wackdi

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

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

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

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

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

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

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

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

Hello Amira! Thank you for your question about evidence. In my opinion you can get a great overview about this issue by the following link (Fetus and Newborn Committee, Canadian Paediatric Society): Red blood cell transfusions in newborn infants: Revised guidelines http://www.cps.ca/English/statements/FN/fn02-02.htm Greetings Dirk

Hello Amira! We are using irradiated erythrocyte-concentrat for all preterm babies (up till GA 37). For CMV we do not have such a clear policy, but we do not give it to babies less than 1000g or GA 30. Greetings Dirk

I agree to Alexander that in the most cases it is worth to try intensive phototherapy before switching to exchangetransfusion. I this context you'll find an interesting article in Pediatrics (2008): Outcomes in a Population of Healthy Term and Near-Term Infants With Serum Bilirubin Levels of >325 µmol/L (>19 mg/dL) Who Were Born in Nova Scotia, Canada, Between 1994 and 2000. http://pediatrics.aappublications.org/cgi/content/abstract/122/1/119