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Showing content with the highest reputation since 01/21/2019 in all areas

  1. 3 points
    It may or may not be applicable, but if you're setting out to use CVP monitoring in sick neonates, it might also be helpful to think about what things might change the CVP (other than what you're trying to measure). There is a robust literature in adults (and older children) looking at the effects of high PEEP etc. on CVP readings. I haven't looked at it in a number of years, but if I was going to start transducing CVPs regularly and getting calls from nurses or house staff about shifts, I'd probably want to have a mental list of all the iatrogenic things that can and cannot change the value of a CVP reading.
  2. 2 points
    I would like to hear about how you diagnose and manage pneumatosis intestinalis. the background - we sometimes comes across infants (mostly preterms) with some GI symtoms, like blood in stools, but without clinical signs and no lab signs towards NEC. But the xray shows some intramural gas. we usually start conservative NEC TX (fasting, antibiotics, TPN) but stop it after a few days of normal blood tests and if xray normalize. there are some Pubmed reports on this seemingly more benign phenomen but would be great to hear how you handle this.
  3. 2 points
    I'd like to share info about a (possibly) not so well-known Evidence Alert service made available by McMaster University. Visit this link and register for alerts on research papers in any field (like neonatology!): https://plus.mcmaster.ca/EvidenceAlerts/Default.aspx Emails do not come often, like ~1-2 /month. The latest included the following papers: Article Title Discipline Rele- vance News- worthiness Efficacy and Safety of EMLA Cream for Pain Control Due to Venipuncture in Infants: A Meta-analysis. Pediatrics Pediatric Neonatology 6 6 Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial. Lancet Pediatric Neonatology 7 6 Therapeutic hypothermia for mild neonatal encephalopathy: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed Pediatric Neonatology 7 5 Just click on the title to review the abstract and/or PubMed record.
  4. 2 points
    We have had the same issue a couple of times. I think the clinical condition of these babies are much better. Despite this, we felt we could not ignore intestinal pneumatosis, but after a few days we started to carefully feed them after seeing IP resolution on USS, besides good clinical condition and negative infection markers. I found this very old article (1974!) and made me think about “CPAP belly”/ distension...
  5. 2 points
    The reason we use gel in term babies is to avoid admissions and transiently support feeds. On the other hand preterm <35wks is by default admitted to nicu so it doesn't make any sense to use gel in them plus you have to start IV D10w or formula NG feeds so gel has no role. Moreover gel is not 100% effective in preventing hypoglycemia same as vaccines are not 100% guaranteed. Having said that we use gels in terms because they have more glycogen reserves as compared to preterm and sustainability is more attainable in terms as compared to preterm.
  6. 1 point
    Thanks Dr Johansson, very useful! It's similar to the amedeo weekly literature newsletters (amedeo.com)
  7. 1 point
  8. 1 point
    We are using it for 34 weeks and above
  9. 1 point
    We had a similar issue a number of times. I personally came across children who seemed fine in terms of abdominal symptoms (no distension, good feeding tolerance) but presented with pneumatosis. In cases of massive pneumatosis we would usually start them on NEC protocol. There are also sometimes children with only small number of gas bubbles in the portal vein or superior mesenteric vein. We would observe them closely. Most of these cases resolve spontaneously without sequelae, we sometimes even continue feeds. I remember a preemie approaching discharge in whom the only etiology we could associate portal gas with was cow milk protein allergy. The baby was fine, discharged home with intermittent pneumatosis. On the other hand, very recently I had a term baby who presented with unilateral seizures and was diagnosed with left-sided MCA infarct. On presentation I noticed massive hepatic/portal pneumatosis with gas transfer to IVC via open venous duct and to the systemic circulation via PFO. I was wondering whether air embolism could have been responsible for neurological presentation in that child. Also, pneumatosis usually preceeds other clinical symptoms, like in this case - this baby developed enterocolitis symptoms 24hours later, without any clinical symptoms on the initial presentation. On a different note, couple years back we almost completely eliminated X-ray for assessment of abdominal symptoms. We now rely on ultrasound which provides more data, is obviously not associated with radiation exposure and unlike x-ray allows for continous assessment.
  10. 1 point
    In my experience CVP is much more helpful as a trend - if I plug in the transducer and it says 8 vs 6, I'm not sure I know what that means. But if it was 8 all day and now it is 6 or 4, I can go looking for a reason for the change or a consequence of that change. If I'm looking for numbers to target early in the course and I'm worried about preload status, I'd much rather know targeted echo (if available at your facility) and/or pH and lactates.
  11. 1 point
    We perform LISA routinely on all preterms < 28 wks right after birth. We do not use any premedication or analgesia. We use a gastric tube and Magill forceps for application of surfactant intratracheally. We follow a slightly modified version of the original protocol from Cologne (as published here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60986-0/fulltext). You can find our publication on our experience with LISA here: https://www.ncbi.nlm.nih.gov/pubmed/23446061 Let me know if you need any more information.
  12. 1 point
  13. 1 point
    Certainly I agree with @Stefan Johansson on the exception to the rule stated by @rehman_naveed. I have never done it, but I've at times wondered if I wouldn't give glucose gel a try in a situation where there was some difficulty obtaining access, just to get the sugar up a bit while I put in an umbilical line.
  14. 1 point
    Hi all, we have published the fifth edition of our e-book “NEOQUESTIONS 1to1” . Please feel free to distribute among your other colleagues to help them gain the knowledge of neonatology. https://docs.wixstatic.com/ugd/92a170_54197b618fb34a39a7702b7679a085ec.pdf With Best Regards NAVEED
  15. 1 point
    One thing to consider about this study (and the other published comparisons between NCH in the USA and UUCH in SWE) is that there are essentially no deliveries at NCH. These babies are born in the community (generally at hospitals with level 3 NICUs) and transported to NCH [I am unsure if the UUCH births were in-born or outborn]. I think the earlier study from Iowa in NEJM already demonstrated fairly convincingly that if you try you get better outcomes than if you don't, and there is a long standing literature on the differential outcomes of inborn vs outborn VLBWs but what remains unclear to me is what the magnitude of this effect is in 22-23 week infants and whether these differences are large enough to effect counseling in systems like the NCH one where active resuscitation also entails transport.
  16. 1 point
    I would just like to share a new document by the World Health Organization, WHO. In a report that come out the other week, WHO present its key findings from an upcoming publication "Survive and thrive: transforming care for every small and sick newborn." While we commonly think about neonatal care and preterm infants in high-resource settings, there is really a lot of public health work to be done when it comes to improve neonatal care in low-/mid-resource contexts. In fact, the world will not achieve the global target to achieve health for all unless it transforms care for every newborn. What I specifically like is that this documents really acknowledge the power of family-based care. To save newborns, the report recommends: Providing round-the-clock inpatient care for newborns Training nurses to provide hands-on care Harnessing the power of parents and families Providing good quality of care Counting and tracking every small and sick newborn Naturally, countries need to allocate the necessary resources. While we (in the rich world) may think that a LOT of money is needed, WHO estimates that an additional investment of US$ 0.20 cents per person can save 2 of every 3 newborns in low- and middle-income countries. IMHO, that's a small investment for the best of benefit. Click here to find the report on the WHO web site. And click here to find "Social media tiles" illustrating the key findings, which I also share below.
  17. 1 point
    The European Neonatal Ethics Conference is one of the premier events discussing issues involving ethical care around a variety of aspects in neonatal care. It is held every 3 years and is being held in Southampton United Kingdom this year. Besides addressing a number of different topics including issues of neonatal palliative care, organ donation and extremes of viability it is opportunity to share ethical practice across Europe. Venue -St Mary's Stadium Southampton UK Dates 14th & 15th November 2019 Initial Flyer Call for Abstracts-We are calling for abstracts for oral presentations, poster presentations, debates and round table discussions. More details are available here Website-http://www.wonepedu.com/NeoEthics-Conference.html Video-
  18. 1 point
    Really wonderful discussion. Thanks @AntoineBachy for raising this question @Hamed i am always waiting for your replies @Stefan Johansson a lot of thanks for such beautiful 99nicu Chapter 12 Clinical procedures_ABMU Neonatal Guideline v 2017 1.pdf
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