Gustaf Lernfelt

I find the different strategies of initial lung recruitment to be very interesting. I went to a course on extreme prematurity in Uppsala, a center resuscitating all att 22W. They intubated almost all micropreemies, and recruited the lung with a ventilator straight away (correct me if I understood this wrong please). This way you could control the pressures and minimise barotrauma, I saw that Iowa and Japan used manual bag ventilation and would like to hear more about why to choose this approach.

We will record the sessions, so it will be possible to watch afterwards. But not live streaming.

I can't say much about the subject itself, but there is a webinar series from the Tiny Baby Collaborative that might give some insights in our differences. The last one isn't up yet, but there were two presentations on respiratory management, how they do in Iowa compared to Köln (Cologne). It really was a significant difference. Prof. Namba is also a member of the TBC-team. https://www.tinybabycollaborative.org/webinars

A full day event dedicated to the future of neonatology and its ethical problems. Neonatologists, public health workers, policy makers, intensivists, philosophers and ethicists will discuss complex ethical questions in the field of neonatology. Institutional and industry representatives will participate in this free of charge non-profit event, which can be attended in person or online (just register for free using the QR-code below or by following the link in this post). Organized by the Catholic University of the Sacred Heart and Pontifical Academy for Life See the full program here at the Italian Neonatal Societys webpage To attend the event you register here

We have a similar approach, since we work in the same country it's reasonable. But I would also like to bring up the possibility we have to let the parents meet with the preterms sibling in an more relaxed setting, our play therapy unit we have for all children getting treated at the hospital, and also accessible to children whose parents are hospitalized. By having a quite generous social security system, we have the benefit of letting the parents take a large responsibility for the care of the infant very early on. We expect many hours of skin-to skin therapy every day, from both parents, and they do most of the feeds and change diapers etcetera, while our staff are there to support them. Since both parents are engaged, there will be many hours away from the rest of the children at home, and just having the possibility to go away with the other child for som play time can be very comforting. So when visiting the hospital, while it's important to also meet the newborn, don't forget about other options for a meaningful time with the parents.

Have you ever considered how you could contribute to neonatal healthcare in developing countries? The Swedish Pediatric Society’s section for global youth and child health has put together an online event on November 9th. It starts at 8:30 CET and is free for all! Hear Joy Lawn from London School of Hygiene and Tropical medicine speak on global newborn care, and short presentations of research projects aiming to improve newborn survival and health around the world. https://events.magnetevents.com/Event/invitation-to-seminar---how-can-sweden-contribute-to-global-neonatal-research-54193/ Don’t miss out!

I really want to thank you for all the splendid stuff you share on your mProve-academy youtube-channel! Great work and such an excellent resource in the #FoamNeo-verse.

As for a Swedish regional setting we use a multistrain probiota for premature children below 32+0 if they weigh 1000 g or more, or are born after 28+0. Starting at 2-4 days of age or when the infant can tolerate 3 ml/feeding. Treatment continues until 34+0, and is cancelled in case of NEC, if 0 per os before surgery, or sepsis with positive blood culture for any of the probiota-bacteria. Blood cultures need to be marked with info about treatment with the probiotic bacteria. If suspected sepsis or other bacteria are cultured treatment stays. So preemies born earlier than 28 won’t be treated unless they whey 1000 g. How this alines with data on NNT and benefits, I have no clue about. A large portion of the most at risk children are excluded from the treatment group. But I guess it’s kind of a Swedish lagom-approach.

For further insights in this discussion, an extra episode of the Incubator podcast was just released discussing current knowledge.

Last week there has been quite som buzz on the social media-site formerly known as Twitter, regarding a decision from the FDA to warn about the use of probiotics in preterm babies. This after a strain of Bifidobacterium Longum was found in a blood culture of a septic preterm infant weighing <1000 g, possibly contributing to the infants death. It was published on September 29th. https://www.fda.gov/media/172606/download?attachment My timeline was filled with people reacting with surprise and also being a bit put down. There has been more and more evidence piling up in favour of probiotic use, and it has been wide spread across many well known centers Two days ago an excellent review was published: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2810095 Showing Probiotics showing were associated with reductions in all-cause mortality, necrotizing enterocolitis, feeding intolerance and hospitalization. Ravi Patel shared a fresh editorial from his team: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2810100 And Kanekal Suresh Gautam shared these to articles in favour of use: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2804952 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2780228 At the same time encouraging to study improvement of dysbiota by other means such as reduced antibiotics use increased use of mothers own milk Reduced use of PPI Decrease caesarians Prebiotics (as in pre not pro) Probiotics to mother skin-to-skin care Jae Kim in Cincinnati summarized it as follows: As with every intervention we do there are always unfavourable outcomes, sometimes severe. Just inserting an UVC can induce a sepsis. What are your thoughts on this development, and how to move further? Have you implemented probiotics, and for which group of babies?

Hyperkalemia 🙂

Hi, Got into a discussion with a neonatologist now primarily working with clinical pharmacology, so I wanted an international perspective. In those cases when beta-stimulants are indicated for hyperkalemia (not first line treatment), would you always use inhalations, or when would you choose IV? Any experiences with other beta-stimulants besides albuterol?

Hi Katja, @Jose Ramon Fernandez shared this in our Nicuverse: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2023.28.22.2300253#html_fulltext https://nicuverse.org/@jramonfernandez/110627529997571394

Thank you all for great suggestions, I will check them all out, and get back to you! I was in contact with a sales person from IngMar this week about their E-learning module, but since it was $1000 a year, your examples are much better.

Hi, As a fellow I would like to learn more about ventilating the preterm infant in a safe setting. Does anyone know about any good neonatal ventilation simulation software, for training and learning different ventilation strategies? Best regards, Gustaf

Thank you for sharing these great videos Nathan, they are very instructive and usefull.

Wouldn’t the use be limited due to too many sources of error? You wouldn’t know if it was the liver or the kidney that took the hit.

Don’t miss this weeks seminar from the Newborn Brain Society on nutrition and the preterm brain. https://us02web.zoom.us/webinar/register/WN_k786xQyCR9udifW6RDYTjA You will also be able to watch it for a week on their webpage: https://newbornbrainsociety.org/media-library/

I believe mom-incubators are made for this setting. https://www.momincubators.com But an incubator could become an oven in the wrong hands, kangaroo-care is a safe alternative. I was told about a project as a student, where worn out incubators where transported to a rural setting in a warmer part of Africa, but the children got overheated and it became a death trap. Maybe the best people to hear with is MSF? I’m sure they thought this through.

#NeoEBM is well established and should stay. I would also enjoy: #NeoCase: For case discussions. #NeoPoll: For polls #NeoNews: For news in neonatology #NeoPod: For podcast related topics #NeoTech: for medtech