Enteral feed advancement in IUGR - how slow/fast do you go?
Critically ill infant after surgically removed ovarian cyst - share advice on differential diagnosesCritically ill infant after surgically removed ovarian cyst - share advice on differential diagnoses. Please note that this case is posted in the Virtual NICU where you need to log in to read and comment.
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By dratiqur in DR ATIQUR RAHMAN KHANQuick Facts:
The sudden and unexpected death of a child younger than a year is called sudden infant death syndrome.
Such infants usually die in their sleep.
Infants between 2 to 4 months are more prone to SIDS.
The doctor will declare the death of the infant as SIDS if no other cause is identified.
The risk of SIDS can be reduced by placing an infant to sleep on his or her back.
What Is SIDS (Sudden Infant Death Syndrome)?
Sudden infant death syndrome, otherwise called SIDS, is the sudden and unexplained death of an otherwise healthy infant, generally during sleep. As most infants die in the crib during their sleep, it is also called crib death or cot death. It can be difficult to find the cause for SIDS. It is thought to be due to defects in the part of the infant’s brain that controls breathing and wakes up the body from sleep.
Doctors and researchers have identified some factors that might be increasing the risk of SIDS, and there are various measures that parents can try to protect their children from SIDS. The most important advice from doctors is to put the baby to sleep on his or her back.
SIDS is rare, but still the most common cause of death of infants under a year old in the US. Babies between the ages of 2 and 4 months are most commonly affected.
Does SIDS Result in Any Symptoms?
SIDS does not result in any symptoms. Babies who are sleeping die suddenly.
What Causes SIDS?
Researchers are yet to conclude the exact cause of SIDS. They believe a combination of the following factors might be responsible:
1) Physical Factors:
Brain Development - Most of these babies are born with some defects in the brain, which makes them more prone to die suddenly. The part of the brain that is responsible for breathing and sleep arousal do not mature enough.
Premature Birth - In babies born prematurely, the chances of the brain not developing completely increases. Such babies do not have proper control over breathing and heart rate.
Respiratory Infection - Breathing problems due to a cold or any other respiratory infection can lead to SIDS.
2) Environmental Factors:
Sleeping Position - Babies that are put to sleep on their stomach or side might find it more difficult to breathe.
Bed Sharing - Babies sleeping with their parents in their bed, or any other mattress that is not specially made for them increases the chances of injury, asphyxia, and strangulation.
Being too Warm - The risk increases if the baby is too warm while sleeping.
Blocked Airway - If a baby rolls over while sleeping on a soft surface like a comforter or soft mattress, it can block his or her airway.
Other Causes - Using an unsafe or old crib, using a very soft mattress, filling the crib with soft toys while the baby is sleeping, not using a pacifier, and not breastfeeding.
What Are the Risk Factors for SIDS?
Apart from the physical and environmental factors, the following factors also increase the risk of SIDS:
Infants between 2 to 4 months of life. More than 80 % of babies that die of SIDS are under 6 months of age.
Having siblings or cousins who died due to SIDS.
Babies exposed to secondhand smoke.
Babies with low birth weight.
Sleep apnea (breathing stops in periods while sleeping).
Mothers can also increase the risk of their baby dying of SIDS. Mothers who:
Are younger than 20 years.
Do not have proper prenatal care.
Try to avoid as many of these risks as possible.
How Does a Doctor Diagnose SIDS?
There is no specific test to determine that the infant died due to SIDS. The doctor rules out all possible causes of death before declaring the cause to be SIDS. The tests and investigations done by the doctor include:
Examining the infant’s body after death.
Examining the place where death occurred.
Evaluating the symptoms that the baby had before death.
Is There Any Treatment for SIDS?
Sadly, there is no treatment for SIDS. As there are no symptoms or signs that can alert the parents before the sudden death, nothing can be done. But, there are various ways to reduce the risk.
What Can Be Done to Reduce the Risk of SIDS?
The following tips can possibly help reduce the risk of SIDS:
Put Babies to Sleep on Their Back - Until they are 1 year old, babies should be put on their back for sleep. While they are awake, you can put them on their side or tummy, as it will make the baby grow stronger. But always keep a close eye on them.
Prenatal Care - Get early and regular prenatal care. Pregnant women should follow a healthy diet and avoid drinking alcohol and smoking. This can help reduce the chances of premature birth and, in turn, reduce SIDS.
Use a Firm Mattress - Always make your baby sleep on a firm bed with a tightly fitted sheet. Avoid using fluffy comforters. Never put soft toys or pillows in the crib.
Breastfeeding - Breastfeed your baby at least for the first 6 months. Until suggested by your doctor, do not give your baby water, sugar, or formula milk.
Pacifier - Give your baby a pacifier while sleeping.
Avoid Overheating - The room temperature should not be too warm, and avoid over covering or overdressing your baby.
Do Not Share a Bed - Infants should sleep in a separate crib, that is placed close to the parent’s bed. Never share a bed, especially if you take medicines or alcohol.
Do Not Smoke Around Your Baby - Do not smoke when you are pregnant and let any person smoke near your baby. Secondhand smoke can be bad for the baby.
Vaccination - Regular checkups and vaccinations to prevent infections can reduce the risk of SIDS.
Avoid using baby monitors and other devices that claim to reduce the risk of SIDS.
Coping With the Loss of Your Baby:
It is essential to get emotional support after losing a baby to SIDS. Most mothers feel guilty and grief. Talking to other parents who have lost their children to SIDS also helps. Communicate with your friends, family, or a counselor. Losing a child strains a relationship, so try to be open with your partner. Give yourself time to grieve.
Abstract There are various factors that lead to constipation in children. For example, irritable bowel syndrome is one kind of a disease which leads to episodes of constipation. Teach your kid to be less stressed, as according to various research studiesBy dratiqur in DR ATIQUR RAHMAN KHANConstipation has become a very common problem in school-going children, owing to the unhealthy diet and lifestyle practices children follow these days. Kids tend to opt for foods like burgers, pizzas, ice-creams and various deep fried foods which are rich in harmful fats. It may not only cause various heart problems in children, but may also lead to various gut problems like constipation, that is, a difficulty in emptying the bowel and passing stools fewer than three times a week.
Following are few of the dietary remedies to treat constipation in children.
High Fiber Foods
Lack of fiber in your child's diet is one of the most common reasons for constipation in kids. Ask your child to consume a lot of fruits and vegetables which are rich in fiber. Fiber is non-digestible, but it helps the stools to pass smoothly. Fruits can be given to children in the whole form rather than as juice. Various fruits like sapodilla (chikoo), grapes, and papaya help eradicate constipation in children.
Plenty of Fluids
Lack of fluids can lead to issues like constipation in children. Make sure your child consumes at least eight to 10 glasses of water per day which will also protect your child from dehydration and prevent constipation. Fluids can be incorporated in various forms in your child’s routine like water, fruit juice, tender coconut water or vegetable juices. Vegetable juices are a good source of moisture and fiber and would also provide nutrients needed for growth and development.
Good Sources of Probiotics
Good sources of probiotics like curd and buttermilk help destroy harmful bacteria in your child’s gut and thus enhance the growth of good bacteria. Never miss out on giving your child probiotics. Not only probiotics, try giving your child prebiotics which enhances the activity of probiotics. Cut fruits can actually be dipped in yogurt dip and given to children along with some sprinkled flax seeds or chia seeds which are very good sources of omega three fatty acids (good fats) and anti-inflammatory in nature and thus protects your kid from various infections and diseases.
Make sure your child performs some kind of activity every day. Sitting in front of the television will only make your kid lazy. Make sure s/he hits the ground and plays games like relay, potato race, kho-kho and sack race which will boost the metabolism of your child and also make him/her active.
These are some of the natural and effective methods to prevent and permanently treat constipation in children.
By Jelli KA in Bubbly Girl in NICUFantastic put together webinar by neonatal transport Seneo work neonatal transport group. Here are some favorite suggestions.
🔷Blanky with mum swell
🔷Thank the Drivers : Be aware of G force driver have take with sudden break.
🔹Consider 🚑 design allow all to have a better transport experience.
From my perspective it was Interesting the neonatal transport Landscape is diverse from the pioneering region Catalonia that NICU/PICU in 1995(🟢) to other regions that don’t. For example, Galicia have a private providers. Madrid & Valencia have dedicated Neonatal teams ( light 🔵). Some team's like the Balear region team have available helicopters/planes. Below is map showing the situation.Regions in
🛑 done by regional Emergency Teams.
Benchmarking there work in a effort to improve the quality, provide constructive feedback and find ways to better ways to collaborate. Benchmarking and humanize care are interlinked with each other.
They also underlined that need to keep in constant communication between the transport teams and the coordination hub.
By AllThingsNeonatal in All Things NeonatalGiving bronchodilators to preemies on a ventilator has certainly been tried before. The major issue to contend with is getting the drug to where it is supposed to be. Anyone reading who has a child with asthma knows that you should use an aerochamber when taking a puff to help with better distribution to the lung. Giving a puff or two without it largely ends up on the back of the throat. Similarly, giving puffs through an endotracheal tuberaises questions about how much of the medication winds up on the plastic tube rather than the smooth muscle of the airways where the medication is intended to be. This has been looked at in a cochrane review as well entitled Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants
Can Albuterol Save The Day?
Albuterol is a beta agonist much like ventolin that can act on the smooth muscle of airways to achieve bronchodilation. Considering that preemies with immature lungs may have issues with both resistance and compliance, Raffay TM et al in their paper Response to first dose of inhaled albuterol in mechanically ventilated preterm infants chose to examine responsiveness in a group of 33 infants (all < 30 weeks at birth) to albuterol. Ideally, responsiveness would be done by pulmonary function testing but given that this was not possible in these infants they chose to examine other indicators of impact. After giving two puffs of 90 mcg of albeterol via a metered dose inhaler without an aerochamber the authors looked at changes in FiO2 as well as compliance and resistance measurements on the ventilator as a means of determining responsiveness. Ultimately, could they get drug into the distal airway in patients who were ventilated at about a month of age as shown in table 1 along with other baseline characteristics?
What makes this different than other studies I suppose is the use of the ventilator measurements and their use of histogram data on oxygen saturation to ascertain responsiveness to treatment. This was an observational study based on a secondary analysis of a previous study so we don’t have sham controls to compare to. Having said that by administering the medication and seeing what happens immediately afterwards it is possibile to get a sense of whether the drug had an effect.
So What if Any Effect Did It Have?
From the figure in the paper the answer is some effect. Overall, post albuterol resistance for the 33 patients overall was found to decrease. Compliance and FiO2 (not shown in the graphs below) did not change though. What did change however was the percentage of time spent below 80 and 85% respectively comparing a 4 hour window pre and a 4 hour window post with respect to histograms from the patient monitor.
Putting it together
Ok so this isn’t a gold standard RCT looking at placebo treatments vs albuterol. It is hypothesis generating though as if resistance was decreased by albuterol one could expect improved delivery of O2 to the distal alveoli and therefore better oxygenation which is what is seen here. Should we be surprised that no difference in compliance is seen with albuterol therapy? I don’t think so as the effect of the drug is not on the distal alveoli and parenchyma but rather the more proximal branching airways. SInce airway resistance is governed by Poiseuille’s Law (you thought physics was over in high school?!) you can see that resistance (R) is directly proportional to the viscosity (n) and length (l) of the airway but inversely affected by the radius (r) to the 4th power. In other words if the radius of the airway after albuterol increases by 25% that effect is amplified to the 4th power in terms of reducing resistance.
I suppose I am buying what they are selling here but again the key is finding a method of getting the drug to deposit not in the trachea or proximal bronchi but to the lower airways. I can’t help but wonder if use of high frequency jet ventilation which carries flow down the centre of the airway might be a very effective way of getting such puffs further into the lung. Speculation of course but perhaps someone a little more creative than I can figure out how to do that and test deposition.
Should we use this routinely? Probably not as an everyday approach but it does make me wonder about those babies who are having a bad day so to speak. If one can glean from the ventilator that resistance has increased from one day to another might this be something worth trying? The authors found that the first treatment was effective but second and third not so much so to me this may just be a “hail mary” that is worth trying when nothing else seems to be working to reduce FiO2 in the presence of increased resistance.
If anyone is doing this routinely I would be curious in hearing your own experiences.
22 October 2021 12:00 PM
0Perinatal Care of the Preterm Baby-Epidemiology and Ethics
This is an online module being organised by the MPROvE Academy starting from the 12th of February till the end of April 2021. The content covered includes limits of viability, prenatal counselling, communication, prognostication, decision making, and a lot more as outlined below. The course has been broken up into content that can be imbibed weekly with a webinar covering that topic. The course has online content, and videos for review by the participants. Participants can access this from anywhere in the world. For more details a video of the course is attached.
For registration please contact Dr Alok Sharma Consultant Neonatologist on firstname.lastname@example.org
04 November 2021 06:00 PM
0Bedside and laboratory neuromonitoring in neonatal encephalopathy
Speaker: Lina Chalak
11 November 2021 05:00 PM
0Medico-legal considerations in the context of neonatal encephalopathy and therapeutic hypothermia
15 November 2021 07:00 PM
0Session 1 (November 15) - Foundations in Neonatal Physiology
Session 2 (November 16) - Intensive Care and Monitoring of the Newborn
Special Session (November 17) - Challenges in Neonatal PH Care
Special Session (November 18) - The Patent Ductus Arteriosus
Session 3 (November 19) - Cardiovascular Pathologies of the Preterm and Term Infant Time Nov 15, 2021 01:00 PM
Nov 16, 2021 01:00 PM
Nov 17, 2021 01:00 PM
Nov 18, 2021 01:00 PM
Nov 19, 2021 01:00 PM
17 November 2021
1The 17th of November each year is the World Prematurity Day. Originally started by parent organisations in Europe in 2008, the World Prematurity Day is an international event aiming at high-lighting the ~15 million infants born preterm each year.
Read more about this day on the March of Dimes web site, and on Facebook.