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  1. NRP 7th edition


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    • In HFOV , the  parameters  setting  does not include  I:E,or  PEEP
    • Hi all I am looking for protocols  for the care of asymptomatic newborns born to mothers with suspected Covid. One question that has come up in my unit is whether an isolette 6 feet away  ( that is turned off to avoid air circulation) should be used as an ideal physical barrier to  protect the baby from the mother and other caregivers. I did see this recommendation briefly at some  site online but unable to find it now! Thanks for your help Mike Mike Sukumar MD Rockville MD USA
    • hi all  Can anybody please explain to me the role of I:E ratio if high oscillatory ventilation. and also  what is PEEP in HFOV?   thanks  
    • I am not an expert like @olamedmac so I cannot comment on the content as such, but I think the structure is excellent and format is superb! Do you do the animated graphics yourself? Great initiative, IMHO delayed cord clamping is one of the most low-hanging fruits in neonatal care. Somewhat OT: as we had to cancel our yearly conference due to the pandemic, we have discussed to arrange short webinars. @Nathan Sundgren would you like to present about Cord clamping over ~15-20 min in such a format?  
    • Dear Nathan, what a tremendous work you have done, and the video is very informative and I hope you will in due time put it official, and I would be glad to share it in the future, after some revisions. I do realize that choosing what references to mention is a difficult task, and it is clear that you have done your your share of reading. Although, I you ask for comments, here are mine (they grew quite lengthy...): You mention/cite Charles Darwin's kid Erasmus, and it says 1801on the slide. Erasmus (b 1731 - d 1802, https://en.wikipedia.org/wiki/Erasmus_Darwin) was actually Charles (b 1809 d 1882, https://en.wikipedia.org/wiki/Charles_Darwin) grandfather. I don't remember my source, but I´ve somewhere been informed that the Aristotle quote is false, and is not to be found in his writing. As I havn´t had the time to read through the  writings of Aristotele myself, I cautiously avoid this citation in my own presentations. Especially if American, I would choose to cite the pioneer of perinatal medicine in North America, William Potts Dewees (https://en.wikipedia.org/wiki/William_Potts_Dewees)  A compendious system of midwifery. 2nd Edn. Philadelphia: Carey and Lea, 1826: "”When respiration is established /.../we apply a ligature to the cord, provided pulsation has ceased in it; but not until then”. Please see the attached article on Dr Dewees. As for benefits in term infants, I'm a little surprised that our paper on 4-year extensive development follow-up is not mentioned, as it was that paper that ACOG cites in their new recommendations from 2017: Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial. JAMA Pediatr. 2015;169(7):631-8. http://dx.doi.org/10.1001/jamapediatrics.2015.0358. In this, newborns were randomized to either delayed (>180 s) or immediate (<10 s) cord clamping, and we concluded that Delayed CC compared with early CC improved scores in the fine-motor and social domains at 4 years of age When it comes to term transition, you mention the observational study by Smit & al on 109 infants. Last may, we published a RCT including 1264 newborns randomized to either < 60 s or > 180 and could show the same results: the delayed group had higher oxygen saturation up to 10 minutes after birth, and a lower heart rate at 1 and 5 minutes. Actually DCC newborns started breathing earlier and had a slightly higher (but significant) Apgar score at 1, 5 and 10 minutes. I believe this study might be mentioned: KC, A., Singhal, N., Gautam, J. et al. Effect of early versus delayed cord clamping in neonate on heart rate, breathing and oxygen saturation during first 10 minutes of birth - randomized clinical trial. matern health, neonatol and perinatol 5, 7 (2019). https://doi.org/10.1186/s40748-019-0103-y As for the discussion on when to clamp the cord on term infants, I'm really sad to find that you endorse the notion that one minute is enough. In the Yao reference you mention, there is i slight improvement also between 1 and 3 minutes. I'm not sure if it is the following paper you cite; Chen, X., Li, X., Chang, Y. et al. Effect and safety of timing of cord clamping on neonatal hematocrit values and clinical outcomes in term infants: A randomized controlled trial. J Perinatol 38, 251–257 (2018). https://doi.org/10.1038/s41372-017-0001-y, but if it is, there is at least a trend for additional improvement up to 3 minutes. Ceriani Cernadas compare immediate, 1 minute and 3 minutes and found significant improvement between 1 min and 3 min (Ceriani Cernadas JM, Carroli G, Pellegrini L, Otaño L, Ferreira M, Ricci C, et al. The Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial. Pediatrics. 2006;117(4):e779-e86.) The continuous weighing study by Farrar et al.   show the same results as Yao and they conclude: Placental transfusion was usually complete by 2 minutes, but sometimes continued for up to 5 minutes. Farrar D, Airey R, Law G, Tuffnell D, Cattle B, Duley L. Measuring placental transfusion for term births: weighing babies with cord intact. BJOG 2011;118:70–75. Our studies in Nepal compare < 60 s and 3 minutes, etc etc. Please join the science and recommend at least 3 minutes - no side effects have been shown! Well, this was my immediate comments; I do admire your effort and wish you all luck on helping to spread the benifits of keeping the umbilical cord intact.         Arch Dis Child Fetal Neonatal Ed-1996-Dunn-F69-70[1]_William Potts Dewees (1768-1841).pdf Andersson et al-2015-Jama Pediatrics.pdf Kc_MHNP_2019_effects_DCC.pdf Ashish et al-2017-Jama Pediatrics.pdf
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