Respiratory Disorders

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 .

I would welcome comments/suggestions from my neonatology colleagues on a specific issue of weaning of postnatal steroids in chronic lung disease. We use low dose dexamethasone, 120mcg/kg/day to help babies come off the ventilator if they seem to be stuck. In rare situations if babies respond only partially, we increase the dose to dexamethasone and try to extubate the baby e.g we will go to 250mcg/kg/day. Following the extubation, on to cpap or biphasic, if after few days baby seems to be going backwards, we sometime increase the dose of dexamethasone to prevent baby going back on the ventilator. So e.g if baby who is on 50mcg/kg/day on CPAP and FiO2 goes up signific…

I know that all of us use some sort of Nasal CPAP support in NICU. And as we get to learn about it, the more we prefer it to conventional tracheal intubation and ventilation. I have often noticed that sometimes preterm babies keep their mouth open (intermittently) while on Nasal CPAP support. I am sure that will cause loss of pressure transmitted to the airways distal to the nasopharynx. I wanted to know how our colleagues around the world deal with this issue. Do you have any protocol to ensure that babies dont keep their mouths open? I am very eager to find out. And if possible you could post some photos in this forum of how you enforce your protocols.…

hello every one .. i found this words ( lung recruitment) difficult to understand and to apply in the real practice any one has experience to aplly the manuever? thanks

I just had a LGA term baby born through shoulder dystocia; noted with respiratory distress shortly after birth. Placed on HFNC, need ~35% FiO2 on 2 LPM. Xray with right hemidiapragm elevation. Question: How long is prudent to wait for surgical intervention in these babies? Thanks