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Everything posted by rehman_naveed
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Common scenario in day to day NICU care. Ventilation wise you should be given high PEEP like 6-7. PEEP of 4 is very low. Most likely the cause of pulmonary haemorrahage in this case is PDA. usually very large PDA have no murmur. echo be done before any iburpofen given to rule out any structural heart lesion. Why you didnot use Volume guranttee on this baby? to give you an idea of what PIP this baby actually need? giving low PIP to treat RDS ?? is questionable. How was the initial course of baby i.e did you exercise Golden hour for this baby, what was the admitting temperature?
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Since we have now a poll going on regarding management of PPHN so I decided to respond to this question asked by one of our colleague. Currently we are managing one such patient in which all above modalities failed and we tried iloprost (prostacyclin) via ultrasonic nebulization and it works very well. we gave it via Pressure control mode of mechanical ventilation not when the patient on sensor medics. Unfortunatley we have no IV form available because the protocol says after nebulization form when the patient improve should be switched to IV form. Our patient is doing well so far with good saturations and decreased oxygen requirement and pressure. Hoping that we will be successful in in weaning from ventilator slowly
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References for use of Bonstan in newborn are 1) Acta Paediatr. 2009 Oct;98(10):1683-5. Epub 2009 Jun 11. 2) Eur J Pediatr. 2008 Apr;167(4):437-40. Epub 2007 Aug 15 3) Please refer to this study by its ClinicalTrials.gov identifier: NCT01389856 I hope others are also using it in severe cases.
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We also use Sildenifil and Bonsten in severe cases
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Dear all Can any one help me in finding video for inserting chest drain for pneumothorax and its proper way for fixation. Thanks
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Many Thanks for reply (Stefan and Ajay). My question is still remaining.Suppose baby is on antibiotics and glucose load is normal 4-6mg/kg/min but Blood Glucose is 14,17,18 or more. How do you titrate insulin by which fraction and then how to wean it off by which fraction. Anyhow thankyou for your valuable information. I think there is no evidence and practice varies from unit to unit.
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My question to all What do you do when babies get hyperglycemia with normal sugar intake of 4-6mg/kg/minutes. Do you start boluses of Rgular insulin or insulin infusion? If insulin infusion do you monitor sugar according to sliding scale? or how do you titrate insulin infusion. Please share with me your policy?
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We take blood both from central line (Broviac not PICC line) as well as from the peripheral blood. This is how we can diagnose central line infection depending on which blood culutre grew organism earlier. If central line grew earlier it means central line infection. We never take any blood specimen from PICC line as it may block it
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For Dr C Paxson Sorry for misinterpretation. When I worte bolus, it means over 30min to one hour. No bolus can be given like Slap of hands. I will still insist on restoring blood volume first by giving Normal saline over 30min to one hour and then start dopamine. Starting dopamine right from the begining is not correct. One thing more I want to add if your ABG is fine with no metabolic acidosis, normal lactate and no tachycardia with good perfusion, donot treat numbers, just wait and see.
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Tricky question. I think the baby is washing PCO2 due to low pressure 13/4 and he is compensating low tidal volume with increase respiratory rate. I believe that low pressure you r giving due to low PCO2, we also come across these situations. Try PSV mode but if still washing PCO2, baby needs extubation and put on CPAP with trigger.
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I want to ask from group what is the recommendation (WHO or AAP or European) about maintaining delivery room temperature or OR temperature. I know that it is 26 degree celsius, but what about those countries where summer is much hotter like mine in Dubai, Saudi arabia etc . I know countries where there is winters most of the times even sitting in 26 degree feels good but in hot countries it is very difficult to sit at room temperature of 26. Any evidence in this regards will be much appreciated.
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I want to ask this question to group that what is their practice of isolating RSV, Adenovirus, Infleunza and Para infleunza viruses infection in their units. 1) Do you isolate the index cases in separate rooms by removing them from main stream? 2) What about those who are exposed to index cases? How long do you keep them isolated ( Gloves, gowns, mask etc) 3) Or you isolate them case by case, no need to isolate them in separate room, but practice contact or droplet precautions at the same place 4) What happens when you donot have rooms to isolate the index cases either they are large in number or you donot have isolation rooms. Thanks
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Dear JACK Can you help or guide me for making data base in MS Acess which you are using for your NICU. I want to use it for my local use at our NICU, I will be oblige if you do the needful. You can contact me at my e mail as well on rehman_naveed@hotmail.com
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Previously we also used to do the same (CBC, CRP and blood CS) on all babies born to GBS positive untreated mothers but we changed our practice now, we do only CBC and CRP in asymptomatic newborn babies and if abnormal we do blood cs and treatment depend on clinical status. Since your baby was clinically well, you did the right decision in my view.
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Many thanks for all who replied , the ideas looks great. will explore them further the sites mentioned by Stefan. Thanks
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We are in the process of collecting our newborn data. I want to ask the forum members is there any data base soft ware that we can use for collecting our newborn data, which is also user friendly. and I am also interested to know what others are doing in their units for this purpose. Many thanks
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There is no significance of high WBC count as part of sepsis in Neonate alone, look for others markers like high IT ratio, high CRP etc.Plus clinically. Low WBC count is more significant than isolated Leukemoid reaction
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Seems some sort of allergy to milk protein or HMF ( Human milk fortifier). What kind of formula these babies are? Give breast milk only and see and remove any additives from feeding for some days. If no EBM then give Neocate formula or any hypoallergic formula. Hope it will works
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Many thanks for all who replied
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I am revising our admission policy to NICU, Can any one share their policy or tell me what is the cut off for gestational age and weight for admission to NICU. We currently have cut off <35weeks and <2Kg. I just want to know what others are doing in admitting Babies to NICU regarding gestational age and weight. Thanks
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I would never continue antibiotics for 7 days in such baby, since mother is PIH , low ANC count can be explained secondary to this. Our practice is going to change soon and currently we are stopping antibiotics at 48hrs but soon will stop at 24hrs if 2 CBC are normal taken 8-12hrs apart as most of our culture if grew anything is within 24hrs, ( based on evidence based) and our audit results of last 4 years. Secondly prolonged antibiotics use can lead to adverse outcome in Preterm babies. You will find this useful Kuppala VS, Meinzer-Derr J, Morrow AL, et al. J Pediatr 2011 (Nov); 159(5):720-725 This is only abstract, can you also help me in finding full text of this article and share full text with us to benefit us all Cheers Naveed
