Stefan Johansson

An interesting article just came on my radar, an international survey study on diagnosis and management of ankyloglossia (tongue-tie). The paper is Open Access in the October issue of @Acta Paediatrica, here: https://onlinelibrary.wiley.com/doi/10.1111/apa.14242 The conclusion reads On topic: here is a great article on Don't Forget The Bubbles (great web resource for ped fellows): https://dontforgetthebubbles.com/tongue-tie-cut/ Where I work, we are commonly consulted by midwifes about tongue.ties, and without knowing an actual rate, I'd say that we do relatively many frenectomies. We give sugar orally as analgesia and then one scissor "snip". What is your approach to the tongue-tie?

@Nathan Sundgren great post! I agree that the major benefit from delaying clamping seems to be *until* breathing starts off. Heard a pretty convincing talk about that on jENS. The study by Katheria et al was commented by EBNEO on: https://ebneo.org/2015/12/does-umbilical-cord-milking-result-in-higher-measures-of-systemic-blood-flow-in-preterm-infants/ We "only" practise delayed clamping (60 sec) for term and preterm infants in reasonably good shape, but we do not have trolleys to start resusc with the cord intact. BTW - at our next Meetup in Copenhagen 7-10 April 2019, Ola Andersson will lecture about "Cord Clamping , 1.0 and 2.0"

I just want to share some brief news about our next Meetup, 7-10 April 2019 at Rigshospitalet in Copenhagen/Denmark. We (i.e myself, @Francesco Cardona @RasmusR @Christian Heiring , Gorm Greisen and Morten Breindahl) are currently working on the program lectures and workshops. I just want to share the first five confirmed speakers and their topics: Morten Breindahl: Neonatal transports – how to do them safe and easy Ola Andersson: Cord Clamping, 1.0 and 2.0 Ravi Patel: How to explain when NEC rates persist – even when a NICU does everything “Right” Ulrika Ådén: Infants surviving at the limit of viability, what are the outcomes? What shall we do? Gorm Greisen: Ethical decision making around the limit of viability- lessons from Scandinavia I'll update you all with more names and topics as they are confirmed Looking forward to meet up in Copenhagen!

We have a ABL900 that is managed by our hospital lab department and they say that the analyses are validated. Meaning that we should trust the values (whether it is S-electrolytes, lactate or hematocrite) as if they had run the test in the "big lab machine". So, I'd say that we generally trust our ABL (as with all tech, it sometimes fails...)

I could not find any data from newborns, but this study on healthy (young) volonteers showed only a slight diff: https://www.ncbi.nlm.nih.gov/pubmed/11553055 This correlation study in adults in intensive care also suggest a good correlation: http://www.thejh.org/index.php/jh/article/view/231/186 We only take venous blood (or arterial from UAC), but good to keep in mind that capillary hemoglobin levels are ~10% higher than central values.

Thanks for sharing and congratulations to your first talk as a "solo speaker". And the macarons, what a great bonus

I just realized that the 99nicu community has grown to >7000 members. An amazing number for an independent grass-rotish project, that aims to create a virtual space for neonatal staff around the world. Naturally, there are members that registered more than 10 years ago who have completely forgotten about 99nicu. But still, we know that our newsletter is recieved by ~6200 members. Regardless of the exact number, we have engaged a lot of people over the years, who have been connecting and sharing questions and expertise. And, in my dreams, I see 99nicu reaching its real potential. Let's hope that dream will come true.

@uvbogden We teach our ped fellows in our neonatal team simulations (those sessions also include some skill training, although team communication is the core) how to use the LMA. So, we "prime" them that LMA is an easy option unless they have some experience with neonatal intubation (or until a neonatologist or anestesiologist comes and support/do the intubation). Maybe that explains why LMAs are occasionally used. I'd estimate 1-2 infants a month get one for ventilation support in the delivery room, but given our 8500 inborns, that also means they are rarely used despite our "priming"

Thanks for a thoughtful post. The idea sounds very good for, I think we (staff) underestimate how parents feel about going home, it is a bigger step than we often believe. Kotiloma FTW And below I embedded a comment posted on FB!

We have laryngeal masks in our "emergency" trays (also a level 2 NICU, with 8500 inborns/y) and the pediatric fellows sometimes use these during term resusc, as an alternative to intubation. According to the manufacturer though, these masks can be used down to 1500 grams. Would be great to hear if anyone use the laryngeal mask on a regular basis for surfactant placement. I suppose it should work! (and it seems to work according to this RCT https://www.ncbi.nlm.nih.gov/pubmed/29174079)

@Jelli KA nice suggestion! We add it to our list of of tentative topics!

Magnesium sulfate to women in preterm labor (or with a medically indicated elective preterm birth) has been shown to reduce the risk of cerebral paresis, as I understand, at least in surviving infants. NICE in the UK writes extensively about the research and their conclusions in this guideline from 2015 (on page 276-289). Here is the summary of recommendations . It would be interesting to hear whether this is an established practise in your settings. To my knowledge, Mg sulfate is not yet implemented in Swedish guidelines (but as I have heard - a national guidelines should be a work-in-progress)

Our national guidelines for VZIG is to give that to infants of mothers that debuted with varicella during the seven days before or after the delivery of seronegative mothers who were exposed to varicella during the last three weeks before delivery who are preterm (< 36 weeks) that has been exposed to varicella during fetal life (maternal infection during pregnancy) or postnatally IF the mother is seronegative With regard to giving oral acyklovir in contexts without VZIG - I don't really know personally what is good to advice but using the same time frames would make some sense I guess.

@AntoineBachy We try to get over to the adult ICU if the mother is there, given that the infant is on CPAP (or less support). Am not aware of papers on multiresistance bugs but I guess that the "local barrier infection control" would work. We have no special hygien/infection control guidelines for these little trips to the adult ICU (but we follow our strict guidelines - hand hygiene, cleaning of equipment etc) We have debated sometimes for who's benefit we do what with skin-to-skin, but personally I am a strong believer that skin-to-skin shall be practised in most conditions At least the infant would still get the same calming experience and even if the mother is heavily sedated, maybe she also experience something positive.

Sorry for slow input from my side, have been either off-work (vacation ) or very much on-work (summer schedule...). And sorry that I did not extend my thoughts in the first post. The questions we debate is 1) to what extent have very and extremely preterm infants an increased risk of Sudden Infant Death (SIDS/SUID) and 2) shall we use apne monitor for an extended period at home (like a few months corrected term age)? Although I interpret research on gestational age and SIDS/SUID prone to bias (mainly confounding) I think this paper in Pediatrics (http://pediatrics.aappublications.org/content/140/1/e20163334.long) is rather convincing that rates and relative risks increase as gestational age shorten, despite adjustments for factors like parental smoking. The critical question is of course whether apnea monitors reduce the risk of SIDS/SUID - but THAT question is hardly possible to investigate given low baseline risks etc. In our unit (Sachs Chuildren's /Stockholm) we don't have guidelines on paper, but we tend to follow the guidelines at Karolinska Univ Hospital; where extremely preterm infants are monitored at home until the age of 3 months corrected age. @bimalc Thanks for sharing that paper, will read it more carefully. I feel we have some degree of "overmonitoring" in our unit, and suffer from some "alarm fatigue" as well... With regard to home monitoring with an apnea sensor monitor, my experience is that the monitors are working well (i.e. either true or false alarms) and most parents report that they felt good to have it. But maybe that is a false feeling of "safety".

@lukaswisgrill we had "how to feed a preterm infant" at the 2017 meeting, but this is certainly a topic that can be further explored. And there should new data coming out from SIFT (https://www.npeu.ox.ac.uk/sift) soon

Relevant questions indeed! I will check with our nursing care specialist also but I think our replies (Sachs Childrens, Stockholm/Swe) are regular hygien guidelines apply, i.e. cleaning with surface alcohol detergent on paper cloth our surface alcohol detergent (70% alc) nursing and our cleaning staff share responsibility for all cleaning (but parents commonly help out too)

Is there a history that the head was ”stuck” outside while the body was about to be delivered? If yes, watchful waiting sounds good.

Dear all, as @Hamed and @Rizalya figured out, our next Meetup is located to Copenhagen in Denmark, at the Rigshospitalet 7-10 April 2019. With regard to the clues provided: Denmark is (as always) scoring high in the latest World Happiness Report Copenhagen is a city with more bikes than people Rigshospitalet was the scene for the praised TV series Riget by Lars von Trier, where a main character was a choleric Swedish neurosurgeon The statue of the Little Mermaid is one of the main tourist attractations in Copenhagen. The Little Mermaid is a classical fairytale, written by HC Andersen Stay tuned for more information! We'll get back with a lot of details about the Meetup during the autumn, and plan to open the registration in November.

To the best of our knowledge, we won’t risk problems from any neurosurgeons at the venue (3rd clue)

Bookmark the dates 7-10 April 2019 (fact)! See you in a happy place (clue)!