Carlos Delgado

Hello everyone. I am discovering an exciting initiative to build an open data commons of health facility data with OpenStreetMap https://wiki.openstreetmap.org/wiki/Global_Healthsites_Mapping_Project In its own words, healthsites.io invites anyone to help establish accurate healthcare location data: https://healthsites.io/map I will explore this alternative, and then I will share with you what possibilities it offers us. If anyone knows of any other possibilities, please share them. Thank you. Regards, Carlos

It is interesting to see organized networks in high-income countries. Research searching for better healthcare alternatives can be a great motivation. From a very practical point of view, it also would be interesting to be able to help organise neonatal networks in low- and middle-income countries using geographical reference points. One geographic information system that has offered helpful alternatives is OpenStreetMap (for example, response to the earthquake in Haiti, Ebola Epidemics, etc). I wonder if we could start with NICUs mapping on that platform to see if support points can be identified around precise locations. If there is a place where some premature babies need support, perhaps identifying nearby points where there is another NICU can be helpful. Please share your comments on your preferences for where and how we could map NICU's positions in low- and middle-income countries, and you could even share your reflections if it is a reasonable alternative for many of us. Possibly, we need the support of someone with more experience in guiding this mapping process.

What is a neonatal network? Interesting definition for NICU networks in the UK: https://www.bapm.org/pages/19-neonatal-networks "Neonatal care for premature and sick babies is organised into geographical areas around the country where hospitals work together and are called neonatal networks. The networks allow doctors and nurses to share knowledge and skills and they help to ensure that the different levels of care are accessible for all babies. By working together, hospitals within a neonatal network create a smooth pathway for a baby and their family and the right level of care is provided as near to home as possible. Neonatal networks often include a designated transport service which means that any baby who has to be moved from one hospital to another is cared for by specially trained medical and nursing staff." Also, there are links to the websites of 13 neonatal networks in the UK.

Thank you for the opportunity to generate constructive reflections on the Vulnerability of Neonatal Intensive Care Units. If we define some criteria, perhaps we can begin organising this classification with greater possibilities of achieving exciting results. We would focus criterion by criterion, and after analyzing the most important ones, we could prepare a list of characteristics to identify Vulnerable Neonatal Intensive Care Units (V-NICUs) and allow us to prepare proposals for support or collaborative research. The first criterion that I propose would be to define the NICU Networks (A "true" network and not just a "theoretical" one). A NICU network is supposed to generate better conditions than an isolated NICU (and therefore vulnerable). You can also propose other criteria to be analyzed in sequence. This first series of reflections would aim to identify bibliographic references or documented experiences on the performance of NICU networks, especially in low- and middle-income countries. Please share your experience or bibliography that allows us to analyze what NICU networks are and how we recognize them. How do I define if my NICU belongs to a Network or not?

Dear Philip I guess the main problem for preterm babies weighing below 2000 grams is temperature control. There are many alternatives for temperature control and Kangaroo care: Bambi belt, BEMPU TempWatch, and many others. Even I designed the chullo-belt for preterm babies as a garment with intelligent technology, which is composed of a hat connected to a belt, including systems and sensors that allow the continuous identification of the position and well-being of premature babies using the kangaroo strategy (However, the chullo-belt still is just a registered idea (file 2362, year 2017), and it is not in production). Thinking outside the box (incubator), I wonder if there are possibilities for a "preterm sleeping bag" including heat control and something else ... What do you think about such an idea ? Kind regards, Carlos A. Delgado Lima, Peru

Good morning, I am pleased to write you. I am a Peruvian neonatologist and I would like to share ideas and comments about Five Inflation Breaths (5-IB) strategy. I belong to a group of pediatrician that is interested in strategies for triggering First Breath at birth (1)... and 5-IB seem very interesting. 5-IB is mostly used in Europe, but not in America (2) (3). I wonder if it is possible to compare such differences through an ecological study analyzing European and American data.... I am writing to ask if someone believe that we can work together in this kind of ecological research?... Could you share with us some statistical data from European sources? In the beginning, my team and I could assume some data analysis and initial draft reports. We can arrange further details on Skype. Please, tell me what you think, Kind regards, Carlos A. Delgado. MD, PhD Lima, Peru cdelgado.isn@gmail.com skype: cdelgado.isn (1) First Breath: http://www.grandchallenges.ca/grantee-stars/0690-01-10/ (2) Klingenberg C, O'Donnell CP (2016) http://www.ncbi.nlm.nih.gov/pubmed/26855292 (3) Perlman J (2016) http://www.ncbi.nlm.nih.gov/pubmed/26855293

Dear colleagues and friends, I have an update... One of those ideas got support and now it is visible on youtube: And also in this site: http://www.grandchallenges.ca/grantee-stars/0690-01-10/ Many thanks ... Kind regards, Carlos

Thank you Stefan, I miss to say that the vote is not exclusionary, that is to say, you can vote for one or for two videos ... Regards, Carlos

Dear Friends and Colleagues, I am a Peruvian Neonatologist very pleased to return to 99nicu (where I belong since 2006). I am back online after some years searching a PhD in Epidemiology in Brazil... Now, mixing neonatology with research, I am presenting a couple of ideas to the contest "Grand Challenges" - Canada. Each video is 2 minutes long and I would like to invite you to see and give your vote for them. A neonatal breathing PAD : This video proposes a cushion-pad to offer a postural support of the neonatal head and ease breathing at birth. This device might prevent neck hyper-extension or hyper-flexion. FIRST BREATH: with a little help : This video shows a device with simplified bellows mechanism to stimulate respiration of the newborn at birth.How to vote: Click Like button, enter the characters you see into the form and click Vote. If you cannot work out what the characters are, click the refresh button in the catpcha to get a new set of characters. Feel free to share this message and links to other colleagues and friends. Thank you, Best regards, Carlos A. Delgado Bocanegra. MD. IBCLC. PhD Pediatrician Neonatologist. Instituto Nacional de Salud del Niño Lima - PERU

Dear 99nicu netters: There is a new article for discussion about our subject (40% oxygen): Hellstrom-Westas L, Forsblad K, Sjors G, Saugstad OD, Bjorklund LJ, Marsal K, Kallen K. Earlier Apgar score increase in severely depressed term infants cared for in Swedish level III units with 40% oxygen versus 100% oxygen resuscitation strategies: a population-based register study. Pediatrics. 2006 Dec;118(6):e1798-804. Do you think that a better Apgar means that 40% is a better oxygen choice? Best Regards, Carlos DELGADO Pediatrician Neonatologist Instituto Nacional de Salud del Niño Lima PERU

Dear swedish netters: I read a very interesting article in Pediatrics: Saugstad OD, Ramji S, Vento M. Oxygen for newborn resuscitation: how much is enough? Pediatrics. 2006 Aug;118(2):789-92. PMID: 16882835 Authors say that "... initiation of 40% has been recommended for the last 10 years (In Sweden)", Them believed it's safe, and also, them think that blenders should be installed in all other countries for use this concentration. I also found that the bag and mask, could offer Oxygen concentration near 40%, without reservoir. (AHA-AAP cpr guidelines). What do you think about this last approach? Best Regards, Carlos DELGADO Pediatrician Neonatologist Instituto Nacional de Salud del Niño Lima PERU

I'm searching for new equipment and I would like to recognize which technical specifications (apart from pressure/volume) makes the differences -in normal ventilation- between neonatal, infant and pediatric ventilators. I would like to compare CrossVent4 (BioMed), Fabian (Acutronics), Millenium (Sechrist), and any other else. Which one do you believe that could be useful for my neonatal surgical unit?. Thanks you in advance for your help,

Background: Neonatal resuscitation and positive pressure ventilation. Decision node: Oxygen concentration: 21%... 40% ... 100% Question: which one is better, under what circumstances? Carlos DELGADO Pediatrician Neonatologist Instituto Nacional de Salud del Niño Lima PERU