The N3RO and MOBYDICK, which studied DHA supplementation in two different ways (via the mother->breastmilk, or directly to the infant, links below) showed that there was no benefit from DHA supplementation only, and seemingly associated with potential risks. But, for the record, being founder of Neobiomics, I do have a conflict-of-interest about omega-fatty acid supplementation. https://jamanetwork.com/journals/jama/fullarticle/2768134 https://www.nejm.org/doi/full/10.1056/NEJMoa1611942

Dear Mohan, We currently have a partnership with @Neobiomics who are arranging a free webinar on this on April 1st: ZoomVälkommen! Du är inbjuden att delta i ett möte: NeoMega36...ARA and DHA Supplementation: Pioneers & First Experiences in European NICUs **NeoMega36 Webinar** By Neobiomics - Karolinska Institutet Science Park DATE: 1 April TIME: 15.00-16:00 CET AGENDA:...May I also suggest listening to this recent episode of the Incubator podcast: https://podcasts.apple.com/se/podcast/the-incubator/id1566031191?i=1000685040875 It doesn’t add much to the discussion, but possibly gives some food for thought. best, Gustaf

@Mohan this webinar will be repeated, 12 June 4 PM CET, more info will be posted later

Is there any role of DHA supplements in preterm babies especially ELBW

I missed this webinar. Any recording or way to see it

In our unit UAC 5 days UVC - 7 to 10 days KSAMC - MCH - NICU Madina Saudi Arabia

UAC 10 days UVC 14 days obviously might need to stay longer for either line based on clinical need

This is a matter of prudential judgement. Of course these lines should come out, when they are no longer needed. The sooner the better but this varies with the clinical condicion of the baby, gestacional age, feasability of placing a PICC etc. One issue of UVC lines is that they tend to migrate, so close follow up specially with ultrasound is necessary. Thank you for your comments

Only for UAC UVC routine for 5-7days, median 5 days. Max 14 days.

We do!

We usually leave UVC no more than 6-7 days and UAC no more than 4 days. The problem comes when the UVC is malpositioned (intrahepatic or low position).... what do you do in this cases?

Thanks for all your inputs. Good to know that there are no strict guidelines. Do you all heparinize these lines especially for ELBW and 25 weeke rs

Our routine use of UAC and UVC is 7 days. We leave UVC longer in some cases. We go to 10 days if needed and occasionally to 14 days with UVCs. We have not seen any higher complication rates with 7 days vs 10 days. Naveed Hussain University of Connecticut/ Connecticut Children's NICU.

Difficult question/answer. In general I'd reduce infusion rates of serum urea exceeds above 10 (or perhaps max 12.5) mmol/L. Please take notion on correct conversion, cause this may sometime introduce errors. But before simply adjusting infusion rates, also assess others causes. Did you provide sufficient concomitant energy (minimal 35 kcal/g animo acids) and electrolytes (esp sufficient phosphate and potassium), and what is fluid status and kidney function?

5 days for UAC, max 10 days for UVC

in our unit, we use to take the UVC off at the fifth day. The arterial at third day. If we don’t have the opportunity to insert a PICC, then the UVC could be until the 10th day but all the staff get nervous 😬

I would say our standard is 5-7 days, can be up to 10 days if needed. We have on rare and desperate occasions left a UAC for 2-3wks - usually in the nanoprems where other IV access/skin integrity is super challenging... of course with escalating infection/thrombosis risk but sometimes chatline may be all we have...

We leave the UVC no more than 10 days, according to the Catheter Clinic, and the UAC no more than 4 days, according to clinical evolution.

The ideal time is the day before you were going to get a line infection from leaving it in. 7-10 days is a good range, but sooner if you can do without it. But in some ELBWs the ideal has to be thrown out the window. I am especially thinking of the 22-23 week or <500g babies where feeds cannot be advanced so fast and peripheral sites for PICC replacements are minimal to none. What then? 21 days if you must or longer if you need the central access and no other alternative.

We typically will leave UVC in for 7-10 days then PICC. UAC can be left in for 7 days, ideally just 3-4 days depending on course of illness

I think UVC can stay for 10 to 14 days, some stretch for a few more days. With rapid escalation of feeding regime, most don't stay this long. UAC is even removed much earlier. In LMICs, UVCs still remain a large part of standard of care due to cost with PICC

When an ELBW neonate is on Amino acid infusion what is the upper limit of blood Urea that must be considered before stopping or reducing the amino acid infusion

How long can a Umbilical Artery line and an Umbilical Venous Line be used in an ELBW neonate when PICC line is not available. Various centers follow different protocols. Your views please

Where I do my Level-4 rotation (Queen Silvias in Gothenburg) they implemented a strategy for the first few days of ventilating ELGANs with RDS aiming at higher frequency to minimize tidal volumes. After the acute phase of RDS is over and lung compliance is improved, a change of strategy is warranted (at latest at 5-7 days of age). But they start at: Setting Start Target MAP 10 – 12 cmH2O 8 – 10 cmH2O Amplitude (ΔP) 40 cm H2O (Max amplitude) 15 – 25 cm H2O (by ventilator) Frequency 15 Hz 16 – 17 Hz Volume 1,7 ml/kg as low as possible, normocapnea I:E 1:1 1:1 If normocapnia (pCO2 5.0 – 6.0 kPa) Note DCO2; increase Hz 1 – 2 and decrease volume 0,1 – 0,2 ml/kg – target equal DCO2 If hypocapnia (pCO2 < 5.0 kPa) Only decrease volume 0,1 – 0,2 ml/kg If hypercapnia (pCO2 > 6.0 kPa) Only increase frequency by 1 – 2 Hz The rationale behind using 1:1 is that if frequency >14 Hz with I:E 1:2 the ventilator will not be able to provide sufficient tidal volumes. After the first few days the HFO-strategy (if you choose to continue with HFO) will change to ventilating at a lower frequency and aiming at 10-12 Hz with the tiniest infants. This might require somewhat increased volumes but with reduced amplitudes. At this stage, in cases that would require longer expiration and where increasing MAP is contraindicated (pulmonary interstitial emphysema, overdistension), I:E of 1:1,5 can be considered. The strategy is compiled by Juliús Kristjansson, he did an amazing work with this. I have only cited the PM. As for the I:E reasoning he cited another Sanchez-Luna article than mentioned above: PubMedEffect of the I/E ratio on CO2 removal during high-freque...•The tidal volume on HFOV is determinant in CO 2 removal, and this is generated by delta pressure and the length of the inspiratory time. What is New: •HFOV combined with VG, an I/E ratio of 1:2 is... aswell as https://pubmed.ncbi.nlm.nih.gov/35136198/ and https://www.draeger.com/Content/Documents/Content/jane-pillow-hfov-br-9102693-en.pdf I hope this could help you in your reasoning, I'm not very knowledgeable in this myself, but it's at least something.