Pyw

Hi all, There is no magical number but i agree you have to start frow somewhere. For < 28 GA we usually begin around 100 ml/kg/d with 1 mmol/kg/d (essentially from drug) but the key is to adapt and adjust according to your patient in the following days. There are two way to loose water : diuresis and insensible water loss (skin++). And one for Na (diuresis). You can measure diuresis but not water loss. There is no anti-diuresis medication but you can reduce your IWL with an high humidity. And when you already have lost too much water you have to replace it. There will be always a delay between the urinary output and your input's adaptation, and you can not be sure of your IWL. So even with a correct input adaptation you will have some suprises with an unexpected weight loss or with natremia. About humidity, we aim 90 - 95 % humidity at least. We always have issue with non water proof incubator (they seems to be water proof only when they are brand new...) and sometimes we barely reach 90-95 %. Nurses also complain about condensation at 99 % humidity. After saying all this good words, i have to say we still have hydro electric balance issues with < 28 GA. We had improvement over the last years. One thing that helped us is to do the right thing at the right moment. I explain, we manage the hydroelectric balance with 4 parameters (weight, natremia,input, output). In our NICU, we used to weigh babies between 8pm and 2 am, to change the prescription in the morning, to plugged the new PN lines between 2 pm and 6 pm, to do the blood test 5am or 8am, and to measure the diuresis every 3 hours. And so the prescription of the PN was done with an 12 hour old weight and at the time we were having a new weight the new lines were plugged for 4 - 6 hours. Now, we weigh every < 28 GA at the same times as the blood test (5 or 8 am) and ask the new lines to be plugged as soon as the prescription is done in the morning. I am not in favor of micro management, because you end up doing the opposite 3h later. You have to let some time from your previous interventions to reasses before doing a new one. I rather adapt once or twice a day but to do so you have to have the right informations at the right moment. And just an another remark, i don't know how you are working in other country but sometimes i do what i can do with what i have. Reading people or guidelines about intakes it seems easy to set the Na at xx ml/kg/d or H2O at xx ml/kg/d or dextrose at xx g/kg/d. Well, in real life when i prescribe a drug it comes with water +/-Na, add Phosphore it comes with Na, add proteins it come with water, our PN for the first days is a D10 % Na/K free or not but i can't decide the level, < 28 GA have some times high glycemia with low Dextrose intake. It is all about a compromise.

Hi, We used to have a colorimetric sensor but in tricky situations we were always wondering whether it had changed color or not. Since then during procedure we have been using an add-on to our Philips monitor (MX 500) to get a waveforme capnography which is much easier to read.