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Showing content with the highest reputation since 10/21/2013 in Posts

  1. 12 points
    One of our fellows showed me these two videos on Youtube, on how to learn brain ultrasound. Both videos are very good! Enjoy Part 1 - anatomy and protocol Part 2 - IVH and PVL
  2. 11 points
    I found this consensus on neonatal management of infants born to mothers infected or suspected COVID19. It's free online access. http://atm.amegroups.com/article/view/35751/html
  3. 9 points
    Great question, Juan Carlos. I am partial to the VN500, but I'm sure both devices can deliver VG quite well. The problem is that babies don't like to be acidotic. Consequently, there is a problem with permissive hypercapnea in the first days of life in small preemies, because their kidneys are not able to compensate for respiratory acidosis. Therefore, the baby will try to generate a tidal volume sufficient to bring the PCO2 down and normalize the pH. As you know when the tidal volume exceeds the target value, PIP will come down and pretty soon, your baby may be on endotracheal CPAP with rising oxygen requirement (due to the drop in MAP), tachypnea and increased work of breathing. You would have to sedate the baby sufficiently to suppress their respiratory drive, which is a bad idea. People find all kinds of ways to reduce the support for the baby's effort, for example changing from AC to SIMV at a low rate, so the baby is unable to generate adequate minute ventilation and correct the acidosis. So, the baby is struggling, but the doctor is happy, because the PCO2 is where he or she wants it. If you can buffer the acidosis by adding some acetate to your TPN and get the pH up to near normal, you might be able to let the CO2 rise gradually. The focus needs to be on pH, not PCO2, because it's the pH that is the primary stimulus for respiratory drive. Basically it is better to support the baby's effort to maintain normal pH and avoid the mistake of looking only at the PCO2. Ultimately, it is the perivascular pH that controls cerebral circulation, but unfortunately all studies keep focusing on PCO2 and ignoring pH. What we know is that rapid fluctuations in PCO2 confer the greatest risk of IVH. Once the baby is a bit older and the kidneys are more mature, it'a s lot easier to allow permissive hypercapnia if they still need mechanical ventilation. I hope this helps, MK
  4. 8 points
    I wanted to let the 99nicu community have the first look at my latest video. It is based on a ground rounds talk I gave on delayed cord clamping several months ago. I updated it and added lots of animation. You can find the video by following this link: https://youtu.be/6qA3CVGp5Sw The video is not public, meaning you can not search for it, but you can follow the link to view it. I'd appreciate any thoughts on the video, especially mistakes you see or if you felt anything I said was misleading about the evidence. Post your comments to this forum and I will respond. I'm hoping to make the video public depending on this communities comments. Also, I feel a bit weird posting or doing anything not COVID19 related these days, but maybe this can be one thing that takes the mind off of the current pandemic for about 16 minutes of your time. -Nathan
  5. 6 points
    In Wuhan and outside Wuhan cities, the local neonatologists/Pediatricians reported only a few cases. No severe cases, All of the infants have no symptoms or only mild symptoms,and also,no death cases.
  6. 6 points
    We recommend stopping breast-feeding until the mothers' COVID-19 test negative for two times . And also we stop vaccinated the suspected infants until the mothers' COVID-19 test negative for two times in the next 2 days.
  7. 6 points
    I visited Hot Topics last year and one of the best lectures (according to me!) was held by Judy Aschner, about the use of sodium bicarbonate being principally useless (and could even have adverse effects). Please click here to read an excellent review article on the topic by Aschner and Poland. Unfortunately only the abstact is available for free, but the article is worth to order! As many other units, we have a strong tradition to consider the use buffer, if pH is less than 7.25 and BE less than -5 (at least in in ELBW infants) The article by Aschner and Poland has been subjected to some debate in our units. The major argument in favour of buffer is that we do not use sodium bicarbonate but Tribonat, which is a combination of trometamol (THAM), bicarbonate och acetate. The theoretical idea behind Tribonat is to achieve intracellular (THAM), extracellular (bicarb & acetate). Personally, I have switched to a quite restrictive approach and rarely use buffer, but try to consider the etiology of the base deficit in the management of acid-base. What's your experience and view upon the use of buffer?!
  8. 6 points
    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
  9. 5 points
    I just wanted to share a link about inotropes, a blog post on a British FOAMed* web site: https://www.paediatricfoam.com/2017/01/inotropes-made-simple/ Managing circulatory failure with potent cardio- and vasoactive drugs can be a challenge, and it is necessary to understand the pathophysiology of the problem to choose the right set of interventions and drugs. *FOAMed = Free Open Access Medical Education
  10. 5 points
    The NOTE programme (collaboration between ESPR and University of Southampton) are opening a Pharmacology module in June, led by Karl Allegaert and Sinno Simons, using virtual/remote teaching. More information in attachment and via link below 🙂 https://www.espr.eu/news/news-detail/e-learning-neonatology-paediatrics/186 Proposal NOTE module DINA4 v3 (1).pdf
  11. 5 points
    The recommendation from the Austrian/German Society for neonatology is as follows: mother COVID-19 positive: isolation of mother and child and no breastfeeding until mother is COVID-19 negative.
  12. 5 points
    A collective of the world’s leading newborn brain care providers have come together and launched the https://newbornbrainsociety.org/ (NBS). This new organization is focused on advancing newborn brain care through international multidisciplinary collaboration, education, and innovation. With founding leadership representation from prestigious programs such as Yale, Duke, Harvard, and UCSF, international representation from Canada, Brazil, and Ireland, and parent collaboration through the Hope for HIE Foundation, the goal is to bring together the resources of many programs to move the field forward in previously unattainable ways. “We started this idea originally through an existing group that was started in 2015 through the Neonatal Neuro Critical Care Special Interest Group (NNCC-SIG). We wanted to facilitate multidisciplinary, international collaboration between clinicians, parents, scientists, and others with a focus on newborn brain care; and no other society or organization currently exists in this structure and philosophy,” stated Mohamed El-Dib, MD, founding member and President of the organization. NBS has plans to sponsor, host and participate in educational events that will expand the field of neonatal neurocritical and neuroprotective care, and develop consensus publications including best practice guidelines and expert opinions in the field of newborn brain care. “We are also looking to provide a platform for members to exchange clinical practice guidelines and parent resources related to newborn brain care, and to support multi-center collaborative activities, quality improvement and research projects related to the field of neonatal neurology and brain development,” stated Donna Ferriero, MD, MS, chair of the NBS Steering Committee. Membership is now open for interested clinicians, researchers, trainees, parents and other community members. For more information, visit Newbornbrainsociety.org
  13. 5 points
    This is not an uncommon dilemma. We have developed a one paged trigger/ assessment tool for babies who meet criteria for monitoring for moderate or severe encephalopathy. It seems to work most times and one of our fellows is conducting an audit to see if we miss any babies with this tool. Based on this case, it sounds like the baby would have met criteria for clinical monitoring for moderate or severe HIE i.e. prolonged resuscitation and possibly Apgar scores? but not pH or BE related values and we would have then assessed this baby hourly for the first 6 hours of life for clinical signs of moderate or severe encephalopathy. TH would have been started as per the trigger tool thresholds. The problem comes when these babies don't meet clinical criteria for moderate or severe HIE and clinical monitoring is ceased and then go on to have seizures some time later - as is seen in this case. The current trend in our unit would be to not cool them at the 12hr mark but I have personally cooled a baby who did not meet criteria for moderate or severe encephalopathy in the 1st 6hrs but then went on to have seizures at ~8hrs of life. We would just optimise other medical intervention and use anti-convulsants (levetiracetam, topiramate and midazolam or lignocaine) to treat seizure burden. I'm not sure if that helps! Cheers Richard HIE trigger tool.pdf
  14. 5 points
    For those of you having follow-up clinics with children born preterm and affected by BPD, check out these European guidelines. A very thorough document. In short, most recommendations (screen shot below) are graded as low or even very low evidence. So there are lots of room for good research! Find the full document here (and yes, it is available as open-access): http://doi.org/10.1183/13993003.00788-2019
  15. 5 points
    Hello, I am paediatric trainee currently working in Level 2 NICU in UK. I am doing the journal club presentation about the use of LMA for administration of surfactant in preterm babies. During my previous placements in Level 3 NiCUs, I never seen anyone using LMAs and I was wondering what experience do the rest of you have with using LMAs in neonates. What training did you undergo? Thank you. Lenka
  16. 5 points
    This is great! Thanks so much. I was in Toronto for the NeoHemodynamics 2018 Conference and Workshop and one of the main take-home messages was that both transitional hemodynamics and knowledge of its physiology are key to tailoring therapeutic interventions both in preemies and term babies. The slides from the talks are available at neohemodynamics.com
  17. 4 points
    https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.15495 With kind permission from Luigi Gagliardi. And as mentioned: the "official" accepted Ms. It is marked as "free download", so it is perfectly legal. (As soon as the final version is available, I will post the link )
  18. 4 points
    Join experts in the field of neonatal neurology as they speak on clinical and research guidelines, educate on new techniques, and answer your questions! April Speakers: April 2nd: Betsy Pilon - Supporting HIE Families April 9th: Seetha Shankaran, MD - Hypothermia for HIE, Updates and Controversies April 16th: Gerda Meijler, MD - Neonatal Head Ultrasonography: How to Scan a Baby, Normal Anatomy of the Neonatal Brain April 23rd: Linda de Vries, MD - Neuroimaging in the Full Term Infant April 30th: Trainee Session RSVP below to confirm your attendance: https://is.gd/RSVP_NBS_Ed_Webinar_April_2 Contact info@newbornbrainsociety.org with any questions.
  19. 4 points
    hi.i live in iran,i have two neonate that mothers are suspected covid -19,what s advice for breastfeeding and vaccination?!
  20. 4 points
    I'd like to clarify that comment a bit: Chile is entering its 6th week since the first COVID19 case was detected. There are areas with a high number of cases, so partial lockdowns are being put in place for 2 to 3 weeks. Those are being lifted (or not) depending on the number of new cases on a daily basis. There is an issue with availability of testing as is the case with most LA countries, but Chile is steadily increasing PCR testing availability country-wide. Recently, universal use of face masks when outside of home was recommended and made mandatory when using public transportation on April 8. People are encouraged to use homemade or commercial cloth face masks and leave surgical masks and N95s for healthcare workers. At my public hospital, we were issued cloth masks to use outside of the hospital, surgical masks for clinical work at the NICU, and plastic gowns, face shields and N95s when there is likelihood to be exposed to aerosols. We are expecting peak contagion to hit us by the end of April-early May and are trying, just like everybody else to flatten the curve. It's still too early to tell how it will go for Chile.
  21. 4 points
    Final video version now public on YouTube. Please share with interested colleagues.
  22. 4 points
    I just got this email from Dr's Meg Kirkley, Clyde Wright and @GauthamSuresh in the US - they are aggregating Neonatal Covid-19 literature to a spreadsheet. A fantastic initiative! Find the continuously updated spreadsheet here: https://docs.google.com/spreadsheets/d/1L9tsrLn9a7LMql_nnUfMA3uS1SSurrj4XUh2yT2bEUc/edit#gid=1867332198 Please find the full email below. Big thanks to Meg, Clyde and @GauthamSuresh for this iniative! _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ We have a resource to share!!! Meg Kirkley (Assistant Professor here in Colorado) and I have been developing a platform to help our Section stay familiar with the rapidly emerging evidence surrounding COVID-19 With that in mind, we created NeoCLEAR: Neonatal COVID-19 Literature Evaluated and Aggregated in Real-time Topic champions within the section are committing to staying abreast in the following areas, to serve as a resource for you: Transmission (with a focus on vertical / perinatal / neonatal transmission): Rob Dietz and Susan Niermeyer Clinical Features of Neonatal Infection: Clyde Wright & Meg Kirkley Diagnosis and Treatment: Laurie Sherlock & Steph Bourque NICU-specific practices and policies: Steph Chassen & Sadie Houin Consensus Statements (reviews & guidelines from medical governing bodies): Erica Mandell & Susan Hwang The Topic Champions are continually updating this spreadsheet which can be sorted by topic, publication date, and publication type. Hyperlinks are provided and the workgroup has provided a brief “key points” column. Gautham has worked hard to include the NeoCLEAR spreadsheet on the perinatalcovid19.org site and it can be found here: https://perinatalcovid19.org/neoclear/ We will do our best to keep it updated and our searches robust! Thank you - Meg and Clyde and Gautham
  23. 4 points
    This is an extract from Prof Jane Pillow's book on HFOV and its applications: You can access the entire publication free of charge from this website - https://www.draeger.com/Library/Content/hfov-bk-9102693-en.pdf - most definitely worth reading! I hope that is helpful! Kind regards
  24. 4 points
    Dear sir Normally one starts off with I:E ratio of 1:2 or in some ventilators represented as a percentage like 33%.what it means is if you have selected a frequency of 10Hz( resp rate of 600) then total Ti for a single breath would be 0.03 seconds. Remember that this IE is for each oscillation and not for recruiting breaths (that has a separate entry parameter) This conventional 1:2 comes from the expiratory time constant which is twice as long as inspiratory. For a given MAP if i am able to manage oxygenation i would not touch on the IE ratio.if you feel that you are not able to maintain oxygenation for a give MAP, in order to recruit more alveolar units one may consider increasing IE to 1:1. But this might result in issues with ventilation also. It is always better to recruit with titrating MAP rather than I:E Regards
  25. 4 points
    This new paper just came onto my radar - on "State-of-the-art neonatal cerebral ultrasound: technique and reporting" in Pediatric Research. Great read! (and if those of us who cannot read, we can look at the pictures like the one below 😛 ) Open access here: https://www.nature.com/articles/s41390-020-0776-y
  26. 4 points
    I find these posters very helpful as well. We will all have to look after eachother in the upcoming crisis. https://www.ics.ac.uk/ICS/Education/Wellbeing/ICS/Wellbeing.aspx?hkey=92348f51-a875-4d87-8ae4-245707878a5c #staffwellbeing
  27. 4 points
    British Association of perinatal medicine has issued guidance today https://www.rcpch.ac.uk/resources/covid-19-guidance-paediatric-services Sent from my iPhone using Tapatalk
  28. 4 points
    UK is not that drastic in isolating neonate from mom https://www.rcog.org.uk/en/news/national-guidance-on-managing-coronavirus-infection-in-pregnancy-published/
  29. 4 points
    @Jose Ramon Fernandez thanks for sharing this link - very helpful.
  30. 4 points
    We use this system on an ongoing basis. Very comfortable and does not damage the nasal septum.
  31. 4 points
    Oh well, so many thoughts after reading this article! Thanks for sharing! Although I agree with every word she says, I think that we should keep in mind that she describes the American reality, which in many ways may be different from European experiences. In many (most?) countries in Europe, we are privileged to have a generous parental leave and (rather) well-coordinated healthcare system. It doesn't change the fact that becoming a parent in the context of the Neonatal Intensive Care Unit must be extremely challenging- and we need to recognize the need to support NICU parents not only during hospitalization but also after the discharge. What really makes me grind my teeth is the fragment about guilt related to insufficient pumping. There is a beautiful (truly) article written by my colleague Sarah Holdren, in which she argues that many NICU mums feel that pumping is actually the only way they can contribute to their infant wellbeing because other ways to engage parents and promote closeness may not be available. I wholeheartedly recommend you reading that comparison of practices in Finland and the USA, the whole article is available here in Open Access. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2505-2
  32. 4 points
    In Linköping we have developed a structure on how to do this in deliveryroom on ELBW less than GW28. It works pretty well if you manage to deal well with the logistic. Receive on the foot-end of deliverybed between the legs of the mother, put the baby in a nest covered by plastic, using a mobile Neopuff with humidified warm gas, Starting with CPAP only awaiting the respond of heartrate and spontaneous breathing, ventilating only if bradycardia, delayed cordclamping. Incubator Close to the bed, connected to mobile CPAP/Ventilator. If intubation immediate Surfactant instillation. We have planned to enhance it into all Babies less than GW32 (33?). Working on a video on it. Apart from a mobile neopuff, an incubator in Place and a mobile CPAP/ventilator you don´t need any extra equippment. But a well trained team and clear logistic is crucial (protocol). /Per
  33. 4 points
    Found this discussion on Researchgate! Did not know they also had a forum there. Lots of good comments. I was taught during my training that reducing dead space is the reason for vittring tubes. But as pointed out, the volume of the cut tub piece is so small that it would have no practical significance, even for an ELBW infant. But I still do it, it is in my ”auto-pilot”... https://www.researchgate.net/post/Will_it_be_better_to_cut_the_ET_tube_a_few_centimeters_after_tube_is_in_place_and_then_place_the_connector
  34. 4 points
    For infants in need of follow up - criteria for our follow up program with neurodevelopmental examination at term, corrected: 3 month, 1 year, 2 year and 5,5 year - we do an examination according to Hammersmith neurological examination. At those intervals we then do Hammersmith, Alberta infant motor scale, Bayley and physical examination by a neonatologist and a physiotherapist and for Bayley a developmental psychologist. For infants with known cerebral injury we also do brain stem audiography and a refferal to an occupational therapist. / Stina, Karolinska University Hospital, Stockholm Sweden.
  35. 4 points
    @Lenks Concerning hypercalcemia (total Calcium of 12 mg/dL is our cutoff for IV saline 10-20 ml/kg with 1 mg/kg lasix. A persistent hypercalcemia in-spite the lasix and total Calcium above 14 mg/dL we would consider glucocorticoids. No experience with bisphosphonates. Calcium intake should be thoroughly reviewed. Although day 7 is early for subcutaneous fat necrosis to cause hypercalcemia, but checking for sites of it could be advised, Further lab. data to know the etiology: ionized calcium, pH, albumin, phosphorus, alkaline phosphatase, PTH, urine sample for spot calcium/creatinine ratio, 25 OH Vit D and 1, 25 OH Vit D. Ask mother and father for Familial hypocalciuric hypercalcemia (autosomal dominant) or check their urine spot calcium/creatinine ratio.
  36. 4 points
    This is a Spanish paper done in Mexico. A transversal research based in an electronic poll sent to Neonatologists and Pediatricians who work in NICU's in the country. We asked them if they were familiar to definitions about orthotanasia, euthanasia, limitation for the therapeutic effort and dysthanasia and which were their usual decisions with babies in end-of-life situations, their relations with families of this babies and then in the discussion we wrote about the changing in the way to manage this stage in terms of adequation instead of limitation in the therapeutic effort. RN etapa terminal - que decide el especialista_2019.pdf
  37. 4 points
    Hi All, I am working as part of a student-team at the University of Cambridge on the idea of developing wireless sensor technology for neonates in the NICU. The overarching goal of this is to progress the technology to a point where it serves to reduce the barrier to kangaroo care. In addition it is hoped the lack of attached wires will have a positive impact on the delivery of care from NICU nurses and doctors in emergency situations. There is also potential to develop the technology to be useful to low and medium income country NICUs. As part of the development we are trying to get opinions from a broad range of healthcare professionals working in NICUs all over the world. Here we have a survey which is aimed at medical professionals. It should only take 10 minutes of your time but all comments are greatly appreciated and will help a great deal towards maximising the clinical impact of the sensor technology. Thanks in advance for any possible comments / advice / insights you can offer - we really appreciate it!! If you have any questions feel free to ask below, Antonio The link again: https://goo.gl/forms/6jpOUd1jUDlTtpVA3 NOTE: We aren't actually associated with the group who published on wireless neonatal sensors in Science last week - and if you haven't seen that paper I would recommend giving it a read!
  38. 4 points
    This is an interesting dialogue. I just had a long disuccussion about fluid management from the delivery room with our neonatal response team nurses. They see quite a bit of variability from our physicians. When we talk about fluids on the first day, we are usually thinking of so much more than just the dextrose/ nutrition containing fluids. We have to consider the "to keep open" fluids running in additional lumens of our UVC and UAC lines. Premature babies are often on antibiotics the first 2 days. Some get saline boluses or blood products. It is very easy to give 20-40mL/kg/d of fluid above the baseline nutrition containing fluid before you even realize it. The 2014 cochrane review of fluid restriction in preterm infants (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000503.pub3/full) includes only 5 trials done in 1980-2000. The fluid restricted arm in the individual studies ranged from 50mL/kg/d to 120mL/kg/d. "Fluid restriction" had more PDAs close and less NEC. The incidence of BPD, IVH, and death were in the right direction (favoring fluid restriction) but not significant. Trying to tie all these factors together and deliver an adequate GIR, I start with D10 fluid at 65mL/kg/d. I presume that flushes and medications will add an additional volume that will quickly put my total fluids in the range of 80 - 110 mL/kg/d, which I think is acceptable on the first day. If I have a low glucose, I first increase GIR by going up on the D10 to 80mL/kg/d, but thereafter I try to concentrate the dextrose containing fluids to deliver more GIR over increaseing the rate of administration. In subsequent days I use weight and sodium values to guide increasing total fluid targets. For almost all circumstances i use birthweight for calculations and continue to use it until the baby is back above birthweight. If the baby has edema and is above birthweight in the first week I stick with birthweight until the edema is resolved. I'm interested in others initial fluid strategies when leaving the delivery room. Where do you start - 60, 80, or more? Do you use D10 or D5 or something else? Thanks in advance for the replies.
  39. 4 points
    Here are some articles which may help to decide initial settings for duopap on Fabian ventilator. Duopap in vlbw RDS china study 2014.pdf Duopap review article.pdf
  40. 4 points
    Our guidelines in Sweden (infpreg.se) is to give oral acyklovir, 10 mg/kg x 4 over 14 days when VZIG is delayed. I guess the same would apply if VZIG is not available at all.
  41. 4 points
    Here is a bundle we use for skin care in ELGANs below 24 wks. I will not be able to provide supporting articles to most of what is done for this population and written here below. Hoping you can find it useful for your team and ELGANs. Resuscitation: · Receive baby in OR sheet (pre-warmed) and place in plastic bag from the OR sheet. Plastic bag an opening to deliver the head from the bag (pre-made) and an opening to over the umbilical stump to be made. Try to keep the bag closed as possible. https://www.ncbi.nlm.nih.gov/pubmed/24042134 · Incubator to be pre-wormed with humidity of 85~90% and temp around 37 ~ 38 C. · No ECG lead; use UAC to obtain vitals or Sa02 probe to get HR · If no UAC, BP frequency on case-by-case basis; change site every time, do not leave cuff on. · Once out of plastic bag, place baby on Biatain Alginate sheet(s) (change sheet every 1 week); avoid skin contact with baby blankets, use Huck towel or OR sheet underneath Biatain. · Use disposable saturation probe. · Semi-sterile conditions: sterile gloves, hat and mask for all resuscitation team members. · ETT to be handled with sterile gloves only. · UVC, UAC insertion using checklist; clean skin with chlorhexidine 2% without alcohol swabsticks and rinse with sterile water. · Plastic bag; hat; warming mattress. Keep plastic bag on until baby in isolette with temperature within normal limits (36.5-37.5 C measured at axillary or back) and humidity level is stable (2-4h). For 1st72 hrs of life · Humidity in isolette: 90 ~ 85%. · In case of skin breakdown: apply Adaptic (non-adherent) and Nu-Gel Hydrogel and cover with hydrofiber wound dressing. · No bath until 7 days. · Minimize use of tape. · Routine diaper care with disposable wipes soaked in sterile water. · Open diaper. · No ECG leads. · Score skin health with a skin care score. From 4 to 7 DOL · Humidity in isolette: 85%; wean by 5% daily after day 7 as temperature allows and based on skin condition. · In case of skin breakdown: apply Adaptic (non-adherent) and Nu-Gel Hydrogel and cover with hydrofiber wound dressing. · Delay bath until day 7. · Minimize use of tape. · Lay baby on Biotain Alginate sheet; change every 1 week until skin condition no longer requires. · Transition to PICC by day 7; If skin condition poor, keep UVC if in good position, until skin condition permits PICC (max 14 days). · Discontinue UAC by day 7. Good luck.
  42. 4 points
    Hello! 1. We have used HFO + VG for some years in our unit. We very often use HFO from start in extremely preterm and not as rescue-treatment. Our experience is good and they tolerate HFO well. I find it easier to control pCO2 with mild permissive hypercapnia in HFO+VG compared to HFO or CV. I think it is definitely an option to use HFO in the first place. But you should make sure that you and the rest of the staff is on the same level there and do some reading first. The frequency in extremely premature babies should be 10-15. We usually start at 10 and probably beneficial to the smallest children to have higher frequencies. Initial setting of ΔP should be around 20-25cm H20 in a newborn ELBW, or titrate until you se discrete chest wall vibration. You would need higher amplitudes when using HFO as rescue. 2. The volumes usually are 1.5-3ml/kg but depend on Hz (higher volumes for lower Hz and vice versa). I find the easiest way to apply VG is to "lock" the volume when you have a blood gas with pCO2 with mild permissive hypercapnia. Set the ΔPmax about 5cmH20 above the setting that you had with VG turned off. The reason why the ventilator starts beeping is that the ΔP is not high enough to allow for the volume requested. So for the patient you describe I would set Hz to 10-12 and the volume should be around 2/kg. Hz in the area 5-10 you should reserve for patients with meconium aspiration syndrome, PPHN and other term babies. 3. Dräger has a brochure on HFO that I find quite good, that covers the theoretical background of HFO and settings, and practical tips. It is available to download. We don´t have Dräger in our unit but their brochure is good.
  43. 4 points
    We for maternity ward stay for infants at 35+0 wks and onwards. I don't know the exact NICU admission rate for 35+0 -- 35+6 infants but the majority stays only at the maternity ward for ~4-6 days, until feeding works and till we know there is no signif jaundice. The midwifes usually add a followup visit after another few days to check weight, jaundice, feeding etc, and then the family only goes to the regular well-baby-clinics (as any other infant) But, we need to support (from the NICU) with planning etc, sometimes we invest relatively much time to make this work. But we feel that non-separation and "non-medicalization" of this group of infants works best in the maternity ward.
  44. 4 points
    Caffeine has been used for over 30 years to treat episodes of apnea in preterm infants. Caffeine citrate is considered one of the most safety and effective drugs, with few or no side effects, used in our Neonatal Intensive Care Units (NICU). Many randomized studies describe the use and benefits of caffeine in the preterm population. Studies based on caffeine prophylactic use in preterm infants, as well as new indications out of apnea of prematurity have been recently published. Despite being one of the drugs most used in our NICU, are not yet available clinical practice guidelines and / or protocols in many of our NICU. Therefore, I invite you to participate in a study to determine the use of caffeine and its indications in NICUs around the world through the following survey. Once analyzed all the surveys, I promise to send you the results. Those you are interested you can send me your email adress and I will send you the survey. Dr. Laura Castells Vilella lauracastellsvilella@gmail.com Neonatologist and NICU’s Manager IDC Salud Hospital General de Catalunya (Barcelona, Spain)
  45. 3 points
    The NeoMate app is very helpful! There is an infusion calculator, where you can easily 'calculate' how much medication needs to go in the syringe, with how much glucose/saline, and at which rate the pump then needs to run. https://london-nts.nhs.uk/professionals/neomate-mobile-app/
  46. 3 points
    You might want to share this link with parents on your NICU: https://parenting.nytimes.com/health/nicu-care
  47. 3 points
    We come across infants that have e hyperinsulinemic hypoglycemia, few are transit responded to diazoxide the rest turn to be Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) they have Mutations of SUR1. and 2 cases with Donohue syndrome (severe insulin resistance, hyperinsulinemia postprandial hyperglycemia, preprandial-hypoglycemia.
  48. 3 points
    BTW and slightly OT - a study on the usefulness of video-laryngoscopy: http://pediatrics.aappublications.org/content/136/5/912
  49. 3 points
    Professor Nick Evans at the Royal Prince Alfred Hospital in Sydney, Australia, emailed some good news about the education programs "Practical Ultrasound for the Neonatologist". The programs, one on echocardiography and one on brain ultrasound, is no longer distributed on CD-roms, but as digital downloads. Prices have also dropped to only 25 AUD (about 17 euro) + local taxes. The current downloadable programs are the same as anyone who bought the CDs since 2006 would have. Past CD customers are offered a digital license for free and anyone who downloads the programs in the near future before any upgrades are available will also get future upgrades for free. As before, the program currently only works on Windows but a Mac version might be offered in the future. The direct link to the on-line shop is https://practical-neonatal-ultrasound.selz.com/. As before, all profits go to support teaching and research in neonatal haemodynamics. The link to the department is http://www.slhd.nsw.gov.au/rpa/neonatal/default.html
  50. 3 points
    Whatever side we take...the most important point to remember is that ventilation should be excellent when using Bicarbonate...if ventilation is not optimal...then the CO2 released from Bicarb in vivo goes nowhere and paradoxically leads to increased acidosis !!!
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