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wackdi

Members
  • Content count

    32
  • Joined

  • Last visited

  • Days Won

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  • Country

    Sweden

wackdi last won the day on October 30 2016

wackdi had the most liked content!

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About wackdi

  • Rank
    Member
  • Birthday 06/13/1971

Profile Information

  • First name
    Dirk
  • Last name
    Wackernagel
  • Occupation
    Pediatrician
  • Affiliation
    Astrid Lindgren Children's Hospital
  • Location
    Stockholm, Sweden
  1. Hi Francesco and Stefan, we are using a C-Mac laryngoscope. The smallest blade is 0. The company told us that a 00-blade is on the way ... but by now we haven't seen it. The view with the C-Mac is fantastic, so I hope that we could see the 00-blade soon. Greetings from Stockholm Dirk
  2. 1st 99nicu Meetup, 12-15 June 2017

    Nutrition and feeding would be a great topic. TPN (as smaik.hiran suggested) but also feeding strategies would be of great interest. su ... and of course the question how optimal postnatal growth (catch-up) should look like. Greetings Dirk
  3. We use Atropine, Fentanyl, thiopental and (sometimes) suxamethonium. In my opinion we have a lot of stiff chest problems even if we give the fenanyl as a two minutes slow push. In a difficult situation I would definitively go for propofol in combination with atropine and maybe fentanyl. Ghanta S, Abdel-Latif ME, Lui K, et al. Propofol compared with the morphine, atropine, and suxamethonium regimen as induction agents for neonatal endotracheal intubation: a randomized, controlled trial. Pediatrics 2007;119:e1248–55. doi:10.1542/peds.2006-2708 The babies are really relaxed and well sedated, so intubation is quite easy (even in difficult situations). Greetings Dirk
  4. Furosemide

    Hi Stefan, maybe you would like to add this (excellent) review too: Pacifici GM: Clinical Pharmacology of Furosemide in Neonates: A Review. Pharmaceuticals (Basel) 2013;6:1094–1129. There is some growing evidence of concerns about the furosemid interaction with chondrocytes in the growth plate leading to growth restriction: 1. Bush PG, Pritchard M, Loqman MY, Damron TA, Hall AC: A key role for membrane transporter NKCC1 in mediating chondrocyte volume increase in the mammalian growth plate. J Bone Miner Res 2010 Jul;25:1594–1603. 2. Iwamoto LM, Fujiwara N, Nakamura KT, Wada RK: Na-K-2Cl cotransporter inhibition impairs human lung cellular proliferation. Am J Physiol Lung Cell Mol Physiol 2004 Sep;287:L510–514. 3. Koo WW, Guan ZP, Tsang RC, Laskarzewski P, Neumann V: Growth failure and decreased bone mineral of newborn rats with chronic furosemide therapy. Pediatr Res 1986 Jan;20:74–78. Greetings from the rainy south side of the town :-) Dirk
  5. Vygon Microsite

    Hi RichMaus, we are using the Vygon micro site since two years ago. We use it round about 3-4 times per month in the "bigger" babies (>1200g) to insert 2F PICCs. It works perfectly well for us as we can use our "standard" 24G iv catheter to start the procedure. I is quit easy (and a very high success rate) to get in the 2F catheters. We are only using PICCs with one lumen but in my opinion it should be no difference to use it with two lumen PICCs. I is a great device and made it possible in our unit to have more babies with 2F lines. Greetings from Sweden Dirk
  6. Inhaled epoprostenol in PPHN

    Very interesting! In the past I had good experience by using Sildenafil enterally (by gastic tube). As I am now working in a Level III NICU i recently found an article about using Vasopressin a adjuvant treatment: http://www.ncbi.nlm.nih.gov/pubmed/24141655 Does anyone have any experience with this drug? Greetings from Sweden Dirk
  7. blood product transfusion

    Hi, I would absolutely agree with Stefan and Naveed! A good randomized placebo-controlled trial showed no clinical relevant changes in haemodynamics in preterm infants. The only significant change was an increase in FiO2 from 0.27 to 0.29. http://www.ncbi.nlm.nih.gov/pubmed/21784442 The article gives you even a good overview on the topic. Greetings Dirk
  8. Sounds like a good idea! You can reach me by my Karolinska mail address or cellphone number. Greetings Dirk
  9. Hi Stefan, Is it really microdialysis you are looking for or is it more the continues glucose monitoring? As there is a growing number of papers publishing on the use of continues glucose monitoring (CGMS) in infants this could be a good alternative when glucose monitoring is your focus. I personally have worked (and have done research) with the Medtronic VEO. Some related articles: Continuous Glucose Monitoring in Newborn Babies at Risk of Hypoglycemia http://www.ncbi.nlm.nih.gov/pubmed/20338573 Continuous glucose monitoring in infants of very low birth weight http://www.ncbi.nlm.nih.gov/pubmed/18971588 If you have questions about CGMS feel free to contact me. Greetings from the other side of the city :-) Dirk
  10. APGAR scoring

    Hello and many thanks for you answers! Going on with this discussion I have gone back to the roots: Virgina Apgar wrote in her article 1953 "A Proposal for a New Method of Evaluation of the Newborn Infant": (2) Respiratory Effort. -- An infant who was apneic at 60 seconds after birth received a score of zero, while one who breathed and cried lustily received a two rating. All other types of respiratory effort, such as irregular, shallow ventilation were scored one. Greetings Dirk
  11. APGAR scoring

    Hi, we had a (more academically) discussion about APGAR scoring. I would like to hear your opinion about scoring breathing effort: A fullterm infant breathing spontaneously but needing CPAP via a T-piece device. Would you score it as APGAR 1 or 2? Would the need of extra oxygen affect your decision? Greetings Dirk
  12. Dear Alistair! We are using a SimBaby too and doing training for the three Karolinska hospitals. Every team from each hospital has one day in the simulator. Each team consists of a midwives, nurses and junior doctors working on the NICU, anaesthetists and sometimes obstetricians. After en brief introduction about teambuilding, neonatal resuscitation and the SimBaby we do the simulation scenarios. Before each scenario there is a short briefing and afterwards there is a detailed debriefing. Our goal is to offer a day at the simulator every second year for every person working with newborn infants/on the NICU. Greetings from Stockholm Dirk
  13. Blood glucose monitoring - which device do you use?

    Hello Stefan! I do not have experience with micro-dialysis but I am studying (pilot study) a subcutaneous glucosemonitor (Medtronic) and having good results with this device in late preterm and newborn babies. (Correlation between HemoCue and the Medtronic device (CGMS)) Greetings from Huddinge Dirk
  14. Vaccination

    In Sweden (Eskilstuna) we are vaccinating at/after 60 days of life but not before 34 weeks of gestation. So we are starting the vaccination-schedule a bit earlier (DTP, HiB, Polio + Pneumococcal vaccine). We are arranging the 1st shot within the baby is on the ward and has at least a saturation-control for one night. If the baby had apnea`s then we arrange the 2nd shot with a 1 night stay at the hospital. Greetings Dirk
  15. ROS for asymptomatic preterm infants

    Hello! A few weeks ago the AAP has released new guidelines in this topic ... maybe interesting to read (free). http://pediatrics.aappublications.org/content/early/2011/07/28/peds.2011-1466.long Greetings Dirk
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