r.dippenaar

I find the statement hippo critical, considering all the litigation on the use of formulae milk and its association with NEC . https://www.millerandzois.com/nec-baby-formula-lawsuit.html https://www.thegomezfirm.com/baby-formula-lawsuit/ https://www.classaction.org/nec-premature-infant-formula-lawsuit https://www.shouselaw.com/torts/baby-formula-lawsuit/ Yet I have not seen a FDA response to this topic Ricky Dippenaar

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 hz 10 amp 20 as a starting point although they seem fo tolerate 1:2 ratio better . Highly efficient system can very easily cause hypocapnia so we use transcutaneous co2 to monitor . Fi02 only minimally increases in most infants and the followup chest xrays inevitably deteriorate out of proportion to the infants clinical picture but clears after a few days. The infant in naturally nursed prone and the head flexed or extended until a good neutral position and a good chest wiggle is observed . The nursing staff love the system and it allows you to bridge to a point where the infant either transitions to nasal CPAP or the nasal high flow vapourtherm systems . Just our humble experience and approach for micro Good luck Ricky Dippenaar

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

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 litigation, we also adopted a policy of restricting indwelling umbilical catheter duration to no more than 7 days based on older studies indicating an increase in infection risk and thrombus formation. The latter article I have attached as an interesting read albeit from 2009 Kind regards Ricky Dippenaar UmbilicalVein1.pdf

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 enterocolitis in 6 years representing 1200 infants for that period. Attributing this to a single intervention would be a unreasonable as aggressive conversion to exclusive breast milk should rather be credited. Attached is an interesting article describing lactobacillus in breastmilk world wide. Ricky Dippenaar HumanBreastMilkLactobacillus.pdf

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.

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

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 advantages of using additional acoustic windows for greater visualisation of the neonatal brain. The author’s foresight in combining the sonographic images with the far superior image resolution of Magnetic resonance imaging (MRI) allows the reader a more accurate reflection of the underlying pathology in question. Scattered throughout each chapter is additional diagrams, specimen photographs, schematics and tables to give a well rounded but succinct synopsis of the intended subject discussed The 419 page atlas depicts over 600 images and has been logically divided into 9 divisions namely , normal anatomy, congenital anomalies, antenatal brain damage, fetopathy, haemorrhage, asphyxia, ischaemic stroke, preterm white matter injury and miscellaneous conditions. Text has been kept to the most essential but with such meticulous detail that each sentence is a pearl of wisdom. Recommenced relevant articles or references sighted within the text conclude each chapter . These references are easily accessible and accurately cross referenced. It is worth taking the time conscientiously absorbing the carefully chosen words and images depicted in the first 10 chapters (Page 1-35) as well as one or two of the recommended references as it will stand you in good stead for the forthcoming chapters. I would highly recommend this atlas accompany the clinician during any cranial ultrasound examination of the newborn as the overall layout allows for quick referencing and can only improve the quality of the examination. Finally, while searching Amazon.com for the estimated cost of the book I noticed the cover page shown matches the aforementioned book but when scanning within Amazon switches to the previous edition of the book which does not really do justice to the latest edition Ricky Dippenaar Head of Neonatal services N1 City & Blaauwberg Netcare Private Hospitals Cape Town South Africa