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Stefan Johansson

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Everything posted by Stefan Johansson

  1. @K. S. Gautham Thanks for sharing! @all - here's the direct link to the paper by Patil et al: https://www.nature.com/articles/s41372-020-0765-3
  2. We sometimes culture infants for herpes simplex born through a normal vaginal delivery and maternal herpes simplex is discovered late during or after delivery (typically recurring herpes). In case of a positive herpes PCR, for example in the upper airway, but negative PCR in blood and cerebrospinal fluid - how would you outline management How do you reason around "colonization" vs "infection" with herpes simplex? My experience over the years, is that a more active management are now adviced from our virology consultants, i.e. iv acyklovir for a relatively long time period.
  3. More from Twitter! @Aedi Budi Dharma - as reply to your question about blood products, we don't use PICC lines for plasma or blood, the lumen of our PICC lines would clot.
  4. We practically only use our PICC lines for parenteral nutrition. The small diameter (28G) only makes it possible to infuse only.
  5. 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.
  6. 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
  7. 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.
  8. 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)?
  9. 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.
  10. 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/
  11. Sorry, no experience from me... we used a summarizing Word-document that was updated every shift in my previous work place
  12. 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!
  13. 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)
  14. 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?
  15. 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?
  16. Great to connect! Internet helps us to cross borders despite the ongoing pandemic. I hope we can soon launch another #99nicuWebinar!
  17. 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.
  18. We will also live-feed the webinar on Facebook: https://www.facebook.com/events/2895857203867600/
  19. @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)
  20. the first 99nicu Webinar - assistant professor Nathan C. Sundgren will lecture on Delayed Cord Clamping, on May 14, 2020 16:00 (CEST) Nathan C. Sundgren, MD, PhD, is medical director of neonatal resuscitation education and assistant professor of Neonatology at Texas Children's Hospital, Houston, Texas, USA. He is concerned about all things related to delivery room care and has published quality improvement work and clinical trials related to delivery room team communication and performance of resuscitation. As an educator, he seeks to use global platforms to spread information on neonatal resuscitation such as on his YouTube channel "TexSun NeoEd." This is our first webinar, and if it works well, we aim to run a series of educational webinars during 2020. Stay tuned!
  21. Today was the day we should have met up But, I look fw to 2021
  22. 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
  23. 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)
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