trish

You are welcome. I hope you find some nice resources to develop a S2S guideline. Many NICUs have guidelines, it might be worth emailing some to see if it would be possible to share. Or perhaps go to the professional body. I see you are from UK, contact the Neonatal Nurses Association http://www.nna.org.uk/ Cheers Trish

Hi Al, I came across this article only just this morning. It is an interesting read on the subject. I also love this YouTube from the March of Dimes Taking the Evidence Based Case for Kangaroo Care into the Clinical Setting Cheers Trish 2018_Lim_Neonatal nurses perceptions of supportive factors and barriers to the implementation of skin-to-skin care in ELBW.pdf

Hi Rehman Yes there is often confusion between paediatric and neonatal resuscitation. The Australian Resuscitation Council (ARC) Guidelines https://resus.org.au/guidelines/ provide different guidelines for compression and ventilation in neonates and paediatric patients. For paediatric patients it states in ANZCOR Guideline 12.2 point 5.3: Chest compressions should not be interrupted if ventilation is given via endotracheal tube. Ventilation should be given just after a compression. This will minimise but not eliminate simultaneous ventilation and chest compression [Class A, Expert Consensus Opinion] For neonatal patients it states in ANZCOR Guideline 13.6 ANZCOR suggests that inflations and chest compressions should be performed with a 3:1 ratio of 90 compressions per minute and a half second pause after each 3rd compression to deliver an inflation (CoSTR 2015, weak recommendation, very low quality of evidence).2 Compressions and inflations should be coordinated to avoid simultaneous delivery of a compression and a breath [extrapolated evidence7]. I have provided a link to this website for your perusal. Hope this helps Cheers Trish

CPAP Canberra Hats to prevent nasal trauma Hi, There is a wonderful hat that was designed by a nurse at Canberra Hospital ACT, Australia, that almost resolves this problem completely. She markets them to quite a number of hospitals throughout Australia. The design is perfect, they come in a range of sizes right down to microprem size. they can be used for midline and Hudson prong types. They hold the prongs away from the septum securely, and can withstand the baby moving. They are washable and reusable. I can't remember the nurse's name, but if you contacted Canberra Neonatal Intensive Care Unit you will be able to contact her. I cannot recommend them highly enough, they are perfect.

Always check clotting studies prior to LP, have worked in a unit with undiagnosed congenital haemophillia, LP resulted in massive blood clot within the spinal cord and serious short term consequences, not sure re long term.

I have researched this subject fairly extensively over the years as there is still much contoversy over correct suctioning technique. During ETT suctioning the application of negative pressure sucks air from the airways and alveoli, the literature does not recommend applying negative pressure while inserting the suction catheter as this can increase the chances of atelectasis and hypoxia. It is not recommended to insert a suction catheter too far into nasal passages and a simple method is to use the finger port (while kinking off the catheter) rather that the catheter to suction nares, especially if secretions are thick and copius. Following is a list of references related to neonatal suctioning, hope this helps 1. Pilbeam, S. P. (2006). Mechanical Ventilation Physiological and Clinical Applications. St Louis: Mosbey Elsevier. 2. Curley, M. A., & Moloney-Harmon, P. A. (2001). Critical Care Nursing of Infants and Children 2nd Edition. Philadelphia: Saunders. 3. Moore, T. (2003). Suctioning techniques for the removal of respiratory secretions. Nursing Standard , 47-53. 4. Ireton, J. (2007). Tracheostomy Suction: a protocol for practice. Paediatric Nursing , 14-18. 5. Tracheal Suctioning of Adults with an Artificial Airway. (2000). Best Practice; Evidence Based Practice Information Sheets for Health Professionals , pp. 1-4. 6. Auckland District Health board. (n.d.). Retrieved March 2007, from National Guidelines Newborn: http://www.adhb.govt.nz/newborn/Guidelines.htm 7. Morrow, B., & Futter, M. a. (2006). Effect of Endotracheal Suction on Lung Dynamics in Mechanically-Ventilated Paediatric Patients. Australian Journal of Physiotherapy , 121-126. 8. Ward-Larson, C., Horn, R. A., & Florence, G. (2004). Facilitated Tucking for relieving Pain of Endotracheal Suctioning in Very Low Birthweight Infants. The American ournal of Child Nursing , 152-156. 9. Cordero, L., Sananes, M., & Ayers, L. (2001). A Comparison of two airway suctioning frequencies in mechanically ventilated very low birthweight infants. Respiratory Care , 783-8. 10. Wilson, G., hughes, G., Rennie, J., & Morley, C. (1992). Evaluation of Two endotracheal Suction Regimes in Babies Ventilated for Respiratory Distress Syndrome. Neonatal Network , 43-44. 11. Kuriakose, A. (2008). Using the Synergy Model as Best Practice in Endotracheal Tube Suctioning of Critically Ill Patients. Dimensions of Critical Care Nursing , 10-15. 12. Christensen, R., Rigby, G., Schmutz, N., Lambert, D., Weidmeier, S., Burnett, J., et al. (2007). ETCare; a randomised, controlled, masked trial comparing two solutions for upper airway care in the NICU. Journal of Perinatology , 479-484. 13. Klockare, M., Dufva, A., Danielsson, A.-M., Hatherly, R., Larsson, S., Jacobsson, H., et al. (2006). Comparison between direct humidification and nebulization of the respiratory tract at mechanical ventilation: distribution of the saline solution studied by gamma camera. Journal of Clinical Nursing , 301-307. 14. Pritchard, M., Flenady, V., & Woodgate, P. (2001). Preoxygenation for trachael suctioning in intubated, ventilated newborn infants. The Cochrane Library 15. Tingay, D., Copnell, B., Mills, J., Morley, C., & Dargaville, P. (2007). Effects of endotracheal suction on lung volume in infants receiving HFOV. Intensive Care Medicine , 689-693. 16. Copnell, B., Tingay, D. G., Kiraly, N. J., Sourial, M., Gordon, M. J., Mills, J. F., et al. (2007). A Comparison of the effectiveness of open and closed endotrachael suction. Intensive Care Medicine , 1655-1662. 17. Maggiore, S. M., Iacobone, E., Zito, G., Conti, G., Antonelli, M., & Proietti, R. (2002). Closed Versus open suction techniques. Minerva Anestesiologica , 360-364. 18. Woodgate, P., & Flenady, V. (2001). Trachael Suctioning without disconnection in intubated neonates. The Cochrane Database of Systematic Reviews . 19. Leur, J. P., Zwaveling, J. H., Loef, B. G., & Schans, C. P. (2003). Endotrachael suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial. Intensive Care Medicine , 426-432. 20. Choong, K., Chatrkaw, P., Frndova, H., & Cox, P. (2003). Comparison of loss in lung volume with open versus in-line catheter endotrachael suctioning. Pediatric Critical Care Medicine , 69-73. 21. Maggiore, S. M., Lellouche, F., Pigeot, J., Taille, S., Deye, N., Durrmeyer, X., et al. (2003). Prvention of Endotracheal Suctioning-induced Alveolar Derecruitment in Acute Lung injury. American Journal of Respiratory and Critical Care Medicine , 1215-1224. 22. Oberwaldner, B. (2000). Physiotherapy for airway clearance in paediatrics. Eurpean Respiratory Journal , 196-204. 23. Ahn, Y., & Hwang, T. (2003). The Effects of Shallow versus Deep Suctioning on the Cytological Components of Respiratiry Aspirates in High-Risk Infants. Respiration , 172-178

I have worked in Australia, United Kingdom, Saudi Arabia and India with many health professionals from many different counties. When you state Apgars it is understood. It is the universal language for neonatal resuscitation. Yes it is subjective, but differences of opinion are usually only marginal. If you have Apgars of 3 or 4 at one /five or 10 minutes, you have an immediate idea of what has happened. As far as giving IPPV, what do you score? I would suggest if you are adequately ventilating then you give a score but you identify clearly on the Apgar chart the baby was recieving IPPV.

We also have problems with nasl damage from nasal CPAP. I agree vigilance is required to prevent pressure on the nasal septum. We also use a colloid dressing to protect the nose, and rotating between prongs and mask is excellent. I am wondering if anybody has any techniques, dressings, ideas on how to manage the septum once the necrosis starts? It is difcult to keep the colloid dressing on as the area is now moist. We have resorted to using a short nasopharyngeal prong CPAP to relieve the pressure from prongs, does anybody have any other ideas? Would also be interested in the powerpoints if they are completed.