Stefan Johansson

I am waiting to board the flight from Stockholm to Philadelphia, to attend the 3rd Evidence-Based Neonatology (EBNEO) conference. Although being biased (as part of the organizing committee), I think the meeting will be great! You can follow the meeting on www.ebneo.org, on the hashtag #ebneo2015 And, I think the EBNEO Society, the principal organizer of the conference, has an important mission: to increase the knowledge about evidence-based neonatology, and how to apply its principals in neonatal medicine. That also includes understanding of the pitfalls, that "evidence" is not binary, and that we can and need to do much more research and development to further improve care. I recently wrote a column about diagnostic testing in the Swedish Medical Journal (Swe. Läkartidningen). http://lakartidningen.se/Opinion/Reflexion/2015/09/Simtur-i-diagnostikens-djupa-vatten/#comments I got a comment in English implying that EBM is in conflict with the old-school notion of being a good doctor. That is not the case, def not in neonatal medicine where the caring for babies and families, from a humanistic point of view is central in our daily practise.

@JACK - I guess we only track this for WHO... as the doc is not on our server But the bit.ly-service is nice - please study and get back

The WHO has published international recommendations to improve the outcomes of preterm birth. I got to know about this document about a year ago while attending a Preterm Epidemology working group meeting hosted by the WHO. Given the fact that preterm birth is the most important risk factor for infant mortality world-wide, I think this document will be very important, especially for preterm babies born in low-resource settings. Read the commentary in Lancet here: http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00183-7/fulltext Find the WHO publication here: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-guideline/en/

Hello! I would suggest to wait, at least for a few weeks. The cases I have come across have resolved spontaneously (but must admit that my experience is limited...) This paper/case report http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3611918/ suggests that plication of the diaphragm can be indicated around 1 month of age.

Professor Nick Evans at the Royal Prince Alfred Hospital in Sydney, Australia, emailed some good news about the education programs "Practical Ultrasound for the Neonatologist". The programs, one on echocardiography and one on brain ultrasound, is no longer distributed on CD-roms, but as digital downloads. Prices have also dropped to only 25 AUD (about 17 euro) + local taxes. The current downloadable programs are the same as anyone who bought the CDs since 2006 would have. Past CD customers are offered a digital license for free and anyone who downloads the programs in the near future before any upgrades are available will also get future upgrades for free. As before, the program currently only works on Windows but a Mac version might be offered in the future. The direct link to the on-line shop is https://practical-neonatal-ultrasound.selz.com/. As before, all profits go to support teaching and research in neonatal haemodynamics. The link to the department is http://www.slhd.nsw.gov.au/rpa/neonatal/default.html

look here to register http://www.anc2015.com/reg.html

Interesting meeting! Please also add it in the Calender.

This video will give you guidance. And here's another one from the POISE network

Can you post the name of the manufacturer? Still interested to purchase this gel, and through a regular channel.

@gayle - how do you sample the blood?

Only if the baby has grunting or increased respiratory efforts. On the other hand, we apply CPAP (through NeoPuff) liberally , i.e. even if the baby has minor grunting etc. But we do not use sustained inflation. BTW, we published a review on EBNEO.org recently about sustained lung inflation. https://ebneo.org/2015/04/prophylactic-sustained-lung-inflation-followed-by-early-cpap-versus-early-cpap-at-birth-in-extreme-preterm-neonates/

We are quite dis-satisfied with our current equipment (Freestyle light, Abbott) https://www.abbottdiabetescare.com/products/patient/fs-lite-overview.html as we often feel that the instrument gives false low values. So... what equipment do you use for routine blood sugar measurements in the NICU and maternity ward? What method do you use for blood sampling?

Thanks for sharing your article. And I agree with your conclusions!

I wonder about hands-on experience with sildenafil for ex-preterm infants with severe bronchopulmonary dysplasia. The literature is not very convincing, seems that right ventricular strain improves (echo) but that clinical benefits (the babies!) is less clear. http://www.ncbi.nlm.nih.gov/pubmed/25824807 http://www.ncbi.nlm.nih.gov/pubmed/25796626 http://www.ncbi.nlm.nih.gov/pubmed/21941230 Please share your comments and experience!

Sorry for slow feedback. I'd suggest you start something simple (that is possible) - such as a case series of a specific condition you care for in your NICU. One of my favourite ideas currently is: among infants admitted due to hypoglycemia, compare iv glucose infusion with enteral "food infusion". You can consider many outcomes, but the main outcome could be something along the lines "time to reach normoglycemia" or "time to independent feeding (breast/bottle)"

I just found this article an "editor's choice" in ADC, a randomized trial on parental presence on neonatal intensive care unit clinical bedside rounds. http://fn.bmj.com/content/100/3/F203.full 95% of parents and 90% of staff supported that parents attending ward rounds and the researchers concluded that: We have been aiming at rounding with parents "as team members" since several years and I have very good experience myself. Parents who often see their babies more hours than any staff can contribute with valuable observations, they become better informed, we can make plans together with parents (feeding strategies etc) and they also become more engaged with everything. How we have solved the confidentiality: those parents in the NICU room that "wait for their turn" listen to radio through Peltor Earmuffs

Sounds very interesting also to hear about your experiences too. We do not use music as an intervention but I recently heard that the StockholmCollege of Music did some research recently in another hospital.

Good start! So, next steps - 1. identify a specific aim/hypothesis and 2. find someone who can guide you to study that aim/hypothesis. Do you have any current ideas yourself? (a trick is - to nail down a really defined/simplistic idea, that can be studied in your current context.)

First of all, you need a mentor/tutor to be your guide. Do you have some kind of academic structure around you?

The baby will need fill its pulmonary circulation through some variant of shunt. Unless the ducts remains open (providing that shunt), a Blalock–Taussig shunt could be an option. Suggests consultation with a pediatric cardiologist and ped cardiac surgeon on the management.

I don't know the cost. But we have the drug "in stock" as we sometimes (rarely) use it iv (http://www.ncbi.nlm.nih.gov/pubmed/8960484). However, as our experience with iv-use is not good we have tried inhalation in a few cases using the prepared iv-solution (1000 nanogram/ml). As the inhaled dose (suggested in article above) is 50 ng/kg, we have added with NaCl up to a volume of 2 ml.

Parents were informed of course. We also considered we could use epoprostenol off-label (like how we use most other drugs in the NICU) as others had used and reported about doses and responses in publications available on Pubmed. In addition to case reports in this review from 2014 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942674/), there are several case-reports and -series in the literature: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342750/ http://pediatrics.aappublications.org/content/130/2/e442.long http://www.ncbi.nlm.nih.gov/pubmed/12461501 While doing some research on this option last year I also found this news story from a hospital in California, not a peer-reviewed paper but adds a perspective also. http://www.childrenscentralcal.org/PressRoom/IncredibleCare/Pages/ReducingCosts.aspx

Welcome (in advance) to the wonderful world of neonatology ! In addition to 99nicu - there are of course plenty of web resources - how starting off with http://www.neoknowledge.org/, http://neonatalresearch.org/, https://ebneo.org and http://newborns.stanford.edu/PhotoGallery/ ? And, http://neonataldoc.blogspot.se/ - a anonymeous and a bit sad blog by a neonatologist, but very well written about difficulties that happen all of us.

Just wanted to share a recent and good experience with inhalation of epoprostenol in PPHN. I currently work in a large level2-unit (≈8000 inborn/y) with no access to NO-inhalation. Infants born in our delivery ward with PPHN and needing level-3-care (i.e. NO/mechanical ventilation) needs to be transferred. We recently had a baby with echo-verified PPHN, on CPAP and with saturations around 88-90% on 100% oxygen. While preparing for premed/relaxation and intubation we connected our CPAP inhalation device and inhaled epoprostenol with surprisingly good response! We avoided intubation and transfer. We gave two inhalations about 30 min apart initially, and shortly our saturations were >95% and could start to decrease FiO2. Doses were repeated every 2nd hour until we reached FiO2 <0.5, in total the baby recieved five inhalations. Before/during and after - the baby was cardiovascular stable (stable normal BP and pulse) and the 2nd echo at about 4h of age showed balanced shunt over the open duct (as opposed to right-left shunting at 1.5h after birth). We used the dose suggested in this article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342750/