Francesco Cardona

Hi Pontus,

agree with all comments before.

we have lots of experience with US-guided central lines, less with peripheral (but some) and arterial lines. It is only done by doctors at our department. We use both approaches: out-of-plane and in-plane.

Regarding the canulas: we use both, most commonly we use the neoflon/venflon. but personally I think the one on the left is superior as it is a lot sharper and has less issues with not being able to puncture the skin or vessels adequately. Though my favourite is the Jelco iv. Once you use it you dont want to go back - especially in kids with thicker/tougher skin. Although it needs some practice as it does not have the "wings" of the neoflon which allows for a better grip.

We have some experience with the guidewire, it comes in handy at times, but needs some practice to handle optimally.

Although aimed at adults, I think this article has lots of good practical advice: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886173/  or also here https://www.pocus101.com/ultrasound-guided-peripheral-iv-insertion-placement-and-access-made-easy/

You might have come across this editorial in the Journal "Nature Medicine".

Most countries have implemented newborn screening and with affordable genetic testing available, there have been studies looking into screening with genetic tests. But what should be tested for? How do we handle markers for diseases that occur later in life? How do we deal with the emotional aspects for parents, children and care givers? And how do we deal with requests from third parties?

https://www.nature.com/articles/s41591-024-03227-9

Very interesting, thanks for sharing!

Very interesting study. Looking forward to the results and further work on this topic!

We give Ampicillin / Gentamicin. Dose of Gentamicin is 5mg/kg first dose, then 36h later 3.5mg/kg @24h intervals. Step up from Ampicillin if there is evidence of other bacteria (resistant?) from mother

Done 🙂

Done

Irish colleagues airlifted Ukrainian patient to Ireland.

https://twitter.com/transport_neo/status/1505611005312831494?s=20&t=fP2I3GwnBeaK60jwfwvomA

https://www.euro.who.int/en/media-centre/sections/press-releases/2022/who-is-working-day-and-night-to-keep-medical-supply-chains-open-and-preserve-ukraines-health-system

Please add any information or resources you have for transporting infants or pregnant women out of Ukraine. We have compiled lists of material for example.

Here is a list of needed items for neonatal transport as recommended by Rosemarie Boland, Australian Neonatal Transport Nurse

https://twitter.com/piatkat/status/1501482359748706305?s=20&t=RiFIoWIiu5ak4M6HUWYnhw

https://docs.google.com/document/d/1vA1Ixm-j7LtbU5nrGULW5zZE5avklXLnRpv9ihsDBlk/edit?usp=sharing

Equipment list for neonatal transport.pdf

Irish news have shared images of maternity ward / NICU in the basement of a hospital in Ukraine

Twitter link

A report in Time magazine on the situation in the children's hospital in Kyiv https://time.com/6152374/children-hospital-kyiv-ukraine-russia/

11 hours ago, kalamazoo said:

Many neonatal and pediatric travel nurses in the USA are available to help in any way possible

What is the best way to contact travel nurses best?

UNICEF has also called for action to help children who are currently threatened due to the war in Ukraine https://www.unicef.org/emergencies/conflict-ukraine-pose-immediate-threat-children

One of the first reports was from a NICU in Dniepro, Eastern Ukraine, featured staff caring for babies in a bomb shelter during the first days of the invasion (feb 24 2022). https://www.nytimes.com/live/2022/02/24/world/russia-attacks-ukraine/newborns-at-a-dnipro-childrens-hospital-moved-into-bomb-shelter

Very good topic.

I agree with Stefan.

CLAMP -> X-RAY (after a few hours) -> PULL

I would probably adapt the time frame if it was recurrent or there is concern of recurrence or the child is otherwise unstable.

We almost exclusively use pig tail drains at this point. In our opinion they are also more comfortable for the infant and they are placed easily.

Our surgical patients though often have straight tubes.

Hi

we use the DART scheme as published and rarely change it. For select patients we have done a second round with precisely the same regimen after a couple of days in between.

FC

This app might also be helpful in simulating monitors - it is free to download from the AAP (American Academy of Pediatrics) and available on OS, Android and PC

https://play.google.com/store/apps/details?id=com.aap.vitals&hl=en&gl=US

Here is a citation that might help: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103976/

They used high dose with 9mg/kg - compared to standard dosing 1-2mg/kg for severe neonatal Kawasaki.

May I ask in what clinical setting you are thinking about using it?

After reading this: https://rdcu.be/cqY8Y

.. we decided to try for ourselves. It does work!

Who uses ultrasound to guide lumbar puncture as well?

Do you prefer to access out-of-plane or in-plane?

Did you run into any unexpected difficulties? Have you identified any helpful landmarks?

I wonder what the share of babies going home in cars is in different countries.. Might this have an effect?

I will add this survey from the US where >96% of NICUs perform a predischarge car seat tolerance screen (CSTS).

https://pubmed.ncbi.nlm.nih.gov/32044465/

Does it help at all? In any case it seems to prolong the stay if an infant fails the screening test.

https://pubmed.ncbi.nlm.nih.gov/29269198/

4 hours ago, Stefan Johansson said:

Do you mean the BPD diagnosis  set by need of resp support at 36w?

https://www.atsjournals.org/doi/10.1164/rccm.201812-2348OC

The definition of bronchopulmonary dysplasia that best predicted early childhood morbidity categorized disease severity according to the mode of respiratory support administered at 36 weeks’ postmenstrual age, regardless of supplemental oxygen use.

I highly recommend the research group around Rebeccah Slater

https://pubmed.ncbi.nlm.nih.gov/?term=slater+neonatal+pain&sort=date

She presented at the 99nicu meetup 2017 in Stockholm, too. I think it is a wonderful introduction to the topic incl caveats on currently used scores.

We do not pause iron supplementation

Unfortunately we have seen a few cases, including some that needed further operations by our ENT. We think we see it more often with cuffed tubes we sometimes use (esp. for patients undergoing surgery). We treat if symptoms or if intubation was difficult and we fear swelling, mostly dexamethasone or prednisolone. Most resolves within 6h.