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Found 17 results

  1. A couple years back at the Canadian Pediatric Society annual meeting a discussion broke out about extubating infants to higher levels of CPAP. Conventional thinking had been to use levels between 5 – 8 cm H2O typically. I shared with the group the experience we had in Winnipeg (unpublished) of using higher levels from 9 -12 cm H2O with some degree of success in allowing earlier extubation. The group thought it was interesting but pointed out the lack of robust research in the area so were not so keen to “try it out”. Non-invasive positive pressure ventilation (NIPPV) has been used for some tim
  2. Precision medicine is a growing field in which genetic factors, environment, metabolism and even lifestyle are taken into account when deciding who should receive a treatment or not. When it comes to bronchopulmonary dysplasia I believe anyone who works in Neonatal care can attest it is a mystery why some infants go on to develop BPD while others don’t. We do know that certain treatment strategies may increase risk such as using excessive volumes or pressure to ventilate and in the last 25 years the notion that your level of cortisol in the blood may make a difference as well. I have written a
  3. This must be one of my favourite topics as I have been following the story of early hydrocortisone to reduce BPD for quite some time. It becomes even more enticing when I have met the authors of the studies previously and can see how passionate they are about the possibilities. The PREMILOC study was covered on my site twice now, with the first post being A Shocking Change in Position. Postnatal steroids for ALL microprems? and the second reviewing the 22 month outcome afterwards /2017/05/07/early-hydrocortisone-short-term-gain-without-long-term-pain/. The intervention here was that w
  4. What is old is new again as the saying goes. I continue to hope that at some point in my lifetime a “cure” will be found for BPD and is likely to centre around preventing the disease from occurring. Will it be the artificial placenta that will allow this feat to be accomplished or something else? Until that day we unfortunately are stuck with having to treat the condition once it is developing and hope that we can minimize the damage. When one thinks of treating BPD we typically think of postnatal steroids. Although the risk of adverse neurodevelopmental outcome is reduced with more moder
  5. Dear All, I would like to ask about your experience with volumen guaranteed mechanical ventillation in case of early onset CLD. We have 24 weeker, who is now 2 weeks old, and having bronchospasms, typical XR signs of CLD, and spontaneous hypoxemic episodes. We try to wean her from MV, but her weight and irregular respiratory activity makes the thing trickier. I was thinking about lowering the PIP, and TV to prevent the further damage, she recieves supportive care for the CLD. I would like to read your experience. Thank you for your answers.
  6. If you work in Neonatology then chances are you have ordered or assisted with obtaining many chest x-rays in your time. If you look at home many chest x-rays some of our patients get, especially the ones who are with us the longest it can be in the hundreds. I am happy to say the tide though is changing as we move more and more to using other imaging modalities such as ultrasound to replace some instances in which we would have ordered a chest x-ray. This has been covered before on this site a few times; see Point of Care Ultrasound in the NICU, Reducing Radiation Exposure in Neonates: Repla
  7. As a Neonatologist I doubt there are many topics discussed over coffee more than BPD. It is our metric by which we tend to judge our performance as a team and centre possibly more than any other. This shouldn't be that surprising. The dawn of Neonatology was exemplified by the development of ventilators capable of allowing those with RDS to have a chance at survival. As John F Kennedy discovered when his son Patrick was born at 34 weeks, without such technology available there just wasn't much that one could do. As premature survival became more and more common and the gestational age at
  8. Producing milk for your newborn and perhaps even more so when you have had a very preterm infant with all the added stress is not easy. The benefits of human milk have been documented many times over for preterm infants. In a cochrane review from 2014 use of donor human milk instead of formula was associated with a reduction in necrotizing enterocolitis. More recently similar reductions have been seen in retinopathy of prematurity. Interestingly with respect to the latter it would appear that any amount of breast milk leads to a reduction in ROP. Knowing this finding we should celebrate ev
  9. There may be nothing that is harder in medicine. We are trained to respond to changes in patients condition with a response that more often than not suggests a new treatment or change in management. Sometimes the best thing for the patient is in fact to do nothing or at least resist a dramatic response to the issue in front of you. This may be the most common issue facing the new trainee who is undoubtedly biased towards doing something. Take for instance the situation in which the trainee who is new to the service finding out that their 26 week infant has a PDA. Their mind races as they
  10. Breast milk has many benefits and seems to be in the health care news feeds almost daily. As the evidence mounts for long term effects of the infant microbiome, more and more centres are insisting on providing human milk to their smallest infants. Such provision significantly reduces the incidence of NEC, mortality and length of stay. There is a trade-off though in that donor milk after processing loses some of it’s benefits in terms of nutritional density. One such study demonstrated nutritional insufficiencies with 79% having a fat content < 4 g/dL, 56% having protein content< 1.5
  11. I am following an infant at home with chronic severe bpd; he's 11 months old, 7.5 months corrected age, on oxygen 23-27% plus inhaled steroids. He has morning fever from about 7:30 AM to 10:00. Remission is spontaneous, peak ranges from 37.5 °C to 38.5 °C. There is no evidence whatsoever of infection (CRP is null, the infant is well, urinalysis etc etc). This has happened from about three months now, with small fluctuations: some days there is no fever, but mostly there is, We thought that in some way the fever could be linked to some dehydration, but it has persisted after stopping diuretics
  12. It seems like a sensational title I know but it may not be as far fetched as you may think. The pendulum certainly has swung from the days of liberal post natal dexamethasone use in the 1990s to the near banishment of them from the clinical armamentarium after Keith Barrington published an article entitled The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs in BMC Pediatrics in 2011. This article heralded in the steroid free epoch of the first decade of the new millennium, as anyone caring for preterm infants became fearful of causin
  13. We would like to invite all our members to join a short survey on parenteral vitamin A, as a preventive therapy against BPD in preterm infants. We are distributing the survey on behalf of Orphanix, an Austrian start-up company that is developing innovative medicines with a strong focus on neonatology. In return Orphanix will support 99nicu with an educational grant for 2016, a mostly welcome contribution! Please use this URL to complete the survey: https://www.surveymonkey.com/r/W8JG8BR
  14. I wonder about hands-on experience with sildenafil for ex-preterm infants with severe bronchopulmonary dysplasia. The literature is not very convincing, seems that right ventricular strain improves (echo) but that clinical benefits (the babies!) is less clear. http://www.ncbi.nlm.nih.gov/pubmed/25824807 http://www.ncbi.nlm.nih.gov/pubmed/25796626 http://www.ncbi.nlm.nih.gov/pubmed/21941230 Please share your comments and experience!
  15. I would like to hear about your choices when it comes to diuretics as BPD treatment. Which drugs and doses do you use?
  16. A one day study day covering hot topics in Neonatal ventilation Organised by the Evelina London Children's Hospital and King's College London Details: http://www.guysandstthomasevents.co.uk/paediatrics-training/neonatal-ventilation-updates-hot-topics-and-workshops/ A4 flyer - Neonatal Ventilation 2014 - low res.pdf
  17. Now we are writting the guide for the bronhopulmonary displasia and there are discussion about the terminology: BPD or pulmonary chronic lung diseases. Which term is correct?
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