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I am not aware of any research on this specific subset receiving DCC. I think the problem is well put by Alex Scrivens above. If the placenta is detached from the uterus and oxygen supply is gone, we cannot leave an asphyxiated baby for 60 seconds with no resuscitation effort. Might they still benefit from the volume transfusion from the placenta? Maybe, but then our only option is to be scrubbed in with the OBs and resuscitate on the intact/ open cord. The data for this is intriguing, but I am not sure it is ready for wide spread adoption. The other situation is where there was an abruption scare but the baby comes out and looks vigorous. I try to do DCC in these cases, but often everyone was so convinced the baby would be depressed that old habits kick in and the cord gets clamped quickly and the baby passed off to our neo team. It is a work in progress here. Anecdotally, I had a baby once getting DCC that was very vigorous and doing well. As the OB clamped the cord after 60 seconds the placenta was delivered. We must have beecome detached at some point during the DCC, but the baby did great.
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Thanks for the pictures! I’ve seen the bottom picture before and that is the only picture of ”ectropion uveae” that looks similar to my findings, although a very mild variant. Mostly it looks like the upper pictures although not that extreme and not extending radially outwards onto the iris but only inwards, into the pupil.
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Great to bump this topic! I made a screen shot of the photo you referred to (below), did those infants have such marked "out-stamped areas" at the iris margin? I also looked into the first suggestion Ectropion uvae, and found something that seemed to look like your first drawing. Which one best illustrates your clinical finding?
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My logic suggests that if the placenta has separated for a period of time or baby has bled into the mother, then DCC may be of limited benefit... (but happy to be proved wrong!) I think the practical difficulty is that we do a lot of sections for 'suspected abruption', where baby comes out ok, in which case I usually do DCC unless baby looks really grim (scientific term) at birth.
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Bumping this one... a very benign condition but for those interested Had antoher patient with these findings and I did som more digging on the topic.... It looks like it could be "Iris Flocculus/flocculi" I teamed up with the opthalmologist today to see that they would see what I saw and she did. They usually call it "epithelial cyst of the iris" and if it´s only on the margin of the pupil they dont check it further. If it´s bigger (like this one covering a third of the caudal part of the pupil) they have follow up checks. There are two Pictures showing iris flocculi in the link below In Figure 2 - A and B http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiKs4mUj5_fAhWjAxAIHVV5BB0Q5TV6BAgBEAs&url=http%3A%2F%2Fwww.apjo.org%2FApjo%2FdownPDF%2Fid%2F462.html&psig=AOvVaw2CHiN8-FCSrDAlRPpuCl_R&ust=1544869834309802 I also found an old article from 1998 where they describe the phenomenon "Flocculus neonatorum" - a self resolving benign nodular flocculus of the Iris in the newborn. https://journals.sagepub.com/doi/abs/10.1177/000992289803700509?journalCode=cpja and they estimate it to be as common as 1 out of 30 newborns so I´m surprised that so few examiners recognise these findings Finally I can sleep peacefully
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Sara Sitar joined the community
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Vivek Parihar joined the community
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Thank you very much for your reply. This article is about fetomaternal transfusion but what I want is applying placental transfusion i.e. delayed cord clamping in such cases or cases like placental abruption
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sldavisslp joined the community
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Is this something you are looking for: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653511/
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Great thesis on telomeres, immune development and oxidative stress in preterm infants. And a funny card :)
Stefan Johansson posted a blog entry in Department of Brilliant Ideas
My colleague Ewa Henckel defended her thesis at Karolinska Institutet on "Cellular consequences of preterm birth : telomere biology, immune development and oxidative stress" last week, including four projects on telomere length, inflammation and lung function viral respiratory infections and cellular aging immune system development and environmental exposures hyperoxia-induced lung damage and the capacity to counter-act surfactant inactivation with a novel antioxidant A great thesis, available for download here: https://openarchive.ki.se/xmlui/handle/10616/46531 For the table seating at the dissertation party, her husband had made clever and funny personal drawings for all guests. I translate mine for you below, it is on the spot Best regards from Mr Conference Organiser PS. BTW, hope to meet up with you at the next "Future of Neonatal Care" conference in Copenhagen. Click here to find out more. -
Dear colleagues, Does anyone have a research paper or on article about placental tanfusion in Antepartum hemorrhage ? Thaks in advance
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I don't know anyone who intentionally sets out to cool babies with mild HIE, but I think there is a degree of therapeutic creep which means that we are probably cooling more babies now than we did a few years ago. The COMET feasibility study is looking at no cooling v 24 hrs cooling v 48 hrs cooling v 72 hours cooling in mild HIE. Their protocol is here: COMET
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Our guidelines are to cool infants with HIE of grade 2-3, or if seizures develop within 6h of life. But I know there are some discussions ongoing, check this paper out (https://www.ncbi.nlm.nih.gov/pubmed/26352683) that is also discussed in a blog post ~2 years back by Keith Barrington: https://neonatalresearch.org/2016/09/29/its-only-mild-encephalopathy-now-can-we-stop-worrying/
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Dhanalakshmi joined the community
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Does size really matter when weaning from an incubator?
Carolina villegas commented on AllThingsNeonatal's blog entry in All Things Neonatal
neonatologa of San Luis PotosÍ MÉxico, we have a thesis about the weight to which we can thermoregulate to the low weight RN we compared 1500g vs 1600g and we did not find differences between the two groups but if we observe that there is a decrease of days stay when they are put to thermoregulatory early. I will publish it soon Dra Carolina Villegas Alvarez -
The issue is that in most resuscitation (at least in my experience) you cannot be confident which is the case at the moment that you are handed a grey and lifeless baby. You are forced to proceed with full resuscitation and if you need volume and O- blood is available, given the alternatives, it seems reasonable to push some blood (of course, if you need volume and appropriate blood isn't available push saline as Stefan suggested - in the acute phase if you're in that much trouble you probably just need some preload while you try to get the heart going again)
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Tomislav joined the community
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No one practices cooling in mild HIE!!! Sent from my MHA-L29 using Tapatalk
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Just remember that premature neonates born after very early rupture of membranes, especially before 20 weeks, may have a dramatic response to iNO. Usually a dose of 10 ppm will be sufficient. We had a poster on our results some years ago in Granada
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Does size really matter when weaning from an incubator?
Wahle commented on AllThingsNeonatal's blog entry in All Things Neonatal
According to our (Dräger) experience weaning from the incubator varies a lot. There are many different weaning protocols around. In order to wean babies faster from the incubator a new automatic Weaning Mode has been developed for the Babyleo IncuWarmer. The Weaning Mode is designed to support different weaning strategies. It reduces the air temperature in controlled steps and intervals while monitoring the skin temperature to automatically wean the baby off the incubator. - Earlier
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In the experience, I remember that the NICU above the transport team I worked for used iNO with ventilation during a 'crisis' with pulmonary hypertension with the goal of stabilizing. It was always available for use during transport. One occasion I was able to observe some bed teaching. In this case there was a neonate who was on iNO and oscillating ventilation for some time before being transferred to another unit for ECMO.
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Infusion calculations in premature infants
Andrej Vitushka replied to Andrej Vitushka's topic in fluid and electrolyte balance
Dear colleagues! Many thanks for nice and fruitful conversation! -
Neonatal MCQ Board Review
rehman_naveed replied to rehman_naveed's topic in education, organisation and evaluation
Thanks @drnono for such a nice detailed answer, if u see the ECG in the question it is wide complex tachycardia, HR around 175, so not at all SVT by any means or even by definition. We can debate about lidocaine vs adenosine but I think from exam perspective I still stand that lidocaine is the answer and correct in book but @tarekhas a point and reference we can't ignore especially when there is VT and SVT aberency. Thanks for your comments. Don't know is there any pediatric cardiologist in this group who can comment to guide all folks. -
Neonatal MCQ Board Review
drnono replied to rehman_naveed's topic in education, organisation and evaluation
Many thanks Dr. Rehman and of course Dr Manzar.. it is really a great TRAINING sourcs as Dr Stefan said.. I have understood from the PALS algorithm that they start with Adenosine in wide complex regular tachycardia only to differentiate between SVT and VT ( SOMETIMES DIFFICULT ). "Adenosine also has a differential diagnostic ability with both narrow- and wide-complex regular tachycardia because of the absence of adverse hemodynamic effects. Adenosine transiently blocks the AV conduction and sinus node pacemaking activity . It terminates SVT but is not effective for nonreciprocating atrial tachycardia, atrial flutter or fibrillation, and ventricular tachycardia. OF COURSE it is not recommended in irregular (polymorphic) tachycardia" (PARK CARDIOLOGY 5ed ). As mentioned in neonatal cardiology 2nd ed :A wide QRS tachycardia should always be treated as ventricular tachycardia until a definite diagnosis is made.The authers prefer to start with Amiodarone which is efficacious for both SVT and ventricular tachycardia making it a reasonable choice if the diagnosis is uncertain. Lidocaine blocks fast sodium channels thereby shortening action potential duration and the refractory period primarily in Purkinje fibers and in ventricular myocytes. Giving the clearence of the strip as wide regular (monomorphic) tachycardia, the 1st possible diagnosis still ventriculat tachycardia so I beleive that LIDOCAINE is still the best choice for Q2.. -
Neonatal MCQ Board Review
rehman_naveed replied to rehman_naveed's topic in education, organisation and evaluation
Thanks Tarek, will take a note of this and will amend it. -
Katrin joined the community
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Neonatal MCQ Board Review
tarek replied to rehman_naveed's topic in education, organisation and evaluation
@rehman_naveedWhat i mentioned is the latest recommendation from AHA 2015 i will try to post it -
Neonatal MCQ Board Review
rehman_naveed replied to rehman_naveed's topic in education, organisation and evaluation
Hi Tarek Thank you so much for the e mail and comments about Q2 of Cardiology. To my knowledge Adenosine has no role in Ventricular tachycardia. Here patient is stable with pulse and BP, so stable V Tach is treated with IV Lidocaine and pulseless V tach with defibrillation and not with synchronized cardio version. I am attaching a reference review article for our discussion.Unfortunately our site didn't upload >1.95MB files so as such I am sending DOI, it is free. Please see page 349. Please let me know what you think. Contrary what you said is what we do in Supraventricular tachycardia, IV adenosine when stable and synchronized DC shock when unstable. Thanks DOI: https://doi.org/10.3345/kjp.2017.60.11.344 -
Infusion calculations in premature infants
bimalc replied to Andrej Vitushka's topic in fluid and electrolyte balance
in VLBW who is not edematous we use BW until 14d or until regain of BW, which ever is first. In the case of an edematous baby, our local practice is not uniform and I think you really need to tailor that to the clinical course (continued edema, or had some diuresis and now is gaining weight again but this time it is 'good weight' and not 'water weight', etc.)- 12 replies
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I'm not sure we did anything particularly involved, iNO at 20ppm and assess if responder or not based on FiO2 requirement (although, in practice, I feel like no one ever turned the iNO off in non-responders, the kids just died eventually). We would try to get ECHO for indirect estimation of PH before starting (and to make sure this wasn't anomalous veins). My original comment still stands though: as this patient sounds like they have evolving CLD, I'd invest more of my time and effort in reviewing XRays and optimizing the vent for CLD. Also, if you haven't started, I'd have a very frank discussion about morbidity and mortality with the family. Have you considered re-posting/cross-posting to the virtual NICU if you are interested in discussing a specific patient? Bimal
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By Nathan Sundgren · Posted
I am not aware of any research on this specific subset receiving DCC. I think the problem is well put by Alex Scrivens above. If the placenta is detached from the uterus and oxygen supply is gone, we cannot leave an asphyxiated baby for 60 seconds with no resuscitation effort. Might they still benefit from the volume transfusion from the placenta? Maybe, but then our only option is to be scrubbed in with the OBs and resuscitate on the intact/ open cord. The data for this is intriguing, but I am not sure it is ready for wide spread adoption. The other situation is where there was an abruption scare but the baby comes out and looks vigorous. I try to do DCC in these cases, but often everyone was so convinced the baby would be depressed that old habits kick in and the cord gets clamped quickly and the baby passed off to our neo team. It is a work in progress here. Anecdotally, I had a baby once getting DCC that was very vigorous and doing well. As the OB clamped the cord after 60 seconds the placenta was delivered. We must have beecome detached at some point during the DCC, but the baby did great. -
By Urban Rosenqvist · Posted
Thanks for the pictures! I’ve seen the bottom picture before and that is the only picture of ”ectropion uveae” that looks similar to my findings, although a very mild variant. Mostly it looks like the upper pictures although not that extreme and not extending radially outwards onto the iris but only inwards, into the pupil. -
By Stefan Johansson · Posted
Great to bump this topic! I made a screen shot of the photo you referred to (below), did those infants have such marked "out-stamped areas" at the iris margin? I also looked into the first suggestion Ectropion uvae, and found something that seemed to look like your first drawing. Which one best illustrates your clinical finding? -
By AlexScrivens · Posted
My logic suggests that if the placenta has separated for a period of time or baby has bled into the mother, then DCC may be of limited benefit... (but happy to be proved wrong!) I think the practical difficulty is that we do a lot of sections for 'suspected abruption', where baby comes out ok, in which case I usually do DCC unless baby looks really grim (scientific term) at birth.
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