Gustaf Lernfelt

I had a discussion with our IPC-nurse. After spending a year at our nearest level-4 unit where there was a problem with intermittent spread of nosocomial infections (viral as well as kleb and serratia), I wanted to change our routines regarding cleaning of ultrasonography probes. Currently, we are using 45 vol% isopropyl alcohol with added tensides.I tried to change into a combination of Kiilto Pro Cleanisept wipes ( with Didecylmetylammonium chloride, Alkylbensyldimetylammonium chloride and Alkyletylbensyldimetylammonium chloride) and 70 percent ethanol disinfection—wipes, as adopted in the other unit to limit nosocomial spread of pathogens in our unit. But since our IPC-nurse said it was not necessary they decided to continue with our current protocol because it was cheaper. Do you have any specific knowledge on how to approach the possible spread of nosochomial infections through ultrasound devices as POCUS becomes more established in every unit? Are there any good guidelines? I have a worry that our IPC-unit does not have the full neonatal perspective on things. All the best,

Very welcome! This sounds great, I do have a NeoIPC-question I would need to consult you about! Or at least two! Do we have a dedicated forum for this?

Swedish guidelines are Fluconazole 3 mg/kg every 3 days in <27W with central lines or / and during treatment with antibiotics. To be removed when neither is present. Can also be considered in cases where broad spectrum antibiotics are used in <30W when suspected intentestinal injury (or recent surgery). References are here, newest publication from 2017: https://pubmed.ncbi.nlm.nih.gov/28285752/ https://pubmed.ncbi.nlm.nih.gov/27298330/ https://pubmed.ncbi.nlm.nih.gov/27350534/ https://pubmed.ncbi.nlm.nih.gov/17943803/

My limited experience, from rotation at a Level 4 center in Sweden that uses Premiloc-dosing for all infants <28W, is that the results are generally positive. It seems to help with stabilising BP, and when maternal infection is a factor, there’s often a need for extra hydrocortisone. Side effects like hyperglycemia are usually manageable with fluid adjustments, but in some cases the infant will need supplemental insuline. The Swedish experience was published not long ago ( https://pubmed.ncbi.nlm.nih.gov/41712209/ ), though it’s hard to reach statistical significance in the micropreemie group given the small numbers, and to correct for differences in ventilation strategies between centers, the overall outcome was positive. While my experience with these patients is very limited, I do trust my seniors who’s says it’s a solid strategy. The only Swedish center involved in the Tiny Baby collaboration has not adapted this strategy as far as I know. I attended a course in extreme prematurity there a few years ago, and the recommendation then was that supplemental corticosteroids should be avoided.

I would say this is what Linkedin is for.

I rarely see this in my own unit, but I came across a case during my rotation at the Level 4 NICU, linked to a traumatic birth. One of our most experienced consultants noted that while it used to be more common, better nursing care during hypothermia treatment has made it a rare occurrence today. We diagnose it clinically and monitor ionized calcium levels every two weeks. If severe hypercalcemia, we restrict vitamine-D and start treatment with prednisone, not sure about dosing though.

While not doing any car seat tolerance screening in Sweden, we have had an issue with being able to refer a baby to home care, due to our car seats not being approved for infants less than 1500 g. This was an extremely small for gestational age infant, who was quite ”mature” in every other sense. And to use neonatal transport services was not an option, since the family needed to be able to come back for check ups, or if there was any other issue with the infant. So we do have great respect for car seats in Sweden aswell 😊

I would say that this is @Roland NNP s expert field! Do you have any comments? 😊

We are seeing a change in practice toward allowing more medications in breastfeeding. Lately I came across an infant whose mother was on Lithium, this has been a no for us in the past, but she insisted on wanting to breastfeed, and while doing a literature search (with the help of OpenEvidence 😁). I found an article in Acta Pediatrica with a reasonable follow-up schedule. PubMedLithium use during breastfeeding was safe in healthy full...Serum lithium concentrations in breastfed infants were stabilised at barely measurable levels after the first weeks of life. Before that, concentrations higher than the mothers were found. Lithium treWhile questions about breastfeeding while taking various medications are common - and we do have a great Swedish resource that Stefan referred to above - most answers tend to be ”we don’t know” or possibly some effect.” there are only a few medications that are a clear no. For me, several immunosuppressants have fallen into that category, so hearing about your practical approach is really valuable!

This is great, we were having trouble in dealing with a wound in a micro preemie the other day, and this would have helped a lot. Thank you!

Outstanding is the correct word! ⭐

We discussed this the other day, and a colleague who recently worked in the Netherlands gave us some explanation on how they practiced at the hospital where she worked there versus here. First of all, we all kind of use our own algorithm when it comes to risk for infection, even if it’s not put into a score. How long was it since the water broke, maternal fever, known GBS-status or was it an elective C-section? Second to that, the region I work in use IL-6 in combination with CRP in newborns, high levels of IL-6 is a strong marker for bacterial infection. On the other hand a low IL-6 at the start of symptoms makes an infection less likely. It reacts very fast at the start of an infection, but fades down within 24 h. But at that time a CRP would be significantly high. So let’s say that you have an infant 3 hours of age, no risk factors, with a high respiratory rate (70). IL-6 and CRP is negative, —> no AB, follow RR. If you would do a new CRP at 24 h and it would be 40 mg/L, this could still be considered possibly normal due to vaginal birth, and would prompt further follow up, but no Ab. If there were any risk factor, and the child showed symptoms we might have started antibiotics, but stopped if the CRP went down again and there were no positive blood culture in 48-72 h. In the Netherlands where she worked everyone with a CRP above 20 mg/L would be treated with Ab. Possibly due to other organisational issues. I know how studies have showed that CRP is CRaP, but I guess it kind of depends on how you use it. This way I find it useful, as a sign of inflammation and not patognomic for infection (depending on the level, we would say around 60 mg/L is a possible limit).

Bringing an old subject back again due to a recent publication in Journal of Perinatology: https://www.nature.com/articles/s41372-025-02348-4 Have we gotten any wiser since this subject was discussed 16 years ago?

As this subject comes up! May I also recommend a revisit to the @EBNEO commentary on an earlier article from a single center in Japan: https://99nicu.org/forums/topic/2688-ebneo-commentary-management-and-outcomes-of-periviable-neonates-born-at-22-weeks-of-gestation-a-single-center-experience-in-japan/#comment-12727 and @piatkat and @Ryo s post in this thread on how to manage micropreemies, with the complete guide on the japanse approach: https://99nicu.org/forums/topic/2661-how-do-you-manage-micropremies/#comment-12636 And last but no least the talk from Fumihiko Namba at our latest 99nicu Meetup: https://youtu.be/-0D6nBwN4_g?si=e0GbxaSAa6pTdJ22