Stefan Johansson

Interesting question! I am not sure about the setting but I don't think we keep rooms warmer than 22 degrees centigrade. Which means that babies needs to be dressed or preferably lying skin-skin with the mother/father.

The use of inotropes is a matter of discussion, and the 99nicu Poll for May 2012 is about the use inotrope use in preterm infant. This poll is inspired by a topic at the Evidence-based neonatology (EBNEO) conference in Stockholm, June 2011. Dr Alan Groves lectured about the use of inotropes, in an excellent and thought-provoking way. You can see this lecture in the EBNEO web cast, as the first lecture on the 2nd conference day (4 June 2011) http://web22.abiliteam.com/ability/show/khcichp/abbott_ebneo/speed.asp A review article by Alan Groves is also promoted as the Leading article this month.

Same here, they are added to the fat emulsion, usually started before 24 hours postpartum.

Sounds almost too good to be that close to work! Maybe you could also send your teenages when the're off, for some extra work - might give their wallets a rest too I usually bike to work (10 km). Being from the country-side ("rural Sweden") I have never become accustomed to commuting by bus/underground. Sounds silly, but I found that others (who have moved in from elsewhere to Stockholm) prefer to bike as well. Greetings from Stockholm!

During the last few days you might have noticed that 99nicu has been offline sometimes, due to technical maintenance. I needed to upgrade the software that 99nicu.org is based upon (vBulletin), and also need to compile new versions of the iOS and Android app. Since we started, I have done software installations and upgrades (auto-didactic with computers) but the more complex these softwares become, the more I sweat before I do this technical maintenance. And, I also feel kind of responsible for the hundreds of people browsing 99nicu every day. If things go wrong, I'd be like a man in a dark forest with the torch just stopped working. I.e. completely lost... and offline. Keep fingers crossed that we manage to get funding in the future to out-source the whole technical backend of 99nicu.

1. Would have taken the same decision in a scenario like that. But, the smallest indication of infection would change that decision. We also commonly take CRP and a blood culture with th first blood tests, to have it done in case we start ab later. 2. Possible, but the risk should be quite low, especially if the mother has recieved prepartal ab. 3. I don't think that the initiation of ab treatment is the problem here, but how long we use them. We need better methods for predicting abscense of infection, so we can give them as few days/doses as possible.

There is an open-source database platform developed by an Australian neonatologist. http://www.99nicu.org/forum/showthread.php?10882-Neonatal-database-platform-for-free! You may also consider to collect your data within the Vermont-Oxford network: http://www.vtoxford.org/ In Sweden, we collect patient-data on a national basis. The database is developed by http://medscinet.com

@fcardona - your Swedish improve

Almost six years has passed since 99nicu.org opened its door. Greetings to everyone from the virtual Headquarter!

And, here's a study from the UK about re-organisation, published in BMJ just a few days ago. Survival increased during recent years. http://www.bmj.com/content/344/bmj.e2105

Great link, thanks for sharing!

Here's a few studies, I take the opportunity to cite myself in the first one Preterm Delivery, Level of Care, and Infant Death in Sweden: A Population-Based Study The Effect of Birth in Secondary- or Tertiary-Level Hospitals in Finland on Mortality in Very Preterm Infants: A Birth-Register Study Perinatal Regionalization for Very Low-Birth-Weight and Very Preterm Infants Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

Regionalization of level-3 neonatal care is advocated by many, as several studies have showed that outcome is better in large/regional NICUs. However, the question of regionalization might be more complicated when it comes to implementation. The 99nicu Poll in april is about policies of regionalization, and how they seem to work in practise. Take the opportunity to post your comments too!

Am on the way to work, writing this post on the 99nicu iPhone app . Have a weekend shift in the NICU. Feels good to do some hospital work for a change, as I am on paternity leave now with our daughter Domestics - also work for a doc!

The conference Evidence-based Neonatology (EBNEO) in Stockholm 2011 was much about the 99nicu community going IRL. I am very happy that we managed to launch the event. And, as you may know already, there will be a 2nd EBNEO conference, 13-16 March 2013, in Egypt. But today I'd just like to tell everyone that review articles of topics presented at the 1st EBNEO in Stockholm are now available on-line, published in a digital supplement in Acta Paediatrica. All articles are available in free full-text format. Click here to read the supplement. If you want to stay tuned about future EBNEO announcements and news, visit www.ebneo.org and www.ebneo2013.com

We use Neopuff in the delivery room and use 4 cm H2O as the general PEEP setting. It's hard to control inspiratory time during manual ventilation (...) but we instruct new fellows to close the circuit with "brief" movements (sort of short inspir time )

"Beyond boundaries" period?

I was thinking of about TORCH (Toxoplasm, Rubella, CMV, Herpes viruses) and also Parvovirus B19. As @vito62 says below, fungal infection could be a possibility too. As you know, both bact, viruses and fungi can be hard to detect in lab tests/cultures. Were the babies term or preterm, very sick or rather well etc?

I see that you had a comment on this topic on Facebook: http://www.facebook.com/99nicu/posts/346104885425944

Where babies cared for during the same time frame? If so, sounds like something contagious, like a viral disease after all. Which viruses did you check for? Did they all recover?

We screen the following groups of "high-risk" infants, cared for in the maternity: - infants to diabetic mothers - near-term infants (35-36 week) - LGA - SGA - infants Apgar<4 at 5 min's, metabolic acidosis BE<-15 in cord blood or hypothermic postpartum B-glucose are checked twice the first 24 hours. If supplementary feeding is started (generally done in the first four groups above), we check b-glucose after the 2nd and the 4th feeds. This is the outlined management in our units depending on b-glucose levels (mmol/L) >2.6 - unchanged strategy and no further controls 1.8-2.6 - increased feeding <1.8 - consider iv glucose infusion < 1.1 - NICU admission, glucose bolus and infusion

Interesting project! Fetal growth issues are common in perinatal medicine and better tools are needed. Are you seeking ultrasound estimate mid-pregnancy and birth weight ?

I think you should get this book, Textbook of neonatal resuscitation http://astore.amazon.com/99nicu-20/detail/1581104987 There is à DVD incl with the book with "examples", I guess they are good. However I have not seem the DVD myself.

If the baby is 4 months old - the hairloss may well be tinea capitis, caused by a fungal infections. http://aapgrandrounds.aappublications.org/content/7/5/57.extract

There is an article in this week's Swedish Medical Journal (in Swedish..., but I guess google translate can be of some help) about the accumulated Karolinska experience of diaphr hernia over 20 years. http://www.lakartidningen.se/07engine.php?articleId=17768 Overall survival beyond 1 years of age (1-20 y of follow-up time) was 77%. The current strategy is early intervention, commonly during the 2nd day of life, if the baby is hemodynamically stable.