Stefan Johansson

Tricky case, I have no experience… How high CPAP did you extubate to? If work of breathing is low, did you try HFOV and see how low CDP you can use? Guess stability and lung mechanics will improve with time, ie you “just” need a shorter term solution?

Hi all and thanks for sharing your thoughts, interesting that this seems to be that regional (for North America). If this is related to the medicolegal context, are there any such cases? @Brian King looking fw to part 2 :) ! And last thought, if many are doing this, and there is equipose, there should willingness to do some ethically approved study/trial?

It is time to gather for the Annual Business Meeting for the 99nicu Society! The Annual Business Meeting is the highest executive organ of the Society, where all Society Members are welcome to join and participate in the formalities around our Society. We will gather on Zoom, 19 March 2026 at 1900 CET. Please find the invitation/agenda (with Teams link) attached. Agenda_2026.pdf AnnualReport2025.pdf Fiscal_Report_2025.pdf

The so-called predischarge Car Seat Tolerance Screening is practised in some units, I think it is less common in European NICUs, at least, I have never come across in the Stockholm units where I have worked (during ~30y 🙂) A recent systematic review an meta-analysis came suggested that the NICU stay was extended without clear benefits (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2844812) Curious to know - what is your practise now and will your practise change?

Hi @Mohan , my experience is a bit limited, we do see fat necrosis from time to time and related elevation of s-calcium too, but asymptomatic. As far as I know, we have not needed to treat anyone, but if so, we would go for "standard management". However, it happens we follow S-Ca during the first weeks after NICU discharge, just in case, but also those infants have normalised their levels with time. I ping @Gustaf Lernfelt @Vicky Payne @ali @Mariana Oliveira - whats your "large level-3" experience?

The SmPC (the product info from the manufacturer) recommends those times for use, I guess our national guideline is a copy & paste from that. We have not experienced any issues using the rota vaccine in our unit. On the other hand, at the time those infants are getting the vaccine, they are already roomed-in in family rooms, i.e. they are not in shared rooms with other infants/parents.

Thank you @piatkat and @Mariana Oliveira for pulling all strings to make this happen. Offering a solid translations functionality is a major move forward, and will all NICU health care professionals from all corners of the world to contribute to our community!

We are approaching the 20 year anniversary of 99NICU and while thinking about our journey, we also came to explore the wider scope, including the feeling of a lost online neonatal community. When I first helped build 99NICU in 2006, it came from a very simple need: a safe place to talk about neonatal care with other health care professionals. Not just to exchange information, like over email, but create a community space to think, question and learn together from real clinical experience. At the time, those kinds of conversations were harder to find online, due to the immature technology. Today, that challenge feels even more familiar, but for other reasons. Many of us now rely on large social media platforms for professional connection. They’re convenient, fast, and always there. But they were never designed for careful clinical discussion. Algorithms decide what gets seen, conversations disappear as quickly as they appear, and the focus is often on confirmation and engagement (likes!) rather than substance. For neonatal care, where nuance, trust, and context matter, that model simply doesn’t work very well. 99NICU was created as an alternative to that. From the beginning, it has been built by neonatal professionals, for neonatal professionals, with no commercial agenda driving the conversations. We have a non-profit structure because independence matters. What makes me most proud, all these years later, is not the platform itself, but the community behind it. Moderators, developers, and contributors are all volunteering NICU staff, colleagues who care deeply about neonatal care and about maintaining an online space where knowledge grow over time. 99NICU is not “social media” in the usual sense. It is a professional community reclaimed — a shared space we collectively own and shape. Last but not least, being independent implies that we need support in a crowd-funding way. Please consider to donate 10 EUR per year to keep our servers running, visit this page to do it today!

Thanks to our latest page about Latest Research with the automated feed on PubMed, this AAP Clinical Report came on my radar about Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy. Great write-up about the background and evidence about HIE and hypothermia treatment. In the recommendation (last page!), AAP recommends 1) blood gas aligning with asphyxia and 2) moderate-severe HIE, before initiating hypotherma. Here in the Outer Rim (i.e. Sweden!), we have a more diverse #1 criteria in our national guideline, Apgar score ≤5 at 10 min, need of ongoing resusc beyond 10 min, and/or acidosis (pH <7.0 or BE <-16 first 60 min). We published about those so-called initial criteria, and one main take home was that the acidosis criteria as such had little impact on the risk to need hypothermia treatment. Low Apgar score and prolonged need of resusc was much more predictive. Apologies for the long intro 🙂 to what I am thinking about - how do you select infant for hypothermia, i.e. what criteria do you apply before cooling down an infant with HIE? Do you have a local, regional or national guideline for this?

Thanks for sharing this question. I translated our national guideline in Sweden, hope this helps. Indication for rotavirus vaccination: born at gestational age ≥ 25+0 weeks: can be given in the neonatal unit. first dose given from 6 weeks of chronological age, and must be given before 12 weeks of chronological age. the first dose may be given from gestational week 34 together with other vaccines if such are needed if possible, give the vaccine 2–3 days before discharge. second dose should preferably be given at least 4 weeks after the first dose and no later than 16 weeks of chronological age. contraindications: previous intestinal surgery, previous intussusception, congenital malformation of the gastrointestinal tract, a history of NEC regardless of stage and treatment (consult pediatric surgery), immunodeficiency (SCID), and/or congenital sucrase deficiency.

Yes @piatkat , time flies! I guess the links to those files got corrupted in on of our software transitions. I can check if I find them on our server but likely difficult. However, this made me think that we could use our Quiz feature for educational MCQs based on review articles and/or textbook material. Lets discuss!

In Stockholm, SE, these infants are sedated via the PICU, as treatment is done via them. So, I honestly don’t know about details. Spoke to a UK colleague today, at a large referral center, and they used chloralhydrate as the standard sedation + topical analgesia, with midazolam as backup (rarely needed)

Tricky situation. A low dose of clonidine, as an adjunkt to opiods may help. But keep an eye on blood pressure!

Thanks Mariana, great topic, and an everyday question. Our standard in Sweden is https://janusmed.se/amning, will share more later 😀

I suppose many of you already know and follow the Tiny Baby Collaborative, and international research group dedicated to improving the lives of children born at ≤23 weeks’ gestation and their families. They do excellent educational webinars about this niche population of preterm infants. You find them all on their site here -> https://www.tinybabycollaborative.org/webinars Check out the latest below:

Hi Arwin, thank for posting, and congratulations to your book 👍! One thought - how about if you write a blog about this here, and share a few posts about your journey within neonatology and how that eventually ended becoming an author? https://99nicu.org/blogs/create/ We can also ask someone to review your book, if you wish. I am happy to support all how to's , just email me on stefan.johansson@99nicu.org

The AAP organises trainees and early career neonatologists in a section called NeoTECaN and I just got on my radar that they run great journal clubs. They publish very informative and educational material on their Youtube channel. I wanted to share their Journal Clubs here, very good for all professions (and experience level) in the NICU! Here's a first one in which Dr. Gayathri Sreenivasan (Neonatal-Perinatal Fellow, New York Medical College) reviews the MoCHA Trial - about extended caffeine through discharge for very preterm infants. The Journal club is moderated by Dr. Wally Carlo (Trial PI, University of Alabama at Birmingham) and Dr. Barbara Schmidt (University of Pennsylvania and McMaster University).

today, on November 17, is World Prematurity Day. We, being neonatal health care professionals, are much aware of the many unmet needs for preterm newborns. But, for the larger context, there is still much to do, creating awareness of the large public health challenge to reduce the burden of preterm birth. If you have some time today, join the WHO webinar about the launch of a new global clinical practice guide for Kangaroo Mother Care (KMC). Register here!