Stefan Johansson

We measure axillary temps (most often parents do it )

We also practise some manipulation in preterm infants but only if otherwise well (preterm infants with functional GI problems) - if we suspect NEC, manipulation is a no-no. This practise is usually not a doctor's decision, usually nursing staff decide to do this if they believe it helps.

Many of you already know about my engagement in Neobiomics, a startup company now launching ProPrems® in Europe. I was asked recently if there was a specific event that made me committed to close the gap between need and availability of a safe way to support the intestinal microbiota. Yes, there was a “Tipping Point” that I can share a few words about, without disclosing patient data. The photo below shows the place in my NICU where a preterm infant stayed some years back, being well on full feeds and expected to have an easy journey with us. When things went into new and unfortunate directions. Although difficulties and suffering is part of what we work with, this event made me feel that I did not provide the best care for my patients. I mean, compared to all interventions we make every other day, and the lack of good evidence for many of them, probiotics supplementation was already in 2014 a no-brainer from an EBM perspective. So, I set off to find a suitable product. But became increasingly frustrated. I thought that manufacturing probiotics could not be rocket science but I experienced that no company could provide what I was looking for. Specifically, when it came to documentation around quality. I discussed this matter with colleagues and realized that I shared my concerns with others. An idea came to my mind that maybe we should just work out a solution ourselves, within the neonatal community. Philipp Novak, a life-science entrepreneur in Austria, was brave enough to get convinced and off we went. Backed by a group of clinicians and researchers. In 2016 we founded the startup company Neobiomics and initiated our collaboration with Chr.Hansen, world-leading manufacturer of bacterial cultures. And now, after 1000s of work hours (pro bono BTW) and with very limited funds, we have now reached the first goal. With ProPrems® there is now a premium product available, with manufacturing quality as we want it (single-dose-packaging, 2y stability in room temp, tested against an extended panel of contaminants, no risk of antibiotic resistance gene transfer). What’s next? To speak in symbols, our plane is on the takeoff strip at full throttle while we are still putting the wings together. So times are both hectic and thrilling. But like when standing in front of a very ill infant in the NICU, I feel that this is something we can manage by systematic and hard work. But of course, ProPrems® needs to find the way out to NICUs. Without a costly "old-school" organization of sales rep’s etc, this may seem challenging. But given the collegial feedback so far, we feel confident our project will sustain. If you get interested to learn more, find more in the attached folder. You can also visit the web sites neobiomics.eu and proprems.eu, or get in touch with me directly at stefan@neobiomics.eu. But please note that ProPrems® will be only available in Europe (that’s why access to ProPrems.eu is restricted from non-EU countries). ProPrems_Folder.pdf

I get in touch

@Rola alzir thanks for your comment. I am not aware of any data supporting the use of ranitidin (or other anti-acid drugs) with ibuprogen. In general, the use of anti-acids seems to have few (if any) positive effects, but side-effects. Read the blog post below by Keith Barrington (from 2013 but still relevant) and when it comes to GERD, check out the document by ESPGHAN https://neonatalresearch.org/2013/12/06/acid-suppression-doesnt-work-and-its-not-safe-phunny-how-we-got-here/ https://www.ncbi.nlm.nih.gov/pubmed/29470322

Found this discussion on Researchgate! Did not know they also had a forum there. Lots of good comments. I was taught during my training that reducing dead space is the reason for vittring tubes. But as pointed out, the volume of the cut tub piece is so small that it would have no practical significance, even for an ELBW infant. But I still do it, it is in my ”auto-pilot”... https://www.researchgate.net/post/Will_it_be_better_to_cut_the_ET_tube_a_few_centimeters_after_tube_is_in_place_and_then_place_the_connector

@bimalc good point about as to whether a surgeon would be consulted. We always discuss those cases with the surgeons, they want to keep updated and don't like to be surprised if there is a deterioration (and we really need them...) In my experience, those we work with are not liberal with interventions, so consultations do not "complicate" the management. But I suppose this may well be a possibility that more surgical consultations also "drive" the rate of surgical interventions. Would be great from other members about this!

Although the photo is a bit low-pixelated, it looks like rather extensive intramural gas, i.e. NEC. Suggest stopping feeds, TPN and antibiotics. Follow the clinical course and consult your ped surgeon.

Good question! This systematic review on heart rates in children clearly shows the decline: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789232/ To be honest, I don't know exactly the underlying mechanisms behind, but I suppose it may be related to both the autonomic drive (symp/parasymp), and that HR is a more important factor for cardiac output during infancy than later in life. Anyone else knowing more of basic physiology than I do ?

@ChantalNICU I suppose there could be variations, this is the Stockholm version

@ChantalNICU Sorry for the delay... (yes, I had forgotten ) this is the written guideline: after preparation, the pumpsyringe and tubings are filled and kept for 20min. Then the tubings are flushed with the solution and then connected to the patient.

Check out this blog post by @AllThingsNeonatal Myself, I must admit I have no experience at all of erythropoetin

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)

👍

@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.