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Showing content with the highest reputation since 12/06/2018 in all areas

  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
    After watching a documentary in ARTE about bacteriophages it made me think about how else is antibiotic resistance in NICU.? It available french / German Here the story phages was told. First discovered use by Felix Derrel to combat infections in the pre-antibiotics era and was later discredited and forget about in the western world Historically they worked rather well, so there is an attempt to bring them back in the light of increasing antibiotics resistance. This rediscovery started with lab study that showed that the phages were effective at clearing infection in rats population sample. Phagoburn Recently, a French team took it to human and show it feasible despite the many challenges. This study was a RCT which a specific process approval and protocols were established. The aim in *Phagoburn*was to see if phages could be useful using to fight infection in burn victims. It was lead by Dr. Patrick Jault and large team .Jerôme Gabbard head Start up tells Pherecydes provided the synthesis of phages. control got standard treatment {silver salts +antiobiotics} and othe got phages.This got published in nature. The was a reduction in the infection rate in phage group, a loading dosing issue among other practical things. Researchers in france say that there a scaling issue to produce larger amounts, as well a regulatory framework. From bioethical point of view it is possible, a more detail informed consent will be necessary.These days research still going a la Croix de Lion Hospital, France. University Hospital ~CHU Lyon~. ( initial used - discovered @pasteur Institute) https://www.arte.tv/fr/videos/078693-000-A/l-incroyable-histoire-des-tueurs-de-bacteries/ Thus what do think any future of phage in NICU?
  3. 3 points
    Oral immune therapy (OIT) has really taken off at least in our units. The notion here is that provision of small amounts (0.2 mL intrabucally q2or 24 hours) can prime the immune system. Lymphoid tissue present in the oropharynx and intestine exposed to this liquid gold in theory will give the immune system a boost and increase levels of IgA. Such rises in IgA could help improve the mucosal defence barrier and therefore lessen the incidence of late onset sepsis. Rodriguez et al described this in their paper Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives in 2009. They followed it up the next year with a pilot study demonstrating how to actually administer such therapy. The fact that this approach has been adopted so quickly I think speaks to the principle that this kind of therapy falls into the category of “can’t hurt and might help”. The real question though is does it actually make a difference? Recently, authors from Brazil presented their findings from a single centre double blind RCT entitled Randomized Controlled Trial of Oropharyngeal Colostrum Administration in Very-low-birth-weight Preterm Infants. This authors are commended for studying this practice in such a fashion and included infants <34 weeks who were <1500g at birth to receive the above mentioned intervention. These infants were compared to placebo who received the same intervention except instead of mother’s own colostrum they were given sterile water. In total there were 149 infants randomized with 81 receiving OIT vs 68 who received a placebo. The primary outcome of interest on which a power calculation was performed was the incidence of late onset sepsis. Other typical outcomes including NEC, ROP, BPD, IVH and death were also followed. Did they find a difference? Sadly to many of you I am sure they did not as is shown in the table below. Surprisingly the authors also looked at levels of IgA in infants in both arms and also found no difference. There is a big problem with this study however that no doubt will lead to a repeat version at some point. While the authors enrolled the numbers above, the numbers that were analyzed in the table are 34 lower in the OIT arm and only 2 lower in the placebo group. In essence, a large number of mothers after enrollment were not able to provide the colostrum that was needed for the study. The study called for 48 applications over a 48 hour period and a little more than half of the mothers were able to do it. Do not be dismayed then that no difference was found here. There is no need to “throw the baby out with the bathwater” and abandon OIT based on this one study. I think what is needed in the future though is a study that enrolls far more than needed to account for attrition due to loss of mothers who can complete the study. Without another study I think the practice will continue but does it really make a difference to rates of sepsis? Who knows but there is no doubt it helps parents who are feeling that they have lost control of a pregnancy that has gone wrong, a positive experience and the feeling that they are doing something for their child.
  4. 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.
  5. 3 points
    While at the #99nicuMeetup, I and @Francesco Cardona were filmed by Miris (one of our exhibiting partners). It was a one-time shot without rehearsal, so we spoke from the heart
  6. 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
  7. 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
  8. 2 points
    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.
  9. 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❤️❤️❤️❤️❤️
  10. 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
  11. 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
  12. 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.
  13. 2 points
    I must say the meetup conference 2019, was outstanding. Is there a chance that the video recording from 2018 meeting will be also available on you tube ? Talat
  14. 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.
  15. 2 points
    We used Protovit for some months when Soluvit wasnt available for us.
  16. 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.
  17. 2 points
  18. 2 points
    A friendly reminder - this is the last week you can register as an Early Bird for our 3rd "Future of Neonatal Care" conference (AKA the 99nicu Meetup), 7-10 April in Copenhagen, Denmark. The program includes important topics such as BPD prevention, cord clamping, HFNC, neonatal transports, transfusions, pain management, NEC-reducing strategies, and management around the border of viability. Furthermore, the last day there will be workshops on EBM, transports, family-centered care and echocardiography. Click here for more information, and to register! Looking fw to meet up in Copenhagen!
  19. 1 point
  20. 1 point
    Time stamps 00:24- objectives 00:50 - disclosures 1:20 - SLI demonstration 1:38 - Meta analysis 2015 : SLI vs PPV : No diff in death and BPD 2:10 - SAIL trial: stopped early due to more deaths < 48 hrs. No diff in death and BPD.(80% infants completed the trial) 2:42 - Schmozler 2018 : Feasibility RCT done , results in favour of CC+ SI 3:04 - Cochrane : surfactant benefits 3:44 - Isayama T: network meta-analysis 2016 5:43 - LISA technique 6:12 - AMV trial by Gopel: LISA reduced MV 7: 28 - Isayama: excluded AMV from network meta analysis: reason explained 7:39 - OPTIMIST: ongoing trial: extreme preterm 7:44 - NINSAPP trial: < 26 week .. Air leak less in LISA 9:22 - LISA vs INSURE: No diff for BPD 10:04 - SURE vs INSURE : less MV(primary outcome) and BPD(secondary outcome): larger infants included, no subgroup analysis 12: 14 - NRN Review 13:14 - Probable formulated protocol Thank you.
  21. 1 point
    @nashwa Would be great to hear the experience by for example @Francesco Cardona , I work in a NICU with ≥28w infants now. As I understand from level3 colleagues, nCPAP with relatively high pressures is the primary mode of respiratory support, and LISA the method to give surfactant, while nCPAP is ongoing. This is said to be a successful strategy for a surprisingly large proportion of the very immature infants (also ~24-25wk), but I don't have numbers or first-hand experience myself. I have even heard discussions that staff worry about intubation skills, and how those skills are trained/kept when only a minority of ELBW infants needs intubation and invasive ventilation. A new world!
  22. 1 point
    An dedicated platform on Neonatal Lung Ultrasound (Neo LUS) amidst the rabbit holes: https://www.facebook.com/groups/1493243264284547/
  23. 1 point
    The use of probiotic Bifidobacterium breve M-16 v has been in use for a fairly long time in Australia for preterms with very positive study reports especially by Dr. Sanjay Patole et al. We in India are currently using the same for the last few months with good results so far
  24. 1 point
    Glucose metabolism in the newborn can be a tricky thing to manage. Neonates can have significant fluctuation in their serum glucose in the first few days of life which can lead heels to look like pin cushions. How many times have you been asked as a physician if there is anything we can do to reduce the number of pokes? That something may have arrived at least in a feasibility study that could pave the way for this becoming the standard approach to hypo/hyperglycemia in the newborn. This is an important area to improve tightness of control as hyperglycemia has been associated in VLBW infants with such adverse outcomes as IVH, ROP and NEC. Continuous glucose monitoring (CGM) with closed loop insulin delivery The principle here is that a meter is inserted subcutaneously that detects blood glucose fluctuations and responds by either increasing infusion of dextrose for low glucose or delivery of insulin. The technology has been around for some time and used in the adult population but is relatively new in this population. I have written about it before in Continuous glucose monitoring in NICU may be around the corner. What follows is the latest pilot study to test this out coupled with glucose or insulin delivery in a closed loop system. The study in this case is out of Cambridge in the UK and entitled Feasibility of automated insulin delivery guided by continuous glucose monitoring in preterm infants . What did they do? The study was a pilot of 20 patients randomized to have an automated system to regulate glucose based on CGM data from 48-72 hours of age vs a paper based algorithm to manage dextrose or insulin infusion rates during the same period. The sample size was one of convenience to test the concept and the period was chosen to allow for time to recruit patients. The sensor used was an Enlite attached to a laptop with software capable of delivering infusion rates to two alaris pumps (one with 20% dextrose and the other with insulin). Target serum glucose levels were set to be between 4-8 mmol/L. The babies included were all under 1200g and had mean weights of 962g in the closed loop and 823g in the control arm. The Results were fairly dramatic in my mind at least. A remarkable 91% of the infants in the closed loop system had glucose levels in the target range vs 26% in the control arm. Nutritional intakes and mean insulin dosing were not any different between groups. No harm in addition was noted from use of the CGMs. You don’t escape pokes all together though as the device does require q6h checks to calibrate and ensure it is reading properly. Every 6 hours is better though than every three for those with brittle control! The Benefit Tightly regulating blood glucose and avoiding both lows and highs has benefits on the low end to neurological preservation. On the high end some complications such as IVH, NEC and ROP may be avoided by better control. The challenge with the system as is at the moment is that it is not widely available. I am eager for a company out there to create software for mass distribution that would enable us to try this out. While the calibration is still required I can’t help but think this is an improvement over what we have at the moment. Stay tuned as I think this one is for real and will appear in NICUs sooner than you think!
  25. 1 point
    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.
  26. 1 point
  27. 1 point
    I am based in South Africa. We tried both the Neobar and Neofit. The Neofit was the better option but agree with the comments above. Having tried both we felt tape was still the better option. We use a barrier film to protect the skin (if available) then extra thin hydrocolloid strips. We then use either zinc oxide or hypofix tape (5 strips) in much the same technique as described above.
  28. 1 point
    @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.
  29. 1 point
    The NICU`s in the Netherlands al secure tubes with tape. It only differs in detail and in the type of tape. At the last NICU congres in Copenhagen there was a poster from Sweden about the tape fixation.
  30. 1 point
    I got the advice on this device some years ago from a US-based RT. It is very easy to adjust the tube position as the tube is secured with velcro over metal "nabs". Don't know if it MR-safe though (manufacturer would know). For smaller preterms (like <1000g) the "tape plates" are too big. And care in high incubator humidity works less well, the tape gets loose. But overall and especially for term infants needing short-term invasive ventilation, this device works really well IMHO. The Karolinska level-3 NICU use tape in a new fashion, I think there is a video clip on Vimeo - will check out next week at work if I can share it here
  31. 1 point
    We use Neobars and find they work well.
  32. 1 point
    @Francesco Cardona thanks for sharing this! I I posted this URL on our FB page (https://www.facebook.com/99nicu) and that post has already been shared 60 times and reached 3000 people (new impact record I think!)
  33. 1 point
  34. 1 point
    Currently Tamil Nadu S India State President of Neonatology Association of Tamilnadu EB member National NNF Greetings to all
  35. 1 point
    Last month I got a chance to day pass at ems2019 to get an update on hospital tranfer#picu by la paz and update on ilcor peadiatric resus by Dr Maconochiel who gave us an insight into how guidelines are elaborated -quite complex.I also the tech lover and intetact resus decives. The Mechanical for compression in for fevices look impressive , and fumctional .I was suprised to see many there are available to date x adult use only. My NLS Top medical devices -tried and tested Monivent(wireless &app). @99NICU so easy to use and it does show the volume needed and how softly you have to press the mask for proper Ventilation. Glad to Paul extensive high skill training , impressised complete with video screens -vocal cords. Brayden @ems2019 new baby manikin (coming soon) great sim as the illumination lines show you when you are putting in depth and the correct rhythm. The adult and pediatric manikins works, glad I could try all three. Adults @ems2019 Lifeband #zoll 👌 visual and descriptive demostration of cardiac arrest scenaritrauma e the mechanical compression can continue as the patient is move to a a safer place. While it was stationary it was also also allow clinicians to administer drug or can use the defibililator. In all was was most engaging challenge to teach about ALS/PLS . Instead if just getting a freebee you had to participate in rheir scenarios. Respirator portable :no o2 short journey .as it has a compressor. 02 Optional port for longer journey Charges:epocc from siemmes health seems a like alternative to istat cartiges if need a change. This thing cartiges Allow for testing of 11 items , as well as a capillary option too. The best feature in terms of transport is the don't require refrigeration. Add Perks - incubator for transfer MRI.allow less handling of the neonate, certainly smaller and more elegant. Clotting granules .These are ganulea that you our onto a bleeding site. look good for trauma Pic of a good transport monitor and compact with optoon to print by corpus credit: corpus minutor z--/DISCLAIMER: I have no ties or Funding from the companies reviews---.z
  36. 1 point
    YOU deserve KUDOS!!!
  37. 1 point
    hi, we dont have solovit in nicu,what s alternative?
  38. 1 point
    Many Thanks @edcarsi for the upload and sharing the article. Another notable study was conducted in Brazil in 2009 (beside SciELO also cited in PMC, available both in Spanish and English) echoing the similar aspects of this perpetual issue even beyond the realm of NEOs: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692009000500003
  39. 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?
  40. 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.
  41. 1 point
    Thanks for sharing this paper about newborns in humanitarian crises. To expand the topic, I qoute the abstract below:
  42. 1 point
    My colleague Ewa Henckel defended her thesis at Karolinska Institutet on "Cellular consequences of preterm birth : telomere biology, immune development and oxidative stress" last week, including four projects on telomere length, inflammation and lung function viral respiratory infections and cellular aging immune system development and environmental exposures hyperoxia-induced lung damage and the capacity to counter-act surfactant inactivation with a novel antioxidant A great thesis, available for download here: https://openarchive.ki.se/xmlui/handle/10616/46531 For the table seating at the dissertation party, her husband had made clever and funny personal drawings for all guests. I translate mine for you below, it is on the spot Best regards from Mr Conference Organiser PS. BTW, hope to meet up with you at the next "Future of Neonatal Care" conference in Copenhagen. Click here to find out more.
  43. 1 point
    Can anyone share his experience in using iNO in PT with Pulmonary hypertension in BPD Sent from my MHA-L29 using Tapatalk
  44. 1 point
    I'm not sure we did anything particularly involved, iNO at 20ppm and assess if responder or not based on FiO2 requirement (although, in practice, I feel like no one ever turned the iNO off in non-responders, the kids just died eventually). We would try to get ECHO for indirect estimation of PH before starting (and to make sure this wasn't anomalous veins). My original comment still stands though: as this patient sounds like they have evolving CLD, I'd invest more of my time and effort in reviewing XRays and optimizing the vent for CLD. Also, if you haven't started, I'd have a very frank discussion about morbidity and mortality with the family. Have you considered re-posting/cross-posting to the virtual NICU if you are interested in discussing a specific patient? Bimal
  45. 1 point
    We are now moving to a dedicated email service for our newsletter. From now on, we will use Sendinblue. With this professional provider of email services, including dedicated IP's, we will be more certain that members actually recieve our emails Given that our terms of use also includes that members need to have a valid email address, we will also be clearing the members' database from those with invalid email addresses. If you want to quit your email subscription, there will be bullet proof link in every email. If you also want to close your membership, you can also email info@99nicu.org and we'll erase your membership data promptly
  46. 1 point
    congratulation... nice concept of solo speaker conference . We call it CME here though.
  47. 1 point
    Thanks for sharing and congratulations to your first talk as a "solo speaker". And the macarons, what a great bonus
  48. 1 point
    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.
  49. 1 point
    Cardiovascular plumbing , that's one of my favourite topics! The pre- and the post-ductal saturations are both arterial saturations (blood from the heart), and refers to arterial oxygen saturation in vessels originating from the aorta before and after the ductal orifice in the aorta. Classically, the pre-ductal values are recorded in the right hand, but one can argue that left-handed saturations are roughly the same (http://www.biomedcentral.com/content/pdf/1471-2431-10-35.pdf). Arterial post-ductal sat's are measured in the foot. Post-ductal saturations become lower than pre-ductal when there is mixing of pulmonary blood through the duct, i.e. in congenital heart defects that are duct dependent. For example, severe coarcations or transpositions of the great arteries typically have lower postductal sat´s. This is the theoretical background to POX screening (http://www.bmj.com/content/338/bmj.a3037.full)
  50. 1 point
    Book review: neonatal cerebral investigation by Rennie,JM; Hagmann,CF; Robertson, NJ; 2008 ISBN-13: 978-0521838481 I´d like to congratulate the authors: their description of the examination of the neonatal brain from the clinical viewpoint is really thrilling! In the first part you find a detailed description of the basic s of physics and technology of ultrasound, MRI, EEG and aEEG including safety issues as well as clinical examinations , normal anatomy and normal imaging appearance including the maturational aspects of the premature brain. Emphasis is taken on repeated examinations at different times. The second part deals with the examination of the neonatal brain. In these chapters the approach to the topics is from the clinical point of view, starting with a problem or a diagnosis and the underlying pathophysiology, followed by a detailed description of the investigational possibilities with the values and limitations of the different techniques and the description of therapies and prognosis. The sections include suspected seizures, hypoxic-ischemic encephalopathy, screening, ventriculomegaly , congenital malformations and more. For example in the chapter “the baby who was depressed at birth” you find the description of what investigations should be done, a detailed passage of pathophysiology, neuropathology and the clinical course, followed by a detailed analysis of the results of EEG, aEEG, the different findings of ultrasound, conventional MRI, quantitative MRI. The chapter is closed by treatment, prognosis and a short description of non hypoxic encephalopathy. The book is providing a lot of great figures (some of them containing up to 32 pictures) and tables, it´s really a treasure; you can use it also as an atlas of neonatal brain imaging. The lists of literature are extensive and valuable. What is missing –but this is not a real problem- is a description of examinations in genetics in the chapter of congenital malformation. It also could have been useful, if evolving techniques that are likely to come into the clinical routine practice e.g. near infrared spectroscopy would have been mentioned. This book should be available in every NICU, and it will be especially useful for everybody learning or performing ultrasound examinations in newborns and also for those who care for the babies and who have to ask the right questions and to interpret the results. Even the experienced physician will find a lot of interesting aspects and insights. The book is especially valuable because of the synthesis of clinical and technical aspects. It teaches the complex interaction between those. Thanks to the authors, I ´ve enjoyed reading this book.
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