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  1. Stefan Johansson

    Stefan Johansson

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    Nathan Sundgren

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    bimalc

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Popular Content

Showing content with the highest reputation since 09/30/2019 in Posts

  1. 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
    11 points
  2. 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
    9 points
  3. 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
    8 points
  4. 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
  5. 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
  6. 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 points
  7. 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.
    6 points
  8. 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
  9. 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
  10. 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.
    5 points
  11. 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 fiel
    5 points
  12. 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
    5 points
  13. 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
    5 points
  14. 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
    4 points
  15. 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
  16. 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
  17. 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
  18. 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
    4 points
  19. hi.i live in iran,i have two neonate that mothers are suspected covid -19,what s advice for breastfeeding and vaccination?!
    4 points
  20. 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 o
    4 points
  21. Final video version now public on YouTube. Please share with interested colleagues.
    4 points
  22. 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
    4 points
  23. 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
    4 points
  24. 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
    4 points
  25. 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
    4 points
  26. 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
    4 points
  27. 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
    4 points
  28. 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/
    4 points
  29. @Jose Ramon Fernandez thanks for sharing this link - very helpful.
    4 points
  30. We use this system on an ongoing basis. Very comfortable and does not damage the nasal septum.
    4 points
  31. 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 d
    4 points
  32. 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
  33. 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
  34. 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
  35. 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
  36. 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
  37. 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
  38. I like this as a starting point https://ep.bmj.com/content/104/1/43.long Maybe this is too basic though?
    3 points
  39. 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.
    3 points
  40. Hi! We use facemasks in almost all situations. The Austrian authorities try to expand the usage of masks in more and more daily situations and we feel obligated to give a positive example. This policy is in effect in the whole Hospital not only the neonatal unit.
    3 points
  41. You can't think about I/E and PEEP, it's a completely different ventilation principle WNHS.NEO.VentilationHighFrequencyOscillatoryVentilationHFOV.pdf
    3 points
  42. Dear Nathan, what a tremendous work you have done, and the video is very informative and I hope you will in due time put it official, and I would be glad to share it in the future, after some revisions. I do realize that choosing what references to mention is a difficult task, and it is clear that you have done your your share of reading. Although, I you ask for comments, here are mine (they grew quite lengthy...): You mention/cite Charles Darwin's kid Erasmus, and it says 1801on the slide. Erasmus (b 1731 - d 1802, https://en.wikipedia.org/wiki/Erasmus_Darwin) was actually Charles (b 180
    3 points
  43. 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
    3 points
  44. While at Wellington NZ NICU, I created a set of infusion calculators for neonatal use These are mostly fixed rate, and they are built around the specific drug ampoule strengths we stock. Michael
    3 points
  45. Expert review (to be) published in AJOG https://www.sciencedirect.com/science/article/pii/S0002937820301976 Sent from my iPhone using Tapatalk
    3 points
  46. This case series from lancet shows no vertical transmission https://www.sciencedirect.com/science/article/pii/S0140673620303603 Sent from my iPhone using Tapatalk
    3 points
  47. thanks @yangw126 thanks @Jose Ramon Fernandez very nice consensus thanks @amirmasoud2012 for the very important question thanks @Stefan Johansson for the amazing group
    3 points
  48. Hi all, have you tried the EOS online calculator for babies >34 weeks ? https://neonatalsepsiscalculator.kaiserpermanente.org/ you can also check the most recent AAP guidelines https://pediatrics.aappublications.org/content/142/6/e20182894 https://www.ncbi.nlm.nih.gov/pubmed/30455344 https://pediatrics.aappublications.org/content/144/2/e20191881 Enjoy
    3 points
  49. Echo! Come to the #99nicuMeetup, Yogen Singh from Cambridge/UK will lecture about PPHN (and run a workshop on echocardiography for neonatologists) https://99nicu.org/meetup
    3 points
  50. I have observed this repeatedly in babies whose mothers were taking SSRI antidepressants, specifically Zoloft. Happy baby who does not cry. Cheers, MK
    3 points
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