Respiratory Disorders

I have a a 30 day of neonate with CDH. never been extubated. Got him down to 50% and in 0.5-1ppm of Nitric Oxide. Have tried weaning him slowly of the NO on multiple occasions. Always go into 90% TO 100% Fio2. Already on maximum doses of Sildenafil. Not oedematous on PCAC 20/5 with good CO2 clearance. I cannot get the final bit of NO off. Any strategies from the forum would be greatly appreciated. PS Operated not paralysed synchronising well good drive

I got this on my radar, through the Twitter feed from @EBNEO - whether surfactant could be administered as easy as an oropharyngeal squirt? Have look in the latest issue of @Acta Paediatrica here: http://onlinelibrary.wiley.com/doi/10.1111/apa.14060/full´ And, here's a video demo posted by the article authors:

We would like to share one of our most recent EBNEO commentaries, on the recently published HIPSTER trial on whether HFNC is noninferior to nCPAP. Please find full commentary on ebneo.org

There is some relatively strong data supporting a saturation target at 90-95%, at least during intensive care (level-3 settings) and for extremely preterm infants. This commentary from EBNEO is quite interesting: https://ebneo.org/2017/02/oxygen-saturation-targets-in-extremely-preterm-infants/ However, the studies on saturation targeting has some methodological aspects that is also good to consider. Have a look on a lecture by Barbara Schmidt below, a lecture that problematize the evidence. Further, what shall we target in the majority of preterm infants not born extremely preterm, and cared for in level-2 settings? Like a 31- or a 34-week infant who may need CP…

In this book, you'll learn multiple new aspects of respiratory management of the newborn. For example, ventilator management of infants with unusually severe bronchopulmonary dysplasia and infants with omphalocele is discussed, as well as positioning of endotracheal tube in extremely low birth weight infants, noninvasive respiratory support, utilization of a protocol-driven respiratory management, and more. This book includes a chapter on noninvasive respiratory function monitoring during chest compression, analyzing the efficacy and quality of chest compression and exhaled carbon dioxide. It also provides an overview on new trends in the management of fetal and transitio…

The "European Consensus Guidelines for management of RDS" has been updated and is now published in the journal Neonatology. Although the title much refers to RDS, this document has a wider scope and is really about stabilization of a preterm infant, ventilatory management included. Other aspects covered are temperature control, hemodynamic stability, and sedation. It is a pity that the full document is behind the paywall of Neonatology - but I guess you will be able to get it through your library. Here's the link to the reference on Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/27649091

Gender need not be publicized on the crib card. It seems presumptuous of hospital personnel to "assign" a gender to a newborn unable to speak for him/herself. Newborns presenting with ambiguous genitalia seem to be even more rare now than they were 40 years ago. When an infant with ambiguous genitalia is born, hours may be consumed compiling enough information about the newborn's genes and imaging studies, and receiving replies from consulting specialists (endocrinologist, surgeon, etc) before the care providers and parents can arrive at the "best resolution of disparate data" and select the "gender of rearing" that seems to be most appropriate for the child. At…

I am following an infant at home with chronic severe bpd; he's 11 months old, 7.5 months corrected age, on oxygen 23-27% plus inhaled steroids. He has morning fever from about 7:30 AM to 10:00. Remission is spontaneous, peak ranges from 37.5 °C to 38.5 °C. There is no evidence whatsoever of infection (CRP is null, the infant is well, urinalysis etc etc). This has happened from about three months now, with small fluctuations: some days there is no fever, but mostly there is, We thought that in some way the fever could be linked to some dehydration, but it has persisted after stopping diuretics and increasing hydration. I've seen a similar picture in a few other bpd babies,…

Dear members, I would like to discuss a case concerning pulmonary hemorrhage in a preterm of 26+2 weeks of gestational age. This little fellow had to be intubated at day 2 after CPAP due to increasing oxygen requirements and dyspnea, he received one dose of surfactant and responded pretty good. During very gentle ventilation he encountered a pulmonary hemorrhage and needed transfusion of erythrocytes and thrombocytes (min. 100/nl). He got vitamin K at the very beginning, blood clotting was unsuspicious, no signs of infection. We treated him with Terlipressin intratracheal and put him on high-frequency oscillation. Despite our efforts the bleeding recurred a couple …

If the baby is so agitated on nCPAP but he still needs it , is it permissible to use any kind of sedation with him ? ــــــــــــــــــــــــــــــــــــــــــــ Mohamad Ismail , Neonatology resident , Mansoura , Egypt .