1) Surfactant in a PPHN situation will give a transient endogen NO-release in the lungs improving SpO2 in the short term. For the long term it is better to start iNO. 1) Surfactant might be indicated in a situation of meconium aspiration syndrome driven PPHN. 1) Regardless, if oxygen index is above 20 (30) = start iNO.

for scenario 1 I would say iNO and no surfactant. The description of CXR does not imply RDS and or secondary surfactant deactivation disease processes. Therefore surfactant may not help.

We don't have a max weight cut-off. We do use low dose sedation though. 0.5 mcg/kg fentanyl. In most cases it does not cause apnea and babies are fine with some stimulation and increasing the PIP on NIPPV. I find the difficulty with the bigger ones is that they are fully awake while you have to do the procedure.

Do you have a max weight? We tried on a larger baby over the weekend and encountered more difficulty probably for multiple reasons. Is there a weight you have found that is too big for this procedure (assuming they are truly surfactant deficient)?

Dear Colleagues! Just a brief question if anyone (more than me) has met a baby with concomitant Mb Down and Prader Willi syndrome? This baby born at GW 30+1, initially severly sick with chylothorax which eventually resolved. Now at about 1 month corrected age with low flow O2, can´t really get off diuretics, feeding only by NG tube, hypotonia, normal heart. Just got the result about PW today and was curious about any other similar child "out there"? Regards Pontus

Thank you

I will just go for number one. NO surfactant. You do not have a CXR indicative of RDS. You have an infant with existing pulmonary hypertension, and clogging the airway with unneeded surfactant will only worsen the disease process. Just as you would not bolus a child with saline to treat hypoglycemia, do not give the wrong drug to treat PPHN.

For #1, you answered yourself dark lung fields, so no RDS, hence no surfactant, looks like vascular phenomena rather than parenchymal as your scenario. Treatment lung protective strategy, and pulmonary vasodilation. for #2, adequate coverage, can be discharge with follow up

2# if mother received B. Penicillin or Ampicillin or cefazolin more than 4 hes before delivery is considered adequate prophylaxis. observation can be enough for 24 hrs if parents are well educated regarding warning signs and have immediate access to clinical services. 1# first of all is ensure adequate recruitment with adequate ventilation then consider surfactant if fio2 requirements still high. 2# to check how much is pulmonary pressure and cardiac function before starting iNO. if adequate myocardial function, can start iNo. If not don’t give. start inotropes to increa

Hi everyone. I use 5%nacl for correct mild hyponatremia and get good feedback.

For #1 - from a pathophys view (decreasing pulm vascular resistance is the key goal) so iNO would certainly be my option. For #2 - given a completely well infant at 24h, we would be OK with discharge at 24h.

I agree with Dr. Mohan. We have started cooling in India in a resource poor set up. We were able to overcome many challenges with lots of training and infrastructure changes. The process is going smooth. There are cheaper options for cooling babies.

Dear Dr. Johansson, I posted a query to 99NICU. I am new to this group. Please let me know if you can see my post. I am pasting the same content here. I would like to know what the forum members feel regarding these two scenario: 1. Term infant with signs of PPHN, CXR: dark lung fields ( idiopathic/primary PPHN), well expanded, on HFOV, ECHO: PPHN. Preductal sats in the 70s-80s. Do you give surfactant or go straight to iNO? There is expert opinion that giving surfactant in these situations worsen the clinical situation. Please share your experience/available literature. 2. Te

I agree! You could expect Hannah and Amanda to provide balanced information.

I would like to know what the forum members feel regarding these two scenario: 1. Term infant with signs of PPHN, CXR: dark lung fields ( idiopathic/primary PPHN), well expanded, on HFOV, ECHO: PPHN. Preductal sats in the 70s-80s. Do you give surfactant or go straight to iNO? There is expert opinion that giving surfactant in these situations worsen the clinical situation. Please share your experience/available literature. 2. Term infant with GBS positive mother. She was started on GBS prophylaxis as per ACOG guidelines when she was in labor and she gets one dose and miss subsequent

Which sedatives analgesia and paralysing agents are used in NICU and the incidence of critical care neuropathy especially with longterm use in NICU?

thanks to you. That's a good point

Just a thought. Since these solutions(3% saline and Sod Bicarb) are hyperosmolar can they increase the risk of NNEC

We talk to the Obstetrician before delivery and find out if there are no contraindication for DCC. If so we plan for 3 minutes for DCC in term babies. For a vaginal delivery after delivery the baby is placed on the mother's abdomen and covered and monitored. Sometimes the placenta is delivered before 3 minutes and presently we are cutting the cord then though this is controversial. If for some reason the cord has to be cut early then only milking is done. For LSCS we keep the baby on the OT table and follow the same procedure. All attending Pediatricians in our hospital are aware of the contra

thanks a lot to you

This is so important, not just for development for for the water loss. People think isolettes are magic, but every time we open them we cause water loss.

We have staff dedicated to reviewing charts, running a checklist for every patient as they approach discharge and rounding with the medical team to call attention to items on the discharge checklist that need attention and to give the medical team an opportunity to highlight 'unusual' discharge needs. For emerging follow-up indications which our institution has not formally added to the discharge planner's checklist (for example, currently we do not have formal guidelines for follow-up in nephrology clinic as we just recently hired our first neonatal nephrologist, but we try to flag babie

If you are asking about enteral supplementation for the 'normal' hyponatremia that ELBWs get after the initial diuresis is complete, our goal is to correct this over a week, though often it takes us 2 weeks to get it right. We follow electrolytes and increase dosing every 2-3 days, paying at least as much attention to the chloride as the Na (we occasionally need to do a mix of NaCl and NaHCO3)