Stefan Johansson

National Institute for Health and Clinical Excellence (NICE) in the UK has published guidelines on how to manage neonatal jaundice. The guidelines provide guidance on the recognition, assessment and treatment of neonatal jaundice in term and preterm infants from birth to 28 days. A series of documents are published at http://www.nice.org.uk/guidance/CG98 In the full guidance document, there are treatment threshold graphs for infants born from 23 gestational weeks and onwards.

You're on! I will get in touch, later (am currently on Iceland!)

how is the weight of the infant? Have never heard about a fully breastfed infant getting hypernatremic from breast milk only. But seen many infants with hypertonic dehydration. Due to nonestabl breastfeeding and lactation

Hi! We use a Vygon catheter, Premicath, 27G. We set a regular periph venous canula under aseptic conditions and simply insert the PICC through it. This catheter has a tiny guidewire inside, making the insertion easy. After the catheter is inserted, we pull the periph venous canula backwards, leaving the PICC in position. Usually, we do not bandage the PICC in until an x-ray control is done (to check the position of the tip)

Haha, great links! (And the Gizmodo/Iphone-story - I really wonder whether their "story" is just a smart marketing trick by Apple. I think this story is too good to be true, despite this blog post.)

Great gadget! A shame I am planning to buy the new upcoming Iphone (presented on the 7th of June...)

interesting discussion! I also admit that we rarely do an lp in early susp sepsis. However, in a child who seem to be septic (altered conscious, in need of mech vent for example), when the crp exceeds 100, we usually do lp as part of the septic screen. But, in the majority of infants, lp is not done.

@fcardona, will send you a thesis as well, just PM your post address.

Work in progress... http://ebneo.org/wp Register for email updates of the EBNEO blog: http://feedburner.google.com/fb/a/mailverify?uri=ebneo&loc=en_US

Will do (i.e. send you my thesis!)

This how we do it (no links ) If we find a murmur "au passant" at the well-baby check in the maternity ward and the infant has been doing just fine, we check saturation levels in hand and foot. 1. if the saturation levels are the same (within 2%), we re-auscultate 1-2 days later. If the family is going home, we do the second exam at the postnatal visit (usually 2 days after discharge). If the murmur is still present 1-2 days later, we do an echo regardless of clinical symtoms etc. Most murmur turn out to be benign, physiol murmurs. 2. if the hand-foot saturation levels are different (>2%), we do an echo right away (three neonatologists are trained in echocardiography in our unit) We (neonatologists) do the first screening, and all follow-ups of uncertain cases, confirmed VOCs etc are done by the paed cardiologists.

Hi! I think most units would return the pre-sample blood volume. I do not have a good reference at hand, but am certain one would make the infant iatrogenically anemic very soon. Think about it this way, a tiny premiee may have a total blood volume 50 ml. Most would take a pre-sample blood withdrawal of 1 ml. Throwing away 2% of the total blood volume every time a sample is taken (as often happens several times/24h in a small sick premiee), that infant would need daily transfusions. There's a similar discussion going on here: http://www.99nicu.org/forum/showthread.php?23797-Pre-sample-blood-volume&highlight=blood+withdrawal I think you can get some input there as well. Ciao!

We also insert PICC lines under aseptic conditions. The area is cleaned, a new iv cannula is set and the actual PICC catheter then inserted. Finally, covered with sterile drapings. Although many infants given PICC lines are on antibiotics (for various reasons), we do not use antibiotic prophylaxis for a PICC line itself.

Hello! Glad to hear you've watched the Wallander-movies. I agree, the (Swedish) films are very good, as the book are. If you ever visit Ystad you can take a Wallander tour! Nice town and fantastic surrounding, we go there every summer, my son plays tennis there so we kind of have to stay there a few weeks every year! BTW, I read in today's paper that the third season of MadMen is available here as a DVD-box. At last!

Hello everyone! I wished we could all go out and have dinner and celibrate this day IRL!

My idea was that a FB page would be a way to interact with other neonatal staff groups, to "drive" traffic here to 99nicu.org. I do not think we should start discussing clinical problems etc on FB. Problem - I do not use FB at all for myself... so a Fan page would need an admin. If someone would like to volunteer administrating a Fan page on FB, we would give moral support!

Factor VIIa (Novoseven) was a drug I used the last week before moving to my editorship at Swedish Medical Journal. Actually, we used it in this case discussed here: http://www.99nicu.org/forum/showthread.php?15779 We were desperate with uncontrolled subgaleal bleeding, the coagulation specialist adviced us to try this (based on the coag parameters we had). If I recall this correctly, we gave two doses. I do not remember the dose/kg.

Now, I do not only need an Ipad, but also a pair of scissors! BTW, they (the Ipads...) will soon arrive in Germany & UK, coming closer to Sweden...

Four years ago, I got an idea to start an Internet community for neonatal staff. At that time I was a member of a Swedish Mac-computer community and had realized that web-based professional networks can become great resources. (BTW, this is pre-historical times of today's Social Media-hype.) I convinced a few of my friends in the NICU at Karolinska to spend MUCH time to set the whole thing up... The 11th of May 2006 was the official opening! It is hard to summarize the development during the past four years, but it is a fact that 99nicu has grown steadily. On average, 2 new member have registered every day since the start. We now count more than 200 unique visitors and more than 4000 page visits. Per day! But, 99nicu is more than numbers. Personally, I do not care about web statistics, when I think about what a community for neonatal staff can achieve. With the bulk of knowledge that has been shared here, for the good of the tiny babies that we all care for in NICUs over the world. I know that advice given in the virtual NICU has had major impact on the outcomes for some infants. That matters to me. The future... well... think about 99nicu in evolutionary terms. We all (you and me and every single member) build this community. What happens here, depends on us. The funding... I am doctor, not a salesman, and there has not been a crowd of investors knocking on the door. Even though I have taken a big bite of the cake myself, 99nicu has also been funded by individual members making small donations (become a supporting member here!) and by educational grants from commercial companies. These latter contributions have been essential for our maintenance costs. Thanks! Finally, I would like to acknowledge: all members who have contributed with ideas, advice and supportive words the original Team for believing in this crazy idea in the first place the current Team - without your efforts, 99nicu would not be the same. Maybe not at all! wife and son for understanding that 99nicu is my contribution to a better world Greeting to all of you! /Stefan PS. Celibrate the Four Year Anniversary in the Lounge!

Time again! On the 11th of May we can celibrate the 4th anniversary! Soon... Thanks in advance to EVERYONE that has worked hard, sent us supportive greetings, and have become friends during these four years. I have elaborated in my blog, about what happened. And why! Best wishes from our virtual Headquarter!

Today is Star Wars Day! May the 4th be with you!

Hoppla! Typo! I meant that the two studies investigated blood withdrawal from UAC and UVC respectively. One may think that presampling from the venous return may have less impact on hemodynamics than sampling from aorta. We typically withdraw 0.5 ml from the smallest UAC. I think this could be a topic for a nice experimental study: design/build experimental blood vessels/a vascular tree, flow blood through it, apply a catheter with drip and then pre-sample blood in various volumes to see how much volume is needed to withdraw for, for example, reliable electrolytes. Piece of cake!

One major difference between these two studies is that blood withdrawal from umbilical vein and umbilical artery catheters were studies, respectively. I think the point is rather that sampling may matter (volume and/or time). For a tiny premiee drawing 2 ml of blood may correspond to several % of the total blood volume.

Hi! One should always try to minimize pre sample blood withdrawal, since hemodynamics change during blood withdrawal. http://www.ncbi.nlm.nih.gov/pubmed/17937686 http://www.ncbi.nlm.nih.gov/pubmed/16373299 Pace of withdrawal seems to matter too: http://www.ncbi.nlm.nih.gov/pubmed/12509598 For the smallest infants with 2.5G UAC we typically withdraw <1 ml.