sSnjezana

Hallo, We have the babies from 23 weeks, and very often there developed anuria with oedema. Bun were to 15-18, creatinin to 135, and hyponatremia. Could you help us about it?

Thanks a lot for that very interesting link. It will be very useful in the practice.

Hello, I think that you have to hold the lecture for your staff about nurse care, hand hygiene, oxygen toxicity, resuscitation, NCPAP, etc. . And, when you are working , talk to the nurses at the same time all about the baby that you just examine, relationship with parents and tell them that put themself in the positions of parents. Any change needs the time, and if you have to determine, the results will come. Best regards Snjezana

Dear all, we use SMOF lipids by Fresenius Kabi- it involves Soybeen fat emulsion, Medium chain lipid acid emulsion, Oliva and Fish fat emulsion. There is better ratio of omega 3 :omega 6, that ratio is more like as mother milk.

Besides assessment of lab results, diuresis, BP, capilary refill time, we use echocardiofraphy for assesment of contractility function and refiling of the heart. The heart sounds and peripheral pulsation are also important, like the heart action. And we use 0.9% NaCl 10 ml/kg /10-20 min as bolus. The most infants react better, and slowly your heart action. Well, we evaluate the kidney function (lab res and diuresis) , the all signs of low perfusion and low function of the heart and than we dised - ususally we give bolus fluids, than dopa, dobuta etc. Unfortunately,we dont have Milrinon.

That policy (>25 weeks/ >500 grams) is in my Hospital. But I agree with surma, that it depends of more facts, like mother and pregnancy history, inflammation, pPRVP, twins and other and certainly of parents . We don't " agressively" resuscitate extremly premature babies , but it depends also of expectancy of parents and behavior of baby. We had baby of 442 grams, but she was 29 weeks, she moved barely, but she was definitly alive, and we resuscitated her, and after 3 months discharged her without a major complications. We wil see...

dear salameh 101 d. All positive cultures are to be taken seriously and infants (particularly prematures) treated empirically until further support to discontinue medications becomes available. - what do you mean- on all positive cultures , blood cultures or other wich can be positive from colonisation? The most my prematures have positive gastric aspirate on 5 th day and E tube aspirate if they are on long MV. Do you think that we must them treated without any signs of sepsis? I think that opinion can worse the situation on NICU. And CRP become high usually 48 hours from onset of sepsis. The first sign can be only tachycardia. I agree with you about meropenem, but we are in some " circulus vitiosus". Anyway, thanks a lot Snjezana

Thank you Francesco on the articles and answer. It will help to me. sincerely Snjezana

Hi, could you help me? We have in my NICU gram neg res. bact ( kl pneum and E. coli) and last year we have 24 VLBW infants with sepsis. Almost all blood culture were negative, however tubus aspirate in the babies on MV and gastric fluids were positive on one of those bacteria. I know that was colonisation, but in the case of sepsis (oliguria/anuria, low blood pressure, impaired perfusion, apnea, need for MV...lab signs- high CRP, leukopenia, thrombocitopenia..) we gave the babies meropenem. And now we have more infections, despite all epidemiogical investigations were negative. 1. I'm considered because meropenem is the second line of antibiotics 2. What do you think about probiotics (as in prehipp) 3. some oral antibiotics for "sterilisation" of gut, which I'm not cheerfull about? 4 or more nurses in Nicu ( 3 nurses on 13 children!!!!)

The major problems in our NICU are control of infection, but I agree with Stefan about another problem- nutrition. In my opinion it is a big problem particular in hospital without the milk bank. Snjezana

Dear All, I perform ultrasound of brain 13 years, and we (my younger collegues and me) use B mode and the doppler techniques. We use not only coronal section through the AF, than over PF, MF and through the temporal windov, also. And I never provoked bradicardia because never use the pressure of probe on fontanelle. And, for venous blood flow through the sinuses is very valuable linear probe. If you use doppler, particular pulse wave, You must think on ISPTA, or termal and mechanic index ( <0,4).

Dear colleague, I agree with you for hyperbilirubinemia and sepsis, too. But bilirubin is the scavenger of oxidative stress and that could be the cause of that. Anyway, its interesting for some research. sincerely Snjezana

Hi everyone, Could you help me? What do you think about feeding prematures ( and VLBW and ELBW) by term formula with probiotics in the first days of their life ( first 10 days). Did everyone hear something about it on some Congress or red about it? I had read a lot of about feeding of prematures, and know that in our premature formula is 24kcl/o.But Adamkin wrote nice book - nutritional strategies for the VLBW infants, and he wrote about premature formula of 24kcal/oz. Lucas wrote about influence term formula on prematures with lower IQ, but my colegues insist on term formula with probiotics. And i know that brest milk is the best. I hope some would answer to me, because I wish the best for my little babies. Thanks

Dear Luciecharron, Could I pls you to send me your guideliness for PICC lines? What do you prefer- umbilical central vein line, or PICC, or peropheral lines for VLBW and ELBW infants in the first days of their life? My email: snjezana1@hi.t-com.hr

Thanks for the excellent article. sSnjezana

Dear All, We use NaHCO3 when we have "unvigorously" baby (Apgar score first min <3) and if he/she have not recovered by ventilation. Also, we use bicarbonate if the baby has significant metabolic acidosis + resp. acidosis and if he/she doesn't recover with changing parameters of ventilation. When is pH < 7,1 and BE> 10-11 , without resp. acidosis we use NaHCO3 during 30min (half of doses). I read that article, it is fantastic. And the question: what does happend with intracellular acidosis when we use bicarbonate in metabolic "blood" acidosis? Another one: what with use of Ca in infusion in that babies, because in hypoxia and asphyxia Ca acts very important role? Hypocalcaemia is the sign of Ca level in blood, what is with Ca level in cells?

Hi, Do you have a opinion about use of term formula (with PUFA and probiotics) for VLBW infants during the first day of life? We dont have bank of human milk, and we started feeding VLBW and ELBW infants with term formula because small concentrations(osmolarity?) of that milk (like NAN1)(???). I dont support this strategy at all. Any ideas? I need this as soon as possible. Thanks Snjezana:confused:

Hello, I have been performing echocardiography in my NICU for 3 years. (I am neonatologist). What do you think, which course in London will be better for me- hands on or echocardiography in Juny?? Sincerely Snjezana