ctestolin

I agree with roserporta. LUS Is much more sensitive than X-ray for pnx. One question: how long do you CLAMP before checking the baby? 6,12,24 hours?

Dear all Lung echography is having more and more importance thanks to its pecularities (simple, repeatable, no X ray exposition to the newborn, small time to achieve data), and thaks to its information about newborn disease (TTN vs RDS, PNX). What is your experience?

In our Center, we re-evaluate PPHN treatment in newborn and we introduced Milrinone (I used once with good result). For milrinone use is mandatory a cardiac echography: cardiologist or experienced neonatologist in cardiac echo Here some information about Milrinone that I took from Literature Milrinone actually is a off-label drugs for PPHN in Italy but several times it is used with good results (parents' consensus necessary) Milrinone has a duble effects: - inotropic effect on cardiac output - pulmonary and systemic vasodilatatory effect, with possibile synergic effect with iNO Indication: PPHN NON-responder to iNO with cardiac echo showing left ventricular disfunction. We associate Milrinone plus Adrenalin (Dopamine increases pulmonary resistences thus incerasing afterload of right ventricule; Dobutamine worses cardiac performances during left ventricole disfunction) Dosing (based on literature): - gestazional age < 30 weeks: loading dose 50-75 microgr/kg in 60 min, manteinance dose 0,375-0,75 microgr/kg/min - gestazional age > 30 weeks: loading dose 135 microgr/kg in 180 min, maintenance dose 0,2-0,75 microgr/kg/min In case of severe systemic hypotension (with total amine dose > 10 microgr/kg/min) the LOADING dose should be reduced to 25 microgr/kg or omitted Maximal duration: 3 days (even if in Literature some authors used milrinone for several days) Since milrinone is metabolized by kidney, reduce loading dose and maintenance dose in case of severe renal impairment REMEMBER: milrinone infusion is NOT compatible with Furosemide (precipitaion of drugs) Milrinone preparation: VIAL: 10 ml e.v. (1 mL=1 mg); diluite 1 ml/kg of Milrinone up to 50 mL of Saline or 5%Glucose (velocity 1mL/h=0,33 microgr/kg/min) Side effets: hypotension (2.9%), supraventricular aritmic pulse (3.8%) or ventricular (12% even if these cardiac efefct are present very rare in pediatric and neonatal population), hyokaliemia (0.6%), trombocitopenia (0.4%) Some Literature: - Carina Teixeira-Mendonc¸aa, Tiago Henriques-Coelhob, Pathophysiology of pulmonary hypertension in newborns: Therapeutic indications Rev Port Cardiol. 2013;32(12):1005-12 - Marcia L. Buck, The Use of Milrinone in Infants and Children PEDIATRIC PHARMACOTHERAPY Volume 9 Number 2 February 2003 - Chryssoula Tzialla, Rosa Maria Cerbo, Gianfranco Perotti, Mauro Stronati Persistent pulmonary hypertension of the newborn refractoryto inhaled nitric oxide treated with milrinone: a case report The Turkish Journal of Pediatrics 2010; 52: 78-80 - Patrick J. McNamara; Sandesh P. Shivananda; Mohit Sahni; David Freeman; Anna Taddio, Pharmacology of Milrinone in Neonates With Persistent Pulmonary Hypertension of the Newborn and Suboptimal Response to Inhaled Nitric Oxide Pediatr Crit Care Med 2013; 14:74–84 - Sanchez Luna , Franco ML, Bernardo B. Therapeutic strategies in pulmonary hypertension of the newborn: where are we now? Curr Med Chem. 2012;19(27):4640-53 - Cabral JE, Belik J. Persistent pulmonary hypertension of the newborn: recent advances in pathophysiology and treatment. J Pediatr (Rio J). 2013 May-Jun;89(3):226-42

How can you describe a neonate without hearth beats and no breath from birth that only after 10 minutes of resusitation present a hearth rate of 30 bpm for 1 min and then stopped, even continuing resusitation? Stillbirth or neonatal death? All steps of resusitation were done according to AAP...

Any news?

We had a similar case in out Dept 2 months ago. I would suggest some metabolic exams (aminoacidemia, Acilcarnitine profile, but more important aminoacids analisys in liquor - suspected Non-ketotic hyperglicinemia - nkh) Aldo new metabolic disease: dose vit b12 and vit b9-folic acids. MRI plus spectrography could be useful. In pubmed you can find reviews on "neonatal hypotonia" very useful (sorry, but now i'm at home after the night shift)

I would suggest some articles: 1) New approaches for persistent pulmonary hypertension of newborn G. Ganesh Konduri, MD Clin Perinatol 31 (2004) 591–611 2) PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN Rational Therapy Based on Pathophysiology Michele C. Walsh, MD, MS, and Eileen K. Stork, MD CLINICS IN PERINATOLOGY VOLUME 28 * NUMBER 3 * SEPTEMBER 2001 pag 609-627 3) Incidence of alveolar capillary dysplasia in severe idiopathic persistent pulmonary hypertension of the newborn J TIBBALLS and CW CHOW J. Paediatr. Child Health (2002) 38, 397–400 4) Alveolar capillary dysplasia: a logical approach to a fatal disease Journal of Pediatric Surgery (2005) 40, 1100– 1105 In my NICU we use iNO with wonderful results. We had a case of iNO-not responder term baby but the final (and fatal) diagnosis was Alveolar Capillary Dysplasia

I use sometimes PEDI SAFE; CORTICONVERTER, STAT ICD-9; OBWELL; GROWTHCHART

Hi to all!!! Does anyone have experience with the use of LIPIDEM in parenteral nutriton? We started few months ago and the preliminary results are terrific!!!! No hypertrigliceridemia, rapid decrease of AST/ALT/GGT and bilirubin in a premie with parenteral colestasys. But only few cases...

To determine the IUGR is important at first (when possible) to talk with the gynecologist: an early IUGR (second trimester) suggests a fetus problem (chromosomal) and rarely infection (but usually a good obstetric have just done all the infection screening panels to the mother), while a late IUGR (therd trimester) is more linked to mathernal problems (infection, smoke, placental problem). Since TORCH screen is (quite) always done in pregnancy, we perform brain echo scan and urine CMV-PCR; chromosome analysis: if the baby has some clear signs of syndrome, it's correct to perform (usually it's a early IUGR), but if absent, we can wait to perform genetic analysis untill something comes out during the follow-up. I think that initially it's important to talk to the mother and to her obstetrician (an obstetric history could be interesting!). By the way: CMV screening for mother: it would be a miracle to have for all pregnancy a CMV Ig screening plus avidity index at the beginning of the pregnancy (how many exams will be eliminated!!!)

<32weeks: 10 mg/kg every 6 h for 2 daus then 4mg/kg every 6 h for 5 daus > 32 weeks: 12,5 mg/kg every 6 h for 14 days references Ng .. Cochrane database syst rev 2008 jul 16;(3):CD001815 Aly ... J Perinatol 2007;27:39-43

Fungal infection in a NICU should be very low (see Vermont database). In Center with high incidence an analisys of risk factor inside the NICU should be performed (hygiene protocol); profilaxys could be used until solution of NICU problems causing fungineal high incidence

Dear Jack I agree with you but in many articles I can find setting similar to a nasal-SIPPV rather than a bilevel CPAP (i.e. we use to set a Ti of 1 - 1,5 sec with rate of 15 per minutes; in all the article I found I always find setting as SIPPV. In the forum about SIPAP there are setting as Bilevel. That's why I am concerned about SIPAP

Thanks Jack for your help. I didn't find any article on bilevel SiPAP? Do you?

I have some doubts: in our unit we use such SiPAP setting, but in literature I always found setting of SiPAP as a nasal SIPPV. DO you know where I can find setting similar to those we use to do?