Stefan Johansson

Have a look in the handbook in this comment: http://www.99nicu.org/forum/showthread.php?8592-PICC-lines&p=30226&viewfull=1#post30226 http://www.nann.org/pdf/PICCGuidelines.pdf

I think the NICE-guidelines are very good, a thorough document and with charts too (can be individualised by gestational day). http://www.nice.org.uk/CG98

As suggested above: I would not try to close the duct without ruling out structural heart disease by echocardiography. In addition, with a fresh bleeding I feel NSAIDs are contraindicated. So, my suggestion: wait and see.

The "temperature" was meant symbolically , we just want to find out how people use nIPPV before publication about the nIPPV trial results.

There are several papers describing the method, for example: http://www.ncbi.nlm.nih.gov/pubmed/20971722 http://www.ncbi.nlm.nih.gov/pubmed/20180736 http://www.ncbi.nlm.nih.gov/pubmed/17476269 http://www.ncbi.nlm.nih.gov/pubmed/19117872 I personally think MIST and INSURE are really two versions of the same idea/practise, the major difference being the degree of sedation during the procedure. Our protocol includes 1. premedication with atropine, fentanyl, penthotal and celocurin 2. intubation and administration of surfactant 3. await spontaneous breathing again and when it comes back (within minutes usually) extubation and back to cpap.

Nasal IPPV is a respiratory support technology that is spreading in NICUs around the world. Those of you attending Hot topics 2012 or EBNEO 2013 probably heard about a comparative study in which nasal IPPV and regular nasal CPAP was compared in extremely preterm infants. We would like to check the temperature how nasal IPPV is used "pre-publication" of the results presented at Hot Topics and EBNEO.

Maybe you had an interesting visit by a representative from Vygon and someone then feelt dedidacted to try this kit out

We don't use it either.

I write this while waiting at the Istanbul airport, on my way home to Stockholm. Still full of impressions from the 2nd EBNEO conference that ended earlier today. The conference was originally planned to be held in Cairo, Egypt, but in the last minute we took the decision to change to a venue in Istanbul. We worried about that the current social and political instability in Egypt could interfere with the conference. Although such a risk was probably very small I think most speakers and delegates had understanding for our precautions. The venue for 2nd EBNEO was the Gonan Hotel in Istanbul, a very nice hotel close to the Ataturk international airport. During 2.5 intense days, we could hear in lectures covering a wide range of topics. Naturally, the focus of the conference was evidence-based clinical care of newborn infants, but we also learned more about the basic science of preterm brain damage and got new insights the fetal-neoantal transition. Importantly, we also heard about follow-up care and long-term outcomes of high-risk infants. As we put so much efforts and resources after delivery, we have an equally strong obligation to put efforts and resources in follow-up care. The 2nd EBNEO conference was not broadcasted on the web as the 1st conference (still available here), but we did our best to live-tweet the most important content. Take a look at the @ebneo twitter feed! Before I finish (and board the plane to Stockholm) I would like to, on behalf of the EBNEO Founding Board, to thank: Hesham Abdel-Hady and Abdel-Rahman El-Mashad, for being President and Secretary General for the 2nd EBNEO conferenceICC, the conference agency, for all practical work and not the least for taking a great financial responsibility for all arrangementsall speakers and all delegates for coming and for sharing expertise, comments and questions The EBNEO project will now travel across the Atlantic. Professor Haresh Kirpalani will be the president for the 3rd EBNEO conference, and it will be held in Sept 2015 in Philadelphia/USA. I am already confident that the 3rd EBNEO will be as succesful as this conference in Istanbul. Subscribe to get future updates about the details of the 3rd EBNEO conference!

Just to confirm the diagnosis, would it be possible to get a skin biopsi? Here're 2 reference about propranolol: http://www.ncbi.nlm.nih.gov/pubmed/23429945 http://www.ncbi.nlm.nih.gov/pubmed/23278381 If the baby is just well and there is no signs of hemangiomas on complicating sites (airway/liver/brain), I'd think it would be possible with a conservative approach. The great number of hemangioms might be problematic, especially if they are grow much before they start to go back spontaneously. I guess a pediatric dermatologist might vore for beta-blockade. Do you have a pediatric dermatologist to consult?

I agree with @Dinesh, looks like a varicella rash. If correct you would see crusts coming soon - any such development? For multiple hemangiomas, we "screen" brain and liver for hemangiomas, using ultrasound.

I am on the way to the 2nd EBNEO conference, waiting in the airport to board. As you probably know, the 2nd EBNEO conference was scheduled in Cairo/Egypt. Due to current circumstances, the conference was moved in the last minute to Istanbul/Turkey. I am very glad and grateful towards the conference president Hesham Abdel-Hady (aka hehady here at 99nicu). It is really a major achievement to make EBNEO happen a 2nd time! There will be no webcast this time, but you will be able to follow the symposias on Twitter @pubneo or @EbNeo or the hash-tag #ebneo2013 PS. BTW, the 3rd EBNEO is taking form too. Unless we meet in Istanbul over the next coming days, let's hope that we meet 14-15 September 2015 in.... Philadelphia/USA.

We always clean the probe between patients. Please note that some alcohols may damage the probe's plastic surface. We are adviced (from the manufacturer) to us an isopropanol-based desinfectant.

The first 99nicu Poll in 2013 is about your use of social media, and which web platforms you use for professional communication with other neonatal staff. When we started 99nicu in 2006, I did not sense the dramatic development of interactive web sites during the years to come. In a way, we were pioneers without knowing about it. But the basic idea behind 99nicu contained everything in the definition of "Social media", according to Wikipedia. We aimed to create a platform for professional communication between neonatal staff, with the aim to promote health among the thousands and thousands of term and preterm infants populating NICUs around the world. I'd will expand on my thoughts about social media in a blog post later, and how its use has changed my own relation to medicine in general, and neonatology in particular. Share your own use of social media sites, and feel free to share your own experiences about your own professional use of social media. Multiple choices are allowed in this poll, i.e. if you use both Sermo and Twitter - tick both alternatives. 8)

Wish you the same!

I don't think so unfortunately.

I have a week off clinical duties for research. After the weather forecast yesterday, I brought my laptop and dataset home, as I realized it could be difficult to get to work. So, now I sit here analysing the effect of maternal BMI on infant health (more to be read in journals near you in 2013...), with a great snow storm outside our house. It's winter, and a very good one ! Almost as good as the exciting odds ratios coming up on my laptop screen!

Here's an article with definitions of various perinatal terms, incl stillbirth: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732966/ In Sweden stillbirth is defined as lack of any heart rate or breathing, which means that a baby with heart beats is live born even if the baby (for some reason, incl extreme immaturity) is not actively resuscitated. In Sweden, stillbirths are defined in the official statistiscs from week 22+0, and regardless of birth weight. Before w22+0, births are categorized as miscarriagies.

Some degree of "cooperation" is needed for effective CPAP therapy. If alternatives like pacifier etc, I would also use low dose analgetics or sedatives. One important aspect is to consider why the baby is agitated and relieve symtoms by cause.

Not me, the unfreq traveller I am But I will follow @pubneo on twitter

Good point - I did not mention this on my slides as studies are still rather small. But we discussed about this possibility. I think it would be worth to make a large RCT randomizing to oral and iv ibuprofen, to settle the question. One reason is the safety issue, one example here: http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2004.tb02702.x/abstract

Do you need the original charts? Otherwise, NICE in the UK has published very thorough guidelines on neonatal hyperbili, with charts too. http://guidance.nice.org.uk/CG98/ https://www.nice.org.uk/guidance/cg98/resources/treatment-threshold-graphs-544300525

in our level2 unit we use ISTAT from Abbott (http://www.abbottpointofcare.com/) Works well for level2 requirements. For more heavy use, I'd advice that a more stationary machine. Good points by @JACK, a good service programme is essential for a stationary machine used heavily.

I'd would say, wait and see/re-check the blood gas.

@24weekers started to follow our twitter account @99nicu - which draw my attention to "24weekers" - a film project by the journalist/film producer Alan Entwistle who became the father of a baby born at 24 weeks gestation. A film that "affirms the value of life". The project seeks crowd-sourced funding through Kickstarter (here!). Moved by the trailer, I really hope that enough people will contribute. This movie would be important document, for the public, for health care professionals, for politicians and not the least for the many-many thousands of those who became parents far too early to the tiny ones, cared for in NICUs around the world. Click here to read more about what Alan Entwistle and his team want to achieve.