feraszaman

Actually, I was commenting that you mention to avoid IM injections, but what do you do with administering regular prophylactic IM vitamin K?

Hi all. I've recently seen some neonatologists treating medical NEC for 10 days with antibiotics and probably NPO just for 5-7 days... Has any one done this or is there any article supporting this kinda approach?

We are still waiting for Lori Ives-Baine's answer, and I wanna emphasize on what Stefan asked for(routes-of-admin and drug-of-choice in various situations and Doses. special situation I'm facing these days when the parents electing for comfort care in severe CDH with chromosomal abnormalities or boarderline prematurity (22-23 wks GA) or Trisomies 13-18 with severe hear lesions.. etc. Those families may elect NOT to "poke" the infant for morphine or fentanyl.. the life span might be sometimes few minutes..how would you approach pain management issues when there's no enogh time route or a way to deliver it .. one more question ..in such situations(expected very short life span..minutes) : does the comfort care really does anything for the baby or it is for us and the parents for the most part ??

Hi dr Salamah Thanks a lot for this awesome work ! I think that subgaleal hemorrhage incidence is higher than 1.5 per 10,000 but actually not reported or recognized.. I've seen few of them in the last 2-3 years. Most of those SGH were already "healed" when I was consulted, coz it was already late !! Usually 8-12 hrs after delivery.. Anyway, I have 2 questions reg. Your protocol: 1- what about vitamin K IM injection or po? 2- I didn't see pain management there, I think it's quite painful to have SGH, any comments? Sincerely yours Feras Alkhudari

It's getting more interesting now!! Thanks for the inputs, hopefully we'll here more ..

Hi there, I think basically if any infant is hemodynamically unstable, he may have unstable end organ perfusion and fullfeeds may hurt more than benifit the infant..once the infant is a bit stable(which is usually acheivable within 3-4 days), trophic feeds, at least, should be started for a few days or 10-15 cc/kg may be continued for few days before increasig the amount wisley. I have hard time to believe that leaving the infant a week or 10 days NPO is a good thing !! ofcourse as long as we are not dealing with NEC or some other GI issues. I wish if I had more recent articles to support my argument but I'm currently at my house not in the hspital to use pubmed or others. but here are some articles that I could find: Journal of Perinatology (2005) 25, S7–S11. doi:10.1038/sj.jp.7211309 you can look at the references at the end of this article and use them. here's another one: Arch Dis Child Fetal Neonatal Ed 2000;82:F29-F33 doi:10.1136/fn.82.1.F29

:confused:Hi All it's a very simple question. what's your protocol regarding the IUGR babies ? we know that the most common reasons for IUGR is maternal morbidities like hypertention, smoking bad diabetes and some other factors like multiple gestation, placental insufficency, TORCH infections and congenital anomalies. The reason I'm asking this is because some reports are saying that it's so rare to have positive TORCH titers thesedays.. so is it a waste of time , money and Blood ! how aboout the head Ultrasound to check for calcification? to do or not to do? so basically if you have someone with preeclampsia, and IUGR or a smoker with multiple gestation and IUGR..or any other scenario you can imagine, how would convince yourself that the reason of IUGR is what I mentioned above not TORCH infections? Thank you much for your answers.. Feras

Well, although I don't have the article at this moment but let me tell when we/I dp LP for an infant late onset sepsis: i.e > 3-7 DOL with or without picc lines or broviac's or any central lines we do the full sepsis workup (BloodCx, Urine Cx and CSF) that if we dont have a source for the infection like an example : 15 days old with Picc line just taking everything by mouth and got sick,apnic, shocky AXR showed Pneumatosis; we consider this NEC and NO LP but if we couldn't find a good reason ..we do LP in addition to the old/new question : to remove or not to remove the Picc line..of course depends on what Bug and how long it has been placed etc.. 38% of blood cx might be negative with meningitis as what Dr.Salameh101 mentioed above which I believe came from a huge study 7-8 years ago but it was multicenter study and the cultures were from different labs and not a unified method for early onset sepsis: we do it in infants with chorioamnionitis or severly depressed infant with no obvious reason (like HIE..) ..anyway: if you asked 3 neontalogist about when to perform LP, you'll get 7 different answers !!

Hi Stefan I'm a member of FB and I'm trying to be a member of all FB groups that are involved in Newborn car, NICU, Perinatal medicine, NICU's overseas and even some other groups like trisomies and other congenital defects..from my limited experience, and I'm not a computer savvy by all means, I found being a member of such groups, like trisomy 18, helped me really well to get close to the patient's families feelings and wishes. It's priceless to be on the other side of the medical care and see how your point of views might change..you might have been diagnosed a handfull of Tri 18 cases but once you are a member of those groups..things are so different. Anyway, Although probably I do think we need our FB group, but it should not open to public ...at least for now probably because of some legal issues..many people can copyy paste many of the members point of views which may be different from case to case of course..good luck convincing some lawyers though !! plus your real names and times of replies and personal views etc... Again , I'm not against or with..but more time needs to be devoted for more discussions. Thank you much.

Isn't that funny? that in my mother tongue language "Arabic" we have the same phrase "we will get children" and when you realise that it's true..you try being more polite and say: Hopefully The God will grant us a baby..

well, We sort of agree about not to use it in the Delivery room. Instead of finding a very convincing answer regarding the soidium bicarb, and after reading all the posts, I find myself facing more questions : 1- If not to use it in the DR ..would you consider it in resusitation of a newborn in the NICU ? 2-I personally rarley use it, and I try to buffer the base deficit by using blood or NS boluses, but then even NS boluses may cause IVH if were given quickly, so the question is shall we tolreate lower PH even down to 7.0 and deficit of -16 ? and shall the criteria of the PH and BE numbers change by different gestational ages or birht weight? I.e Full term resusitaion vs. VLBW. 3- how about increasing the TPN Acetate in kids with persisitent metabolic acidosis (like with mod to large PDA) or kids with continious NG suction like Gastroschisis ones? 4- using bicarb looks like using a big band-aid on a deep wound cut to cover it up to stop bleeding, but the cut may bleed again ..and we use bigger bandaid(more bicarb) ..until bleeding stops, now do u thing the bandaid did it ? or it was just a matter of time(with the help of fluid, dopa, fixing the respiratory acidosis, etc..) regardless of the bandaid-bicarb? Thank you !

SiPap is a new tool for me since I started in the new hospital I moved into. Honestly, my personal view is like: Sipap is great because of the mask that we use, by decreasing the degree of nasal septum injury and edema of the nasal airways. however , I'm not convvinced that the "PIP" has anything to do with it ..not even the rate..it's just the mask.. one time , 2 years ago, I read about a study was done in Rome, Italy usinf something close to Sipap or even cloder to Bipap but synncronized with the baby's breath..I think that would be ideal. lastly, I found usful in preventing the reintubation more that preventing the intubation for the first time. Again, my experience is limited, it's been just 6 months since I've used it for the first time.