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    South Africa

r.dippenaar last won the day on December 16 2020

r.dippenaar had the most liked content!

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About r.dippenaar

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    N1 City Hopsital
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    Cape Town, South Africa

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  1. Evening we have both devices the Fabian VG is great but recently we were alerted to a software update for VG so little cautious on our sub 500 grm babies at present . The Draeger similar positive experience no issues. In our experience we would attempt extubating the infant provided no haemodynamically significant pda or major IVH. But achieving the MAP of 10 is often difficult with non invasive nasal Cpap even with biphasic/duopap option . So we have opted for non invasive nasal osscilation using Ramanathans RAM nasal cannula fits directly onto the vent y connector with same MAP or 1 higher
  2. We have been using intravenous Paracetamol for a few years now rather successfully on the recommendation of our resident paediatric cardiologist. The effects on a haemodynamically significant PDA appear to be equivocal but most noteworthy, the nursing staff are particularly fond of it in the the extreme premies as subjectively it appears to them the patients are more peaceful and comfortable . I've attached an interesting article which is quietly reassuring. It would be nice to have pharmacokinetic and pharmacodynamic studies , hopefully in the future Paracetamol_PDA.pdf
  3. We have all faced this conundrum but ultimately the risk of malposition has been highlighted in a number of reports such as Grizelj R. Severe liver injury using umbilical venous catheter: case series and literature review. Am J Perinatology 2014 Nov; 31(11): 965-74 Fuchs EM. Umbilical venous catheter-induced hepatic hematoma in neonates. Journal of neonatal-perinatal medicine 2014 Jan 1;7(2): 137-43 As a result our unit introduced ultrasound confirmation in an effort to mitigate complications, shorten duration of UVC line insertion time and decrease risk of litigati
  4. Probiotics will always a contentious subject and I personally agree with the comments above, but also of interest is from the available literature aside from less than a handful of isolated cases in relation to the global footprint of probiotic use within the Neonatal ICU's it at least appears to do no harm. We have used probiotics extensively from 2007. Our preferred choice has been Lactobacilli Reuteri in a commercially available preparation and this choice was largely based on availability and quality assurance of product in South Africa. We have not had a single case of necrotising enteroc
  5. We have been using High flow nasal prongs for some years now with great success but predominantly as step down from nCPAP. In addition the Vapotherm system has been gaining a tremendous amount of support especially from the nursing perspective . Peter Reynolds from the UK recently showed their results and experience with this system as a primary mode of non invasive support . Pediatrics. 2013 May;131(5):e1482-90. doi: 10.1542/peds.2012-2742. Epub 2013 Apr 22.
  6. We use PICC lines extensively in particular the 1 Fr Vygon premicath which is inserted through a conventional 24 G cannula. Its ease of insertion was further improved a few years ago with the inclusion of a guide wire and generally takes longer to secure the line than insert it. The vast majority of our lines are inserted in the leg, the guide wire in my opinion has minimized malposition and as yet we have not seen one enter the hepatic vein. Prior to the guide wire we had a few cases of bizarre paths. Regards
  7. An Atlas of Neonatal Brain Sonography 2nd Edition (Clinics in Developmental Medicine No. 182-183) Paul Govaert & Linda S. De Vries Publishers: Mac Keith Press 2010 Hardcover t book Est. Cost $ 498.00 ISBN: 978-1-898683-56-8 Available from Amazon.com Quintessentially these two highly experienced and well published authors have produced an unparalleled reference book aimed at the practising neonatologist as well as the paediatric radiologist . This revised edition not only includes improved ultrasonic imaging as a result of technological advancements but also highlights the advan
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