Stefan Johansson

I have only one experience from cytostatic medications to newborns, an ELBW infant who developed histiocytosis while being in the NICU. This infant was treated with etoposide, dexamethasone, and immunoglobulin. The case was reported in Acta Paediatrica, here's the PubMed URL: http://www.ncbi.nlm.nih.gov/pubmed/17888050

I just came across a very interesting initiative, taken by Ian Callander,an Australian neonatologist; the development of an open-source software platform for collection of clinical data during neonatal care. As I understand it, the data can be used for quality control, follow-up statistics, and clinical audit. More info is posted here: http://home.iprimus.com.au/Callanders/

We had a discussion regarding our "protocol" for teddy bears, i.e. where we accept teddy bears and similar toys which parents/friends/relatives give to children in the nicu. Currently we allow such toys in the beds of stable infants (typically infants fully fed enterally), and on the side board beside incubators. However, we thought we might re-evaluate this policy, since we really do not know to what extent those toys might be colonized with bacteria. Do you have a Teddy Bear Policy?

99nicu has recently celebrated its second anniversary (...the lounge for further details...) and we are now entering the third year of our community. I would like to start a discussion for feedback and comments from you. What can we change to make things better? Personally I think there are several important tasks to accomplish: * continue to encourage discussions in the forums (that's what we are here for) * make people post job offers on our Message Board (it's easy and free) * offer really good member benefits, such as full-text access to journals * improve ways for members to interact with each other One issue to tackle is also our financial situation, to promote current ways to support 99nicu (supporting memberships and our bookshops), and to find sponsorships. Funding is necessary for our plans to offer full-text access to journals, and also to cover our increasing costs for external technical support. With regard to new features at the web site, we will soon update the software. The new version contains several nice community features, which makes it possible for you to start your own user groups, among many other things… Finally, I would like to thank everyone who has encouraged me and the 99nicu Team during the past two years. My very best regards to all of you!

Just a quick comment: our approach is to look for glucosuria. If there's no glucosuria we are generally conservative (leave things as they are) but reduce glucose administration. If blood glucose is much elevated and we find glucosuria, we may use insuline infusions, according to the NeoFax recommendation. But as Darya points out - beware of HYPOglycemia.

We would treat conservately if the duct has responded partially and the shunt is definitely non-significant. I would advice that you repeat the echo from after a few days and then as needed, to make sure the duct does not re-open. It is not uncommon that medical treatment result in functional closure but you can still see a small restrictive shunt with colour doppler. Although some factors make such ducts prone to re-open (especially the situation extreme prematurity+septicemia), they commonly close anatomically with time. But it is good to know they do (echo!)

I live through a kind of refractory post-doc phase. I defended my thesis last Friday (080418), managed pretty well , the party in the evening was wild and crazy , and I am about to adapt to the new life of being 'MD PhD'. I think I need to 'digest' what has happened. The last few nights, I have had some really strange dreams about things that did (and did not) happen that day. I guess Freud would be delighted to hear about this... It feels good to be back in business again. I am sure some regular clinical commitments will help to get back to reality again. Babies don't really care about PhD's. And I am still me!

Well, it depends. If a RN is presenting research on a congress, costs are funded by travel grants from independent funds, an academic institution, or the hospital etc. Travels to national congresses or courses are paid by the hospitals, but only if the congress/course and the associated expenses have been approved by the head of the department.

Dear Manuel, There's a few topics that come into my mind for your speech on the congress: * prenatal screening of congenital heart disease - there's plenty of studies and one can really argue for both pro's and con's. * renal pelvic enlargement. * nuchal clearence - chromosomal abnormalities like Down syndrome * pregnancy dating for assessment of gestational age * diagnosis of fetal arytmias Hope this short input helps.

I think you would need to discuss this with the provider of the gas system. I would think it is a quite tricky thing to achieve. You would probably de-pressurize the whole system and you would need loose gas tubes to keep ventilators going while the cleaning is done. What made you think the gas system is colonized?

We have no rules about parents access, they can visit their infants any time of the day/night, all days a week. It works good. We also make parents do some of the nursing too, like nappy changes and gastric tube feeding.

Dear Mariam, you raise several very thoughtful questions. We sometimes come across friends and relatives in the NICU and generally (if close friends & relatives) the staff involved decide not to be a care-giver. I have done that myself, refrain from being formally responsible (but yet involved in discussions etc) for the care of families I know privately. Thereby not saying that's a correct strategy. And, I have not experienced something similar. I guess every case need to be individualized with a certain degree of consensus with those involved. Personally I would not consider your situation to be unethical, but it might be inappropriate. On the other hand, the choice (what-to-do) may partly be up to the parent involved. If this nurse and mother feels strongly that she can both take care of her own infant and another patient with the same professional approach, it may not be a conflict to be mother and staff. I would feel uncomfortable to formally forbid a parent to take care of its own child, if professionalism regarding the child and other patients can be ensured. Being in the same situation... well, I would probably not feel like taking any medical responsibility if my own child would end up in the NICU, but leave this to my colleagues to take care of.

Could you please specify, is it the ventilation system that is colonized?

I am pretty sure our hospital pharmacy prepares en "ex-tempore" solution. I will see if I can find out some details regarding manufacturer of the base solution etc. UPDATE. I spoke to our own pharmacist and I was right. He also said that the Swedish Pharmacy Production unit accept external orders of the caffeine citrate solution (5 mg of caffeine /ml), and adviced you to contact the production unit ( info.aplsto@apoteket.se ). I have no idea about prices / regulations regarding export etc. He also referred to more general information here: http://www.apl.apoteket.se/Engelska/index2.htm

Thanks, tomorrow is the day to pick it up at the printing company!

The web broadcast of this conference is now able to view here: www.karolinska.se/pediatricstc (Click on Watch The Meeting, in the right column, submit your name and email, and start watching.)

Yesterday I approved the final proof for my thesis book "Very preterm birth - etiological aspects and short and long term outcomes". It is being printed right NOW and I will have a LARGE stack of books by next week. Will post a photograph. My latest years of hard work and psychological tension will have the ISBN nb 978-91-7357-498-3 If you spend a day in Stockholm on the 18th of April, welcome to my dissertation in Leksellsalen, Karolinska University Hospital. Grand thesis defence in the morning, big party in the evening (just send me a mail and I will return an invitation!) UPDATE 080319... pile of books!

Hi! We do not have MRSA very often, but during those rare occasion we practise "barrier" care (more strict hygiene routines than usual), i.e. dedicated staff, nursing the infant in its own room when possible or admitting no new infants to that room, protection cover dress, gloves when nursing, and very-very strict hand desinfection by parents. We do no bathe infants in desinfectants. However, our policy deals with colonization, so it's basically a different thing compared to the scenario you have to deal with. I hope someone else can give you better advice!

I envy you doing PDA surgery in the NICU, we need to transport infants to the operating theatre. LA/Ao-ratios... your right, 1.4 is what's considered to be the lower limit for enlargement. However, I personally think LA/Ao-ratio is somewhat difficult, depending on the angle of the ultrasound probe it is easy to mis-judge this ratio, especially in tiny patients. When we do echoes (ourselves) we look try to look also for functional indications of shunting, such as diastolic velocity in the left pulm artery, doppler wave-form in the duct itself, and diastolic flow in postductal aorta. I wished we used systemic venous return as a indication of shunting (see publications by NIck Evans & co-workers in Sydney, Australia).

Dear Darya, there's really a lot of opinions and experience about PDA, its diagnostic criteria and treatment, but I personally think it's not easy to get really good evidence-based strategies. Maybe you could find some useful info in a very recent Cochrane-review about surgery vs indo: http://www.ncbi.nlm.nih.gov/pubmed/18254035 Interestingly, authors write suggesting that early surgery would be better than late surgery. My personal opinion is that a drug is better than a knife. So, if you would get ibu or indo as treatment options, I would advocate that to be the primary treatment option. PDA (open) surgery, although a short procedure, is a major surgical trauma to a tiny infant, and can often be avoided when NSAIDs are initiated during first postnatal days. With regard to the example above - it seems that the duct is wide-open (3 mm in a small infant), although the LA/Ao-ratio is not very high. It may be so that you still have elevated pulmonary resistance, keeping shunting volumes relatively low. My experience is also that LA/Ao-ratio is not easy to interpret when the baby is on HFOV, since the constantly elevated intrathoracic pressure has a similar effect on shunting. I would vote for PDA closure!

Neonatology 2008 Neonatology 2008, March 27 - 28, 2008 Emory Conference Center, Atlanta, Georgia Day 1: The Neonatal Gastroenterology: From Nutrition to Infection to Protection Day 2: Neonatal Pharmacology - Treatment Decisions Day 2: Legal/Ethical Issues in the NICU: Hot Spots and Minefields Additional information, program brochure and payment by credit card is available on the Division of Neonatal-Perinatal Medicine website at: http://www.pediatrics.emory.edu/NEONATOLOGY/ For program brochures and registration forms contact Karen Parker at 404-727-3360 or Karen_Parker@oz.ped.emory.edu For sponsorship interest and exhibit opportunities contact Rita Ibarra at 404-727-5765 or ribarra@emory.edu

Here the list of scheduled and planned seminars and congresses organized by IPOKRaTES during 2008. Check out their web site www.ipokrates.info, or email ipokrates@mcon-mannheim.de for further information Scheduled seminare and congresses Neonatal Nutrition and Gastroenterology, Nevsehir, Turkey, May 29-31, 2008 UPDATE in Neonatology, Sun City, South Africa, May 29-June 01, 2008 Cardiovasc. Intensive Care in Neonates & Children, Zurich, Switzerland, June 26-28, 2008 Neonatal Comfort: Analgesia, Sedation and individualized Loving Care, Madrid, Spain, June 12-14, 2008 Neurodev. Follow-Up of ”at risk” children, Turku, Finland, Sept 11-13, 2008 , and Bari, Italy, Nov 13-15, 2008 UENPS (Union of European Neonatal and Perinatal Societies) is a European Roof organisation at present comprising 23 national neonatal or perinatal societies and is organizing its first congress “Global Neonatology & Perinatology”and “Academic Olympics”, Rome, Nov 17-19, 2008 Current Concepts in the Intensive Care of Critically Ill Neonates & Children, Riga, Latvia, Sept 17-19, 2008 Current Concepts in the Intensive Care of Critically Ill Neonates & Children, Belgrad, Serbia, Oct 8-10, 2008 Infections Diseases and Immunologic Disorders in Newborns + Children, Bangalore, India, Sept 4-6, 2008 Renal, Water and Electrolytes, Mumbai, India, Sept 25-27, 2008 Renal, Water and Respiratory Disorders, Ho-Chi-Minh City, Vietnam, Aug 22-24, 2008 Nutrition and Gastroenterology, Cairo, Egypt, Dec 2008

Norbert, you're right! Anna, I'm sorry I did not read your post carefully enough (reading tracheomalacia instead of laryngomalacia, my fault). How are things developing?

Well... we would call our ENT consultant and leave most decision-making to him. I just searched PUBMED and found some nice articles. Actually, tracheomalacia was not a Mesh-term, which I found a little strange, given how common it is. I found nothing on steroids+tracheomalacia. A qualified guess would be to that the ENT advice would be tracheostomi to get off the ventilator, and while awaiting spontaneous resolution, OR to do some kind of ENT surgery. Please keep us posted how things develop! Review: http://www.ncbi.nlm.nih.gov/pubmed/6847290 Laser epiglottopexy: http://www.ncbi.nlm.nih.gov/pubmed/16982974 Aortopexy: http://www.ncbi.nlm.nih.gov/pubmed/16516630

I suppose sound is transmitted through the web cast. If that's not the case, please contact eva.wesslen-eriksson@karolinska.se UPDATE: It seems that the load on the broadcast is pretty high. I did not get a broadcasting window open when I clicked on PLAY (see pict 2 above), but after I had clicked several times (repeatedly) on PLAY, the window appeared. Looks fine from my computer, slides appear fine, I see the speaker and sound (speaker's voice) is good. I guess the organizers are interested in your feedback. Please post it here or send an email to Eva Wesslen-Eriksson (eva.wesslen-eriksson@karolinska.se)