Alexander Rakow

The Neonatal Department at the Karolinska Unviversity Hospital, Stockholm, Sweden is advertising 3 senior and 3 junior Consultant Posts in Neonatal Medicine. With 48 cots on three sites we are one of the largest neonatal unit in northern Europe and still expanding. We work in close collaboration with Obstetrics and Fetal Medicine teams as well as Cardiology, Surgery, Nutrition, ENT, Ophthalmology, Neurology, and Neurosurgery. We also host neonatal transport with a commitment for land, and air based transport. There are about 28000 deliveries each year in the Stockholm where about 22000 deliveries are in-house at the Karolinska University Hospitals at Dandery, Huddinge and Solna. Activity levels for ITU/HDU are very high and this is one of the busiest units in the whole of Scandinavia. Enthusiastic and highly motivated clinicians are invited to submit an application for a substantive Consultant Neonatologist post. In order to be appointed you must have completed specialist training in Paediatrics and Neonatology as by European standards and hold a license to practice with the Swedish Board of Health and Welfare (Socialstyrelsen). For the senior Consultant job an academic degree as PhD or higher is mandatory. The Swedish Board of Health and Welfare requires all medical staff to speak Swedish at C1 university level. https://candidate.hr-manager.net/ApplicationInit.aspx?cid=1354&ProjectId=177100&DepartmentId=61951&MediaId=5 Application closing date 30-06-2021 For further details and information please contact: Alexander Rakow MD PhD Överläkare, Sektionschef ME Neonatologi Solna Consultant, Clinical Director Neonatal Unit Solna Karolinska University Hospital, Solna, Stockholm, Sweden +46 725968444 alexander.rakow@sll.se // alexander.rakow@ki.se

Dear Fernando we usually use frequent (up to hourly) saline 0.9% nebulizer in the first place, some advocate hypertonic saline but I have no experiance with that in neonates. In severe cases we have used Acetylcystein (ACC Sandoz®, ACC eco®), Ecomucyl®, Fluimucil®, Mucostop® und Solmucol®) nebulized with good effect. A good physiotherapist is worth a lot in these infants. Make sure you have checked all the rare differential diagnosis for severe hypersecretion like CF, ciliar dysfunction, neuromuscular diseases and congenital airway abnormalities. All the best and merry Christmas Alexander Rakow

No, your bloodgas will Look better, but no effect on outcome, in fact Babys cardiac function might be impaired.

Agree with the above, but you explicitly described your shock situation as caused by a sepsis and in that case you probably would have to consider that clotting is going to be deranged. So FFP and PLT might be necessary but as mentioned, maintenance as usual G5-10%. One other thing is the choice of inotropes. Most established inotropes are Dopamine, Dobutamine and Adrenalin and most of the time in this order. Unfortunately the main reason for initiating these drugs is still low blood pressure which , as we all know, is a very poor predictor for organ perfusion. I would like to bring to your mind that Milrinone can be of great benefit in patients with so called “cold shock”, patients with poor peripheral perfusion and impaired diastolic function. The myocardium is suffering from sepsis as well, and just constricting the periphery in order to have a better blood pressure does not make thing easier for the heart.

For infants below GA of 28 weeks the delivery room temperature should be 26° C at least (ILCOR). Hyperthermia is definitely not good for any child. I have recently been to Vietnam with an average temp inside of about 32-36°C and have just asked that question to one of the Peadiatricians working with Neonatal Care. They have not observed abnormal high core body temperatures in there infants despite high environmental temp. What about doing a little observational study? Just check you infants core temperature. All the best Alexander

Dear Fernando, to be honest, not in neonates. I do have some experience on Simdax in PICU patients mainly above the age of 3-4 years. We kept these patiens on PICU for a few hours, sometimes for a day during the first treatment just to make sure that they would not get too hypotensive, tachycardic or arrythmic. All the patients I remember were pure cardiology patients. Performing ECHO myself, I was always deeply impressed by the effect of Simdax. You could give it a try (depending on the diagnosis) but make sure you have your cardiologist on board. Have you considered Milrinone? All the best Alexander

Excellent presentation, I particularly like the comments on the need for publishing negative data, as it concerns my own research to a great extend.

At our unit, or even the one I previously worked for, the initial treatment would focus on the underlying reason for PPHN, if there is one and the optimization of PH, CO2, O2, and blood pressure. Next step would be the use of NO if available. In addition or in the more chronic phase Sildenafil would come in probably even Illoprost would be tested.

Definitely authentic!

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You can buy this book from Amazon.com. 99nicu is a partner of Amazon and a purchase using the link below, results in a small portion of the order value being paid back to 99nicu. At no extra cost for you. Click here to order this book through Amazon.com!

You can buy this book from Amazon.com. 99nicu is a partner of Amazon and a purchase using the link below, results in a small portion of the order value being paid back to 99nicu. At no extra cost for you. Click here to order this book through Amazon.com!

You can buy this book from Amazon.com. 99nicu is a partner of Amazon and a purchase using the link below, results in a small portion of the order value being paid back to 99nicu. At no extra cost for you. Click here to order this book through Amazon.com!

You can buy this book from Amazon.com. 99nicu is a partner of Amazon and a purchase using the link below, results in a small portion of the order value being paid back to 99nicu. At no extra cost for you. Click here to order this book through Amazon.com!