raviagarwal

No, I would not do ET

I generally follow NICE guidelines for exchange and don’t do split bilirubin, during first 96hrs.

I think 0.18% saline is available and would be a better choice in ELBW infants.

Interesting and a little challenging case! High TLC is difficult to ignore but studies have shown that high TLC is not very sensitive/specific marker of neonatal sepsis (not as useful as leukopenia is). It would be useful to know serial inflammatory markers (CRP etc). Also, I wonder why CSF was done (symptomatic baby or part of routine sepsis work-up etc). What is CSF red cell count as that can change the CSF picture. Obviously herpes is ruled out as -ve PCR. It is interesting to see CSF white cells count (0) on day-7 in a preterm and I wonder if first CSF was blood stained. To conclude, if we have other supportive evidence, then will treat as possible bacterial meningitis with 14 days of appropriate antibiotics - this is obviously a pragmatic approach.

I would welcome comments/suggestions from my neonatology colleagues on a specific issue of weaning of postnatal steroids in chronic lung disease. We use low dose dexamethasone, 120mcg/kg/day to help babies come off the ventilator if they seem to be stuck. In rare situations if babies respond only partially, we increase the dose to dexamethasone and try to extubate the baby e.g we will go to 250mcg/kg/day. Following the extubation, on to cpap or biphasic, if after few days baby seems to be going backwards, we sometime increase the dose of dexamethasone to prevent baby going back on the ventilator. So e.g if baby who is on 50mcg/kg/day on CPAP and FiO2 goes up significantly with no obvious reasons, we will increase to 100mcg/kg/day and then start weaning after few days when FiO2 come down. This obviously leads to baby being on steroids for weeks but wonder what else we can do! In many occasions this strategy did work and babies stayed on CPAP and then gradually weaned to be able to go home in oxygen. I wonder if my colleagues have some other thoughts. Thanks

My preference will be to give FFP only after assessing the whole situation (i.e address the etiology). In my unit all the babies get VitK at birth and we rarely repeat it. There is plenty of evidence that initial vit K given IM works as a depot and therefore provides sufficient duration of additional vit K to protect for deficiency.

Hi, NAIT usually presents as petechiae in a well newborn, who then shows low platelet counts; usually quite profound, in 20-40,000. Mother's platelet count is normal with no h/o any auto-immune disorder. Subsequent tests from baby and both parents confirm NAIT with baby having anti-platelet antibodies, transferred across from mother (very similar to Rhesus disease). If the baby's platelet counts respond to platelet transfusions, then I prefer not to give IVIG as later is a blood product pooled from multiple donars. NAIT is a self limiting disorder and baby's platelet counts improve after few weeks as long as we support that with platelet transfusions, there is no rush to expose the baby to a blood product from multiple donars.