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Everything posted by Stefan Johansson
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Thanks @Roland for sharing and thanks for your workshop contribution to our recent conference too! our nurses (like NNPs) use a Venflon and then insert the PICC line through that. Would you recommend us to investigate this new device? Any ideas where to get it in Europe? BTW, I move this topic form the Society Lounge (closed space for Society members) to the Procedures forum, to allow also those with only the web site account to reply. If anyone wish to join as a Society member, it is 10 EUR per year, click here to do it! https://99nicu.org/subscriptions
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Hi! How do you notice this increase in the daily fluids ? More hypernatremias and larger weight losses? We live in the sauna land (well, at least neighbouring 🇫🇮) but stick to closed incubators and high humidity
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Still, medical care is about balancing benefits and risks. When preterm infants are fed formula, the other alternative is not always breast milk (being unavailable), so there would be no “choice”. IMHO this legal case is just a bad example of a legal culture with few, if any, benefits. I sincerely hope we will never see anything of this in Europe. BTW, we also transition to formula around 32-33 weeks if there is insufficient mother’s own milk.
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We have an issue with emails going out from the web site dashboard. This is due to a faulty plugin in the software and a fix is underway. The web site as such is working as usual. This email issue leads to a few things: we cannot share Newsletters until this is fixed no topic email subscriptions is going out if you register for a User account, there are no email confirmations going out We will keep sharing the latest topics etc in the NICUVERSE, and on LinkedIn, Facebook and X. If you have any questions, please email info@99nicu.org -
Thanks for sharing this @chandas - NEC is such a terrible disease but law suits like this one is just a sign of cynism IMHO, lawyers "milking" the system so to say. You raise an important question, would be interesting to hear from US staff about the implications of this law suit.
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Not regularly any longer. (I am also non-believer after the Neurosis trial) But sometimes, someone (not me!) starts inhalations, I'd say typically at ~32 weeks post-conceptionally if BPD-development is more complicated ("higher" FiO2 [I'd say >50% and increasing] and "higher" CPAP-pressure dependency). We have guideline about this though.
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Thanks for posting. Where you thinking about the short-term challenges, before discharge from the NICU, or post-discharge challenges. Handling nutrition to achieve reasonable growth/development will be key. Need of (partial) parenteral nutrition may prevail for some time, and how the remaining gut process oral/enteral feeds can also be a difficulty. Support from a dietitian is usually needed in my experience. In my local experience these infants and families are usually connected the pediatric gastro department.
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We have come across that medicinal products have become unavailable. Our three latest examples are dextrose gel used for hypoglycemia management (I think this is a food supplement, but still) iron drops for supplementation preterm infants (so, used a lot!) multivitamin drops for preterm infants (finally back on the shelf...) @Bernhard Csillag also posted about phenobarb (see link below) Do you share this experience in your various contexts? I understand that newborns and especially preterm infants are small patient groups for companies to "build business around", and that we have less "power" than say cardiologists working with much larger numbers of patients. However, if this is a trend, that availability of products we need is challenged, that would be very worrying
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@selvanr4 would you know?
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Hello! We do not change the TPN composition while increasing enteral feeds. But, at a level of ~75% enteral feeding, we usually switch from TPN to 10% glucose (+electrolytes). (we do not prepare TPN inhouse, but use commercially available ready-made TPN)
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With the new year just starting and on behalf of the 99nicu team, I would like to take the opportunity to share our best wishes for 2024 to everyone here! Virtual snacks served in our Lounge 2023 was a year of milestones for the 99nicu community. In addition to all activity in our forums, we organized several webinars, converted the community into a properly registered non-profit organisation, linked up with EBNEO to promote their work, and made final plans for our upcoming conference, 3-6 April in Lisbon. For myself, being the initiator of 99nicu back almost 20 years ago (!), I am just glad to see how this project keeps developing. From the beginning we had the ambitions to build a professional network being accessible, independent and truly international. We have come far on that journey, and I am really looking forward to see what to see what the future holds. Last but not least - the world has grown into a complicated place, with several conflicts impacting newborn health. Let us hope for constructive and positive developments in 2024, with less war and more peace. -
Best wishes for a Merry Christmas and a great New Year! Greetings from my roots in rural Sweden
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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.
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Thanks for sharing, looks interesting. I tried to read the links but it did not work, can you please share the links below?
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@Gustaf Lernfelt Mprove is already in the Links directory but added Neocardiolab!
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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!
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Web site providing information and resources on Neonatal Point of Care Ultrasound -
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
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until
Check out the Nordic Perinatal Care Spring Meeting in 18-19 April 2024! Find program and registration info on the link below: -
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
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@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
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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
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Check this out!
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Check this out! More info: https://www.bapm.org/events/reducing-the-rates-of-bronchopulmonary-dysplasia-bpd-a-new-bapm-toolkit
