Internet Access Issues

Just a note to let everyone know that I have not fallen off the planet, even though we are on the bottom half, we are well stuck on. No internet access at the last place, and none next week either. I will restart the postings as soon as I have reliable access.

 

See you all soon!

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Not neonatology: the antipodes week 5. Te Anau, Mount Luxmore, and the Otago peninsula

We moved on again last week, spent a few days at Te Anau, which is just east of fiordland, in the southern part of the south island. From here we were able to go on a trip to cruise on Doubtful Sound, a long beautiful fiord which we cruised right to the ocean (to encounter Fur Seals, dolphins and albatross) and back.

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Doubtful Sound

The next day  we decided to hike the first, steep, part of the Kepler track. New Zealand is a great place for walkers, there are a number of Trails and Tracks which are very well maintained and signposted, and pass through glorious scenery. Several multi-day walks are now famous, including the 4 day Milford Track, which is usually very wet, and not recommended for children, and the 4-day Kepler track. This is a loop track of about 60 km total, which has 3 huts along the trail for overnight stops. It is actually a track which was designed as such from scratch, compared to most which have gradually developed over the years from the walking trails of multiple earlier hikers. The first part of the track is quite steep, rising about 900 metres in the first 8 kilometres, up to the Luxmore hut. We decided to do this first part of the walk with the kids, after crossing the lake in a boat to miss out the first 8 km from the town to the start of the climb, planning to walk the whole track back to the town when we got back down the slope.

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View from the summit of Mount Luxmore

After our lunch at the Luxmore hut we decided that it would be a shame to miss the last part of the climb to the actual summit of Mount Luxmore, so we decided to add the “little” extra to our hike. After a short, relatively, flat section the track started to climb again, with about another 300 meters up over a 5 km section of the track, ending with clambering over broken rocks to reach the summit at 1471 metres, having started the day at lake level, about 270 metres.  The views were glorious, and we were all feeling proud of ourselves, but it was maybe a mistake in the end, by the time we got back down the mountain and walked around the lake, we had covered over 31 kilometers in the day, which is the equivalent of completing the difficult half of the Kepler Track, in one day, with kids aged 7, 9 and 11 years old! The kids were exhausted, as you can see the picture at the end of the post on Violette’s blog, but they were all very proud of having climbed to the peak, and of covering such a long distance.

At the end of the week we moved on to Dunedin, to a house on the Otago peninsula.

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Otago Bay, from our window

With this great view over the Otago bay. The peninsula has some interesting easy walks (to compensate for Mount Luxmore) with great widlife viewing opportunities, including the only mainland nesting site of an albatross. The Royal Northern Albatross nests on the tip of the peninsula for the last 80 0r or so years, and you can also see Little Blue Penguins, and New Zealand Sea Lions. Getting close to abatross was great, they are huge, although not the biggest of the albatross apparently.  Here is one in flight, close to a gull, which I think was a black backed gull, already a very large bird.

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Albatross and Gull

We hadn’t been sure about the part of our trip, visiting the Otago peninsula, but in the end the visits to Dunedin (the Museum and the Cadbury chocolate factory being hits with the children) and the walks, with and without wildlife encounters, were really worthwhile.

I have been experimenting a bit with HDR photographs, here are 2 that I think were succesful, both from the region.

boat hut otago peninsula

Hooper’s Inlet, on the Otago peninsula

 

seal beach otago peninsula

Allans Beach

 

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Not Neonatology: Baby Birds! Aaaah..

Some of you may recently have seen a partially completed blog post, that accidentally got emailed out to people. It was actually a draft of a post for my son’s blog (I should add that apparently what Axel photographed as a Yellowhead is actually a Yellowhammer) . He and Violette are both intermittently blogging about our trip. Their blogs are at Tentacules.blog.com and at Violettebj.blog.com, Tai also supplies blog posts for Axel’s blog; he has been the most productive with his drawings of his favourite activities each day, accompanied by a text that he writes himself.

So, for anyone who likes bird pictures, here are a few of my own to satisfy your cravings. We have been lucky enough to be here when many birds are raising chicks, and have seen quite a few examples, starting with this stilt, whose baby is on the other side of the stream.

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This Variable Oystercatcher got quite noisy and agitated if you got too close to her (him?) and her chick.1-IMG_4425

The Red-Billed Gulls had many chicks in their colony1-IMG_4526

Yellow-Eyed Penguins are critically endangered; this was taken in a protected habitat. The chicks should soon fledge and set off on their own.1-IMG_4640

This is a juvenile Caspian Tern, who was being watched by a parent, who was about half a metre away. UPDATE* this is apparently a White-Fronted Tern, not a Caspian, thank you Brian Darlow, for the correction, and also for helping increase my lifetime list by one!

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And this pair of pretty Australasian Crested Grebes and chick were seen on lake Alexandrina, the chick has a zebra striped head and is soooo cute.

crested grebe baby

This ungainly, but attractive bird is a Pukeko, its chick is in the long grass in front of it:1-IMG_4998-001

here is a close-up:

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All the birds above are native New Zealand species, I will end with an introduced bird, the California Quail. Many birds have been introduced for reasons that aren’t clear to me, who would bother introducing House Sparrows or Starlings? Quail chicks can’t help their origins though, I suppose, these were being shepherded by their parents.

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Shining a Light on Brain Oxygenation

A few years ago I was at a conference, where Gorm Greisen made a comment, after a talk I had given, that we really needed RCTs of new monitoring techniques, and specifically NIRS. Proving that a new technique actually improved outcomes was the best way to show that it was actually measuring something important, and that responding to the monitor was a good thing to do.

I admire people who will make comments like that, and then follow through on them.

A publication from a multi-center European group, led by Gorm, has accomplished the first stage of this evaluation. About 160 very preterm babies all had NIRS devices in place over the first 72 hours of life, they were randomized to either have the results displayed to the care staff, or hidden until the end of the study. The primary outcome was the percentage of time spent outside of the target range of 55-85%, which is thought to be a safe target range, based on prior data from some of the investigators. Having the NIRS data available reduced the out of range (and particularly the hypoxia) periods dramatically.

It is not immediately clear to me from this publication exactly what the investigators did when the NIRS was too low (or too high). But another publication includes the treatment algorithm, which includes suggestions of what to do when the the cerebral oxygen saturation is below 55% or above 85%. You could argue with some of the details of the responses suggested, but in general they seem reasonable.

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It seems therefore from this excellent trial, that knowing the value of the cerebral NIRS derived oxygention can help to stabilize the value within what are thought to be appropriate ranges. Hopefully the next stage in this evaluation will be to prove that this affects clinically important outcomes, in this trial mortality and severe brain injury were both less frequent in the NIRS visible group, but the differences, although large in relative terms, could well have been due to chance. A larger study focussed on these complications, with long term follow up, is now really needed, more than ever.

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Not neonatology: the antipodes week 4, Queenstown, Ben Lomond, and glenorchy

After our time in the geothermally active centre of the north island of New Zealand, we have now changed island. Queenstown is on the shore of Lake Wakatipu, we were there for new years eve and fireworks over the lake, and were fortunate enough to have rented a place with a glorious view.

wakatipu sunset

We celebrated the new year with a hike up to the peak of Ben Lomond. The track leaves from Queenstown, which is at an altitude of about 300 metres, but you can take the first part on the gondola, up to about 800 metres. Then a fairly vigorous climb up to 1748 metres. The kids were finding it a bit tough at 1525 metres, so we stopped at an outcrop for a snack, then I carried on to the summit while they started the walk back with Annie.

Ben Lomond kids

The view from the top was stunning, with the New Zealand Alps and lakes laid out below.

Ben Lomond peak

Towards the end of the week we went to the north end of lake Wakatipu, to a village called Glenorchy, where there is a nature reserve, and a splendid view over to moutains topped with glaciers. Glenorchy

 

 

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Je Suis Charlie

I am horrified by the atrocity in Paris. Freedom is under attack. The best response I have read so far is a blog post in the Spectator by Alex Massie. And the many thousands of people who have congregated in demonstrations in squares around France.

In response to his own question: “What can we do?” Alex Massie answers like this :

Only, perhaps, this. We can hold the line. We can make our stand, a stand for liberalism and reason and liberty and we can hope – however flickeringly – that this will, in time, be enough to prevail.

Je suis Charlie? In truth, I don’t know about that. I hope so. But, really, I don’t know if enough of us are Charlie Hebdo just as I know too few of us were prepared, 25 years ago, to say I am Salman. But there is no longer either the time or room to hide. If you were not Charlie Hebdo yesterday it is time, today, that you were.

That’s our faith. Here we stand. For otherwise what – and who – are we?

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Very early caffeine

Some caffeine before getting out of bed would be handy sometimes, but our new publication, using data from the CNN, that I was involved in, was actually looking at caffeine us in the preterm baby, early during their lives.

We were trying to confirm if the effects of caffeine early in the life of very preterm babies during actual use in the NICU, would reflect the results of the CAP trial. So we examined the outcomes of babies who had caffeine in the first 2 days, compared to caffeine use later in life. There are of course risks of doing this sort of analysis, babies who get caffeine in the first 2 days may be quite different to those who start the drug later, so we corrected the analysis for all the variables that we thought might be important. Babies who received caffeine earlier were indeed more likely to survive without BPD, and less likely to have a diagnosis of a PDA.

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