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Stefan Johansson

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Everything posted by Stefan Johansson

  1. Very interesting project. I think group dynamics in the NICU is far more important than most would admit! Decision-making in neonatal care certainly benefit from better team work. I will be spying on your unit, once you have put the principles above into practise.
  2. Dear Manuel, I do not have real knowledge about this and would appreciate responses from other members too. We also get s-lactate levels on our new blood gas machine but we do not consider the values so much. Naturally, in investigations for metabolic diseases, we generally check lactate in blood and liqour. But I guess your question is more related to whether lactate reflects poor peripheral perfusion (indicated by your protocol for giving saline bolus if lactate increase). Will do some PubMed search later since this question also interests me, just need some recovery from my night shift!
  3. We do not change feeding during transfusions.
  4. Hi! Cutting the frenulum feels, to me, as one of the least evidence-based treatment in neonatology. (also saying that we do a lot of non-evidence based things everyday!) We do this very infrequently, but sometimes, if the midwifes feels sure about that feeding could be associated with a tight frenulum. Our ENT people would suggest themselves to do it, since a bad cut can heal with even further tightness. But we do ourselves too sometimes, with a pair of scissors, max 2 cuts, to the tounge muscle.
  5. Hi! It seems that this child may have a rather prominent deformity, and it may not correct itself at this late age. It is difficult to tell from the description whether is it position related (baby sleeping with head on one side) or whether it is truly a craniosynostosis. Although very rare but if we feel treatment can be necessary, we get a second opinion from neurosurgeons specialised in craniosynostosis surgery. A plain x-ray is usually done to look at bone mineralisation in the sutures. Although surgery is done for cosmetic reasons, I think a "cosmetic" indication is good enough in cases with progressive cranial deformity. Have not heard of any experience of the helmet treatment you refer to.
  6. 99nicu soon has 1500+ members, and it would be interesting to hear your opinions about our community. The web visitor statistics shows a steady and rising number of visitors too, but we feel that 99nicu does not reach its full potential yet. How can we facilitate discussions? Which features are missing? Are you getting too many emails, or too few? Can we improve design and functionality? Creative ideas about funding? Speak freely!
  7. Have any of you approached the manufacturer about this?
  8. Could this finding be related to the blood flow re-distribution in utero of IUGR infants - that the reduced circulation in the abdominal organs somehow lead to elevated IRT? Have you checked Pubmed, your question may be a nice and well defined research idea?!
  9. It is easy! 1. Go to the image library 2. CLick on UPLOAD in the Gallery Navigation Box. 3. Just follow instructions: choose a category such as "brain", locate the uploading file on your computer, write a title and a short information text about the slide. Finally, press upload and you're done! 4. All members have permissions to delete their own pictures from the Library. So, try the trial-and-error method! We have set a limit to 500kb per picture/illustrations, and each member can upload up to 100 images. If you have photos that are large (in kb!), please try to compress those in datasize, to keep downloading times down, and spare our server space.
  10. Firstly and importantly, we use lidokain only when fenobarbital and/or midazolam fails to control seizures. The dose we recommend in our (local) protocol is as loading dose of 2 mg/kg, and continued by 2-6 mg/kg/hour. ECG surveillance is mandatory and we try seponate within 48 hours.
  11. Interesting observation! Do you routinely check IRT in SGA infants? (We don't)
  12. Dear all, we are planning to open an Image Library, for illustrations that could be used when explaining common neonatal problems for parents, for lectures etc. This idea originally came from an email sent through NICU-NET, another great internet resource. As the forums, this Image Library would be member-driven, i.e. any member can upload pictures to the Library, into categories divided into organ systems. Questions: 1) Would you like to beta-test this new function?! 2) Any input on the systematics of the Library? Our suggestion is to arrange pictures by organ system. Any feedback is appreciated!
  13. 8th World Congress of Perinatal Medicine Florence, Italy, 9-13 Sept 2007 Visit the congress web site for more information.
  14. A difficult case! Are the infant on all the mentioned drugs or have you tried one by one? Are the seizures confirmed by EEG? Have you tried to give pyridoxin (vit B6)? Lidokain may be an option too.
  15. Hi Rennee! Our policy is to re-feed residuals if they consist of digested breastmilk, and substract the residual volume from the planned feed (keeping the total volume the same). If residuals looks greenish or otherwise "unfresh" we usually throw it away, and skip the planned feed. Depending on other clinical signs, residuals also later (despite the skipped feed) we handle each case individually. But we are quite scared of NEC in the ELBW infants, and it is not uncommon with a rather careful feeding strategy.
  16. Dear ammar, difficult scenario! We would probably add epinephrine, while decreasing dobutamine slightly. If you have echo easily accessible one may also try to increase the NO dose, while doing doppler and see if it is possible to decrease pulm resistance.
  17. Hesham Abdel-Hady sent us an email about the recent neonatal ventilation course at the Mansoura University Children's Hospital: He also enclosed two pictures from the conference. Do not forget that you can advertise your courses and conferences here on the message board, and also add these as events in our calender. If you need help, send us an email (info@99nicu.org)!
  18. Thanks for encouraging words! We will do our best to do some better marketing, to get this ship of the ground. The bundle-of-books competition is only our first campaign!
  19. The answer is yes, there are now guidelines for cooling, but all treated infants are included in an observational study. I don't have the guidelines at hand right now, but pathol CFM is NOT included as a criteria. Personally I feel more research is needed on this technique and thaht CFM seems to be a reasonable inclusion criteria. But I can also understand that one may argue that the treatment works, although I think the scientific evidence is a bit weak so far.
  20. Yesterday we made a major upgrade of the forum software. Among other things, we fixed a problem with so-called cron-jobs, which take care of automatic technical things on the forum. If you subscribe on discussions you will now notice that subscriptions work! Everything looks the same after the upgrade, except for changes in our Chat facility. you enter the Chat through the alternative '99nicu Chat' in the QuickLinks menu above (top right). the Chat rooms are incorporated in the 99nicu web page and does no longer open in a separate window. For more info about our Chat, read this thread. (Why upgrades? Improved functionality! Bug fixes! To prepare for the upcoming major upgrade of vBulletin, which includes a blog function, i.e. enabling any member to start their own blog within our community. This upgrade is expected some time during the fall 2007.)
  21. Dear all, 99nicu has now been online during one year. As being the informal team leader of the 99nicu Team, I take the freedom to express our thoughts about what we have achieved so far, and our ambitions for the future. *** *** *** *** *** *** *** *** *** *** The Past Internet is the technology for communication and dialogue, and I got the idea in 2005 that staff in neonatal medicine should also gain from those possibilities. I had been a member of a computer forum for several years and had experienced the great potential in the networks created in Internet communities. Colleagues and I processed our ideas and visions and in May 2006, we launched 99nicu.org with the ambition to create a friendly, busy and helpful Internet community for professionals in neonatal medicine. The Present During this first year online, I think we have reached our first goal, to attract members. Almost 100 members have registered every month. Today, 99nicu has more than 1100 members from all over the world! From the web statistics, we can also see a steadily increasing number of visitors. In April 2007 we reached a new all-time high, with >1500 unique visitors. However, we are still waiting for our community to “take off”, and to see more activity in the forums. We (i.e. the 99nicu Team) can provide the platform, but all of us (i.e. all members) create the contents. The future of 99nicu lies in your hands! One may argue that our marketing has been quite poor. I can only agree on such criticism. However, marketing costs money and we have had unexpected difficulties to attract advertising firms. We can only hope this will improve in the future. 99nicu needs to utilize the dog behaviour of man, so commonly used in marketing - if someone throws a bone, man will try to catch it*. In the near future, 99nicu will throw some small bones too… The Potential I believe 99nicu has a great potential! We just need to get used to this form of communication (the User Manual…) and to realize that we cannot just sit and wait for something to happen. The Neonatal World can improve and unite, and we make it happen, together! Don’t have respect for the technology! Share your questions, knowledge, opinions and experience in the forums. What do you expect from 99nicu in the future? What can we improve? What features do you want us to develop further? Your feedback is of great value! Wishing you all the best and see you around! *I am throwing a stone in the glass house here, but I think that we in the health care sector are keen to run for bones, just consider how the technology and drug companies do their marketing.
  22. According to my experience, pain may also contribute to cardiovascular instability. Depending on the severity of the hypotension, we may still use a low dose of morphine-infusion, together with intravenous paracetamol. Ketamine may be an option as well, although I have no personal experience using that.
  23. I cannot do anything but agree. One should do a study about the reliability of Apgar scoring in healthy term infants. It is quite likely that the 9-10-10-scores for well infants have problems with both sensitivity and specificity (says the perinatal epidemiologist in me). If someone put this idea into practise, please acknowledge 99nicu in the article
  24. Dear Adrius, it is not possible to re-start the poll with different alternatives, you would need to start a new thread (by the way, you can add a poll yourself too, when starting a new thread!) But I suggest we continue the discussion about your second question below. I think Apgar scores are a quite crude marker of the condition of the infant at birth, but it gives some basic information about the unwell newborn infant. By using it on every child, midwifes and doctors do Apgar scoring "by automatic", also in cases where Apgar scores have some value. But I think you Adrius have a point, scoring the 9-10-10 infants may not be reasonable for its own sake!
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