Stefan Johansson

Yes, we almost always use two different additives, extra lipids and protein.

I would suggest that you browse OMIM http://www.ncbi.nlm.nih.gov/omim/ I made a quick search for with the keywords "white forelock" and "heterochromia" and got a few hits including various forms of Waardenburg syndrome. Are there any associated malformations?

Another aspect of dobutamine is that it has some beta2-agonist action, related to vasodilatation: http://www.ncbi.nlm.nih.gov/pubmed/9279221

Here's the link: http://www.hopkinscme.net/ofp/eneonatalreview/Newsletters/1108.html

This is not a book about neonatal medicine. But read it anyway! You will have a good time and feel enlighted about a fascinating world outside your neonatal unit. Where strong commercial interests and strange characters profit BIG MONEY from people aiming for a healthy life-style. Bad Science is written by the British doctor and writer Ben Goldacre. The book is based on his column in the Guardian, a leading newspapers in the UK. His mission is (what is seems) to bring basic principles of science to the general public, thereby uncovering the critical eye of people who are cheated to spend on miracle cures because of "studies have shown"-statements. As you know, most goods and services in the healthy-life-style industry are nothing but fraudulent rubbish. Ben Goldacre cleverly dismantles pseudo-science, such as Detox, Homeopathy, Pills solving complex social problems, etcera. Even when Ben Goldacre refers to hyped health prophets in the UK I haven't heard of, I find Bad Science truly amusing reading. His bottom-line: "If I had a T-shirt slogan for this whole book it would be I'll think you'll find it is a bit more complicated than that". Taking antioxidant pills (and the wide spread belief that these pills do good to you...) as an example, Goldacre goes through the four major errors in pseudo-science. Does data exist at all? The concepts of observation and intervention, are they mixed up? Is lab data being extrapolated far beyond reason? Are positive trials cherry-picked? A large bit of the book is about heavy irrationality, but Bad Science also deals with a more serious side of science. As you know, the quality of medical research varies quite a lot... For example, in the chapter "Is mainstream medicine evil?" Goldacre goes through ("for the doctors who bought the book to laugh at homeopaths") common statistical tricks that may boost scientific reporting of, for example, trials sponsored by pharmaceutical industry. These tricks include play with the baseline, ignore drop-outs, change outcome to fit your needs of a positive trial and after the study is completed, "torture the data and it will confess to anything", and "try every button on the computer". He also problematize the fact that media promote the public misunderstanding of science due its traditional way of communicating "good stories", and why "clever people believe stupid things". The only alternative to read Bad Science would to follow Goldacre's Guardian column and blog, both freely available here and here.

Regarding the fetal deaths; has H1N1 been identified in fetal tissue by PCR or culture?

Hi! I have meet people who advocate this practise and some who don't. I have not used this strategy myself. On the other hand, the units I have been working in have all had the tradition to perform very few urine cultures. In cases where the issue has been risen (like urinary tract malformations), whether there's really a cystitis/pyelonefritis, I have always made a bladder puncture to make sure the sample is not contaminated.

Nice material! I was so much into seeing the film that I missed that the movie is the illustration to the booklet presented! Click on the arrows underneath the booklet and you turn its pages. And, click on "Download PDF" to keep it.

I just wanted to say that I have no experience of the kind you request. My experience with older infants (ex-premies with BPD for instance) is that TcPCO2 works less well as the infant matures. But, maybe your equipment works better on older children. Have you asked the company representative for clinical data on the agreement between TcPO2 and PaCO2 (in blood)?

Dear Roy, despite the fact that I would advocate diagnostics of seizures first, I have commonly found that phenobarbital is started (10-20 mg/kg) on clinical grounds before CFM/EEG is available. So, if there´s no equipment to diagnose seizures, I would argue that symptomatic treatment of clinically evident irritability and seizures is appropriate. One can debate whether this phenobarbital and similar drugs really changes long-term outcome, but short-term it is usually well tolerated and may result in less irritability. I found these two papers, both from the same research group: http://www.ncbi.nlm.nih.gov/pubmed/16390805 http://www.ncbi.nlm.nih.gov/pubmed/15188805 They do not address your specific question, but give some light of the use of phenobarbital.

I have been wondering the same. According to the current guidelines I briefed, mothers with H1N1 needs to be isolated post-partum and the well infant does not need profylaxis unless the "situation is critical" (for the mother). Breast feeding is ok. Preterm infants with suspected H1N1-infection would need isolation in the NICU and be candidates for treatment with Tamiflu (2 mg/kg once daily over five days). But, I would like to express a word of caution about the guidelines I refer to. I would think it is hard to generalize guidelines about H1N1 since the virulence may differ between countries, and that different health authorities come to different conclusions, given the scarce amount of documentation for various strategies/dose regimes etc. I am sure many members would like to hear from other corners of the world, about other strategies. Please share how you tackle H1N1 in NICU settings. PS. Here's a link about a H1N1 case in a NICU in the US. http://cbs4.com/local/H1N1.Swine.Flu.2.1074463.html

Sorry about my short previous response. This is also how we do it!

Chloral hydrate (25-50 mg/kg)

I would not.

Very interesting question. I have often felt about "Do Not Resuscitate"-decisions in two different ways. Usually, one senses the situation correctly from the clinical scenario and "by gut-feeling". On the other hand, I have personally often felt that there's a lack of official policy on the decision-making process. I think one could decide upon a "work-flow"; how care and the infant's condition is assessed in the team; 2nd opinions from another consultant; parental involvement etc-etc. Some would argue that those steps are difficult to write down on a paper, but I would argue that it is a strength for a department to have these steps defined. We all need to consider certain aspects before we can consider treatment to be futile, so why not put this work-flow into words. A defined decision-making process would also be beneficial in contacts with parents, and give care a higher degree of transparency. "This is how we these decisions are formed". In the scenario you describe, I think one needs to consider the suffering of the individual infant. Although this is a hypothetical situation (and I know nothing about the legal aspects of the DNR form you have); if care seems futile and the infant is suffering this would be more important for me than not having the form counter-signed. For myself, I think papers are important, but the suffering of patients comes first. PS. A similar topic was discussed here: http://www.99nicu.org/forum/showthread.php?t=46

FFP = Fresh Frozen Plasma We generally administer 10 ml/kg of plasma and then re-check coagulation parameters, and repeat plasma if needed. Specific coagulation factors are not used unless very special circumstances.

I visited my first Hot Topic conference last year, it was great! Hope to go there this year too. I have started a "Social Group" for the Hot Topics: http://www.99nicu.org/forum/group.php?groupid=2

I can only agree on your clinical impression. One major problem with major bruising is the abnormal coagulation often detected, and I think there a reports supporting abnormal coagulation status with poor outcome. If I was not on holiday, I would search Pubmed

Our surgeons opt for early closure of diagphragmatic hernias, during the first week of life.

Could you please give us some more clinical information?

Dear Thabet Masri, I have not come across cases with non-ketonic hyperglycinemia and cannot be of any help with this question. But, I took a look in my old Nelson Textbook of pediatrics, that says that this metabolic disorder "appears to be" autosomal recessively inherited. No effective treatment exists, according to Nelson, but the textbook tells that attempts have been done to counteract the effect of glycine on neuronal cells, such as treatment with strychnine or diazepam and that "beneficial effects" have been seen in mild forms of this condition. Does anyone else have experience from this condition?

What do you mean by 'aminoplasmal' and 'AA' -I am not familiar with these terms.

I think this is a very good idea too. The main technical issue is data storage, but we will look into this. Do you have videos yourself you would like to share?

Gosh! I only use Cyberduck, MAMP, Dropbox and Quicksilver. My productivity boost meter is only 4/25!

Our bag&mask is place on a small shelf behind the the incubator/radient warmer. Every infant has its own set of bag&mask, and the mask has an appropriate size and is connected to the bag. The bag&mask is seldomly used and I think they are changed every week. If they are used, they are changed every 24h.