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Showing content with the highest reputation since 02/22/2019 in Blog Comments

  1. 2 points
    Please also see the results that we have in this matter in Vietnam in journal of antibiotics https://www.sciencedirect.com/science/article/pii/S2213716519301456 and in Plos one and help suggest strategies for how to manage the high rates of colonized children/neonates in South east Asia before it is spread to other parts of the globe.
  2. 2 points
    Here are some answers on @AllThingsNeonatal blog above; Dear Michael, thanks for posting your thoughts on our paper: https://rdcu.be/bP2Ew Regarding < 1 minute compared to > 3 minutes we had the same criteria in our RCT on 540 healthy newborns with 12 months follow-up, showing reduced anemia (http://dx.doi.org/10.1001/jamapediatrics.2016.3971) and improved development assessed by ASQ (http://dx.doi.org/10.1159/000491994). Most major studies on DCC in term infants define DCC as 2-3 min or more. Regarding outcomes in the above mentioned study (https://doi.org/10.1186/s40748-019-0103-y) I can only regret that we didn´t include the important data on temperature and NICU admittance; for you and your readers, here they are. Temperature Celcius: DCC 36.3 (0.5) vs ECC 36.3 (0.5), p=0.05, Mean difference -0.05 (-0.11 – 0.00) Fahrenheit: DCC 97.3 (0.9) vs ECC 97.4 (0.8), DCC 36.3 (0.5), ECC 36.3 (0.5), p=0.05, Mean difference -0.05 (-0.11 – 0.00) Measured at (minutes after birth): DCC 17.1 (8.9) vs ECC 16.7 (1.6), p=0.38, Mean difference 0.4 (-0.3 – 1.1) NICU admittance, N (%): DCC 5 (0.8%) vc ECC 5 (0.7%), p>0.99. As I hope you´ve noticed, we published a study last week on intact cord resuscitation where we included data on temperature and admittance to the NICU: https://doi.org/10.1186/s40748-019-0110-z Kind regards, Ola Andersson
  3. 1 point
    I cannot access the full text from home, but it strikes me that intermittent hypoxia is, at best, a surrogate for the clinical indication I and my colleagues have done trials of post-pyloric feeding in this patient population. As you say, practices vary, so perhaps I'm an outlier, but I use post-pyloric feeding for the very specific subpopulation of BPD patients for whom I am trying to modulate the mode of support (eg wean the baby who is 'stuck' on a low level of CPAP or a HFNC from positive pressure to a low flow canula that can be weaned on an outpatient basis). These trials of post-pyloric feeding typically run ~1 - 2 weeks and the outcomes we follow are (in order from least to most important): intermittent hypoxemia, baseline FiO2 changes, changes in level of support. I agree that those who seldom or never resort to transpyloric feedings need not change their practice based on this study, but I'm not sure this trial addresses the way transpyloric feeding is used in my part of the world.
  4. 1 point
    The use of probiotic Bifidobacterium breve M-16 v has been in use for a fairly long time in Australia for preterms with very positive study reports especially by Dr. Sanjay Patole et al. We in India are currently using the same for the last few months with good results so far
  5. 1 point
    I would urge caution in assuming that tight glycemic control improves patient centered outcomes, though certainly, it would appear that if one were to test that hypothesis, it might be worthwhile to test it using such a closed loop system to give the intervention the best chance at success.
  6. 1 point
    I am a fan of HFNC, but agree that patient selection is important. I see it working less favorably in the bigger babies (in weight and gestation). In my practice, although there may be a negligible increase in HFNC days, this is not with ongoing supplemental oxygen requirement. Lesser nasal trauma, more comfortable baby and definitely a more positive engagement / involvement from parents when on HFNC makes me lean towards its’ use. But of course, there is always the faithful CPAP to fall back to when things don’t work. This study has highlighted 2 things to me: when a baby is < 1 kg, start with 6L/min flow. When weaning below 4L/min, be mindful of CO2 retention, work of breathing and possible increment in oxygen requirement, which might indicate atelectasis.
  7. 1 point
    And if you havent seen Ola Andersson's lecture from the 99nicu meetup, go and check it out here:
  8. 1 point
    @bhushan I share your concern about the BPD/CLD rates. We have no hard data but my def impression is that we keep HFNC for longer times. On the other hand, if infants are more comfortable and (as we use HF) the HF is used without oxygen (for ”stability”), maybe the BPD definition is the problem, not the resp support mode.
  9. 1 point
  10. 1 point
    YOU deserve KUDOS!!!
  11. 1 point
    congratulation... nice concept of solo speaker conference . We call it CME here though.
  12. 1 point
  13. 1 point
    Thanks for sharing and congratulations to your first talk as a "solo speaker". And the macarons, what a great bonus
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