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Everything posted by wackdi

  1. Hi Francesco, Thanks for the information. What a pity. Maybe the measurements are similar but than the blade is too long. For a skilled person it will be possible doing the intubation but this is not the classic procedure (different angel etc). This means (IMHO ) that the C-Mac can not be used for teaching intubation in infants below about 1200g. Have a nice weekend Dirk
  2. Hi Francesco and Stefan, we are using a C-Mac laryngoscope. The smallest blade is 0. The company told us that a 00-blade is on the way ... but by now we haven't seen it. The view with the C-Mac is fantastic, so I hope that we could see the 00-blade soon. Greetings from Stockholm Dirk
  3. Nutrition and feeding would be a great topic. TPN (as smaik.hiran suggested) but also feeding strategies would be of great interest. su ... and of course the question how optimal postnatal growth (catch-up) should look like. Greetings Dirk
  4. We use Atropine, Fentanyl, thiopental and (sometimes) suxamethonium. In my opinion we have a lot of stiff chest problems even if we give the fenanyl as a two minutes slow push. In a difficult situation I would definitively go for propofol in combination with atropine and maybe fentanyl. Ghanta S, Abdel-Latif ME, Lui K, et al. Propofol compared with the morphine, atropine, and suxamethonium regimen as induction agents for neonatal endotracheal intubation: a randomized, controlled trial. Pediatrics 2007;119:e1248–55. doi:10.1542/peds.2006-2708 The babies are really relaxed and well sedated, so intubation is quite easy (even in difficult situations). Greetings Dirk
  5. Hi Stefan, maybe you would like to add this (excellent) review too: Pacifici GM: Clinical Pharmacology of Furosemide in Neonates: A Review. Pharmaceuticals (Basel) 2013;6:1094–1129. There is some growing evidence of concerns about the furosemid interaction with chondrocytes in the growth plate leading to growth restriction: 1. Bush PG, Pritchard M, Loqman MY, Damron TA, Hall AC: A key role for membrane transporter NKCC1 in mediating chondrocyte volume increase in the mammalian growth plate. J Bone Miner Res 2010 Jul;25:1594–1603. 2. Iwamoto LM, Fujiwara N, Nakamura KT, Wada RK: Na-K-2Cl cotransporter inhibition impairs human lung cellular proliferation. Am J Physiol Lung Cell Mol Physiol 2004 Sep;287:L510–514. 3. Koo WW, Guan ZP, Tsang RC, Laskarzewski P, Neumann V: Growth failure and decreased bone mineral of newborn rats with chronic furosemide therapy. Pediatr Res 1986 Jan;20:74–78. Greetings from the rainy south side of the town :-) Dirk
  6. Hi RichMaus, we are using the Vygon micro site since two years ago. We use it round about 3-4 times per month in the "bigger" babies (>1200g) to insert 2F PICCs. It works perfectly well for us as we can use our "standard" 24G iv catheter to start the procedure. I is quit easy (and a very high success rate) to get in the 2F catheters. We are only using PICCs with one lumen but in my opinion it should be no difference to use it with two lumen PICCs. I is a great device and made it possible in our unit to have more babies with 2F lines. Greetings from Sweden Dirk
  7. Very interesting! In the past I had good experience by using Sildenafil enterally (by gastic tube). As I am now working in a Level III NICU i recently found an article about using Vasopressin a adjuvant treatment: http://www.ncbi.nlm.nih.gov/pubmed/24141655 Does anyone have any experience with this drug? Greetings from Sweden Dirk
  8. Hi, I would absolutely agree with Stefan and Naveed! A good randomized placebo-controlled trial showed no clinical relevant changes in haemodynamics in preterm infants. The only significant change was an increase in FiO2 from 0.27 to 0.29. http://www.ncbi.nlm.nih.gov/pubmed/21784442 The article gives you even a good overview on the topic. Greetings Dirk
  9. Sounds like a good idea! You can reach me by my Karolinska mail address or cellphone number. Greetings Dirk
  10. Hi Stefan, Is it really microdialysis you are looking for or is it more the continues glucose monitoring? As there is a growing number of papers publishing on the use of continues glucose monitoring (CGMS) in infants this could be a good alternative when glucose monitoring is your focus. I personally have worked (and have done research) with the Medtronic VEO. Some related articles: Continuous Glucose Monitoring in Newborn Babies at Risk of Hypoglycemia http://www.ncbi.nlm.nih.gov/pubmed/20338573 Continuous glucose monitoring in infants of very low birth weight http://www.ncbi.nlm.nih.gov/pubmed/18971588 If you have questions about CGMS feel free to contact me. Greetings from the other side of the city :-) Dirk
  11. Hello and many thanks for you answers! Going on with this discussion I have gone back to the roots: Virgina Apgar wrote in her article 1953 "A Proposal for a New Method of Evaluation of the Newborn Infant": (2) Respiratory Effort. -- An infant who was apneic at 60 seconds after birth received a score of zero, while one who breathed and cried lustily received a two rating. All other types of respiratory effort, such as irregular, shallow ventilation were scored one. Greetings Dirk
  12. Hi, we had a (more academically) discussion about APGAR scoring. I would like to hear your opinion about scoring breathing effort: A fullterm infant breathing spontaneously but needing CPAP via a T-piece device. Would you score it as APGAR 1 or 2? Would the need of extra oxygen affect your decision? Greetings Dirk
  13. Dear Alistair! We are using a SimBaby too and doing training for the three Karolinska hospitals. Every team from each hospital has one day in the simulator. Each team consists of a midwives, nurses and junior doctors working on the NICU, anaesthetists and sometimes obstetricians. After en brief introduction about teambuilding, neonatal resuscitation and the SimBaby we do the simulation scenarios. Before each scenario there is a short briefing and afterwards there is a detailed debriefing. Our goal is to offer a day at the simulator every second year for every person working with newborn infants/on the NICU. Greetings from Stockholm Dirk
  14. Hello Stefan! I do not have experience with micro-dialysis but I am studying (pilot study) a subcutaneous glucosemonitor (Medtronic) and having good results with this device in late preterm and newborn babies. (Correlation between HemoCue and the Medtronic device (CGMS)) Greetings from Huddinge Dirk
  15. In Sweden (Eskilstuna) we are vaccinating at/after 60 days of life but not before 34 weeks of gestation. So we are starting the vaccination-schedule a bit earlier (DTP, HiB, Polio + Pneumococcal vaccine). We are arranging the 1st shot within the baby is on the ward and has at least a saturation-control for one night. If the baby had apnea`s then we arrange the 2nd shot with a 1 night stay at the hospital. Greetings Dirk
  16. Hello! A few weeks ago the AAP has released new guidelines in this topic ... maybe interesting to read (free). http://pediatrics.aappublications.org/content/early/2011/07/28/peds.2011-1466.long Greetings Dirk
  17. Hi! I'd like to add a great article about neonatal thrombocytopenia that is worth reading: Blood Rev. 2008 Jul;22(4):173-86. Epub 2008 Apr 22. Thrombocytopenia in the neonate. http://www.ncbi.nlm.nih.gov/pubmed/18433954 (sorry not free) Greetings Dirk
  18. Hi! In the study mentioned by Stefan they used Caffeine both as a treatment and prophylactic drug. We do so too. Especially if the baby is born less than 28-30 weeks of gestational age we often use it prophylactic. We usually wean the babies from the drug by not adapting the dose to the increasing weight and try to stop it with about 34-35 GA. While on Caffeine-prophylaxes/therapy we have them on SaO2 monitoring for dosing reasons. Many greetings from Sweden Dirk
  19. Hello! Here are some articles on the topic (I hope this would help you): Cochrane Review on Midazolam (free article): Cochrane Database Syst Rev. 2003;(1):CD002052. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Ng E, Taddio A, Ohlsson A. Quite a good overview on the topic (mostly animal studies) (free article): Anesth Analg. 2007 Mar;104(3):509-20. Use of anesthetic agents in neonates and young children. Mellon RD, Simone AF, Rappaport BA. Intresting article about molecular mechanism of several drugs (free article): Anesthesiology. 2009 Apr;110(4):703-8. Update on neonatal anesthetic neurotoxicity: insight into molecular mechanisms and relevance to humans. Patel P, Sun L. A bit off topic but discusses midazolam in the field of intubation/sedation: Pediatrics. 2010 Mar;125(3):608-15. Epub 2010 Feb 22. Premedication for nonemergency endotracheal intubation in the neonate. Kumar P, Denson SE, Mancuso TJ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Many greetings from Sweden Dirk
  20. A quit interesting article about (i.v.) paracetamol, dosage and analgesic effect: Arch Dis Child Fetal Neonatal Ed. 2004 Jan;89(1):F25-8. Pharmacokinetics of single dose intravenous propacetamol in neonates: effect of gestational age. Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721651/?tool=pubmed Greetings Dirk
  21. wackdi


    Hello! We are wondering about our vaccination scheme for our preterm babies. That preterm babies have a higher risk to suffer from a invasive infection is a well known problem. To protect this children for example the American Academy of Pediatrics, the Department of Health in GB and the STIKO in Germany recommend to start the vaccination schedule early (for example 8 weeks of live). The vaccinations schemes includes diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, hepatitis B, poliovirus, and pneumococcal conjugate vaccines. I would be thankful to hear/read, how your vaccination schedule looks like and what kind of vaccine you are using. What kind of patient do you observe for the risk for apneas ? Greetings Dirk Literature (example): http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/1/193 http://www.rki.de/nn_216436/EN/Content/Prevention/Inf__Dis__Surveillance/Vaccination/Immunisation__schedule,templateId=raw,property=publicationFile.pdf/Immunisation_schedule.pdf
  22. Hi, das Thema kam mir doch bekannt vor :-) Liebe Grüße Dirk

  23. Thank you so much for your detailed answer! This helps a lot to get an impression from a practitioner (And not from a salesman ;-) )! Greetings Dirk
  24. Hello! We are breastfeeding/feeding them (shortly before the examination) for a CT-Scans and Chloralhydrate for MRI-Scans. Debra: How do the infants tolerate the bag you have described? Do you feed them before examination? How often do you have to stop the exam because of a crying baby? What do the parents say about it? I know: Many questions ... but I would be deeply grateful to get a short answer. Greetings from Sweden Dirk
  25. Hi! In the Cochrane review Caffeine had the same effect i treating apneas but had several advantages: Adverse effects like feeding intolerance and tachycardia were lower in the Caffeine groups. http://www.cochrane.org/reviews/en/ab000273.html So we are using only Caffeine(citrate) in our unit. Best wishes Dirk
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