Nathan Sundgren

Do you use premedication for LISA/ MIST procedure? What combination do you use? We have started our LISA procedures successfully, but a lot of concerns from our faculty that we should be using premedication as we do for intubations. Any advice much appreciated.

I'm not sure I have much advice to offer. Our nursing has worked hard to maintain CPAP. We are very fortunate to get 1:1 nursing staffing even for CPAP in the first 3 days for our small babies and we get 1:1 nursing for extubations to CPAP or NIPPV.

1. C 2. No 3. A. mask. I am starting to use an (C) LMA in special circumstances as first line for ventilation.

Do you have a max weight? We tried on a larger baby over the weekend and encountered more difficulty probably for multiple reasons. Is there a weight you have found that is too big for this procedure (assuming they are truly surfactant deficient)?

@Florian I would love to use the catheters you are talking about, but they are not available in the United States. I specifically spoke to a Chiesi rep and they don't see making the effort to get FDA approval here anytime soon. @M C Fadous Khalife Glad you liked it.

Thanks for the feedback @dj 188 and @Tamimi . We do have clear guidelines on pressure settings and we are targeting above 30% FiO2 to make sure the surfactant is early rescue and not late. I have not wanted to necessarily limit weight or GA, but we recognize the biggest benefit is likely in the <1500 gram, and technically easiest in something larger than the sub 500g babies. I too wish we could get the surfcath. Drawing the line on the angiocath is my least favorite part of the whole thing.

So I've seen LISA done once, I've now done it once, next is to roll it out unit wide in our NICU. See one, do one, teach one, right? I'd like to hear from those of you that have been doing LISA/ MIST for a while now. What is the best tip you have? What do you know now that you wish you had known when you first did LISA? What barriers to implementation did you have when you started? Any feedback is welcome. Also, I made a video for our nurses and respiratory therapists to just introduce the idea. Not too in depth, but something to get our education rolling. See what you think.

Tough question, but something we see in various shades of similar. I would personally try the 2 rounds of steroids as in the scenario, but I would strongly hesitate for a third. I would probably tolerate a lower sat goal to keep the baby off 100% oxygen, fluid restrict more, and then wait. Grow, grow, grow. If I had to intubate (for whatever reason I "had to") I think I would focus on growth for several weeks before possibly trying the third round of steroids to extubate again. This is, of course, based on as little EBM as I can imagine, and faced with the actual circumstance I would probably actually do something completely different each time.

https://journals.lww.com/pidj/Abstract/9000/INTRAUTERINE_TRANSMISSION_OF_SARS_COV_2_INFECTION.96099.aspx A case report of likely vertical transmission as well.

Sorry. The link does not work for me.

Final video version now public on YouTube. Please share with interested colleagues.

@olamedmac what a privilege to have you respond to this thread. Thank you. I will definitely make some revisions based on your suggestions. I was nervous about the Aristotle quote, since his work is all Greek to me, but I thought I had it from a reputable source that it was true. Your suggested quote is many times better. I really thought I had the Erasmus - Charles Darwin connection correct, but I should have double checked my facts there, too. I will also fix this. As you said, deciding which articles to include does get tricky as I was really working hard to keep the video to 15-20 minutes long, and usually the shorter the better. I will look again at including some of your suggestions. As for the 60 second recommendation, I wholeheartedly agree with you about 3 minutes in term babies. Honestly, as a neonatologist, my mind is mostly thinking of the preterm babies. I do think right now that 60 seconds is probably the best compromise for preterm babies, especially since not many are resuscitating on the open cord. I need to make a better distinction in recommendations for preterm to term. I did try to express this by saying a few times in the video to consider longer for stable term babies. I think you are right that I can make a stronger statement for the term babies being 3 minutes. @Stefan Johansson the webinar idea sounds great and I'd love to give it a try. Thanks. Maybe we can DM on twitter for more discussion?

I wanted to let the 99nicu community have the first look at my latest video. It is based on a ground rounds talk I gave on delayed cord clamping several months ago. I updated it and added lots of animation. You can find the video by following this link: https://youtu.be/6qA3CVGp5Sw The video is not public, meaning you can not search for it, but you can follow the link to view it. I'd appreciate any thoughts on the video, especially mistakes you see or if you felt anything I said was misleading about the evidence. Post your comments to this forum and I will respond. I'm hoping to make the video public depending on this communities comments. Also, I feel a bit weird posting or doing anything not COVID19 related these days, but maybe this can be one thing that takes the mind off of the current pandemic for about 16 minutes of your time. -Nathan

A big thanks for sharing. I hope it is helpful to many of you. Follow the You Tube channel - TexSun NeoEd - if you like it. You never know when I might put something else up.

We talk about it. I want to get there, but one not so great experience makes me hesitant. If we are doing INSURE in our delivery room, I don't think it is practical enough and leans more to emergent in those cases. But if we are admitted in our unit, then I think it is the best. I'm convinced its better for babies getting intubated in general, but not consistent in my practice yet. FYI, we don't routinely use muscle relaxant and our standard is atropine and fentanyl.