Jelli KA

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Last month I got a chance to day pass at ems2019 to get an update on hospital tranfer#picu by la paz and update on ilcor peadiatric resus by Dr Maconochiel who gave us an insight into how guidelines are elaborated -quite complex.I also the tech lover and intetact resus decives. The Mechanical for compression in for fevices look impressive , and fumctional .I was suprised to see many there are available to date x adult use only. My NLS Top medical devices -tried and tested Monivent(wireless &app). @99NICU so easy to use and it does show the volume needed and how softly you have to press the mask for proper Ventilation. Glad to Paul extensive high skill training , impressised complete with video screens -vocal cords. Brayden @ems2019 new baby manikin (coming soon) great sim as the illumination lines show you when you are putting in depth and the correct rhythm. The adult and pediatric manikins works, glad I could try all three. Adults @ems2019 Lifeband #zoll 👌 visual and descriptive demostration of cardiac arrest scenaritrauma e the mechanical compression can continue as the patient is move to a a safer place. While it was stationary it was also also allow clinicians to administer drug or can use the defibililator. In all was was most engaging challenge to teach about ALS/PLS . Instead if just getting a freebee you had to participate in rheir scenarios. Respirator portable :no o2 short journey .as it has a compressor. 02 Optional port for longer journey Charges:epocc from siemmes health seems a like alternative to istat cartiges if need a change. This thing cartiges Allow for testing of 11 items , as well as a capillary option too. The best feature in terms of transport is the don't require refrigeration. Add Perks - incubator for transfer MRI.allow less handling of the neonate, certainly smaller and more elegant. Clotting granules .These are ganulea that you our onto a bleeding site. look good for trauma Pic of a good transport monitor and compact with optoon to print by corpus credit: corpus minutor z--/DISCLAIMER: I have no ties or Funding from the companies reviews---.z

Thanks for sharing @edcarsiarticle in spanish on palliative care in neonates in detail. It emphasis the importance of communication among the clinical team and with parent, involving them in their care.From the bioethical perspective value the metaphor of building bridge with the parents so improve and facilitate those difficult conversations ahead. Here are echoed many of the issues in neonates referring to end of life care. I found especially helpful the explanation of 'comfort care' -orthotanasia -allow nature to take its course * favouring natural dying progress ,while supporting the family through this rough 💔 period . In this way we avoid overtreatment. For example in case of 22 wkrs or neonates with severe malformations.

"Check out this blog post by Keith Barrington whether transfusions trigger NEC. Or does anemia." https://neonatalresearch.org/2019/04/16/do-transfusions-trigger-nec-or-does-anemia/. Both this blog post and this previous on platelets are very interesting. It le me think how really complex is NEC, every time I look into there is seems to another layer of complexity. The debate and talks on 99 NICU meet give a lots think about. .These talks and article on platelets got me thinking. Would it make any difference it we slow the rate of transfusion of platelet? NEC can cause premmies to become unwell and be even,transfer several times. TANEC can terribly and disheartening consequences , which indeed leaves and on impact on clinicians.bimalc idea quote above is a good one that could give a guidance together with clinicians expertise on who get NEC or Not .

Several tweet posted on the subject of music therap­y, namely by Fiona Lawson and Dr. Michae­l Narvey. It prompted me to share paper on the on the Music therapy(MT) in NICU as I was abl­e to research for my posgrad as a way of­ humanizing NICU experience. I had a top­ic on my mind for a while since I used t­o work in the NICU. I First heard of this kind of therapy from a french television TV5. Here I saw how music was used in a neurological ward for its appeasing edge. Music therapy i­n Medicine has been around since ancient time.­es.In the NICU it has been used as a therapeutic tool for more than 25 year The US is a pioneer in the field ­, a good example is a Florida University where Dr.Jayne Stanley [1] developed the Lullaby dummy­ -©PALS - by the company Power Devices. There are many initiative­ exploring the benefits of music therapy around the World. Most i­nitiatives center their studies using the *NIDCAP* Neon­atal framework. The location spans from Spain to Brazil passing by Canada back to Sweden.For example, I found 5 Spanish initiatives, like "Música en­ vena" which is still on going in the NICU-La­ Paz Hospital-. Together with research studies I also used testimonials of professionals (music therapist and clinicians), such as the o­ne described in the blog *the amia musica* . Live music seems to be most beneficial to­ preterm infants vs record music . They also established that the n­oise level should be under 55dB.Music therapy has been shown to pro­vides several benefits.To summ up they are as follows : #-Firstly, 🎶therapy provides a reduction ­of heart and breathing rate proving the ­ calming effect.of therapy. #-Secondly, ­addition 🎶 therapy can help form mother-­baby bond especially when done in conjun­ction with kangaroo care,as well reducing parental stress #-Third and fina­l, studies suggests that the cumulative effe­ct in preterm belongings to the music therapy group­ where discharged earlier compared to­ the control group. . . .This conclusion are ­backed up by research studies reviewed. I­t is strength was the number and varied types of research­ : RCTs, study/control to ­observational or *prisma* meta analysis.All studies reported on or more positive results.T­he weakness of the studies review was th­e small sample number in some studies. T­he other was some quality sta­ndards were not ideal. Thus , there are ­plenty of indicators to suggest there a certain level of validity of music therapy. . I feel it is ­important to take into account the long te­rm effect of music therapy on neuro-dev­elopment of preterm infants admitted to ­the NICU.A further finding revealed that too mu­ch or too little stimulation is detrimen­tal to a premmie. On the other hand, we also have­ consider what Anderson and Padel [2] say when they talk about deepening our knowledge of ­ Hypothalamic -Puititary-Adrenal Axis (H­PA) on the stress response in neonat­es. In this posgrad assignment were ­asked to propose a specific proposal .So I proposed to evaluate the levels of stress in neon­ates and find out if music therapy can he­lp. For this purpose the levels of cortisol levels need to be measured before and after a sessio­n of Music therapy. So If the levels of cortisol are indeed ­lower after a session MT this would indicate this therapy could be another indicator it is beneficial. A device like the new transdermal ­patch designed by Stanford University [3] that measures cor­tisol levels in Athletes. This pra­ctical tool could used the to measure the cortisol levels and avoids the unnecessary p­ain of needle bricks. References: [1]Tom Butler: FLORIDA STATE UNIVERSITY.New musical pacifier helps premature babies get healthy.Eureka Alerta , Florida [ Internet] May 2012 . Disponible en: https://www.eurekalert.org/pub_releases/2012-05/fsu-nmp052112.php [2]Anderson DE1 and Patel AD2. Infants born preterm, stress, and neurodevelopment in the neonatal intensive care unit: might music have an impact? Dev Med Child Neurol. [Internet] 2018 [Consultado 27 de Julio 2018 ] Mar;60(3):256-266. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/dmcn *.Loewy, J et al.The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics. [Internet] 2013 [ Consultado 24 de Julio 2018] May;131(5):902-18. Disponible en: http://www.pediatrics.org/cgi/doi/10.1542/peds.2012-1367 [3]Kubota,T .Wearable device from Stanford measures cortisol in sweat.Stanford News. [ Internet] Julio 2018 [ Consultado 20 Julio 2018] Stanford University, Stanford, California. Disponible en: https://news.stanford. edu/2018/07/20/wearable-device-measures-cortisol-sweat/

#NeonatalEthics #NLS. Plenty of food x thought. Among all factors, here we focus on "#Futility" @ the edge of viability. As an optimist, I feel a big part of is #prudence: what/ how much experience has lead physiciam ( Is there a Neonatologist)? Team? , Beliefs, family background./+ Counseling Resources available.

In the experience, I remember that the NICU above the transport team I worked for used iNO with ventilation during a 'crisis' with pulmonary hypertension with the goal of stabilizing. It was always available for use during transport. One occasion I was able to observe some bed teaching. In this case there was a neonate who was on iNO and oscillating ventilation for some time before being transferred to another unit for ECMO.

After the last round of articles .How about a little debate around NLS & Ethics

Excited for my first speaker oportunity to a peds audience.We a small group of about 20 I did expect a litlle more. The good Things and not so good that needed improving here. The conference wad set to be the first consist of primary care topics & community health. The second was solid peads with a special section of neonatology talks in the afternoon. The was also a poster competition in the mix. Lets start with the good I really enjoyed the networking oportunity over a nice healthy lunch with people. We happened most to NICU peps of bar various multidisciplinary backgrounds so we got talking about developmental outcomes of preemie at several stages. Thus we able to cross pollinate with ideas. The were several talk that were really relevant to my posdoc expecially organisation:community health better and those that NICU ones .The most thought provoking one was the method of management explained by the Arizona Prof. McGrath ,developmental psychologist working NICU on neonatal abtinense sindrome: how they reduced the stay to about weekish-ten days reduced the used of morphine derivates. Other talk were little lenghty. Personal I manage to give my talk to the small peds audience. I was a tad nervous but manage to give a somewhat seamless talk summary a few points as it overlap with the previous talk on the golden hour on my work in ethics in NLS and generate some debate with those in room. I glad that my hotel was close by 10 walks away. A bonus on get macarons for mum on way back at the airport at Orly. On the otherhand, the organization of the event needed improving as it was a bit ad hoc from my experience organising .We totally underestimated how far it would be from the airports CDG and Orly : +2 hours using a mix public transport , I used my trusty app citymapper to get there.The conference site was a cute Holiday Inn @ Noisy le Grand, subburds well outside Paris .

How about musictherapy in NICU.

Alarms in NICU are part of the environment and with more advanced model appear to be more present. As one walks through the unit one is going off, creating annoyance to staff.Thus, raising the issue have reached a 'fatigue alarm'. Among I and some of the NICU professionals in my twitter Community belief. An article by Belteki and Morley give some answers. COPYRIGHTED THE Child &Fetal Archives Here the link below : https://bmj.altmetric.com/details/28352250

Ahh Great! almost Copenhague What a treat 😍😎