Stefan Johansson

From @Nathan Sundgren on Twitter:

We use a Siemens sequia machine (~10y old), don’t know the model number by heart (on vacation). For CNS imaging we use a 10Mhz probe.

This is indeed a valid question - I have also thought this myself, We also change every 24 hours BTW. Thanks for sharing that paper, was not aware of it. Would be great to bring this question into a research context (i.e. like large collaborative observational study, presumably with historical controls + some experimental "sham" work). I'd be in such an project

we don’t have a written guideline, but if the infant is doing well, and passing urine normally, we’d don’t do renal investigations per routine. However, in infants smaller than -3 SD in weight, we tend to screen more, often also blood and USG for renal morbidities.

Hi, how is this baby doing? Sounds like there are multiple problems, although they probably have a common (syndromatic) cause. Did you come further in genetic/syndrome diagnostics? intestinal signs and symtoms of ileus , do you now know the cause (malrotation, obstruction, vascular/ischemic etc)?

I know the Sensormedics well, it is a great machine and with few buttons I am not aware of any VG addon. The hyperinflation may be related to the PIE as such, maybe you could even reduce the CDP slightly more. My experience with decreasing the Hz is mostly related to management of CO2-retention, but I would def try to lower Hz in this case. Just keep an eye on CO2-levels so you don't end up in hypocarbia.

I have also similar cases, knowing the surprise, first looking at abdominal x-ray and then looking at the baby seeming rather well! I found a few case reports published, see here https://pubmed.ncbi.nlm.nih.gov/26034708/ and here https://pubmed.ncbi.nlm.nih.gov/12900715/

Sorry, no experience from me... we used a summarizing Word-document that was updated every shift in my previous work place

Great topic! During my years at the Karolinska NICU, we used HFOV a lot (these days, the SensorMedics was *the* machine), much thanks to my mentor Baldvin Jonsson who was trained by @Martin.Keszler. This "low-volume strategy" with HFOV is still the prevailing strategy with airleaks in Stockholm, as far as I know from my level2+ context these days, i.e. reducing pressure as much as possible at the expense of increased FiO2. Sounds this infant manages well!

I like projects outside my clinical and academic work. 99nicu was the first big project that came out in public from my "Department of Brilliant Ideas". Since several years, I have devoted a lot of work for a project that eventually led to the startup Neobiomics, since 2019 under the wings of the Karolinska Innovations AB. Neobiomics provides ProPrems®, a high-quality multi-strain food supplement. Entering the startup universe has been like embarking a rollercoaster journey. In many ways a personally rewarding experience, but it has also been walking a challenging path with many obstacles to overcome along the way. Regardless of the ups and downs, bringing an idea into a startup context will make you work. A lot. (And for most of the first few hundred/thousand hours, without renumeration.) I recently saw a TED-talk by Darria Long (see it below), on how systematic strategies in emergency medicine can be used to cope with high work loads in general. And it struck me that we, as health care professionals, are well fitted as startup founders. Not anyone make the choice to work in health care. IMHO, we are a selection of people sharing a special compassion for what we do. And, through long education and training, the importance of know-how and experience is incorporated in our DNA. How does all this make health care professionals fit for startups? we build and work through trustful relations we like to meet the unknown we work hard for a clear objective, even if the outcome may be uncertain despite limited resources, we manage things first thanks to limited resources, we can prioritize our work is problem-based, not solution-based our work has structure, even in a seemingly chaotic situation the detective work in medicine makes us good lateral thinkers Naturally, the startup universe requires its own specific skills (finance, legal, development, communication etc-etc). And the trajectory for becoming a startup founder is similar to becoming a health care professional - one needs to learn, practise and connect with others to make something out a brilliant idea. You have an idea? Make it happen! (this post is dedicated to KI Innovations AB)

From Twitter: We also change fluids from an umbilical catheter to a PICC line, "scrubbing the hub" carefully at the switch. We also have a very very low rate of CLABSI. Great to hear more people's feedback on this every-day question. @Vicky Payne - how do you do it?

This is a pattern I have not seen. As I understand (without knowing much!), epileptiform activity is an increase in voltage. But given that the aEEG trace is an summation of lots of neurons, if the seizure activity somehow would lead to a suppresion of surrounding activity, maybe the sum of it all would be a reduced voltage? 🤔 Did the neurophysiology dept come up with any explanation?

Great to connect! Internet helps us to cross borders despite the ongoing pandemic. I hope we can soon launch another #99nicuWebinar!

Thanks @HickOnACrick for posting about this, I sense it may become a hot topic Three of us ten neonatal consultants and one fellow too, are relocated from our NICU to the adult Covid-ICU. I recently spoke to one of them about how things were and he was also a bit surprised about high PEEPs/PIPs and the non-use of HFOV. He said that things are "just very different", but on the other hand, adults are different in many respects too. I am myself just too far from adult care to have a good opinion, but it will be interesting to see how this discussion takes off.

We will also live-feed the webinar on Facebook: https://www.facebook.com/events/2895857203867600/

@Pototo We would probably keep the same volume of 170 ml/kg/d if the baby is hemodynamically stable (but some increased volume may be needed) If blood sugars are OK, we'd definitily keep our regular parenteral nutrition going (or otherwise prepare individualized TPN)

Today was the day we should have met up But, I look fw to 2021

We do not recommend anyone in our NICUs to wear facemasks. Only staff use masks (N95's) if we admit infants to Covid-19+ mothers (and if the infant has stayed close with the mother before admission). OT: we do not recommend face masks in the general population in Sweden, but our authorities also gives advice different to many other countries. So, I don't think this is so representative https://edition.cnn.com/2020/04/10/europe/sweden-lockdown-turmp-intl/index.html

Another aspect of filtering air... our hospital hygiene was a bit sceptical about our wish to use filters. They argue that the humidity will make the filter less effective, i.e. viruses can still be coming through. Like more simple face mask filters (not the N95's) that are also more for the "look" after a while on, than for stopping viruses. But, we will still use those filters, they won't make things worse at least (unless a large dead space etc, thanks a lot @Martin.Keszler for that input)

Thanks Edward for posting, I believe this is a common situation. I will share your post in our various channels, lets hope for more useful feedback than mine. I have not been involved in getting filters to our unit, but I just wanted to share what we use (for the NeoPUFF, Fabian CPAP and Leoni vent's)

Just checked out the NEOCLEAR COVID-19 spread sheet and there are already 100+ publications aggregated. @clydewrightmd @GauthamSuresh and Meg - many thanks for doing this great work!

@Nathan Sundgren I send you a DM on Tw!

The Swedish national guideline also recommends incubator in this situation. here you can download the latest version (5 April), but of course in Swedish... https://neo.barnlakarforeningen.se/wp-content/uploads/sites/14/2020/03/Rekommendation-om-handläggning-av-gravida-och-barn-till-kvinnor-med-verifieradelsannolik-Covid-19_ver-2_200405.pdf

I am not an expert like @olamedmac so I cannot comment on the content as such, but I think the structure is excellent and format is superb! Do you do the animated graphics yourself? Great initiative, IMHO delayed cord clamping is one of the most low-hanging fruits in neonatal care. Somewhat OT: as we had to cancel our yearly conference due to the pandemic, we have discussed to arrange short webinars. @Nathan Sundgren would you like to present about Cord clamping over ~15-20 min in such a format?