Jose Ramon Fernandez

Hi Philip, check out this Spanish project: https://medicalopenworld.org/

Ampicillin plus gentamicin in our NICU, according Neofax dosages. We stop antibiotics if blood culture is negative (48-72 hours) and no clinical or laboratory signs of active infection.

Hi, Nashwa. Any dysmorphic features or involvement of other organs (echocardiogram, brain US, ophtalmologic evaluation, vertebral X-ray...). I remember few years ago a case in our unit that was an Alagille syndrome and direct bilirrubin was raised from the start. I assume that metabolic work-up is normal (hypothiroidism, alfa-1 antitrypsin deficiency). I'm not sure of the role of hemolytic disease as the leading cause of such an early cholestasis in your case. Please, keep us updated on his clinical course. Greetings from Spain.

We always use Replogle tube and pediatric surgeons always insert a thoracic drainage, but I'm not sure if they are evidence based practices. I like this clinical guideline from Royal Children's Hospital Melbourne. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Replogle_tube_management/

We have used IV epoprostenol in some cases with iNO refractory PPHN showing very good response. https://www.nature.com/articles/s41372-018-0179-7

I found this consensus on neonatal management of infants born to mothers infected or suspected COVID19. It's free online access. http://atm.amegroups.com/article/view/35751/html

I have no experience with this drug. I attach one letter to editor (is in spanish but you can get some references from it). http://www.analesdepediatria.org/es-azul-metileno-utilidad-el-tratamiento-articulo-S1695403310005527

May be congenital varicella syndrome scars? Any rash before 20th week of pregnancy? I would rule out congenital varicella syndrome with PCR of VZV and look for associated malformations (eye,cerebral US...)

Maybe this paper could help you,it´s from 2003, but I used it few years ago with your same purpose. Greetings from Spain http://www.ncbi.nlm.nih.gov/pubmed/12615035 Another paper that seems to be useful: http://www.ncbi.nlm.nih.gov/pubmed/17561765

You´re welcome I don´t remember a recent case of such problem,but what we use to do is to freeze the milk (no matter of time). It seems there is no contraindication regarding to weight (you can brestfeeding even prematures less than 1500g). At the end,the benefits of breastfeeding are greater than damages for the baby.

Greeting from Spain. I hope this Pubmed search cuold help you. It´s known that especially very low birth preterms could be infected by CMV excreted by breast milk,but this risk seems to be lower if you put breast milk at -20ºC before you feed the baby. Making a pubmed search with "Cytomegalovirus"[Mesh] AND "Breast Feeding"[Mesh] with those Limits activated: Humans, English, French, Russian, Spanish, Newborn: birth-1 month we get 28 results.I point you those I consider most interesting: http://www.ncbi.nlm.nih.gov/pubmed/19687768 http://www.ncbi.nlm.nih.gov/pubmed/20630814 (article in spanish)

Hi collegues. I think Waardenburg is the first option. Although is probably less common disease on neonatal period, we shouldn´t forget about Chediak-Higashi syndrome. This syndrome appear with partial albinism and reduced iris pigmentation too. Are her parents relatives?? There is any hematological alteration?? Congratulations for your work and for this web Here is a link from OMIM with the clinical synopsis of Waardenburg and Chediak-Higashi: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=277580 http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=214500