try to solve problem logical (in-, decrease tidal volume, suctioning, ...) and if the patientt doesn't respond wel we do further diagnostics (X-ry, bloodgas, ...) The mainstream technology is more stable because you have less trouble with leakage ;-) Gr. Thilo
    3 points
  35. Join our Webinar Journal Club on neonatal airway management, 9 June at 1630-1715 CET After the initial Journal Club on neonatal airway management in our forum, we would like to engage with you in a live Webinar together with Joyce E O'Shea, Alexandra Scrivens, Gemma Edwards, and Charles Christoph Roehr, the authors of review article on "Safe emergency neonatal airway management: current challenges and potential approaches". The review article examines how to acutely manage the neonatal airway, and the challenges related facemask ventilation and intubation. In this 45min Webinar Journal Club, we will discuss the following three topics: emergency airway management elective airway management who should do/train what Click here to register ! https://meduniwien.webex.com/meduniwien/j.php?RGID=r05ba14c0a7deea737f44aa6c0c13c8e8 On 9 June and once registered on the link above, click here to access the webinar! https://meduniwien.webex.com/meduniwien/j.php?MTID=ma871fe9a5934e3892b7ec7f9ff51a4ad Panelists Joyce O’Shea - born and educated in Cork, Ireland. Paediatric and neonatal training has been between Ireland, Scotland and Australia. Developed an interest in neonatal resuscitation and airway management especially intubation when working as a research fellow at the Royal Women’s Hospital, Melbourne. Has worked since 2014 as a neonatal consultant at the Royal Children’s Hospital, Glasgow, Scotland. Continues to be passionate about making airway management as safe as possible for infants and neonatal trainees. Charles Christoph Roehr, M.D., PhD. Associate Professor - the Clinical Director of the National Perinatal Epidemiology Unit - Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, with a strong interest in studies which answer clinically relevant questions. Clinically, Charles works as an Academic Consultant Neonatologist at Southmead Hospital, Bristol. His own research interests centre around understanding the cardio-respiratory adaptation during fetal-to-neontal transition and on how to best support the newly born infant. A strong proponent of evidence-based neonatology, he acts as the NLS Scientific Co-Chair and guideline author for the European Resuscitation Council (ERC) and is a member of the International Liaison Committee on Resuscitation (ILCOR) neonatal guideline writing group. Charles also serves as President of the European Society for Paediatric Research (ESPR). Gemma Edwards – ST5 paediatric trainee in the West of Scotland. Studied in Dundee and has worked in Glasgow for 7 years. Has worked on projects looking at neonatal intubation over the last three years and particularly interested in ways to support trainees with airway management skills. Alexandra Scrivens - ST6 neonatal GRID trainee (first year fellow equivalent) in Oxford, UK. Previously clinical research fellow for the NeoCLEAR study. Am a social media editor for EBNEO and trainee representative on the resuscitation council UK NLS subcommittee. Main areas of interest are procedures, resuscitation, decision-making and respiratory care of term and preterm babies. Enjoy trail running, paddleboarding and spending as much time outdoors as possible!
    3 points
  36. Hi Everyone, Given the infants remain servo controlled in either jacket or mattress and central lines can be visualised (provided no coagulopathy) it seems extremely harsh to ask a parent to not be able to hold their child for almost four days (if you include rewarm period). A study into aEEG response to cuddles might reveal some interesting results?? https://pubmed.ncbi.nlm.nih.gov/30721531/
    3 points
  37. Check out The Incubator, a (first?) dedicated podcast for NICU professionals hosted by Dr. Ben Courchia and Dr. Daphna Yasova Barbeau. I have listened to two episodes and can highly recommend it. The pod is weekly and about new evidence in neonatal care and the fascinating individuals who make this progress possible. Find here https://www.buzzsprout.com/1739595
    3 points
  38. @piatkat A Pod-category now in the Links Directory https://99nicu.org/links/
    3 points
  39. Intubation, feels like a topic where science and art (and opinions!) meet! And, a sensitive topic as well, when intubation is discussed, it can almost feel we discuss a ritual rather than a medical procedure In my first years as fellow, doing intubations was something that was quite stressful for myself, and early on the learning curve also for the infants... so, I think the question on how and who to train is well put but this paper. In our hospital , we have a video laryngoscope, but as trained to do direct laryngoscopy I admit I have never tried in on a patient, only in a simulation setup. But recently I had a live experience that was very positive, where the an anaesthesiologist did a video-guided intubation after a failed try with the regular laryngoscope, and it just seemed to much easier, and better for all (also the infant!) LMAs - our pediatrics fellows has been trained to use those, and our experience is very good, an airway can be almost always be secured until more experienced clinicians arrive. If you don't have LMAs in your emergency cart in the delivery room, I can only recommend to get it.
    3 points
  40. 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 the number of times per year I even pick up a laryngoscope outside of a simulation (and as often as not, given that several experienced providers have tried to intubate before me, I'm busy re-engineering the situation to improve success or avoid need for intubation rather than somehow getting the tube in when others could not). I am confident that I've probably reached the point where I am significantly safer/better with VL than DL. This isn't just about trainees any more.
    3 points
  41. 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 happen. It is 2 AM and the fellow on call is notified that they need to come and see a patient. On arrival the bedside nurse shows them a syringe that contains dark green murky fluid. The fellow is told that NG tube placement was just being checked and this is what was aspirated. The infant is fine in terms of exam but the question is asked “What should I do with this fluid”. The decision is made that the fluid looks “gross” and they discard it and then decide to resume feedings with a fresh batch of milk. Both parties feel good about discarding what looked totally unappealing for anyone to ingest and the night goes on. If this sounds familiar it should as I suspect this happens frequently. Logical Fallacy A colleague of mine introduced me to this concept and I think it may apply here. Purdue University’s writing lab defines a Logical Fallacy in this way “Fallacies are common errors in reasoning that will undermine the logic of your argument. Fallacies can be either illegitimate arguments or irrelevant points, and are often identified because they lack evidence that supports their claim.” I think we may have one here that has pervaded Neonatology across the globe. Imbedded in the fallacy is the notion that because the dark green aspirates look gross and we often see such coloured aspirates in patients with necrotizing enterocolitis or other bowel disease, all green aspirates must be bad for you. The second fallacy is that the darker the aspirate the more seriously you should consider discarding it. This may surprise you but on their own there isn’t much of anything that has been shown to be wrong with them. Looking for evidence to demonstrate increased rates of NEC or other abdominal issues in an otherwise well patient finds pretty much nothing to support discarding. A challenge to discarding Athalye-Jape G et al published Composition of Coloured Gastric Residuals in Extremely Preterm Infants-A Nested Prospective Observational Study. The study was a nested one in that questions about gastric residuals were taken from two studies on the use of probiotics. As with other studies on the use of probiotics there were some benefits seen as shown in Table 2 but that is not the main reason for sharing this study with you. The main reason for the share of this paper is what is in Table 3. Although not significantly different the mean estimates for concentration of bile acids in the pale and dark green aspirates came close to being different. Other nutritional content such as fat, protein and carbohydrate were no different. As the bile became darker though the bile acids tended to increase. It is this point that is worthy of discussion. A Breakdown of the Aspirate I’m with you. When you look at that murky dark green fluid in the syringe it just seems wrong to put that back into a belly. Would you want to eat that? Absolutely not but when you break it down into what is in there, suddenly it doesn’t seem so bad. We assume that we would not want to refeed such putrid looking material and that is where the logical fallacy exists. What evidence do we have that refeeding that fluid is bad? As I said above not much at all. Looking at the fact that there is actual nutritional calories in that fluid and bile acids as well you come to realize that throwing it away may truly not be in the best interest of the baby. Calories may wind up in the garbage and along with them, bile acids. Bile acids are quite important in digestion as they help us digest fat and moreover as they enter the ileum they are reabsorbed in large quantities which go to further help digestion. In addition bile acid concentrations are what helps draw fluid into bile and promotes bile flow. By throwing these bile acids out we could see lower bile volumes and possible malabsorption from insufficient emulsification of fat. The other unmeasured factors in this fluid are the local hormones produced in the bowel such as motilin which helps with small bowel contractility. Loss of this hormone might lead to impairment of peristalsis which can lead to other problems such as bacterial overgrowth and malabsorption. Now all of this is speculative I will admit and to throw out one dark green aspirate is not going to lead to much harm I would think. What if this was systematic though over 24 or 48 hours that such aspirates were being found and discarded. Might be something there, What I do think the finding of such aspirates should trigger however is a thorough examination of the patient as dark green aspirates can be found in serious conditions such as NEC or bowel perforation. In the presence of a normal examination with or without laboratory investigations what I take from this study is that we should question are tendency to find and discard. Maybe the time has come to replace such fear with a practice of closing our eyes and putting that dark green aspirate right back where it came from.
    3 points
  42. We do not use it, due to two main reasons. 1. We had few serious side effect such as: intestinal perforation 2. The drug is not available anymore in Israel We are now practicing IVH prophylaxis measurements such as: delayed cord clamping, temperature stability, 4 hand treatment, insertion of umbilical lines to avoid IV punctures, volume guarantee ventilation etc.. and the IVH prevalence seems to decrease, therefore no need of INDO.
    3 points
  43. As @rehman_naveedsaid, this is NOT excess sodium provision. The baby is total body water depleted from all the ways an ELBW can lose free water (mostly skin and urine). You minimize insensible water losses (plastic bag, double wall isolate if available, etc) and, if these measure are not sufficient, provide more free water by increasing your total fluids. Without knowing the details of your fluid management, it is difficult to say more, but from your question, this is almost certainly the problem. What day of life are you seeing this issue? How much weight loss are you seeing (a marker of water losses early in life)? What is your current fluid management?
    3 points
  44. Look: The folowing App: Heat Balance (From Dräger).
    3 points
  45. I´ve never used the Neo tee, but other T-piece resuscitators which work fine, especially in preterm babies but I was a bit concerned reading this article showing that some devices do not deliver set PIP at all times https://fn.bmj.com/content/104/2/F122.abstract A so called PEEP valve on a bag in my opinion does not create a sufficient (or any...) PEEP. You need some kind of device with a flow. Maybe in a term baby using a 500 ml bag and slowly squeezing the bag keeping FRC, but still you don´t know the amount of PEEP. A good adjunct in this situation could be to to use a Respiratory Function Monitor as whatever device you use you don´t know the leakage or more important the tidal volume. Even if the PIP is set the compliance changes and suddenly you might ventilate with to large VTe harming the baby.
    3 points
  46. Hi. This is Chakradhar. I had my PGD in neonatology CPD mode from Southampton. I have studied and finished my Academic MSc in Neonatal Medicine from Cardiff University. It standalone module based study. There six modules in PGD from cardiff. First year includes 3modules namely Acute respiratory care, Acute cardiac care and neonatal critical care. Second year includes acute neurological care, gut and nutrition and neonatal & paediatric transport. After successfully completing the pg diploma in neonatal medicine, you should apply for MSc dissertation year (3rd year) and work under two supervisors, 1. a senior neonatologist supervisor and 2.second supervisor for any other assistance. You are evaluated on basis of 1.weekly group discussion which contributes 5% of your final scores, quality eb discussion given priority rather than quantity of statements, 2. Weekly mcqs 3. Formative and summative assignments. You will enjoy the evidence based teachings from experienced faculty. Other self modules teach you regarding plagiarism, paraphrasing, EBM, research tools, referencing system..... many more. I had completed all 5 Note modules from Southampton (ESN) by CPD mode. Included modules were 1.neonatal nutrition 2.neonatal neurology 3.neonatal pharmacology 4. Hemodynamics and cardiology and 5.neonatal pulmonology. Dr Mike and Dr Neelum Gupta will interact with students during discussion. 50 hours live sessions with direct contact with students and 200hrs indirect learning. I had enjoyed both the degrees and working confidently in my nicu with bedside echo, cUSS, Cranial doppler ultrasound, lung USS and abdomen esp early identification of NEC.. etc. Regarding Fees structure, it hikes every year slightly. It's online, standalone module based learning, convenient, you can study from your office or home. Vast online library available .... all literature available at your fingertips.
    3 points
  47. Dear colleagues! There is a burning question on my mind. Has anybody done one oft these two part-time distance learning MSc programs - MSc Neonatology (University of Southampton - https://www.southampton.ac.uk/courses/neonatology-masters-msc) or MSc Neonatal Medicine (Cardiff University - https://www.cardiff.ac.uk/study/postgraduate/taught/courses/course/neonatal-medicine-msc-part-time)? If so, what was your experience with it? Would you do it all over again? Was it worth its money? Was it compatible with working full-time? Initially I wanted to join a PhD program, but unfortunately this is almost impossible right now and probably for the next few years at my hospital as there are almost exclusively neonatal clinicians working here although it's a (relatively new) university hospital. That's why I am searching for academic alternatives and found these two already mentioned programs.
    3 points
  48. Evening we have both devices the Fabian VG is great but recently we were alerted to a software update for VG so little cautious on our sub 500 grm babies at present . The Draeger similar positive experience no issues. In our experience we would attempt extubating the infant provided no haemodynamically significant pda or major IVH. But achieving the MAP of 10 is often difficult with non invasive nasal Cpap even with biphasic/duopap option . So we have opted for non invasive nasal osscilation using Ramanathans RAM nasal cannula fits directly onto the vent y connector with same MAP or 1 higher hz 10 amp 20 as a starting point although they seem fo tolerate 1:2 ratio better . Highly efficient system can very easily cause hypocapnia so we use transcutaneous co2 to monitor . Fi02 only minimally increases in most infants and the followup chest xrays inevitably deteriorate out of proportion to the infants clinical picture but clears after a few days. The infant in naturally nursed prone and the head flexed or extended until a good neutral position and a good chest wiggle is observed . The nursing staff love the system and it allows you to bridge to a point where the infant either transitions to nasal CPAP or the nasal high flow vapourtherm systems . Just our humble experience and approach for micro Good luck Ricky Dippenaar
    3 points
  49. I am practicing on an exclusive mother and child care hospital in a resource poor setting in Western Odisha India where we get a lot of babies with birth asphyxia. For the last 4 yrs we have been using a low cost device called Mira Cradle which uses phase change material in a a polyurethane cradle. We have found it to be very effective in maintaining the requisite temperature for 72 hrs without use of electricity. This has resulted in favorable out comes especially in babies with moderate encephalopathy
    3 points
  50. The software platform for 99nicu.org is now updated to the latest version. This brings a new look to the web site but more importantly, the update adds some new functionalities that paves the way for an upcoming smartphone app. Lets hope we soon can have 99nicu practically on our finger tips! (although the mobile web version of 99nicu also works great, check out 99nicu.org on your smartphone too)
    3 points
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