With significant transepidermal water loss due to poor skin integrity of 22-23 week gestation, I was wonder if there is any ideas to:

1) secure line access (when tegaderm /occusive dressing does not adhere)?  We currently use tegaderm to secure UAC/UVC line along with PICC lines/PIV.  But with tegaderm not adhering the first few days of life, difficulty in securing PICC lines.  UAC/UVC we can secure in pace with tighter suture.

2) have anyone have experience with No-Sting and if so recommendations and experience?  Since the company does not recommend its use.  

3) any measures to decrease transepidermal water loss besides: keeping humidified isolette closed.

 

Thanks

Edward Lee, MD

Winchester Medical Center NICU

Winchester, Virginia

From Tw:

 

 

We have similar practices as Dr. Razak. For 22 wk we start humidity at 90%. UAC/UVC are secured over tegaderm. We also do not place any chest leads for first 7days. Strict cluster care Q6H. 

Peripheral cannulae we fix only with steri-strips, UVC/UAC by single suture. Long lines come in only when skin has matured somewhat, at 4-5 days age (we use tegaderm for them).

3 hours ago, talatahmed@sbcglobal.net said:

Strict cluster care Q6H. 

This is so important, not just for development for for the water loss.  People think isolettes are magic, but every time we open them we cause water loss.

On 9/26/2020 at 6:32 AM, Stefan Johansson said:

From Tw:

 

 

Dear Dr. Johansson, I posted a query to 99NICU. I am new to this group. Please let me know if you can see my post. I am pasting the same content here. 

I would like to know what the forum members feel regarding these two scenario: 

1. Term infant with signs of PPHN, CXR: dark lung fields ( idiopathic/primary PPHN), well expanded, on HFOV, ECHO: PPHN. Preductal sats in the 70s-80s. Do you give surfactant or go straight to iNO? There is expert opinion that giving surfactant in these situations worsen the clinical situation. Please share your experience/available literature. 

2. Term infant with GBS positive mother. She was started on GBS prophylaxis as per ACOG guidelines when she was in labor and she gets one dose and miss subsequent two doses, prolonged labor. Last dose of antibiotic was given 8-12h ago. Baby is well on exam, no chorioamnionitis diagnosis by OB. Mother request early discharge at 24h. Do yo consider this as adequate IAP and discharge baby or watch baby for 48h as per AAP guidelines? Also, another case of mother receiving AIP 3h prior to delivery and she request discharge at 24h. Please share your practice. Thank you