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  2. I have found a few case reports about NICU graduates with BPD being admitted to PICUs with Covid-19. However, I have yet to find a case report of a former ELBW infant, who is still in the NICU, acquiring SARS-CoV-2, and deteriorating as a consequence. With regards to publishing, well, that is in part why I started this thread. It seemed like I was observing a novel effect of a novel virus, but wanted to see if others were seeing it as well. I reached out to my local University NICU's Medical Director, and they have not seen it in their NICUs. I have a couple other calls in to othe
  3. @HickOnACrick thanks for sharing - have you considered to publish this experience? In Sweden (Uppsala, neighbouring city to Stockholm), there was an ex-preterm infant that came back to the ER a few weeks after discharge and ended up on the vent. Being Covid+. I don't know anything from first-hand sources, but read about this spring in the national newspaper https://www.dn.se/nyheter/sverige/sa-raddades-bebisen-i-uppsala-sveriges-yngsta-covid-patient/, maybe a Google translate would make the long article there possible to read in Google-English
  4. We also use: (weight in kg x 3) + 9 + length of cord This gives us an approximation of UAC depth. Half of UAC length approximates UVC depth. We use an AP radiograph to confirm placement. There is a method by which one can use the cardiorespiratory monitor to determine position of the UVC. Essentially you set the monitor to give an auditory beep with each heart beat. Advance the UVC until the frequency of beeps decreases (this implies the tip of the UVC is at the SA node), then pull the UVC back about 1/2 cm and it should be in a pretty good position. However, those I h
  5. Most I have worked with, including myself, will begin TPN as soon as possible in VLBW and ELBW babies, even with babies that have evidence of metabolic acidosis. In the larger babies, we are more likely to start a "clear" solution of trophamine, dextrose and calcium, or even just a straight dextrose solution - initially. To control blood glucose levels, mostly we can get by with just adjusting the IV rate until we can order a new bag of TPN (once daily). If adjusting the rate is not working (or we have reached a rate we are not comfortable with), we will "Y-in" an appropriate dext
  6. Good lesson for all. No experience so far. May be long mothers with babies in NICU long term should be checked every two weeks or so.
  7. Hi Vicky We use 0.5% Aqueous Chlorhexidine for premature infants less than 30/40 or less than 1000grams. We have only had one 24/40 triplet with 6-7% partial thickness contact burns from this solution. James
  8. Last week
  9. Thanks, I learned a lot in this group I am Member since 2006,,, we need to increased seminar,, video,, lectures,, journal club discussing recent papers in neonatology,, in updates issue's Thanks Ramadan
  10. Thanks @Darwin Ranada Do you a webinar series, with an educational perspective?
  11. Former 27 weeker, 895 gram male (now 1700+ and 36 and 6/7). STAT C-section for abruption, Apgars 1/3/5. Suspected antepartum anoxia/hypoxemia based on blood gases. Developed renal failure, elevated transaminases, etc. Very difficult respiratory mgmt, at 2 months of life, still on 5LPM HFNC and 50% FiO2 which is far outside the norm for us. This weekend, increased frequency and severity of apnea prompted a septic workup, including viral respiratory panel by RT-PCR. Negative for all the common resp viruses (including RSV, metapneumo, and flu), negative blood culture (now day 3), but
  12. What about lecture series on updates on the management on the different common neonatal disorders
  13. I think what you are doing and have done is commendable. Your effort goes far beyond many borders and that is something that I deeply appreciate. At the moment I cannot think of anything else that I can suggest to you. I just want to ask you a question, and I apologize that this is not the space to do so. In the event that I had a neonate with TPN support and due to some situation this patient suffered hypovolemic shock or even cardiac arrest, should I suspend TPN? With what solutions would you recommend me to handle it in that period of time? I apologize again, I'm very sorry
  14. @LIA GRAVARI Thanks for suggestion about an online Journal Club. Would you think this should be best done on Zoom (or similar)? @Emilio Escobar Thanks for your feedback! Do you think we could do something to support your daily practise even more?
  15. We've been practising LISA from 2007 on in the dpt i was til 2016 an the meds were Coffein Atropin Propofol, later we saw it worked well without caffein- unfotunately i'm not up to date concerning neuro(developm.) issues with using Propofol in preemies, if ist's still safe i would use it again, worked well titrating 1mg/kg Up to 2 or 3
  16. Please add - is there a rooe fot exchange transfusion in sckerema
  17. Is there a role for FFP in the management of sclerema neonatorum?
  18. Goodnight everyone. I must clarify that I am not a neonatologist, but as a pediatrician I am interested in learning from people as expert as you. The hospital where I work is very humble and lacking, like many in Latin America, but that doesn't stop me from learning from the best like you. I always try to do the best with what I have, and much of what I have I learn with you. Thank you very much for forming this forum and I hope that it continues for a long time to come. My infinite gratitude to the founders and to those who answer my questions. God bless you
  19. Pregnant with SARS-Covid infection at 16 weeks. Birth at 38 weeks. Newborn with very good general condition at birth. On the second day of life, thrombocytopenia (10,000 / mmc)is accidentally discovered. Platelet antibody tests were negative. On the 4th day of life anemia and leukopenia. Inflammatory tests and serologies for TORCH are negative. Can this pancytopenia be related to the maternal infection?
  20. I love that I can hear other Neos opinions i would love to have a journal club online
  21. My infinite gratitude for taking the time to answer me. One more question, do you administer the saline solution and the TPN in Y? Thanks again
  22. This article raises the sustained concern/interest that I have had for a while pertaining to the “difficulty” for clinical practices to change when sound scientific information becomes available. As a clinical researcher, PhD not MD, working with preterm infants’ ability to feed by mouth, it is frequent that when I ask caregivers the basis upon which a particular approach is practiced, the response I get is that this is how it is done. In view of the interest I receive from practitioners re. my research, I have noted over the last two decade that very little change in practice has oc
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    • I have found a few case reports about NICU graduates with BPD being admitted to PICUs with Covid-19. However, I have yet to find a case report of a former ELBW infant, who is still in the NICU, acquiring SARS-CoV-2, and deteriorating as a consequence.    With regards to publishing, well, that is in part why I started this thread. It seemed like I was observing a novel effect of a novel virus, but wanted to see if others were seeing it as well. I reached out to my local University NICU's Medical Director, and they have not seen it in their NICUs. I have a couple other calls in to other large centers, but am awaiting their response(s). I plan to get IgG and IgM ELISA next week, considering whether it's worth testing mom's milk for virus and/or antibody. My local support for academic endeavors is greatly limited (county hospital), so I would welcome a collaboration if one has access to a more robust academic infrastructure.    The baby's FiO2 needs are slightly higher today (35-40%). Work of breathing is better today, but baby remains dependent on the backup rate on NIPPV (currently set at 35 bpm). I have tested this daily by decreasing the rate at bedside. Baby continues to ride the rate and quickly desaturates if rate is weaned. A rate of 25 led to SpO2 of 70%.   This, along with some increased irritability have me slightly concerned about neurologic sequelae. Thus far, his cranial ultrasounds have been clear - even for PVL. Baby is not receiving any sedation that would interfere with respiratory drive. The last blood gas was typical of a BPD baby - a mostly compensated respiratory acidosis - thus I believe the CO2 is available to drive respirations. We have discussed whether to do an LP every day for the past 5 days, but we do not feel the baby is clinically stable enough for that yet.    Echo yesterday was unchanged from about 2 weeks ago - PFO with mild PHN. Function looks good.    We are not routinely obtaining blood gases or radiographs. Prior to NIPPV, while on 5 LPM HFNC, baby had significant atelectasis, low volumes, and chronic changes. We plan for a repeat chest radiograph tomorrow to track changes, if any.    Most recent CBC has trended toward neutropenia, but the ANC was still ~2500.    We started more frequent and prolonged tummy-time today. I guess the kids call that "proning" these days  We have considered chest physiotherapy, but worry the baby will not tolerate cup percussions.    Baby remains on full feeds and oral dexamethasone, caffeine, MVI, and midazolam as needed. We lost IV access, and although it makes us nervous to not have access, we do not have a need for an IV right now. Caffeine dose is 5 mg/kg BID.    At this time, we are using the DART protocol for dexamethasone. We made this decision based on our comfort level with using this regimen. However, if the FiO2 need continues to increase, we may need to rethink the dose. By limited accounts, it seems in PICUs they are using a dose about 4x the starting DART dose.    It seems about once per year, we have cared for a former ELBW baby, that has never left the NICU, and acquires a viral respiratory pathogen and has clinical viremia. We are day 4 of severe symptomatology with this baby. We understand that some adult covid patients have a "honeymoon" period, lasting for 7-10 days, then can acutely become critically ill. By our experience with other VRPs, this is about the time we expect slow but continued improvement.    Overall, we are trying to balance the baby's ex-premie with BPD needs with the additional support for his suspected Covid. Thus we have continued to limit blood draws, maximize nutrition, minimize radiation, continue the MVI, etc.     
    • @HickOnACrick thanks for sharing - have you considered to publish this experience? In Sweden (Uppsala, neighbouring city to Stockholm), there was an ex-preterm infant that came back to the ER a few weeks after discharge and ended up on the vent. Being Covid+. I don't know anything from first-hand sources, but read about this spring in the national newspaper https://www.dn.se/nyheter/sverige/sa-raddades-bebisen-i-uppsala-sveriges-yngsta-covid-patient/, maybe a Google translate would make the long article there possible to read in Google-English   
    • We also use: (weight in kg x 3) + 9 + length of cord   This gives us an approximation of UAC depth. Half of UAC length approximates UVC depth. We use an AP radiograph to confirm placement.    There is a method by which one can use the cardiorespiratory monitor to determine position of the UVC. Essentially you set the monitor to give an auditory beep with each heart beat. Advance the UVC until the frequency of beeps decreases (this implies the tip of the UVC is at the SA node), then pull the UVC back about 1/2 cm and it should be in a pretty good position. However, those I have seen use this technique still confirm with chest radiography.    I would like to gain experience in POCUS as it might limit exposure to radiation. 
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