Sweden

Hi I´m a swedish nurse and would be glad to help, but I do need a little more information. Anna

Our policy regarding UAC/UVC is that we (the nurses) have to ask the doctor the first time. If they have been up once usually all restrictions are gone. Right now one of the staff is holding one of the babies with UAV and UVC trying to keep the baby calm (and accept the CPAP). I have never seen a UAC/UVC pulled by accident and here parents usually do the lifting themself! All research shows that babies (including Anna

Our limits are 80-95 for all babies with oxygen. We are very cautious to increase (or decrease) oxygen. We have a low incidence of ROP. I can have a baby with sats of 20 and still not increase oxygen. If he/she is on CPAP and not breathing what´s the point....Lots of babies on ventilator are up and down all the time and oxygen levels usually doesn´t change that much... Anna

We usually start their first feedings within 2 hours of birth (regardless of gestation age) and advance as tolerated. Most are on full feeds within a week ( We have a low incidence of NEC in Sweden so it seems to work.... The 22 weeker (520 g) I´m taking care of right now is 5 days and on full feeds since yesterday..... Anna

Hi I´m sorry if this is a dumb question, but why are you bagging when you are suctioning. When do you do it (before / after)? I´m a nicu nurse here in sweden and we never use bagging in conection to suctioning, but maybe it´s different with older children? We try to use two persons for suctioning (except in extreme emergencies) simply because it cuts down the time the baby is without his/her ventilator. It also gives an extra set of hands to calm and support the baby. We don´t use RT´s here so it´s usually two nurses doing it. We don´t use in-suctioning in my unit and we only use clean gloves (not sterile) and then keep the catheter sterile. Anna

We use bank milk for all premature children and for lots of surgical kids. We even give it rectally to stimulate the intestine for thoose with "short gut"! They usually stay on donor milk until mum can keep up with the supply/demand. About 90% of our kids from the neonatal unit are breastfed at discharge and never recieve anything else than breastmilk! Parents have to give their consent but I haven´t met anyone that said no after hearing the benefits... Anna

Hi Suzanne Can someone use the H1B visa if they do have work experience (I have worked NICU for almost 8 years), relevant license and VS? Does the job have to differ from other staff nurse positions? My transcript papers from my nursing school (3 years general + 1 year pediatric) says Bachelor of science in nursing, but would they need to be further evaluated (CES?)? My I-140 is in (Jan 2007) and I have no intention of breaking any contract, I`m just trying to see if there are options.... My employer states on their website that H1B is a possible route to take and that they are non-cap. I don´t want to approach them about this before I have some more information. Anna:confused:

KMC = Kangaroo Mother Care

I seriously doubt that, what about all rest the of the patients in the hospital. I´m just guessing, but I think they get food served to them......... We allow the parents to eat in the ICU area as long as they don't do it during KMC (not that many do). In the private rooms (were babies and parents stay) it´s up to them to decide how to handle food. Anna

:redbeathe Happy birthday! I hope you will have a wonderful day! Anna

1) For premies, when do you start feeding them? Day 2 or 3? I know that if you feed them starting day 1, they can get NEC. In the meantime, do you start TPN? Or is TPN only if the baby is going many days without eating? What kind of IVF do you like to use? D10W + NS or 1/2 NS, + KCL, + Ca? - We start feedings within 2-3 hours of birth, D10 and/or TPN is started as soon as possible (if the baby isn´t on full feeds from the start ofcourse). When you start to feed premies, do you have to slowly advance it, or do you just immediately give them feeds that would have them at 100 kcal/kg/day? - Some are full feeds right away (usually GA > 30 weeks), others advance their feedings as soon as they tolerate it. 2) How much spit up do you tolerate before you decide that either medication or NG tube needs to be used? Do you not care as long as they arent aspirating, brady, apneic, choking, and gaining weight appropriately? - We tolerate spit up as long as the baby otherwise is doing ok and gaining weight (spit up is ok, puking all the time isn´t). Medications for gastric reflux is really uncommon, we don´t see much gastric problems. 3) Do all/most premies get OG/NG even if they have no feeding/airway issues? - No, we try to avoid OG/NG tubes if it´s not absolutely necessary. 4) How do you adjust feed schedule if the baby is on a vent? - Vented patients are fed the same way as all others (bolus fed every 2 hours). The ventilator is not a considered much of a factor when deciding feeding. 5) How much weight is a baby supposed to gain each day? Like 10g or so? - That entirely depends on the baby (GA, condition, current weight and so on). 6) When you start human milk fortifier? Only if the baby has had several days of BM with poor weight gain? Or does every premie get HMF regardless of their weight gain? - HMF is usually started after about 2-4 weeks if he/she isn´t gaining enough weight on just breastmilk (we can go up to 220 ml/kg/day depending on baby´s condition). 7) All these babies are supposed to lose weight for at least the first week regardless of what you feed them, correct? - All babies loose weight, we try to keep it Anna

Neonates are an entirely different patient group and the same rules don´t apply.... Some of my patients make regular desats down to 10 (sats) and we watch and just stand back and wait for them to recover again. Doing somehing, anything, even just opening the incubator doors only means that the baby will take longer to recover. To stand back even if the patient is doing poorly is one of the hardest lessons one needs to learn doing neonate care. It doesn´t mean that I don´t care about it, I still do an assesment and try to decide the moment when this isn´t ok anymore. Some babies go from 97 to 15 to 96 in just a few minutes, disturbing them just means they will stay longer in the lower range. Sorry, didn´t mean to hijack the thread.. Anna

We recently had a 18 month toddler (born after 24 weeks, still ventilator dependant) but I do think we hold the record for the oldest "child" because we had a boy here for 20 years. He was home during the day,went to regular school but since he had a syndrome that made him ventilatordependant when he slept he came to the unit to sleep.

It´an amino acid mixture (with all 18 essential and non-essenseal amoni acids required for protein synteses), where the propotions tries to mimic the content of breastmilk (includes taurin as well). It´s a way of giving the baby more protein and to use all iv fluids for nutrition. Works just like amino acids in regular food but since it´s given directly into the systemcirkulation it gets to skip absorbtion through the bowel and bypasses the liver. Anna:typing

We use a mix with Vaminolac and water in all our arteriall lines, umbilical or peripherial. Heparin is never used in my unit. Umbilical lines are cleaned wih NS for a baby under 30 weeks, for all others it´s chlorhexadine. Anna

I don´t think there is a hospital in Sweden that has a nursery, it´s all couplet care. All hospitals allow someone (usually dad and siblings) to stay and help mother and child. Dad gets 10 days paid leave from work to be there for his new familymember. I find it hard to believe that the baby would get the opportunity to feed whenever he/she wants to if they don´t have mom near 24/7 (but I could be wrong.....). Babies at my hospital all sleep with their parents, babybeds are only given to thoose that actually ask for them. If the baby has any kind of problem (hypoglyc/respiratory) they do Kangaroo mother care 24/7. Anna

The parents usually do the daily wash, not the weekly (where everything is taken apart and scrubbed). Most of them see this as something useful to do, we don´t force anyone to do it.... The baby with mold was a extremely sick and tiny 23 weeker, so bathing wasn´t exactly our first priority..... Anna:nuke:

No rings of any kind (germs do not know the difference between a wedding band and another ring). This applies to both staff, parents and visitors. Isolette covers are changed daily along with everything else around the baby. Isolettes are changed weekly but wiped down inside and out daily. Usually one of the parents wash and change everything when the other parent do KMC. It used to be a big pain with changing everything daily since it had to be not only washed but also ironed once dry...... Takes forever to iron an isolette cover not to mention everything else! Now we have a special dryer that heats the fabric enough to kill the germs. Our unit has changed a lot regarding fabric care since we sent samples to infection control. There were LOTS of germs growing on the sheets and other things close to the baby, even if it was just washed. One baby actually had mold growing on her back, and that was the thing that started the whole investigation....... Anna

Yes, she´s in the Lancet, Acta Paediatrica, Br Med J and Pediatrics. She´s one of the most respected when it comes to KMC research. Anna

I love seeing parents realise that they have actually become parents, that the baby in their arms are inded their child! Traditional care of premature/sick babies usually delay the process a bit, it must be harder if you don´t get to hold your baby. But a few nights ago I admitted 29 week twins (c-section) and got the opportunity to put both babies in their fathers arms within 10 minutes of birth. They went down to the nicu still clinging to dad and his face was lit up with the biggest smile I have ever seen. They both ended up needing CPAP, iv´s, bloodsamples and iv medicine´s, but everything was done with them on dad! He slept with his children on his chest and never left the unit..... Two days later they are off the CPAP and the whole family are together in a private room. I love kangaroo care!!!:redbeathe Anna

Hi Try searching for articles by Nathalie Charpak, she´s written several good articles. Anna

Best christmaspresent is a giftcertificate for around 20 dollars (could be used at a variety of different department stores). This year my hospital is celebrating 300 years and we were told we would be getting a present that was a combined christmas/hospital 300 year gift. We didn´t get it by christmas since the production in Italy was delayed and everyone´s expectations just rose even higher... A better present made in Italy, it sure sounded nice... This week we finally got it, but when I opened it I didn´t know quite what to say. I couldn´t even see what it was suppose to be used for. It´s two small spoons made out of silver (maybe it was suppose to resemble an old medicine spoon) ! They are worth somewhere around 140 dollars but I can´t see myself using them much...... Anna

To get your ATT, be able to sit for NCLEX and then recive your RN licence in CA all hours must be covered on a official school transcript. Hospital courses / work experience will not be accepted by the BON. Suzanne, one of the moderators in the international forum is an expert and might be able to give you more information (possible schools). Anna Ps. If you are talking about a midwife licence, just ignore my post and do a search since I know it has been discussed before.

1st European Conference on the Kangaroo Mother Care method 6-7 October 2008 Uppsala, Sweden Main topic: Why KMC in a high tech setting? Target group for the conferenceare persons involved in maternal and child health care, perinatal, neonatal, and pediatric care, and peer counsellors - irrespective of profession. Key note speakers: Nils Bergman, South Africa Nathalie Charpak, Colombia Melvin Konner and Susan Ludington, USA Kerstin Ulvnäs Moberg and Ann-Marie Widström, Sweden 7th International Workshop on Kangaroo Mother Mother Care 8-11 October 2008 Uppsala, Sweden Target group: Persons, involved in clinical work, education, administration or research - irrespective of profession. The number of participants is limited to 100 and will be distributed between countries to obtain optimal distribution. Workshop goals: To discuss obstacles to and possibilities for KMC in high tech settings as well as in settings with limited resources, and the revised WHO guidlines for KMC, currently under preparation. :welcome: to Uppsala, Sweden For program and further information see: www.akademikonferens.uu.se/KMCeurope08 email: [email protected]

Thank you for the extremely fast response to my question, where else can you get an answer within 5 minutes! The agency is sending me all the papers this week since I´m the one paying the visa fee. I can´t see what they would win by lying to me but I guess I will find out what´s going on this week. I certainly hope things will start to move forward, I can´t wait to get to california! I actually found some numbers about immigration sweden-usa and it seems to be under 300/year, so I guess you´re right....... Anna