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Stefan Johansson

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Posts posted by Stefan Johansson


  1. Thanks for posting!

    I am sorry but I cannot give advice on this matter as we don't keep/admit infants with bronchiolitis in the NICU, they are transferred to a PICU or a regular pediatric ward (to avoid viral spread in the NICU).

    Would be interesting to hear what bronchiolitis cases you have in the NICU. Also infants admitted from home? If yes, what is your policies/guidelines to avoid spread to other infants? Single rooming?


  2. @chantal - do you check pre/post-feed weights in your NICU? We used to do it some years back but stopped as we felt it added more figures than guidance... Would be great to hear your experience.


  3. @felipeym thanks, I think this portable technology will be the future also in high-income settings.

    And yes, I think the probe was too large, not the handle as such but the "imaging surface" was like 2x3 cm, so practically too large for convex surfaces like the skull or chest in a small baby.

    But, this should be possible to solve. I think that the probe size is choosen by the company to fit a the targeted user base of staff working with larger children and/or adults.

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  4. We don't measure breastfeeding volumes in infants given iv fluids or enteral NG tube feeds, but we make some assumptions.

    During the first 1-2 days of life, we don't take colostrum volumes into account at all, especially if the infant is just make some attempts to breastfeed.

    Later and when on NG tube feeds, we make a pragmatic plan and reduce the NG tube volumes with a reasonable volume.

    "Reasonable" in terms of ml? For a term infants with vigorous breastfeeding attempts we may reduce NG tube volumes withs with 1/3 per day (i.e. aim to take the NG tube out within 3 days). For a preterm infants, we usually reduce the NG tube feeds with 5-10 ml/feed after a good breast feeding attempt in preterm infants.

     


  5. Finally... my colleague brought the Butterfly probe and and Ipad, and I took some brain images and echocardiography views. The probe has a large surface and lot of gel is needed to avoid artefacts.

    Naturally, the quality is not comparable to our real machine. On the other hand, I think that the quality was surprisingly good, almost like the XP128 (back in the days... :) ) . Looking at the AV valves with color doppler also worked reasonably well.

    I did not go into any details in the software, but similar to a "real" machine, adjusted settings could probably increase the image quality.

    I attach two photos and a long axis echo-view (VLBW infant)

    PNG image 3.png

    PNG image 4.png

    PNG image.png

     

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  6. Thanks for sharing this (not uncommon!) clinical scenario. Will be interesting to follow the discussion.

    Actually, this topic will be one of the interactive lecture sessions on the #99nicuMeetup in Vienna next year :) , one of the real experts in this field has semi-confirmed.

    I find this tricky myself, I like to stick to our guidelines. In practise, we typically handle a case like this with an inter-collegial discussion (sometimes also involving our neighbouring level-3 NICU) and reach consensus how to act that way. In this case, I think the jury would be out for some time before deciding. What we'd decide in this case, an open question in my view.


  7. This article in NY Times came on my radar, written by a parent whom is also an obstetrician.

    Very well written piece and I would really recommend it. Sparkles a lot of thoughts on what we do, what we achieve, and the parental perspective.

    Quote

     

    The NICU is like a war zone, except the battle takes place in your baby’s body. You can do some things that are truly helpful, like holding your infant against your bare skin (kangaroo care) — although there were so many tubes and wires, it felt as if I was holding a bundle of electronics. You can also pump breast milk...

    But mostly you just have to bear witness.

     

    Find the article here: https://parenting.nytimes.com/newborn/prematurity-baby-burden

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  8. 17 hours ago, Nathan Sundgren said:

    A big thanks for sharing. I hope it is helpful to many of you. Follow the You Tube channel - TexSun NeoEd - if you like it. You never know when I might put something else up.

    @all - here is the URL: https://www.youtube.com/channel/UC3g3Gs_HiffehrdWiivKReg

    @Nathan Sundgren - also consider to share your videos directly here too, just start a topic in a forum, write a sentence or two and copy/paste the Youtube URL and it will embed automatically :)


  9. Difficult scenario, I must admit have no personal experience.

    But if I'd get the phone call from the ambulance and asked for advice it would something like this - "Keep the warmer but stop ventilation. Keep everything else as is and we arrange with extubation, catheters out, cleaning/dressing etc when you and the parents has arrived safely here"

    Warmer and stopped ventilation - I would feel disrespectful towards the infant if he/she got cold and also to keep on ventilating.

    I would consider the actual death time as is (during transport) but I would feel really bad if the parents would not present when the body of the infant is taken care off after death. 


  10. @nashwa Would be great to hear the experience by for example @Francesco Cardona , I work in a NICU with ≥28w infants now.

    As I understand from level3 colleagues, nCPAP with relatively high pressures is the primary mode of respiratory support, and LISA the method to give surfactant, while nCPAP is ongoing. This is said to be a successful strategy for a surprisingly large proportion of the very immature infants (also ~24-25wk), but I don't have numbers or first-hand experience myself.

    I have even heard discussions that staff worry about intubation skills, and how those skills are trained/kept when only a minority of ELBW infants needs intubation and invasive ventilation.

    A new world!

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