Francesco Cardona

http://www.tncneoconf.com/home/

The Division of Neonatology and NICU of Sant’Anna Hospital in affiliation with the “Crescere Insieme al Sant’Anna” Scientific and Research Neonatology Foundation is proud to announce the 3rd edition of the “International Conference on Clinical Neonatology”, to be held in Torino, Italy on May 24-25-26, 2012.

In line with the spirit of the successful previous editions, that were held in November 2009 and March 2010 this conference’s goal is to present the latest scientific evidence on the care, treatment and follow-up of preterm neonates. Once more, the congress will be a multidisciplinary program of neonatal and perinatal research and practice, giving the opportunity to interact and share clinical and research experiences with colleagues in the Neonatology community.

Prominent international speakers from all the fields of Neonatology and Pediatrics will provide comprehensive, up-to-date, research-based answers to the most frequent questions that arise at patient’s bedside in everyday practice.

Torino is a splendid venue for this meeting and will give all the delegates the opportunity to enjoy the unique charme of its beautiful baroque buildings, old churchs and renowned monuments, as well as with the unforgettable taste of the local cuisine specialties like chocolates, truffles, and ravioli not to mention the famous wines and spirits.

Please let me invite you and join us in attending this exciting event ! As the Chair of the organizing committee, I look forward to welcoming you in Torino”.

Thanks for the excellent links!

I found the study you mentioned, plyon0962

http://www.centerforpolicyanalysis.org/wp-content/uploads/Final-NICU-Report.pdf

Do you have any links for some of the articles, Stefan?

We use Neopuff as well in 28wks plus and try to give sustained inflations (about 2sec per inspiration) and 6-8cm H2O as PEEP

for the smaller ones we use a Benveniste system to apply high PEEP and flow - it is not possible to apply ventilations with this system though..

As I understand it the problem with cellular phones are their signals when receiving or answering calls.

I guess electronic devices not sending out GSM signals are not making the same problems. So using these devices (e.g. ipad) may be safe.

I am just concerned that there have been reports that they have seen devices turn off suddenly when exposed to cellular phones - now this might be a real problem. And I know this has happened at our department and we couldnt figure out why it did happen.

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Our presence on the most popular social media site is primarily aimed at finding new users. Current users are informed about the latest news and discussions on the 99nicu site. For example our recent article on the new iphone and android apps caused the latest stir on our facebook page.

Additionally feel free to “like” any of our articles on our 99nicu site. You find the button right beneath the article headline. This will help spreading the word about our site.

So - come join us on https://www.facebook.com/99nicu as well! Tell us what you think about our facebook page. We are happy about any likes and comments!

A small follow-up on my answer from yesterday. I have talked to my uncle who is an electrical engineer and he was more concerned about using cell phones than any doctors I have spoken to about it. The biggest threat seems to be electromagnetic interference e.g. signals from the cell phone interfering with the normal functioning of equipment on intensive care wards ( e.g. everything we use on our wards). These machines have mechanisms to detect these interference signals but they are not 100% efficient in doing so. Especially making and receiving calls or messages is problematic as the biggest amount of signals are transfered at that point.

I found this an interesting read: http://bit.ly/wV7cOE

I felt rather uneasy after reading it e.g. changes in ventilator frequencies were seen...

So maybe the next time we ask around who changed the settings on the ventilator we should also think about our phones as culprits.

Maybe we doctors are underestimating the harm we are doing because we dont understand it & we dont want to part with our wonderful phones?

Cell phone use is officially not allowed on our wards, but everybody uses them anyhow.

After looking at a lot of books - my favourite is Polin & Fox "Fetal and Neonatal Physiology" - there is a new edition out now. it has lots of details and goes into matters in depth. It is more the book to have if you want to understand the mechanisms of the diseases. Probably you wont find one book to cover everything though..

Also have a look at Robertsons and Avery's.

try this:

Interestingly - they found that more "closed" ducts reopened in the oral group though. there was also no mentioning if children differed related to respiratory status at time of randomisation or ongoing infection - two important variables that affect efficiency of closure.

Interestingly they were convinced a priori that oral ibuprofen would be better than iv. ibuprofen and powered their study accordingly -i wonder what studies were the basis for that.

Most important though: if your goal is closing of the duct, both routes of administration seem to be possible

Another similar study from Ankara, turkey

http://www.ncbi.nlm.nih.gov/pubmed/21094951

very similar results, too!

OBJECTIVE:

To compare oral ibuprofen with intravenous ibuprofen for closure of patent ductus arteriosus in very low birth weight (VLBW) preterm infants.

STUDY DESIGN:

In a prospective, randomized study, 102 VLBW preterm infants with patent ductus arteriosus received either intravenous or oral ibuprofen at an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 hours. The success rate and evaluation of renal tolerance using cystatin-C were the major outcomes.

RESULTS:

Patent ductus arteriosus closure rate was significantly higher with oral ibuprofen (84.6% versus 62%) after the first course of the treatment (P = .011). The cystatin-C level increased significantly after treatment in the oral group (P = .001), but did not change with intravenous ibuprofen (P = .4).

I guess it depends on what you would define as "true case". As I understand the literature any prolonged period (say weeks) of hyperglycemia qualifies for neonatal diabetes. If it stops within the first 3 months i would call it transient neonatal diabetes. But I do not know of any definitions, anyone else?

.. some more reading here: Temple et al. Transient neonatal diabetes - a disorder of imprinting

After two months of treatment we are finally seeing an improvement in insulin demand - so maybe (just to prove me wrong..) our's is just transitory as well. It was definitely severe SGA, so obviously there is a connection there...

Microdialysis would have been truly interesting, but we are only in the beginning of getting experience with that. We use capillary sugars and guide our subcutaneous pump with that.

We currently have a case of neonatal diabetes on our ward. the baby is getting basal/bolus insulin therapy now. incidence is estimated at 1 in 500.000.

anyone of you have any experience with that?

We were happy to find this article:

http://www.nejm.org/doi/pdf/10.1056/NEJM199509143331105

how about slideshare? http://www.slideshare.net

or - if you let them know your phone number, you can have longer videos than 15min as well..

might be difficult though to have the lecturers agree to this. what was the precise wording in the lecturer's contract about publishing the lectures?

If you want to follow the official nomenclature - it is based on the results of the consensus conference from 2001:

http://ajrccm.atsjournals.org/cgi/content/full/163/7/1723

DEFINITION OF BRONCHOPULMONARY DYSPLASIA: DIAGNOSTIC CRITERIA

Hope this helps.

We have used levetiracetam in certain cases as well - but not as first line treatment. Our neurologists are very enthousiastic about it. In two cases I remember we did not see any improvement of symptoms though. There are a couple of ongoing trials I believe:

2 are registered on clinicaltrials.org from the US (UCSD and Cincinnati) and I remember that there is also a European multicentre-trial with levetiracetam as first line agent that is ongoing.

So more data is coming.

In Vienna, we try to stick with the recommended schedule as for term neonates (i.e. at their age, not corrected for prematurity). We might delay by a month if we feel the infant is too sick to be vaccinated at the recommended time. We try to immunize all eligible neonates before discharge, but we do not vaccinate on the day of discharge, as immunizations are associated with higher frequency of apnea. Hacking et al.

Better vaccine coverage if immunizations of preterms is started in the hospital Denizot et al.

Interesting case, Alex. Admittingly the literature on fetal complications after LMWH is sparse. I assume you are relating to this case study (Bauder et al.)

Most of our data on LMWH and placental transfer are based on studies in the 80s. It is generally thought there is no placental transfer of LMWH, although the effect of factors like preterm delivery and placental complications are unknown.

So far the recommendations are that LMWH is safe during pregnancy VTE, Thrombophilia in pregnancy - Guidelines 8th ed.

Suffice to say - i.v. immuneglobuline in neonatal sepsis is not standard treatment Cochrane. unfortunately the INIS Trial has not published its results, but according to data shown at Hot Topics 2010 - there is no indication for iv immuneglobuline in neonatal sepsis. furthermore it seems that there has been publication bias in the trials published on i.v. immuneglobuline so far (that is: only studies that showed an effect were published, and most of them were pretty small)

I also used huddle about a year ago - didnt really catch on though...

www.huddle.com

Looks pretty intuitive - I like it!

We will salute to this day when we all gather in Stockholm!

Really looking forward!

To the continued success of 99nicu in the future!

hip-hip hooray!

Great to be part of the ride!

Great links, Thank you!

There is an article that shows that cerebral blood flow decreases during sampling from an umbilical artery. The more time you take while drawing blood and the less blood you remove, the better.

Umbilical artery catheter blood sampling volume and velocity: impact on cerebral blood volume and oxygenation in very-low-birthweight infants.

At our department we only use saline to flush and we do this by hand.

Interestingly also sampling from a UVC leads to decreased blood flow in the brain (research by the same group): Blood sampling via umbilical vein catheters decreases cerebral oxygenation and blood volume in preterm infants.