Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org

Leaderboard

  1. Stefan Johansson

    Stefan Johansson

    Administrators


    • Points

      569

    • Posts

      2,753


  2. Francesco Cardona

    Francesco Cardona

    Administrators


    • Points

      149

    • Posts

      522


  3. bimalc

    bimalc

    Members


    • Points

      137

    • Posts

      165


  4. piatkat

    piatkat

    Moderators


    • Points

      128

    • Posts

      177


Popular Content

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

  1. 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
    12 points
  2. 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
    11 points
  3. 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
    9 points
  4. 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
    8 points
  5. On behalf of the 99nicu Team, I would like to invite you to participate in our 2nd Journal Club! The article we chose this time is a review article on "Safe emergency neonatal airway management: current challenges and potential approaches" by Joyce E O'Shea, Alexandra Scrivens, Gemma Edwards, and Charles Christoph Roehr. This artile is not Open Access, but I hope you can get it from your hospital library. The review article examines how to acutely manage the neonatal airway, and the challenges related facemask ventilation and intubation. Some of the key messages in this paper are: Intubation success rates are low, especially for inexperienced trainees Universal intubation competency for all pediatric and neonatal trainees and consultants may no longer be possible Videolaryngoscopy can help increase rates The laryngeal mask airway (LMA) is a promising alternative to intubation Some of the questions we would like to discuss are: What is current practice in your department? How to do you manage the airways and who is doing what? What do you think are the strengths of this review article? What do you think are some of the limitations? Will this review have an impact in your department? If no - why? If yes, how? We are looking forward to hearing your thoughts and opinions! UPDATE: More information on the virtual journal club on June 9th here: https://99nicu.org/99nicu-news/join-our-virtual-journal-club-meetup-on-neonatal-airway-management-9-june-1630-1715-cet-r124/
    7 points
  6. Check out the , now for the first time as a Virtual Meeting. More info on the attached PDF. Visit the web site for more info and to register: https://www.epiclatino.co/in-english
    7 points
  7. So I've seen LISA done once, I've now done it once, next is to roll it out unit wide in our NICU. See one, do one, teach one, right? I'd like to hear from those of you that have been doing LISA/ MIST for a while now. What is the best tip you have? What do you know now that you wish you had known when you first did LISA? What barriers to implementation did you have when you started? Any feedback is welcome. Also, I made a video for our nurses and respiratory therapists to just introduce the idea. Not too in depth, but something to get our education rolling. See what you think.
    6 points
  8. 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 points
  9. 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.
    6 points
  10. 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?!
    6 points
  11. 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
    6 points
  12. A series of free, online guest lectures in pulmonology, courtesy of the NOTE and ESPR collaboration. I have added these dates into the calendar, but you can sign up for these by contacting noteteam20@gmail.com. All times are in CEST.
    5 points
  13. We do, in our unit. No specific guidelines though. We generally encourage cuddles at every opportunity, including in the delivery room. Sent from my iPhone using Tapatalk
    5 points
  14. https://www.neonatalconversations.com Neonatal Conversations is another NICU dedicated podcast, based out of Sydney, Australia. The first episode, conversation with Nick Evans around use of inotropes is terrific.
    5 points
  15. We will shortly be changing our standardised lipid infusions from syringes to bags which will have a 48hr hang time. Several units in Ireland have already adapted to a 48hr (over several years) hang time for an aqueous bag and we have not noted any increase in infection. Theoretically it should reduce the risk as you are breaking the central line only once every 48hrs as apposed to every day. Despite initial concerns from the neonatal nurses they have embraced the change and are looking forward to changing the lipids to 48 hours as well. The biggest risk is that when the lipids are infused as a separate infusion errors can occur when setting the infusion rates unless there are robust systems in place for checking, prompts on the pumps etc. Unfortunately we have discovered that no one is manufacturing a light protected IV administration set in any colour other than shades of yellow which would help clearly distinguish each infusion. Therefore labelling the lines will be important both before and after the pump, two -person checks at each change of infusion and subsequent infusion rate changes, hourly checking set rate and volume infused and checks at each shift changeover. Another suggestion following an error in the UK is to consider having dedicated pumps for Lipid infusions only.
    5 points
  16. From prof Takeshi Arimitsu, invited speaker at our previously planned Meetup in April 2020 (but cancelled due to Covid), I got an email about an interesting case report from their large neonatal center in Tokyo. They have published about a 268 gram 24-weeker with intact survival. I share the last sentences of the summary below. The publication is available open-access and in full-text here: https://www.frontiersin.org/articles/10.3389/fped.2020.628362/full Looking fw to follow the discussion about this extraordinary case.
    5 points
  17. Time really flies, and it now 15 years ago since we started to plan for the 99nicu forums, opening in May 2006. In many ways, this project has been a key part throughout my own neonatology carrier. I have learnt so much about the diversity of how to practise neonatology, and I have also learned to know many people around the world. I had not get to know you without this virtual platform. But with time comes age and I have started to think about how to future-proof the operation and development of 99nicu. I, @Francesco Cardona and @Vicky Payne have started to think about where to go from here. what do you like with 99nicu? how does it benefit your work? what can we do better? what are you missing? Please share what you think!
    5 points
  18. No electrolytes (except possible Ca) in the first day or so, introduce modest amounts of Na and K in IVF/PN on day 2 or 3 based on diuresis and serum Na level. Closer monitoring is required in ELBW/EPT infants. In my experience in the early going the biggest problem people get into is giving too much free water as opposed to being off on the amount or timing of Na administration. After a couple of days the biggest problem, especially in ELBWs, is that massive amounts of acetate given in TPN to compensate for the normal RTA are not adjusted quickly enough and people overshoot and end up with iatrogenic metabolic alkalosis. Later we see the problem of inadequate provision of NaCl manifesting often as poor weight gain (especially in the ELBW advanced on term donor milk).
    5 points
  19. Dear Mohan, from all studies by the team of Professor Stuart Hooper and Professor Arjan te Pas, we know that aeration of the lungs is the master switch to transistion a baby from placental circulation to autonomous circulation. As long as the placenta is not delivered, there is gas exchange and the newborn receives oxygen-rich blood via the placenta. It is therefore important that the baby aerates its lungs before cutting off placental circulation - to ensure that baby's heart receives sufficient oxygen rich blood from the placenta during transition. When the placenta has been delivered, there will no longer be any gas exchange, but there still may be a possibility for placental transfusion, which has some benefit to increase blood volume. This is a nice article on this topic: https://www.frontiersin.org/articles/10.3389/fped.2019.00405/full
    5 points
  20. 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
    5 points
  21. 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
    5 points
  22. 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.
    5 points
  23. 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
    5 points
  24. 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
    5 points
  25. 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
    5 points
  26. 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
    5 points
  27. 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
    5 points
  28. This might be useful to some, covers paediatrics and some neonates. "Waiting until 48 hours to stop antibiotic therapy in all children is an outdated approach. Research shows that 90% of bacteria will have grown by 24 hours and 95% by 36 hours. In children with low BSI suspicion, stopping antibiotics at 24–36 hours with good safety-netting advice avoids unnecessary hospitalisation without jeopardising patient safety" https://ep.bmj.com/content/edpract/106/4/244.full.pdf Just for fun.......anyone stopping at 24 hours?
    4 points
  29. Recently I've participated in a small scientific meeting with the neonatal team from Uppsala, Sweden, and from what I understand they are trying to involve parents in a more meaningful way to care for their infants during therapeutic hypothermia. I know that so far they have published this qualitative study https://onlinelibrary.wiley.com/doi/10.1111/apa.15431 and a bit earlier this study https://pubmed.ncbi.nlm.nih.gov/31084824/ :"Being unable to hold the infant skin-to-skin during HT has been shown to be stressful [10], and although skin-to-skin contact has to be limited due to thermoregulatory constraints, infant holding is indeed feasible [23]." I hope this gives you some fresh perspective I have no idea if we have anybody from Uppsala here, @Stefan Johanssondo you maybe know?
    4 points
  30. @Stefan Johanssonshal we make a folder "Podcasts" in our Links directory?
    4 points
  31. I loved it! Here’s a little compilation of podcasts that I’d shared with my staff Sent from my iPhone using Tapatalk
    4 points
  32. During the development of our Premature Baby Manikins (first the 28/29 week gestation and then the more recent 22/23 week gestation) we have observed a lack of suitably sized DL & VL equipment designed to deal with these extremely low birth weight babies (i.e. the blade sizes are simply too big!). It would be interesting to share what DL & VL devices you are using as we see a fairly high proportion of failed intubations (or at best too much force being applied to achieve intubation) in the training / simulation setting. While the cause, in part, can be associated with variances in an individuals technique, it is not helped by the seeming lack of suitable equipment. As the 'gestation / viability window' has come down over time, has equipment design kept pace with this and do you use different protocols (including different devices) for different gestations?
    4 points
  33. In the past, we paused iron supplementation during three days after a blood transfusion. However, we thought this routine did not really make sense as the iron load from a blood transfusion would correspond to ~1 month of iron supplementation In infants with many transfusions, we do check S-Ferritin, and halt iron supplementation if S-Ferritin is >350 μg/L.
    4 points
  34. Same as you, for the most part. Keys in my view are: 1) Anticipation of risk factors (length of intubation, cuffed tube, lack of leak, parenchymal lung disease which may make the child more prone to struggle with even transient upper airway narrowing, etc) 2) Early recognition/treatment with nebulized Epi and Steroids as well as consideration of heliox as a further temporizing measure until steroids can kick in 3) Shared mental model with frontline staff that re-intubation may be more challenging and/or need to happen fairly expeditiously if the airway cannot be preserved non-invasively
    4 points
  35. Also there are papers now looking at "cooling outside criteria" which are interesting too e.g. late preterms, stroke..... This RCT was in adults but suggests worse outcomes in adults undergoing therapeutic hypothermia who have bacterial meningitis.....https://pubmed.ncbi.nlm.nih.gov/24105303/ A neonatal study (Jenkins et al 2013) has looked at immunosuppressive impact of cooling. Newer possibilities: cooling in NEC?!? https://pediatrics.aappublications.org/content/125/2/e300.short and lots of work now looking at adjunctive therapies like xenon and erythropoetin..... And perhaps a topic for a separate discussion thread....and I think topical to practice (in UK) cooling in mild HIE?!? https://fn.bmj.com/content/105/2/225.abstract?casa_token=urlRBLGeNVgAAAAA:mpPfBX_gPwzVlNLIpUYO9ETpCgdI20zJNzxhuJ2EoqU-hcqW3NGeoqpYXAH9GN-6fZrhsSx-mRk
    4 points
  36. Useful resources on managing a difficult airway developed from the British Association of Perinatal Medicine....practical flow charts and equipment to have to hand! https://www.bapm.org/resources/199-managing-the-difficult-airway-in-the-neonate
    4 points
  37. I am treating umbilical granulomas with common salt application at my place for >25 years with excellent results. This can be done by mother or grandmother by applying small piece of rock common salt over the granuloma ( preferably after feeds so that it stays there for at least 3 hours) and fixing it with a plater. I advice twice a day application for a week. It's just a home care remedy for umbilical granulomas.
    4 points
  38. In our March Concord Talk, Prof. Arjan te Pas will educate us what the key success factors are when incorporating cord clamping into stabilisation of preterm infants and share the experiences of his clinic in practicing physiological-based cord clamping for over 4 years. March 2nd at 15:00u (CET). Register via: https://concordneonatal.com/concord-talk/
    4 points
  39. Genetics may have something to play a role. Worldwide, survival rates are increasing and complication rates are decreasing. I believe that tomorrow's outcomes will be better than today's as a result of advances in treatment. I am studying publications written by all of you, and I am implementing what I have learned every day in my practice.
    4 points
  40. Friends, I am glad to share that an article of mine about racial disparities, titled 'I Can't Breathe' was just published. Here is the link to the full text of the article (the full text is not available if you go through the journal website). Please share widely - I hope it stimulates action by readers to reduce racial disparities in care and outcomes in the field of perinatal and neonatal care. https://rdcu.be/b6cgM
    4 points
  41. 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.
    4 points
  42. 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
    4 points
  43. 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
    4 points
  44. 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
    4 points
  45. 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
    4 points
  46. 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/
    4 points
  47. 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
    4 points
  48. 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.
    4 points
  49. 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.
    4 points
  50. 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.
    4 points
This leaderboard is set to Stockholm/GMT+02:00
×
×
  • Create New...