Jelli KA

A article that most struck lately: This article by Dr. G.Moore et al researchers at the University of Ottawa, accessible #FOAM, give a good thoughtful analysis to whether chest compression & epinephrine cause more harm than good to V.preterm infants using 'principals' as an ethical framework aka the Spanish /French say does 'Encarnecimiento Terapeutico' a concept complex. As I understand, away to explain it what happens when you go beyond overtreatment? When continuing treatment is medically futile, but you keep going it starts to cause more harm than it yields benefits. Here the author explain with explain with examples why chest compression and justified in cases of need - concludes with a maybe.

Thanks for the article. It very interesting to see help manage the spread antibiotic resistance . Lots to learn.

After watching a documentary in ARTE about bacteriophages it made me think about how else is antibiotic resistance in NICU.? It available french / German Here the story phages was told. First discovered use by Felix Derrel to combat infections in the pre-antibiotics era and was later discredited and forget about in the western world Historically they worked rather well, so there is an attempt to bring them back in the light of increasing antibiotics resistance. This rediscovery started with lab study that showed that the phages were effective at clearing infection in rats population sample. Phagoburn Recently, a French team took it to human and show it feasible despite the many challenges. This study was a RCT which a specific process approval and protocols were established. The aim in *Phagoburn*was to see if phages could be useful using to fight infection in burn victims. It was lead by Dr. Patrick Jault and large team .Jerôme Gabbard head Start up tells Pherecydes provided the synthesis of phages. control got standard treatment {silver salts +antiobiotics} and othe got phages.This got published in nature. The was a reduction in the infection rate in phage group, a loading dosing issue among other practical things. Researchers in france say that there a scaling issue to produce larger amounts, as well a regulatory framework. From bioethical point of view it is possible, a more detail informed consent will be necessary.These days research still going a la Croix de Lion Hospital, France. University Hospital ~CHU Lyon~. ( initial used - discovered @pasteur Institute) https://www.arte.tv/fr/videos/078693-000-A/l-incroyable-histoire-des-tueurs-de-bacteries/ Thus what do think any future of phage in NICU?

This September I had the opportunity to go to BAPM-EBNEO to kept Learning a out Neonatology and hopefully network with the EBNEO, so glad I see lots of you face to face. This kept motivated to finish my PhD as I re-embark in find a new supervisor _only 1.5 yrs to go. I was real hard to let of the clinician in me as , this is my comfort zone. As a budding academic learn I get explore ideas and ways to implement them as bioethicists , as well finding ways to humanize the NIcU via processes. Last year, I took a small detour as jr.posdoc and spent time studying system thinking, process and how to improve health using design thinking. An important fact , I beat my fear of being back in UK .I had mild anxious feeling about going to bapm but Northerners are such lovely folks. At the end of the day it you team of people will fluctuate for good & bad. ----------- Product Reviews: Review BAPM. Probiotics Pro-prems finally available in individual sachets pre-dose sachets that in my opinion provide a higher security and is more practical. Only maltodextrin . Need mixing with 3 ml in H20. This has more of a track record as it collaboration with a company who been working bio culture for a long time pharmaceuticals grade certified. Vegan alternative for well babies is Labinic drop available liquid bottle comes in 5mls flask_recommended dose 0.2ml( a syringe is needed). Ideally given with maternal milk ( EBM ). * free off dairy, soya, sweetener, presevatives. Good for neonates with intolerances. Both have different formula of microbiota but have a 1 bifidobacterium probiotic in common. Amount of bacteria are specified in the ingredientes list of of proprems on the box. Nëo from ant neuro aEEG The most distinctive item to provide EEG monitoring to Neonate at the bed side. It features a user friendly screen, allowing NICU professionals easy access to interpret resulting brain waves. Electrode are applied through a cap, as I understand help to give a clearer signal. Bliss finally got to nicu mile stone card which are such lovely way to involve parents and make progress. Favorite is parent centered care poster. Bili bluelight . Compared to the standard it is small portable and easily stored . complement comes with a stand.Practical and can carried around, easily stored in the unit. Li-lac As one who had to deal a lot of of documentation I found Li-lac EBM labeling, sorting and tracking useful from quality & safety point of view. I found quite easy to use and track on a smartphone,and it builds an audit trail.Not sure how easy the set up is . Especial mention to SHED/S/upport & H/elp for E/very D/ad : providing specific support for dad whose babies are admitted to NICU. Disclaimer: I have no ties to any of companies. Review Health devices enthusiasts academic. Permission for all pics .

Go through the equipment check . I start checking incubator follow the step but their a mal function. Instead of declare a failure have a second look it, they usually can a fresh look. When I worked for transport we simulate equipment check to at night to avoid equipment failure when tired and hungry. Here have a novice go through the new protocol steps , this way you can find bumps and pit falls. Hope it helps.

Hola , Some time ago I read this really good article by Petra Hüppi who performed an RCT on use EPO in sinergie with HiE. Also Dr.Nicola Roberston who quite a bit of work on this area.

Having read this article has many good ideas in my experience. The design rethink many good idea . 👌 for the safety of the neonates. I'd like to highlight 2 features. 1) ambulance tv screen/camera allows connexion the hospital site, such as when a tertiary center is necessary. Here a neonatologist can lead the team to provide optimum care of the neonate on transfer. It can use for example the zoom© software enabling remote telehealth service. Alternatively , the ambulance designed by the generalitat de catalunia is powered 4G-5G comm .Its communication system is has a direct to the hospital site , where a clinical is there to provide supportany time. 2), I feel solar roof can provide some autonomy on transport. It also a sustainable option , make it a bit more green.

Congratulations

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