Stefan Johansson

👋 @Kartika Darma Handayani , thanks for sharing this question. I have read and learnt a lot about the intestinal microbiome but your take is new to me :) I looked into PubMed and did not find anything - can you elaborate how you came up with this research question and what exactly you would like to study (etiology of plac accrete?)

The new web site is taking form, there are lots of new ways to present content and working out what the optimal ways to do it. Most importantly, the navigation through all content is re-vamped. The menu (left column on your laptop/desktop, or lower right corner on your smartphone) has three parts: MY 99NICU: shortcuts to latest updates (Unread content etc) FORUMS: all the discussion forums, sorted in their categories COMMUNITY: everything else :) i.e. blogs, event calendar, webinars, link directory etc-etc Please share your feedback about the web site here, where can we improve?

I hereby share a legal disclaimer to everyone participating in this thread ! Yes, you are very right one needs to be careful with opinions. Being declared guilty is a black-white decision, but like medicine, it is based on probabilities (although, if someone is shot by a person 1 meter away and holding a smoking gun, the probability is almost 100%!). And to be honest, I was not much aware of the case before it showed on my various radars about "experts", so I am not into any details. Still, if someone is declared guilty based on reasoning and no technical evidence, then it is mind-shaking to think about all stakeholders in this case. Letby herself, parents of the diseased infants, staff members, everyone in public authorities engaged etc-etc. So many levels of impact. My personal mind-shake is also about that I connect to similar cases in Sweden where HCPs was judged guilty in processes not living up to standards (later found out). In one legal case here, a GP and a forensic pathologist was sentenced for cutting up the body of a dead woman with drug addiction, and it all seems this legal process was just so incorrectly managed (the "da Costa case") back in the 1980s. Some pretty basic journalism, that resulted in a recent documentary, has revealed so many strange details, and it all just seems those two are completely innocent. Since that case went up to the highest court, it seems though that their sentences cannot be re-assessed in a new legal process. The other case I connect to is the "Astrid Lindgren case", this was about an anesteiolgoist accused for killing a former extremely preterm infant admitted to the PICU after discharge from the NICU, that was like a "witch process" from the mediveal times! If there are some good public reading etc, please share some links for background etc. I tried to google but the web is so full of stuff about this, I find it hard to find good sources.

Final call for the International Survey on Probiotics use in Preterm Infants! It is still open for responders (we want to reach the goal of 200 responders). Please consider! https://forms.office.com/e/0rbYem4Bwg

I assume you may already know about the so-called Letby case, where a neonatal nurse was accused and charged for several neonatal deaths, deemed intentional by the UK courts. A panel of neonatology experts have now reviewed the (legal) evidence and found that (medical) evidence speaks for alternative and natural causes of death. I find it hard to fully grasp the whole situation, first of all, if someone being unguilty is declared guilty, that is disastrous at so many levels, from the imprisoned person to the society as a whole. Calling this "Epic fail" is not enough. I wanted to share a comment by Prof Neena Moody in London, a piece to the point. What do you think and feel around all this? https://www.theguardian.com/commentisfree/2025/feb/12/lucy-letby-case-trial-justice

Exciting times are ahead of us! We are approaching the Big Leap upgrading to our community software to a new version. This is a major upgrade, but we hope there won't be too much issues while doing it. In addition to lots of tech stuff, the look and feel will also change, especially on your mobile 😀 In case the site drops offline 🫣 we will share updates on Mastodon, BlueSky, and LinkedIn. We are yet to finalize the timeline for doing this. You will know it when you see it!

If the clinical history is typical (complicated vaginal delivery etc), we don’t do anything investigation apart from clinical assessment. We liberally refer to our physiotherapist for assessment and follow up However, if the arm is completely paralytic, then we ask neurology/neurosurgery for advice, but I have not myself been involved in a case that went for nerve suture. But I understand that could be an option.

Hi @agoz, we normally don’t do any investigation for cephal hematomas unless the clinical diagnosis is unclear (when we do ultrasound to confirm)

@PHutchings I am referring to the first neonatal check before discharge home

Interesting observation, did you measure serum levels of insulin?I have always thought that the higher risk of post.term infants to develop hypoglycemia (like doubled even in "low-risk" post-term deliveries https://fn.bmj.com/content/102/4/F286.long) was related to less good energy storages but interestingly, the MSD manual mentions that post-term infants may have higher levels of insulin (https://www.msdmanuals.com/professional/pediatrics/perinatal-problems/postterm-infants) I tried but failed to find levels on s-insulin in post-term infants on Pubmed, anyone else with input?

Fully agree, also the "easy patients" deserve an individualized strategy, similarly to the TLC that we otherwise dedicate to the tiny preterm infants.

Thanks for raising this question, I think this is a more common patient than those needing iv fluids / TPN! For a term infant we typical start with 40 ml/kg/d and a late preterm (say 34-36w) we usually go for 40-60 depending on fetal growth, clinical situation etc. We increase feeding volume w 20-30 ml/kg/d. We feed every 3 hours, so a 3 kg term would have 120 ml first 24 hours. We would probably feed some thing like 10 ml x 1-2, 15 ml x 5-6 and then 20ml per feed. it is common we do not go up to ”full feeding”which at our NICU is 170-185 ml/kg/d. If the infant is starting breastfeeding practise early (for example, term infant with TTN) we usually stop at 125~150 to promote a quicker full breastfeeding. Of course, we do take b-glucose, weight development, nutritional needs due to clinical symptoms and everything like that into account, so all infants have their own path too

I want to bump this thread, we are still collecting responses to this survey, we are half way to reach the 200 replies needed.

Hello again, as you know there are several surfactant brands around. Which surfactant do you use and why?

We are discussing a lot around how to organise the ”well baby checks”, ie the medical assessment of all infants discharged home from the delivery/maternity unit? How is this set up in your various contexts? Is it a doctor or midwife doing it? What exactly is included in the exam/assessment?

This is a very interesting publication from the UK, about IVH rates in infants born <29 weeks from 2013 through 2019. Rates are increasing over time, findings along the lines of other studies showing that outcomes does not improve much despite all work we do to change things for the better Would be great to hear yout thoughts about the paper but also how you aim to reduce IVH risks / like IVH prevention tool kits etc https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828692

It has indeed been a great year! And I am very much looking fw to 2025

@Mo7 interesting and unexpected resust!

Just found out about the new resusciation guidelines, out since a few weeks! Lots of authors... and the PDF is 100 pages (and annoyingly water-marked with the logo of the journal Circulation!) Has anyone already read this and could share a short version ? Find here: https://pubmed.ncbi.nlm.nih.gov/39540293/

An interesting paper came on my radar, about the importance of a structured nutrition strategy for preterm infant (https://www.sciencedirect.com/science/article/pii/S0378378224002202) It is a single-center experience in Budowice in the Czech Republic, comparing the time before and after a "nutrition care bundle" was introduced. In short, the bundle consisted of following changes: parenteral nutrition strategy targeted individualized fortification of breast milk (using software-based nutrient calculation system) anthropometric dynamics (z-score) weekly multidisciplinary nutrition round max total volume/kg/day was changed from 180 -> 150 The reported results are clearly relevant: infants reached full enteral feeding quicker, and had more favourable growth dynamics (less drop in weight and head circumference Z-score). Interestingly, PDA rates also decreased (discussed as related to lower volume intake / day). Although a small study etc, the results are good food for thought. What does your nutrition strategy/guideline look like? Would be interesting to hear, given how many ways there are to reach Rome, as the saying goes

Found a CD-ROM with the educational program "Head Ultrasound for the Neonatologist". Is it a bit old (says 2008) and one needs QuickTime installed to run it. It says it runs on Wind XP but I assume later Windows-versions should work too. Drop me a Direct Message if you are interested to get it, I give it away for free.

Thanks @Mari K, and great to have connected in the NICUverse

I came across this paper about "colostrum-kits", that a structured way of informing mothers before risk deliveries about colostrum and how to express it, can shorten the time it takes to first colostrum feeding. (link below) Would be interesting to hear from you all if/how you do this in your NICUs. https://link.springer.com/epdf/10.1186/s13006-024-00682-5

Thanks @wackdi @Roland NNP and @deshmukhls for your support. I was a bit ahead of the times a year ago. When I left Tw/X in 2023, people thought I was "woke" but IMHO it was then already clear where the platform was heading. Glad to that so many people, and especially medical professionals, also exit from there now and building new networks on Mastodon and BlueSky.