Stefan Johansson

To the best of my knowledge, I don't think this is used in Sweden. What are the indications for lavage in Japan? Meconium aspiration? Or also preterm RDS?? Would be great to hear also HOW you do this and your experience.

@yangw126 but do you change NG tube every week also if the infant is postop esofageal atresia? We also change tube every week in preterm infants in general. But, postop esofageal atresia, our surgeons want us to leave the NG tube as long it is needed, i.e. take it out when the infant can feed orally

We had the discussion recently about long-term use of anti-reflux medications after esophageal atresia repair. Drugs like lansoprazol can really clogg the NG tube (like concrete!)... and from what I read in this systematic review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899117/) it seems that there is no clear benefit. Although the quality of evidence is classified as low, and that "more research is needed". Do your pediatric surgeons advocate the use of anti-reflux medications after esophageal atresia repair? If yes, for how long? If the infant needs NG tube feeding for a longer period time (like 4-8 weeks), how often do you change the NG tube? Asking for a friend

Although it seems more simple with one antibiotic, it may not be the best strategy, for reasons related to resistance development. Carbapenems (like meropenem) are typically used as the treatment option when other antibiotics fails due to (known or assumed) resistance. So, depending on the bacteriological context, it may or may not be a reasonable 1st-line choice. And carbapenem resistance is worrysome thing for health care beyond the NICU. So, a reasonable bottomline would be along the lines "If it works, don't fix it"

@Abdul kasim jaleel ahmed I guess you are thinking about the Kaiser Newborn Sepsis Calculator. Here http://newbornsepsiscalculator.org

I don't know if/how things have improved after the change. And since I left Karolinska a few years ago (for "the other hospital" ) I don't know the exact rationale. Will lunch with @Alexander Rakow tomorrow, will ask him for details. OT and IMHO: But despite using almost only breast milk (donated or expressed) for very preterm infants, NEC is a reality around here A fact that is the driving force for the academic startup Neobiomics I started with a few EU-based colleagues.

Infants to mothers with "high-risk" status (HBeAg+, OR anti-HBeAg+ and high load of HBV-DNA), we administer immunoglobulin soon after birth. Since mothers are screened for chronic infections at the maternal antenatal care center, ab-status it is usually known at the time of delivery. The pediatrician/neonatologist on call are informed over the telephone and the delivering midwife gives the injection. Infants to mothers with "high-risk" status should be sampled at birth with regards to HBsAg and antiHBc (indicative for intrauterine infection), and at the age of 18 months the child is sampled for anti-HBs (vaccineffect) och HBsAg och antiHBc (detection of infection), as the risk of vertical infection is not eliminated despite postpartum proph and early vaccination. @M C Fadous Khalife thanks for the recent reference!

Sounds like pushing the skin-to-skin care to its boundaries! Personally, I think it is not a bad idea as such, I guess one just needs to get used to it. However, it is not uncommon that intubation is not just something isolated, but part of a stabilizing efforts that includes more procedures/medications etc. In other words, I am not sure skin-skin-care is the right thing to do in an infant with respiratory failure, whatever its cause. My personal experience is that I have used parents to comfort the infant (holding support) on the open bed while intubating, i.e. including them in the team doing the stabilization.

Reactions in our #SoMe channels!

The Stockholm practise is meropenem (as monotherapy) Prev cefotax and an aminoglyk was first line treatment (+ metronidazol usually...)

Got this on Twitter

This discussion reminded me about this trial in ADC... although average gestational age was ~27 weeks, I guess very few, if any, were infants born at 22-24 week. But iodine-disinfectant should be avoided (better safe than sorry!) http://fn.bmj.com/content/103/2/F101

We are on important missions in the NICU. From time to time, we all sense the strong rewarding feeling that our work mattered a lot. I love the hands-on work in the NICU, but I also believe strongly in pursuing work at the meta-level of things. That we can change care and improve outcomes through research, quality improvement, and taking our professionalism outside the box. And to the web! Naturally, the 99nicu “global village” is one of those meta-level journeys for me. I have shared small bits of information previously about a new project with a really big scope. Together with an EU-based group, I started Neobiomics, an academic startup project that will provide a super-high quality bifidobacterial product requested by neonatologists, “from the community, to the community”. The composition of the product is based on this RCT. Launch is planned in Europe mid-2019, and outside Europe during 2020. Although the product itself is much requested, I personally think that this project has a much wider potential. With access to a highly advanced machinery (literally!) at the production facility, it should be possible to make other compositions (other sets of bacteria, other bacterial numbers, +/- other compounds etc) for some really cool comparative trials. Manufacturing quality is key, but as important in this project is the not-for-profit business models. Naturally, we need to create something sustainable, but taking a perspective of social entrepreneurship enables the largest possible outreach. We are still working mainly behind the scenes in the Neobiomics HQs, but relatively soon, we will step on stage and start creating buzz As part of our communication strategy, we are now collecting Testimonials from neonatologists believing in bringing this product "from the community, to the community". If you share the basic idea behind this project, please consider to click here and share a Testimonial for publication on neobiomics.org And… stay tuned PS. The project above has nothing and everything to do with the talk below. Creativity is the Power to Act.

@Hamed I am no longer at the level-3 NICU at Karolinska but I cross-checked with @Alexander Rakow : they apply nothing but sodium chloride 0.9% for cleaning the umbilicus for UAC/UVC insertion (meaning only gentle mechanical washing and no chlorhexidin) For diaper change - I did not cross-check but think they use water

Thanks @Hamed for sharing those detailed guidelines! Here in Stockholm, the guidelines are very similar. I think the only major difference is that we wash with physiological sodium chloride for infants <25 weeks.