As a health care provider, I am pulled in many different directions when caring for babies in the intensive care unit. Our front line staff doing the day to day or moment to moment care and procedures are often pulled to an even greater degree and need to make choices continually as to priorities for care. As the saying goes there are only 24 hours in a day or in this case a call shift although many institutions have shortened shifts to more humane 8, 10 or 12 hour days. When you are faced with so many different calls for assistance it does leave one in a predicament as to how all of the work ..read more

Hypoxic ischemic encephalopathy is a very scary condition for both families and health care providers.  In my career as a Neonatologist one of the greatest accomplishments has been the recognition that 72 hours of moderate hypothermia can make a big difference to the outcomes of such children.  In days gone by our best estimates of outcome relied on Sarnat staging of HIE.   Since the cooling approach was adopted widely however I have relied more on a wait and see approach when advising families on what to expect.  On some occasions, is spite of cooling babies go on to dev ..read more

The newborn brain could be described as finicky at best. One of the most difficult things to treat are those things that we can’t see. When a baby is delivered and goes on to develop neurological manifestations, it remains a difficult puzzle to sort out as to what the cause is. Of course, we use all manner of technology to sort this out. The use of EEG, amplitude integrated EEG are helpful in this regard to give us a window into brain excitability but we use all manner of technology to sort this out. When it comes down to it, though we often rely on clinical signs to give us a best guess into ..read more

When it comes to non-invasive ventilation the field has become a little more crowded in recent years at least in our institution. In the recent past if one decided to extubate an ELGAN the biggest decision was what CPAP pressure to use. These days we have the option of high frequency nasal ventilation (nHFOV) or non-invasive positive pressure ventilation (NIPPV) to choose from as additional options. Both of these modalities have their uses and I have written about nHFOV before as in Nasal High Frequency Oscillatory Ventilation For Preventing Intubation. On this post though I want to look at NI ..read more

Hypoxic ischemic encephalopathy is a very scary condition for both families and health care providers.  In my career as a Neonatologist one of the greatest accomplishments has been the recognition that 72 hours of moderate hypothermia can make a big difference to the outcomes of such children.  In days gone by our best estimates of outcome relied on Sarnat staging of HIE.   Since the cooling approach was adopted widely however I have relied more on a wait and see approach when advising families on what to expect.  On some occasions, is spite of cooling babies go on to deve ..read more

Anyone who has watch the delivery of a baby knows that in some cases things go very smoothly and in others every care provider in the room would likely have tachycardia themselves. In some cases where labour is quite prolonged and some degree of cephalopelvic disproportion exists, the fetal head can become quite wedged in the pelvis. When this occurs it is not uncommon to hear of an ob/gyn having to dislodge the entrapped head from below and then perform a c-section to get the baby out safely. In some of these cases though on the newborn exam a depression of the skull is found such as with th ..read more

This is one of the most difficult things to determine. Families being given a diagnosis of asphyxia in their baby often ask the question when did this happen? For sure this is not an exact science and in my opinion it is often difficult to answer the question with certainty. There are of course situations in which we can offer an educated guess such as if there is a witnessed acute cord compression such as with a cord presentation. In many other instances though it is more difficult to ascertain. When meconium is passed in utero it is attributed to a hypoxic insult leading to internal anal sph ..read more

Hypoxic Ischemic Encephalopathy or HIE is a condition in which a baby presents with cord blood gases, a gas at one hour of age, low apgar scores and neurological findings which point to an event occurring that has interrupted blood flow to the brain.  The Canadian Pediatric Society further defines this by looking at who may benefit from whole body cooling to mitigate the risk of an abnormal outcome for these patients.  The criteria are shown below from the CPS Guideline Invariably when HIE has occurred and there is neurological injury, two predominant patterns appear on MRI.  Th ..read more

It’s been a while since my last post. Like many centers across North America and worldwide the resuscitation of premature infants as young as 22 weeks is becoming more commonplace. Our own center is in the process of working towards coming up with evidence-based approaches to the care of these fragile infants. One of the questions that has long been asked is whether antenatal steroids really make a difference at these earliest gestational ages. The argument against effectiveness would be that the cards are just so stacked up against these preemies that even steroids may not help. Making matt ..read more

In an effort to reduce the incidence of IVH many patient care bundles in the last number of years have advocated for minimal handling. As part of approach to minimal handing an effort to keep the head straight and in some centres elevated has been postulated to help with enhancing venous outflow from the head. By reducing the passive gravity aided flow from the brain back into the thorax the theory would be that this would help minimize venous pressure in the draining cerebral system. Lowering pressure would in turn theoretically reduce the risk of IVH and hopefully the most severe types. The ..read more