Stefan Johansson

I kind of agree, House is a good diagnostician and it is easy to laugh at his "jargong". But I wished he could "get a life", with Cuddy for example.

How about: - hypothermia after birth asphyxia - nosocomial infections in the NICU - NIDCAP

Not that I'm aware of. We have no contraindication to vit K prophylaxis after delivery (of course, parents is free to say no or choose oral vit K, but this is very rare) I tried to find something in pubmed but found nothing of interest. Just curious to know if you have a more specific question in mind.

Check this out: http://pediatrics.aappublications.org/cgi/content/abstract/122/4/831 The issue raised by the authors is rather that bicarbonate is useless. Even, the authors write:

I am sorry but I will not be able to attend this year. It would have been great to see you there for an informal 99nicu meeting! And, my non-attendance should not hinder others to meet in the name of 99nicu. We're all one community!

Hi! We would opt for a similar strategy, correction of 48-72 hours. We probably also give enteral nutrition (mother's milk) and reduce the drips as needed. Check urine output and follow serum electrolytes closely!

I know the editor-in-chief of Acta (prof Hugo Lagercrantz), I email him and ask about the idea.

Good idea. As an editor I know one needs to consider the format before submitting. It seems that ADC has no suitable format for this kind of paper, but the "different view"-series in Acta may be suitable. I am terribly busy right now, but would like to participate in the group as a co-driver. Selvan - would you like to be the coordinator?

In our units, peripherally inserted central lines are pretty common. Some nurses have been trained to insert these lines. The procedure is simple 1) a regular peripheral venous canula (PVC) is inserted 2) a 27G line is inserted through the canula to a desired length (needs to be checked with x-ray) 3) the PVC is pulled back over the line and taped together with the outer end of the line I do not work much clinically these days (since I am working for the Swedish Medical Journal) but will take some photos when I get the opportunity.

I got this link from a colleague in Tromso, Norway (that's far away in the North, even north of Sweden!) www.unn.no/barn/metodebok It's a complete manual of neonatal intensive care, available as a PDF document. If you're "Scandinavian" (i.e read Danish, Swedish or Norwegian of course ), this is a good source of information.

Difficult question, it depends what you put into the word "unsatisfied"! I try to think about parents as collaborators. As JACK wrote, communication is the key to success, but despite all possible efforts I have also experienced many occasions when we have not been able to get on well with parents. One needs to feel convinced that provided care is professional (i.e. have good confidence) and that one does what's in the best interest of the infant. If parents do not see this, I personally feel that I can take that. Or rather, have to take it as a part of myself acting professional (thereby not saying that I do not moan in the staff lunch room...) I have not been a parent in an NICU setting myself, but I can feel empathy for parents, when their psychological pressure is released as anger towards care, technology, staff etc-etc. Their situation is hard. I often wonder how well parents accommodate among bleeping machines connected to their small child.

Looks like the infant developed a pustular rash. How about this condition? "Acute Generalized Exanthematous Pustulosis: A Rare Clinical Entity With Use of Piperacillin/Tazobactam." http://www.ncbi.nlm.nih.gov/pubmed/19352142

But I wonder if this is really the same technology as used in the ICE trial? I have a slight memory from a meeting and it seemed that the "ice pack"-strategy had no servo-control, but seemed very basic. BUT, it worked. Anyone from Australia/New Zealand who could comment on this?

I wished I had one to give you, but I have none. Will send you one if I get one!

I got an invite to Google Wave. Have registrered. But what now?! (I really do not know what to do! ) Anyone else here beta-testing Google Wave?!

This is a tricky question. We have our central lab and they are accredited to some standards I know nothing about. We do not do our own analyses (with the exception of blood gases (using the ISTAT machine) and blood glucuse (using Freestyle))

Hi everyone! You need to be specific and suggest a particular book you want to review. Ciao, Stefan

I do not know of simple techniques for selective head cooling but the Australian trial ICE used a pragmatic approach to induce systemic cooling with ice packs. I have heard about this method at the Hot Topics congress, but have found only one reference in Medline, from 2004. It might be so that they have not reported more from this trial. The researchers' bottom-line was... there are lots of fancy equipment but ice-packs serve the purpose almost as good. Inder T, Hunt R, Morley C, Coleman L, Stewart M, Doyle L, Jacobs S. Randomized trial of systemic hypothermia selectively protects the cortex on MRI in term hypoxic-ischemic encephalopathy. Journal of Pediatrics 2004;145:835-7 http://www.ncbi.nlm.nih.gov/pubmed/15580212 I suggest you contact the authors of this report for advice.

Before the end of the year, we have euros to spend... and our plan is to spend it on books that can be reviewed. The deal is, we buy you a book from Amazon, have it delivered directly to you, in exchange for a review in four weeks time. You may want to review books in neonatology, but you can also choose to review any books you feel we may want to read about (music, medicine, art, novels etc-etc) When you have finished your review, you will need post the review yourself in the review forum, here! (that's a piece of cake, but we will assist you if you need help) Please respond to this thread or email info@99nicu.org, if you want to review a book.

You're welcome! Nice to find someone in the Lounge (that's not often... )

Although I think religion can be supportive at these occasions, I believe that suffering and grief is a universal human feeling. I mean, for example, if African parents with 8 previous children loose a newborn baby, I am sure they share feelings with a couple in Sweden, losing a child that was a result of in-vitro fertilization. I belong to the state-church of Sweden (i.e. I am a protestant) but I must admit I hardly ever go to church as a practising christian. Maybe I cannot find religious support for myself due to myself being closer as an atheist or agnostic, but I find it hard to "understand" or reason about the death of a newborn infant. Nature is mysteriously cruel sometimes. Just in case someone would misunderstand my first post, what I have sometimes lacked in the NICU is not really a clinical protocol "Handling grief - chapter 1-9". But more that the working group should be more aware of grief and to "see" it, in ourselves and in others in the team. That we have an opportunity to put some words to it before leaving our shift.

My answer is... no (if the infant is not agitated)

Thanks for raising this important topic. Personally, I can be influenced a lot about death and misery in the NICU. And, I believe we could help each other in the NICU to manage these events in a more professional way. We are so keen to formalize and structure a lot of things/procedures, but this field is a white map for everyone to "do their best". I do not have any good solutions how we could cope in a better way, my point is that we may not just go away for a coffee break and then start working "business-as-usual". How I have solved this... my daily bike trip to/from work is my most important time for reflection (this may seem a bit strange, but it's true!). I process a lot of the days burden this way. Music and ordinary family life are also essential. I must rush now, will follow this discussion closely!

This thread may give you some info: http://www.99nicu.org/forum/showthread.php?t=6624

We have a "milk bank" of donated breast milk, where lactating mothers can donate breast milk. The honorarium for these donations is quite small but enough mothers do it for the good sake. I think most have past experience of neonatal care and want to contribute when they have other (well and term) children. As far as I know, donor milk can be used for several infants, but the batch id's are recorded. Parents need to give consent whether their infant can get donor milk. In our units we almost always use donor milk until the mother herself produce enough milk to feed her infant. All mothers are instructed to start pumping and typically are able to fully feed their infants after a week.