JACK

A father has used his tech knowledge for making a brilliant apnea monitor for his baby http://technabob.com/blog/2012/08/21/wii-mote-baby-breathing-detector/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+TechnabobtechNewsBlog+%28Technabob%29&utm_content=Google+Reader

Here are policy and procedure for NICU of University of Connecticut. Useful for reference while developing local policies. http://nursing.uchc.edu/unit_manuals/nicu_nursery/index.html http://nursing.uchc.edu/unit_manuals/ccmc_nicu/index.html And not to forget the New Zealand resource: http://www.adhb.govt.nz/newborn/DrugProtocols/ http://www.adhb.govt.nz/newborn/NsgTools/NsgTools.htm http://www.adhb.govt.nz/newborn/Guidelines.htm Australia: http://www.rch.org.au/nets/handbook/index.cfm?tabnav=all

This is an excellent resource for NICU - Holistic Improvement: http://www.vtoxford.org/quality/ebook/ebook.aspx Download Link Another resource from NHS: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107845

For cleaning the bottles we use these : http://www.philips.co.uk/c/avent-baby-steriliser/25286/cat/#filterState0=MCC_STERILIZERS_SU_GB_CONSUMER%3Dtrue We do not use steel containers. source: http://guidelines.gov/content.aspx?id=23797 At the same time this source says steel containers are ok: http://books.google.com.sa/books?id=96LEZb5s7psC&lpg=PA161&ots=x4IlOwS_Ot&dq=human%20breast%20milk%20storage%20in%20steel%20containers&pg=PA161#v=onepage&q=steel%20containers&f=false

http://www.llli.org/faq/milkstorage.html

Thanks for the link

That is also an excellent idea....healthy competition

Let me add this link here: http://www.utenti.unife.it/giampaolo.garani/Sedazione-Farmaci/Articoli%20Dolore/Pediatrics6-04%20ErroriMedici.pdf

It sounds simple, but actually it turns out to be very complicated and controversial. The question is are we improving our NICU ? Has our NICU performance remained the same for the past few years? What about the performance of our NICU staff members (Medical and Nursing ) ? Are they improving themselves? That was the easy part. Now the difficult part. We can only improve a thing which can be measured. So to improve our NICU, we have to monitor some parameters of our NICU and then trend it and then find what we want to improve in that measure and then plan an intervention and then implement that intervention and then monitor the performance after the implementation of the interventions. (phew that was difficult to type right !) So lets see....if we heard that NICU in XYZ hospital had mortality of ELBW babies 5 years back of 50 % and that now they are reporting ELBW mortality of 20%...we definitely know they have improved themselves. How about nosocomial infection rate in a NICU in XYZ hospital was 5 per 1000 patient-days 5 years back and now was 1.5 per 1000 patient-days...we definitely know they have improved. One very nice example to illustrate this improvement is here: http://www.lafayettegeneral.com/pavilion/Level-III-Neonatal-Intensive-Care-Unit-1/Key-Performance-Indicators-3 There are so many parameters to be monitored in a NICU..I think we just have to select what is suitable in our setup balancing our resources. We have to be cautious not to overdo it...as then it will only be on paper and have no actual benefit for the NICU. the other (more difficult part) is to monitor the performance of NICU staff. Here also there are many options. One beloved one is compliance with infection control practices (especially ...hand hygiene). Success rate of intubations could be used for residents. How about IV infiltration (IV burns) rate for nurses? Morbidity/Mortality outcomes for consultants/attending ? Once staff know that they are being monitored...performance automatically improves. Once you start rewarding good performance......then people start having a healthy competition to improve themselves....the ultimate winner is the patient...NICU performance measures improve.....And thats the ultimate aim...to improve patient outcomes... The floor is open.

The mortality data is encouraging however the morbidity data are still an area for alarm. Especially the morbidity in babies with birth weight more than 1 kg. For this weight group, we usually feel confident of a very good outcome. http://www.ncbi.nlm.nih.gov/pubmed/22614775 http://pediatrics.aappublications.org/content/129/6/1019.long

The case reports I read here: http://pediatrics.aappublications.org/content/129/6/e1601.abstract http://www.ncbi.nlm.nih.gov/pubmed/22641760?dopt=Abstract seemed very promising. I hope they become standard practice soon.

Evidence Based Confusion !!!!

I read a paper here: http://www.ncbi.nlm.nih.gov/pubmed/22370669 Tlucek PS, Grace SF, Anderson MP, Siatkowski RM. Effect of the oxygen saturation target on clinical characteristics of early- versus late-onset retinopathy of prematurity. J AAPOS. 2012 Feb;16(1):70-4. PubMed PMID: 22370669. Now I am getting more confused...

Congrats...we are all very happy for you

From first hand knowledge your lecture was good and your presentation style was excellent.

I found a study also studying sevoflurane http://www.ncbi.nlm.nih.gov/pubmed/18946288 (Note: The full article is free to download !)

Just as drugs can get recalled when a problem is discovered, the same can happen with any medical equipment. Your hospital Bio-med division/department should be the one to alert you in case of any equipment recall. They should be immediately informed of any such recall either by the supplier/manufacturer/authorized agent/distributor or by the local governmental authorities. However it is always better to be extra sure to keep an eye on the following websites: Archived FDA Recall notices: http://www.fda.gov/Safety/Recalls/ArchiveRecalls/default.htm Current Recalls http://www.fda.gov/MedicalDevices/Safety/RecallsCorrectionsRemovals/ListofRecalls/default.htm If any of the 99nicu members know of any other resources, or are aware of any medical device recall - kindly share it with us.

BTW....I think all Pasta producers are against low-carb diets----it is harmful for their business ;-)

Looks like an adventurous start to your arabian adventure

Just to put things in perspective for yu http://www.accuweather.com/en/sa/riyadh/297030/daily-weather-forecast/297030?day=16

Looks excellent....

will contact you

Use a blender - needs O2 and Air supply - Example : http://www.viamed.co.uk/eng/?uid=&sessionid=&page=catagory&cat=360&subcat=419 Another example: http://www.biomeddevices.com/index.html?neo_blend.html&3 or use a room air plus O2 blender Eg: - http://www.nascor.com.au/public_html/business/pdf/oxygen-air-mixer-brochure.pdf (I am not sure if the last example is made for use in a cpap circuit but I am sure it can be made to work !!! )

We have developed our own local neonatal database in MS-Access. It has being going strong for the past 5 years. It has been very useful for us. Other than being helpful in calculating mortality statistics, it also helps us in seeing the morbidities and its various associations with multiple factors. (Eg. Threshold ROP and Fungal Sepsis ). It helps us plan for the RSV season and calculate our vaccine requirements. It helps us calculate trends, recognize clusters. Excellent for seeing our own performance and improving ourselves. Ms Access being very easy - all the VBA code was done by doctors. We also do use Google Fusion ( http://www.google.com/fusiontables/public/tour/index.html ). We often upload our data to this, for analysis or when we need to have our data online for access by someone remotely.

Google translate: "Do not rule out any inborn error of metabolism with acidosis curse ... or not be excluded that there is any alteration in the type of formula feeding babies who are getting these ..."