Stefan Johansson

It is possible to email content directly to info@99nicu.org for anonymous posting. In the forum rules (http://www.99nicu.org/forum/custompage_disclaimer.php) and as a sticky post in the virtual NICU (http://www.99nicu.org/forum/showthread.php?8404-About-for-the-Virtual-NICU-read-this-before-admitting-a-patient!) we stress that patient integrity is important (and the responsibility of the posting member). We strongly recommend parental consent before posting. When I post questions related to individual patient myself, I always ask parents for consent before I post. In general, parents have been very positive to get 2nd opinions from international staff. Do you/would you ask for parental consent? If the parents give consent, would you still want to post anonymously? If parents say no to publication, I'd advice not to post, regardless if the post is done anonymously.

Despite the fact that we can use surfactant as we need to, we would most likely not admin surf at this late stage. In addition, the baby has a relatively long gestational age. I'd suggest your management is focused on gentle ventilation and weaning.

This is how we do it: all milk containers are marked with the baby's personal i'd nb and name. The nurse reads this info loud in front of the parents. If none of the parents is present, this crosscheck is done together with another staff member. The nurse then signs that the container is given to the parents/assisting nurse who feeds the baby.

Excellent links!

We use plastic bottles with screw tops for storage for all infants (term or preterm). I do not know where the come from (Medela?) but the plastic bottles are/should be free from BPA. When milk is warmed, the plastic bottle is put in a stainless steele containers with luke-warm water.

It is good that outcomes improve over time, but the absolute morbidity risks are still too high. Thanks for sharing this article (free full text in Pediatrics)

99nicu reached 5000 members the other week! A big achievement that you, me and all other members have contributed too. Our next goal is 10000 members, let's get there together! Spread the word about 99nicu to colleagues and neonatal friends!

Do you have infants intubated orally or nasally? How are the single rooms staffed? Are parents generally present?

There is some respiratory depression but hardly happens that the baby needs mechanical ventilation after the procedure (has happened once, as I recall it, MV was used for 1 hour) So, we don't use Naloxone generally. The spontaneous breathing comes back shortly after the instillation of surfactant and we then just extubate the baby. Fentanyl dose: 2mikrog/kg Penthotal dose: 2 (-5) millig/kg MIST... personally I think that the laryngoscopy is the a stressful part of the procedure, and therefore I would not feel good about not using any analgesia/sedation, even if surfactant would be admin with a small feeding tube/without intubation. But, I guess others have different opionions about this.

Several members have emailed me and asked for copies of nursing guidelines/protocols. If you have a good protocol about nursing the infant on MV and want to share it, please post here and attach the document. Or email me at info@99nicu.org and I can add it to this thread.

We all are aware of the fact that infants on mechanical ventilation need good nursing care, and we would like to promote this topics during July. The 99nicu Poll in July is about nursing guidelines and whether you have a written protocol for such care. If you want to upload your own protocol, please do. You can add attachments to your post. If you need help to add a protocol to your post, please email me on info@99nicu.org and I will assist you.

We don't have a written protocol for this and would use dose recommendations in one of the manuals (like Cloherty), like 0.01 - 0.2 units of insuline / kg per hour My small experience, one needs to monitor b-glucose closely...

Never heard of (my bad, I guess). Will explore!

But confused on à higher level ?!

@drsanjujoseph You might get some input from reading the Poll thread about ventilators: http://www.99nicu.org/forum/showthread.php?24407-99nicu-Poll-what-ventilators-do-you-use-on-your-ward

As Bohlin (Kajsa Bohlin) is my colleague we use the protocol as described in her paper from 2007 (http://www.ncbi.nlm.nih.gov/pubmed/17476269) Our indications are gestational age>27+0 weeks, RDS documented by x-ray and an a/A-ratio (despite CPAP 4-5 cm) of <0.22. We premed the babies with atropin+fentanyl+penthotal (and some use celocurin for muscle relaxation too) before intubation and administration of surfactant (we use Curosurf) Surfactant is instilled as a slow injection through a sideport of the ET-tube, during ongoing gentle ventilation (NeoPuff), pressures depending on the baby's condition. We don't have a fixed time/nb of breaths after admin of surfactant, but continue ventilation until the baby is breathing spontaneously again and we can extubate (typically a few minutes) Would be interesting to hear more views/protocols!

Poll added!

We use Curosurf (Karolinska, Stockholm)

I Will add a poll when we know the four teams in the semifinals!

Hope to be able to reveal more tricks in the future, after our current PDA projects @JACK, thanks!

We would do this differently - admit the family to the maternity ward as usual, check status (the midwife takes temp, breath frequence and pulse) every 6 hours the first day (at 6, 12 and 18 hours) but not later if the baby is completely well after 24 hours. The baby stays at least 48 hours on the maternity ward. We check CRP and blood counts on liberal indications though.

Good News! Congratulations!

@Al the best team won... Please beat Ukraine too!

Sweden has only lost once against England during the latest 40 years, according to the news. I think Swe and England have the same problem , lots of good players but the national team just can't make it happen...