Stefan Johansson

Hi Nele, we run the milk bank for the Stockholm Region in our hospital but I don't know the technical solutions, I will check later, am on vacation right now :)

I bump this thread with this new article in BMJ (thanks for sharing @Francesco Cardona ) "From genome to exposome: universal newborn genetic screening is the wrong focus if we want to improve population health" I especially like these two passages: https://www.bmj.com/content/389/bmj.r1349 I

I also feel a bit frustrated about no-mans-land we may end up in with PDA questions... There are more data on what-not-to-do, than about what-to-do! Regarding your specific question, a common take would probably be along the lines of the recent AAP Clinical Report (link here), to wait and until the infants is >2 weeks of age. And, then go for pharmacological closure attempt, especially if <28 weeks, on invasive ventilation and with clear echocardiographic signs of cardiac load. Very few surgical ligation are done in Sweden nowadays (as compared to the less good "good old days") BTW, there is a new national PDA guideline to be launched in Sweden, hope to share a translation here once it is published!

During the latest 99nicu Meetup, we had this session, enjoy!

I know there is an enema study going, Uppsala in Sweden is part of it. And as you know, there is much use in Japan. What liquid used? I think mostly sodium chloride, this is what we use WHEN we do enemas in our unit (which is unusual)

Thanks @Jelli KA ! And on topic, a recent blog post too by @kbarrington https://neonatalresearch.org/2025/05/29/caring-for-the-most-extremely-immature-infants/

Many thanks @Greice Batista for starting this important topic. While we have good access to donor bank milk, we usually restrict donor milk use to infants <32 weeks or <1500g. The logic is simple pragmatism, we would not have enough if we would universally adopt donor milk to all say <34 weeks. We do not use IV fluids or TPN unless the infants is unstable and needs intensive care, and I think you share our experience that the majority of those infants ≥32 weeks are just fine. Only nCPAP for transient tachypnea or mild RDS is not a reason to switch from full enteral feeding to IV fluids in our NICU, given reasonable feeding tolerance. We typically aim for 40-60 ml/kg/d enterally the first day of life and then gradually increase to full enteral feeding within 5-6 days (≥150 ml/kg/d). The formula we use is "partly hydrolysed", and we keep using it until there's mother own milk or until discharge, whatever comes first. If the mother does not intend to breastfeed, we commonly switch to regular term baby formula before discharge. My personal advice to parents is to get the basic / cheapest one, there is such a big business of around formula and most more expensive variants of term formula is IMHO not backed by data showing benefits. But there are many variations on this theme, as you probably also experience. When it comes to cow milk allergy specifically, this is nothing we discuss in the NICU. Back in the days, there were a lot of advice given to parents and also to health care professionals about avoiding "XYZ" to reduce the risk of "ABC", but I agree with you that the trend in the Allergy World is rather that early gradual exposure is beneficial for tolerance. How do you do in your NICU with IV fluids, formula types, volumes etc?

Thanks @ialhifzi could you add the ref to the list you shared above? @praveen the second ref i the list above is the meta-analysis by Wang et al https://pubmed.ncbi.nlm.nih.gov/37782505/ Taken together, there is reduced risks generally, but strain specific effects are still an area for research

This paper came on my LinkedIn radar, a paper showing that LISA was quite effective in meconium aspiration management, reducing the need for invasive ventilation and also NO need. Do you use LISA for this indication? BMJ Paediatrics OpenLess invasive surfactant administration for meconium aspi...Background The role of less invasive surfactant administration (LISA) using a thin catheter in the management of meconium aspiration syndrome (MAS) is unclear.Study design A retrospective study of...

Acidos without low apgar or need for resusc - at least those are not at risk of hypothermia We don't admit for this reason but back in the days, "my professor" taught me to give buffer when BE was lower than -15 😬 PubMedLow Apgar score and need for resuscitation increased the...A low Apgar score of and/or a need for resuscitation is more relevant for identifying infants eligible for therapeutic hypothermia, compared to other A criteria. This knowledge could be used clinic...

If the infant would be admitted to the NICU, we would probably use P20.9 or P20.1 depending on the symptoms (less or more, respectively). However, if there is only acidosis in umbilical samples and no symptoms at all, and the infant goes with the parents to the well baby / maternity ward, we would probably just use Z00.1A for ”healthy newborn”. The example you describe sounds like such an infant :)

Thanks @Vicky Payne for sharing, IMHO this would be the preferred process also here in Sweden. Is there any research (numbers please!) what level of diagnostic accuracy you have with this setup? The argument here in Sweden is that doctors are needed to do all this, to avoid that cases of XYZ are missed. Which I disagree with, as we all know, not even doctors live in the perfect world.

The American Academy of Pediatrics, AAP calls NICU staff, researchers, families and all others policy makers, kicking off the #BabiesNeedScience campaign on April 25! While the initiative seems to originate in the current US context, we all know that science is essential for improving public health of infants world wide. As an organisation connecting health care professionals in a global network, we share the values behind this campaign. It may seem like an obvious position that science is instrumental for evidence-based practices in NICUs. However, we experience a time in history where high-pitched opinions want to change the narrative about meaningful public health strategies to reduce the disease burden of newborns. Therefore, the #BabiesNeedScience campaign is a timely initiative that we fully support. We want to encourage all 99nicu members to join this campaign, by speaking out why #BabiesNeedScience, on this web site and in your social media channels. Support and follow AAPs example. https://www.instagram.com/p/DIsjikrxc4h/

Many thanks @Mariana Oliveira, and I fully agree to your take home message. Only because something is not the Big Time Magic Bullet, some small magic is often enough as that also has value. Perfect is said to be the enemy of Good, I think this applies also to much of our NICU ambitions.

Among the changes, it is now possible to add so-called animated GIFs to your posts, when you need to convey something with a picture worth more than 1000 words, as the saying goes. Please use carefully 😀

Our strategy, in addition to feeds and swaddling, we give kloralhydrat 25-50 mg/kg orally/enterally (if NG). In addition, we always have a periph ven cannula and give midazolam iv if needed.

I got a DM with a Youtube link, with the recording of the Expert Panel presentation, broadcasted by Reuters

I wanted to share a few Journal Clubs that @EBNEO did a few years back, great educational videos that are published on their Youtube account. I suggest that one watches them in the order as embedded below! P-values - should it be this simple? Interpreting effects Network meta-analyses

Thanks @drdeepsj for sharing here, I am happy to share this in a coming Email Newsletter.

Those of you using cont glucose monitoring, do you have some specialised (research?) technology or do you use the ones also used by older kids and adults? We tried one of the latter, and our experience was that "it looks good, but feels bad", i.e. we got a lot of data points, but the precision not good (both over- and under-estimation of the true blood glucose from the validated method)

Lets assume that this hypothetical patient is given a total of 100 ml/kg/d: enteral feeds of ~20 ml/kg/d and the remaining ~80 ml/kg/d as TPN, individually mixed to reduce glucose intake (TPN solution ~5% glucose). TPN protein intake would correspond to ~2 mg/kg/day