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Stefan Johansson

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Stefan Johansson last won the day on March 23

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About Stefan Johansson

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    99nicu Team
  • Birthday 06/20/1966

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    consultant neonatologist
  • Affiliation
    Sachs Children's Hospital
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    Stockholm, Sweden

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  1. I guess many took impression by data from the TIPP-trial, that suggested that surgical ligation of PDA was associated with increased risks of BPD, ROP and neurosensory impairment. http://www.jpeds.com/article/S0022-3476(06)01108-5/abstract Data from a recent and relatively large cohort in Canada, where postnatal preligation morbidities where taken closely into account, has now showed that previous research may be explained by confounding by indication. http://jamanetwork.com/journals/jamapediatrics/article-abstract/2606520 In other words, surgical PDA ligation as such may not be associated with adverse outcomes. Nevertheless, I personally believe that PDA surgery is a very invasive procedure and should used only if the clinical scenario is complex and the PDA is considered to have a major role for that scenario.
  2. For the 99nicu Meetup, not only the venue but also the budget is down-sized So, there won't be funding for the kind of web cast we originally planned. Instead we plan to use Periscope, the live streaming service that (I think) is a Twitter-owned service. It seems from the Periscope test run below, that the image quality from using a smartphone is not superb (despite having the latest model!) but if you plan coming to the 99nicu Meetup and are experienced with Periscope Producer, please drop me a PM or an email. PS. The video is cropped... go to here https://www.periscope.tv/w/1ynJOWYbnaWJR to view it with the full width
  3. @Khaque we had no data on lactate, it is not routinely measured in umbilical cord blood. @tarek although we did not formally investigate the components of pH, I'd say that PCO2 and BD would explain they differences over gestational age. We plan to dig further into the prognostic value of acidosis but the literature and My clinical experience too: I am not so convinced that acidosis alone is a good prognostic factor.
  4. Maybe we were a bit too optimistic about the 99nicu Meetup, when we booked a big and fancy venue However, we will not be 200 people on the meeting, or at least, we cannot take the risk NOT becoming 200 people. While you will still be able to book accommodation at the Clarion Hotel, we will run the conference in a smaller aula for 80 people at "my hospital". The aula (i.e. our hospital) is within 1200 meter walking distance from Clarion Hotel. So, in short, the same great program in a place that will allow great interactivity! What about our plans to make a web cast of the meeting... well, we plan to use some service like Periscope. Or some other DYI solution. Simple, free! See you in Stockholm!
  5. Although we use no "definition" in our unit, I'd consider 7.00 as severe acidosis in a newborn. And 7.10 in an infant who is "crashing" in the unit due to sepsis, NEC etc. For research purposes, our idea is to use something like <1st percentile as definiton of fetal acidosis
  6. @livesynapse I could not agree more about "within-team rudeness" - it is very contra-productive. Maybe you were thinking of this publication (?): http://pediatrics.aappublications.org/content/136/3/487 (I cut and paste from the abstract below)
  7. @Andrej Vitushka Actually, we firsts included also elective CS in the "normal reference group" to get more statistical power in the analyses. However, the reviewers thought differentely and we skipped those. I don't have exact data in my head but elective CS had sign higher pH than normal vag delivery, but it was really on the 2nd decimal.
  8. Thanks for another great post! And I want to congratulate you for doing what you do, I believe that the professional neonatal community can share and engage much more in the public space. Unless my English is like a 14y-old, I'd attempt to blog too... but, I just feel that language would be a limitation.
  9. Dear all, I want to share one of my latest papers, in Journal of Perinatology. The publisher sent me a free full-text URL so if you click on http://rdcu.be/pLGB you can download the PDF. So, with a large very detailed obstretric database we could investigate what is a normal umbilical artery pH in well preterm and term infants. In the paper you also find a graphical representation what is a normal pH (a percentile chart, like a growth chart) Our take-home-message is that fetal acidosis may not be well defined as a static cut.off (like <7.00 or <7.10) but rather like a gestational age-adjusted measurement, like <1st percentile.
  10. @Hendrien Do you sometimes use the Tecotherm cooling madras for this purpose (keeping preterm infants 37'C)?
  11. We are very happy that NeoMed becomes a partner of the 99nicu Meetup! @NeoMed - thanks for contributing to our Meetup! NeoMed is a leading manufacturer of tube and syringe systems for enteral feeding of preterm infants.
  12. Interesting question! We do not, but in our level2 setting we only deliver infants from 28+0 weeks and onwards. (But we use bags for all <32weeks or <1500g at delivery unit stabilization) would be possible study in a trial, but what should be a clinically relevant outcome?
  13. Thanks for a great post! I agree very much about the discussions in the NICU about BPD, in our unit not so much about the definition but how to manage it. As we tend to increase the saturation targets, and BPD is defined by oxygen supplementation at a certain time point, we likely increase the incidence of BPD only by setting a higher saturation target. Naturally, babies with bad lungs are at risk of doing less well in developmental terms. But the lungs or the BPD-definition may not the problem itself, more a proxy for a high-risk scenario. Related to this blog post, I started a discussion in the lung forum about saturation targeting, find it below
  14. There is some relatively strong data supporting a saturation target at 90-95%, at least during intensive care (level-3 settings) and for extremely preterm infants. This commentary from EBNEO is quite interesting: https://ebneo.org/2017/02/oxygen-saturation-targets-in-extremely-preterm-infants/ However, the studies on saturation targeting has some methodological aspects that is also good to consider. Have a look on a lecture by Barbara Schmidt below, a lecture that problematize the evidence. Further, what shall we target in the majority of preterm infants not born extremely preterm, and cared for in level-2 settings? Like a 31- or a 34-week infant who may need CPAP and supplemental oxygen only for a few days. Another common discussion is what alarm limits should be applied. If the target is 91-95&, does the alarm need to go off at 89 and 97%? Please complete the poll above on saturations targets and alarm limit, and comment below.
  15. @hkhawahur it will be a triple-strain combination