Everything posted by Stefan Johansson
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How do you organise the ”well baby checks” from the delivery / maternity unit?
@PHutchings I am referring to the first neonatal check before discharge home
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Post term & transient hyperinsulinism
Interesting observation, did you measure serum levels of insulin?I have always thought that the higher risk of post.term infants to develop hypoglycemia (like doubled even in "low-risk" post-term deliveries https://fn.bmj.com/content/102/4/F286.long) was related to less good energy storages but interestingly, the MSD manual mentions that post-term infants may have higher levels of insulin (https://www.msdmanuals.com/professional/pediatrics/perinatal-problems/postterm-infants) I tried but failed to find levels on s-insulin in post-term infants on Pubmed, anyone else with input?
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Term/late preterm - how much volume to start enteral feeding?
Fully agree, also the "easy patients" deserve an individualized strategy, similarly to the TLC that we otherwise dedicate to the tiny preterm infants.
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Term/late preterm - how much volume to start enteral feeding?
Thanks for raising this question, I think this is a more common patient than those needing iv fluids / TPN! For a term infant we typical start with 40 ml/kg/d and a late preterm (say 34-36w) we usually go for 40-60 depending on fetal growth, clinical situation etc. We increase feeding volume w 20-30 ml/kg/d. We feed every 3 hours, so a 3 kg term would have 120 ml first 24 hours. We would probably feed some thing like 10 ml x 1-2, 15 ml x 5-6 and then 20ml per feed. it is common we do not go up to ”full feeding”which at our NICU is 170-185 ml/kg/d. If the infant is starting breastfeeding practise early (for example, term infant with TTN) we usually stop at 125~150 to promote a quicker full breastfeeding. Of course, we do take b-glucose, weight development, nutritional needs due to clinical symptoms and everything like that into account, so all infants have their own path too
- Probiotic supplementation to preterm infants - an international survey study
- Which surfactant do you use?
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How do you organise the ”well baby checks” from the delivery / maternity unit?
We are discussing a lot around how to organise the ”well baby checks”, ie the medical assessment of all infants discharged home from the delivery/maternity unit? How is this set up in your various contexts? Is it a doctor or midwife doing it? What exactly is included in the exam/assessment?
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IVH rates in infants <29w increasing from 2013 ->2019
This is a very interesting publication from the UK, about IVH rates in infants born <29 weeks from 2013 through 2019. Rates are increasing over time, findings along the lines of other studies showing that outcomes does not improve much despite all work we do to change things for the better Would be great to hear yout thoughts about the paper but also how you aim to reduce IVH risks / like IVH prevention tool kits etc https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828692
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2024: It's a Wrap! Holiday Greetings and Highlights
It has indeed been a great year! And I am very much looking fw to 2025
- Severe BPD and prolonged stay in NICU
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New resuscitation guidelines (Nov 2024)!
Just found out about the new resusciation guidelines, out since a few weeks! Lots of authors... and the PDF is 100 pages (and annoyingly water-marked with the logo of the journal Circulation!) Has anyone already read this and could share a short version ? Find here: https://pubmed.ncbi.nlm.nih.gov/39540293/
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Nutrition care bundles was associated with improved growth
An interesting paper came on my radar, about the importance of a structured nutrition strategy for preterm infant (https://www.sciencedirect.com/science/article/pii/S0378378224002202) It is a single-center experience in Budowice in the Czech Republic, comparing the time before and after a "nutrition care bundle" was introduced. In short, the bundle consisted of following changes: parenteral nutrition strategy targeted individualized fortification of breast milk (using software-based nutrient calculation system) anthropometric dynamics (z-score) weekly multidisciplinary nutrition round max total volume/kg/day was changed from 180 -> 150 The reported results are clearly relevant: infants reached full enteral feeding quicker, and had more favourable growth dynamics (less drop in weight and head circumference Z-score). Interestingly, PDA rates also decreased (discussed as related to lower volume intake / day). Although a small study etc, the results are good food for thought. What does your nutrition strategy/guideline look like? Would be interesting to hear, given how many ways there are to reach Rome, as the saying goes
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Practical Head Ultrasound for the neonatologist - anyone wanting a spare CD-rom?
Found a CD-ROM with the educational program "Head Ultrasound for the Neonatologist". Is it a bit old (says 2008) and one needs QuickTime installed to run it. It says it runs on Wind XP but I assume later Windows-versions should work too. Drop me a Direct Message if you are interested to get it, I give it away for free.
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Our farewell to Twitter/X: staying true to our values
Thanks @Mari K, and great to have connected in the NICUverse
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Colostrum-kits - what do you think, what do you do?
I came across this paper about "colostrum-kits", that a structured way of informing mothers before risk deliveries about colostrum and how to express it, can shorten the time it takes to first colostrum feeding. (link below) Would be interesting to hear from you all if/how you do this in your NICUs. https://link.springer.com/epdf/10.1186/s13006-024-00682-5
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Our farewell to Twitter/X: staying true to our values
Thanks @wackdi @Roland NNP and @deshmukhls for your support. I was a bit ahead of the times a year ago. When I left Tw/X in 2023, people thought I was "woke" but IMHO it was then already clear where the platform was heading. Glad to that so many people, and especially medical professionals, also exit from there now and building new networks on Mastodon and BlueSky.
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Our farewell to Twitter/X: staying true to our values
I made an X-it from Twitter a year ago (wrote about it here) and today we within the 99nicu Team also decided that we will delete our Twitter/X account. Our ongoing mission is to foster a global community for neonatal professionals, engaging on platforms that reflect our core values: inclusivity, collaboration, and meaningful dialogue. Twitter used to be such a platform. However, recent shifts in that platform's culture, policies, and overall direction have prompted us to re-evaluate our presence there. We believe that professional networks thrive in environments that prioritize trust, respect, and integrity. As many of you see, Twitter/X is no longer such a network. In short, we leave X and focus our efforts on platforms that better align with our vision and core values. Our focus will be our moderated forums here in 99nicu.org but we will also communicate through our Mastodon-server aka the NICUVERSE and through BlueSky. To our followers on X - thank you for your support and contributions over the years. We hope you will stay connected with us through other channels, where we can better cultivate a sense of belonging and purpose. This isn’t an end, just a shift toward a brighter, more collaborative future for our neonatal community. Let’s keep the conversation alive, just in a better space.
- 22-weekers - what is right / reasonable / wrong, and what is the path ahead?
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Celebrating World Prematurity Day: Raising Awareness Together
Today on November 17 marks World Prematurity Day, a global initiative to increase awareness about the challenges and impacts of preterm birth. With approximately 1 in 10 babies born prematurely worldwide, this issue touches millions of families and healthcare providers, highlighting the need for collective action and understanding. At 99nicu, we are committed to contributing to this important cause. Preterm birth remains one of the leading causes of neonatal mortality and long-term health issues. However, with the right care, many of these tiny infants can survive and thrive. World Prematurity Day is an opportunity to come together to improve outcomes for preterm infants through education, innovation, and collaboration. Together, we can make a difference in the lives of premature babies and their families. Let’s keep increasing our efforts to ensure that every preterm infant gets the best possible start in life. This year, we contribute to the World Prematurity Day by partnering up with the Adult Preemie Advocacy Network to power a series of webinars throughout November, to raise awareness of the varied long term impacts outside of the NICU into adulthood. Find all info about this webinar series here!
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Premedication for LISA/ MIST
IMHO ketamine seems like a very good choice. We use fentanyl and my experience is not the best, it usually works but sometimes we do see thorax rigidity or insufficient analgesia. Do you also premed with atropine? Have you done some kind of systematic discomfort scoring etc, ie are you happy with the analgesia?
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Our many thanks to Prof Barrington for his support of 99nicu and our NICUVERSE
We would like to share our many thanks to Professor Keith Barrington for his support of 99nicu and the NICUVERSE, our Mastodon server designed as a dedicated social space for the neonatology community. In his recent blog post, Keith Barrington highlighted the importance of online networks where neonatal professionals can connect and collaborate. He encouraged neonatologists, neonatal nurses, and other NICU team members to join both platforms, emphasizing the value of accessible, supportive communities where members can freely share research insights, clinical experiences, and more. As one of the most respected voices in neonatal research, his endorsement of 99nicu and the NICUVERSE is not only an honor but a reminder of the power of community in our field. His longstanding dedication to fostering dialogue and education within neonatology has helped elevate these platforms as safe and enriching spaces for global discussion, where newcomers and experienced professionals alike can learn, question, and contribute. While 99nicu.org opened already in 2006, our NICUVERSE is an extension of this mission, a social media platform powered by Mastodon, a non-profit platform, where our community can engage without the distractions or privacy concerns of mainstream social media. Join the NICUVERSE here PS. We are planning a Mastodon webinar soon, stay tuned! PS2. The changing Social Media landscape has also made us explore BlueSky - also a platform with great potential!
- Severe BPD and prolonged stay in NICU
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Membrane stabilizing effect of steroids?
A bit tricky to find seemingly relevant references about corticosteroids and "membrane stabilisation" in preterm infants. I did find some old references, for example this one https://www.jci.org/articles/view/107832 Otherwise, when it comes to the Q's about BPD prevention - I would you to look at the latest Cochrane meta-analysis and the two PREMILOC publications (which IMHO is a promising strategy) https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010941.pub3/full https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00202-6/abstract https://www.nature.com/articles/s41390-023-02785-x
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Less than one week to go till Adults Born Preterm: The Honesty Sessions launches!
We will be releasing the recording of the first webinar as soon it is ready. In the meantime, you can see the 2nd session here:
- Probiotic supplementation to preterm infants - an international survey study