rehman_naveed

There is no evidence that starting partially hydrolyzed formula prevent NEC.It may be good that you publish your data, it will be huge data since you started using it since 2017.

"Hello, I am interested in learning about your NICU's practices regarding antibiotic administration for late-onset sepsis. Is it standard procedure in your unit to administer antibiotics within the 'golden hour' following a sepsis call? If this is the case, what workflow strategies do you use to guarantee a lumbar puncture and urine culture are obtained before the first dose is given?"

Your answer is present in Premiloc trial.

Simple answer to your question is transfer them at that age to PICU, they often manage such babies quite comfortably

Again it depends on your unit rate of bpd, if > 70% steroids mainly dexa help in long term NDI but if <30% it harms. Your baby at 36wks on Ncap 6, 30% steroids are not at all recommended. Wait 40-44 wks, if still send home on oxygen via cannula it all depends where you work and how is community support and parents wishes

We use but not in babies you mentioned. Cpap with 30% should come out of it in due time. Steroid reserved for grade 1 bpd

We use morphine and fentanyl. When NOWS occur or are suspected, we add clonidine. We usually avoid midazolam, as it may cause seizure-like episodes, which may trigger septic workups, unnecessary investigations like EEG, etc.

After clamping there is no reaccumulation of air, removal of chest tube should be first followed by extubation. It’s my opinion

Something here doesn’t make sense. Cpap 12 and 21%fio2. Agree with above tracheobronchomalacia possible. What happened actually when you wean cpap? Is work of breathing increased or oxygen. I would advise wean cpap to lowest possible number and then low flow. HFNC is not a weaning mode from cpap, it’s a wrong concept.

Thanks for your question. Breast milk is very precious, we don’t waste it as enema, when we know that once feeding is established meconium will come out anyway and if not there are other ways to do it . Please don’t waste precious milk.

We published our experience just recently using buccal midazolam. See below Daoud G, Karayil Mohammad Ali S, Chakkarapani AA, Durrani NUR. Intervention Bundle for Optimization of Procedural Sedation for Newborns Undergoing Magnetic Resonance Imaging: A Single-Center Quality Improvement Project in Qatar. Biomed Hub. 2024 May 22;9(1):73-82. doi: 10.1159/000538762. PMID: 39015198; PMCID: PMC11249786.

It's great to have discussion on this topic. I would prefer NRP over PALS in babies in the NICU, as it is not a one-man show here; it's the whole team in resuscitation with a shared mental model. If the whole team is comfortable with PALS, then go ahead and do the PALS algorithm, and if the whole team is NRP-tuned, then the NRP algorithm. Is it because to avoid confusion whether to attempt chest compression first (PALS) vs. intubation first (NRP)? It's also when to give epinephrine and what dose. Most of the babies in the NICU still have respiratory causes of deterioration and not cardiac arrhythmias as their cause of deterioration.

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