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  1. Stefan Johansson

    Stefan Johansson

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  2. piatkat

    piatkat

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      69

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      122


  3. Vicky Payne

    Vicky Payne

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      58

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      51


  4. Francesco Cardona

    Francesco Cardona

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      40

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      473


Popular Content

Showing content with the highest reputation since 05/13/2020 in all areas

  1. Check out the , now for the first time as a Virtual Meeting. More info on the attached PDF. Visit the web site for more info and to register: https://www.epiclatino.co/in-english
    7 points
  2. So I've seen LISA done once, I've now done it once, next is to roll it out unit wide in our NICU. See one, do one, teach one, right? I'd like to hear from those of you that have been doing LISA/ MIST for a while now. What is the best tip you have? What do you know now that you wish you had known when you first did LISA? What barriers to implementation did you have when you started? Any feedback is welcome. Also, I made a video for our nurses and respiratory therapists to just introduce the idea. Not too in depth, but something to get our education rolling. See what you think.
    6 points
  3. 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
    5 points
  4. 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
  5. 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
    5 points
  6. No electrolytes (except possible Ca) in the first day or so, introduce modest amounts of Na and K in IVF/PN on day 2 or 3 based on diuresis and serum Na level. Closer monitoring is required in ELBW/EPT infants. In my experience in the early going the biggest problem people get into is giving too much free water as opposed to being off on the amount or timing of Na administration. After a couple of days the biggest problem, especially in ELBWs, is that massive amounts of acetate given in TPN to compensate for the normal RTA are not adjusted quickly enough and people overshoot and end up with
    5 points
  7. Dear Mohan, from all studies by the team of Professor Stuart Hooper and Professor Arjan te Pas, we know that aeration of the lungs is the master switch to transistion a baby from placental circulation to autonomous circulation. As long as the placenta is not delivered, there is gas exchange and the newborn receives oxygen-rich blood via the placenta. It is therefore important that the baby aerates its lungs before cutting off placental circulation - to ensure that baby's heart receives sufficient oxygen rich blood from the placenta during transition. When the placenta has been delivered, there
    5 points
  8. The NOTE programme (collaboration between ESPR and University of Southampton) are opening a Pharmacology module in June, led by Karl Allegaert and Sinno Simons, using virtual/remote teaching. More information in attachment and via link below 🙂 https://www.espr.eu/news/news-detail/e-learning-neonatology-paediatrics/186 Proposal NOTE module DINA4 v3 (1).pdf
    5 points
  9. 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:
    4 points
  10. 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-in
    4 points
  11. 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
    4 points
  12. 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 g
    4 points
  13. 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
  14. 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
  15. 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 b
    4 points
  16. 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
  17. 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
  18. 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
    4 points
  19. 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
  20. 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 n
    4 points
  21. Dear colleagues! Monday Jul 20th 2020 the first successful LISA procedure was made in NICU of Multiprofile Hospital for Active Treatment Pazardjik Bulgaria. Baby girl 28 weeks, 950 grams from mother with chorioamnionitis. Still on CPAP (no ventilation), no Dopamine, looks well, few apneas. I know that nothing is certain but it is a step towards the right direction. Congrats to our team!
    4 points
  22. Intubate-Surfactant- Extubate or INSURE has been around for awhile. The concept is to place an ETT while an infant is first on CPAP and then after pushing surfactant in quickly remove the ETT and put back on CPAP. This does not always go as planned though. If after surfactant the FiO2 remains above 30% many people would keep the ETT in place as they would surmise that the infant would fail if the tube was removed. They would probably be right. Sustained inflations have fallen out of favour ever since the SAIL trial results were published and written about here . Having said that, the c
    4 points
  23. Friends, I am glad to share that an article of mine about racial disparities, titled 'I Can't Breathe' was just published. Here is the link to the full text of the article (the full text is not available if you go through the journal website). Please share widely - I hope it stimulates action by readers to reduce racial disparities in care and outcomes in the field of perinatal and neonatal care. https://rdcu.be/b6cgM
    4 points
  24. https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.15495 With kind permission from Luigi Gagliardi. And as mentioned: the "official" accepted Ms. It is marked as "free download", so it is perfectly legal. (As soon as the final version is available, I will post the link )
    4 points
  25. 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? 🤔🧐🤓
    3 points
  26. May I ask whether anyone has experience with a prolonged hanging time of a parenteral nutrition (PN) bag (incl lipids) of up to 48h? We are probably changing our PN regimen into an all-in-one bag. Since the bag contains >400 mL, it would suffice for most premature infants for 2 days. One strategy could thus be to prolong hang time from 24h to 48h to cut PN costs by half. A recent Australian study (attached) also suggests this would be a feasible approach: https://www.ncbi.nlm.nih.gov/pubmed/23320598 Since our pharmacy will do all additions to the bag in an aseptic env
    3 points
  27. Do you want to know how to stabilize newborns with an intact umbilical cord? Join our Concord Talk on April 6, with Ronny Knol, neonatologist at Erasmus Medical Center. As a special guest, Bram Dees, will share his experience as a parent of his daughter Lara, who was supported on the Concord Birth Trolley. The new ERC guidelines 2021 are now acknowledging the importance cord clamping. Compared to the 2015 guidelines, ERC NLS 2021 recommends that cord clamping should ideally take place after the lungs are aerated. Where adequate thermal care and initial resuscitation interventions can be s
    3 points
  28. 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 h
    3 points
  29. Great idea to have a journal club. Currently although parental presence is encouraged it occurs very seldom in our units.
    3 points
  30. 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
  31. 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
    3 points
  32. What about lecture series on updates on the management on the different common neonatal disorders
    3 points
  33. 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 Respirat
    3 points
  34. We have started LISA just last year in Umeå, Sweden. We use premedication schedule with caffeine, atropin and esketamin (Ketanest). Works well. Our nurse staff have got many problems to accept laryngoscopy without any premedication.
    3 points
  35. 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
    3 points
  36. 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 super
    3 points
  37. 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
    3 points
  38. Dear Colleagues, As I have shared before, www.perinatalcovid19.org is a free website that provides many useful resources for management of mothers and babies during the covid-19 pandemic. Please visit and browse through the publications, guidelines, and other useful links. I have added some interesting new articles that are 'hot off the press' - these are labeled as 'New' and are in red font. Hope you find this site useful!
    3 points
  39. Soon to come: Monivent Neo100 – providing feedback and guidance during manual ventilation of newborns. Monivent Neo100 product teaser
    3 points
  40. 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
  41. Its great that alot of units are adopting it. I think the important things to sort out when starting LISA is having a clear criteria for weight and GA and pressure cut off. Also to discuss seduction options including low dose opioid vs none. also choosing the appropriate methods including maybe the Hobart methods using the angiocath that may be easier for operators.
    3 points
  42. We sometimes culture infants for herpes simplex born through a normal vaginal delivery and maternal herpes simplex is discovered late during or after delivery (typically recurring herpes). In case of a positive herpes PCR, for example in the upper airway, but negative PCR in blood and cerebrospinal fluid - how would you outline management How do you reason around "colonization" vs "infection" with herpes simplex? My experience over the years, is that a more active management are now adviced from our virology consultants, i.e. iv acyklovir for a relatively long time period.
    3 points
  43. I recently had the honour of being asked to present grand rounds at the University of Manitoba. My former Department Head during the question period stumped me when he asked me what role angiotensin converting enzyme 2 receptor (ACE2) has in pediatric COVID19. Like all great teachers, after I floundered and had to confess that while I was aware there is a role in COVID19 I wasn’t sure of the answer, he sent me a paper on the subject. The reality is that a very small percentage of COVID19 illness is found in children. Some estimates have it at 2%. Why might that be? It’s what’s in the n
    3 points
  44. https://journals.lww.com/pidj/Abstract/9000/INTRAUTERINE_TRANSMISSION_OF_SARS_COV_2_INFECTION.96099.aspx A case report of likely vertical transmission as well.
    3 points
  45. Just a few days ago, Professor de Luca in Paris showed a paper with a scientific evidence of vertical transmission of Sars-Cov-2. An excellent (although sad) news by an excellent professor. Coincidentally, yesterday the National Perinatal Institute, in Mexico made a webinar about this topic. In this slide, what you can see, they are showing in the left, that 17 of 86 placenta tested positive to Covid PCR; that 11 of 22 amniotic fluids tested positive and that 6 of 17 human milk the same. All in mothers positive to Covid-19. Hope this will be of interest for you all.
    3 points
  46. Hi, We always synchronise CC and ventilation 3:1. We found out, by measuring Tv during unsynchronized CC - Ventilation using our ventilator, that compression at the same time as a Ventilation breath leads to no lung ventilation. Birth in Simulation setting as in Resuscitation setting. Using BMV, LMA or uncuffed tube doesn’t make any difference. Please let me know if someone has the same experience.
    3 points
  47. Dear Friends, Please visit www.perinatalcovid19.org , a free website that has many resources to help you deal with the covid-19 pandemic. New research on covid-19 is posted here regularly. Hope you find it useful. Please send me information and suggestions that will help serve your needs. Dr. Gautham, Houston, Texas, USA
    3 points
  48. I also believe higher Frequencies should be used in this patient - this is taken from Zannin et al. on the use of different frequencies https://www.nature.com/articles/pr2017151.pdf: At lower frequencies - a lot more pressure reaches (and damages) the alveoli. This is dampened a lot more at higher frequencies (>12-15 Hz): so even if you set higher pressures - a lot less reaches the alveoli, but ventilation remains same. We have used this approach in a few patients. In the end it was a combination of using the minimal ventilation (accepting lower Sats and higher CO2s) acceptable
    3 points
  49. A problem that most units would see when looking after babies at the extremes of viability. We have used HFOV + VG (VG 1-3mL/kg) to manage these babies and generally don't have to reduce the frequency below 10Hz. Using "Sigh Breathes" can also be useful in these babies but like another poster suggested, using an early DART course may be useful as well as treating other underlying co-morbidities e.g. anaemia, VAP, PDA etc. This is taken from Prof Jane Pillow's manual on the use of HFOV that is published by Drager. Just thought it would be worth sharing. Let us know how you get
    3 points
  50. Great question, Juan Carlos. I am partial to the VN500, but I'm sure both devices can deliver VG quite well. The problem is that babies don't like to be acidotic. Consequently, there is a problem with permissive hypercapnea in the first days of life in small preemies, because their kidneys are not able to compensate for respiratory acidosis. Therefore, the baby will try to generate a tidal volume sufficient to bring the PCO2 down and normalize the pH. As you know when the tidal volume exceeds the target value, PIP will come down and pretty soon, your baby may be on endotracheal CPAP with
    3 points
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