Stefan Johansson

One of our fellows showed me these two videos on Youtube, on how to learn brain ultrasound. Both videos are very good! Enjoy Part 1 - anatomy and protocol Part 2 - IVH and PVL

I agree witg @LokrajShah. We would not do x-ray routinely either.

@Schumz The Nutrium-progr cannot run unless you have a license (checked by IP-nb, and I think it won't work on Macs, we run it on Windows at work). But I guess there are similar programs (maybe also as freeware?). If the infant has good growth with 165 ml/kg/d, I'd stick to that. Can you get a nb of calories and nutrients /kg/d? For the program - email prof magnus.domellof@umu.se and ask - he's the man behind Nutrium.

@Schumz great discussion topic! We titrate nutrients with a computer program (https://www.nutrium.se/) and make individual fortification and breast milk analyses (regardless if donated or mother's own expressed BM), to see how many calories, protein, fat (well, fat energy %), and other nutrients are given per kg. We aim for every infant to regain its "potential" weight (for example, most ex-ELBW infants start off with a growth failure), so when the anabolism kicks off post-level3-care, some of us get a bad feeling that the baby is growing "like crazy". When the baby really just comes back to its own growth potential. However, we take some precautions. In practical terms, we reduce fortification if there is accelerated growth, but do not reduce volumes usually. But, nature also helps most of those infants practise breast feeding (or bottle feeding for that sake), with succesive reductions in tube feeds. So, my brief suggestion in this case would be: continue with 180 ml/kg/d, calculate the nutritional intake and take it from there. If there is too much calories, reduce fat before protein fortification. Don't worry about diuretics and some periph edema, as you know that is mostly a matter of cosmetics (and will go away by itself). (But, since there are as many opinions around feeding as with PDA therapy - I believe there are several other ways to handle this )

We have now published the program and opened the registration here: https://99nicu.org/meetup/program/ Will send out an email to all. Looking forward to meet some of you there! If you have any fellows wanting to be part of the Young Lecturer Session - please ask them to look here: https://99nicu.org/meetup/young-lecturer-sessions/

@Hamed I think the program is full now but if we can get a fellow to submit a lecture for the Young Lecturer Session that would be great. Please share ´in your networks if you think you know a candidate for such a mission: https://99nicu.org/meetup/young-lecturer-sessions/ BTW, while at EBNEO in India (#ebneo2017 tweets here), I heard Barbara Schmidt lecture on caffeine and she is just such a fantastic speaker. She spoke mostly about the story behind the CAP trial (that we all rely on now for caffeine) and all results from birth to their latest followup paper in JAMA (click to read). I can promise that we will have her on the invitation list for next-next meeting 2019

@chienyichen maybe they have read a paper from 2015, a relatively small trial reviewed by @EBNEO , read the link below. I personally think that paper only shows a proxy outcome and that a larger trial with meaningful clinical outcomes (like RDS, BPD, IVH etc-etc) should show benefits before changing practise. (but we do delayed clamping though ) https://ebneo.org/2015/12/does-umbilical-cord-milking-result-in-higher-measures-of-systemic-blood-flow-in-preterm-infants/

I guess many of you have seen that the Australian placental transfusion study is now published in NEJM. In this RCT - 1500 infants born <32 weeks were randomized to early vs late clamping (≤10 vs ≥60 sec). The results were... no clear benefits, the odds ratio was 1.00 (0.88.-1.13) for the combined primary outcome of death or major morbidity. We have not yet discussed in our NICU how to relate to those findings - we currently practise delayed clamping (at 60 sec). Thoughts?

How are things going @spartacus007? Any progress?

I would like to share this video about a "23 week miracle", cared for by @AllThingsNeonatal and his team in Canada. It is a short film about the journey of a 23 week daughter born in a smaller unit. It is really a beautiful story about a preterm baby, and power of parenthood. The film includes a product placement (you won't miss it ) but that does not take away the main message in this video - that parents are essential and should be involved to the greatest extent possible.

1. I remember that BMJ had a Christmas Appeal (for donations) about this device: http://www.lifebox.org/what-we-do/pulse-oximetry/ 2. I pass on this question... I read here http://www.lifebox.org/purchase-oximeter/ that the probe is from 3 months... but I suggest you email and ask specifically about neonatal use

@spartacus007 the epoprostenol dose (in this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342750/) is: We have used the intermittent dose of 50 ng/kg (typically in term born infants on CPAP, with PPHN, and FiO2 ~0.9-1.0)

@yalsaba @tarek very good point!

@spartacus007 do you have reason to believe that there is a more severely growth restricted lung? Maybe a trial of inhaled epoprostenol? We use it infrequently (as we do not have NO in our level-2 unit) and sometimes with (surprisingly) good effect. https://www.ncbi.nlm.nih.gov/pubmed/22558521

If you are close to the surgical unit (like same building), I would not necessarily do it. Especially if you know only the liver is in the thorax. If you need to go on the road (transportation), I would prefer intubation and mech vent regardless, to secure the airway, just in case. Probably they will operate soon after arrival anyway, so time on ventilator is not so much a critical factor.