Stefan Johansson

Would be a really interesting option to instillation of surfactant (intubation), further enhancing the possibility to a "gentle" approach based on nasal CPAP.

I am going to Hot Topics this year. Anyone else going there?! Let's have a 99nicu meeting!

Our latest research paper, about low birth weight and later risk of developing type 2 diabetes, was recently published in Epidemiology. (Abstract - click here!) I feel relieved, it was a lot of hard work to do the study, and not the least, to get it published. Therefore, I got happy when Reuters News Agency wrote about it (click here or here to read the article!) There are many reports showing a link between low birth weight and type 2 diabetes; the lower the birth weight, the higher the risk. However, as discussed in Lancet already in 1999 (Hattersley, Lancet 1999;353:1789-92), there may be no causal link between low birth weight and type 2 diabetes. Instead, the two problems could be explained by a common genetic background, i.e. the same genes may increase the risk for both low birth weight and type2 diabetes. And, by using a large twin cohort, we could demonstrate that the association between LBW and type 2 diabetes seems to subjected to such "genetic confounding". Our findings contrast to the current paradigm (that poor fetal nutrition would leading to low birth weight would "program" the fetus to develop diabetes later in life). I think we experienced a bit of negative publication bias before the paper was finally (and easily) accepted in Epidemiology. Reviewers in the "Big-Medical-Journals-With-Wellknown-Abbreviations" were a bit unfair in their judgements. (It seemed that they 1) did not understand twin study methodology as such, and 2) did not believe our findings could be true). With this in mind, I was glad and surprised that a medical writer from Reuters News Agency got in touch once the paper was published. Joene Hendry wrote a very nice article about the study. Unfortunately I am not allowed to share this article with you here. Reproduction of Reuter's material is strictly prohibited, and a permission would be (at least) 800USD! But if you're curious, click on the links above to read it at the Reuters web site or at MedlinePlus.

The Olympic games are over, and I am leaving the TV sofa. In spite of the politicopropagandistic extravaganzas, I think the games were great: lots of fighting spirit, fantastic achievements, the chaotic mix of emotions. Some people were winners (probably not only those who travelled home with gold medals), and some people felt like losers (also some with medals in their luggage, I'm sure). Although sports is only a small part of life (for most of us) I think sports contains most bits and pieces what Life is all about. We try, train, perform, and achieve. Then we reflect and react. Finally, most of us need to try all over again. Neonatal medicine is much about individuals fighting for finishing lines too. Most will be winners and some will be losers. And, I am not thinking about you. But the babies we care for.

I know from one of the authors that a new edition of the Atlas of Neonatal Brain Sonographythis is in pipeline. The book Neonatal Cranial Ultrasonography: Guidelines for the Procedure and Atlas of Normal Ultrasound Anatomy is another good and recent book about neonatal cerebral ultrasound.

Firstly, discuss your situation with other residents in the same situation. Doctors have a tendency to say that "life was bad for me, now it is bad for you". That must not be the case. Strive for even small improvements for yourself and your current colleagues, as well as for future residents. Secondly, every resident is worth a good mentor! Residency in neonatology can be very stressful - you will face a lot of work, difficult decision-making, and sad/happy moments - and you need a senior doctor for discussions and support regarding all various matters. Thirdly, work load is high for all staff in neonatal care... BUT hours get better with time. It may sound crazy but most people (incl you!) can live with poor working conditions for some time. Once you're qualified, working life gets better.

We do not have a protocol for such treatment. On the other hand, most of our extremely preterm infants are given antibiotics from the start (due to a suspicion of infectious etiology of preterm labour/PPROM, due to invasive procedures like UACs/UVCs). Our drugs of choice are bensyl-pencillin and gentamycin. A problem with antibiotic treatment is that it is more easy to start than to withdraw... many of our preterm infants are treated for long times. What is your criteria for stopping ab treatment?

I guess you are referring to research done by a Sydney-based group (Evans, Kluckow and co-workers). http://www.ncbi.nlm.nih.gov/pubmed/16690639 I personally find this group's research very interesting, since it challenges our current (old-fashioned) view on ductal shunting. For example - most consider shunting to be very small shortly after birth (due to high pulmonary vascular resistance) and increase with time, but this group has shown that shunting can be most severe during the first hours of life, resulting in low systemic blood flow (which in turn is strongly related to IVH. The strategy of "early targeted PDA closure" (in contrast to PDA prophylactic treatment) was suggested by this group. The idea (as I understand it) is to give NSAID with Milrinone shortly after birth after low systemic is diagnosed with echocardiography, 1) to close the duct and 2) improve systemic blood flow If I remember correctly there's a clinical trial (RCT) running in Australia. I do not know the alternative treatments infants are randomized to. But... I hope we will learn more about this strategy in the future. The knowledge of neonatal hemodynamics, ductal shunting and PDA treatment really needs to be further developed.

Agnieszka, the Polish system seems more flexible than ours. I personally think a "fast-track" to neonatology would be good also for Sweden. One example; a colleague is a specialist in anestesiology, and she wants to become a neonatologist. Despite the fact that she is trained in intensive care/anestesiology - she will have to go through 5 years of pediatric training before she can formally enter a neonatology fellowship. I think that's a waste (of time... of expertise... of common sense...)

And the internship after graduation from medical school, adds another 18 months. And since research training is not counted in, writing a PhD comes on top too. So, even if you're getting through the whole system asasp, you will be middle-aged before you're a fully qualified neonatologist! My bottomline... I think our education is a bit too long. Less is more!

Did/do you buy those shields from somewhere, or are they "home-made"? Could you post a photo?

I would like to add another argument for Tc-monitoring... can be used for CO2-monitoring during nCPAP.

I think it is good to have neonatology as a subspecialty of pediatrics, considering the need for policlinical follow-up visits after neonatal intensive care (with a lot of general pediatric councelling!) In Sweden, every neonatologist completes pediatric residency (about 5 years), which includes about 6-12 months of neonatal medicine. The following neonatal specialty takes another 3 years. I personally think the Swedish system is a too rigid though. During the pediatric residency, we should be able to individualize the programme to a greater extent than we can today.

Interesting. Which article did you get this figure from? I guess you mean an increased risk of childhood malignancy (since I guess the standardized lifetime risk for cancer much-much higher than 1:500)

Hi Norbert! I have never heard about such an association, sounds like a far-fetched argument to me. I browsed PubMed but I could not find anything there. Did you get any info about the primary source for this discussion (case report etc)?

Anyone experienced in SQL-databases? Have worked with the Mediawiki platform...? If yes, send me a mail (stefan.johansson@ki.se) or a PM!

And... do not forget the Leading Articles. All articles are available in full text! http://99nicu.org/forum/forumdisplay.php?f=102

I recently read an article about Haruki Murakami, a Japanese novelist. I had never heard of him before but this man is a literature "Mega-star"! (Which tells more about me than about the fame of Murakami) While reading about Murakami, I felt this is a good person. We had things in common! Integrity. Sense of humour. Wife's always right. Likes jogging and vinyl records. And Twin Peaks. So, I bought his book "Kafka on the Shore" to bring on our summer holiday trip. I have only read the first 50 pages, but I can really recommend this novel! This is original, mind-breaking and sophisticated literature. This summer, I will be stuck with this Japanese mystery!

"Get real - get online" - that seems to apply also to newborn infants! Our hospital (with the largest number of newborns/year, in Sweden at least) as adopted an increasingly popular feature - web-babies! There's a camera installed below the roof in the waiting room for the doctors health check - parents can just put their newborn baby below it, press the "click" button and then the "get online" button. Good or bad... I guess, not too bad anyway http://www.ds.se/Web/NormalPage____4225.aspx

Johanna, interesting policy! Where did you get those shields from? Can you post some technical details (size, weight etc) and maybe photos?!

If you are interested to join the 99nicu Team in the Wiki-project... email info@99nicu.org We are especially interested to get in touch with people who know about the technical aspects of Wiki software.

I guess you all know about the success of Wikipedia, the world-wide, free and open dictionary, where anyone can contribute with expertise and knowledge (and des-information too...). Anyway, the 99nicu Team has discussed whether to open a Neonatal Wiki. In contrast to the discussion forums that deals mainly with clinical questions and advice, a neonatal Wiki would focus on guidelines, protocols etc. I personally think the idea is good. Software is available. Many people would probably be interested to contribute with their knowledge, skills and experience. As the database grows, I am sure a lot of people would be find a neonatal Wiki increasingly useful. What do you think about such a project?

Most of us want to become parents. But, is it a human right to reproduce? Some people may argue in favour, but I am not sure I would. Despite the importance of reproduction itself (for all species, incl mammalians like Homo Sapiens), nothing can be taken for granted. In neonatal medicine we know that normality is not a 100% state, sometimes the other side of the coin shows up too. Generally, I would argue that we regard expecting and having children in a more respectful way. At least in the Swedish language, I dislike how some couples may express their future plans. Many couples say that they will "get children" (Swe. "skaffa barn") as if infants could be picked up somewhere. I like the phrase "having a child" (Swe. "vänta/få barn") much better, this phrase has a different deeper meaning. An infant is a gift, given to you.

We are discussing whether we should protect infants from unintentional (primary) radiation, using gonadal shields during chest x-rays. Currently, we do not use such shields. This interesting article was published in Journal of Perinatology (see abstract below) Pubmed-link: http://www.ncbi.nlm.nih.gov/pubmed/17625572 Would be interested to hear your opinions and experiences on this topic.

Do you mean at the time of delivery? If yes, our answer is No. If you mean before tube feeding: nurses/assisting nurses check the NG tube position (and gastric retentions) before feeds.