Stefan Johansson

We have no clinical protocol for deep vein trombosis, but consult the coagulation specialist in our hospital in each separate case of more complicated coagulation disorder. In a case of a term infant with a symptomatic aortic trombosis (after a UAC) we gave dalteparin-natrium (Fragmin) in the dose of 100 units/kg twice daily (NB: we do not treat non-symptomatic aortic fibrin clots after UACs, if found accidentally during echo's, but follow those until the resolve spontaneously) Generally (and personally) I think one need to be careful to heparinize infants due to the risk of hemorraghes, but each case needs an individual consideration.

I have not heard about this association. But I found this case report in Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/7993523

We don't. This question was discussed some time ago, in this thread: http://www.99nicu.org/forum/showthread.php?t=110

While biking home from work tonight I thought about my blogging habit, or, the lack of a blogging habit! I figured... blogging is the art of being present. And there has not been much time for x-tras the last few weeks. I have been heavily involved in the update of the forum software (as you may have noticed... soon we will officially announce a lot of new features...), and clinical work has been demanding. But, as the summer is here, things tend to slow down and I hope to be more present. But now... time to switch on the TV at the 99nicu HQs... Sweden-Russia in the UEFA 2008 Championships (football!) We must win to qualify for the quarter final.

University Hospital of Northern Norway and University of Tromsø, Norway organize a postgraduate course in Perinatal Cardiology 17-19 September 2008. The course is intended for residents and specialists in gynecology & obstetrics, neonatology and pediatrics. Please find the course programme attached. The fee is 2700 NOK. Email for more information: kurs.tromso@legeforeningen.no or visit this web site (in Norwegian...): http://www.legeforeningen.no/index.gan?kurskatalog_side=kurs_detaljer&Kurs_ID=T%D8-23785 PS. I attended this course a few years ago and found it very interesting. And the geographical location is something extra. Tromso in Norway is located quite a bit north of Sweden! I am not sure whether my Tromso-colleagues would agree, but I could feel the smell of the icebears around Svalbard Perinatal_Cardiology_2008.pdf

English, please

How about those.... Current understanding and management of retinopathy of prematurity. http://www.ncbi.nlm.nih.gov/pubmed/17435431 The 'ideal' management of retinopathy of prematurity. http://www.ncbi.nlm.nih.gov/pubmed/16304583 Evidence-based review of retinopathy of prematurity prevention in VLBW and ELBW infants. http://www.ncbi.nlm.nih.gov/pubmed/17163000

I browsed PubMed and found the following references. Teddy bears in NICU beds seems like a bad idea! ***************** Bacterial colonization of toys in neonatal intensive care cots. Pediatrics 2000 Conclusion: With time, all the toys in NICU cots became colonized with bacteria. Many were potentially pathogenic. Toys may be reservoirs for potential infantile nosocomial sepsis. infant, newborn, toys, infection, neonatal intensive care. http://www.ncbi.nlm.nih.gov/sites/entrez/10920174 Evidence-based practice: examining the risk of toys in the microenvironment of infants in the neonatal intensive care unit. Adv Neonatal Care 2004 Pre- and postintervention infection rates were compared. NI rates decreased from 4.6 to 1.99 per 1,000 patient days over a 6-month evaluation period. Although this decrease was not statistically significant, it was the lowest rate recorded in 5 years. http://www.ncbi.nlm.nih.gov/pubmed/15368211

Our current guideline in Stockholm, regarding prenatal transfer to a level-3 setting, is to centralize deliveries <27+0 weeks if no special circumstances are known, such as SGA, twins, malformations etc. In other words, "uncomplicated" deliveries at 27 and 28 weeks are born regularly in level-2 settings, since we expect those infants to do well on nasal CPAP, and (if needed) the INSURE technique. Naturally, sudden deliveries and not treated with antenatal steroids, is a risk factor of mechanical ventilation. Ideally, those women may be transfered prenatally, but if that's not possible, infants are taken care by locally. If nCPAP and INSURE does not seem to be a good option (i.e. severe RDS), the infant is transfered postnatally after primary surfactant administration, and while being on mechanical ventilation. In addition (and a bit off-topic), I think that the road to success, keeping tiny infants on nCPAP and performing INSURE, is good neonatal nursing.

I have only one experience from cytostatic medications to newborns, an ELBW infant who developed histiocytosis while being in the NICU. This infant was treated with etoposide, dexamethasone, and immunoglobulin. The case was reported in Acta Paediatrica, here's the PubMed URL: http://www.ncbi.nlm.nih.gov/pubmed/17888050

I just came across a very interesting initiative, taken by Ian Callander,an Australian neonatologist; the development of an open-source software platform for collection of clinical data during neonatal care. As I understand it, the data can be used for quality control, follow-up statistics, and clinical audit. More info is posted here: http://home.iprimus.com.au/Callanders/

We had a discussion regarding our "protocol" for teddy bears, i.e. where we accept teddy bears and similar toys which parents/friends/relatives give to children in the nicu. Currently we allow such toys in the beds of stable infants (typically infants fully fed enterally), and on the side board beside incubators. However, we thought we might re-evaluate this policy, since we really do not know to what extent those toys might be colonized with bacteria. Do you have a Teddy Bear Policy?

99nicu has recently celebrated its second anniversary (...the lounge for further details...) and we are now entering the third year of our community. I would like to start a discussion for feedback and comments from you. What can we change to make things better? Personally I think there are several important tasks to accomplish: * continue to encourage discussions in the forums (that's what we are here for) * make people post job offers on our Message Board (it's easy and free) * offer really good member benefits, such as full-text access to journals * improve ways for members to interact with each other One issue to tackle is also our financial situation, to promote current ways to support 99nicu (supporting memberships and our bookshops), and to find sponsorships. Funding is necessary for our plans to offer full-text access to journals, and also to cover our increasing costs for external technical support. With regard to new features at the web site, we will soon update the software. The new version contains several nice community features, which makes it possible for you to start your own user groups, among many other things… Finally, I would like to thank everyone who has encouraged me and the 99nicu Team during the past two years. My very best regards to all of you!

Just a quick comment: our approach is to look for glucosuria. If there's no glucosuria we are generally conservative (leave things as they are) but reduce glucose administration. If blood glucose is much elevated and we find glucosuria, we may use insuline infusions, according to the NeoFax recommendation. But as Darya points out - beware of HYPOglycemia.

We would treat conservately if the duct has responded partially and the shunt is definitely non-significant. I would advice that you repeat the echo from after a few days and then as needed, to make sure the duct does not re-open. It is not uncommon that medical treatment result in functional closure but you can still see a small restrictive shunt with colour doppler. Although some factors make such ducts prone to re-open (especially the situation extreme prematurity+septicemia), they commonly close anatomically with time. But it is good to know they do (echo!)

Thanks to everyone who have supported our backstage work during those two years. AND not the least thanks for all contributions to the topics discussed here! BTW I am in Turkey with my family will fly back tomorrow! Plan to be online on the 11th if the plane lands well Stefan from Antalya. Turkey (very nice stay *****)

Thanks for adding our birthday to the Calender! We should have thought about that ourselves... I added a link in your announcement.

I live through a kind of refractory post-doc phase. I defended my thesis last Friday (080418), managed pretty well , the party in the evening was wild and crazy , and I am about to adapt to the new life of being 'MD PhD'. I think I need to 'digest' what has happened. The last few nights, I have had some really strange dreams about things that did (and did not) happen that day. I guess Freud would be delighted to hear about this... It feels good to be back in business again. I am sure some regular clinical commitments will help to get back to reality again. Babies don't really care about PhD's. And I am still me!

Howdi! I got 7 bottles of champagne after I had defended my thesis last week. Let's spend some bubbles on this occasion

Well, it depends. If a RN is presenting research on a congress, costs are funded by travel grants from independent funds, an academic institution, or the hospital etc. Travels to national congresses or courses are paid by the hospitals, but only if the congress/course and the associated expenses have been approved by the head of the department.

Dear Manuel, There's a few topics that come into my mind for your speech on the congress: * prenatal screening of congenital heart disease - there's plenty of studies and one can really argue for both pro's and con's. * renal pelvic enlargement. * nuchal clearence - chromosomal abnormalities like Down syndrome * pregnancy dating for assessment of gestational age * diagnosis of fetal arytmias Hope this short input helps.

I think you would need to discuss this with the provider of the gas system. I would think it is a quite tricky thing to achieve. You would probably de-pressurize the whole system and you would need loose gas tubes to keep ventilators going while the cleaning is done. What made you think the gas system is colonized?

We have no rules about parents access, they can visit their infants any time of the day/night, all days a week. It works good. We also make parents do some of the nursing too, like nappy changes and gastric tube feeding.

Dear Mariam, you raise several very thoughtful questions. We sometimes come across friends and relatives in the NICU and generally (if close friends & relatives) the staff involved decide not to be a care-giver. I have done that myself, refrain from being formally responsible (but yet involved in discussions etc) for the care of families I know privately. Thereby not saying that's a correct strategy. And, I have not experienced something similar. I guess every case need to be individualized with a certain degree of consensus with those involved. Personally I would not consider your situation to be unethical, but it might be inappropriate. On the other hand, the choice (what-to-do) may partly be up to the parent involved. If this nurse and mother feels strongly that she can both take care of her own infant and another patient with the same professional approach, it may not be a conflict to be mother and staff. I would feel uncomfortable to formally forbid a parent to take care of its own child, if professionalism regarding the child and other patients can be ensured. Being in the same situation... well, I would probably not feel like taking any medical responsibility if my own child would end up in the NICU, but leave this to my colleagues to take care of.

Could you please specify, is it the ventilation system that is colonized?