rehman_naveed

Thanks @Gustaf Lernfeltfor initiating this thread. I would say that What ever treatment we gave to babies , have side effects, and we already know that giving Live bacteria to baby, possibility of sepsis is there, but we take chance as once NEC is there, it is a very nasty disease, with lot of complications affecting future life of baby and family. I think it will be difficult now ( at-least in USA) after that FDA letter, that neonatologists will dare to start on Probiotics. We may see increase surge of NEC more in coming many months in USA, and it will be a good QI project one can start and see pre and post FDA letter increase in NEC cases in unit where probiotics was initially given and now it was held. Time to promote more Human milk availability, less use of antibiotics, early CVL removal, consider the principle of less is more and Outside USA consider or continue using Probiotics if your baseline risk of NEC is high as we can’t ignore the fact that Probiotics Prevent NEC.

Why for hypercalcemia beta agonist indicated?

Yes we always measure. Just asking you a question that supposed these were not done and on table baby die due to bleeding, who to be blamed? Pre planned investigation and blood products arrangements are necessary. Not everything is evidence based, some common sense is also must. I hope this helps. regards

Can share any evidence about use of dexmet use in newborns. I am currently in the process of making guidelines but didn’t find any robust evidence about its use in newborns but still I know many nicu use it. Thanks

Hi there I would be grateful if someone will help me in understanding how to calculate cumulative dose of Narcotics received by baby while staying in NICU. A baby in NICU can have narcotics/sedative infusions, intermittent injections for many days to week depending on surgical or medical condition. To reduce Narcotics use in NICU , I need to reduce the number of days the babies were on Narcotics and also to reduce the cumulative dose per kg. To retrieve data, from system suppose a baby receive 3000mcg total morphine in 60days, so to calculate per kg dose which weight should be taken. Definitely babies gain weight during these 2 months period. I Will be oblige if someone explain with example. Many thanks for reading

We don’t deduct conjugated bilirubin from total, exchange is done based on total bilirubin. Exchange is not performed in pure conjugated hyperbilirubinemia , as it does not cross BBB.

Hi Colleagues May I ask a question, What does free water deficit means for Hypernatremia? I know the definition but what does it actually means when treating hypernatermia with crystolloids solution. For example if serum Na is 190, free water content of 0.9% NaCl is 19%, 0.45% Saline is 59% and 0.2% Saline is 81%. How this will help in giving free water to a baby weight 4Kg with Na 190 mmol/L, who require approximately 576ml of Free water in 4 days to drop Na slowly to 142 mmol/L. Many Thanks in advance.

So what is the question? 0.45% saline is the least you can give Hypernatremia in ELGA babies is likely not due to excessive Na intake

We usually don’t intentionally give unless they are already on. We discontinue as well early no matter chest drain is out or in.

Yes there is no VG, instead use PRVC for volume control ventilation

Hi only difference is PEEP is added to PIP while in others PEEP is separate. Meaning the PIP which baby get includes PEEP. Rest of concepts are same.

For #1, you answered yourself dark lung fields, so no RDS, hence no surfactant, looks like vascular phenomena rather than parenchymal as your scenario. Treatment lung protective strategy, and pulmonary vasodilation. for #2, adequate coverage, can be discharge with follow up

Yes our anesthesiologists routinely use cuffed tubes for any procedures not restricted to CDH We didn’t find any severe adverse events though sometimes mild post extubation stridor, also cultural acceptance in NICU community is an issue. Naveed

We usually do the same as what you mentioned, increase 20% fluids ad check Na frequently say Q6hrly. Once Normalize reduce TFI. Yes we replace free water with Na free solution but give maintenance Na which Baby any ways get from UAC heparin Saline ( 0.45% saline) and put 2mmol/Kg in TPN as acetate to tackle acidosis. We can go up as much as 200ml/kg/day and maximum Humidity to 95%. Never give saline bolus and NG drip with sterile water. I hope it helps

We use nasal intubation to have stability, fixation is usual with tape