Stefan Johansson

Thanks for posting this video. Must be painful for the baby. I uploaded a few images in the Image library some time ago on "Amniotic band syndrome" (same patophysiology) http://www.99nicu.org/forum/photoplog/index.php?n=53

Happy anniversary "unputdownable" - that's a word I know from experience: http://www.99nicu.org/forum/entry.php?65-Hackers-meet-us-if-you-dare.

A forum dedicated to breast feeding is a good idea. I am pretty sure we had that discussion a few years ago. I think we should have it as a sub-forum to Nutrition. Will set it up asap!

Hi! I have no fixed protocol for this topic but personally (and I think that my colleagues share this opinion) is to check both Hb, EVF and reticulocytes when we check for anemia in "recovering" preterm infants. If reticulocytes are low and Hb/EVF can be accepted (and the baby is gaining weight and is reasonably well/stable of course!), I try to postpone a transfusion as much as possible to stimulate reticulocyte production. Similarly, high reticulocytes and an acceptable Hb/EVF... same strategy. When I come to think of this... we try hard to postpone all tranfusions, we only give erytrocytes when we feel anemia is truly "symtomatic" (whatever that may mean )

I think we could either 1) upload them here as attachments or 2) share as links. Large files should preferably be uploaded on services like the one @Jack proposes.

I just want to share the link to the e-book "MRI of the neonatal brain", freely available on the web site www.mrineonatalbrain.com The content was printed as a book in 2001, but is out of print. Professor Mary Rutherford who edited the book wrote to me: My thanks to Sutirtha Roy who shared this link in a comment to the Leading article about how cranial ultrasound correlate with MRI findings.

Two years ago, I wrote about a large project that I initiated with another colleague and a "premiee"-parent, "Small child foundation" (Swe. Lilla barnet fond). The idea was to create a nation-wide charity foundation for research about newborn babies and their future health. Similar to March of Dimes. The "Lilla barnets fond" was officially founded late 2008, and since then we have worked hard (as volunteers) with strategic issues, including fund-raising and PR. This is a follow-up report with royal gossip! Yesterday we achieved a major milestone. The Swedish Prince Carl Philip, the official patron/protector of Lilla barnets fond, handed over the first research grants to the research projects, which were top-ranked by the foundation's scientific committee. In total, the researchers recieved 260.000 SEK (about 27500 EUR / 38000 USD). After the meeting, I and a few other board members met up with Prince Carl Philip and informed about our future ideas. Prince Carl Philip was very interested of neonatal care issues! He even wanted to be specifically involved in a future campaign... Picture? Here! And here!

Thanks for sharing this link!

Here's the link, chapter 15 is about neonatal resuscitation: http://circ.ahajournals.org/content/vol122/18_suppl_3/ (seems to be free full-text!)

Cardiovascular plumbing , that's one of my favourite topics! The pre- and the post-ductal saturations are both arterial saturations (blood from the heart), and refers to arterial oxygen saturation in vessels originating from the aorta before and after the ductal orifice in the aorta. Classically, the pre-ductal values are recorded in the right hand, but one can argue that left-handed saturations are roughly the same (http://www.biomedcentral.com/content/pdf/1471-2431-10-35.pdf). Arterial post-ductal sat's are measured in the foot. Post-ductal saturations become lower than pre-ductal when there is mixing of pulmonary blood through the duct, i.e. in congenital heart defects that are duct dependent. For example, severe coarcations or transpositions of the great arteries typically have lower postductal sat´s. This is the theoretical background to POX screening (http://www.bmj.com/content/338/bmj.a3037.full)

I completely agree with @feraszaman. I'm on the subway (!) but can share our practise, ie enteral feeds as tolerated. We aim For at least minimal enteral feeding with nec being on of few exceptions

I have done OMIM searches but have not come up with any good diagnosis. Have done various searches related to the ambiguous genitals / intersex conditions. Do you have more details of the clinical features: is there artrogryphosis of the knees? bilateral pes equinovarus? is the karyotype available? My principal thoughts go like this: is this a male genotype and aphallia, or a female genotype with sever virilization?

I completely agree. We are more likely to make to investigate infants born symmetrically SGA. But one needs to keep in mind, this is also the group where we find infants who are constitutionally small.

This is not a simple question at all! Actually, in my own work plave I have suggested for a long time that we should have written guidelines for investigations of IUGR/SGA infants. I have seen tons of TORCH screens, and have never come across a positive results when taken in a well small baby. Our current practise (no protocol there is...) is to investigate the smallest infants (typically less than -3 SD from expected BW or somewhat larger babies but in need of neonatal care) with TORCH, Urine-CMV, head ultrasound, chromosomes (regular karyotype). Infants between -2 and -3 SD, it depends. In well infants in maternity wards (normoglycemic, congruent birth weights in older children, normal maternal history ETC) nothing is usually done. But sometimes... TORCH It would be great to hear more input. I am sure many people would be very grateful if someone would like to share structured written guidelines.

Very interesting links indeed! (I had not come across crowdsourcing before (meaning "the process of seeking a problem's solution from a wide community")) Much, but not all, of the contents at 99nicu is public. I wonder about the proportion of laymen browsing here? Wish it could be possible to find out.

Hehe! Your alternative suggestion to assess Apgar is great!

Here's the publication that "catapulted" the use of propranolol for hemangiomas, it is availble in full-text at nejm.org http://www.nejm.org/doi/full/10.1056/NEJMc0708819 If you look among the "citing articles", I am sure you can find more information/case reports which can guide your decision. This is an interesting case report about hypoglycemia in an infant treated with beta-blockers after steroid therapy: http://www.ncbi.nlm.nih.gov/pubmed/20738795

I think you would need to be even more specific to be succesful in pubmed searches. For example, focus on one issue, such as pain management, postop wound inf, postop enteral nutrition after gi-surgery.

This discussion is moved to the virtual NICU. Please log in and continue the discussion here: http://www.99nicu.org/forum/showthread.php?23938-Persistent-white-out-lungs

Great resource! I especially found the lecture interesting about historical notes: http://www.aap.org/nrp/pdf/drWiswell.pdf Risk of respiratory distress in preterm infants, observation published in Egypt 1500 BC (!).

Not me. I should if I could

Thanks for posting this interesting topic. My experience is limited to morphine (pain, anxiety) and midazolam (jitterinezz, seizures). If these drugs are not used therapeutically before the end-of-life-decision, they are usually given as boluses i.v. or s.c. on demand. Your strategies seems much more refined than what I am used to - would be very interesting to hear more about your protocols. Do you have written protocols for comfort care? How do you choose routes-of-admin and drug-of-choice in various situations? Doses?

Also check this thread out: http://www.99nicu.org/forum/showthread.php?4655-managing-head-deformity-in-infancy

Just got the latest issue of Acta Paediatrica, there's a RCT on plagiocephaly therapy: http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2010.01872.x/abstract

Thanks for sharing your protocol!