Stefan Johansson

Tricky question. This review paper may give some insights (into the limitations of the topic...) https://www.ncbi.nlm.nih.gov/pubmed/24477225 We would probably also get the advice from our transfusion medicine dept to give low-molecular-weight heparin (LMWH) for a limited time while performing repeated ultrasounds. If the inferior vena cava flow is not clearly obstructed when the thrombus stabilize, my (limited) experience is that the long-term outcome is good. Although the likely explanation is a previous intra-vessel catheter, I'd follow the advice by @rehman_naveed to screen for abnormalities in the coag system.

@Amir Fassihi Thanks so much for your kind words. Let's hope we as a large community can support your venture to create something very innovative! Looking fw to meet up, in Vienna in April or at our 2019 meeting

We have a relatively large simulation unit inhouse and we practise on a regular basis. If you come to our coming meetup in Vienna, you should participate in their workshop (led by two neonatologists and two neonatal nurses) 99nicu.org/meetup/program/workshop-simulation/

Many diff diagnoses to consider... Check this open access summary in PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921882/ I'll see if I can find a PDF also to email to you (check your inbox!)

One of the more interesting trials to wait for is Baby OSCAR (UK study): https://www.npeu.ox.ac.uk/baby-oscar/information-for-hospitals

I found this on drugs.com: https://www.drugs.com/breastfeeding/cannabis.html Seems like there is not so much data. Although gut feelings should not gear our minds too much, I personally would not actively promote breast feeding in such a case. OT and needless to say, IMHO marijuana and parenthood would be a combination that no infant should need to be exposed to. In our little pond here in Sweden, we are obliged to inform parental abuse to the Social Services (according to our laws on child protection and the child's own interest)

@prakashmanikoth thanks! Have added that app also to the Links Directory https://99nicu.org/links/

Dear @Aymen Eshene, thanks for sharing these stories and their impact. Contexts are different but I think anger, disappointment and distrust are common roots for conflicts regardless of where we work. I hope there are few personal threats (and at least less guns!) in many settings. I have only felt threatened myself once and that was very long ago. Some years ago I was part of a complex resuscitation scenario, and the infant died after about 1 hour of full resusc (when we halted). Despite that autopsy revealed congenital lung hypoplasia as the cause of death, the communication with parents went completely off the route and everything became very "inflamed", and we were all reported by the family to the authorities. I can just say that many of us had bad feelings during this process, despite that we knew that everything had been done by the books, medical-wise. I think what drives us to feel so bad (as I see it from the amateurish psychology perspective) is that we still worry that we actually did something wrong, that the errors will be discovered and that we then will get into real trouble, including newspaper headlines. With time, I have been thinking about two aspects of these situations: with "seniority" one gets more responsibility, gets involved in more complicated scenarios, but is generally also regarded with more respect from parents, BUT also face more of these hard situations (communication-wise) deaths, severe morbidity and suffering of infants and/or parents still feels - at least I do not get used to them although I think I have developed my ways to manage Although it may sound far too simple, I believe that parental empowerment (i.e. familybased care) is one strategy that can help to attenuate strong reactions, so that parents feel engaged and involved in the NICU, hopefully creating a greater awareness and understanding about what's going on with their child. And most importantly, a good team spirit of all staff categories is essential where problems of this kind can be shared in mutual respect.

As you know, our conference the Future of Neonatal care in Vienna is approaching! When we went through the registrations yesterday, it struck us that delegates will come from all corners of the world. There are already delegates coming from 21 countries! Just to visualize, we marked the countries on the map below. It will be great to meet up with all of you coming! And, although we will represent many different context, I also believe it is a very good example of how a great diversity of people are sharing common questions and problems. My personal reflection is that not only infants are similar around the globe, neonatal staff also share a passion of doing great things for the tiny ones. And yes, we still have vacant chairs in the lecture hall. Be mostly welcome to register for the meeting, regardless if you already have colleagues from your country attending

Can you clarify - do you wonder whether (in PICO-format): P: infants with PICC lines I: with a facemask and a head cap C: compared to no mask/cap O: reduce the risk of PICC-related infections? Could you share a photo (given parental consent)? We nurse as usual, i.e. does not use any special gear if the baby has a PICC-line. But I have no PubMed reference on our practise...

@Kykie Thanks , have added QxMD and NICU Fluids to the Link Dir!

The Society for Evidence-Based Neonatology (EBNEO) had its 4th International Conference in Hyderabad, India, last November. Although being baised, as the chairman of EBNEO, the conference was a huge success, thanks to that the EBNEO was held in association with Indian Association of Pediatrics Neonatology Chapter. Without the IAP/NEOCON committee led by Dr Srinivas Murki, we would not have managed to set this conference up, that counted many hundreds of national delegates from all regions of India. A set of lectures by Barbara Schmidt, Ashok Deorari, Sourabh Dutta, Courtney Wusthoff, Roger Soll and many others, are now available on Youtube. You can also view my lecture on Fetal Programming Enjoy!

@tarek @Urban Rosenqvist I translated the original post