Jump to content


Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org


Popular Content

Showing content with the highest reputation since 08/13/2019 in all areas

  1. 11 points
    I found this consensus on neonatal management of infants born to mothers infected or suspected COVID19. It's free online access. http://atm.amegroups.com/article/view/35751/html
  2. 9 points
    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 rising oxygen requirement (due to the drop in MAP), tachypnea and increased work of breathing. You would have to sedate the baby sufficiently to suppress their respiratory drive, which is a bad idea. People find all kinds of ways to reduce the support for the baby's effort, for example changing from AC to SIMV at a low rate, so the baby is unable to generate adequate minute ventilation and correct the acidosis. So, the baby is struggling, but the doctor is happy, because the PCO2 is where he or she wants it. If you can buffer the acidosis by adding some acetate to your TPN and get the pH up to near normal, you might be able to let the CO2 rise gradually. The focus needs to be on pH, not PCO2, because it's the pH that is the primary stimulus for respiratory drive. Basically it is better to support the baby's effort to maintain normal pH and avoid the mistake of looking only at the PCO2. Ultimately, it is the perivascular pH that controls cerebral circulation, but unfortunately all studies keep focusing on PCO2 and ignoring pH. What we know is that rapid fluctuations in PCO2 confer the greatest risk of IVH. Once the baby is a bit older and the kidneys are more mature, it'a s lot easier to allow permissive hypercapnia if they still need mechanical ventilation. I hope this helps, MK
  3. 8 points
    I wanted to let the 99nicu community have the first look at my latest video. It is based on a ground rounds talk I gave on delayed cord clamping several months ago. I updated it and added lots of animation. You can find the video by following this link: https://youtu.be/6qA3CVGp5Sw The video is not public, meaning you can not search for it, but you can follow the link to view it. I'd appreciate any thoughts on the video, especially mistakes you see or if you felt anything I said was misleading about the evidence. Post your comments to this forum and I will respond. I'm hoping to make the video public depending on this communities comments. Also, I feel a bit weird posting or doing anything not COVID19 related these days, but maybe this can be one thing that takes the mind off of the current pandemic for about 16 minutes of your time. -Nathan
  4. 6 points
    the first 99nicu Webinar - assistant professor Nathan C. Sundgren will lecture on Delayed Cord Clamping, on May 14, 2020 16:00 (CEST) Nathan C. Sundgren, MD, PhD, is medical director of neonatal resuscitation education and assistant professor of Neonatology at Texas Children's Hospital, Houston, Texas, USA. He is concerned about all things related to delivery room care and has published quality improvement work and clinical trials related to delivery room team communication and performance of resuscitation. As an educator, he seeks to use global platforms to spread information on neonatal resuscitation such as on his YouTube channel "TexSun NeoEd." This is our first webinar, and if it works well, we aim to run a series of educational webinars during 2020. Stay tuned!
  5. 6 points
    In Wuhan and outside Wuhan cities, the local neonatologists/Pediatricians reported only a few cases. No severe cases, All of the infants have no symptoms or only mild symptoms,and also,no death cases.
  6. 6 points
    We recommend stopping breast-feeding until the mothers' COVID-19 test negative for two times . And also we stop vaccinated the suspected infants until the mothers' COVID-19 test negative for two times in the next 2 days.
  7. 6 points
    It’s been some time since I last posted here. Many things have changed in my life since then- the most important transition being my decision to move to Finland to work as a research fellow with the Baby-friendly Ventilation Study Group in Turku. The life of a beginning clinical researcher deserves a separate post here (it may even come at some point). To celebrate my first anniversary in Finland I would like to share 3 things I wish somebody had told me before I moved here. Enjoy! 1.Get nylon pants. The weather in Finland is truly whimsical. We have had a kind spring, warm summer, and lovely, colorful autumn. I was able to enjoy each of these seasons, biking in the Archipelago, watching sun that never sets, traveling north to see ruska, and finally seeing Northern Lights for the first time in my life. My only concern here is rain. It doesn’t follow laws of gravity AT ALL. How is that possible, that those raindrops are not falling DOWN from the sky, but they are literally attacking you from every direction? It took me some time to overcome my frustration and find a solution. I have closely observed (relatively) happy Finns and discovered that the most important clothing item here is… nylon waterproof pants. The trick is they have to be big enough that you can pull them over your regular pants to keep you dry and warm when it rains. This small thing has definitely improved my comfort here. It has also created that precious feeling of belongingness- I could finally proudly join the rustling and swishing sisterhood of waterproof pants. 2. Drop in the fertility rate is a real thing. Ok, I am a doctor and I KNOW it is a real thing. I know that statistics don’t lie. I know. But I kind of didn’t want to acknowledge that it may actually impact my study. We have had a fairly good start of the patient recruitment, which had kept me busy in spring. But then summer had arrived, and the recruitment slowed down. I kept thinking that maybe it’s just because of the summertime in general (like preemies would be able to pick a season when they want to arrive early, right?). But then autumn has come, and it was time to face the music- I have a problem. In order to recruit the desired number of infants, I may either stay here forever OR I need to come up with a clever solution very soon. Thankfully, I have amazingly supportive supervisors here and we decided- we are expanding! That means more traveling for me (and possibly more blog posts for you)! 3. Compulsive talking about 99nicu may help you to dance more salsa. That statement may seem rather weird, but there is a logical explanation. Very recently I’ve had a chance to attend a regional neonatal meeting in Finland. I was asked to present highlights from the 99nicu Meetup in Copenhagen. Since I like the whole concept of 99nicu.org and loved two conferences I had attended, I took that task very seriously- meticulously prepared my PowerPoint presentation and practiced my performance out loud at home. I decided to tell participants about lectures I remembered the best- neonatal transports, simulations in the NICU and infants surviving at the limit of viability. You may argue that there were more important lectures there, but those were the ones that still “spark joy” after all these months. Do you remember that sim scenario of postpartum seizures in a birthing pool that Ruth Gottstein talked about? I’ve discussed it with so many people in so many places already, that it might have become my favorite topic of random conversations with strangers. Anyways, I think the presentation went well- participants awarded me the prize for the best presentation of the evening! I received a gift card that I can use for cultural or fitness activities in Turku- including more salsa classes in my favorite dance school. Voila! Thank you 99nicu!
  8. 5 points
    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
  9. 5 points
    The professional communication during the Covid-19 pandemic really shows the potential to share expertise and experience through web-based channels. Journals, societies, regular news media, social media platforms etc-etc play an important role for us to keep updated, and many web sites have also opened up their content free of charge. We will learn many things from facing and tackling this pandemic, but one major change will certainly be our communication channels. Many are discovering the web-based possibilities to learn and discuss. We will do our best to facilitate professional communication within the neonatal community. And, finally it seems that the company providing our software (IPB) will finally roll out a smartphone app. Which means that 99nicu will literally become available in your pocket through a "99nicu App". The screen shots below comes from the beta-version of the app now used by the company providing our software. And yes, there will be light-mode and dark-mode Stay tuned!
  10. 5 points
    The recommendation from the Austrian/German Society for neonatology is as follows: mother COVID-19 positive: isolation of mother and child and no breastfeeding until mother is COVID-19 negative.
  11. 5 points
    A collective of the world’s leading newborn brain care providers have come together and launched the https://newbornbrainsociety.org/ (NBS). This new organization is focused on advancing newborn brain care through international multidisciplinary collaboration, education, and innovation. With founding leadership representation from prestigious programs such as Yale, Duke, Harvard, and UCSF, international representation from Canada, Brazil, and Ireland, and parent collaboration through the Hope for HIE Foundation, the goal is to bring together the resources of many programs to move the field forward in previously unattainable ways. “We started this idea originally through an existing group that was started in 2015 through the Neonatal Neuro Critical Care Special Interest Group (NNCC-SIG). We wanted to facilitate multidisciplinary, international collaboration between clinicians, parents, scientists, and others with a focus on newborn brain care; and no other society or organization currently exists in this structure and philosophy,” stated Mohamed El-Dib, MD, founding member and President of the organization. NBS has plans to sponsor, host and participate in educational events that will expand the field of neonatal neurocritical and neuroprotective care, and develop consensus publications including best practice guidelines and expert opinions in the field of newborn brain care. “We are also looking to provide a platform for members to exchange clinical practice guidelines and parent resources related to newborn brain care, and to support multi-center collaborative activities, quality improvement and research projects related to the field of neonatal neurology and brain development,” stated Donna Ferriero, MD, MS, chair of the NBS Steering Committee. Membership is now open for interested clinicians, researchers, trainees, parents and other community members. For more information, visit Newbornbrainsociety.org
  12. 5 points
    This is not an uncommon dilemma. We have developed a one paged trigger/ assessment tool for babies who meet criteria for monitoring for moderate or severe encephalopathy. It seems to work most times and one of our fellows is conducting an audit to see if we miss any babies with this tool. Based on this case, it sounds like the baby would have met criteria for clinical monitoring for moderate or severe HIE i.e. prolonged resuscitation and possibly Apgar scores? but not pH or BE related values and we would have then assessed this baby hourly for the first 6 hours of life for clinical signs of moderate or severe encephalopathy. TH would have been started as per the trigger tool thresholds. The problem comes when these babies don't meet clinical criteria for moderate or severe HIE and clinical monitoring is ceased and then go on to have seizures some time later - as is seen in this case. The current trend in our unit would be to not cool them at the 12hr mark but I have personally cooled a baby who did not meet criteria for moderate or severe encephalopathy in the 1st 6hrs but then went on to have seizures at ~8hrs of life. We would just optimise other medical intervention and use anti-convulsants (levetiracetam, topiramate and midazolam or lignocaine) to treat seizure burden. I'm not sure if that helps! Cheers Richard HIE trigger tool.pdf
  13. 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
  14. 4 points
    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 )
  15. 4 points
    Join experts in the field of neonatal neurology as they speak on clinical and research guidelines, educate on new techniques, and answer your questions! April Speakers: April 2nd: Betsy Pilon - Supporting HIE Families April 9th: Seetha Shankaran, MD - Hypothermia for HIE, Updates and Controversies April 16th: Gerda Meijler, MD - Neonatal Head Ultrasonography: How to Scan a Baby, Normal Anatomy of the Neonatal Brain April 23rd: Linda de Vries, MD - Neuroimaging in the Full Term Infant April 30th: Trainee Session RSVP below to confirm your attendance: https://is.gd/RSVP_NBS_Ed_Webinar_April_2 Contact info@newbornbrainsociety.org with any questions.
  16. 4 points
    hi.i live in iran,i have two neonate that mothers are suspected covid -19,what s advice for breastfeeding and vaccination?!
  17. 4 points
    First off I should let you know that we do not do transpyloric feeding for our infants with BPD. Having said that I am aware of some units that do. I suspect the approach is a bit polarizing. A recent survey I posted to twitter revealed the following findings: I think the data from this small poll reveal that while there is a bias towards NG feeds, there is no universal approach (as with many things in NICU). Conceptually, units that are using transpyloric feeds would do so based on a belief that bypassing the stomach would lead to less reflux and risk of aspiration. The question though is whether this really works or not. New N of 1 Trial I don’t think I have talked about N of 1 trials before on this site. The trials in essence allow one patient to serve as a study unto themselves by randomizing treatments over time for the single patient. By exposing the patient to alternating treatments such as nasogastric or nasoduodenal feedings one can look at an outcome and get a sense of causality if a negative or positive outcome occurs during one of the periods consistently. That is what was done in the study Individualising care in severe bronchopulmonary dysplasia: a series of N-of-1 trials comparing transpyloric and gastric feeding by Jensen E et al from the Children’s Hospital of Philadelphia. The authors in this study determined that using a primary outcome of frequency of daily intermittent hypoxaemic events (SpO2 ≤80% lasting 10–180 s) they would need 15 patients undergoing N of 1 trials between nasogastric and nasoduodenal feeding. Included infants were born at <32 weeks and were getting positive airway pressure and full enteral nutrition at 36 0/7 to 55 6/7 weeks PMA. Infants who were felt to be demonstrating signs of reflux or frank regurgitation were enrolled. The findings Thirteen of 15 enrolled patients completed the study. The two who did not complete did so as their oxygen requirements increased shortly after starting the trial and the clinical team removed them and chose their preferred route of feeding. Randomization looked like this: Of the 13 though that completed and using an intention to treat analysis of the other two the findings were somewhat surprising. Contrary to what one might have thought that transpyloric would be a lung protective strategy, the findings were opposite. Overall the combined results from these 15 patients demonstrated that nasogastric feedings were protective from having intermittent hypoxic events. How can this be explained? To be honest I don’t really know but it is always fun to speculate. I can’t help but wonder if the lack of milk in the stomach led to an inability to neutralize the stomach pH. Perhaps distension has nothing to do with reflux and those with BPD who have respiratory distress with some degree of hyperinflation simply are prone to refluxing acid contents due to a change in the relationship of the diaphragmatic cura? It could simply be that while the volume in the stomach is less, what is being refluxed is of a higher acidity and leads to more bronchospasm and hypoxemic events. What seems to be clear even with this small study is that there really is no evidence from this prospective trial that transpyloric feeding is better than nasogastric. Given the size of the study it is always worth having some degree of caution before embracing wholeheartedly these findings. No doubt someone will argue that a larger study is needed to confirm these findings. In the meantime for those who are routinely using the transpyloric route I believe what this study does at the very least is give reason to pause and consider what evidence you have to really support the practice of using that route.
  18. 4 points
    I'd like to clarify that comment a bit: Chile is entering its 6th week since the first COVID19 case was detected. There are areas with a high number of cases, so partial lockdowns are being put in place for 2 to 3 weeks. Those are being lifted (or not) depending on the number of new cases on a daily basis. There is an issue with availability of testing as is the case with most LA countries, but Chile is steadily increasing PCR testing availability country-wide. Recently, universal use of face masks when outside of home was recommended and made mandatory when using public transportation on April 8. People are encouraged to use homemade or commercial cloth face masks and leave surgical masks and N95s for healthcare workers. At my public hospital, we were issued cloth masks to use outside of the hospital, surgical masks for clinical work at the NICU, and plastic gowns, face shields and N95s when there is likelihood to be exposed to aerosols. We are expecting peak contagion to hit us by the end of April-early May and are trying, just like everybody else to flatten the curve. It's still too early to tell how it will go for Chile.
  19. 4 points
    Final video version now public on YouTube. Please share with interested colleagues.
  20. 4 points
    I just got this email from Dr's Meg Kirkley, Clyde Wright and @GauthamSuresh in the US - they are aggregating Neonatal Covid-19 literature to a spreadsheet. A fantastic initiative! Find the continuously updated spreadsheet here: https://docs.google.com/spreadsheets/d/1L9tsrLn9a7LMql_nnUfMA3uS1SSurrj4XUh2yT2bEUc/edit#gid=1867332198 Please find the full email below. Big thanks to Meg, Clyde and @GauthamSuresh for this iniative! _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ We have a resource to share!!! Meg Kirkley (Assistant Professor here in Colorado) and I have been developing a platform to help our Section stay familiar with the rapidly emerging evidence surrounding COVID-19 With that in mind, we created NeoCLEAR: Neonatal COVID-19 Literature Evaluated and Aggregated in Real-time Topic champions within the section are committing to staying abreast in the following areas, to serve as a resource for you: Transmission (with a focus on vertical / perinatal / neonatal transmission): Rob Dietz and Susan Niermeyer Clinical Features of Neonatal Infection: Clyde Wright & Meg Kirkley Diagnosis and Treatment: Laurie Sherlock & Steph Bourque NICU-specific practices and policies: Steph Chassen & Sadie Houin Consensus Statements (reviews & guidelines from medical governing bodies): Erica Mandell & Susan Hwang The Topic Champions are continually updating this spreadsheet which can be sorted by topic, publication date, and publication type. Hyperlinks are provided and the workgroup has provided a brief “key points” column. Gautham has worked hard to include the NeoCLEAR spreadsheet on the perinatalcovid19.org site and it can be found here: https://perinatalcovid19.org/neoclear/ We will do our best to keep it updated and our searches robust! Thank you - Meg and Clyde and Gautham
  21. 4 points
    This is an extract from Prof Jane Pillow's book on HFOV and its applications: You can access the entire publication free of charge from this website - https://www.draeger.com/Library/Content/hfov-bk-9102693-en.pdf - most definitely worth reading! I hope that is helpful! Kind regards
  22. 4 points
    Dear sir Normally one starts off with I:E ratio of 1:2 or in some ventilators represented as a percentage like 33%.what it means is if you have selected a frequency of 10Hz( resp rate of 600) then total Ti for a single breath would be 0.03 seconds. Remember that this IE is for each oscillation and not for recruiting breaths (that has a separate entry parameter) This conventional 1:2 comes from the expiratory time constant which is twice as long as inspiratory. For a given MAP if i am able to manage oxygenation i would not touch on the IE ratio.if you feel that you are not able to maintain oxygenation for a give MAP, in order to recruit more alveolar units one may consider increasing IE to 1:1. But this might result in issues with ventilation also. It is always better to recruit with titrating MAP rather than I:E Regards
  23. 4 points
    This new paper just came onto my radar - on "State-of-the-art neonatal cerebral ultrasound: technique and reporting" in Pediatric Research. Great read! (and if those of us who cannot read, we can look at the pictures like the one below 😛 ) Open access here: https://www.nature.com/articles/s41390-020-0776-y
  24. 4 points
    I find these posters very helpful as well. We will all have to look after eachother in the upcoming crisis. https://www.ics.ac.uk/ICS/Education/Wellbeing/ICS/Wellbeing.aspx?hkey=92348f51-a875-4d87-8ae4-245707878a5c #staffwellbeing
  25. 4 points
    British Association of perinatal medicine has issued guidance today https://www.rcpch.ac.uk/resources/covid-19-guidance-paediatric-services Sent from my iPhone using Tapatalk
  26. 4 points
    UK is not that drastic in isolating neonate from mom https://www.rcog.org.uk/en/news/national-guidance-on-managing-coronavirus-infection-in-pregnancy-published/
  27. 4 points
    @Jose Ramon Fernandez thanks for sharing this link - very helpful.
  28. 4 points
    We use this system on an ongoing basis. Very comfortable and does not damage the nasal septum.
  29. 4 points
    Oh well, so many thoughts after reading this article! Thanks for sharing! Although I agree with every word she says, I think that we should keep in mind that she describes the American reality, which in many ways may be different from European experiences. In many (most?) countries in Europe, we are privileged to have a generous parental leave and (rather) well-coordinated healthcare system. It doesn't change the fact that becoming a parent in the context of the Neonatal Intensive Care Unit must be extremely challenging- and we need to recognize the need to support NICU parents not only during hospitalization but also after the discharge. What really makes me grind my teeth is the fragment about guilt related to insufficient pumping. There is a beautiful (truly) article written by my colleague Sarah Holdren, in which she argues that many NICU mums feel that pumping is actually the only way they can contribute to their infant wellbeing because other ways to engage parents and promote closeness may not be available. I wholeheartedly recommend you reading that comparison of practices in Finland and the USA, the whole article is available here in Open Access. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2505-2
  30. 4 points
    In Linköping we have developed a structure on how to do this in deliveryroom on ELBW less than GW28. It works pretty well if you manage to deal well with the logistic. Receive on the foot-end of deliverybed between the legs of the mother, put the baby in a nest covered by plastic, using a mobile Neopuff with humidified warm gas, Starting with CPAP only awaiting the respond of heartrate and spontaneous breathing, ventilating only if bradycardia, delayed cordclamping. Incubator Close to the bed, connected to mobile CPAP/Ventilator. If intubation immediate Surfactant instillation. We have planned to enhance it into all Babies less than GW32 (33?). Working on a video on it. Apart from a mobile neopuff, an incubator in Place and a mobile CPAP/ventilator you don´t need any extra equippment. But a well trained team and clear logistic is crucial (protocol). /Per
  31. 4 points
    Found this discussion on Researchgate! Did not know they also had a forum there. Lots of good comments. I was taught during my training that reducing dead space is the reason for vittring tubes. But as pointed out, the volume of the cut tub piece is so small that it would have no practical significance, even for an ELBW infant. But I still do it, it is in my ”auto-pilot”... https://www.researchgate.net/post/Will_it_be_better_to_cut_the_ET_tube_a_few_centimeters_after_tube_is_in_place_and_then_place_the_connector
  32. 4 points
    For infants in need of follow up - criteria for our follow up program with neurodevelopmental examination at term, corrected: 3 month, 1 year, 2 year and 5,5 year - we do an examination according to Hammersmith neurological examination. At those intervals we then do Hammersmith, Alberta infant motor scale, Bayley and physical examination by a neonatologist and a physiotherapist and for Bayley a developmental psychologist. For infants with known cerebral injury we also do brain stem audiography and a refferal to an occupational therapist. / Stina, Karolinska University Hospital, Stockholm Sweden.
  33. 4 points
    @Lenks Concerning hypercalcemia (total Calcium of 12 mg/dL is our cutoff for IV saline 10-20 ml/kg with 1 mg/kg lasix. A persistent hypercalcemia in-spite the lasix and total Calcium above 14 mg/dL we would consider glucocorticoids. No experience with bisphosphonates. Calcium intake should be thoroughly reviewed. Although day 7 is early for subcutaneous fat necrosis to cause hypercalcemia, but checking for sites of it could be advised, Further lab. data to know the etiology: ionized calcium, pH, albumin, phosphorus, alkaline phosphatase, PTH, urine sample for spot calcium/creatinine ratio, 25 OH Vit D and 1, 25 OH Vit D. Ask mother and father for Familial hypocalciuric hypercalcemia (autosomal dominant) or check their urine spot calcium/creatinine ratio.
  34. 3 points
    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.
  35. 3 points
    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, giving steroids & extubating as soon as possible - even if that necessitated reintubation in some cases. In one sided PIE we have also used thoracic bandaging to limit lung excursions. In two cases we have also resected the destructed lobe to allow for better ventilation of the rest of the lung with success. Taken from the paper of Zannin et al. You can see that lower set P (pressure) levels at low frequencies lead to a lot higher alveolar pressures than if higher frequencies are used. This means you are injuring the lungs more by using lower frequencies - even if you think you are using lower pressures. In comparison a pressure set at 40 at a freq of 15 Hz leads to lower alveolar pressure.
  36. 3 points
    In Amsterdam we do not were masks at the NICU; will do when a COVID19 + neonate is admitted, but so far that has not happened. When parents are positive, the babies will be tested twice in two weeks; we will were normal masks untill negative. In regular live we do not were mask, we have a light lock-down.
  37. 3 points
    You can't think about I/E and PEEP, it's a completely different ventilation principle WNHS.NEO.VentilationHighFrequencyOscillatoryVentilationHFOV.pdf
  38. 3 points
    Great!, Thanks to the Topic Champions. Just a suggestion to be added: the first neonatal described in Spain: postpartum trasmission, 1st RT-PCR test negative on day 7th in asymptomatic phase, turned positive on day 9th. https://www.analesdepediatria.org/es-pdf-S1695403320301302. So not rely on a single negative test in high-risk newborns under investigation! Best wishes to everybody. Keep safe and strong minded Roser Porta Hospital Dexeus Barcelona, Spain 1stcaseNeonatalnfectionSpain.pdf
  39. 3 points
    The NeoMate app is very helpful! There is an infusion calculator, where you can easily 'calculate' how much medication needs to go in the syringe, with how much glucose/saline, and at which rate the pump then needs to run. https://london-nts.nhs.uk/professionals/neomate-mobile-app/
  40. 3 points
    Dear all, I want to share a website that I have created - www.perinatalcovid19.org Please share widely. It has resources to help all of us manage the covid-19 situation we are all facing. I am open to suggestions on how to make it more useful. K.S. Gautham, MD, DM, MS, FAAP Professor of Pediatrics, Baylor College of Medicine Section Head and Service Chief of Neonatology Texas Children's Hospital 6621 Fannin, Suite W6104 Houston, TX 77030
  41. 3 points
    For months I've been dreaming to have a possibility to work from my sofa in my pyjamas. Now my dreams are coming true 😅 I keep hearing from people "oh but there's nothing you can do about it!" and it just triggers me. We can all contribute to improve the safety of the most fragile citizens by undertaking some measures. At least in this sense we are not completely "powerless"!
  42. 3 points
    Dear fellow Ph.D. students, full-time researchers, and other fellow scientists, please #staythefuckhome. In many grant proposals, we write "this research has the potential to save lives, because... ". Let's face it- most of our research won't save lives (or at least not at once)*. No matter how fantastic our research projects are, science takes time. But what can actually save lives immediately is US STAYING HOME. This way we - the (relatively) young people in big academic campuses- won't be spreading the virus that might be deadly for others: for an old lady in the shop (who takes care of her ill husband at home), our senior supervisor (who is also an attending in the unit, so in case he gets sick, they would be running understaffed), a young mother (who will have only moderate symptoms, but will have to arrange some care for her children- possibly transferring them to her own parents, exposing them to an infection). Let's think outside of our own bubble. I don't know if there's much more we can do, but if we are lucky, it might be just enough. Work from home, write from home, think from home, read from home. We always complain that there's not enough time to read and learn- here's your chance! And if your main area of interest is neonatology, there's a fantastic treat for you- if you stay home. Karolinska NIDCAP Training and Research Center organizes a *fabulous* online conference. Go to their pages, write an email (stina.klemming@sll.se) and get your link to access this amazing event. Kind regards, Katarzyna #staythefuckhome Piatek *unless you're actually working on the vaccine or new drug for coronavirus- then just keep working ❤️
  43. 3 points
    The CDC has come out with recommendations: It is unknown whether newborns with COVID-19 are at increased risk for severe complications. Transmission after birth via contact with infectious respiratory secretions is a concern. To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued, as described in the Interim Considerations for Disposition of Hospitalized Patients with COVID-19. See the considerations below for temporary separation: The risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team. A separate isolation room should be available for the infant while they remain a PUI. Healthcare facilities should consider limiting visitors, with the exception of a healthy parent or caregiver. Visitors should be instructed to wear appropriate PPE, including gown, gloves, face mask, and eye protection. If another healthy family or staff member is present to provide care (e.g., diapering, bathing) and feeding for the newborn, they should use appropriate PPE. For healthy family members, appropriate PPE includes gown, gloves, face mask, and eye protection. For healthcare personnel, recommendations for appropriate PPE are outlined in the Infection Prevention and Control Recommendations. The decision to discontinue temporary separation of the mother from her baby should be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. The decision should take into account disease severity, illness signs and symptoms, and results of laboratory testing for the virus that causes COVID-19, SARS-CoV-2. Considerations to discontinue temporary separation are the same as those to discontinue transmission-based precautions for hospitalized patients with COVID-19. Please see Interim Considerations for Disposition of Hospitalized Patients with COVID-19. If colocation (sometimes referred to as “rooming in”) of the newborn with his/her ill mother in the same hospital room occurs in accordance with the mother’s wishes or is unavoidable due to facility limitations, facilities should consider implementing measures to reduce exposure of the newborn to the virus that causes COVID-19. Consider using engineering controls like physical barriers (e.g., a curtain between the mother and newborn) and keeping the newborn ≥6 feet away from the ill mother. If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed COVID-19 or is a PUI should put on a facemask and practice hand hygiene1 before each feeding or other close contact with her newborn. The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on transmission-based precautions in a healthcare facility. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnant-women-and-children.html Breast feeding Breast milk provides protection against many illnesses. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. CDC has no specific guidance for breastfeeding during infection with similar viruses like SARS-CoV or Middle Eastern Respiratory Syndrome (MERS-CoV). Outside of the immediate postpartum setting, CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant. Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers. A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.
  44. 3 points
    Would be nice if they would have recommended continue pumping and discard to maintain breast milk supply until everyone is negative.
  45. 3 points
    It could be helpfull https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnant-women.html
  46. 3 points
    No, but I feel the need to point out that (part of) the rationale for acetate in PN for premature infants is not for base infusion, per se, but rather to displace chloride and avoidance of iatrogenic hyperchloremic metabolic acidosis which is obviously a completely different problem than the bicarb infusions discussed in this thread. Contrary to the presented data that bicarb infusion is useless, there is a reasonable amount of data (though less for premature infants) that hyperchloremia is quite harmful. I'm not aware of any data arguing against acetate in parenteral nutrition for displacement of chloride. My experience is that it is almost never required and the handful of times I have done it I doubt that it is of any value. On the contrary, I have found that with appropriate fluid/volume management, aggressive use of acetate in parenteral nutrition to limit chloride infusion and good renal protection, metabolic acidosis is easily managed in all but the most extreme cases.
  47. 3 points
    I have observed this repeatedly in babies whose mothers were taking SSRI antidepressants, specifically Zoloft. Happy baby who does not cry. Cheers, MK
  48. 3 points
    Just for the purpose of recall.(Cochrane 2013, Jacobs) Evidence of peripartum asphyxia, with each enrolled infant satisfying at least one of the following criteria: i) Apgar score of 5 or less at 10 minutes; ii) mechanical ventilation or resuscitation at 10 minutes; iii) cord pH < 7.1, or an arterial pH < 7.1 or base deficit of 12 or more within 60 minutes of birth. AND Evidence of encephalopathy according to Sarnat staging (Sarnat 1976; Finer 1981): i) Stage 1 (mild): hyperalertness, hyper-reflexia, dilated pupils, tachycardia, absence of seizures; ii) Stage 2 (moderate): lethargy, hyper-reflexia, miosis, bradycardia, seizures, hypotonia with weak suck and Moro; iii) Stage 3 (severe): stupor, flaccidity, small to mid position pupils that react poorly to light, decreased stretch reflexes, hypothermia and absent Moro. AND abnormal standard EEG or aEEG findings(this in addition to above as in NeoNeuro Network RCT by Simburner, Germany). Evidence Laptook etal. Effect of therapeutic hypothermia initiated after 6hours of age on death or disability among newborns with Hypoxic-ischemic encephalopathy, Jama 2017 October 24;318(16): 1550-1560. •Randomized clinical trial •April 2008 –june 2016 •Moderate or severe HIE enrolled at 6-24 hours after birth. •Twenty one US neonatal research network centers •There were 168 participants and 83 were randomly assigned to hypothermia and 85 to noncooling. Results 76% probability of any reduction in death or disability.(Biasian Statistics and analysis) 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness. Gist: TH can be tried for its benefit though not greater than that of starting early but with due consideration of parents participation and Consultant in decision making.
  49. 3 points
  50. 3 points
    I´ve learned to cut in order to "optimize" VTV-mode so that the ventilator can read correctly and adjust to the Vt I want. I´m not sure though if it really matters... https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.20954
This leaderboard is set to Stockholm/GMT+02:00
  • Create New...