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  4. Video about "Pneumothorax - Early Diagnosis and Management-Pathophysiology"
  5. Go to www.mproveacademy.com register and look at toolkits lots of checklists and videos you will get in this regard
  6. I am based in South Africa. We tried both the Neobar and Neofit. The Neofit was the better option but agree with the comments above. Having tried both we felt tape was still the better option. We use a barrier film to protect the skin (if available) then extra thin hydrocolloid strips. We then use either zinc oxide or hypofix tape (5 strips) in much the same technique as described above.
  7. I've used roughly the same thresholds as Hamed, fudging a little higher or lower based on symptoms. In addition to the collateral information Hamed recommended, the single biggest thing to figure out (in my experience) is whether this is iatrogenic or not. Often times, iatrogenic hypercalcemia even at high levels, can self-correct whereas if there is a real underlying cause, that too can suggest definitive therapy. Assuming it is not iatrogenic and the Family history is non-contributory, I would at least consider a diagnosis of William's Syndrome.
  8. I practice in two very different ICU environments, one delivery and one which is more of a med-surg ICU closer to a PICU than a NICU in many ways. I think the data are clear and many of the previous respondents concur that NaHCO3 in the delivery setting is at best useless. For the ELBW with anticipated renal losses NaHCO3 should almost never be needed because these losses can be anticipated and should be incorporated into nutrition to avoid the biochemical inevitabilities noted in the articles Stefan cited. I suppose I might use bicarb in the preemie population if I had metabolic acidosis and evidence it was effecting cardiac output and even then I probably would not correct past 7.2. However, in the case of the older child or the med-surg patient where some specific pathologic perturbation has led to rapid collapse and I suspect part of that mechanism is bicarb deficit, I would have no hesitation to rapid correct the pH. I have several times done this and watched the EKG improve in real time.
  9. When I was a fellow, I trained at a delivery hospital that used flow-inflating bags and it made this sort of failure very easy to recognize (if there was any defect in flow, the bag would not inflate). The downside to this is that without flow you can't give ANY respiratory support (after a critical incident of this kind where the flow inflating bag actually ripped in the middle of a resuscitation, we started stocking an emergency ambulance bag as back-up).
  10. Please, I would like to know what experiences you have with the use of erythropoietin to treat perinatal ischemic hypoxic encephalopathy. Sincerely, Fernando Agama C. Unidad de Neonatología Hospital Enrique Garcés, Quito-Ecuador
  11. Having read this article has many good ideas in my experience. The design rethink many good idea . 👌 for the safety of the neonates. I'd like to highlight 2 features. 1) ambulance tv screen/camera allows connexion the hospital site, such as when a tertiary center is necessary. Here a neonatologist can lead the team to provide optimum care of the neonate on transfer. It can use for example the zoom© software enabling remote telehealth service. Alternatively , the ambulance designed by the generalitat de catalunia is powered 4G-5G comm .Its communication system is has a direct to the hospital site , where a clinical is there to provide supportany time. 2), I feel solar roof can provide some autonomy on transport. It also a sustainable option , make it a bit more green.
  12. Routinely, we would confirm umbilical lines with a cross table lateral view additionally to the AP view. Although, in the X-ray kindly presented here I do agree with @bimalc the UVC is mal-positioned and no need for a later view. This UVC could be pulled back to be 2 cm below the level of the base of the umbilical stump = (2 cm + length of the umbilical stump) and be used as a low line = (as a peripheral line) /Or if still a central line is indicated a PICC could be placed. I would revise the need of a central line in this infant. In the scenario if this infant was just being resuscitated after delivery and this UVC was just placed in and still the area around the umbilicus is sterile, trying to replace this UVC with a new one, the new UVC will usually follow the track made by the first one. Another way is, if the opening of the umbilical vein could accommodate passing another UVC through without removing the first one, the new UVC could pass in the correct direction. A gentile pressure on the liver downwards and medialy would facilitate passing the UVC in the proper direction.
  13. Same here in Japan, as well as in our unit in Canada, no special management for preterm infants of smoking mothers. Although we have a concern towards smoker parents when they visit their babies in the NICU, we do ask them not to smoke before coming to the NICU and to wear newly washed cloth which doesn't have smoking smell in them.
  14. @Lenks Concerning hypercalcemia (total Calcium of 12 mg/dL is our cutoff for IV saline 10-20 ml/kg with 1 mg/kg lasix. A persistent hypercalcemia in-spite the lasix and total Calcium above 14 mg/dL we would consider glucocorticoids. No experience with bisphosphonates. Calcium intake should be thoroughly reviewed. Although day 7 is early for subcutaneous fat necrosis to cause hypercalcemia, but checking for sites of it could be advised, Further lab. data to know the etiology: ionized calcium, pH, albumin, phosphorus, alkaline phosphatase, PTH, urine sample for spot calcium/creatinine ratio, 25 OH Vit D and 1, 25 OH Vit D. Ask mother and father for Familial hypocalciuric hypercalcemia (autosomal dominant) or check their urine spot calcium/creatinine ratio.
  15. Very interesting and vital topic congratulations for your choice I think I can use NaHco3 for correction of metabolic acidosis if oxygenation is optimum .
  16. Sure you will be provided with guidelines here ..but allow me to mention some points according to my view ...we should treat the cause first and I think we should revise the nutrients intake of this baby either intravenous fluids ; total parentral nutrition or even milk formula if bottle fed .
  17. Thank you all for replay ..I just noticed that respiratory distress unfortunately I see in infants of smoker mothers was more severe and not easily controlled like non smoker mothers .
  18. How are you all ☺👋hope you are all fine ..allow me to share this point of view with you Scene 1. Very critical baby and receiving ambu bag ventilation not improving ... Befor announcing failure of this step : ..check your equipment ;proper positioning of ambu mask ..ambu bag valves ..your oxygen flow meter is open and on proper oxygen level .. Any one like to share with me examples of equipment check befor announcing failure 😊
  19. Full term born with this pic ...Not seen every day..initially diagnosed cutis aplasia
  20. This is a case of meconium aspiration on mechanical ventilation Very poor peripheral line ..on dopamine and medazolam infusion .
  21. Hello all! I am a neonatologist, working at the Karolinska University Hospital in Stockholm. We reviewed our ETT fixation strategies during 2017-2019 in a Quality Improvement Project. We generally nasally intubate our infants, from week 22-term infants. We looked at devices, and were especially interested in the NeoBAR, NeoFit and an attractive method used in England with a clip (can´t recall just now what it was called) but all these were more suitable for oral ETT. After this ploughing of the market for devices and tapes, we decided that improving our taping technique with a new tape sort was the optimal choice. In fact, it was a disappointment how few fixation methods/devices are available and how little interest the companies we contacted had in helping us. When we decided on our standardized taping method we focused on a "one fits all" method, as we have many co-workers that need to learn the method, furthermore we focused on "less tape is more" with the amount of tape. Our standardized methods are shown in the links, that Stefan already shared with you (see above). We have followed our unplanned extubation rate which has decreased significantly after implementation and we also follow the rate of skin contusions/ulcerations due to taping. It would be very interesting to here more thoughts on taping techniques and devices suitable, especially for nasla ETT. Thank you for starting this chat and for letting us att Karolinska share our experiences. best regards Anna
  22. Same here - although maternal smoking is less prevalent nowadays, we have/do not managed infants differently. Although smoking is related to preterm birth as such (see for example https://www.ncbi.nlm.nih.gov/pubmed/15901269) - my personal experience is not that maternal smoking would (as such) relate to severity of respiratory morbidity.
  23. Dear all, can anyone post any guideline to guide us to manage a 7 day old neonate with hypercalcaemia. Trying to get hold off very specific information about when to start Fursemide (the cut off level for cCa), the dose and when to start bisphosphonates? Thank you. BW, Lenka
  24. The UVC is clearly malpositioned. We could have an academic discussion of what vessel you've ended up in, but that thing is never going to get to the IVC/RA junction. It is also worth noting that the enteric tube appears coiled on itself also needs to be adjusted. Just curious, but was the indication for line placement?
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