1 pointWe are using it for 34 weeks and above
1 pointIt 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.
1 pointWe 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.
1 pointReally 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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