Stefan Johansson

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

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.

From prof Takeshi Arimitsu, invited speaker at our previously planned Meetup in April 2020 (but cancelled due to Covid), I got an email about an interesting case report from their large neonatal center in Tokyo. They have published about a 268 gram 24-weeker with intact survival. I share the last sentences of the summary below. The publication is available open-access and in full-text here: https://www.frontiersin.org/articles/10.3389/fped.2020.628362/full Looking fw to follow the discussion about this extraordinary case.

Check this out :

Hi again, new day and off-call at the home desk (and Nick Caves latest album in the background, link below). @HickOnACrick Thanks again for sharing your story. First of all, I wish you the best getting out of your tunnel soon. I read in-between your lines that you seem to have some support from work but also have your own strategy to get through. Burnout in the NICU is a real thing, it has happened to staff in my closer network. I am myself coming "close to the wall" from time to time, but have so far been pulled back, foremost by my wife. She has a great temperament, so she tells me (off) clearly when it is time to shape up. Which has been a lifeline for me, I have very little self-insight into how to handle a workload / work situation that is getting monstrous. Before last summer, she did this exercise with me, that I had to write down all "threads" going on in my head on separate postit-notes, and prioritise them. A good learning experience to see all different things I tried to keep up, with clincial work, research projects, 99nicu.org, previously ebneo.org, a startup, QI-projects etc-etc. My own (bad) excuse is that hard work is part of my DNA. I am a first-generation academic in my family (a real rural Swede!), and the working-class messages I grew up with and impregnated me was much like "hard work is rewarded", "you work for your next job", "get up at 5:00 to get going". So, working like crazy has always been the norm for me, and it has also taken me from rural Sweden to the capital of Stockholm . And, I feel a special satisfaction from the physical exhaustion from hard work (like night shifting). I principally, I am clearly better at working than having time off. That's just how it is. Interestingly, none of my superiors (like heads of departments etc) has ever discussed those things with me. It is rather the way that - the more one delivers, the more a superior may ask you to get involved and deliver even more. I have never been advised around a more healthy work-life-balance. From a HR perspective, there are many examples of Epic fails when it comes to those questions. In many ways I love neonatology, and think it is a specialty that has suited me well. But it also takes on me. During the last few months, I have been more stressed and grumpy. The pandemic is clearly part of this, and my work with a startup (Neobiomics / ProPrems®) is another reason for my slippery slope... (this experience is a longer separate story...) But in the NICU I feel frustrated about the discrepancy / gap between our self-images/-confidence (as "know-how-driven professionals") and the daily practise that keeps moving on, as it is so hard to change/revise old practises no matter how strong evidence for an alternative approach. Sorry for just writing without too much structure... lets see if/what others share here.

Thanks for sharing your experiences, will share my own thoughts and experiences later (getting late here). This is the most relevant topic IMHO Just this first: since first day in our education/training, we have been ”raised” to sustain in a work environment that creates a malignant combo of long hours under high pressure, unlimited load (there is always more work to do) and some lack of self-control. Not really sustainable... and its hard to navigate in such a landscspe.

@HickOnACrick thanks for sharing - have you considered to publish this experience? In Sweden (Uppsala, neighbouring city to Stockholm), there was an ex-preterm infant that came back to the ER a few weeks after discharge and ended up on the vent. Being Covid+. I don't know anything from first-hand sources, but read about this spring in the national newspaper https://www.dn.se/nyheter/sverige/sa-raddades-bebisen-i-uppsala-sveriges-yngsta-covid-patient/, maybe a Google translate would make the long article there possible to read in Google-English

Thanks @Darwin Ranada Do you a webinar series, with an educational perspective?

@LIA GRAVARI Thanks for suggestion about an online Journal Club. Would you think this should be best done on Zoom (or similar)? @Emilio Escobar Thanks for your feedback! Do you think we could do something to support your daily practise even more?

Time really flies, and it now 15 years ago since we started to plan for the 99nicu forums, opening in May 2006. In many ways, this project has been a key part throughout my own neonatology carrier. I have learnt so much about the diversity of how to practise neonatology, and I have also learned to know many people around the world. I had not get to know you without this virtual platform. But with time comes age and I have started to think about how to future-proof the operation and development of 99nicu. I, @Francesco Cardona and @Vicky Payne have started to think about where to go from here. what do you like with 99nicu? how does it benefit your work? what can we do better? what are you missing? Please share what you think!

Check out also this thread:

From Twitter!

Hi, I am sorry I cannot share any experience about this. Lets hope someone else will!

Greetings from Stockholm! This systematic review may shed some light https://pubmed.ncbi.nlm.nih.gov/27109092/ or at least get you confused on a higher level We are rather liberal with both and with a pragmatic approach: surfactant if oxygenation is challenging (while hoping for no big air leaks), and antibiotics if inflammatory parameters get high and we feel uncertain whether it is pure inflammation or also caused by infection.

Hi there! I believe we use the same monitors, is it OK if I fw the questions to our Philips contact in Stockholm?

Based on the ELVIS findings, I would argue for a less conservative approach. https://pubmed.ncbi.nlm.nih.gov/29440132/, https://pubmed.ncbi.nlm.nih.gov/30878207/, https://pubmed.ncbi.nlm.nih.gov/32800815/ We follows VI in those cases. In our limited experience, the "tube of choice" by our ped neurosurgeons in Stockholm is a reservoir (that we empty on a regular basis) rather than a real shunt.

Twitter is really great some time. Check out this discussion started by @AllThingsNeonatal about paralytics for intubation!

@Vicky Payne Found these previous threads:

And I reply on the app :) (which I find a bit clunky still) we would use phys sodium chloride for ELBW infants

Please use five minutes to respond to this survey: https://survey-picterus.typeform.com/to/OtdOz9Ix Through my own engagement in various projects as social entrepreneur, I have come across several like-minded colleagues The Norwegian neonatologist Anders Aune is the founder of Picterus, a start-up in Trondheim/Norway. Pictures has invented a smartphone app that measures the degree of neonatal jaundice. The app is developed to work well in low-resource contexts where undetected neonatal jaundice is estimated to cause more than 100.000 deaths per year, plus the many thousands of infants developing permanent brain injuries due to hyperbilirubinemic encephalopathy. As jaundice can be easily managed with light treatment at low cost, there is a need for a low-cost diagnostic tool. Picterus is a solves the problem. Anders Aune has asked me to share a short survey, collecting some data on potential use. Please use five minutes to respond to this survey: https://survey-picterus.typeform.com/to/OtdOz9Ix

We don't have a written guideline but I tell you how we do First of all, we give enteral feeding 3h with the iv-dextrose. Depending on the total volume/24h, the enteral volume depends but usually (if the infant maintains S-Na etc), we are fairly liberal and allow higher total volumes than we would normally do (like 100+ ml/kg/d the first day of life) When the infant is normoglycemic, we have a standard way of decreasing the iv-infusion, we typically reduce the glucose infusion (most often we can use 10%) with 1 ml/hour at every 3h meal. Usually we plan enteral feeding volumes for the coming 24 hours, but in these cases we may adjust feeding volumes every 12 hours. So, we start off with iv glucose and enteral nutrition, and gradually shifts over to full enteral nutrition. We keep checking blood sugars a ~2-3 times after we have stopped the infusion.

Hmm... I must admit I don't know. I report this to the software company and asks.