manberbenitez

In our unit we have very few cases of Candida sepsis, so we really dont ue fluconazloe prophylaxis. we have a infectious committe and they check the rowth in cultures everyday, so if there is any suspicious of growing we start treatment.

Hi Susan, for years we are using the Inca Prongs that have a security system for the tubes, in my opinion very comfortable for the baby we dont have any problems, and we cover the nose with Duoderm extra thin and make the holes for the cpap, by this way we prevent malfunction of the cpap and protect the nose. Hope this help.

Dear Stefan Thanks a lot for your opinion, in my opinion I disagree with this, but in my hospital there is a tendency to do it in all the patients. thanks a lot Manuel

DearNICU friends. I want to know your opinion about take a Urine culture like a control of antibiotic response in such cases of urine infections. Does this decision is really helpfull or we are waisting time and money. thanks a lot for your help Manuel

thanks a lot for your help and opinion, is very usefull for us. your friend. manuel

Dear friends: I have a problem with one pediatrician of my hospital, she is the head chief in the PICU and she want to standarized some rules that we are not agree in my NICU, so I want you opinio if I have to change it, I will. 1.- First of all, how frequent did you change your in line suction system in each ventilate patient. 2.- When you have a ventilate patient with this kind of system, always you have to increase your FiO2 (inspired oxygen) at 100% level, pre and post suction ???, 3.- What happen in those patients that we have in HFOV and in line suction system, did you change some parameters or you leave it like you have it, 4.- Do you have some protocol for in line suction in neonate that want to share with me. I give you my e mail, in case you want to send to me by this way Manberbenitez@yahoo.com.mx Manuel Bernal Thanks a lot in advance, but I have to demostrate others opinions in the world.

we have the same manner of work like mbayari, we only give medical information to the parents.and they are the only persons that can be in the nicu with the baby

Mariam: we have a similar case not a nurse but a neonatologist (women) and we decide with her Mom to be treated for my colleagues. I think is better a "cool head" to take better medical decisions. Here in mexico we have a famous phrase " newborn or child with medical parents is a point of bad prognosis".

Dear Norbert Here in mexico generally we use only water and soap during the bath, in the first 5 to 7 days we use sometimes a product name merthiolate, I think is timerosal and a mercuric salt. we repeat very frequently to our moms that do not cover with anything and ventilate very frequently. hope this help

thanks for your opinion kumari. I appreciate so much

Dear Nicu99 members: Yesterday I received and invitation to participate in a Radiology Congress, The topic is "The value of prenatal ultrasound in neonatology". Can you share with me your opinions about which can be the most importante topics that I have to take in account. thanks a lot for your opinions Manuel Bernal Benitez Head Neonatologist Hospital de Especialidades Miguel Hidalgo Aguascalientes Mexico Manberbenitez@yahoo.com.mx

Dear stefan : The congress is not in english ???

Here in my unit ( mexico) we dont use fungus prophylaxis in any case, we try to limite the time and reasons for antibitotics uses, and try to not stay with the catheters a lot of time. we use fluconazole initially if we only suspect the presence of fungus, but whne we have the isolation of Candida we use anphotericin. have a good day Manuel Bernal Benitez Centerario Hospital Miguel Hidalgo Aguascalientes Mexico Head Neonatologist Manberbenitez@yahoo.com.mx

Dear Alexey: We dont have any experience with the use of the SLE 5000. we use the 3100A, and with respect of the IT, the percentage of 33% give you a relation I:E of 1:2 for3 to 15 hertz. The percent of IT should never increased because it will lead to air trapping and fulminant barotrauma. Total IT should only be increased by decreasing frequency, thus leaving the I:E ratio constant I:T can be decreased to 30% to heal airleaks. Hope this help you Manuel Bernal Benitez Centenario Hospital Miguel Hidalgo Aguascalientes Mexico Head neonatologist Manberbenitez@yahoo.com.mx

we dont stop feeding during transfusions

Dear 99Nicu friends: In this thread I want to know your opinion about: 1.- Which is the real validity of result of lactate in blood gases. 2.- Does the lactate in the neonatal period is really a predictor of good or bad prognosis(neurologic) 3.- Can you tell which decision you make whne you have a blood gas lactate value high. 4.- Which is the value of blood gas lactate that really worry. This questions are because in my unit there is a tendency of give a saline bolus at 10-15 ml/Kg in all the babies that have little, moderate or high lactate value. I understand that if there a severe organic disfunction is logically that the lactate value it will be high, but there ar others causes of high lactate that no require saline bolus. thanks in advance, and if you haVE SOME articles I will appreciate. Your friend. Manuel

I think that the apgar score was usefull in his moment, but today we evaluate every newborn baby more especifically because we use the neonatal reanimation program. The Apgar Score sometimes do not denote anything for example in a mother with anesthesia effects. I think in the future we have to make a differente score which really evaluates the hemodinamically condition of a baby and his neurologic outcome. Remember that the great % of babies with cerebral palsy had normal apgar score. thanks.

Dear Friends: Can anyone could tell me if there really association with Ranitidine and late onset sepsis in neonate. I have only 1 article( Bianconi Simona et al, J Perinat Med 35 (2007) 147-150) but I think there other factors that influencing in the appareance of sepsis. Do we have to stop to use it ( Im agree that dont abuse it, but definitively stopped) Thanks for your opinions. Manuel Bernal Benitez Neonatology Aguascalientes, Mexico Manberbenitez@yahoo.com.mx

sorry for this lately answer, here in mexico we dont have MTC oil, and the presentation in to big for one baby, so we have to useo corn oil ,first we have to be feeding at the maximium amount of proteins that can we give to the patient, then if we don have a good weight gain, we add corn oil 0.5 ml to 1 ml in each feed or alternate depend the nutritional constant that we are looking for. hope this help.

1.- Check the amount of IV liquids that you are given 2.- Check the arterial pressure, and mantain in normal range for age or weight 3.- Check th renal function. 4.- If you have orally supplementation, be carefull with the protein amounts that you are given. 5.- Are you give , L cysteine, more than the regular amount in relation to protein supplementation can produce metabolic acidosis. 6.- Check symtomatic PDA. 7.- Metabolic screening. hope this help

dear stefan we leave the arterial catheters only 5 days, there are reports of hyperreninemic hypertension ( usually low catheters).We use it high. your friend manuel

Hi I really aprreciate for your intersting. This is a very rarely surgery, and we only have 2 reports in the literature with 5 and 6 years follow up. The principal mechanism of the ping pong ball is only mechanically stabilisation of the mediastinum. First when we receive after the surgery ( without the ping pong ball) we saw that sometimes the patient suddenly turn pale, bradycardia, and hypotension, and diaphoretic so we read about this symptoms and conclude that was a postneumonectomy syndrome. we the surgery put the ping pong ball inside the chest, we have a more stable mediastinum and we dont have any more events. thanks a lot

Can anyone have an opinion of the case thanks

Dear Liliroom Try Manual of Neonatal Respiratory care Authors: Sinha y Donn

Dear 99 friends: This is a case discussion, about a neonate that we received in my NICU at 45 days of life, with 34 weeks gestation initially,cesarean,Birth weight of 2000 grams, required mechanical ventilation because RDS, then complicate with pneumothorax, so he had a thorax drainage for 3 days, then he has pleural effusion,with a gramm negative infection, so he received 3 differente kinds of antibiotics, the last one was Imipenem with Vancomycin with good results initially but he had a residual pulmonary infection with cavitation with fibrosis, so he had to go to mechanical ventilation again. At this moment, the baby arrived to my NICU, we made a Tomography Scan that show us a real pulmonary damage with fibrosis, and pulmonary sequestration so my pediatric surgeon saw him, and confirm to us that the only way was to make a pneumonectomy. The surgery was ok, in the other lung ( left lung) we saw CLD images so we gave to him dexamethasone for 10 days and we took him from ventilator. 2 days after the surgery, the baby had episodes of bradycardia,pallor,and apnea, that we recover with PPI, and thsi episodes repeat frequently so we think in Postneumopnectomy Syndrome. My pediatric surgeon introduced 2 ping pong balls in the right Lung Cavity , and until today the baby is going well. So my questions are: What do you think about this case. Do you have some experience in this kind of surgery.or postneumopnectomy syndrome, because we only find 1 report in literature. Thanks for your opinions.