Bernhard Csillag

Thank you for your replies! I agree, that one should never use breast milk for anything else than nutrition as long as there isn’t spare milk available or donor milk demand. the question is, is it really a “waste” of breast milk in that case, or is the potential benefit for the gut (possible Immunologic effects, possible effects on the microbiom, less irritation of the gut with lower osmalarity, possible propulsive effects, …) a reason to make it a good option. As we learned from intravenous use in the past, NaCl 0,9% isn’t a really physiologic choice at all.

In this paper out of China (https://doi.org/10.1001/jamanetworkopen.2024.7145) Zheng shows the safety and discusses the possible pathophysiologic effect of breast milk used for enemas in preterm infants for meconium evacuation. Lange et al (https://doi.org/10.1111/apa.16528) and also Gross et al (https://doi.org/10.3390/children9081122) showed that breast milk enemas are used in NICUS in Germany, although in a small amount of cases. We are using breast milk for enemas for some time now with good experiences. As the evidence is still little, I was wondering if there are some experiences of other centers. What is your opinion?

Manly very high sodium und hyperchloraemic acidosis. But also oliguria. We ended up with fluid rates of 210-250ml/kg/day. sauna is the way to go! thank you!

Hi everybody! Our nurses got recommendations for nursing preterms - even extreme little ones - in an open cod. They say, that the movement of the air through the Arm-Holes is cooling the babies too much, if the cod is closed, and with an open cod, the heater keeps the baby warm enough. When we tried now open-cod-nursing temperature was not a problem (it wasn‘t before either), but what we noticed, was, that the extreme preemies needed a LOT more daily fluids than in the times of closed cod nursing. At least, this was a noticeable coincidence - and one, that supported our skepticism, as an open cod looses all the humidity. So right now we are in discussion, what is best for the little ones. Do you have similar experiences? Other thoughts? thanks, best wishes, Bernhard

Thanks you for your answers. we used LEV for 1st line therapy for some years, but often ended up with a co-therap with phenobarbital, so we switched back to pheno as 1st line at the time the new ILAE Recomendatilns came out. so now we will do LEV as 1st line after temesta for acute therapy and Phenytoin as 2nd line, in case phenobarbital really is getting non available. thank you for your reply

Hi Everyone! Our Pharmacy told us, that there is an rising shortage of phenobarbital. Being 1st line treatment for neonatal seizures again, this brings some problems with it. What would you prefer as 1st line treatment instead? - Guidelines are kind of favouring Phenytoin as an alternative - but has more significant sideefects. - Levetiracetam? Not that promising, right? Any alternatives? Best wishes, Bernhard

I just came across some papers about etomidate for sedation - causing no haemodynamic problems, but I hardly find any paper or recommendation for or against using etomidate in neonates. What I learned so far: - No haemodynamic suppression - Not analgetic - very often onset of myocloni - High tone of pharyngeal muscels - so relaxation needed - Adrenal suppression - in a relevant duration? That one could be a relevant argument against using it in neonates. - 0,3 mg/kg/Dose - Don't know anything about neuroapoptosis. Any experiences? Thank you! best wishes, Bernhard

Hi! I suppose it is, because a rising bilirubin in the first 48h hours is most probably due to rhesus immunization and could rise so fast, that you won‘t treat it soon enough - so with a rising bilirubin in the first 48h you should start treatment earlier. Perhaps it has something to do with an immature blood brain barrier, too. it is based on the work ob buthani … as you mentioned before An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation. J Perinatol 2012;32:660–4

There is also a good webapp for the preterm buthani values: https://pbr.stanfordchildrens.org

We used Albumin a lot in former days either for correcting hypalbuminaemia, or for fluid blouses in assumption it holds the fluid inside the blood vessels. well, we learned, that it doesn‘t stay intravascular at all. Moreover it moves extravascular, takes fluid with it and binds it outside the vessels- making edema even worse and harder to resolve. We now use only Elomel isotonic for Volume therapy. now we only use albumine to correct hypalbuminaemia - but I really don‘t know if that is good either either. there is a paper called „Uses and misuses of albumin during resuscitation and in the neonatal intensive care unit“, that explains a lot: http://dx.doi.org/10.1016/j.siny.2017.07.009 hope that helps, bernhard

Oh no, I missed it. Will there be a recording available? thx

We always use s-nippv (Graseby Capsule) with PEEP of 6-8(-10) and starting PIP of 15-17 - changing PIP according to development of CO2. Tinsp 0,4. Around 30-32 GA we tend to use nCPAP with Backup s-Nippv. From 32GA we start with nCPAP alone.

What dosage do you use with PenG? 25.000 or 50.000 per kg per dose. (Frequency depending on PMA)? thank you!

… and how comfortable are you with your choice? So, we all know, that there has been and still is a wide variety of combinations for premedication for intubating a neonate - even more difficult when dealing with preterms. As far as I know, most current recommendations favour using an opioid, a muscle relaxants and mostly atropine. I “grew up” using thiopental and fentanyl +- Rocuronium and often times a second dose of fentanyl was needed until placing the tube (nasoteacheal) was tolerated. So for me, using Fentanyl and Rocuronium without an hypnoticum right away, makes me somewhat uncomfortable fearing too little medication effect and too much awareness. So, what is your combination and how do you feel using it? I’m curious ….

Thank you for your answers. pen/Tob sounds like a good way to start and P/T for LOS sound very reasonable, too. Cochrane tried to look into this topic without a result. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127574/ Thank you!