chandas

Many colleagues would be aware of the recent lawsuit in Illinois against Mead Johnson alleging Enamel causing NEC in a preterm baby which the US Court found in the family's favour with an award of $60 million. Whilst the allegation that any cow's milk-based formula CAUSES NEC (rather than saying that human milk protects against NEC) may not be widely held view here, I wondered if colleagues are seeing any fallout from this lawsuit. Clearly this would raise parental concerns and the professionals would find it difficult to recommend any cow's milk-based formula for a preterm baby if the mother can not or does not wish to provide her own breast milk.

TThere is a British Framework of Practice that addresses these issues in detail ....and involves parents! Perinatal Management of Extreme Preterm Birth Before 27 weeks of Gestation (2019) | British Association of Perinatal Medicine (bapm.org) (https://www.bapm.org/resources/80-perinatal-management-of-extreme-preterm-birth-before-27-weeks-of-gestation-2019)

No need for exchange transfusion at this age and with such high direct bilirubin but needs urgent evaluation for biliary atresia.

We only check cord blood DCT for babies of mothers with known antibodies during pregnancy. Their routine use, or even in mothers with O blood group is very unlikely to be of benefit. For mothers with RH-ve blood group, routine antenatal anti-D administration does result in positive DCT but this in invariably of the mildest degree (trace or 1+).

We use caffeine citrate 5 mg/kg once a day for maintenance. Very rarely, we need to use up to 10-12 mg/kg/d and old use twice a day schedule if still needed at term (extremely rare)

We would use the fast (30 ml/kg/d increment) regimen in the SIFT trial even for babies with IUGR but would adopt the standard (18 ml/kg/d increment) for those with absent or reversed end-diastolic flow or raised blood lactate in first postnatal day. If there is feed intolerance, then use of low dose erythromycin as prokinetic usually helps to maintain/advance feeds.

1. Consider osteomyelitis and septic arthritis. 2. Leucocyte Adhesion Defects (LAD) cause leukocytosis. Delayed cord separation and lack of pus are indicators; haematology/immunology will be able to check for it.

Haven't seen sclera neonatorum for ages now. Aggressive antibiotic therapy and exchange transfusion may help but generally babies don't survive with sclera.

HFOV would be ideal but for conventional ventilation, fast rate, short inspiratory time and low pressures would be the ideal strategy along with lateral decubitus positioning and/or selective bronchial intubation if unilateral. The details lof thje clonventional styrategy are in Keszler M, et al. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr 1991;119:85-93.

Not an instructional video but a picture booklet that we have developed locally as our guideline. Can't attach the guideline here due to it size but you should be able to access it by following think link (https://dl.dropboxusercontent.com/u/4701858/Pigtail Chest Drain insertion.pdf)

There is no evidence that treating GBS colonisation would reduce the risk of late-onset disease; even intra-partum prophylaxis has little effect on the late-onset disease. The approproate management for the twin sister would be early institution of Penicillin if she shows any signs of illness but otherwise nothing else is needed. Dr Sanjeev Deshpande Consultant Neonatologist Shrewsbury, UK.

Morphine does not produce local analgesia and infiltration of lignocaine is necessary to provide local analgesia in addition to systemic morphine. I would be weary of using intrapleural lignocaine lavage though for its systemic absorption. Dr Sanjeev Deshpande Consultant Neonatologist Royal Shrewsbury Hospital Shrewsbury, UK

Colonisation of endotracheal tubes is very common and the organisms thus cultured bear no relationship to the actual causative organisms in neonatal sepsis. The only benefit of knowing the colonisation is having knowledge of the organisms currently infesting the nursery. If an unsual pathogen starts colonising the ET tubes, it should prompt a look into infection control measures on the unit.

The reason for the decline in use of routine morphine analgesia is the outcome of the NEOPAIN trial. Whilst providing sedation and analgesia for ventilated preterm infants seems intuitive, the trails suggest that we may be causing more harm than good. It could be that we do not have the correct agent, or do not yet know how best to target the opiates appropriately whilst minimising harm.