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Stefan Johansson

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Posts posted by Stefan Johansson


  1. We sometimes culture infants for herpes simplex born through a normal vaginal delivery and maternal herpes simplex is discovered late during or after delivery (typically recurring herpes).

    In case of a positive herpes PCR, for example in the upper airway, but negative PCR in blood and cerebrospinal fluid - how would you outline management How do you reason around "colonization" vs "infection" with herpes simplex?

    My experience over the years, is that a more active management are now adviced from our virology consultants, i.e. iv acyklovir for a relatively long time period.

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  2. This is indeed a valid question - I have also thought this myself, We also change every 24 hours BTW. Thanks for sharing that paper, was not aware of it. 

    Would be great to bring this question into a research context (i.e. like large collaborative observational study, presumably with historical controls + some experimental "sham" work). I'd be in such an project :)

     

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  3. Hi, how is this baby doing? Sounds like there are multiple problems, although they probably have a common (syndromatic) cause.

    Did you come further in genetic/syndrome diagnostics? intestinal signs and symtoms of ileus , do you now know the cause (malrotation, obstruction, vascular/ischemic etc)?


  4. I know the Sensormedics well, it is a great machine and with few buttons :) I am not aware of any VG addon. The hyperinflation may be related to the PIE as such, maybe you could even reduce the CDP slightly more. My experience with decreasing the Hz is mostly related to management of CO2-retention, but I would def try to lower Hz in this case. Just keep an eye on CO2-levels so you don't end up in hypocarbia.


  5. Great topic! During my years at the Karolinska NICU, we used HFOV a lot (these days, the SensorMedics was *the* machine), much thanks to my mentor Baldvin Jonsson who was trained by @Martin.Keszler

    This "low-volume strategy" with HFOV is still the prevailing strategy with airleaks in Stockholm, as far as I know from my level2+ context these days, i.e. reducing pressure as much as possible at the expense of increased FiO2.

    Sounds this infant manages well!

     


  6. This is a pattern I have not seen. As I understand (without knowing much!), epileptiform activity is an increase in voltage. But given that the aEEG trace is an summation of lots of neurons, if the seizure activity somehow would lead to a suppresion of surrounding activity, maybe the sum of it all would be a reduced voltage?

    🤔

    Did the neurophysiology dept come up with any explanation?


  7. Thanks @HickOnACrick for posting about this, I sense it may become a hot topic :) 

    Three of us ten neonatal consultants and one fellow too, are relocated from our NICU to the adult Covid-ICU. I recently spoke to one of them about how things were and he was also a bit surprised about high PEEPs/PIPs and the non-use of HFOV. He said that things are "just very different", but on the other hand, adults are different in many respects too.

    I am myself just too far from adult care to have a good opinion, but it will be interesting to see how this discussion takes off.


  8. We do not recommend anyone in our NICUs to wear facemasks. Only staff use masks (N95's) if we admit infants to Covid-19+ mothers (and if the infant has stayed close with the mother before admission). 

    OT: we do not recommend face masks in the general population in Sweden,  but our authorities also gives advice different to many other countries. So, I don't think this is so representative

    https://edition.cnn.com/2020/04/10/europe/sweden-lockdown-turmp-intl/index.html

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  9. Another aspect of filtering air... our hospital hygiene was a bit sceptical about our wish to use filters. They argue that the humidity will make the filter less effective, i.e. viruses can still be coming through. Like more simple face mask filters (not the N95's) that are also more for the "look" after a while on, than for stopping viruses. But, we will still use those filters, they won't make things worse at least (unless a large dead space etc, thanks a lot @Martin.Keszler for that input)

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