Stefan Johansson

I would say No! I am not sure if the morbidity associated with late preterm birth would would be worse compared to the possible side-effects of steriods (I mean long term effects, which we really know little about). (And off-topic; we strongly advice obs&gyn and parents-to-be, to push "elective CS" to week 39 unless it is needed for special indications.

I agree completely! I would need properly designed trials when it comes to antibiotic therapy. It should not be that difficult using a multicenter approach. My personal feeling is that we "marinate" our infants with too many different antibiotics and for too long. But, we would all need better data supporting shorter courses.

Just one more comment - we have national guidelines regarding antibiotic treatment incl length of therapy. But I suspect the documentation for length of therapy is meager, i.e. we do what we are used to do. I also recall our (within-the-unit) controversy regarding aminoglycoside dosing(once- or twice-daily in full term infants). The literature does not really give good evidence that one regime is superior to the other. At that time I thought the general scientific guidance for ab therapy was rather weak.

You caught me. Dogma it is!

Our responses: Q1. Usually 10 (-14) days, depending on what bacteria that grows in the culture. Q2. Usually 7 (-10) days, depending on the "certainty" of the culture-neg infection* Q3. We use CRP as a guidance, but generally stick to the courses above *In the very common situation with a relatively well term infant and slightly elevated CRP (-50) at presentation (which then decrease to normal), we generally use a three day course. That is the time it takes to get a negative response from the microbiology department.

The link is not valid any more... But, it seems to be able to order a CD http://www.hottopics.org/cdsales.php

Nice video! Since you also offer this video (almost for free I would say), I copy this post to the Classified ads forum. And embed the video there too

Excellent link!

Myocardial hypertrophy is very common in infants to diabetic mothers, and one really needs to discuss whether it is related to any symtoms. My experience is that this hypertrophy resolves spontaneously without specific treatment. But, those infants are usually followed up after discharge with one or two echo's. If the hypertrophy is symptomatic I would need to learn more about specific treatment. I guess that beta-blockers may be helpful but would let our cardiologists decide.

In acute situations we mainly rely on arterial access via umbilical arterial catheter, and if not possible to a peripheral arterial catheter (preferably radial catheter). For venous access in the acute phase we mainly use umbilical venous access, and if not possible peripheral venous access. We may go for a percutaneous peripherially inserted central catheter (i.e. regular peripheral venous catheter first, then we insert a 27G line through the PVC to a central position), but those are mainly used for parenteral nutrition. I guess we could learn better central venous techniques though.

Hi Norbert! We commonly use DuoDerm (against pressure of cpap-prongs, enteral feeding tubes etc). We are now exploring exactly which products we have in stock so to speak, since some of Convatecs products appearantly contain colophonium. Do you have the first-hand source of this information? Would really appreciate to see that, before any decision-making here.

Pacifiers, of various brands and sizes. The tiniest one is used only for infants <1500 grams. The regular pacifiers are of the brand NUK and the special CPAP-pacifier has the product name Wee Thumbie.

If perfusion is fine, we would probably decrease volume input to normal, adding sodium in normal amounts, (about 2-3 mmol/kg/d), but follow water balance, renal function tests, and serum electrolytes closely. If the renal function is not compromised for some reason, the infant will probably handle the extra volume and the hypernatremia will resolve spontaneously. Unless the hyperglycemia results in glucosuria, we would not treat it, just monitor it. If there's a very large urinary output due to glucosuria, we would consider to admin insulin. (My personal experience is that one needs to be really careful with insulin, iatrogenic hypoglycemia may occur...)

We would do the same; not to treat "pure" colonization, but keep the positive cultures in mind if clinical symtoms arise

Nope.

I am a "project-oriented" person, i.e. I get a lot of "brilliant ideas", and try to realize some of them. With variable success/failure. Another side of this personality trait is that I get bored quite easily, if things get... boring The latest project I took the initiative is... a large Swedish charity foundation for peri-/neonatal research: Lilla barnets fond (Small child foundation). We (me, five other neonatologists, and one premie-parent) are just about to finish the formal paperwork and we plan for an official launch in a few months. Swedes are donating increasing amounts of money to charity foundations. For example - last year the Child cancer foundation recieved 14 million euro. Since research in neonatal medicine lacks funding from a large-scale fund-raising organisation, I thought we should start one. With the ultimate aim to marginalise the (generally accepted) idea that research is something that can be done with embarrasingly low scholarships, or during free time (evenings, weekends). There's no natural law that neonatal research in Sweden should not paid by salaries. "kamikaze" project?! Well, similar to other projects, there's a great risk this project will drive me to the rim of work-overload. If I had been in therapy, someone would have told me that it is part of the "pattern".

Thanks for the advice! I have just ordered the book Tokyo. Japan fascinates me very much, I do not know why really, but the mix of hypernmodern and ancient times is one part for sure. Another Japanese writer I can recommend is Kenzaburo Oe. He got the Noble Prize in literature in the 90s, I read a few of his books then (one of which is about his son with a congenital brain malformation, I think the Swedish title was "Time for football").

I have contacted WHO and UNICEF with a request about the BFHI, whether a web community can become accredited. Will report back when I get a response.

I do not really know from where we buy those, but they are not the usual ones from baby shops. They are quite small, and there a "vagination" on the upper rim, so it does not align too much against the cpap device (prong holder). I can take some photos and post later. I am not aware of any pressure side-effects, but you got a point there. On the other hand, the pacifiers are not there all the time, they go in and out so to speak , and when infants are asleep they are usually not needed.

"Pubmed Slider Interface" - interesting idea. Makes it easier to do searches, but "everything" is already there at the regular PubMed site, one just need to learn how PubMed is organised and how the syntax works (not difficult!) I have started to use a great reference manager for Mac's Bookends. (http://www.sonnysoftware.com/bookends/bookends.html) Works better than EndNote!

ammar, do you have the link to the abstract in PubMed?

Pacifier is our first technique-of-choice, but sometime we make a soft cushion of elastic band which we position under the chin. AND, parents (which sit by the incubators/beds a lot) are asked to help us to support their babies, i.e. keeping the pacifier and cushion in position. Those of you using a chin strap, does it work well? Is it well tolerated (in terms of comfort)? Although loss of cpap-pressure through the mouth is commonly seen, it is seldom a clinical problem according to my experience. As long as no clear symtom appear (apneas, "disturbingly" high TcCO2, or steady saturation less then 87%), we do not change anything, but look upon it a "weaning". However, some infants are very dependent on pressure. For example, those with severe BPD can be very problematic, especially since those infants can be much older and much more active.

If it is possible to make a web community a Baby Friendly Website, it's a great idea! Do you know how we could accomplish this?

Let's make a meeting place somewhere. I do not yet know details about my hotel and I have not yet planned my travels. But, keep in touch!