manojpotdar

Dear Husam Salama, Can you email me protocol for neonatal ventilator esp HFOV. Thanks. Manoj Potdar

Hi, I am working as a registrar in level 3 NICU for last 3 years. I did MD in Pediatrics from India. I want to do fellowship in Neonatology. Can anybody guide me to get fellowship in USA or Canada?

Thanks, Dr. Petrov. I will go through it and I will ask question if needed.

Dear Dr Petrov Can you share the protocol for VIP Bird with me. Thanks

Dear Dr Shenoy The first formula X ml = TV(DD-LD)/(HD-LD) ml of HD in TV is to get desired concentration (any) of dextrose solution by using solutions of two different dextrosity . The second formula Y= PV(DD-PD)/50-DD ml of 50% dextrose required, is to increase the dextrosity of existing solution. like if you add 6.25 ml of D50 to 100 ml of of D18 % than dextrosity will increase to 19.88% while if you add 6.7 ml than dextrosity will increase to 20.00 %. Yes , it is a small difference but formulas are to give you exact desired dextrosity .

Dear Dr Shenoy, These two formulas are for two different situations. I will reply you soon. Potdar

We can prepare by both the ways. There is no difference except for cost factors I guess. I posted formulas for this in Forum: education, organisation and evaluation. Manoj

In many neonatal nursery IVF mix is made by adding sterile water and D 50%. Which is more costlier. We can make IVF mix by D10 and D50%. Formula-- General formula for any two solutions with different dextrosity= Total volume required= TV ml of solution containing higher dextrosity(HD%)= X ml ml of solution containing lower dextrosity(LD%)= TV- X ml Desired dextrosity= DD X ml = TV(DD-LD)/(HD-LD) ml of HD in TV ml of LD in TV = TV- X ml exp- Total volume required is 100 ml Desired dextrosity is 16% and we have D10 and D50% HD=50% LD= 10% ml of D 50 (X ml) = 100(DD-10)/(50-10) ml of D 50% ( X ml) =100(16-10)/40 ml = 600/40 ml = 15 ml ml of D10%= 100-15=85 ml

Dear Dr Naveed, I made the equation more simple than before.

That was an example only.

Potdar’s Neonatal formula to decrease the dextrosity Present volume-- PV ml Present dextrosity – PD% Desired dextrosity – DD% ml of sterile water required— Y ml Formula :- (PV x PD) +(Y x 0) = (PV+Y) x DD Y=PV(DD-PD)/DD ml of sterile water needed Exp— Weight of infant 1 kg Total fluid required @100 ml/kg/day = 100(PV) Present Volume—100 ml Present dextrosity --- 20 Desired dextrosity—18 Ml of sterile water required— = (100 x 20) + 0 = (100+Y) x 18 = 2000 = 1800 + 20 Y = 20Y = 2000-1800 = 20 Y = 200 Y = 200/20 Y=10 ml of sterile water OR Y= PV(DD-PD)/DD Y= 200/20 = 10 ml of water This small amount of water may dilute the electrolytes. For this, either you can add electrolyte in same proportion or may increase the fluid rate to give this extra amount in set time if clinically feasible.

Potdar’s Neonatal formula to increase the dextrosity Present volume -- PV ml Present dextrosity – PD% Desired dextrosity – DD % ml of 50% dextrose required— Y ml Formula :- (PV x PD) +(Y x 50) = (PV+Y) x DD Y= PV(DD-PD)/50-DD ml of 50% dextrose required Exp— Weight of neonate-- 1 kg Total fluid required @ 100 ml/kg/day—100 ml (PV) Present dextrosity --- 18% Desired dextrosity—20% Ml of 50 % dextrose required— = (100 x 18)+ 50 Y = (100+Y) x 20 = 1800 + 50 Y = 2000 + 20 Y = 50Y- 20Y = 2000-1800 = 30 Y = 200 Y = 200/30 Y=6.7 ml of 50 % dextrose. OR Y = PV(DD-PD)/50-DD Y = 100(20-18)/50-20 Y = 200/30 =6.7 ml of 50 % dextrose This small amount of dextrose may dilute the electrolytes. For this, either you can add electrolyte in same proportion or may increase the fluid rate to give this extra amount in set time.

Dear Colleagues, Its a common problem in NICU that due to hypoglycemia or hyperglycemia, we have to either discard the TPN or change the IVF mix. Its a huge loss to the hospitals. I made few formulas to change the dextrosity which I want to share with all of you. Send me mail so that I can send directly to you. manoj_potdar@yahoo.co.in

(1) What dextrosity we can use through PICC catheter? We are using 25% if catheter is at the junction of SVC/IVC and rt atrium, 20% if in deep vein and 12.5 % if in peripheral veins. (2) For how many days we can keep the PICC lines? (3) Is there any need for routine blood culture (PICC) to be sent ?

Dear Lucie charron We are inserting PICC line regularly now. Please mail me the detailed information regarding PICC line. My email id is manoj_potdar@yahoo.co.in. Thanks Manoj