Stefan Johansson

Is this real or real?

I browsed J of Pediatrics today and found this case report: http://www.jpeds.com/article/S0022-3476%2809%2900839-7/fulltext The authors write that this complication is not previously reported, but I have seen one in my unpublished policlinic once

This is an interesting question. Our strategy is to ligate a preaurical skin tag if it is are thin-based. Multiple tags and broad-based are referred to the ENT surgeon for excision. The ligation is done after admin of 30% sucrose. I have only seen a few infants "post-ligation" and the cosmetic result has been excellent. My main concern lately has rather been whether one gets good enough pain relief with sucrose. Some infants reacts with more pain than they deserve for this procedure, that's my opinion. Extra digits - same strategy. Very thin-based are ligated whereas broad-based are referred.

I guess traditions vary, but we use adrenalin only if dopamin and/or dobutamine are insufficient.

The gps works ok, for some reason it takes a while before it connects (i think it is a software issue, it is a random issue) but once with a gps connection we found our way ok. To be honest i have only test-used it a few times since we mostly know where to go (home-work-home circuits). This summer we will driving our son to various tournaments in the south of Swe and then the gps will be tested under real conditions. Bottom-line: grade 3/5 extra: there are voices in many languages, drving with a german voice spice the journey up a bit! From my e72

Timing, asap after the 72h hypothermia, generally between 7 and 14 days (postnatal age), Cut-off, don't know.

This is the Karolinska strategy: the clinical protocol advocates MRI with diffusion on all newborns with HIE grade 2 and 3. The current research protocol includes also MRspectroscopy. From what my colleague said, this is the strategies used at UCL (Univers College London). Ciao! Stefan

We almost always use syringe pumps (for all drips, drugs etc) and keep a rate of 0.8-1.0 ml/hr. We add 20 units of heparin / 100 ml sodium chloride. My personal feeling is that it is rather the "age" of the PICC (nb of days it has been used) that determines if it will clot or not, than the infusion rate.

Hi! In the hospital I used to work, there were about 5-8 elective C-sections every weekday. (the obs department had a separate maternity ward for elective C-sections only). No ped/neo-dr was attending unless there were special circumstances. For the vast majority of of C-sections an attending neoantologist was not indicated, as judged by the midwife&obstetrician responsible for the C-section. I have not looked into the literature on this topic, but the strategy in our hospital worked just fine.

Thanks for sharing a nice resource. In this context, I would also like to recommend OMIM http://www.ncbi.nlm.nih.gov/omim/

We had an unpleasant experience last week. Our account at the web host was hacked. Even, badly hacked! This is what probably happened: I added a subdomain years ago and played around with a Wordpress installation (that's the kind of thing you can do just for fun, or do I need to see someone ) . I left this wp-installation and thought it was resting in peace, not aware of the bomb our account was keeping within its boundaries. Apparently, hackers sniffed this installation and manage to break into it and install spam-scripts and other not-so-friendly-executable-files. When hackers (in GERMANY, we KNOW that, the IP address was 77.237.242.241) activated the spam-script, bells were ringing really hard at our web hosting company and our account was shut down. Thanks 77.237.242.241! Thanks to immediate help from staff at our webhost (www.ODERLAND.se, if you ever need a web host in Sweden) 99nicu was up and running again within a few hours. Unfortunately, our own IP-address will be blacklisted for some time. Therefore we may have some problems with our own, legitimate emails going out from us. Thanks to ALL participating in the rescue mission of 99nicu!

I kind of agree... Apple knows how to do their thing, which included how to keep control (without discussing mr Jobs himself, I think the Apple management structure very much a pyramid. The man on the top rules. Hard!) It is said that there will be some kind of file/media content system though. Let's hope the competition from other systems (don't forget Chrome OS) will keep also sceptical Apple users happy!

3rd congress of the European Academy of Paediatric Societies October 23-26 2010 Copenhagen, Denmark For more information: www.kenes.com/paediatrics

PubMed has some publications regarding fetal effects of interferon: http://www.ncbi.nlm.nih.gov/pubmed/16047033 http://www.ncbi.nlm.nih.gov/pubmed/17106162 http://www.ncbi.nlm.nih.gov/pubmed/11125927 http://www.ncbi.nlm.nih.gov/pubmed/12398565

Mannitol, I have never come across this drug in neonatal care. Increased ICP in neonates, difficult topic since the cranial bones are not fixed and that head circumference can grow with increasing pressure. I have just made a quick search on medline and found this promising reference: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 11. Use of hyperosmolar therapy in the management of severe pediatric traumatic brain injury. http://www.ncbi.nlm.nih.gov/pubmed/12847347 Unfortunaltey, no abstract or free full-text showed up beside the ref, but if you have access to that journal, it might be interesting reading.

I guess the key is to good airway management including maintaining an optimal lung volume (cpap or PEEP). Tube position may have a role (http://www.ncbi.nlm.nih.gov/pubmed/18027311) Chest physiotherapy needs further studies according to a Cochrane review (http://www.ncbi.nlm.nih.gov/pubmed/18646156).

The following guidelines are from the Swedish Pediatr Pain group. If you read Swedish....http://www.svenskbarnsmartforening.se/svenskbarnsmartforening/dokument/nyfoddhetssmarta.pdf I translate the dosing recommendations: PO or PR doses 28-31 weeks (gest.age): 25 mg/kg loading dose, thereafter 15 mg/kg every 12 hour (x2) 32-36 weeks: 25 mg/kg loading dose, thereafter 15 mg/kg every 8 hour (x3) > 36 weeks: 25 mg/kg loading does, thereafter 15 mg/kg every 6 hour (x4) IV doses (infusion time 30 min) 28 – 31 weeks: 7,5 mg/kg every 12 hour (x2) > 32 weeks: 7,5 mg/kg every 6 hour (x4) Term infants AND >1 weeks postnatal age: 10 mg/kg every 6 hour (x4)

I would like to lift these links, very interesting reading. But, it would be interesting to know how widespread the use of pro-biotics are (we don't). I add a poll to this thread!.

Each Karolinska unit have a "Milk kitchen" - a dedicated room for preparation of milk, additives etc. Looks like a kitchen too. But very clean!

Happy ending then! Glad to hear that you managed your case with a conservative strategy. General comment: aggressive active strategies are is always easy, sometimes they are not necessary.

Could you upload an x-ray? It is hard to say but it seems plausible that the pneumo contributes to the respiratory distress. You could try to evacuate the pneumo once again with a needle. If air returns on x-ray, you def have a leak which probably needs to heal under drainage.

I hardly ever follow TV-series. Hospital hours are not very compatible with that. In addition, I am boring enough to spare my TV sessions for News and Sports. During the previous decade, I can only remember that I saw Sopranos. I got a DVD-box for Christmas from my wife. Mad Men season 1. Not having heard about this series, I was blank to what to expect. Now, we have both become Mad Men junkies... For those of you who don't know about this TV-series (as I did not): the story is about an advertising firm in New York City in the 1960s. How life is evolving around work and family life. How lives can crack and fall apart. How lies work. And don't work. View the introductionary graphics on Youtube... As all good things are subjected to parody... a Simpsons Mad Men version can also be seen on Youtube! http://www.youtube.com/watch?v=KcmM7Jh2Y3k PS. Due to copyright restrictions, I could not embed the clips above. You have to go to Youtube to view them.

Fantastic roads! Near-death-experiences guaranteed?!

Thanks for sharing this link! It's really a great resource. Long time ago when we had just started 99nicu, we approached NICUniversity for a strategic partnership, but had no response at that time. Maybe it would be an idea to contact them again. What do you think?