Stefan Johansson

Interesting case - I'd guess that "our" surgeons would opt for early repair also for a 34-weeker. What is the birth weight? We'd do the same as in @Hamed's unit, i.e. put on mechanical ventilation (until surgery is done) and feed post-surgically. @Andrej Vitushka hope this helps and that you did not unexpected suggestions Please share feedback how things develop

@amirmasoud2012 well... not all photos/videos says more than 1000 words

@tarek Excellent slidedeck from Cochrane! (Ping @Francesco Cardona)

@harnon are you referring to this paper: https://www.ncbi.nlm.nih.gov/pubmed/21166684

With the current lack of magic bullets to treat BPD, some affected infants get a long list of pharmaceuticals... A new acquaintance for me is montelukast. A Pubmed-search did not convince me much, I found only two clinical studies: one positive and one negative. Also found an experimental study from 2016, suggesting that the idea of leukotrien-inhibition may be plausible though. Do you use it for BPD-treatment (manifest BPD)?

Our every-day job is to meet parents and their preterm infants. We have our professionalism, skills and family-centered care strategies. But how do we understand the large gap those families need to bridge, and how parenthood evolves when a child arrives too early? For myself, music has always been important (even essential!) in my own reflections about wider scopes. When it comes to parenthood, I can strongly recommend the record Mother Tongue by Rebekka Karijord, a Norwegian composer and singer. Mother Tongue is a beautifully strong and moving record about parenthood complicated by a preterm delivery, about experiencing a cesarean section far too early ("...this is a riot of blood and steel/bending me open, violently..."), and how a tiny infant still could "weigh more than...the universe, to me". The lyrics, as I interpret, is also about parenthood in a deeper sense. The music itself is so delicate and precise, and yet powerful at the same time. This is a record we should listen to. Get it on CD. Or on vinyl if you still play such records, like I do . And bring it to your next staff meeting. And of course, Mother Tongue is also available on Spotify.

@Hamed Thanks for sharing valuable info. however, on head positioning, have you seen recent Cochrane review?

BTW and slightly OT - a study on the usefulness of video-laryngoscopy: http://pediatrics.aappublications.org/content/136/5/912

I am not sure, but think that the C-Mac system has Miller0-blades but not smaller. But the Accutronic system goes down to Miller 00: https://www.acutronic-medical.ch/products/infantview.html Again not sure, but I think that one of the Karolinska NICUs (Huddinge) has an Accutronic system @wackdi am I right?

I got this on my radar, through the Twitter feed from @EBNEO - whether surfactant could be administered as easy as an oropharyngeal squirt? Have look in the latest issue of @Acta Paediatrica here: http://onlinelibrary.wiley.com/doi/10.1111/apa.14060/full´ And, here's a video demo posted by the article authors:

Came across this paper in @Acta Paediatrica about the Helping Babies Breathe (HBB) program in Kenya. 10 months post-training, there was a >50% reduction in the rate of hypoxic ischemic encephalopathy, from 1.6% to 0.7% of live-births. The mortality rates decreased in numbers from 0.4% to 0.2%, but this was not statistically significant. However, the study was not powered to find this difference. The paper is available in full-text here. And, related editorials are available here and here. Does anyone here have hands-on-experience from working with the HBB-program? Would be interesting to hear about it!

The photographer Johan Bävman is touring around the world with a photo exhibition about "Swedish Dads". The exhibition shows fathers on parental leave. Swedish newspapers recently wrote about the reactions in Sydney, Australia (see exhibition before 26/9). A (female) columnist in Sydney Morning Herald referred to the exhibition like "porn for stressed moms". I wouldn't agree on that headline but the column itself is interesting, and the reasoning about how the society could/should become more equal. The photos are nothing but fantastic! See some below and visit Bävmans web site to see them all here. I touched upon this topic long ago, in a short blog post here in 2012, that "it's not all about motherhood in the maternity wards and NICUs". Our family-centered neonatal care includes all parents, i.e. expect the father to be as present and care-giving as the mother. For myself, being a "Swedish Dad", I never considered NOT taking parental leave when we had our children. When our son was born in 1996, it was more easy as I was a pediatric fellow. But even in 2011 when our daughter was born, going off work during ~6 months was a natural thing to do for me despite being a consultant neonatologist. We work such a lot during our life-time, and we don't have too much ice-cream with our little ones (but it's great when we do ) I am well aware that many countries have less generous systems for parental leave (especially regarding the amount of time funded but welfare systems). But, I strongly recommend all father to take leave with children, and manage the household while the mother is going back to work. It is an investment for life. Have a look at the video about the photo project below and enjoy some of the photos, embedded with permission from Johan Bävman. If you visit Stockholm later this year, the "Swedish Dads" exhibition comes to Galleri Kontrast in Stockholm (30/9 - 29/10).

The strategy in the hospitals in Stockholm is to have pre-defined prescriptions in the electronic records, so the IT-system gives some guidance in prescription. There is for example "dosing control" so we get a red flag if a dose seems out of range for a specific weight. There are written instructions for all drugs on typical dosing, infusion/injection times etc. We also have written "dilution instructions" for all drugs that needs any handling that goes beyond taking something out-of-the-box. We are encouraging all staff to use the written instructions even if they are experienced. Despite all systematic work, medication errors still occur sometimes... although rarely... then we make a "process analysis", with the aim to identify systematic errors that we can target. Most important (in my experience), is to have an "allowing" athmosphere, so staff always feel ok to ask any question about drugs, infusion setups etc-etc. No matter how experienced we are, we all need advice and 2nd opinions sometimes.

The dedicated Meetup web site is about to get up and running on https://99nicu.org/meetup/ - have a look Sign up for the Meetup Newsletter! Read about the Young Lecturer Sessions, great opportunity for younger neonatal staff!

@Josephine This may be too obvious but are those infants with gastroschisis delivered through CS in your hospital?

@mosarrat that strategy makes sense, to maintain alveolar expansion but without over-stretching. What typical PEEP do you apply, what tidal volume/kg do you aim (or is usually possible?) at and how low do you go with Ti?

@rehman_naveed to have everyone writing in the same style and format , that is challenge I doubt a medical record in Swedish would make much sense for you but I post here how the notes are constructed. For any kind of notes for both dr's and nurses (admission note, daily/weekly notes, discharge report etc-etc) we have fixed templates. It is possible to write everything under the first headline (which is the note typ name), but most people sort the information by the defined headlines. So, my best advice to you is to make templates and start to educate how to use them. As with everything else, the story-telling of medical information needs education and practise. In principal we have the following structure: Regarding your questions above: 1. we preach the necessity of doing good notes 2. we write everything in the same electronic system 3. Like above, i.e. system based approach 4. In the weekly note, we summarize only the previous week. But in the "Summary Note" - that includes info from birth and till current date, we include everything, also resolved problemn. For example the Respiratory headline in a Summary note may be something like "CPAP from birth, but developed x-ray confirmed RDS and given surfactant (INSURE) at 12 hours. CPAP until DD/MM, HFNC from DD/MM until DD/MM, and without support since DD/MM. Supplemental oxygen until DD/MM." 5. Well, our daily bedside work is still on paper... so this is where details are available. However, we want the important numbers in the note (the Respir headline), and most importantly the planning (what to do at certain developments in O2/CO2 , etc)

Sorry I cannot share anything valuable about this Have only experience from low-volume strategy on HFO only (but have good experience with HFO for any air leaks incl PIE)

@bimalc we had a LISA-like lecture this year but we may find a way with another perspective. Great talk by Kajsa Bohlin below BTW, you find it as the final lecture here: https://99nicu.org/meetup2017/ I think we should also have a session on ethics, would be fantastic to have Annie Janvier and/or Dominic Wilkinson to speak about the grey zone of viability. BTW, you can listen to Janvier in the ADC podcast.

We monitor aEEG (CFM) continuosly, so if we see recurrent subclinical seizures (i.e. ≥2 episodes) we most often treat. If we consider the aEEG to be abnormal or if we have poor seizure control, we commonly also follow regular EEG, for example 1-2 during cooling (of 72h) and then maybe every 7-14 days until we see normalization. But I feel that EEG has become less frequently done, as we mostly rely on aEEG.

To my knowledge, this is not common practise in Sweden. @AllThingsNeonatal @kbarrington - do you have something to share about rewarming?

I guess you mean progress notes as "text" (?) We use electronic patient records as well and use two types of notes that help us remember everything and help us write the discharge summary. Every week we write a "weekly note" that summarize the past week, under a standardized set of "tags" (Respiration / Cirkulation etc-etc). We also write up a "summary note" 1-2 times a month, that is more like a discharge note up to that timepoint. With our electronic system it is possible to "copy a note to a new note", which makes these summarizing notes rather easy to keep update.

Although we have not yet nailed the venue or date for the next 99nicu Meetup (April 2018, in Vienna!), we want to start to crowdsource the program In short, we are searching for topics YOU want to see in the program! No matter how controversial, evidence-based, or big or small, we want your input on topics that help you perform better in the NICU, thereby improving long-term outcomes infants you care for. Also share your dream team of speakers from any corner of the world, who are dedicated, engaging and know how to convey take-home messages! Of note, we are not only looking for superstars. We also want to offer the 99nicu Meetup stage for raising stars. Maybe YOU should come and give a talk