Karen

We have changed our practice in the last few years. General rule is if SPTL, PROM, resp support required >4hrs (or Work of breathing / Fi02 req increasing earlier) or other risk factors present at delivery, we tend to initiate IV Abx on admission (Benzyl Penicillin and Gentamicin). If repeat CRP is normal, no growth in culture and baby is well, we tend to stop Abx prior to 24hr dose (i.e. receive 2 doses BenPen and 1 dose Gent). Also, if prolonged raised lactates but normal neurology, we tend to septic screen and initiate IV Abx. Same scenario, stop at 24hrs if all okay, however, we have found a number of congenital infections in these infants. Based on ongoing clinical picture, we would consider stopping Abx at 5-10 days but if meningitis, 2-3 weeks. For LOS, we still do jump into early septic screen and IV Abx rather quickly due to rapidness of deterioration for our extreme prem infants. We generally use Vanc and Gent (if central lines insitu) or Fluclox / Gent (if not lines) and usually stop prior to 48hr dose if no signs sepsis.

Definitely is a difficult diagnosis to make as collection techniques, delays in running sample and polycythaemia can affect the result, often considered spurious. If asymptomatic but persistent, we would run a free flowing venous sample. If our 'true' level was >6, we would initially we would stop any infusions with K+ added then we would consider insulin infusion, diuretics, Calcium bolus.

We use the microsite MST Set 2Fr from Vygon. This works well. Cannula splits and can be removed. Just realised they also have a guide for inserting the wire!!! I've never used it and instead rely on my steady hand 🙂 However, I think I will try it as my eye sight is waning and I'm certain it will be helpful

We would likely initiate peripheral TPN, either through the UVC pulled back out of the liver shadow (i.e. low-lying) or through a peripheral IV. Our peripheral TPN is very low concentration Calcium and Phosphate. Depending on the stability of the infant, we would also insert a PICC line, however, if we could provide adequate nutrition with peripheral TPN, we would often wait until infant reaches 72hrs of age to decrease risk of IVH (limit handling).

We used to use Morphine 100mcg/k and then Suxamethonium (1mg/k), however, this was really substandard as morphine takes too long to have a good effect. We have since changed to a new regime of Atropine (10mcg/k), Fentanyl (4mcg/k) and Sux (2mg/k). This has worked extremely well for our infants. If we are just "MISTING" a baby, we use same dose of Atropine and a smaller dose of Fentanyl. Fentanyl is given over 5 minutes which seems to really help lower the risk of chest wall rigidity and with the Atropine, we see so much less bradycardias.

We currently have an app that we use but most of us tend to add 1-2cm to this calculation as it often comes out short. A manual calculation that often comes out closer to correct insertion length is: UAC - weight x 3 + 9cm + cord and UVC - 1/2 of UAC length For determining correct position on xray, T6-9 for UAC and at level of diaphragm but not in right atrium. We often will do a lateral film (shoot through) along with an AP to determine the UVC tip is above the liver shadow. We occasionally will use USS to determine tip of UVC can be seen but is not in right atrium if we want to avoid another xray, however, this is not the most accurate measure.

Hi Vicky Due to skin fragility in this cohort of infants (and previous experience), we use the 0.1% Chlorhexidine irrigation solution in all infants < 28/40 until the epidermal layers stratify

We do not routinely check a well-infant's pulse ox prior to discharge, however, if there is any questions of congenital cardiac defects, either by history or examination, we would then check pre and post ductal saturations.

I agree...the size of the syringe is probably not a huge issue as long as when aspirating it is done slowly without a lot of pressure, as want to avoid a stomach biopsy. We are just looking at checking placement and whether ausculating for air is a good idea or not. Our first choice is litmus paper and if no aspirate, then is air a good 2nd method of confirmation?

I am in the process of updating our present policy on orogastric and nasogastric tube feeding and am looking at the size of tube in relation to the size of the infant. A few different opinions I have come across are that infants under 800, 1000 or 1200 grams should use a size 5Fr and over 800, 1000, or 1200 grams should use a 6Fr., however, I cannot find any research to justify if any of these weights are correct. What standards does your unit use and do you have research to justify your reasoning? Thank you.

Hi Gayle In our unit, we start with Ampicillin and 2nd Gentamicin. We give Ampicillin over a slow IV bolus of 5 minutes, and then Gent is given over 30 minutes. At one time we waited 30minutes between medications, however, our pharmacist at the time determined through research, that as long as there was a good flush between medications, that the Gent could be given immediately following the Ampicillin. To my knowledge, we have not run into any difficulties managing in this way.