Stefan Johansson

Some good journalistic work from the UK about all challenging questions around the greyzone of viability: https://www.theguardian.com/society/2024/nov/19/look-theyre-getting-skin-the-moral-challenge-of-saving-the-worlds-tiniest-babies

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?

This is indeed a tricky Q, I think there is a gradual shift over time from the neonatal to the pediatric code. But at four months corrected age, I would think most would go for pediatric strategies.

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

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:

I wanted to share a link to a short survey done by Sara Bjurman, a fellows I supervise. It only takes a few minutes to complete and the link is https://forms.office.com/e/0rbYem4Bwg Find the intro-info below:

Interesting podcast about the Tiny Baby Collaborative Team, by the Incubator.

The video playlist is now available!

This just came on my radar, a review of premedication for a LISA procedure. https://fn.bmj.com/content/early/2024/10/10/archdischild-2024-326947.info It all comes down to very little (no!) guidance...

Thanks @Mari Ohnstad for sharing this. I fully agree to it all principally, but how are the actuals discussed around 22weekers going in Norway? I know about the survey among pediatric residents (what they themselves would want in case of a preterm birth) where practically all would go to the forest rather than a hospital in case of a threatening 22w delivery. https://onlinelibrary.wiley.com/doi/full/10.1111/apa.16631 This commentary is also a good read trying to add some more grey colors to the (at least in Swe) black-white picture. https://www.jpeds.com/article/S0022-3476(24)00051-9/fulltext

I wanted to share an interesting paper from the UK, about the costs of operating a human milk bank. Donor human milk is what most of us prefer before preterm formula, until there is mother's own milk, so the interest in banking seems to be increasing. There is even a European Milk Bank Association. We run a relatively large milk bank in our hospital, serving the four NICUs in Stockholm with donor milk (our NICU + three Karolinska NICUs), I think our milk bank handles a few qubic meters of donor milk (few 1000 liters) per year. The paper below is from the UK and they surveyed all UK Milk Banks (but all did not reply) about the costs. The results? The total average annual cost of operating a milk bank was £202 719 per year. The cost per litre averaged £173 (range £95–£275). I don't know whether to think about this as expensive or not, and how it compares to fortifiers, vitamins, iron drops, probiotics, MCT oil and other supplements that may be given on a daily basis? Say a litre is 200 GBP/EUR, then a daily volume of 160 ml/kg/d would mean that the milk cost is 32 GBP/EUR per day for a 1kg infant. Cheap as chips?! Would be great to hear your thoughts https://fn.bmj.com/content/early/2024/09/26/archdischild-2024-327543

I wanted to start a discussion about infants born at 22 completed weeks (i.e. 22+0 -- 22+6). Swedish Television recently broadcasted two programs about "the Miracle Kids", an investigative journalistic approach. We do have a national guideline in Sweden, advocating that neonatal intensive care can be considered at this gestational age (here in Swedish, Google translate will help to get this in your local language). The take-home message from this coverage by Swedish Television are that 1) most 22-weekers are offered intensive care, 2) mortality is high still and adverse longer-term outcomes are very common in survivors, and 3) the societal support for those families after NICU discharge (even in Sweden!) is poor. Here are the episodes #1 and #2, but in Swedish. I have suggested Swe Television that they offer English subtitles, but yet not. Maybe some smart AI or translation service can help! Today another interesting paper surfaced on my radar, US data from VON, reporting mortality, and discharge with/without complicartions and tech dependency. The Figure below from the paper gives a good summary. It would be very interesting to hear your experiences and reflections about the difficult questions around 22-weekers. The tv-programs have sparkled a lot of professional discussion in Sweden, and the need for structural followup and societal support etc. But I think there are Big Elephants in the (delivery) room is really, what are the right, reasonable and wrong strategies around 22-week deliveries. Before I share my own thoughts, would be great to hear from you!

Hi! In addition, to admission due to symtoms (regardless of gestational age), we plan admission for all infants <35 weeks. We admit mostly newborns, but consider admission of infants the first few weeks of age, if there is a non-infection as the main differential diagnosis. So for example, we can admit jaundiced infants if they present after a few days. Before admissions from home, we screen for RS-, influensa- and Covid19-virus, and if negative, those infants get admitted

Great @EBNEO summary with the Incubator pod cast here! https://podcasts.apple.com/se/podcast/the-incubator/id1566031191?i=1000669580275

Hi Gustaf! Yes, this was a saying I was also taught at the Kungliga Karolinska NICU back in the days, when used in situations that were complicated… so, wisdom from the walls? I really don’t know the literature, but certainly this had an impact on blood pressure and short term lung issues (extubation). My thought now - steroids should ideally be given on clinically defined indications, e.g. for BPD prevention (if one has faith in those studies). I assume it also has some role for infants stuck on the vent, to facilitate extubation (?) Apologies for this un-initiated reply

Great editorial and I agree the final words that Generally speaking, I am less in favor of testing for disease that lacks preventive or therapeutic treatments. I am not too much into this domain of rare diseases myself, but my clinical experience is that infants/children with really rare disorders, families are often glad to get a "name" for the disease but can also be disappointed to learn there is not much to offer except more general support (and management of symtoms) I see a risk this kind of screening would mostly be used to satisfy a well-resourced middle class (that would also cover the testing costs themselves), and become another "reassurance thing" those families do, to further dig into the good health of their newborn, along the lines what is "nice to know" rather than what is a "need to know"

@Katja I was on shift yesterday and the Karolinska transport team came (for a transfer) and they also told that this humidifier was coming back, they did not know which company etc, just that "availibity was fixed". So good news!

It is time to gather for the Annual Meeting for the 99nicu Society! The annual business meeting is the highest executive organ of the Society, where all Society Members are welcome to join and participate in the formalities around our Society. We will gather on Zoom, 5 Sept 2024, at 1600 CET: https://us06web.zoom.us/j/6260912884?omn=84219965583 Please find the invitation and agenda attached. Agenda_2024.pdf AnnualReport2023.pdf