This is a great website for seeing pictures of common newborn exam findings including the benign to serious. Nice explanations too for how to differentiate several similar findings.
http://newborns.stanford.edu/PhotoGallery/
Thursday, August 2, 2012
Friday, January 13, 2012
The Best Christmas Present Ever!
Last month I had the great honor of serving a number of families and patients in the Maine Medical Center Neonatal Intensive Care Unit. As my previous post indicates, the month was a wonderful one for me which did nothing but reconfirm my absolute commitment to pursuing neonatology fellowship training once I complete my pediatrics residency training.
One of the best experiences of the month was taking care of a little guy who I'll call "Alex." "Alex" was a 30 week singleton preemie who I would consider one of my first patients since after attending his delivery I also had the chance to continue following him until my rotation came to an end. His parents were incredibly gracious and dedicated to their son and made this experience all the more heart-warming. This little fellow was known as the rockstar of the NICU; by his second day of life he was extubated and on room air; he took the full volume of feeds for his weight without difficulty; he was simply a joy to care for and it brought a smile to my face just to see him open his tiny mouth wide in a sleepy yawn as I stretched his legs out each morning and to watch his mother proudly show off his newest Christmas hat, temporarily adding Christmas cheer to his isolette as she remained in search of the perfect Christmas outfit for her tiny bundle of joy.
As I neared the end of my rotation, I went in one evening before heading home to talk to Alex's parents and let them know it was the last week I would be coming in to see them. His mother not only responded with disappointment but asked if she could mail me a picture and Christmas card and I readily offered my address, trying not to show the full extent of my excitement that I might get to continue to 'follow' my little patient after leaving Maine. I got a warm hug goodbye on my last day in the NICU but I felt that I was the one who should be thanking them.
Last week, as I was checking my mailbox, seeing the envelope with the Maine return address nearly brought tears to my eyes. Enclosed was a Christmas card with a wonderful note from Alex's parents as well as a picture of little Alex in a red stocking hat bundled inside a Christmas stocking. Apparently his mom's search for a preemie sized Christmas outfit had been unsuccessful, but not to be deterred, she portrayed him as the gift of which they'd been dreaming. Allowing me to be a part of their world, their family, was the greatest honor they could have bestowed upon their eager neonatologist-in-waiting. I can only hope that future Christmases will include an updated picture of Alex...this time, at home with his family and wearing exactly the Christmas outfit his mother lovingly sought for him. For me, at home in NC, the now-framed card and picture will live on my desk as a reminder to pursue the best, for that is what my future patients deserve.
One of the best experiences of the month was taking care of a little guy who I'll call "Alex." "Alex" was a 30 week singleton preemie who I would consider one of my first patients since after attending his delivery I also had the chance to continue following him until my rotation came to an end. His parents were incredibly gracious and dedicated to their son and made this experience all the more heart-warming. This little fellow was known as the rockstar of the NICU; by his second day of life he was extubated and on room air; he took the full volume of feeds for his weight without difficulty; he was simply a joy to care for and it brought a smile to my face just to see him open his tiny mouth wide in a sleepy yawn as I stretched his legs out each morning and to watch his mother proudly show off his newest Christmas hat, temporarily adding Christmas cheer to his isolette as she remained in search of the perfect Christmas outfit for her tiny bundle of joy.
As I neared the end of my rotation, I went in one evening before heading home to talk to Alex's parents and let them know it was the last week I would be coming in to see them. His mother not only responded with disappointment but asked if she could mail me a picture and Christmas card and I readily offered my address, trying not to show the full extent of my excitement that I might get to continue to 'follow' my little patient after leaving Maine. I got a warm hug goodbye on my last day in the NICU but I felt that I was the one who should be thanking them.
Last week, as I was checking my mailbox, seeing the envelope with the Maine return address nearly brought tears to my eyes. Enclosed was a Christmas card with a wonderful note from Alex's parents as well as a picture of little Alex in a red stocking hat bundled inside a Christmas stocking. Apparently his mom's search for a preemie sized Christmas outfit had been unsuccessful, but not to be deterred, she portrayed him as the gift of which they'd been dreaming. Allowing me to be a part of their world, their family, was the greatest honor they could have bestowed upon their eager neonatologist-in-waiting. I can only hope that future Christmases will include an updated picture of Alex...this time, at home with his family and wearing exactly the Christmas outfit his mother lovingly sought for him. For me, at home in NC, the now-framed card and picture will live on my desk as a reminder to pursue the best, for that is what my future patients deserve.
Wednesday, January 11, 2012
Board Pass Rates for Pediatric Residency Training Programs
One thing that every residency applicant wants to know is how well a program will prepare them to take the Pediatrics board exams at the end of their training. The American Board of Pediatrics publishes first time board pass rates for all accredited Pediatrics Training Programs within the U.S., Canada and P.R. Check out this link if you want to know the pass rates for the programs to which you are considering applying.
American Board of Pediatrics Residency Board Pass Rates
American Board of Pediatrics Residency Board Pass Rates
Saturday, December 3, 2011
Half-way through my month in the NICU and I never want to leave!
So far, this has been, hands down, the most amazing rotation of my medical school career. I have amazingly wonderful patients and families, just as inspiring 'teachers' in the NICU NNP's and neonatologists, and patient and encouraging nurses who care infinitely about the welfare of their patients.
Many of the NNP's with whom I am working this month have been working here, in the NICU, for more than 20 years, some more than 30 years. They have seen neonatology grow through infancy into the well-respected and research-backed pediatric subspecialty that it is today. It is a rapidly evolving field, as it has been since it's establishment. The advent of several key therapeutics, such as artificial surfactant, has spun the practice of neonatology from one of many poor outcomes to miraculous rescues of the most fragile lives to challenging the ethics of saving the earliest of babies.
One thing I have witnessed in my two weeks on this rotation is the involvement in the March of Dimes organization with every family whose child is admitted. I have long respected this organization and am anxious to contribute to it on a professional level, but I am also certain that the role they play in the lives of families present and future is monumental to parents struggling to understand the why, how, and what of their respective situations. I am grateful that my future specialty has such and organization with whom to partner.
The most precious twin baby girls were my first patients of the month. As of earlier this week, they have both graduated to the "Continuing Care Nursery," where they can continue to practice eating, growing and prove that they remember to breath as they should. I am no longer responsible for their medical care, but with their parents' blessing I have asked if I can stop by for the occasional visit to check in on them. Their parents are beautiful people and, I'm certain, are going to do fabulously with these adorable little girls.
They will always hold a special place in my heart, as I told their parents, as my first ever neonatology patients. For someone who has been longing for the day when I can enter the field of neonatology officially, recalling the course of these sweet babies will be a memory I call on when the day is not going as well or when I need a reminder of why I chose this field. It also has served as a perfect motivation to me to in this, my last year, of medical school. With graduation now just 182 days away (almost exactly 6 month!), it would be easy to coast in, finish up my interviews, submit my Match lists and wait for June to arrive. Instead, the needs of these little babies has my brain churning with ideas for ways to get involved with the specialty even before I know where I'll be entering pediatric residency in the fall. If something that weighs a mere 2 pounds has the grit to beat their odds, you can bet that I'm going to work as hard as they are at giving them every chance to succeed. I think I have my work cut out for me!
Many of the NNP's with whom I am working this month have been working here, in the NICU, for more than 20 years, some more than 30 years. They have seen neonatology grow through infancy into the well-respected and research-backed pediatric subspecialty that it is today. It is a rapidly evolving field, as it has been since it's establishment. The advent of several key therapeutics, such as artificial surfactant, has spun the practice of neonatology from one of many poor outcomes to miraculous rescues of the most fragile lives to challenging the ethics of saving the earliest of babies.
One thing I have witnessed in my two weeks on this rotation is the involvement in the March of Dimes organization with every family whose child is admitted. I have long respected this organization and am anxious to contribute to it on a professional level, but I am also certain that the role they play in the lives of families present and future is monumental to parents struggling to understand the why, how, and what of their respective situations. I am grateful that my future specialty has such and organization with whom to partner.
The most precious twin baby girls were my first patients of the month. As of earlier this week, they have both graduated to the "Continuing Care Nursery," where they can continue to practice eating, growing and prove that they remember to breath as they should. I am no longer responsible for their medical care, but with their parents' blessing I have asked if I can stop by for the occasional visit to check in on them. Their parents are beautiful people and, I'm certain, are going to do fabulously with these adorable little girls.
They will always hold a special place in my heart, as I told their parents, as my first ever neonatology patients. For someone who has been longing for the day when I can enter the field of neonatology officially, recalling the course of these sweet babies will be a memory I call on when the day is not going as well or when I need a reminder of why I chose this field. It also has served as a perfect motivation to me to in this, my last year, of medical school. With graduation now just 182 days away (almost exactly 6 month!), it would be easy to coast in, finish up my interviews, submit my Match lists and wait for June to arrive. Instead, the needs of these little babies has my brain churning with ideas for ways to get involved with the specialty even before I know where I'll be entering pediatric residency in the fall. If something that weighs a mere 2 pounds has the grit to beat their odds, you can bet that I'm going to work as hard as they are at giving them every chance to succeed. I think I have my work cut out for me!
Thursday, November 24, 2011
Neonatal hyperbilirubinemia
Having just started a new rotation in the NICU at Maine Medical Center in Portland, Maine, I've already come upon the question of phototherapy several times with unsatisfactory conclusions. To manage the hyperbilirubinemia plaguing my two charges, twin ex-32 week (ADORABLE!) baby girls, I've done several interweb searches, consulted the all-knowing Harriet Lane Handbook, and conducted an Up-To-Date search with little, if any, helpful guidelines pertaining to these kids.
The problem is, most bilirubin curves are for 35 week infants and up. And most guidelines regarding preemies offer suggestions for the first 7 days of life, but not beyond. So the current therapy is a hybrid of the two guidelines mixed in with a Tablespoon of experience from the unit's neonatologist du jour. This is a frustrating situation to say the least, not only because some extra thought is required to determine 'to light or not to light', but also because it's not entirely clear if the therapy we're using is really the best treatment for these little girls.
In light of all the other advances neonatology has made in the last decade-plus, it's realistic to think that some studies will begin to pop up soon with more evidence-based data and guidelines for babies like these who fall between current recommendations. In the meantime, here are the current guidelines for preemies and full-term infants when it comes to phototherapy treatments for neonatal jaundice:
And for premature infants:
Begin phototherapy in infants less than 35 weeks GA and who are less than seven days of age :
GA <28 weeks - TB >5 mg/dL (86 µmol/L)
GA 28 to 29 weeks - TB 6 to 8 mg/dL (103 to 137 µmol/L)
GA 30 to 31 weeks - TB 8 to 10 mg/dL (137 to 171 µmol/L)
GA 32 to 33 weeks - TB 10 to 12 mg/dL (171 to 205 µmol/L)
GA >34 weeks - TB 12 to 14 mg/dL (205 to 239 µmol/L)
The problem is, most bilirubin curves are for 35 week infants and up. And most guidelines regarding preemies offer suggestions for the first 7 days of life, but not beyond. So the current therapy is a hybrid of the two guidelines mixed in with a Tablespoon of experience from the unit's neonatologist du jour. This is a frustrating situation to say the least, not only because some extra thought is required to determine 'to light or not to light', but also because it's not entirely clear if the therapy we're using is really the best treatment for these little girls.
In light of all the other advances neonatology has made in the last decade-plus, it's realistic to think that some studies will begin to pop up soon with more evidence-based data and guidelines for babies like these who fall between current recommendations. In the meantime, here are the current guidelines for preemies and full-term infants when it comes to phototherapy treatments for neonatal jaundice:
For infants >35 weeks, guidelines for initiating phototherapy:
- For infants at low risk (≥38 weeks gestation and without risk factors), phototherapy is started at the following TB values.
- 24 hours of age: >12 mg/dL (205 micromol/L)
- 48 hours of age: >15 mg/dL (257 micromol/L)
- 72 hours of age: >18 mg/dL (308 micromol/L)
Infants in this category who have TB levels 2 to 3 mg/dL (34 to 51 micromol/L) below the recommended levels may be treated with fiberoptic or conventional phototherapy at home.
- For infants at medium risk (≥38 weeks gestation with risk factors or 35 to 37 6/7 weeks gestation without risk factors), phototherapy is started at the following TB values.
- 24 hours of age: >10 mg/dL (171 micromol/L)
- 48 hours of age: >13 mg/dL (222 micromol/L)
- 72 hours of age: >15 mg/dL (257 micromol/L)
The threshold for intervention may be lowered for infants closer to 35 weeks and raised for those closer to 37 6/7 weeks.
- For infants at high risk (35 to 37 6/7 weeks gestation with risk factors), phototherapy is initiated at the following TB values.
- 24 hours of age: >8 mg/dL (137 micromol/L)
- 48 hours of age: >11 mg/dL (188 micromol/L)
- 72 hours of age: >13.5 mg/dL (231 micromol/L)
And for premature infants:
Begin phototherapy in infants less than 35 weeks GA and who are less than seven days of age :
Another useful tool for determining the same, available online and as a mobile app, is BiliTool. Using the baby's date of birth, date and time of blood sample and total bilirubin level, a risk stratification (ie, "low risk," "moderate risk," etc) is assigned to guide in determining need for phototherapy. These guidelines however are only intended for infants >35 weeks gestational age as premature infants have been determined to need more aggressive phototherapy protocols.
Wednesday, October 19, 2011
The notepad used by the Pediatric Cardiology nurses
For those days when you've just had to be thankful for the little things!
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