Stefan Johansson

Breastfeeding mothers having propofol sedation at surgery, may have green discoloration of the breast milk, I just read a short clinical pharma column in the Swedish Medical Journal. I found this longer case report from Canada about this, it seems propofol metabolites can discolour biological fluids other than urine. The authors advice no breast feeding until the color has normalised. Rare thing but still interesting to know and be aware of! https://pmc.ncbi.nlm.nih.gov/articles/PMC6306180/

Here is the winner 😀, the VentFirst study, I paste the graphic abstract below. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818953

@Vicky Payne so well deserved 🎉🎉🎉!

We should invite people like Johan Gyllensvärd and Eric Giannoni to a webinar discsussion around this!

Thanks @Mariana Oliveira for kind words, and yes, I shall find my way. I think, a more street-smart one 🙂

Yes, we do have a low use of antibiotics in Sweden. We did some informal looks into the Kaiser Permanent Sepsis Calculator with hypothetical cases, whether our clinical strategy would differ from the recommendation from the Calculator. It seemed that our current approach was still more restrictive compared to the Calculator, so, we have some secret sauce when it comes to anitbiotics use. There are two recent publications about antibiotics use in Sweden, giving some raw numbers on the proportion of infants given antibiotics (roughly 2% of all NICU admissions): https://fn.bmj.com/content/early/2025/07/18/archdischild-2025-328944 https://pubmed.ncbi.nlm.nih.gov/38517437/ But even with this small rate, there are substantial variations between hospitals, without different sepsis risks, so it seems possible to improve the use even further.

I’ve done it, the last night shift. What in many ways defines us, devoted to neonatal care, is no longer part of my working life. One of my gifts in life has been endurance and grit, allowing a good amount of workload. It has enabled my long journey from the countryside where I grew up to an intellectually affluent position with many hats: one clinical, one academic, one for greater-good projects (like 99nicu!), and one as a startup entrepreneur. But with time and age usually come limitations, even for me. Approaching my 60s, and accepting that our family’s cardiovascular phenotype is also my trajectory, I decided to follow the advice to stop working shifts. There’s no drama or anything like that (no need to send flowers!), but I want to stay in good shape until the finishing line. Still, quitting night shifts is a big step for me, one I’ve been hesitant about. While there are many upsides, including a sense of relief, I also feel a certain fear of missing out. I think many of you reading this can relate to how shift work becomes part of your DNA when you dedicate your professional life to neonatal care. Babies are born seven days a week, and they don’t care if delivery happens at 2 a.m. on Midsummer’s Eve.* As NICU staff, we know this. Our setup is planned accordingly, and most of us would admit that we actually like this lifestyle, being able and willing to open our large toolbox of small things, at any time. During my many shifts over the years, I’ve been privileged to meet countless families and their newborns under challenging circumstances. In most (though unfortunately not all) cases, these situations have brought relief and reward, especially when later meeting families and NICU graduates at our follow-up clinics. So, what now? Honestly, I’m not entirely sure. My daytime clinical role won’t change much, but the bigger shift is in my overall “business model” for work. In Sweden, on-duty hours can be compensated with time off instead of pay. For example, if you work a weekend, you can get a full week off with salary instead of “grabbing the money.” For me, time has its own precious value, and our model of compensating shift work with time have allowed me to engage in many fulfilling but unfunded projects still connected to neonatal care. Such as research, 99nicu and EBNEO, and starting Neobiomics from scratch. Now, without the opportunity to “earn time” from night shifts, I’ll need to rethink how to fit my life into a tighter schedule. That’s not entirely a bad thing, but it will require new, creative ways to keep working for the bigger picture. ⸻ *Maybe this isn’t the best example — at 2 a.m. on Midsummer’s Eve in Sweden, many Swedes are still awake, enjoying the early morning sun. But you get my point.

Help Select the 2024 EBNEO Impact Article of the Year!The EBNEO Impact Article of the Year (IAOTY) celebrates research that shapes neonatal practice and sparks global discussion. From the Impact Article of the Month (IAOTM), EBNEO editors have selected the eight most impactful articles of 2024, and now it’s the community’s turn to decide which study stands out. The public vote is open for five days, and the two articles with the highest votes will advance to the final round, where the neonatal community will select the ultimate IAOTY winner. Only one vote per participant is allowed; multiple votes will be monitored and removed. This award reflects not only scientific excellence but also the voices and priorities of clinicians worldwide, true to EBNEO’s mission of making evidence-based neonatology both accessible and impactful. Which 2024 publication will have the most impact on neonatal care? Click here to vote or visit https://ebneo.org/impact

we wanted to promote two neonatology media projects. First of all, the Preemie voices videos, meeting some of the preemie participants who wrote the inspiring letters in “Preemie Voices” book by Dr Saroj Saigal. Both videos, from 2014 and 2024, are added to the Links Directory but also embedded directly below. Our second recommendation is to follow Neonatology Now, a podcast hosted by European School of Neonatology. The most recent episode is a very interesting interview with Prof Barbara Schmidt.

Here's the link to the recording of the Journal Club, password is GNJC

Tricky question, I agree with you @gmavrogeorgos , abdominals symtoms can be many so one needs to think about the whole picture where distension (however defined) is only one part of the puzzle. We used the measure abdominal circumference back in the days, super tricky and rarely gave any relevant numbers IMHO

Preterm infants getting unstable "than expected" at their vaccination at 2 months (the extra dose we give in the NICU), we sometimes give the first regular vaccination (3 months of chronological age) at our hospital policlinc, and make the family wait 2-3 hours after the vaccination. I have not experienced that any infants has become unstable, but we offer this as an extra precaution, and as a bonus, we do not loose the "credibility" of vaccinations as such. The second regular dose, at 5 months chronological age, is then given at the regular child care center where all other children get the vaccinations. In my experience, this works well for everyone, the infant, the parents and for us :)

Mercy Perinatal is thrilled to announce another amazing international venture for our neonatologists, paediatricians, allied health clinicians, neonatal nurses, midwives and even keen obstetricians! LIVE via Zoom, we will have an international panel discussing landmark neonatal papers and whether or not they should change your clinical practice… even immediately! Hosted by Mercy Perinatal’s own Prof. Brett Manley and Dr. Shiraz Badurdeen, and the inimitable Prof. Ju-Lee Oei from Mater Brisbane, the sessions will reflect the successful format of the established Global Obstetrics Journal Club – a deep explanation of the papers; insights directly from the key investigators of the studies; and then erudite conversation with a superstar, global panel including: world-renowned physiologist Prof. Graeme Polglase and the incredible Dr. Kong Juin Yee from Singapore. Plus, live Q&A with YOU, our online audience. We have you hooked, right? Registration is free, and always will be, but you need to book your place today at: https://mercyhealthau.zoom.us/webinar/register/WN_5I49-2WYSHm2klkp-7BCUw Find the two papers discussed here: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(24)00315-6/fulltext https://jamanetwork.com/journals/jamapediatrics/article-abstract/2836681 Final Announcement GNJC Base Social Media - August .mp4

Unfortunately not :(

We rel often see some minor instability and irritability when we give the first (extra-dose) vaccin at 2 months in preterm infants. We mostly wait and see until symtoms disappear and sometimes give paracetamol. Although rarely, it happens we need to give HFNC before all is fine again.

@NHowold this is why I believe that a community driven project would be a great fit for this type of software, maybe connected to EMBA? Would be happy to be part of such a project :)

Thanks @Wigand , looks very interesting and open source too! I think a milk bank solution indeed could be the perfect thing for a community-driven open source software (like my favourites Zotero, Collabora, NextCloud and Mastodon). My German is rudimentary but I understand it correctly that this is a generic biobank software? Did you need to do a lot of adaptions or do you use this more or less out-of-the-box? I am not fully into the new EU regulation about donor breast milk, but does the use of this software comply with those (traceability etc)?

Hi Nele, we run the milk bank for the Stockholm Region in our hospital but I don't know the technical solutions, I will check later, am on vacation right now :)

I bump this thread with this new article in BMJ (thanks for sharing @Francesco Cardona ) "From genome to exposome: universal newborn genetic screening is the wrong focus if we want to improve population health" I especially like these two passages: https://www.bmj.com/content/389/bmj.r1349 I