Stefan Johansson

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.

All our OAEs are done by an assisting nurse at the maternity ward. For well infants cared for in the maternity unit, it is done at after 72h postnatal age. Infants in the NICU are checked before discharge, at least 24 hours after removal of the nasogastr tube.

Looks like erythema toxicum neonatorum ?

We do! We use the central line for TPN that is available. Of course we prefer a percutaneous long-line catheter, but in sick premies for example, the UAC is commonly used.

1. Doses... dopamine and dobutamine is usually given 2.5-12.5 microgram/kg/min; adrenalin 0.1-0.3 microgram/kg/min 2. Combinations - yes sometimes... if dopamine does not give enough response (whatever that may be...) 3. glucose (50 mg/ml) 4. We have fixed dilutions of inotropes, and change the infusion rate depending on the response: dopamin/dobutamin 0.3, 0.6 or 1.2 mg/ml and adrenalin 10 microgram/ml.

You just need to write your email address and name at the webcast page. No password is required. Send me a PM if you need assistance.

Would be a good idea, but I think youtube can only take 10 min clips (?). I will contact the web cast provider and ask for alternatives after the first year.

Please also consider to upload pictures to the "Image Library" above! If you need assistance to upload pictures there, please get in touch (info@99nicu.org)

Short comment: you should see the lecture by Barbara Schmidt from EBNEO! Here the link to the EBNEO web site (http://ebneo.org/wp/index.php/2011/06/tweets-photos-and-web-cast-open-access/) and here is the direct link to the full web cast (http://www.webbtv.nu/ebneo2011). Barbara lectured during the 2nd day.

I guess you have found this link to the Auckland drug database: http://www.adhb.govt.nz/newborn/DrugProtocols/NeostigminePharmacology.htm According to an old protocol I have kept, the recommended oral dose of pyridostigmine should be about 20 times (0.2 mg/kg) the intravenous dose of neostigmine (0.01 mg/kg). Regarding dosing interval: I hope someone else with hands-on experience shares the experience here. I guess x2-3/24hours would be a good start. If the baby is to weak for full breast feeding, supplemental feeding with a nasogastric tube would be a good option, while awaiting the spontaneous resolution of the neonatal myastenia.

In one hospital where I worked in the yearly 2000s, the dr on call was always asked to attend such deliveries. To perform upper airway suctioning when the head was out... this was before the publication of the RCT that showed no benefit of such an aggressive strategy (http://www.ncbi.nlm.nih.gov/pubmed/15313360) - but still...! I think I can speak for all hospitals in Stockholm: the neonatologist/resident on call is not attending deliveries when there is no sign of fetal distress.

I think you describe a common problem - the difficulty of implementation. That introduction of a new treatment modality goes beyond the actual intervention, and includes education, putting a desired strategy into "words", writing it down, the learning curve when staff starts to do the intervention etc-etc. As I know that you already know My suggestion - form a working group including several categories of staff and discuss the medical, nursing and techn aspects of cooling. We pretty much use the TOBY protocols (as we were a center in the trial), and I am quite sure there are lots of documentation on their web site still: https://www.npeu.ox.ac.uk/toby/protocol https://www.npeu.ox.ac.uk/toby/leaflets https://www.npeu.ox.ac.uk/toby/dcfs Good luck and I wish you the best with the implementation!

Difficult question, a DVT is not something we would normally consider, and the explanation seems reasonable. If there are no other signs of inflammation or pain, we would probably wait and see BUT look for worsening very carefully, and remove the PICC on "liberal" indications. We would probably try to position the leg (in comfortable positions) to see if that would reduce the swelling too.

That's probably why it usually works to wean to 2 cm. The majority of patients with nCPAP in our unit is preterm and we have the impression that this strategy also helps to control apneas. But of course, infants with stable breathing on 2 cm are with no or little oxygen need are usually - we generally take the cpap off, and only add supplemental oxygen IF needed. @ali, to what pressure do you wean before trying without cpap?

I seek advice about how to work as a neonatologist in Canada. Does anyone, trained outside US/Canada, have experience from working there? Or, can anyone from Canada give advice? What formalities need to be met? I and my family have some very vague plans about staying for a year in Vancouver in the future (2013?). If dreams come true, I am sure it would be great

I wish I could be of any help, but we do not have this board examination in Sweden. In addition, I will pass on something you probably already read eNeonatal Review from John Hopkins

Interesting! Could you please give a link (Pubmed)?

We wean the ncpap pressure to 2 cm and the FiO2 to about 25% as a general guideline, before switching to lowflow nasal O2. For many preterms, we wean to 2 cm and FiO2 21% (air), and then try without nasal O2.

I am really sorry, the ICD10 code we use is Z00.1A I change to the correct code in my first post above too

Do you still use ICD9? we use ICD10 and for a "healthy infant investigaton" we use Z00.1A