Leonora DEsposito

Could genetic play at this outcome ? Leonora D'Esposito.

Thanks! Sharing with my residents and other Neonatologíst in my Hospital in Dominican Repúblic.

Great !!! You put a big smile on my face.

Best wishes for 99NICU !!!. Sharing the knowledge and caring for babies all over the world . Thanks Stefan !!! A big Caribbean Hug from Dominican Republic.

We often send home stable premature babies of less than that weight and GA, because if we left them in the unit they get infected. First we train the mother. Make sure his breastfeeding well. And controling temperature in a basinete with a lamp for 24hrs.. We check them every other day during the first week ( with weight ). then weekly until 2,500 gr. Believe me they do better at home, but training the mother or the grandmother is key to sucess. Kangaroo care is another good aproach . Good luck.!!! Blessings for the baby.

Hi Friends. I recently saw an interesting video about surfactant administration without an ET, using a thin feeding tube with a Magill forceps. Anybody with experience using this method ? Any articles available ? Thanks. Kind Regards.

Hi Aymen. Welcome to 99 NICU. I'm a Neonatologist from Santo Domingo, Dominican Republic. ( an Island in the Caribbean ) I 'll share some ideas about infection control with you.I think active surveillance will make a huge difference in the morbidity and mortality of your Unit. It is a good idea to have a group of people responsible for this, but you need to involve your nurses. Nurses are the ones who take direct care of the babies, of course infection control includes all health care team. Correct hand washing is the most important measure, alcohol based hand rub , must be available ( near ). IV. lines, solutions and lab samples must be done with strict asepsia. Try cleaning every shift with alcohol or disinfectant in the area where nurses prepare solutions or meds . When changing diapers, nurses need to remove gloves, and wash hands immediately. Avoid multi-dosis vials. Remove iv lines as soon as possible,make a rational use of antibiotics to avoid resistance, feed your babies with mothers milk the sooner the better. If you don't have people with hospital cleaning experience you need to read about it, and teach them. A program of continual education and motivation of all staff is very important because we forget easily about cleaning our hands. Good luck !!! Best wishes for your people in Lybia.

Thanks Stefan, this Photo gallery is FANTASTIC . Excellent learning and teaching tool. Love it !!!!

Thanks for answering my concerns , Francesco . Unfortunately the companies( Abbot or Richet )don't have that kind of studies.I found the same concern in some neonatologist from Argentina, long time ago, when it was marketed for the first time. We are thinking about making a small trial to have our own results. Thanks again for taking the time to help me . This is the beauty of 99 NICU. Regards. Leonora .

Hi dear friends... I'm looking for advice. Our Hospital is facing a hard financial time. We use Survanta as our brand surfactant. Administrators wants to buy a cheaper surfactant ( Richet... from Argentina ) . We want to make sure we are using in our babies products that are safe and effective. Really concern .... Wellcome your opinions. Kind Regards... Leonora.

Hello ! We also use saline O.9%, plus acetylcisteine. Our nurses use an electric toothbrush, cover with gauze as vibration therapy to move the secretions. You have to be careful when giving respiratory therapy to a newborn, specially if is a LBW infant, because if you use percusion, you could increase the IVH, risk. Best Wishes . Leonora.

We use Atlanta Takaoka... Believe me, this are highly efficient, ventilators. Ours are busy 24/7 . Very easy to use. Residents, nurses and attendings like them .

Hi Dr. Dinag.I'll be very happy to share with you our experience. I will send you the pictures of our CPAP, as soon as I can , I'm now out of town for personal reasons.This is a rudimentary way of giving some pressure, to babies that need respiratory support. But we can talk about a before and after, in our mortality rates from respiratory failure, as soon as we learn how to use them. Thanks for the oppportunity to help your babies from so far away. Thanks 99 NICU !!!!!. Regards. Leonora.

I would like to Know about your policies for babies with mother with recent urinary tract infection ( w positive culture ) or vaginal infection. Controversy around..... Sometimes babies look fine , lab is Ok and they put them on antibiotics until blood culture is negative. Are we exposing this babies to the nosocomial flora ? And taking them away from their mothers unnecessarily ?.Regards. Leonora.

Excellent review . Thank You. Sharing it with the residents. Easy lecture. !!!!!!

!!!!!! Happy Birthday 99 NICU !!!! Sharing and Caring to help the babies all over the world. This is a labor of LOVE !!!! Congratulations to the founders and all members and supporters .A Hug for You Stefan. Leonora.

Thanks Selvan. Very useful. I'll share the second link with the residents. Easy to understand and practical tips.

We use an humidifier in our oxygen source sorry I forgot to mention it. We don't have a way of making it warm. This is not perfect but does saves lives. Regards. Leonora

Hi Dr Ayub I'm glad to share with you our experience with the bubble CPAP. I'm a Neonatologist in Dominican Republic and we have a very good experience with it. To make the CPAP you will need a neonatal oxygen nasal canula,a 3 way stopcock ,2 pieces of plastic hose, a saline solution plastic bottle, centimeter, Z-O, and a source of oxygen. First prepare the bottle. Empty the saline a little more than half way,with a blade open a slit and pass through it one hose ( you can use an IV line ).Make a presssure guide with the centimeter and the Z-O, stick it in the bottle from the bottom up. Conect to the 3 way stopcock, then conect the nasal canula ( you need to cut it to make it fit), and the oxygen hose. When everything is in place you need to see the bubbles in the saline to know is working properly. We begin with 3-4 lts of O2, and 3-4 cms of pressure. Move with clinical condition and oxygen sat. The tip of the saline hose is what you will move up or down to change the pressure. It really help.. and its not hard to make. Our nurses do it in a blink, it only takes practice. Give it a try. I hope this is clear enough to help you. This is the beauty of 99 NICU. Best wishes for you and your babies.Leonora

I'm so happy to have the opportunity to stay in touch through the blogs with this wonderful community. Wishing all members of 99 NICU, Merry Christmas and a New Year with Health and Joy. Peace on Earth.... Blessings for All. Leonora

Hi Gopan We use to take the ETs ,out of the freezer just a few minutes before using them. With the laryngoscope in place, wait for the vocal cords to open ( without touching them ) to insert the ET. I share your concern about laryngospasm, but we don't see it often. That way we intubate succesfully ( oral or nasal ), without stylet. Regards Leonora

When I was a residentI.. We use to have the ETs in the freezer, that make them stiffer. and the procedure was easier. I would like to hear any coments..... Regards. Leonora.

Dear colleagues .I'm sorry ,but I can't upload the X rays. In the middle of this case we experienced problems with Radiology.Poor quality films. Case update: baby doing better,no pneumothorax today.Ready for CPAP.Thanks for your opinion.

This is about a 2 days old baby 36weeks,delivered by C section. Mother with urinary infection. Dx with Pneumonia. Developed respiratory distress,managed with Survanta plus nasal CPAP. X rays with Pneumothorax.Evacuated by needle puncture .(32cc of air ). Persistent distress,intubated and with mechanical ventilation improved. New X rays with 30 % ?? pneumothorax .Attending decided not to place chest tube. Big controversy..I would like to hear your opinion in this case. Regards .

I found the article about pulmonary intersticial enphysema really useful. It help me treating the smallest of our preemies. Thanks for the Link to e Medicine. JACK.