Stefan Johansson

Well, I'd say it depends on the hemodynamic impact of the shunts. From the clinical condition of the infants it appears that the volume load on the right ventricle (from the ASD/VSD) and lung circulation (from the ASD/VSD/PDA) is not very great. If the PDA-shunt is significant, there seems to be nothing to lose with pharmacological treatment although it is a bit late to have good odds for closure. If the child is well, and PDA is not very significant, you could probably just wait for spontaneous closure too.

I get the impression that the heart may look relatively large, but due to poor lung expansion (the first three pictures). On the fourth xray, lung expansion is better and the heart seem to have a normal size. Could you please give some more clinical info - was there an inflammatory response (incl elevated CRP)? How long did the respir distress endure? Was mechanical ventilation needed?!

That sentence will become a classic! And I agree, too.

Hi from Sweden! We use a white board as well, but it is placed in the staff office which parents do not have access to. I am not sure whether this is really according to (Swedish) regulations on patient integrity, but that's how we solve it. The board gives a great over-view of how days by the "production line" proceeds, and helps a lot in our every-day plans for discharges and transfers. In addition to the white board, we also keep a regular patient list (password-protected word-document on a intranet server) with info that's updated twice daily. This list is used during the "over-lap report" / when the shifts change.

Hi! I got an error message when trying to access the pictures. You can also upload the pictures as attachments to this thread (click on Edit/Go advanced and below the text box you find Additional Options and the button for attaching files). BW, Stefan

This is my list for 2007... Best research experience... our brilliant study on twins, their birth weights and later risk of type-2 diabetes Worst research experience... four rejections of the manuscript of the brilliant study above... (NEJM, Lancet, JAMA, Diabetes...) Best neonatal gossip... how the family Zlatan Ibrahimovic escaped the paparazzi photographers from the maternity ward... (well, this is from 2006, but I heard the story just recently) Most fascinating journey... Turkey, no doubt! Best gastronomic surprise... Dennis pizzeria in Turku (awarded "Best pizzeria in Finland") Best cultural event... (Dweezil) Zappa plays (Frank) Zappa: not a usual within-family show-biz event, but a fantastic consert! Most overrated family life happening... the introduction of Cable TV in our house Best sport event... the Wimbledon thriller/final: Federer-Nadal (on TV...)

International neonatal cardiorespiratory symposium, March 6-8 2008. Medical Education Center, Hamad Medical Corporation Doha, Qatar Download the attachments for more information. StableCourseSchedule March2008.doc program.pdf

I would also like to say Happy Holidays to everyone! And thanks for all support during this year! See you all (on the web...) next year!

In our hospital(-s), fathers are allowed into the actual operation theatre, and sit by the mother during the c-section, IF the mother is awake (no general anestesia). Only during strict emergencies (delivery within a few minutes after the alarm is sent to the or/anestesia/neo-teams) the father is not in the room by the mother (general anestesia), then he waits in the resuscitation room with the neo team. The father is almost always present during resuscitations, sitting in the background, with someone from the obsetr or neo staff by his side. The father wears like a overall over his cloeths, regular shoe "protection over-shoes" and the usual OR cover over the hair.

Ipokrates Seminar: Neonatal pulmonary critical care: State-of-the-art in respiratory assistance, delivery room care, prevention and treatment of chronic lung disease. March 13-15, 2008 Dubai, United Arab Emirates Find the programme attached below, and visit this web site for further info and online application. Program_Dubai_20081.pdf

When speaking to people in non-medical professions about daily life in neonatal care, many people wonder how we cope with everything. This remarkable mix of well-baby-nursery problems, medical and ethical issues in the NICU... and all parents... and their fear, anger and happiness. I do not really know what to respond to such questions, but a bit of the answer might be related to how we combine a rational mind with empathic capabilities. I mean, when standing in front of a newly delivered 25-weeker, immediate care is much driven by rational decision-making. But we (should…) also consider comfort issues already in the delivery room, and such strategies are probably based on what we believe the infant is really experiencing. Right there on the resuscitation table, medicated, intubated and on the ventilator. How we manage to cope with everything in our daily service in neonatal care may be related to how well we create a succesful synthesis of rationality and empathy. Not an easy task.

Great news! This is one of the nice aspects of neonatal care, happy endings!

Heard from a colleague of a rough weekend on-call, in a unit somewhere out there. Generally, for myself I like working really hard... I feel good after a bit of mental flow and manual work But the weekend I was told about must have been hard, as indicated by the number of pediatric subspecialties and units that were also involved: oncology surgery anestesiology nephrology radiology transfusion medicine infectious diseases ECMO... Reflections... professional networks are nothing but very important (no Network = no Care) team work around the patient is essential for success (no Team = no Life)

Our pre-med strategy usually includes a slow injection of morphine before intubation (0.1-0.2 mg/kg iv) and pentobarbital immediate before intubation (2-5 mg/kg iv).

Hi Sarah! I guess my Swedish perspective won't help much when it comes to specific advice, but I hope you can get input from our US members. But, you should not feel discouraged by a long educational journey, whatever will be your ultimate goal. Motherhood and academic achievements are not contrasting issues, you just need to be more organised than the average student. Maybe you could also post your questions at one of our partners: www.studentdoctor.net BW, Stefan PS. I moved your thread to the forum for education.

Unfortunately not! Finalizing my thesis right now. But in 2008 I plan to visit Hot Topics, maybe we could have a 99nicu meeting?!

Welcome to the 99nicu Blogs! Given the possibilities to share experiences, thoughts and opinions through a blog, we could not resist to add the latest feature of the software (vBulletin) used for the 99nicu forums. As a 99nicu member, you can start your own neonatal blog here! And write comments in blogs written by other members. Read the announcement in the News forum, download the blog manual and... get started! PS. If you are unfamiliar with blogging, take a look at blogbasics.com and Wikipedia for more information!

brochure.pdf

Cardiology_in_Neonates_and_Infants_2008.pdf Hands-on_Cardiac_Morphology_Feb_2008.pdf Dr_S_Yen_Ho's_2008_courses.pdf

We check a serum level before the second dose.

Ian, family support is really on of the corner stones of neonatal care and we have now added a forum dedicated to family support (here!) The Family Support-forum is sorted under the section General Neonatal Care. Two of the discussion previously started in other forums have been moved there.

Got a mail from one of our members about a nice web site; a short introduction about neonatal brain ultrasound: http://www.radiologyassistant.nl/en/440c93be7456f The link is also added to our link collection found on our portal page.

Hej! We (at the Karolinska univ-hosp) only have specific guidelines about pyridoxin (100mg/kg) in our protocol. If you want a copy (in Swedish), just send me a PM. Do you know whether pyridoxal phospate is available in Sweden?

Great question! During the non-RSV-season (spring-summer-autumn) we generally allow relatives and siblings to visit IF they are well and without any signs of common colds etc. During the RSV-season (i.e. according to the virology lab, when they see RSV+ cultures from the emergency rooms around Stockholm) we have quite strict guidelines and do not allow any visitors besides the parents. Fortunately, we do not have so much of MRSA in Sweden (yet...) so we do not worry much about that. Generally I think visiting policies are difficult to set, there are not much of "evidence" out there, so common sense is what's left for guidance. And common sense is not also a general thing, I mean that we have quite different opinions about what's reasonable.