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  • 99nicu now on Slack


    Stefan Johansson

    Although 99nicu.org has a great mobile interface, we lack a dedicated smartphone app.

    I had a very good discussion with a few colleagues recently that were using Whatsup for chat communication with other neonatologists, and they suggested 99nicu should also start an alternative channel for more simple smartphone communication.

    As we want to make room for quite a number of people, we have choosen Slack.com as the technical platform for this extension of the 99nicu community. While keeping the simplicity of chatlike smartphone use, it is still possible to organise discussions into "channels" and "threads"

    What shall we use Slack for? It is all up to us but as there is push notifications directly to the smartphone, I believe we use Slack for patient discussions, when we need prompt advice.

    To join the 99nicu Slack Channel, you first need to download the Slack app to your mobile. Then we just need to invite you one by one :)

    So, if you want to join, message me or @Francesco Cardona , or simply email info@99nicu.org

    The team address is 99nicu.slack.com

    Slack_1200x519.png



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  • Posts

    • @bimalc and @tarek Thank you both for your comments and sharing your experiences. I do understand your points and concerns. Our standard starting point for TFII is 50 ml/kg/d on day 0 for micro preemies, but we tailor the TFI for each case depending on mean arterial blood pressure, cardiac size on chest X-ray, ECHO heart findings, and urine output. Thus one preem may be receiving a TFI of 50 ml/kg/day on day 0 and another preem with the same GA and BW receiving a TFI of 80 ml/kg/d. Each case is different. In addition, our rate of increase is 10 ml/kg/d as a basic standard, but still, it could be higher depending on how the same factors mentioned above go In an NICU in Canada, the TFI was 60~80 ml/kg/d for micro preemies < 26 weeks GA, and 100 ml/kg/d for < 24 weeks GA, as a standard, and when these fluid volumes were not enough to maintain the BPs and there was poor peripheral perfusion indicated by high Lac and prolonged CRT, saline boluses were given and inotropes were considered. The daily rate of increase was as a standard 20 ml/kg, unless the prem was puffy or chest X-ray showed increased lung fluids, then daily increase in TFIs was decreased or skipped. I do not imply that one strategy is better than the other, however, tailoring the fluids and inotropes given per each preem`s condition for me sounds practical. We have a special session on tailoring IV fluids and inotropes for preterms next month in the 62nd annual conference of the Japanese society of neonatal health and development http://jsnhd62.umin.jp/en/abstract.html . This could be an important topic to be also discussed in next 99NICU meeting @Stefan Johansson     
    • I have done 80/kg in the past; I think we agree on the importance of uop,etc. and adjusting fluids based on weight, output and labs.  50/kg just seems unlikely to be sufficient in my experience, but if there is international experience suggesting otherwise, I might need to reassess my practice
    • @bimalc One of my friends in Minnesota i discussed this issue with her they are starting with 80 ml/kg and checking of sodium ,uop and adjust ivf accordingly so not all in US starting with 100 ml/kg And i am in favour of restricted intake initially and adiustement according UOP ,Na and Urea More fluids more IVH PDA and pulmonary hge So the most important is follow up and adjust accordingly allowing for physiological wt loss in the first 5 days
    • @Hamed I am interested to hear your fluid management for micro preemies is quite different than practice in the US.  I do not imply that one is superior to the other, but I must ask what difficulties (if any) you have in maintaining normal fluid electrolyte balance with only 50mL/kg/day of fluids in the smallest babies?  In the two units I currently work in, such a baby would typically receive 100mL/kg/d on day 0 and increase 10-30mL/kg/d.  My experience has been that even with humidified isolettes (or at least the ones I have used over the years) such babies can lose massive amounts of weight/water and become very hypernatremic if we are overly cautious with fluids early on.
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