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Stefan Johansson

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Everything posted by Stefan Johansson

  1. @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
  2. 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
  3. @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!
  4. 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.
  5. 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 ?
  6. @ChantalNICU I suppose there could be variations, this is the Stockholm version
  7. @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.
  8. Check out this blog post by @AllThingsNeonatal Myself, I must admit I have no experience at all of erythropoetin
  9. 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.
  10. 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.
  11. 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
  12. @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.
  13. Dear Char, you would have loved to attend this lecture at the latest #99nicuMeetup, and participate in the debate that followed. Complex topic!
  14. A new Cochrane review related to EUGR https://www.evidencealerts.com/Articles/AlertedArticle/87436
  15. 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
  16. We utse the Neo-fit tube grip. Works well! https://www.coopersurgical.com/medical-devices/detail/neo-fit-neonatal-endotracheal-tube-grip
  17. 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
  18. This is funny (and IMHO - because it is somewhat true)
  19. @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.
  20. 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.
  21. @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
  22. Dear @Akash Sharma, thanks for posting about this! We spend much time on nutrition, but personally, I tend to feel confused on this higher level. Some infants grow well, while some infants grow poorly whatever we do... We use a computerized program (https://www.nutrium.se/) and make individual fortification to every preterm infant. Weights are plotted on a growth curve (starting at 24 wks) and we aim to achieve a "normal growth velocity". For SGA infants we tend to think about the patophysiology, if it is IUGR due to placental reasons (like pre-eclampsia), we think there is a potential for this baby to be AGA. So we expect catch-up growth and (if needed) try to promote that with fortifications. We don't use the term EUGR in our unit, but we strive to get all infant withn the "normal" weight range, for us that means that we want infants within +/- 2 SD on the growth chart. Coming to your question... we tend to use the growth-chart-definition of poor growth rather than body-composition analyses or clinical endpoints (which are also more like outcomes of growth)
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