Stefan Johansson

Great to bump this topic! I made a screen shot of the photo you referred to (below), did those infants have such marked "out-stamped areas" at the iris margin? I also looked into the first suggestion Ectropion uvae, and found something that seemed to look like your first drawing. Which one best illustrates your clinical finding?

Is this something you are looking for: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653511/

My colleague Ewa Henckel defended her thesis at Karolinska Institutet on "Cellular consequences of preterm birth : telomere biology, immune development and oxidative stress" last week, including four projects on telomere length, inflammation and lung function viral respiratory infections and cellular aging immune system development and environmental exposures hyperoxia-induced lung damage and the capacity to counter-act surfactant inactivation with a novel antioxidant A great thesis, available for download here: https://openarchive.ki.se/xmlui/handle/10616/46531 For the table seating at the dissertation party, her husband had made clever and funny personal drawings for all guests. I translate mine for you below, it is on the spot Best regards from Mr Conference Organiser PS. BTW, hope to meet up with you at the next "Future of Neonatal Care" conference in Copenhagen. Click here to find out more.

Our guidelines are to cool infants with HIE of grade 2-3, or if seizures develop within 6h of life. But I know there are some discussions ongoing, check this paper out (https://www.ncbi.nlm.nih.gov/pubmed/26352683) that is also discussed in a blog post ~2 years back by Keith Barrington: https://neonatalresearch.org/2016/09/29/its-only-mild-encephalopathy-now-can-we-stop-worrying/

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Thanks @Andrej Vitushka for posting about this every-day NICU question! In Stockholm, I think we are mostly following the table 30.1 from Avery (in the first post), i.e. a rather high fluid intake in the smallest infants, typically ~100/110 ml/kg/d in the most immature infants and going down to 60 in term infants. @Nathan Sundgren - with regard to what to give: we tend to start with parenteral nutrition right away, in infants that we judge will not take much enterally: in practise all infants <1500g. As already pointed out - it is always a question about fluids from medications, boluses, low-flow infusions keeping catheters open etc. The principle is easy (count everything that is not fluid therapy due to hypovolemia) but in practise there is variation. My experience from infants above the extremely preterm range (i.e. ≥28 weeks) is that it is hard to know what is the right thing. Even with slightly different fluid regimes, they mostly seem to do good in terms of water balance.

What a great training resource!

@Numan hameed please post your question about CPAP in this forum: https://99nicu.org/forums/forum/49-ventilators-and-care-of-the-ventilated-infant/

I have no personal experience. In very severe cases of BPD we sometimes try sildenafil and/or inhal iloprost, assessing pulm pressure before/after with echo.

Given recent results from placebo-controlled trials on inhaled budenoside and systemic hydrocortisone, how do you practically approach the questions on steroid use in your NICU? As you are probably well aware, the NEUROSIS trial (inhaled budenoside) showed some reduction in BPD among survivors, but the 2y followup showed a increased nb of deaths in the budenoside group and no benefit with regards to neurodevelopment (NEJM 2015 and NEJM 2018). The PREMILOC trial found that systemic low-dose hydrocortisone reduced the BPD risk, without a clear benefit on neurodevelopmental outcomes (Lancet 2016 and JAMA 2017). Further, a meta-analysis came out just the other week (J Ped 2018) that also concluded that survival without BPD was increased with this strategy. With regards to clinical practise in Sweden, the latest report from our national quality register (info from 2017) presents that systemic steroids are used i ~50% of infants <25 weeks, and in ~30% of infants 25-27 weeks. The corresponding figures for inhaled steroids are ~35% and ~25%. Yet the "national" BPD rate (oxygen need at 36w) is reported as high as ~75% in infants <25 weeks, and ~45% in infants born between 25-27 weeks. (full report here, but in Swedish) So, what do you in practise? Do you use either, neither or both inhaled/systemic steroids to reduce BPD? I personally feel a confused how to navigate in this landscape 🤔

Am curious to hear your stories later We dont have iNO so I have nothing to share. But in term infants we have sometimes used epoprostenol - I shared a story ⤵️

Hello in Canada! If time allows and circumstances looks complicated / bad; we def would 1) prepare for a UVC, 2) prepare syringes with sodium chloride bolus and 3) order O- blood to the resusc room. Better safe than sorry! I would argue that the volume may be more important than the erytrocytes, but I think the "jury is out" and that other people argue differently. Let's see what others respond!

As you have heard, our 3rd conference aka "99nicu Meetup" and "Future of Neonatal Care", will take place 7-10 April 2019, at Scandic Sluseholmen in Copenhagen, Denmark. We are very glad to open the registration today! Given that we already have 100+ pre-registrations from 30+ countries, we recommend you to sign today! From the pre-registrations, we also know that workshops will be popular. As workshops have a limited number of places, you should register ASAP if you plan to attend a workshop. Click here to register! Click here to download the program folder! If you have any questions about the registration, please email reg@meetingplanners.dk See you in Copenhagen!

Dear Edgar, we rarely use that diagnosis (ICD-10, P91.4) , but do it sometimes if a baby has had somewhat low apgar (like 6-7) and has been admitted due to some irritability. Like an "asphyxia light" diagnosis. However, I would regard it the diagnosis as a bit subjective. Am not aware of any formal definition of "Neonatal Cerebral Depression".