Stefan Johansson

This is how we do it - not necessarily the right way to do it Ill infants (on ventilator/HFOV) are usually given furosemid, 1-2 mg/kg/d, but after extubation many infants are switched to thiazides+spironolactone. We continue the therapy for quite some time, but usually before they are ready to start weaning off from CPAP (4-6 weeks are typical). As many have pointed out - it is questionable whether to use diuretics at all. But, we still do use them.

I spoke to a colleague now working at Guys and St Thomas hospital in London, UK, at the PICU for pediatric cardiac surgery. He sees plenty of patients with Down syndrome and they do not routinely use smaller tubes. Although there are many referrals (i.e. long-term follow-up done somewhere else), he has not heard that tracheal stenosis would be more prevalent among Down children. But, as you know, the pulm vascular bed can be hyperreactive and a difficult intubation might trigger pulmonary hypertension. (Although we see not so few newborns with Down syndrome (with 10.000 inborn babies/year), we rarely need to intubate them in the neonatal period. A personal reflection, AV commune or other complex cardiac malformation seem uncommon in the Down population I investigate with echo. I wonder if it reflects that amniocentesis is more common when the fetal screening ultrasound shows a possible cardiac malformation (week 16-18), and that fetal diagnosis of Mb Down is more common in fetuses with cardiac malformations. I.e. is VOCs less prevalent in the current population of infants with Mb Down? That could be a hypothesis worth testing in a study!)

Our routine practise is to promote breast-feeding as much as possible. Almost all preterms have mother's own milk during the NICU stay and it is routinely fortified as long as the baby is tube feed (up to total protein 4 g/kg/d, and calories/fat until normal growth is reached). When the baby starts to breast feed, the tube feeding is being reduced until the baby is fully breast-fed AND growth is still ok. However, we commonly see that, after the tube is taken away, supplementary bottle feeding is needed for a good growth. About 40% of all ex-preterm infants (-34 weeks) are fully breastfed at the time of discharge, another 40% are partially breast-fed and 20% are bottle-fed. My experience is that fortified milk is less well tolerated (from bottle, I guess it tastes differently). Our dietician sometimes advice to give some suppl feed's on bottle, occasionally also fortified. So, in short - we allow exclusive breast-feeding, but monitor the growth curves.

This is the INIS trial - we wrote a short note about this on Home : http://www.99nicu.org/forum/content.php?256-IV-immune-globulin-does-not-affect-outcome-of-neonatal-sepsis Published in NEJM late 2011, N Engl J Med 2011; 365:1201-1211

@svilata Thanks for the URL to the WHO site , much better than the one I use (-d )

The 99nicu iPhone app has just been approved by Apple and is now available on iTunes store. Free of charge and free from ads, of course. One nice feature is that posts from the app is marked "Posted from iPhone app" Here's the link to iTunes. On your iPhone, search in iTunes store for "99nicu" and you'll find it.

I have no personal experience but have also heard that caffeine may improve the respiratory drive. From what I heard, CPAP/BIPAP or tracheal canulation + mech vent is needed during sleep. I am curious to hear more about presentation and how you set the diagnostis.

Looks great!

I should make this announcement later but cannot refrain from telling you half the story now There is now a 99nicu app, at least for telephones running Android. Click here to download it from Android market. One nice feature is... when you post from the app, your posts get marked "Posted from Android app". Please try! (you may wonder about the second half of the story... yes, we have an iphone app in pipeline... But the process to have it approved by Apple (Almighty) is more complicated. So, iphone user, you need some patience.)

It would be interesting to hear about the need for echocardiography, and whether it has increased. According to the studies, specificity for this screening has been very high, i.e. the rate of false positive being low. And consequently, the argument is that the screening can be introduced without increasing the workload much for echo technicians/cardiologists.

We use the Z00.1A for the well-baby-checks in the maternity wards.

There is a growing body of data suggesting that pulse oximetry before discharge from maternity wards can identify complex but yet asymptomatic cardiac malformations. It would be interesting to hear how common such screening has become. Please comment below too! The poll is open until 31 Jan 2012.

I must say that my experience is very small in this regard. We would give some sedation if needed, but not relaxants, to babies on a ventilator. (for "non-emergency" intubation we sometimes give celocurin, 2 (-3) mg/kg as a single dose.)

I'd just like to wish everyone Happy Holidays and a Happy New Year! And, also thank all the many people sharing their expertise in the forums, both as questions and as comments. During 2011, we had some very positive emails from members telling how discussions here changed practise (and probably outcomes too). Which makes me believe even stronger in this kind of crowdsourcing. For next year, we will announce some new and cool features, making 99nicu even more useful... stay connected

Thanks for your kind words! I am happy that you and all others are here. Neonatal crowdsourcing! Best wishes for 2012!

Thanks for sharing great articles! And, what about the period after year 2000? What errors comes in the "post-experience" period?

Need to...

Europ Society for Neonatology has an online training course: http://www.neonataltraining.eu/ I do not know how to be enrolled but there are contact details on the site (URL above). I would also suggest: 1. Subscribe to http://www.hopkinscme.edu/ofp/eneonatalreview/ 2. Subscribe to http://www.neonatologytoday.net/ 3. Join http://www.nicuniversity.org/ 4. Watch the EBNEO webcast: http://ebneo.org/wp/index.php/2011/06/tweets-photos-and-web-cast-open-access/ On twitter, follow @pubneo, @ebneo and @harvardneo. And @99nicu of course

That's a wise statement. And funny too!

This is off-topic but relates to the freezer-advice. Up till the early 2000s we used a rather stiff tube. To make intubation easier the tube was boiled and then taped to a curved form where it was kept until it had cooled. When we used the tube it had the "right" curvature and could be put in place with great ease! Now, we use softer tubes. And instruments to steer it into the trachea too.

For now, it is only some graphics. More news come soon!

Here 's a sneak preview of something we're working on... If all goes well, we'll tell the rest in January

Great video! (@fcardona, I tried to embed this video in the post, but could not..., strange!)

You can buy this book from Amazon.com. 99nicu is a partner of Amazon and a purchase using the link below, results in a small portion of the order value being paid back to 99nicu. At no extra cost for you. Click here to order this book through Amazon.com!

I open this thread for the member sasa, who originally posted this topic in the Blog section. In our house-keeping of 99nicu.org, we aim at publishing all discussion topics in the forums, whereas the Blogs are meant for more personal reflections.