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Stefan Johansson

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Blog Comments posted by Stefan Johansson


  1. Great post (and title!), and I really like to principal idea to nebulize surfactant.

    But, I find the baseline risk of intubation very very high in this relatively mature group of preterm infants. The difference seemed driven by the 32-33 week group, in which 75% (10/13) were intubated if not given nebulized surfactant!

    I don't have the exact number but in the very preterm group (w28-31) the majority is managed conservatively on CPAP only (no surfactant via INSURE/MIST).

    So, this study must be either limited by internal validity problems (selection bias?), or have lower external validity due to CPAP strategies and RDS management strategies that may be different compared to many NICUs (like ours).

    IMHO, more research is needed.


  2. Sounds like pushing the skin-to-skin care to its boundaries!

    Personally, I think it is not a bad idea as such, I guess one just needs to get used to it.  However,  it is not uncommon that intubation is not just something isolated, but part of a stabilizing efforts that includes more procedures/medications etc. In other words, I am not sure skin-skin-care is the right thing to do in an infant with respiratory failure, whatever its cause.

    My personal experience is that I have used parents to comfort the infant (holding support) on the open bed while intubating, i.e. including them in the team doing the stabilization.

    • Like 2

  3. Great commentary on this paper in J of Peds!

    I think the first principle of doctoring, Do No Harm, is sometimes missed when it comes to caffeine. And that the other common belief, More Is Better, is taking over critical thinking.

    The main evidence for its use it the CAP trial by Barbara Schmidt and here group, where the majority of infants had 20 mg/kg as loading dose, and then recieved 5 mg/kg. But at least around here (i.e. the Swedish pond), there is a trend towards high-dose treatment (i.e. 10 mg/kg).

    But as you suggest, as we believe that caffeine is causally related to improved outcomes, reaching a therapeutic level is a logic approach. +1!


  4. Interesting post!

    Some colleagues tend to use it for more severe BPD-patients (although on CPAP etc), but I just have not felt convinced myself, which was why I posted this topic some time ago.

     

    Will read up on the reference you gave (but I tend to agree that there could a whole lot of observer bias there...)

    PS. BTW, I fixed the images, I copied & pasted the image URLs from allthingsneonatal. com

    • Like 1

  5. When I read this publication with my clinical epidemiology-glasses, I wonder if the results (and conclusions) are just an example of the cohort effect.

    @AllThingsNeonatal you are very nicely referring to that possibility, when you discuss the possibility of a changing distribution of gestational age over time, and mortality differences over time (that probably reflect change in care over time).

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