My Day Of Slogans.

It was a glorious day! It was bright and sunny. It definitely reflected on my face beaming with happiness as I reached another milestone in my life;I turned fifty!! On this happy occasion, my mind asked me "Where Do You Want To Go Today" (Microsoft), but, my wife an Apple fan felt that I should Think Different (Apple's slogan) and asked me if I can take her minivan for a regular maintenance servicing. Life was looking so exciting and positive; accepting her request needed no further thought as I always believed in; if wife asks-Just Do It (NIKE).

I merrily made an appointment for that afternoon. The ride was so smooth and handling was so precise that it felt like The Ultimate Driving Machine (BMW) that day. Even Divesh may not have had this great pleasure of driving his Maserati, I thought. Does it need servicing at all, when it drives like a super car! In my fifty years, I never had this proud and positive feeling.

As my car glided in to the parking lot and came to a musical halt, I could envision in the background the claps of utter joy, as if the plane landed smoothly congratulating the perfect pilot. I gently nodded my head acknowledging the applause and assured like Greyhound (Leave The Driving To Us). Though, I don't use LG goods, but I seem to be experiencing their strikingly sticking slogan-Life is Good!

As I majestically meandered to the service desk intoxicated with pride, the service manager greeted with a confidence-You Are In Good Hands With Allstate. I looked at my Casio watch;it seemed to warn me-Expect The Unexpected. My positive attitude of the day overlooked the reason for his-Life is Good feeling, till he gave me an estimate of $1530 for the servicing. No doubt, he was sporting that LG smile! I then remembered my better half reminding me"Don't Leave Home Without It" (American Express). I pointed to my simple Nissan Quest minivan, hoping that he mistook my majestic amble for a Maserati driver. He too pointed at the same Maserati masquerading as Nissan.

It didn't take much time to go from Whopper feeling to a Popper feeling. It was obvious he didn't believe in McDonald's slogan- We Love To See You Smile! I was still pretty hopeful. I gave a long and convincing speech about my loyalty to the company; like Diamonds, good customers Are Forever. I could see the tears webbing in his eyes looking at my macerated Maserati face. He assured me that he would speak to the supervisor about a possible discount. My hopes rekindled and life was good again.

He came back with a beamer (BMW) face and Avis attitude (We Try Harder) and announced that I got a $153 discount. It was a GE moment for him (We Bring Good Things To Life). Positive attitude always helps, I pondered. "You are very lucky", he blurted". Of course, it was my birthday-how can things go wrong, I blundered! "you came on the right day" he continued merrily, "you got a SENIOR CITIZEN discount", he finished mercilessly. It was a Kellog's Rice Krispies moment for me (Snap, Crackle, Pop).

I thanked the fellow customers for adjusting my angle on the floor from 0 degrees to 90 degrees. As I was witnessing the bright stars that sunny afternoon, I murmured; LG stands for what.....

Pradeep-Bat(tered) Man.

Eureka-An Archimedes Principle That I Experienced.

Travel is a great teacher, so preached my travel agent on the phone, when he noticed that I did not take a vacation for 1 year. I was not sure, if he was a preacher or was my wallet leecher! I suppose, he meant about culture, etiquette, life style, etc. But, I did not know that I would learn about the luggage instead! Having taken 8 suitcases for a 7 day cruise before, we decided to go light this time! How about skipping the lunch before the dream vacation, I thought. When, I peered in to the Expedia booking, it became clear that my airline may charge us for check-in luggage. Hmm! It may cost us whopping $200 just for the luggage. That just made my head lighter. It soon became evident that this lightness may eventually spread to my wallet too! I suggested to Radha, that we should cut our luggage, and not our lunch. She looked at me in amazement at my sparkling intelligence. The sparkle didn’t come from my reflective scalp as she firmly believes that my intelligence only comes in sparks! We completely avoided check-in luggage.

It was certainly a good idea to go heavy with lunch. The airline’s motto seemed very obvious; go-lite with sprite. There were no snacks and not even peanuts, but instead, they provided us with diuretic sodas. I suspiciously looked around to see if I was the chosen one for this new airline program. Non-discrimination - seemed to be their policy too! It was obvious that they were all hell bent upon slimming us before we landed. I was not sure how it helped the air travel though! The immigration authorities however, heartily welcomed the newly slimmed and trim visitors.

I quickly looked around, after we left the airport. It was good that we packed light. There was barely anyone who was fully dressed. It was a beach city, what can we expect! I would be an odd person, if I wore anything above my waist. The dawn’s discomfiture of attire can retire here. However, I was flabbergasted to see that six-pack body was no longer a fashion here. The new trend was-one ROUND PACK. I looked at myself and smiled-I am in vogue too. My daughters can no longer complain that I was old fashioned. I can easily blend with the rest as there would be none to detest or protest my scintillating scalp or bewitching belly-my years of hardly work! I slowly began to wonder, if the local government and the airlines had some mutual understanding to send slim people to balance the bulging population!

We decided to visit a famous underground river and my daughter was fully excited at that very thought. I had a chilling revelation en-route to that tourist attraction. It is not just a sight-seeing venture but a water drenching adventure. The guide described that we have to swim or wade through the entire 1 mile length of the river. The depth varies and could be pretty deep at places. I had cold sweat despite hot temperatures outside. I was oblivious to this fact and was not prepared for this trepidation filled expedition. My swimming skills were mediocre at the best and my situation was akin to a brand newborn baby. Before, he can completely relish the joy of his own birth, he is swiftly welcomed with a rectal thermometer and a painful vitamin K shot in the thigh! I was looking for a good excuse to avoid this welcome gift. Eureka! I did not bring swim trunks. My ecstasy was quickly drowned by my wife’s announcement that she brought one for me.

The water was cold so were my hands and feet. We were provided with life-vests-a mandatory for all the visitors, I believe. Some solace in this hapless situation, I thought. But, I had experience with these life jackets in the swimming pool; I never completely floated. My daughter gave me a lot of encouragement and finally made me enter the waters. I valiantly fought the attempts to drown myself. Fortunately my daughter patiently held me and calmed me down and I waded through the waters. It was underground and hence was dimly lit. I could not gauze the depth and there were no guards to save us and the rest of the group already went way ahead of us. I was a panic stricken chicken! After more than 1 hour of dreadful drenching frenzy, a guard appeared from nowhere and asked how tall I was! Then he coolly said that the deepest part of the river was 5 feet and I could walk the entire length, if I chose to. I realized that there was a serious break down of communication here. With all the energy, I expended, I was sure, I had a year worth of exercise.

We then went for little shopping later, and my wife as quite impressed by an aquamarine necklace waved at her face by an enthusiastic local vendor. He quoted $25 as it had lot of semi-precious looking stones and had a great design. She thought that the price was reasonable. But, I wanted it cheaper and bargained it for $12. We hassled and settled for $15. My wife was once again amazed at the flashes of my brilliance. As we were ravishing our new possession, another vendor walked up to us and showed the exactly same necklace and asked us if we could pay at least $1. We looked at each other and we all shared the same philosophical expression. It was an instant transformation from delight to despair.

Our resort had an infinity pool. The pool was so designed that, it gave an illusion that it was continuous with the ocean. The pool was filled to the brim. Hence, the water in the pool appeared continuous with the ocean waters. I checked the depth of the pool. Hurray! It was only 4 feet. I slowly entered the waters. I did not dare to swim. When I tried in the past, I splashed the water everywhere and I almost emptied the pool. It took a long time to fill it back and I could not face the scorching looks of the deprived swimmers. Once bitten twice shy! I was just standing at the beginning of the pool enjoying the beautiful evening and the fantastic ocean view. Then suddenly two men or twins probably, little more than my size-well! Four to five times my size to be precise just jumped into the pool. Wow! Eureka! I experienced the Archimedes principle- “The weight of the displaced fluid is directly proportional to the volume of the displacing object”, or Any floating object displaces its own weight of fluid.

There was a huge wave of water rather two! An instant tsunami in the pool. The force had such a magnitude; even some of the six footers were drowned by the massive waves. I was thrown on to the pool platform. People were scattered hither and thither. There was pandemonium in the pool. Just as we were recovering from this bedlam, we heard shrieks and cries from the other end of the pool. The wave took a boy over the infinity pool into the overflow collector area. The bottom of the collector had iron drain covers. The force with which, he fell into that, his foot got struck in between the iron rods of the drain cover. The coast guards ran from the beach area perplexed by this unforeseen Kodak moment, and rescued the boy with steel cutters. I think those Hollywood directors were not aware of this simple Archimedes principle and spent millions of dollars to create Poseidon adventure or Titanic. It just took two people in a jiffy and we had a perfect storm. That was the most inexpensive re-creation of tumultuous turbulence.

Phone Pulse Oximetry!

It is not surprising. This apparently works with every phone OS I believe.
http://www.engadget.com/2011/05/19/phone-oximeter-saves-lives-puts-journeys-lawyers-on-red-alert/
ulse oximetry on a cell phone



Pairing pulse oximeters with mobile phones will catapult pulse oximetry from the hospital into non-hospital settings. The inherent computing power of the mobile phone, its peripheral resources (LCD display; audio, serial and USB connectivity), battery power and everyday availability offer the opportunity to create a low-cost stand alone device that can be used by non-specialist healthcare workers and even patients at home. Real-time wireless communication of results to specialists offers another distinct advantage over traditional pulse oximeters. We are developing just such as intelligent mobile device, the Phone Oximeter.
http://www.phoneoximeter.org/the-phone-oximeter/

Long-term Outcome of Brain Structure in Premature Infants: Effects of Liberal vs Restricted Red Blood Cell Transfusions

Participants Magnetic resonance imaging scans for 44 of the original 100 subjects were obtained.

Intervention Liberal vs restricted transfusion.

Main Outcome Measures Intracranial volume, total brain tissue, total cerebrospinal fluid, cerebral cortex and cerebral white matter volume, subcortical nuclei volume, and cerebellum volume.

Results Intracranial volume was substantially smaller in the liberal group compared with controls. Intracranial volume in the restricted group was not different from controls. Whole-cortex volume was not different in either preterm group compared with controls. Cerebral white matter was substantially reduced in both preterm groups, more so for the liberal group. The subcortical nuclei were substantially decreased in volume, equally so for both preterm groups compared with controls. When sex effects were evaluated, the girls in the liberal group had the most significant abnormalities.

Conclusion Red blood cell transfusions affected the long-term outcome of premature infants as indicated by reduced brain volumes at 12 years of age for neonates who received transfusions using liberal guidelines.
http://archpedi.ama-assn.org/cgi/content/short/165/5/443?rss=1
Archives of Pediatrics and Adolescent Medicine

Severity of chorioamnionitis and neonatal outcome

Journal of Obstetrics and Gynaecology Research, 05/11/2011

Sato M et al. - The authors found no significant differences in stages of chorioamnionitis between infants with and without neonatal diseases except for respiratory distress syndrome. A significant inverse relationship was observed between the stage of chorioamnionitis and development of respiratory distress syndrome.
Methods

The authors reviewed the neonatal intensive care unit discharge files and placental pathology reports of 302 preterm infants.
The presence of various stages of chorioamnionitis as well as absence of an association with chorioamnionitis (non-chorioamnionitis) were compared among neonatal diseases.

Results

Preterm infants were grouped according to three stages of chorioamnionitis or the absence of an association with chorioamnionitis.
Gestational age differed significantly between these groups. Before controlling for gestational age, the chorioamnionitis stage was significantly higher among infants with chronic lung disease, retinopathy of prematurity and intraventricular hemorrhage than in infants without these diseases.
The chorioamnionitis stage was lower in infants with respiratory distress syndrome than without.
After controlling for gestational age, the stage of chorioamnionitis was significantly lower in infants with respiratory distress syndrome than in infants without respiratory distress syndrome, whereas, significant differences were not detected between the presence and absence of chronic lung disease, retinopathy of prematurity and intraventricular hemorrhage.
This is a reprint from MDlinx.com

Isolated prenatal choroid plexus cysts do not affect child development

http://onlinelibrary.wiley.com/doi/10.1002/pd.2757/abstract;jsessionid=C19BFABA56741F16859D212540B68474.d01t01
A prospective design was implemented to identify CPC cases and controls in mid-pregnancy. Cases (n = 25) and controls (n = 45) participated in a follow-up visit when children were 18 months of age.
Results

No significant differences were found in any outcome measure between children with prenatal CPC detection and those without.
Conclusion

Findings should provide reassurance to practitioners and parents that isolated CPCs in fetuses with normal karyotypes do not affect child development after birth.

Outcome at 4.5 years of children born after expectant management of early-onset hypertensive disorders of pregnancy

http://www.ajog.org/article/PIIS0002937811002225/abstract?rss=yes
outcome at the age of 4.5 years in 216 children, born after expectant management of severe early-onset hypertensive complications of pregnancy.
Results
Fetal and neonatal mortality was 9% and 8%, respectively. Of the 178 survivors, 149 (84%) were seen for follow-up. Mean GA was 31.4 weeks and 90% were born growth restricted. Abnormal developmental outcome occurred in 20% and abnormal composite outcome in 37%.
Conclusion
Perinatal mortality or abnormal child development occurs in one third of pregnancies with early-onset and severe hypertensive complications and is highest in the lowest GA and BW ranges.

Intubation bot lets doctors safely shove tubes down unconscious human throats

http://www.engadget.com/2011/04/16/intubation-bot-lets-doctors-safely-shove-tubes-down-unconscious/
Dr. Thomas M. Hemmerling from McGill University Health Centre (who also helped develop the McSleepy anesthetic android) has created the world's first intubation robot. Called the Kepler Intubation System (KIS), it's a robotic arm with a video laryngoscope that's controlled via joystick -- allowing MDs to slide an endotracheal tube into any with minimal fuss and maximum safety.

Antenatal Steroids for 22-23 weeks gestation

http://www.jpeds.com/article/S0022-3476%2810%2901151-0/abstract
a retrospective analysis of 11 607 infants born at 22 to 33 weeks of gestation between 2003 and 2007 from the Neonatal Research Network of Japan.
Cox regression analysis revealed that ACS exposure was associated with a significant decrease in mortality of preterm infants born at 22 or 23 weeks of gestation (adjusted hazard ratio, 0.72; 95% CI, 0.53 to 0.97; P = .03). This effect was also observed at 24 to 25 and 26 to 27 weeks of gestation and in the overall study population.
Conclusions

ACS exposure improved survival of extremely preterm infants. ACS treatment should be considered for threatened preterm birth at 22 to 23 weeks of gestation.

Antibiotic Exposure in the Newborn Intensive Care Unit and the Risk of Necrotizing Enterocolitis

http://www.jpeds.com/article/S0022-3476%2811%2900238-1/abstract
Results

One hundred twenty-four cases of NEC were matched with 248 control subjects. Cases were less likely to have respiratory distress syndrome (P = .018) and more likely to reach full enteral feeding (P = .028) than control subjects. Cases were more likely to have culture-proven sepsis (P < .0001). Given the association between sepsis and antibiotic use, we tested for and found a significant interaction between the two variables (P = .001). When neonates with sepsis were removed from the cohort, the risk of NEC increased significantly with duration of antibiotic exposure. Exposure for >10 days resulted in a nearly threefold increase in the risk of developing NEC.
Conclusions

Duration of antibiotic exposure is associated with an increased risk of NEC among neonates without prior sepsis.

RBC Transfusions and Extension of IVH!!

http://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2011.03081.x/abstract;jsessionid=77A09B82CD7BD12A05826302C638022C.d01t03

Red blood cell transfusion of preterm neonates with a Grade 1 intraventricular hemorrhage is associated with extension to a Grade 3 or 4 hemorrhage
Vickie L. Baer
RESULTS: Grade 1 IVH was identified in 417 neonates; 24 subsequently became a Grade 3, and 22 a Grade 4. These 46 were born earlier, 25 ± 2 weeks versus 30 ± 3 weeks (p = 0.000), with lower birth weight, 811 ± 284 g versus 1432 ± 603 g (p = 0.000); lower 5-minute Apgar scores, 5 ± 2 versus 8 ± 2 (p = 0.000); and slightly lower cord pH, 7.24 ± 0.16 versus 7.28 ± 0.10 (p = 0.009). Older gestational age was the most significant contributor lowering the odds of IVH extension (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.98). Administering a red blood cell (RBC) transfusion up to and on the day the Grade 1 was detected was the most significant contributor increasing the odds (OR, 2.92; 95% CI, 2.19-3.90) of extension. In both groups (resolving vs. extending) criteria for ordering transfusions were similar as was the proportion of transfusions given out of compliance with guidelines.

Conclusions:An association exists between RBC transfusion and extension of a Grade 1 IVH into a Grade 3 or 4. However, the explanation is unclear and could involve either the reasons transfusion are ordered or the transfusions themselves. Additional studies are needed to discover why neonates are more likely to have IVH extension if transfused.

NeOProM

NeOProM: Neonatal Oxygenation Prospective Meta-analysis Collaboration study protocol

http://www.biomedcentral.com/1471-2431/11/6
I am just presenting the summary of evidence as of now. Very interesting though!
In the Benefits of Oxygen Saturation Targeting (BOOST) trial , 358 infants born at less than 30 weeks' gestation were randomly assigned, from 3 weeks or more after birth until they breathed air, to target a SpO₂ range of either 91-94% or 95-98%. This trial found no evidence that higher SpO₂ targeting improved growth or development, but it did increase days of oxygen therapy and use of health care resources.
In a more recent cohort study, Tin et al that lower SpO₂ correlated with improved short term respiratory and growth outcomes in infants born at less than 28 weeks' gestation.
Babies in the neonatal intensive care units (NICU) targeting SpO₂ 70-90% had ROP surgery less often than those in the NICUs targeting SpO₂ 88-98% (6.2% v 27.2%, 80% relative risk reduction (RRR), p < style="color: rgb(153, 102, 51); font-style: italic;">ventilated less often (13.9 v 31.4 days), fewer needed oxygen at 36 weeks' postmenstrual age (18% v 46%, 61% RRR), and fewer were below the 3rd centile for weight at discharge (17% v 45%, 62% RRR) (all p <>v 53%) and cerebral palsy (15% v 17%) at one year were similar.

Long-term effects of routine morphine infusion in mechanically ventilated neonates on children’s functioning: Five-year follow-up of a randomized controlled trial.

http://www.painjournalonline.com/article/PIIS0304395911001266/abstract?rss=yes
conducted a follow-up study among 5-year-olds who, as mechanically ventilated neonates, had participated in a placebo-controlled trial on effects of morphine administration on pain and neurologic outcome. They were now tested on intelligence, visual motor integration, behavior, chronic pain, and health-related quality of life.
scores on one IQ subtest, “visual analysis,” were significantly negatively related to having received morphine and to open-label morphine consumption the first 28days. The finding of a significant effect of morphine on the “visual analysis” IQ subtest calls for follow-up at a later age focusing on the higher-order neurocognitive functions.

2) Lactobacillus reuteri accelerates gastric emptying and improves regurgitation in infants

http://www.ingentaconnect.com/content/bsc/ejci/2011/00000041/00000004/art00010
European Journal of Clinical Investigation, Volume 41, Number 4
Thirty-four infants completed the study (19 infants receiving probiotics and 15 placebo).At baseline, the whole group of infants was similar to the control group as regards anthropometric and physiological data. The median fasting antral area was significantly reduced, (P = 0·01) the delta in gastric emptying rate was significantly increased (P = 0·01) and the median episodes per day of regurgitation was reduced (, P  < 0·001) in the probiotic group compared to the placebo group. In the whole group, the frequency of regurgitation and the basal antral area showed a positive correlation (r = 0·53, P = 0·004). Conclusions  In infants with functional GER, L. reuteri DSM 17938 reduce gastric distension and accelerate gastric emptying. In addition, this probiotic strain seems to diminish the frequency of regurgitation.

Prevalence of Congenital Heart Disease Assessed by Echocardiography in 2067 Consecutive Newborns

http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2011.02248.x/abstract

Acta Paediatrica

Methods:  A cohort screening study was conducted in an unselected series of all live-birth newborns. Two-dimensional and color Doppler echocardiography was performed at 0 to 4 days of life in 2067 consecutive neonates who were born at the Hamamatsu University Hospital, Japan, between May 2005 and April 2010.

Results:  There were 104 cases of CHD in the 2067 live births. Ventricular septal defect and patent ductus arteriosus were the most frequent cardiac abnormalities. The prevalence of newborns with CHD who had signs or symptoms of CHD and/or required invasive intervention was 21.3 per 1000 live births. However, 60 patients (29.0 per 1000 live births) with CHD were asymptomatic and did not need invasive intervention. The overall prevalence of CHD in this series was 50.3 per 1000 live births.

Conclusion:  This prospective study using echocardiography for all newborns shows a higher prevalence of CHD than almost all of the previous studies.

http://www.springerlink.com/content/l82373354314746j/

Accuracy of Cardiac Auscultation in Asymptomatic Neonates with Heart Murmurs: Comparison Between Pediatric Trainees and Neonatologists

The overall ability of pediatric trainees in identifying congenital heart disease (CHD) was moderate [area under the curve (AUC) = 0.855] and significantly lower compared to neonatologists (AUC = 0.919, p = 0.007). However, at “lower” levels of clinical confidence (i.e., clinical diagnosis of possibly pathologic murmurs), pediatric trainees had good ability in excluding CHD (sensitivity 94.6%; negative likelihood ratio = 0.09). The ability of cardiac auscultation for diagnosing CHD in asymptomatic neonates is limited and dependent on the physician’s experience and level of clinical confidence. Echocardiography should remain an option for all neonates with a possibly pathologic murmur.
Bottom Line: If you are in a place where echocardiogram is not readily read by the pediatric cardiologist, then you may record it with Littman's stethoscope (Digital) and email it. Studies have shown that one can reduce the echiocardiograms being done to rule out a pathjological murmur.

How should an ideal spouse be in this digital world?

This analysis is based on real life observations. On the Valentine’s Day, I followed the tradition of buying flowers for my spouse. The flower’s tradition was followed by traditional I love you expression. She was ecstatic and very much appreciated what I did. Her feelings were genuine. It wasn’t long ago, that I had an argument with her about not replacing my pen, after she was done with it. Though the issue was trivial, it ticked me off. I rebuked her, but, she explained that as she was busy making dosas (Indian Pan cakes) and hence she could not get to it. I realized that she was trying to write a new recipe, when the dosa needed immediate attention. I was still piqued that I could not find my pen in time, discounting any credit that she rightfully deserved for trying to make the family happy with new dishes and giving us a break from the monotony. But, I wanted her to be perfect!

It was then my friend rang the bell and I gave a break to my sour feelings. He was craving to see my new HP Slate 500, my pride new possession. My mood changed swiftly from sour feelings to soaring spirits. I began to demonstrate with exhilarated eagerness all the hardware options it came with (USB port, two cameras, SD card slot etc.) unlike the Ipad. He was fired up by now and I could see the verve and sprightliness in his face. He earnestly asked if it has any apps! I smiled and showed with renewed vigor the Intel’s appup center and some free apps especially for tablet pcs. I double clicked on the Unit Converter app. It was a bit slow to open up. Alas! It took no time to shake his head and deliver his spirit smothering verdict-It is Windows! He completely discredited all the alluring attributes; it possessed but was irked by one app, which was sluggish! Before, I could react to his irrational judgment; I was paged to attend a cesarean delivery. I was baffled by his attitude. He out and out disparaged its worthy attributes and swayed in to negativity by one small inconsequential application.

After, I was done with the C-section, the resident was earnestly waiting to show me his new Iphone4. He was revved up and showed many of the features, which I was already familiar with. He further wanted to impress me with CNN app. Alas! It did not open despite multiple taps. He immediately switched to show me the text to speech option. The moment it initialized, it began speaking after every tap he made on the Iphone. “safari”, “address bar” www.google.com “oil companies”. It opened up the page, he wanted to scroll down and tapped on the bottom of the page-“screw your” it spoke as they were the last words on the screen and he was touching that part of the screen to scroll. There was no scrolling, but it again announced unabashed “screw your”. He was unperturbed and tried again, “screw your” spoke repeatedly to turn other people’s faces in dismay. Another Iphone owner came to his rescue and suggested that he should use 3 fingers to scroll, when text to speech was app was active. Finally, we all heaved a sigh of relief.

But, I was shocked, as he continued-“look at this operating system, why will I ever go for any other smartphone, when this is so outstanding!” I was bewildered by the opposing attitudes of Microsoft and Apple fans. One was focused on the negative trait, however petty it was, and the other on the positive attributes solely. It then dawned upon me that my own behavior was not much different from my friend who was disappointed by one dopey app, since all he wanted was a perfect operating system, which probably does not exist. I was also so focused on petty inconsequential aspect of my wife that for a moment, I completely ignored the larger positive side of my spouse. My reaction to my friend’s judgment is in many ways akin to how our spouses feel about us when we express our intolerance to their short comings, ignoring everything they do for us.

What, if we adopt the attitude of this Apple fan in real life, which was so focused upon what the Iphone did for him on the whole, ignoring the aberrations? We will probably remain happy and take care of our spouses giving them their due appreciation and regard. Though this won’t sway me to become an Apple fan will make me a fan of an Apple fan!

211 G to A Variation of UDP-Glucuronosyl Transferase 1A1 Gene and Neonatal Breastfeeding Jaundice

http://journals.lww.com/pedresearch/Abstract/2011/02000/211_G_to_A_Variation_of_UDP_Glucuronosyl.14.aspx

The uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1) gene polymorphism was shown to contribute to the development of neonatal hyperbilirubinemia. We hypothesize that the variation of UGT1A1 gene may contribute to neonatal breastfeeding jaundice. We prospectively enrolled 688 near-term and term infants who were exclusively breastfed (BF group) or were supplemented by infant formula partially (SF group) before onset of hyperbilirubinemia.

Neonates with nucleotide 211 GA or AA variation in UGT1A1 genotypes had higher peak serum bilirubin levels and higher incidence of hyperbilirubinemia than WTs (GG). This phenomenon was only seen in BF group but not in SF group when subset analysis was performed. This suggests that neonates who carry the nucleotide 211 GA or AA variation within coding region in UGT1A1 gene are more susceptible to develop early-onset neonatal breastfeeding jaundice.

Milking Compared With Delayed Cord Clamping to Increase Placental Transfusion in Preterm Neonates: A Randomized Controlled Trial

http://journals.lww.com/greenjournal/Fulltext/2011/02000/Milking_Compared_With_Delayed_Cord_Clamping_to.2.aspx
Methods: All delivered before 33 completed weeks of gestation. In this single-center trial, women were randomized to either standard treatment (clamping the cord for 30 seconds after delivery) or repeated (four times) milking of the cord toward the neonate.
Results: Mean birth weight was 1,263±428 g in the clamping group and 1,235±468 g in the milking group, with mean gestational age of 29.2±2.3 weeks and 29.5±2.7 weeks, respectively. Mean hemoglobin values for each group at 1 hour after birth were 17.3 g/L for clamping and 17.5 g/L for milking (P=.71).
median number of transfusions within the first 42 days of life (median [range]: clamping group 0 [0–7]; milking group 0 [0–20]; P=.76).
My Point: We need to assess how much time was spent in milking and if associated chorioamniobnitis is an issue and if IVH incidence is different.

Oseltamivir-NICU experience

http://www.nature.com/jp/journal/vaop/ncurrent/full/jp2010159a.html
About 11 infants were treated for H1N1 and 21 were prophylaxed with Oseltamivir.
Age ranged from 2 days to 11.4 months (mean, 2.1 months). Corrected gestational age and weight at initiation of oseltamivir ranged from 32 to 86 weeks (mean, 41 weeks) and 775 to 8635 g (mean, 3074 g), respectively.

Conclusion:

Oseltamivir appears to be well tolerated in preterm and term neonates and infants with complex underlying conditions. More studies are needed to determine optimal dosing for treatment and prophylaxis in this vulnerable age group.

Levetiracetam in Neonatal Seizures

http://jcn.sagepub.com/content/early/2011/01/06/0883073810384263.abstract
Published as a retrospective study from CHOP, Philadelphia in Journal of Child Neurology. Twenty three neonates were given levetiracetam in a dosage of 16mg/kg +/- 6mg/kg.
Levetiracetam was associated with a greater than 50% seizure reduction in 35% (8 of 23), including seizure termination in 7. Further study is warranted to determine optimal levetiracetam dosing in neonates and to compare efficacy with other antiseizure medications.

RBC Transfusions & Severe IVH!

http://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2010.02980.x/abstract

RESULTS: Fifty-four cases were matched (1:2) with controls. No differences were found between cases and controls in initial pH, sepsis, ventilation, coagulation studies, or proportion with severe thrombocytopenia. However, during the period when the head ultrasound was normal, cases were more likely to have had a red blood cell (RBC) transfusion (p <>

CONCLUSION: These findings suggest a new hypothesis. Namely, RBC transfusions given before the development of an IVH are an independent risk factor for developing a severe IVH.

Point: One more reason to be mindful of what we do in the first week of life. This study does not mean that we have proved transfusions lead to IVH. But, it makes us pause and ponder of what we do so routinely.

Early Opioid Infusion and Neonatal Outcomes in Preterm Neonates ≤28 Weeks' Gestation

https://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0030-1270112
A retrospective analysis of preterm infants ≤28 weeks' gestational age (GA) admitted to neonatal intensive care units in the Canadian Neonatal Network was conducted comparing infants on the basis of receipt of opioid infusion during day 1 and day 3 after birth.
A total 362 infants received opioid infusion on day 1 and day 3, whereas 4419 infants did not receive opioid infusion.

Neonates who received opioid infusion had higher risk for mortality (adjusted odds ratio [AOR] 1.57, 95% confidence interval [CI] 1.13, 2.18), severe neurological injury (AOR 1.63, 95% CI 1.30, 2.04), severe retinopathy of prematurity (AOR 1. 39, 95% CI 1.08, 1.79), and bronchopulmonary dysplasia (AOR 1.36, 95% CI 1.03, 1.79). Early exposure to opioid infusion in the first 3 days was associated with higher risk of adverse outcomes in extremely preterm infants.
POINT: Narcotics are known to produce apoptosis of neurons in animal models. So, ask yourself-do we need to give it today and if so, why? Everything we d, can affect the outcomes, so be judicious!

BP recording dock for Iphone/Ipad

http://www.ihealth99.com/video1
This is cool neat device, with which you can not only record the BP but share it with your doctors or well wishers. I believe it costs about $99.