Stefan Johansson

Could there be increased protein loss from the intestines? http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=11158480&query_hl=2&itool=pubmed_docsum Turner syndrome (45X) may also have congenital hypoalb; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=3465177&query_hl=6&itool=pubmed_docsum

Dear Manuel and Dolphine, I completely agree with both of you; 1) mechanical ventilation may get somewhat "mechanical" 2) inspiratory time is individual and may change breath by breath Please have a look at the link below, it explain the lung mechanics in relation to IT well. http://www.adhb.govt.nz/newborn/TeachingResources/Ventilation/RespiratoryFunctionMonitoringAndGraphics.htm We tried a Drager babylog 8000 some time ago and if I remember correctly this machine could adjust IT breath by breath. On a term infant we saw that IT ranged up to 0.55 sec. Manuel, do you use a ventilator, where you could monitor the flow curves, as in the Drager Babylog?

Most (all?) baies I've come across were managed conservatively. Does the CCAM in your infant have any mass (compression) effects?

Dear all, I'd like to forward this link to a web based atlas on congenital heart disease, from Yale Universtiy, US. http://info.med.yale.edu/intmed/cardio/chd/contents/index.html

I guess we're all familiar with situations when we withdraw intensive care for infants for which further care is considered futile. In our units all such decisions are taken in consensus with the neo-staff team and the parents. Although it is rather obvious when intensive care becomes futile, the actual process of decision-making may vary from patient to patient. I would be interested to hear about how you make end-of-life decisions. Have you formalized decision-making? How are the parents involved in this process?

I have only experience of the Ecutronics Fabian; we're about to buy new ventilators for our nicu at Karolinska and had a Fabian over a trial period. We're currently using a Sechrist machine with a "Florian" module added, "Fabian" is a new generation of the "Florian" system I guess. Anyway; the "Fabian" was nice to handle - easy to get started and quit when running. It has a kind of max volume option but it does not have a volume garantuee algorithm as the latest Drager ventilators. As far as I understood is cuts the inspiratory time, when the set max volume is delivered to the infant. The price for "Fabian" (on the Nordic market) was very competitive, and we did seriously consider to buy it (although we'll probably buy Stephanie ventilators when we'll upgrade).

Dear Andrew, you're absolutely right that the latest ILCOR document gives no strict guidelines regarding O2 during resuscitation, although ILCOR explicitely say that room air could be used at the initiation of resuscitation (see quoted section below). I'd guess the new upcoming Swedish guidelines will contain similar statements as to the British recommendation you refer to, ie joining at the same fence! ******* From the ILCOR report: "Although the standard approach to resuscitation is to use 100% oxygen, it is reasonable to begin resuscitation with an oxygen concentration of less than 100% or to start with no supplementary oxygen (ie, start with room air). If the clinician begins resuscitation with room air, it is recommended that supplementary oxygen be available to use if there is no appreciable improvement within 90 seconds after birth. In situations where supplementary oxygen is not readily available, positive-pressure ventilation should be administered with room air."

Dear Manuel, we have Sensormedic HFV ventilators in our unit. My personal opinion is that the Sensormedics are great and powerful machines, for any-sized infant <500g to >5000g. However, tubes (ventilator-ET tube) is short and rather rigid, which makes turning the child a bit tricky, but one gets used to this. Sensormedics (if you run several in the same room as we frequently do) may also be regarded as a bit noisy. I have also used the HFV option in the Stephanie ventilator, in small preterm infants. I really liked the Stephanie, flexible tubing, possibility to switch from MV to HFV without changing machine, less noise and the smaller format of the actual machine. We have not tried or used the Vip Bird you're referring to. Good luck with your purchase!

Well, I don't think the new guidelines will differ at any major points. The conclusion of the workshop last year was that the (Swedish) working group needed to await the ILCOR report.

Did you check immune status of the staff caring for this child? I understand that infants with congenital rubella excrete large amounts of viruses. There is a national database (in Swedish unfortunately) on infections during pregnancy, www.infpreg.com. This info on Rubella (in Swedish..) but at the bottom you'll find references which you may find useful.

Check this out, from todays issue of NEJM! Clinical research at its best! Caffeine Therapy for Apnea of Prematurity, Barbara Schmidt et al Editorial comment by Eduardo Bancalari Caffeine as BPD treatment!? I think this finding was a bit surprising for the research group, given that authors stress the possibility of a potential harmful effect of xantines in the Intro of the paper. I think the (ongoing) follow-up studies will be of great interest, I hope they'll publish results soon.

As far as I know, there's only supportive treatment for thromobocytopenia related to congenital rubella, i.e. I would transfuse if platelet levels got critically low (<15-20). Anyone else with recent experience of congenital rubella?

There's a revision in pipeline, of the Swedish guidelines on resuscitation. There were quite a lot of discussion regarding the evidence of using O2 immediately after birth, at the workshop discussing this revision. The data from Saugstads group in Norway and others would suggest that room air would be fine, but practises vary a lot. I'd reckon our new (Swedish) guidelines will be suggesting less/no extra oxygen from the start of the resuscitation, but vaguely suggest that oxygen may me added/increased later during the resuscitation. Now, while awaiting the new guidelines we use 40% in our unit. PS. I added a poll to this discussion. DS.

99nicu is officially opened! ...after plenty of configuration work and beta testing. Please feel free to spread the word about this community for professionals in neonatal medicine! Looking forward to read your discussions here at 99nicu! Stockholm, 11th of May 2006 99nicu Team