Stefan Johansson

Best wishes for a Merry Christmas and a great New Year! Greetings from my roots in rural Sweden

I have no personal experience but bosentan briefly mentioned in our new national guideline about "hemodynamic problems in the newborn" and I also found some guideance in a regional guideline ( @Gustaf Lernfelt VG-region delivers!) It is mentioned as an addition to "for example" sildenafil, and both sources warn for liver function impairment. One interesting aspect - seems bosentan couple to two receptors, both endothelin-a and endothelin-b , and those mediate opposite effects (ET-a vasoconstrictive and ET-b vasodilatory). So, a paradoxal effect early in the treatment is that the PPHN worsens, they write.

Thanks for sharing, looks interesting. I tried to read the links but it did not work, can you please share the links below?

@Gustaf Lernfelt Mprove is already in the Links directory but added Neocardiolab!

NICUPOCUS.com - a great POCUS web site came on my radar, I added it to our links directory. It covers some basic knowledge, and POCUS of lung, heart (incl PDA) and line position. Recommended!

Check out the Nordic Perinatal Care Spring Meeting 2024! Find program and reg info in attached PDFs and on the link below! https://www.perinatologinenseura.fi/koulutukset/kevatkokous-2024-yhteiskokous-ruots-2/ Prices, accomodation.pdf Program.pdf

I think this presentation by Prof Namba is so interesting, he will also come to our conference in Lisbon in April, so then we will have an opportunity to meet up and discuss with him personally. Several interesting things and different compared to the "minimal handling" strategy we aim for: frequent ultrasounds (but I suppose the idea is to really to optimise hemodynamics) lots of inotropia, volume and steroids for hemodyn management (!) regular enema treatments (I think this would be seen as a No-No in our context @wackdi do you agree?) phenobarb to most infant to prevent IVH

@M C Fadous Khalife I think the product/brand as such may be of less importance, one needs to consider the risk of bacteremia/septicemia with probiotic strain, regardless of product used. However, "baseline risk" (i.e. probability) of such bacteremia/septicemia is most likely very very low, given what is reported. This systematic review came out in 2022: https://link.springer.com/article/10.1007/s00431-022-04452-5 So, as with everything we do in the NICU, one needs to balance benefit vs risk

We use albumin only rarely and in very specifikt situation with hypoalbuminemia, our typical dose is 0.5-1.0 g/kg this gives a good overview: https://publications.aap.org/neoreviews/article-abstract/23/9/e625/189354/Use-of-Albumin-in-the-NICU-An-Evidence-based

Very interesting webinar organised by BAPM, 20 Dec 2:30 PM (GMT) More info here: https://www.bapm.org/events/reducing-the-rates-of-bronchopulmonary-dysplasia-bpd-a-new-bapm-toolkit

Hi Natascha! We don't have a specific guideline but do allow siblings to visit, given they are well (no respiratory tract infections) and "old enough" as judged by parents. We have not seen (to my knowledge) RSV outbreaks or similar. No special hours. No formal age restriction. Same hygiene restrictions apply to all (staff, family etc), but once cleaned and disinfected, siblings can touch. In the early period (in incubator, lines, ventilatory support etc), we usually focus on the parents and avoid smaller children visiting but restrict to parents but once patients are in nursed in family rooms, we have a liberal view on siblings visiting. But they do not stay over night in the family room. My experience is that sibling visits are uncomplicated, usually the siblings are setting the boundaries themselves, and never stay long enough to cause any friction or problems for anyone

We also add MCT as a fortifier to breast milk if growth is suboptimal

We have a national guideline about this, you can find it on the link below. It is in Swedish, but I think Google translate can help Am on vacation in London (https://nicuverse.org/@stefanjohansson/111340868985434432 ) but let me know if you need help with specific info from it. https://neo.barnlakarforeningen.se/wp-content/uploads/sites/14/2017/12/Osteopeni-20-dec-2017-reviderad-slutversion.pdf

Dear @Carlos Delgado, thanks for taking this initiative and starting a Club space for this large and important topic. Looking fw to see this develop and whenever you need, we within the 99nicu Team are here to facilitate from our "backoffice"

This opinion article by Prof Hugo Lagercrantz, also editor-in-chief of @Acta Paediatrica , came on my radar. It is about how to approach infants born at the viability limit (i.e. 22 weeks). The article is in Swedish, but Google translate may help of you are interested to read through. https://www.svd.se/a/mQ929l/hugo-lagercrantz-hur-pass-tidigt-fodda-ska-vi-forsoka-radda Prof Lagercrantz's takehomes are: NICU care and post-NICU care of these infants requires a national strategy in addition to health care providers (doctors specifically!), philosophers, theologists, paralegals and brain researchers should contribute in writing such a national strategy I would like to add, parents should also be included in such a process! As of now in Sweden, we have a national guideline from 2016 about referral to university hospitals from 22+0 and onwards. I would argue this document is a good start, but it lacks several aspects, for example when/how to withhold or withdraw care. This document is currently being revised, hope it will be communicating a wider approach to this difficult question. Would be great to learn how you base decision at the border of viability? Who decides what and when?

@Francesco Cardona lets discuss and decide something around both ideas

My thoughts goes like this, that not much will change. If I may make an analogy to politics: I foresee few people shifting between the Probiotics Positive Party and the Probiotics Sceptics Party. So, the positive ones will keep being positive (thanks to strong arguments from key stakeholders), while the sceptic ones will feel they get new fuel for their position.

The 99nicu.org web site is built on the Invision Power Board software. In the next version (v5) there will be a major overhaul of the user interface, allowing for an even better way of presenting and browsing content here. You can get a sneak preview in the video below (a bit techy, but still )

The reason for the unusual strategy in Sweden, to give probiotics to infants at 28-31 weeks and not <28 weeks, is because the national nutrition group argued the evidence for infants <28 weeks was insufficient. The result of this discussion was to recommend in the very preterm population (28-31 weeks) and make a full-scale RCT in extremely preterm infants (<28 weeks), the PEPS trial, see link below. It is currently running and hope to present results in a few years time. The plan is ambitious, to randomise 1600 infants <28 weeks, so it might take longer. https://clinicaltrials.gov/study/NCT05604846

I just wanted to share a few short words as a welcome to you who have become a Society Member. Thanks so much for joining and we in the "99nicu Team" are looking forward to engage you in discussions how the 99nicu Society can develop in the future. Ciao for now and see you around!