Stefan Johansson

Same here - although maternal smoking is less prevalent nowadays, we have/do not managed infants differently. Although smoking is related to preterm birth as such (see for example https://www.ncbi.nlm.nih.gov/pubmed/15901269) - my personal experience is not that maternal smoking would (as such) relate to severity of respiratory morbidity.

Thanks so much for your feedback And, it is really all members, like you @tarek that "create" the content and the athmosphere by sharing expertise and experiences. Without that, the would be no community.

Dear all, Karolinska University Hospital has published their tube taping practise on Youtube. @Karolinska and Anna Gudmundsdottir - thanks so much for sharing! Nasal tube fixation Oral tube fixation

@bhushan I share your concern about the BPD/CLD rates. We have no hard data but my def impression is that we keep HFNC for longer times. On the other hand, if infants are more comfortable and (as we use HF) the HF is used without oxygen (for ”stability”), maybe the BPD definition is the problem, not the resp support mode.

Dear Char, you would have loved to attend this lecture at the latest #99nicuMeetup, and participate in the debate that followed. Complex topic!

A new Cochrane review related to EUGR https://www.evidencealerts.com/Articles/AlertedArticle/87436

I got the advice on this device some years ago from a US-based RT. It is very easy to adjust the tube position as the tube is secured with velcro over metal "nabs". Don't know if it MR-safe though (manufacturer would know). For smaller preterms (like <1000g) the "tape plates" are too big. And care in high incubator humidity works less well, the tape gets loose. But overall and especially for term infants needing short-term invasive ventilation, this device works really well IMHO. The Karolinska level-3 NICU use tape in a new fashion, I think there is a video clip on Vimeo - will check out next week at work if I can share it here

We utse the Neo-fit tube grip. Works well! https://www.coopersurgical.com/medical-devices/detail/neo-fit-neonatal-endotracheal-tube-grip

We use it to reduce cardiovasc instability. See ref's below: https://www.ncbi.nlm.nih.gov/pubmed/6747766/ https://www.ncbi.nlm.nih.gov/pubmed/15470200

This is funny (and IMHO - because it is somewhat true)

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@ChantalNICU thanks for posting! Wished I could share my own experience but it is very small... and now I work in a level-2 context. Just wanted to share 1) the video from the 2019 Meetup (below), 2) the hyperglycemia protocol from Sydney (https://www.slhd.nsw.gov.au/RPA/neonatal/protocols.html) and 3) the Auckland insulin guideline (http://www.adhb.govt.nz/newborn/DrugProtocols/InsulinPharmacology.htm) I can check with my level-3 colleagues in Stockholm after the summer vacation, if they have their own local guideline.

We practise pre-med for INSURE (atropin+fentanyl+pento and some use celo) - my experience is good with regards to cardiovasc and respiratory stability. But as @Nathan Sundgren says, we don't premed if we need to do INSURE right after delivery. Around here, the INSURE procedure also means pre-med, while LISA/MIST is the term used when surfactant is given without pre-med. Originally, when LISA/MIST was first done and studied by Angela Kribs and co-workers (https://www.ncbi.nlm.nih.gov/pubmed/17359406; https://www.ncbi.nlm.nih.gov/pubmed/18298776; https://www.ncbi.nlm.nih.gov/pubmed/18298776) I think their idea was to minimize any drug-related impact on the breathing drive. So they tested with no drugs and it worked well for them. I know many share this experience, that surfactant can be instilled without any pre-med. I personally feel concerned about the laryngoscopy as such, I believe atropine and analgesics would still have a place also in LISA/MIST. And for younger colleagues less experienced with laryngoscopy and intubation, I think the procedure may also be more uncomfortable for infants not given analgesia.

I'd just like to bump this survey :)

@bimalc Yes, we use the Miris milk analyzer. Our hospital runs the Milk Bank for the Stockholm region , so we have all this inhouse (and do milk analyses for all other hospitals as well). Mothers start pumping usually day.1 so after a week or so, most preterm infants get their own mother's milk. Until then, from the milk bank. All milk bank batches are analysed, and mother's own milk is analysed after ~10 days and then weekly or bi-weekly. A small amount of each pumping (1-2 ml I think) is collected during 24h and this selection is analysed. With the software Nutrium (https://www.nutrium.se/, also a small Swe company BTW, started by a neonatologist in Umeå) we input the milk spec's and then "add" the fortifications in the software, to tailor it per baby. We are directed by the growth curve and also the recommendations (ESPGHAN etc). The software gives a very detailed feedback, all macro and micro-nutrients are marked red, yellow and green depending if ("too little/much", "close", and "within recommendations"). If milk is not analysed, we use a "sham" specification, one for "immature/early" and one for "mature/late" breast milk until we have data on the actual batch of breast milk. So, we spend a some time and resources on nutrition although it sometimes feel we over-engineer, we really aim to optimize nutrition on an individual basis. And the whole setup has become integrated in our daily routines, so it works smoothly. There are some publications where this detailed nutrition data (extracted from this software) has been used, the second ref also showing that many extrem preterm infants get malnourished during the first weeks of life. https://www.ncbi.nlm.nih.gov/pubmed/26690864 https://www.ncbi.nlm.nih.gov/pubmed/23855971