manberbenitez

Dear Carlos Valdes: I have to write you in english, because this is an international forum, The use of ambroxol wasa classical therapeutic method from europe ( Italy), basically for RDS via IV, but when we dont have surfactant I saw 4 or 5 cases of intersticial emphysema.Ambroxol inhalation is not common in neonatology, and probably you could havea lot of secretion production so its not so good, I agree with Mohamed Mayari MD, that the best way to treat atelectasis is to prevent it, and you should have to give a good physiotherapy, IV requirements liquids, humedification and heated air, and change regulary the position of the baby, and obviously a good caloric intake to have a good mechanical chest properties. Be carefull with a infection, because some time there is a endobronchitis and infection association. In some cases a short course of steroids could be fine, and probably in the more difficult cases, pulmozyme, could work very good, but is too expensive. Nice to meet you and hope this help you.

Dear Dolphine : Im agree with Stefan, the cause probably is not RDS, and I think more on congenital pneumoniae so is very important to try to see the results of the cultures to have a idea of which antibiotic use. In this case I have some questions, about it : ¿How much cpap do you used?,¿Did you combined Cpap with caffeine?,¿How is the nutritional status of your baby? this last point I think is very importante because sometimes we supposed that the baby have to breath, but the calories we give it, are too low. Probable we have an atypical pneumoniae and we have to do special cultures,¿ Does the mother has any kind of infection?, ¿Did you take a vaginal culture for strep?. Im not sure that the BPD diagnosis in this case is real, because you have a not resolve problem. Hope this help Your friend Manuel Bernal

Dear Friends Thanks for your opinions, and I agree that the IT is totally dynamic with each breath, but we have to put some value in the ventilator. Yes we use floww graphic ventilators and is very intersting to see all the changes that we do, reflect in the real mechanical neonatal world. thanks in advance. I thanks for the URL. Manuel

Dear friends: I want to know your opinion about the IT that you use in different pathologies.In my NICU I have a problem, we have differents kind of patients with RDS, congenital pneumonia, NEC etc etc, that we have to ventilate, but sometimes I found that all my patientes have 0.33 IT ( conventional ventilation) like a rule, no matter what the problem is. In acute phase of an RDS probable we can need short IT like 0.2 - 0.3 sec and we can obtain 3-5 Time constants and get a good ventilation, but what happen with all other patients that sometimes has not respiratory problems, with a good compliance and we can use IT between 0.3 to 0.5 sec. Do we have to ventilate all the neonatal pathology with 0.33 sec or obviously do we have to individualized. Sorry for this question but I have problems with other neonatologist in ventilate a 4kg newborn with 0.33 sc IT or a micropremie 750 grams with the same IT. thanks in advance for your opinions.

Dear friends We are in the process of buying one high frequency ventilator, but Im not decide for which of one, we only have a little experience with sensormedics, but I know that Vip Bird 8000 Drager is very good. In your experience and considering that probable we only can buy one of both, which coluld you recommend to me. Thanks for your help

Dear Mirko: Here in Mexico, there is a routine to make a gastric lavage at born,personally I think there is no reason to do it, some neonates that swallowed a regular amount of maternal blood, probably have some intolerance feeding at the begining, but are very few, so in general I consider that this practice have no reason to do it