
Everything posted by Francesco Cardona
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several doses of I.V immunoglogulin in neonatal sepsis
Suffice to say - i.v. immuneglobuline in neonatal sepsis is not standard treatment Cochrane. unfortunately the INIS Trial has not published its results, but according to data shown at Hot Topics 2010 - there is no indication for iv immuneglobuline in neonatal sepsis. furthermore it seems that there has been publication bias in the trials published on i.v. immuneglobuline so far (that is: only studies that showed an effect were published, and most of them were pretty small)
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Drugs during Breast feeding
Great links, Thank you!
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taking blood out of a arterial line by preme's
There is an article that shows that cerebral blood flow decreases during sampling from an umbilical artery. The more time you take while drawing blood and the less blood you remove, the better. Umbilical artery catheter blood sampling volume and velocity: impact on cerebral blood volume and oxygenation in very-low-birthweight infants. At our department we only use saline to flush and we do this by hand. Interestingly also sampling from a UVC leads to decreased blood flow in the brain (research by the same group): Blood sampling via umbilical vein catheters decreases cerebral oxygenation and blood volume in preterm infants.
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Apps for iphone, ipad a/o android
from our facebook page
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gram negative resistance bact*
I understand your concerns and also our hospital had to deal with higher rates of infections. I agree about being worried of constantly having to use meropenem in these patients. So far in premature infants using probiotics has only shown to reduce incidence of NEC, but not sepsis in general. So I am not sure you would achieve your aim through these measures. The final verdict on oral antibiotics is not yet out, so I would not recommend this as a first line either. More nurses is always beneficial I feel and burden of workload can be a strong predictor on rates of infection. One common successful route in reducing infections is educating the staff on hygienic measures and being strict about enforcing those measures. Have a look at these articles (there are a lot more out there..) http://www.ncbi.nlm.nih.gov/pubmed/20570396 (on controlling MRSA transmission) http://www.ncbi.nlm.nih.gov/pubmed/20970881 hand hygiene is one of the most cost effective and protective measures out there, but probably also one that is the hardest to comply to
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Sepsis by Serratia marcescens
Maybe you will find the following articles helpful: http://www.ncbi.nlm.nih.gov/pubmed/19933039 http://www.ncbi.nlm.nih.gov/pubmed/18419363 http://www.ncbi.nlm.nih.gov/pubmed/19783209 We had an outbreak of S.marcescens at our ward a couple of years ago. Containment was only possible by strict hygienic measures and isolation. Hope this helps.
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opencare v/s incubators
There are 2 cochrane reviews on this issue: Gray compared Cot-nursing versus incubator care for preterm infants: 173 patients included, no conclusion possible New reviewed the optimal weight to transfer babies to the open cot: only quasi-randomized controlled trials: no conclusion possible Laroia: there is no real difference between one-wall and two-wall incubators As a warning though: in this review from Flenady the authors showed that radiant warmers increase IWL (insensible water loss) considerably, but as you can see there is not alot of data out there.
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new nrp 2010 guidelines
The recommendation says: link and further: admittingly not very precise but not zero. In the text they also mention, the cord should not be clamped until no more pulsations are visible. Currently we dont practise this at our hospital, but I believe we should.
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Babies, the Swedish Prince Carl Philip, research and myself
Francesco Cardona commented on Stefan Johansson's comment on a blog entry in Department of Brilliant IdeasFantastic news, I am very much impressed! Success for the future!
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Monitoring filter blocked
Do you generally have a problem with too much moisture in your ventilator circuits?
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Analgesia and Sedation in Neonatal End of Life Care
Thanks for sharing your ideas on this important matter. I would like to link to this article by Verhagen et al. pubmed: There seems to be quite some contrast in how these end-of-life situations are handled in different countries and even within countries. Also see the commentary by Thomas Berger In our unit we mostly use opiates for pain relief. If the baby is a newborn we would consider using a piv for i.v. injection into the umbilical vein. We offer parents a quiet place where they can stay with their child indefinitely. I find the alternative routes (sublingual and intranasal) very interesting. Regards
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new nrp 2010 guidelines
Finally: In term infants receiving resuscitation at birth with positive-pressure ventilation, it is best to begin with air rather than 100% oxygen. If despite effective ventilation there is no increase in heart rate or if oxygenation (guided by oximetry) remains unacceptable, use of a higher concentration of oxygen should be considered. and the European Version is here: http://www.resuscitationjournal.com/article/S0300-9572(10)00455-7/fulltext
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Doctors on social networks - professionalism in the virtual world
Francesco Cardona commented on Stefan Johansson's comment on a blog entry in Department of Brilliant IdeasHere a look on how patients networks work http://www.slate.com/id/2270169/pagenum/all/#p2
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Cognitive surplus - the context for 99nicu
Francesco Cardona commented on Stefan Johansson's comment on a blog entry in Department of Brilliant IdeasNot quite the same topic but in nature about internet sites like 99nicu - and probably the idea behind the virtual nicu: Should you crowdsource your medical problems? http://www.slate.com/id/2270169/pagenum/all/#p2 Interesting especially the part of patients starting their own little informal drug trial.
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3rd congress of the European Academy of Paediatric Societies
Anyone going to be in Copenhagen besides myself? Anyone taking part in the Pre-congress courses?
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EMBRACE
Francesco Cardona replied to Francesco Cardona's post in a topic in Respiratory Support & MonitoringThat's where I came across the company ;-)
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EMBRACE
While surfing the net I came across this product from a non-profit organization. Anyone have experience with it? http://embraceglobal.org/
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Changing catecholamine infusions - blood pressure drops unavoidable?
We are having an ongoing discussion on our ward about blood pressure drops when changing catecholamine infusions (dopamine, adrenaline..). We often observe that even if new infusions are slowly started while slowly discontinuing the old infusion (over a couple of hours) we encounter drops in blood pressure every so often. Some argue that it is best to just quickly exchanging the syringe is just as effectful in mainting adequate pressure. What are your experiences with that? how do you deal with this issue?
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99nicu + Facebook = true (soon)
Francesco Cardona commented on Stefan Johansson's comment on a blog entry in Department of Brilliant IdeasI cant wait!
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omega 3 in Total Parenteral Nutrtion
Might be an interesting poll to see who uses alternatives to soy based lipid emulsions: omegaven, clinoleic etc.
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Author of book chapter. For free. But that's ok.
Francesco Cardona commented on Stefan Johansson's comment on a blog entry in Department of Brilliant IdeasI am very interested - I am currently enrolled as a distance learner for a Masters degree in Epidemiology.
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Lumber Puncture in early onset sepsis
Could you quote the article you base your numbers on? We - admittingly - rarely perform a lumbar puncture at our ward and I am interested to read up on the available data.
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PICC line
1) We use up to 33% Dextrose (it is the recommendation of the company) and will lower % if the PICC line lies in a peripheral vein to 15% (evidence?). 2) We keep them about 4 weeks and change them after that - sort of a trade off as every day increases the risk of an infection (read this 3) This article doesnt quite answer your question, but might give a you a basic idea of the problem.
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omega 3 in Total Parenteral Nutrtion
I agree with Omer. Before blaming long-time parenteral nutrition I would try to find out if there is any underlying disease responsible for liver failure. Are there any anatomical intestinal or hepatic problems? - Do ultrasound of the liver (-> you definitely want to exclude biliary atresia), try barium enemas and contrast studies to see if intestines are patent Is there an underlying metabolic disease? - Do workup for aminoacidopathies, organic acidopathies, metabolic screen, carnitine pathway Infectious screen? - bacterial, fungal or viral Any medications you are giving that may cause liver failure? if all is negative look for more severe diseases (admittingly the list is endless..) Ascites would make me worried in any case.. Gastroenterology consult is definitely indicated If you still cant figure it out - I would suggest explorative laparotomy
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omega 3 in Total Parenteral Nutrtion
Regarding your first question on omega3: I guess the scientific basis for use is amongst others this article by Gupa et al. http://www.ncbi.nlm.nih.gov/pubmed/18310188 There are a couple of ongoing trials in neonatal and pediatric patients and preliminary data look very promising http://www.clinicaltrials.gov/ct2/results?term=omegaven Another option being contemplated is clinoleic based on olive emulsion which seems to be beneficial as well. If I may make a bold prediction I believe soy-based emulsions will be almost gone within the next 10-15 years. I would say the way to go is to join big randomized trials and see if the short term promises can be upheld in good large trials.