Stefan Johansson

Strange! Is the baby still not given enteral feeds? Are regular blood tests normal (blood counts incl trombocytes, CRP, acidbase, electorlytes)?

I have always thought that the original idea of the Apgar score was a neurological assessment - and have therefore graded breathing depending on regularity of the breathing drive: 0= no breaths, 1=some/irregular breathing, 2=regular breathing (regardless of effort/O2) Another area of confusion and debate is the score for color, almost worth a topic on its own

Good point! But I learnt about one interesting option recently from a French unit where they set a nasogastric tube and use a contineous "feed infusion" to treat hypoglycemia!

Take a look at the topic about sugar gel give orally, a research article published in the Lancet: I think you can find some in the Methods section about how they actually did the study.

I just want to say Happy Holidays to everyone, on behalf of the whole 99nicu Team! We don't share any New Year's promises for 2014, but there are exciting news in the pipeline. Besides polishing corners off the new software, we have plans for at least one educational activity... Sincere thanks to everyone contributing with questions, expertise and experience in the forums! Best wishes for the New Year!

Hi! I can just fw our nursing protocol, i.e. no references, but we aim a max pressure of 20 mm Hg above the "vessel pressure" for peripheral venous cannulas and regular UVC and UAC. Which means max of 40 mm Hg in a regular venous cannula, and max 20+MAP in an UAC. For peripherally inserted central lines (typically 27/28G) we start at a max pressure of 150 mmHg, but we allow the max pressure to be as high as 300 mm Hg.

Hi again! I just wanted to get back - as you probably have noticed we have switched the web site has been re-designed (and a new software). As before, the forums will be the core of 99nicu.org. Unfortunately the Social Group feature had to go as that is not a feature available in the current/new software we use. However, I think that forums, the chat service and blogs might well be good for you to use. One advantage with a dedidacted category/forum would be that we can set up a dedicated newsletter from that specific forum, in you would believe that would be a good feature for your group.

I follow @pubneo of course! (but is unfortunately not so close to my Tw-feed as I'd like to be)

Next in the series "Link to like" is a fantastic web resource by Mary A Rutherford, a pediatric neurologist with 20 years of experience of MRI. She has made her book "MRI of the neonatal brain" available as a free e-book on the web. Sometimes there is a free lunch Link to like: www.mrineonatalbrain.com

Can you share some high-lights from Hot topics?!

Here! http://www.sswahs.nsw.gov.au/rpa/neonatal/cardiac.html

And for sale... I see that companies selling these devices work hard

@JoanneO - very interesting that you use it for years. I will make a serious attempt to introduce this method at the hospital I will be moving in Febr. Send my best regards to Deborah Harris!

Reading the Methods in the manuscript tells: - the gel was 40% glucose and prepared by the hospital pharmacy - dose was 0.5 ml/kg, "massaged" into the buccal surface and before a feed - administration was done by midwifes (or researcher involved in the study). I feel keen to test this in our hospital!

Here is also a paper that was one of our Leading articles some time ago: High-Flow Nasal Cannulae for Respiratory Support of Preterm Infants: A Review of the Evidence

Do we not read and talk about research findings more often than we critically discuss methods that led to the findings we discuss? Trained in clinical epidemiology, I often believe we should discuss methods more, especially before we move into processes of changing clinical protocols on treatments and diagnostic methods. EBM! Nature published a very nice article about how to interpret research claims. The idea was rather to aim the article towards non-scientists but I think their advice is worth to high-light for a medical audience. ( and read the article in full text here) The 20 tips are... Chance cause variation (results can be due to chance) No measurement is exact (as we didn't know) Bias is rife (it certainly is) Bigger is usually better for sample size (yes!) Correlation does not imply causation (we all know this, but we tend to forget that) Regression to the mean can mislead (it does) Extrapolating beyond the data is risky (and set patients at risk) Beware the base-rate fallacy (it is hard to diagnose uncommon conditions) Controls are important (or rather, they are essential, and it is essential to select controls right) Randomization avoids bias (or at least reduces bias) Seek replication, not pseudoreplication (research needs to replicated) Scientists are human (and therefore im-perfect) Significance is significant (but confidence intervals are more important than p-values) Separate no effect from non-significance (abscence of evidence is not evidence of abscence) Effect size matters (but remember that effects tend to decrease with study size, i.e. the world is not as good as it seems to be in small trials) Study relevance limits generalizations (i.e. don't generalize findings among 33-weekers to 23-weekers) Feelings influence risk perception (and that's why we tend to be more afraid in a plane than in a car, despite the higher death risk to drive) Dependencies change the risks (some factors or events are related, in additive or multiplicative ways) Data can be dredged or cherry picked (see #12) Extreme measurements may mislead (and usually do not have a single cause)

Here is another video, showing how to insert a pig-tail chest tube: http://www.neoknowledge.org/chest-tube-pigtail/

Course in Neonatal Cranial Ultrasound, ender the directorship of Dr Frances Cowan, alongside Professor Linda de Vries and Dr Gerda van Wezel-Meijler, all renowned and highly respected professionals in the field. The basic course 5 March 2014 and the advanced course 6-7 March 2014, in London, UK. The fee for all three days is 435 GBP. Read more about this event here: http://www.symposia.org.uk/main/eventprog.asp?evcd=14.01 http://www.symposia.org.uk/main/eventprog.asp?evcd=14.02

I guess many of you read about the Sugar Babies Study, about giving dextrose gel to (well) infants at risk of developing hypoglycemia. Link to the paper in Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961645-1/abstract I would be glad to hear more from people with experience from this treatment, involved in the trial or having experience outside the trial. - is the gel produced by pharmacies "in-house" or bought from a manufacturer? - who is administrating the gel (midwife, nurse, doctor?) - dose weight-dependent (SGA vs LGA babies)? - experience regarding b-glucose and admissions to the NICU? etc...

What manufacturer do you get your ET-ttubes from? The holder seems interesting for us.

Sounds like a good tool, indeed! I think there are lots of creativity that could be freed for doing simple tools with great impact on maternal and infant health in the world. I also come to think about Lifebox, a simple and cheap pulse oximeter, which recieved well-deserved attention by the BMJ (Christmas appeal 2011) http://www.lifebox.org/ http://www.bmj.com/content/343/bmj.d8085

Back in the early Internet days, Portals with link collections were hot and big business. Today, we use search engines and "google" whatever we need to know. And, we have learned the URLs to the sites we use most often by heart. But, there are still a some really good web based resources that is worth to be promoted and high-lighted. That's my idea with a series of posts with "Links to like" First out is neonatalresearch.org, a professional and yet personal blog by professor Keith J. Barrington, neonatologist and clinical researcher in Canada. Keith J. Barrington is writing about and commenting neonatal research. By subscribing to his new posts* on the or following the blog on Twitter, you will feel up-to-date and enlightened. Link to like... http://neonatalresearch.org *how to subscribe: visit the web site and submit your email address in the "subscribe" widget in the left sidebar

Interesting programme!

I have thought that impeded hemodynamics (during HFOV) is related to over-expansion of the lungs, i.e. only at distending pressures exceeding what is needed to get an optimal lung volume. But, I think you're after a threshold for intrathoracal pressure, which can be achieved with high settings, despite yet suboptimal lung volumes ? Look forward to hear from others on this topic!