Stefan Johansson

It's a bit tricky to photograph variations in skin colour. Suggestion: warm the back/arm of someone (not a baby, but a colleague, family member etc) carefully (sauna/hot bath/hair dryer) - experiment taking pictures of a small skin area (or even better, shooting a video-clip), before/after compression with your finger tip.

Here - a new publication comparing PO and IV ibuprofen, published yesterday in ADC. I paste part of the abstract below http://fn.bmj.com/content/early/2011/12/05/archdischild-2011-300532.abstract

Bought a new book and my daughter (11 months old now) takes a closer look... (and yes, she reads more suitable "look - a flower" books too) If you wonder whether Atlas of neonatal brain sonography suits your child, read the review here, and buy it from Amazon here.

Please report your conclusions from your research. The topic is highly relevant!

Thanks all for your input! Maybe I should also share the our strategy: furosemid 1 mg/kd/dose once daily to start with, but we change to chlorotiazid (Diuril) 10-20 mg/kg x 2 and spironolactone 1-3 mg/kg x 1 if the baby is planned to stay on diuretics for longer periods. Previously, we used much furosemid for longer periods of time, and my impression now is that we only rarely have problems with hypokalemia and nefrocalcinosis.

I work at a Karolinska unit located at Danderyd Hospital, with 10.000 deliveries per year, the largest delivery unit in Sweden. In fact, almost 10% of ALL Swedish babies are born here (110.000 Swedes are born/year)! We have several vacant positions for qualified neonatologists. Work with me! Applicants must speak Swedish or other Scandinavian languages. PM me for more info or email the head of the unit bjorn.westrup@karolinska.se Click here for more info in Swedish, and here for more info in English.

In NICUs we do so many things every day, some very simple, some very complex and difficult. My own days are crammed with activity right now. During a short coffee break today, I and a colleague tried to think about everything we do. The Big Take!

@Deena - thanks for posting, you did it just right! I now work in a large level-2 NICU, so the question of NO is not an issue for us. Our policy is much like the one described by @gopan2596, pregnant nurses (and doctors) work as long as they feel comfortable. We take some special considerations. What comes in my mind is infants infected by CMV (or rather, that we know are infected with CMV) - we do not assign these babies to pregnant staff.

I would like to hear about your choices when it comes to diuretics as BPD treatment. Which drugs and doses do you use?

Maybe I was too hard on Sweden - but I just felt the great contrast between Stockholm and NY. Sweden is a great country in many ways and I have not plans to emigrate But, we are just such a tiny and uniform spot on the complex world map.

I just found out that we do not longer have the device that was tested here in the early 2000s (http://www.ncbi.nlm.nih.gov/pubmed/16299875), but a "updated" version... So, the truth is that we are using a non-validated device. Which does not seem to work for neonates. We'll speak to Abbott (the manufacturer) but we are now really looking into the market for a new method for blood glucose monitoring.

Sounds promising. Keep us (in Danderyd and in the world) posted!

We currently use the Freestyle glucose monitoring device (a variant of this one http://www.abbottdiabetescare.com/freestyle-lite-blood-glucose-monitoring-system.html) but feel frustrated about it. This monitoring system was evaluated at Karolinska about ten years ago (http://www.ncbi.nlm.nih.gov/pubmed/16299875) and the correlation with our previous "gold standard" - venous blood sugars measured with the Hemocue machine - was found to be good. Now, we often see that low values obtained with the Freestyle are commonly normal when venous samples are measured by the regular lab or with Hemocue. What equipment do you use for blood glucose monitoring in your unit? Does anyone have experience from micro-dialysis of newborns/preterms?

A rarity indeed! I have not seen a "true" case, I remember one very preterm that we suspected for having neonatal diabetes, but it was "transient hyperglycemia", just less "transient" than it usually is. Do you use microdialysis or regular venous/capill b-sugars to monitor insulin therapy?

Don't miss Popburger! http://lxtv.com/1stlookny/video/7761 And, if you are an espresso addict like myself, DON'T waste your caffeine intake at Starbucks. There are lots of small espresso bars around. One of the best espresso's - New York University bookstore (726 Broadway).

I would think that a UVC (see also link shared by JACK above) that is correctly positioned is ok under these circumstances.

I have searched PubMed for literature about your question above, without success. Our strategy is to use the umbilical vein if it is possible to catheterize it (circle argumentation...), i.e. the first few days postpartum. For us, exchange transfusion is a really rare procedure, and the few exchange transfusions we need to do are virtually all related to hemolytic disease that is evident early postpartum (typically during the 1st or 2nd postnatal day).

So, the bottom-line was... some kind of eczema?

I have not used Keppra but this article summarizes the experience of 23 cases: http://jcn.sagepub.com/content/26/4/465.abstract

We tend not to bother about a few red blood cells. 15 is an almost "clean tap" When it comes to red blood cells, I think one needs to remember that subarachnoidal bleeds can happen also in newborns, and be the cause of a larger nb of RBCs. The suspicion can arise at the actual tap, if the needle is inserted easily and the CSF coming is dripping evenly pink, we usually check the "CSF wavelength" (do not have the proper English word for measurement) which change if there are hemolyzed red cells in the CSF.

Hi & welcome to 99nicu! I had not heard about the NWI tool before but I guess you refer to this one: http://journals.lww.com/pedresearch/Fulltext/1997/04001/The_Nwi__A_Simplified_Score_of_Infant_Narcotic.108.aspx I must admit that I have not much experience from abstinence assessment (as we have rather few abusing mothers in our catchment area), but we use the Finnegan score. While browsing the webb I found this image of a Finnegan score sheet: http://www.virtualcurriculum.com/N3225/Spring2010/jessica_marzena/finnegan%20scale_diagnosis.jpg Are you using the NWI tool? What is your experience?

Thanks for posting this interesting question. There are a lot of subjects where I feel concerned, but I think my top-list is 1. poor growth in preterm infants, so commonly seen during intensive care (I'd say, we see a state of malnutrition which should be addressed more) 2. infection control 3. prediction of long-term morbidity

Another possibility is neonatal pustular melanosis, also a self-limiting condition that can be present at birth. I think this is some kind of "relative" to the much more common eryth toxicum neonatorum. Here a link to emedicine: http://emedicine.medscape.com/article/909753-overview Correct or not, when I suspect this diagnosis, I check CRP and blood counts and want to see normal results there.

I can only speak for the situation in Sweden but here the clinical work is kind of separate from the academia, organisational-wise. For myself, I wrote my thesis in (perinatal) epidemiology. About very preterm births, its short- and longterm risks. My advice to you: find a research group with interesting research AND good mentors/supervisors. Once you know how to do research ( after your PhD) you can apply your methods in clinical situations.