feraszaman

I wonder what was the indication to place UVC at day 14 ? I.e Abo or Rh happen very early .. G6PD ? Or just breast feeding hyperbilirubinemia ?

Hi all: There was some recommendation from AAP regarding fortifying the formula or breast milk in VLBW for 6-9 month or until the infant get into acceptable growth chart lines. As far as I k ow, many VLBW don't have a catch up growth may be until somewhere between 1-2 years. Of course even worse with the sick infants , SGA or IUGR. My questions are: What is your routine practice in discharging VLBW on fortified formula or BM. How do you recommend continuing that? Do their pediatricians follow the recommendation? How would you decide the fortification strength and length? Studies ? How do you guarantee that the nursing mother will continue pumping and fortifying the milk? Meaning its a bit hard and nursing right from the breast is much easier.. Do you recommend Breast feeding late say 4/-5 times and some 22 cal/oz 2-3 times daily ? Thank you ! Feras

Ive heard some recommendation to use smaller ETT with down syndrome babies secondary to their risk of developing subglottic stenosis . Any ideas?

Today I was flipping thru "atlas of the newborn" and looked at many photos of gangrenes in the Lowe extremities secondary to arterial thrombosis or wrong placement. Somehow I decided to take out the UAC as soon as possible..(I do keep them for 5-7days usually) It was scary stuff !!

We do if UVC went east or south.. Or if infant is so edematous and hard to place a PICC..

Hi all: We try to place PICC lines in upper extremities, if difficult then we go to lower extremities .. Sometimes scalp veins look very "tempting" to advance them through .. My Question for you: Do you have any advice in sense of indications, contraindications, complications etc ?? Thanks FA

Agree, but it may be reasonable to treat for 7 -10 days if you could not do a spinal tap if there was chorioamnionitis suspicion ..

This is a huge topic ! Probably you have to go thru topics of neonatal surgery like CDH, ECMO,necrotizing enterocolitis , abdominal wall defects Fetal surgery and compare the morbidities, mortalities , technics etc

LLL

Neonatal review book( Dara broadsky) , cloherty hand book ESP of ID section, are the most intensified. Buy the material of neonatal board review course . There's a book PDF MCQ from 80's .. U get 10-15 percent of questions from there .. Assisted ventilation for Goldsmith , fannarof, if u want That's what I did ! I passed !

Congrats for all of you who established this friendly community which is functioning as a senior neonatologist with accumulated experience of 3000 years !! Wish you and us the best of the best ..waiting for more endeavors .. Like writing a book or book series of different issues of neonatology.. Not just sure we can do it .. But also it will be the best ! FA

Hi all: Any one using Mastisol to secure the ETT? We've had couple of incidents were it looked like "chemical burns" may be because of the a bit too much of Mastisol. So what is the census here ? Do you use it or not ? or we can make up another question: How do you secure ETT esp. in VLBW? Do you use any liquid adhesive?, if yes , what kind?

I am not sure if this is funny or not , but I used not to hold feeding during transfusion, then all of my collegues were holding the feeds and looking at me like I'm an alien from the outer space with 2 heads !! so I did hold the feeding for few years then it appeared that it doesnt really affect the NEC incidence so now I am doing the following: I feed the infant, then start RBC's transfusion over 2 hours. using one IV to adminster the RBC's ,check sugar in the middle, then resume feeding in an hour or 2 after finishing the transfusion. I'm not sure if you classify me under who's holding or not holding ! :)

I was wondering to call something a congenital pneumonia? Some centers call RDS a congenital pneumonia and treat it for 7 days Abx if infants > 35wks GA required O2 more than 4-8 hours. Others will treat if RDS lasted for >48 hrs ..others may not treat and will call RDS and will treat just for 48 hrs and watch closely for Bcx and clinical status and finally some centers may call it TTN even if the infant required FIO2 .. My question is : 1-When do you call "something" congenital pneumonia? i.e what are your criteria? 2-What is the msot common pathogen you think? 3-Do you treat? if yeas, for how long? (assuming you will use amp and gent) Thanks for sharing ! FA

Well, what if HR < 60 and you tried chest compression and epinephrine 3 times and you were sure ETT is in and PPV is being given.. When do u stop ?? It may take long time for the HR to stop.. Do you keep trying for 30 min? One hour?

She is gorgeous !! Congratulations Stefan , wish you and your family the best.

Thanks Stefan for your help. Unfortunately, It's hard to do it out of the U.S these days. I wish some day I will be able to attend a course for both in Stockholm BTW: you still recommend the interactive cd of dr Evans from Australia ? 3-4 years ago you guys used to offer them for purchasing ..

Hi all: I'm a certified neonatologist and very much interested in learning echocardiography for neonates . are you aware of any program , courses, or classes ( on site or online) that can help me with this? I heard that if you do 300 echo( mixed adults and peds) and a cardiologist certify you as some one who can do echo's, that would be enough.. Is that right? Any way , I live in PA , USA in case you can help me with this!

You are absolutely right! Although you may think it's as easy as 1+1=2 .. unfortunately , we only see the tip of the iceberg. In other words, Urine output! Kind regards

An experienced neonatologist told me one time that if you are concerned about an infant ( term or preterm) who is showing some signs of sickness , and covering his face with his hands and avoid looking at you ( not opening his eyes) , that means he is SICK until proving otherwise.

it's an awesome idea..go for it .

This a fantastic idea!! I love it , may be we should have like a section of "pearls of wisdom" and the categorized to several subtopics like general neonatology, Cardiac, Respiratory..etc

Recently, I've attended a lecture discussing the issue of PRBC's transfusion . Some Neonatologist think we "wait" too much .. I liked what Stefan said about symptomatic , whatever that means!

there was a nice breif article about that recently http://www.neonatologytoday.net/newsletters/nt-oct10.pdf

It depends on the etiology of the hyperbilirubinemia, for instance, Hyperbilirubinemia secondary to breast feeding, (I mean dehydation W/O hypernatremia) you may need to give a bolus or two of NS and then 1.5 maintenance of IVF over the next 24 hrs of D10 1/4 NS hrs depending on the dehydration degree) ..but Hyperbilirubinemia secondary to Blood group icompatibitlity has really nothing to do with the given fluid unless you need to keep infant NPO for exchange or spme.. If you can give us more specific question, the answer might be more oriented! Thank you for sharing the question with us.