Stefan Johansson

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

Thanks for sharing, this is an interesting paper! What we do in Stockholm - hernias are typically repaired as the "last thing" before discharge home. This works well in our local experience.

Hi @Katja, the Stockholm ANTS (neo transport service) do use this humidifer too. I checked with my colleague @Erik Borgstrom (ANTS doctor) and they try to save their small supply while they look into alternatives. This means that "shorter" transports for infants ≥30 weeks are going without humidification. I keep you posted what alternative they will go for, please also share any updates from you search.

We do not use olive oil for energy fortification at all, but sometime MCT oil. There a discussion about MCT oils recently, see link below.

I found this reference: https://www.sciencedirect.com/science/article/pii/S0009898121004447 The given ref value for infants is wide, from 180-1400 picomol/L, the 50-percentile is in the range around 400 picomol/L. (the lines repr 2.5, 50 and 97.5 percentiles)

Good article in Washington Post about this topic! with these law suits (and several more Seems to come up), there can be significant ”collateral damage” for infants. https://www.washingtontimes.com/news/2024/jul/2/tort-bars-newest-collateral-damage-preterm-babies/

This is also my first thought, that the DAT+ is not related to the AB0 type but another antigen.

Yes, but I think one needs to take those rates with some grain of salt. For example, as the BPD def relies on O2/resp support: unless populations share same baseline risk and same saturation / resp support strategies, rates are doomed to differ…