Stefan Johansson

Would be interesting to hear more about the legal action against midazolam.

Friday afternooon. Had just come home from holiday and rang up my friend and colleague. For a chat. He was still at work. The doctor on the on-call-schedule had not showed up. Mistake, but still! Tempted by the "short notice bonus" for the night shift (money can drive me to do things too...), I volunteered, went to the NICU, changed clothes and was handed over the new pager. The new pager - a massively bulky something! (new and modern technical things tends to get smaller and smaller. Maybe this was the exception from the rule). A calm evening. Went to bed at midnight. The pager went off at 3 am. Woke up, fiddled with the pager, looking at the large NOT-backlit LCD-screen in the dark. The telephone number was shown in the upper left corner with very tiny-tiny digits. Damn large screen, why the **** are the digits displayed so small in the upper left corner ??!! PRESBYOPIA, here I come... 8)

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!

could this issue be an example of "confounding by indication", i.e. the underlying medical condition is associated with the outcome rather than the therapy. In this case, cns problems causing seizures relate to poor brain volume, not midazolam. What do you think about that?

Found a site which collects medical powerpoint presentations. Check this out, one about craniosynostosis, pretty good! http://medicalpptx.blogspot.com/2010/07/craniosynostosis.html

I forgot one possibility that could be used: the virtual NICU. That's the closed forum to which only members being logged in have access.

This weekend, I am the consultant on call, based on a hospital with the highest delivery rate in Sweden. In all, 10.000 infants are born here per year, i.e. almost 10% of all babies born in the whole of Sweden. Compared to Swedish standards, this is a Baby Factory. As a consequence, the maternity ward rounds are busy. Problem: I get bored by the well baby checks, when there are too many. I feel like a tape recorder, answering the usual set of questions from parents. My ambition is always to see every individual infant as the person he/she is, but after the tenth baby check I need to fight against the Mechanical Me. Anyone sharing these forbidden thoughts Now, back to work!

I would top-rank medication errors and infection control as major challenges in our daily practise. As the third most important issue - nutrition (enterally & parenterally). I have a strong feeling (supported by prelim data from a well-designed study ) that malnutrition is a big problem for our preterm babies on the ward.

When 99nicu opened in 2006, we were adopters of the main idea with Internet, the power of dialogue and sharing. Why not use that for professionals? And, we saw lots of possibilities and the sky was the limit. Today, professional social networks directed to staff in health care are becoming increasingly common and popular, and some of them have grown huge! Like www.sermo.com. (If you want to read an over-view of the largest sites, read this blog post by David Isaacson, community manager at doc2doc.) But, what responsibilities do individuals have, when experience and opinions from clinical scenarios are shared? I came across a thoughtful blog post by Bryan Vartabedian, pediatrician writing the blog www.33charts.com. He wrote: In principal, I completely agree that medical care can, and should, develop through web communities. In fact, we should view professional networks as complementary to other channels for information (such as Pubmed, textbooks, formal education, conferences, etc-etc). But, individual patient integrity comes above all, and as medical professionals, we need to take that integrity into consideration when we interact with colleagues on-line. How could we do this? My top list: ask the parents for consent anonymize all information change clinical details (or make new up) without significance for the question asked ask someone else (such as a friend working on the other side of the world) to submit the question report back to the parents about the "outcome" of your online consultation

Excellent resource! Would like to high-light the Excel spreadsheet "Treatment threshold graphs". http://guidance.nice.org.uk/CG98/treatmentthresholdgraph/xls/English

1) we use up to 30%, (we keep our PICCs always no more proximal than v cava superior) 2) we keep them as long as needed, and do not change them "per protocol". If there's a sepsis not responding as expected to regular antibiotic treatment, we take them out though. 3) we stopped doing this on a regular basis. we invariable got positive cultures from the picc tips, but had infants doing just fine so we figured this was a systematic contamination.

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!

In my real-world-job as managing editor of the Swedish Medical Journal, I got an email from a reader regarding one of my editorials. I had written about general principles in the world of sports and that the world of health care have lessons to learn. For example, that the degree of success depends on the extent of practise, preparation, team work etc. (btw, greetings to Spain being World Cup Champs 2010, you're worth it ) Anyway, this reader posted a video clip about how we feel motivation and you can view it below (takes 10 min of your life). We are increasingly becoming aware of that money is not the sole drive of motivation. "Autonomy", "masterity" and "purpose" are more important factors for work satisfaction. Importantly, these factors makes people contribute to fantastic projects like Wikipedia in their free time. In a recent issue of Wired, there is a similar topic covered by an article about the "Great Cognitive Surplus" - there is a revolution going on how we use our free time. Having said that, I want to share a new milestone from 99nicu, that there are now more than 3000 registered members. I want to acknowledge all people who share their expertise here! Motivation, that's the word!

In our (and likely, all Swedish NICUs) nurses insert iv cannulas and take routine blood tests (direct venous cannulation and from umb art catheters). UVC, UAC, and periph arterial cannulas are inserted by dr's, PICC insertion vary but in the units I work there are specially trained nurses for PICC insertion. Personal reflection: this work would dominate over more patient management and I feel it is a good sharing of work, i.e. I am in favour of nurses doing this.

I'd think you could do PCR (on liqour) for at least #1, #2, #4 and #5. one of my own study from my thesis may give some hints on diagnostics : http://www.ncbi.nlm.nih.gov/pubmed/18930808 My suggestion is that you involve your lab and discuss diagnostics with them too. After all, someone will need to do the analyses! Wish you all best of luck!

Depends on what baby we talk about. And we have no written guidelines on this... In a term well baby in maternity we seldom know Hb/EVF, but if blood samples are indicated (for some reason) and we see an EVF less than 40 and the mother plan exclusive breast feeding we would probably do a follow up, and sometimes also prescribe iron supplementation until we know how the Hb/EVF develops. In a graduating ex-preterm infant, we usually have a rather high tolerance for lower values, IF the baby is on iron supplementation AND has a documented active erytropoesis (high reticulocyte count). Most of the dr in our units would accept EVFs around 28-32, I personally feel uncomf with EVF less than 28, but as all these infants have recent follow-ups after discharge, we monitor EVF closely.

Have you yet decided what viruses that you may want to diagnose?

Very interesting indeed. Seems like a very serious project, would also like to hear any input from people with experience. Found this TED talk on youtube.

We try to restrict the nb of days with UVC as much as possible, and switch over to a PICC if we believe an infant will need parenteral fluids for more than a just a few days. Infants to diabetic mothers are usually cared with regular peripheral vein catheters. Here's a reference about complications with all catheter types. http://www.ncbi.nlm.nih.gov/pubmed/15777826

hello! I guess you mean the procedure to insert picc's and uvc's, we do not replace them unless very special circumstances. In our unit, a picc is usually inserted by a single nurse, trained for the procedure. The arm/leg is draped in sterile dressings, and the nurse is dressed in a sterile gown as well. Uvc's is inserted by a doctor, usually assisted by a nurse. Sometimes the dr does the insertion him/herself. Sterile conditions as above.

10 mg/ml. No reference at hand, gone fishing (holiday)

Am on holiday, will share how nurse management is organised in our units when I get back! Do you want to keep this topic in the Lounge, otherwise I could move it to the "Organisation" forum

Evidence-based neonatology. 2-5 June 2011. Stockholm, Sweden For more info: www.ebneo.org Click here to subscribe to email updates here.

See the 5th post in this thread: http://www.99nicu.org/forum/showthread.php?14094-MCQs&p=15834&viewfull=1#post15834