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Everything posted by Stefan Johansson
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It is now possible to bookmark 99nicu.org on your smartphone browser (Safari for Iphone users, Chrome for Android users) and place the bookmark on your mobile phone screen. When you then tap on the "bookmark", browsing 99nicu looks and feels like using an app If you have an Android phone, you can get push notifications when topics you follow are updated etc, just go to your notification settings in your profile to active such push notifications. As of now, Iphone users cannot get push notifications yet. Instead, you need to rely on the notifications given on 99nicu (on my screen shot below, the nb "6" in the right upper corner) This technology is called Progressive Web Application (PWA). IMHO is works so well that I will mostly access 99nicu.org from my phone now!
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Unfortunately I don't know about any active members from Uppsala, lets see if we can get someone involved from there. I don't know the last author of these two papers but saw her email was ylva.thernstrom_blomqvist@kbh.uu.se
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Great discussion here, and it was also a very interesting discussion in our live event. See the recording below.
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And here - the webinar recording!
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We don’t have parents holding cooled infants either. But I like the idea, despite mech ventil, cooling matress, lines etc, why not?
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Join our Webinar Journal Club on neonatal airway management, 9 June at 1630-1715 CET After the initial Journal Club on neonatal airway management in our forum, we would like to engage with you in a live Webinar together with Joyce E O'Shea, Alexandra Scrivens, Gemma Edwards, and Charles Christoph Roehr, the authors of review article on "Safe emergency neonatal airway management: current challenges and potential approaches". The review article examines how to acutely manage the neonatal airway, and the challenges related facemask ventilation and intubation. In this 45min Webinar Journal Club, we will discuss the following three topics: emergency airway management elective airway management who should do/train what Click here to register ! https://meduniwien.webex.com/meduniwien/j.php?RGID=r05ba14c0a7deea737f44aa6c0c13c8e8 On 9 June and once registered on the link above, click here to access the webinar! https://meduniwien.webex.com/meduniwien/j.php?MTID=ma871fe9a5934e3892b7ec7f9ff51a4ad Panelists Joyce O’Shea - born and educated in Cork, Ireland. Paediatric and neonatal training has been between Ireland, Scotland and Australia. Developed an interest in neonatal resuscitation and airway management especially intubation when working as a research fellow at the Royal Women’s Hospital, Melbourne. Has worked since 2014 as a neonatal consultant at the Royal Children’s Hospital, Glasgow, Scotland. Continues to be passionate about making airway management as safe as possible for infants and neonatal trainees. Charles Christoph Roehr, M.D., PhD. Associate Professor - the Clinical Director of the National Perinatal Epidemiology Unit - Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, with a strong interest in studies which answer clinically relevant questions. Clinically, Charles works as an Academic Consultant Neonatologist at Southmead Hospital, Bristol. His own research interests centre around understanding the cardio-respiratory adaptation during fetal-to-neontal transition and on how to best support the newly born infant. A strong proponent of evidence-based neonatology, he acts as the NLS Scientific Co-Chair and guideline author for the European Resuscitation Council (ERC) and is a member of the International Liaison Committee on Resuscitation (ILCOR) neonatal guideline writing group. Charles also serves as President of the European Society for Paediatric Research (ESPR). Gemma Edwards – ST5 paediatric trainee in the West of Scotland. Studied in Dundee and has worked in Glasgow for 7 years. Has worked on projects looking at neonatal intubation over the last three years and particularly interested in ways to support trainees with airway management skills. Alexandra Scrivens - ST6 neonatal GRID trainee (first year fellow equivalent) in Oxford, UK. Previously clinical research fellow for the NeoCLEAR study. Am a social media editor for EBNEO and trainee representative on the resuscitation council UK NLS subcommittee. Main areas of interest are procedures, resuscitation, decision-making and respiratory care of term and preterm babies. Enjoy trail running, paddleboarding and spending as much time outdoors as possible! -
@piatkat A Pod-category now in the Links Directory https://99nicu.org/links/
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Check out The Incubator, a (first?) dedicated podcast for NICU professionals hosted by Dr. Ben Courchia and Dr. Daphna Yasova Barbeau. I have listened to two episodes and can highly recommend it. The pod is weekly and about new evidence in neonatal care and the fascinating individuals who make this progress possible. Find here https://www.buzzsprout.com/1739595
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We foremost use PICC lines for 1) TPN and 2) for longer-term antibiotics / anti-viral (not for the initial doses, but after the first few doses) Apart for incompatibilities as suggested by @Vicky Payne, I am not aware of any specific pharmaceuticals that cannot be infused.
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Intubation, feels like a topic where science and art (and opinions!) meet! And, a sensitive topic as well, when intubation is discussed, it can almost feel we discuss a ritual rather than a medical procedure In my first years as fellow, doing intubations was something that was quite stressful for myself, and early on the learning curve also for the infants... so, I think the question on how and who to train is well put but this paper. In our hospital , we have a video laryngoscope, but as trained to do direct laryngoscopy I admit I have never tried in on a patient, only in a simulation setup. But recently I had a live experience that was very positive, where the an anaesthesiologist did a video-guided intubation after a failed try with the regular laryngoscope, and it just seemed to much easier, and better for all (also the infant!) LMAs - our pediatrics fellows has been trained to use those, and our experience is very good, an airway can be almost always be secured until more experienced clinicians arrive. If you don't have LMAs in your emergency cart in the delivery room, I can only recommend to get it.
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On behalf of the 99nicu Team, I would like to invite you to participate in our 2nd Journal Club! The article we chose this time is a review article on "Safe emergency neonatal airway management: current challenges and potential approaches" by Joyce E O'Shea, Alexandra Scrivens, Gemma Edwards, and Charles Christoph Roehr. This artile is not Open Access, but I hope you can get it from your hospital library. The review article examines how to acutely manage the neonatal airway, and the challenges related facemask ventilation and intubation. Some of the key messages in this paper are: Intubation success rates are low, especially for inexperienced trainees Universal intubation competency for all pediatric and neonatal trainees and consultants may no longer be possible Videolaryngoscopy can help increase rates The laryngeal mask airway (LMA) is a promising alternative to intubation Some of the questions we would like to discuss are: What is current practice in your department? How to do you manage the airways and who is doing what? What do you think are the strengths of this review article? What do you think are some of the limitations? Will this review have an impact in your department? If no - why? If yes, how? We are looking forward to hearing your thoughts and opinions! UPDATE: More information on the virtual journal club on June 9th here: https://99nicu.org/99nicu-news/join-our-virtual-journal-club-meetup-on-neonatal-airway-management-9-june-1630-1715-cet-r124/
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In the past, we paused iron supplementation during three days after a blood transfusion. However, we thought this routine did not really make sense as the iron load from a blood transfusion would correspond to ~1 month of iron supplementation In infants with many transfusions, we do check S-Ferritin, and halt iron supplementation if S-Ferritin is >350 μg/L.
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Big topic, and lots of available reads! I would suggest to start off with two review papers, the first one describing long-term outcomes from the key RCTs (like the NICHD and TOBY trials, and the other one about neuroimaging (like a historical overview). https://pubmed.ncbi.nlm.nih.gov/27863707/ https://pubmed.ncbi.nlm.nih.gov/27673422/
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I like the underlying principal, that we shall empower and engage parents. I see the major take-home message as being how few parents were present, something that can certainly be improved. From a methodology perspective, I think there are some major limitations (I know, I take the role as Reviewer #3 now...😞 the cohort is from 2014-7, so the findings may (hopefully!) be outdated, that more parents are present nowadays the association between parental presence and the lack of positive or negative impact on intubation outcomes: this may be baised by differences in who the professionals were having parents present/absent, and whom were the parents that did attend. I think both professionals and parents may have impacted the "chance to be present", this may have pushed the point estimates in various directions... i.e. the groups with no-presence vs presence may be less comparable So I feel mostly a bit confused on a higher level, which is also not a bad thing When I was a fellow, we always asked parents to go out before intubation, but I'd say this was for something we wanted, not be nervous by parents looking at how we succeeded. Nowadays, my own principle is that we shall do as much as possible with parents attending, of course respecting parents' own preference. I believe that fantasies are worse than reality, i.e. better to experience and "see" what is actually happening than to be told afterwards. As @bimalc shared above, I also experience that many parents decide to leave the room when their child will be intubated. But I also had one experience some years ago, when a parent stayed at hold the infant together with a nurse, during intubation. For myself, this was an emotional experience, to see how a parent comforted so well during a rather dramatic and stressful situation for this infant. It strengthened my belief that family-centered care is the way to go.
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99nicu has taken the step to Instagram! Follow on https://www.instagram.com/99nicu/ This idea was brought up by @piatkat in discussion within the new extended 99nicu Team. Our plan with this new channel... yet to be fully determined, but presence where many others are present is generally a good thing
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We have re-introduced our auto-generated Newsletter. It will come on Wednesdays, and include practically all updates in the forums, the blogs, the Links Directory etc-etc. I hope this will not be too frequent interval, and instead facilitate you to keep updated and also help you to join discussions, post your own topics etc-etc. Most of you probably subscribe to this since before. If not, go to your Account Settings and make sure to activate it. It is key that your email address assoiciated with your membership is up-to-date. A memberships with an invalid email address will be cleared from our database.
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Can you check here: https://www.karolinska.se/for-patienter/graviditet-och-forlossning/sjuka-nyfodda-barn/app/ -
Everything in the NICU is not about the complicated level-3 cases. I learned something new over the weekend shift, that umbilical granuloma can be treated with regular table salt (!). Another colleague had read about this and tried on one of our ex-preterm graduates with a granuloma. Seemingly good outcome. Had to do some Pubmed-browsing and found two papers on the topic, the latter being a systemic review https://pubmed.ncbi.nlm.nih.gov/31120144/ https://pubmed.ncbi.nlm.nih.gov/33154632/
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We welcome Vicky Pane @Vicky Payne and Katarzyna Piatek @piatkat to the 99nicu Team! Vicky is an Advanced Neonatal Nurse Practitioner (ANNP) and Principal Teaching Fellow from the U.K. She teaches trainee ANNPs on the MSc of Advanced Clinical Practice at the University of Southampton, and is interested in the translation of evidence into practice and implementation of evidence in practice. She is currently undertaking a PhD studying the implementation of care bundles to reduce central line-associated bloodstream infections in the neonatal intensive care unit. Katarzyna is a polish physician, currently working full-time on her Ph.D. research project within the Baby-friendly Ventilation Study Group in Turku, Finland. She is passionate about family-centered care and meaningful parental presence in the NICU. Enthusiast of Latin dances, Polish cuisine, and Finnish nature (excluding mosquitos and snow in May). Both Vicky and Katarzyna have been strong 99nicu supporters and advocates for a long time, lecturing on our (pre-Covid) annual conferences, moderating webinars and being active members on the forums. @Francesco Cardona and I am very happy to have you coming onboard in the 99nicu Team! We will achieve great things together!
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I think about the connection between PPHN and low BP as related to several possible mechanisms: cardiac (impacted left ventricular function due to other increased to right sided pressures) and vascular (vasodilatation from PPHN treatment). As PPHN is also rather a symptom, the underlying etiology as such may also impact cardiac function. For example, in the case of asphyxia/mec-aspiration, reduced myocardial function may be more related to that than the actual PPHN as such. Here a nice review of PPHN! https://neoreviews.aappublications.org/content/16/12/e680
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This would depend on the baseline risk of maternal hepatitis B-infections. We do not give HB-Ig and/or HB-vaccines in this situation. But, we have a good understanding of whom needs HB-Ig/vaccines. The maternity health care checks serologies and practically all pregnant women in Sweden visit such maternity health centers.
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The so-called Dresden Symposium is held online this year. Free of charge! Check out the PDF for more info. Programm-12.-Symposium-on-DR-Management-2021.pdf -
