Stefan Johansson

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Cholestatic jaundice is fairly common in my experience, among very preterm infants given TPN for shorter or longer periods of time. Depending on the dynamics of the s-bili, we do nothing but follow s-bili over time until it resolves (which is should do if the diagnosis is correct). If the s-bili is high or is increasing we medicate the baby with vitamin-K (0.1 mg/kg x1) , vitamin-E (7.5 mg/kgx2) and ursodeoxycholic acids (typically 10-15 mg/kg x 3), while following s-bili.

I agree with @ajaymenon, choices of fluids would depend on the etiology of shock and how clinical markers/lab parameters develop. I would use normal saline and/or blood products for hemodynamic volume support. When it comes to inotropes, I would probably start with dopamine and add dobutamine if needed. Vasopressor support with higher dose dopamin and possibly epinephrin.

I bump this thread as we discuss to introduce a bar code scanning system. ´Would be interested to hear more about technical details, incl brand names/retailers

We use a dilator with a "drop"-formed tip. Works pretty well. I have googled for such a dilator without success. Was it manufactured by a medtech company or was it "home-made"? Could you post a sketch?

If you're interested in evidence-based medicine, publication bias, research mis-conduct, and #BadPharma - don't miss this #TedMed talk by Ben Goldacre:

The IX International Conference on Kangaroo Mother Care will be held on 22 to 25 November 2012, at Ahmedabad Gujarat India. More information here: http://www.kmcindia2012.org/

@goosman - best of luck! Feel free to tell the audience that you recruited responders also through 99nicu

me to

I am very glad to announce that there will be a 2nd Evidence-based Neonatology conference, in Cairo, Egypt, 13-16 March 2013. The registration has just opened on www.ebneo2013.com The programme looks very interesting, and topics include: Fetal and neonatal programming Hyperbilirubinemia in the preterm infant Necrotizing enterocolitis- prevention and treatment Preterm brain damage Preterm aEEG and its prognostic ability: what is known? Observational and randomized data in transfusion for preterms – what is the comparison? PDA revisited – Patent ductus arteriosus: to treat or not to treat? Evidence for placental transfusion in term and preterm infants Transfusion-associated NEC C-section for preterm birth and neonatal morbidity Developing a cheap surfactant for the third world – planning stages of a large RCT Survival without disability to age 5 years after neonatal caffeine therapy for apnea of prematurity Linking Physiology with clinical practice – New insights into stabilization of preterm infants at birth Implementation of evidence based neonatology – the EPICE project Economic outcomes of prematurity Follow up of high-risk infants All information about 2nd EBNEO conference is available on www.ebneo2013.com If you want more information by email – please contact info@egyicc.com

We change position every three hours and also use à special madrass (which name I cannot remember right now...)

Not us! But I heard Ann Hellström at the EBNEO in Stockholm 2011 and it seemed to be a service worth exploring.

Our babies are also lasered at the OR.

Unfortunately not. I planned to present an abstract from this study (http://www.ncbi.nlm.nih.gov/pubmed/19841112) but I had no funding for travels Please report back how you like it there. Incl Hamam-visits!

Here the web site for NOTE http://www.neonataltraining.eu/

Sweden is a good country for parents and when it comes to becoming a father, I think our society is becoming more and more "inclusive". Illustrated by the welcoming photo outside the maternity ward, an infant - with the father in the background. In our Karolinska NICUs we are "rooming-in" parents in family rooms, where the baby is taken care of by the parents as much as possible. We promote the presence of both parents. When only one parent is staying over, it is not uncommon that the father is the one doing that. Still, we, i.e. fathers in Sweden, have more to work on, before we can say that we equally share all family commitments and responsibilities for our children.

We order TPN solutions from our hospital pharmacy, individualized for each infant. As we increase fat and protein load over three days, we make one new "recipe" per day over the first three days, and then we usually order TPN solution 2-4 times a week for each patient, depending on water balance, volume target per day etc. We really aim for individualized nutrition but we feel our strategy is expensive and time consuming, and are looking for ways to simplify. I.e. looking for commercially available TPN solutions, or letting the hospital pharmacy pre-produce a set of "bags" that enable an individualized approach that is "good enough".

This is a good question, one that we should ask ourselves. Let's hope many members share their personal stories! My original plan was to become a general paediatrician. But, I was hooked by neonatal medicine during my first rotation in the NICU, during my training in paediatrics. Much thanks to a great mentor. I have not regretted that I took that path. I really enjoy the combination of work we do: well-baby checks in the maternity ward, caring for infantsin the neonatal ward, meeting ex-premies at the follow-up-clinic, research and teaching. With age, I tend to enjoy the daytime work with follow-up clinics and teaching more and more, but the thrill when complicated things happen during night hours is still something I like... With all good tools we have, I often feel good about what we, as a team, have achieved for a sick baby. In short, I think that there a few medical specialities that are as interesting, rewarding, and challenging.

In Sweden, the goal is set to one level-3 bed per 1000 deliveries. Our level-3 care is pretty much regionalized, I think there are 8 NICUs that are formally categorized as level-3, on a population of 9 million people and 110.000 births per year. Regarding level-2: I think the national standards vary more than the level-3 need around the world. My own example, in the Karolinska unit where I work, there are 10.000 inborn infants (gestational week 28+0 and up), and we have 20-24 beds. We usually use all beds all the time... Our admission rate is slightly lower than the national average (about 8.5 vs 10 %), part of the explanation is that we keep some infants in the maternity wards that would qualify for neonatal admission in our hospitals with a larger number of beds.

Agree!

We would use HFOV as our mode of ventilation, and use a distending pressure that is relatively high without leading to over-distension. We would mostly use erytrocytes, aiming for an EVF around 40. Besides that we would use plasma to support volume and coagulation. Trombocytes would only be given if trc-penia develops, depending on the dynamics of the trc counts.

Parenteral nutrition is necessary for critically ill infants, and there are several ways to get solutions for parenteral nutrition. From mixing own solutions in the NICU to using commercially products "ready-to-use". What is your current practise regarding the TPN solutions. I will share the Karolinska way (which we currently discuss to revise...) in a separate post later.

I am just reading the yet unofficial and near-final programme for the 2nd EBNEO-conference, scheduled 13-16 March 2013 in Egypt. Topics will (probably) include: Mode of delivery and morbidity in the preterm infant? Developing a cheap surfactant for the third world – planning stages of a large RCT Survival without disability to age 5 years after neonatal caffeine therapy for apnea of prematurity Resuscitation of the preterm infant Implementation of evidence based neonatology - the EPICE project Economic outcomes of prematurity Follow up of high-risk infants Stay tuned the conference web site (where you can also register): www.ebneo2013.com

Def looks like scar/keloid tissue! Have you done biopsy and histopathology?

Thanks for your kind feedback! Did you also attend one of the symposias?