rehman_naveed

Hi Imlang Welcome to this site, i hope you will gain a lot from this site. Many thanks for your reply and an excellent reference and guideline which helped me a lot in re drafting our guidelines for golden hour. Initially I thought since no body is replying , I presumed that none of the NICU are practicing this golden hour for preterm babies but with this document which you sent a link is an excellent one, I really appreciate it. Thankyou once again

Dear Collegues I just want to ask about the other units practice of "Golden Hour " practice of Preterm babies. My question is basically how you are managing and what exactly you are practicing in Golden hour. I will appreciate your input.

Can you please tell what is ROS??

Many thanks Stefan for your reply, but when I put Z01.9 in google ICD 10 code it gives me "Special examination, unspecified ". Is this is the code you often use for discharging Normal healthy newborn from well baby nursury?

Dear Colleagues I want to ask what is the diagnosis you write while discharging Normal Newborn from Well baby nursury, i.e ICD 9 code . This I am asking for billing purposes. eg Normal Newborn ( Not in ICD code), Routine infant care etc Please let me know for which I will be obliged With regards

For UAC and UVC no need for lateral CXR, AP is enough. Whosoever is doing the lateral x ray is doing wrong and adding more x ray exposure un necesary. It means they will also be doing lateral CXR to confirm Endotracheal tube position as well. On PICC line insertion in lower limb u need lateral x ray as well to see if the tip in not in spinal vein

Your answer is in your question itself. Baby with respiratory distress ( it means RR >60/min) needs immediate CXR to rule out that underlying cause which you mentioned as well as I add Pneumothorax. If the baby in respiratory distress has underlying pneumothorax intervention needs to be done urgently. delaying CXR 4-6hours later may aggravate things. By the way why you want to delay CXR after 4-6 hrs,

Dear Colleagues I am in a process of writing guidlines for our NICU. I need you help in writing these guidelines. I need one question for example Which babies needs to be seen in NNU clinic a part from Preterm babies which we see usually upto 18month. for example babies like Normal term babies with TTN( Transient tachypnea of newborn), Hypoglycemia etc needs to be followed in NNU clinic. If any one wants to share his or her unit guidelines , i will highly appreciate it. With best regards

Depends on symmetrical or asymetrical IUGR. For asymetrical IUGR we do nothing, but for symmetrical we do head US, Urine for CMV and eye examination. we also have no written guidelines

Thanks for the comments. I am also in favour of nurses doing it. Any body to comment on this issue from UK and also how you handle such tasks of IV canulations + blood Sampling.

I was wondering who are inserting IV canula to babies in your NICU and also taking blood sampling like CBC and rotuine stuff. 1) Doctors 2) Nurses In Our unit Nurses insert IV lines and draw routine investigations. only blood Cultures are taken by Doctors. Of course nurses take it from heel prick or venous samples. I have seen this practice in some NICU that Doctors insert IV lines and take blood samples. Is it evidence based that doctors in NICU also act like Phelebotomists??. Imagine a 30-40 bed NICU and doctor at night call have to take ABG, CBC etc , and how he or she will focus on patient management? Any comments on this issue will be appreciated

Did any body attended that meeting or know some how of it? I am interested also in knowing about the current revised guidlines of GBS positive mother who is untreated and deliver a baby >37weeks. My query is "Is it worth to do blood CS, CBC, CRP in asymptomatic baby born to such a mother? Any one want to share their protocol? experience? ideas? articles evidence based? I have seen recent canadian guidelines which does not recommend blood Cs in such babies but AAP still recommend

Hi yes LED phototherpay is better than ordinary phototherapy, we are not using it in our unit. following link may be useful; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808577/

I thank every one with their valuable suggestions. What I concluded from this discussion that Lumbar puncture is Opinion based and not an evidenced based especially in early onset sepsis. Early onset sepsis needs LP when high suspicion of chorioamnionitis, GBS positive mother with symptomatic baby, mother having fever and symtomatic baby. Regarding late onset sepsis LP should be and must be a part of septic work up ( what we call as triple tap, blood Cs, Urine Cs and CSF CS) unless clear cut cause is there like NEC, Pneumonia, cellulitis, osteomyelitis etc and of course depending on the bug isoloated, LP can be done retrospectively

Quite strange, two extreeme practices. May I ask on what basis you are starting fluids at 60ml/kg/day( Which according to me is too little) and on the top to continue intensive phototherapy for 3 days wow, too much intense light . Thats why i share this topic to have my practice an evidence based because i dont know whether I am doing it correctly or not

Thanks for sharing the formula but my question is How to decide that such baby require 20% Dextrose instead of 18% dextose, ( it can be any percentage). But for example if baby of 1kg is requiring 18% dextose @ fluid intake of 100ml/kg/day, it means you are giving too much sugar to this baby(12.3mg/kg/min). If such a scenario either some thing wrong with the baby (Hyperinsulinsim or other causes requiring high sugar). Premature ,low birth weight babies must be given at least 4-6mg/kg per min dextrose before starting insulin for any hyperglycemia.

You can share here , we will love to see it and practice it. whats wrong here on this forum?

May I know what is the time duration that we can use Intense Phototherapy ( or what you call as Capsule) and how much fluid a baby must receive while on intensive phototherapy. Any evidence regarding this?? we here use it for 4hrs and fluids we give @180ml/kg/day, but i dont know whether we are practicing right or wrong?

Thanks Stefan for your valuable input

My question is whether or not to do lumber puncture in early onset sepsis, not in sepsis per se. Say for example in one day old or two days old baby admitted with respiratory distress?

Is there any recent study after 2006 or any recent evidence addressing this issue of " lumber puncture in early onset sepsis in neonate". Regards

Most of the C sections are done in our hospital under spinal anasthesia, so feeding breast milk is not a problem. We feed within one hour of birth the colostrum and in at risk neonate ( GDM on insulin, LGA or SGA babies etc) we monitor blood sugar. If mother has under gone C section under GA, then if at high risk, we feed them formula feed till mother is fully awake in feeding the baby. I hope this will help in solving your query

Hi I need to know about your unit policy in babies diagnosed with simple cardiac murmur at >24hrs of age. What is your approach to such a babies, Do you consult cardiologist to see the baby, or you discharge the baby with cardiology follow up or etc etc. Please share with me any evidence based guideline or policy of your hospital with regards

Hi Nowadays in our unit discussion is being going on to recommend or otherwise disregard the Evidence regarding " PRE-DISCHARGE CAR SEAT CHALLANGE FOR PRETERM BABIES". I know cochrane review (2005) says it is not recommended at all but AAP( American academay of Pediatrics) recommend it. If any one has any recent evidence regardign this important issue, please update me and provide me some recent references I will be great ful regards

Not at all. PICC line is sterile and 2 days old canula is not sterile at all. But yes we can insert PICC line thru IV canula (new one) under sterile condition. This is what we are doing currently and we donot have any problem