Francesco Cardona

Looking good!

We also have liberal use of CPAP after birth, so if in doubt about respiratory effort of baby we support (with Perivent). No sustained inflations either in this age group.

We use Accu-Chek as well, sampling is done by heel prick. Low values (<35mg/dl) are sometimes off, but always in the same ballpark.

Hi lmedina81,

We have used remifentanil in other indications in neonates with mixed results. Thorax rigidity seems to be a bigger issue compared with fentanyl.

Compare:

http://www.ncbi.nlm.nih.gov/pubmed/20231228

furthermore, at the last EAPS conference in Barcelona there was a Dutch group reporting their experience with remifentanil (I dont recall where in the NL) and they reported high incidence (up to 50%) of thorax rigidity as well.

Comment from our Facebook page

link

All Things Neonatal are you sure these are double PDAs and not MAPCAs? Would need to rule out the presence of other MAPCAs before deciding on whether prostin needs to be continued or not.

I am interested.

francesco.cardona@gmail.com

How do you deal with acute bleeding on your ward? e.g. gastric bleeding or pulmonary hemorrhage?

Have any of you ever used tranexamic acid? At what dose? I know our anesthesiologists use it every now and then?

We give max 3 doses of surfactant. The third dose would only be given if we had seen an effect with the second dose and oxygen levels, ventilator settings were creeping up again. Happens very rarely though

We do not have any guidelines for that though.

Interesting idea. We have on individual occasions given surfactant to our patients, mostly without any significant respiratory improvement.

Surfactant levels seem to be reduced in pneumonia http://www.atsjournals.org/doi/abs/10.1164/ajrccm.153.1.8542113#.U-I7bGNBl14

There seems to be some recent research on this issue though:

in mice: http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.1996.tb05580.x/abstract

possibly it is another phospholipid that is disrupting the function of surfactant during pneumonia: http://www.ncbi.nlm.nih.gov/pubmed/?term=20852622

Hi Robyn, I talked to our representative and got this link for training material:

http://www.draeger.net/local/products/babylog_vn500_trainer_multi/flashpage.htm?lang=en#id=A1100

Maybe you will find this helpful.

Hi Robyn, have you contacted your Drager representative? they are mostly more than willing to give you any education material they have which is often quite helpful.

Unfortunately I cant help with you the website, as registration from Austria is not supported either!

Unfortunately this study (http://clinicaltrials.gov/ct2/show/NCT01088997?term=milrinone+neonates&rank=1) has been terminated prematurely.

Would have been interesting to find out more about the drugs effects in neonates.

Hi Stefan,

when I started training we used morphine as well, but we have changed to fentanyl as well. We combine it with vecuronium. We do not give any additional sedative or atropine.

I do not recall any incidences of laryngospasm from fentanyl, but stiffening of the chest does occur maybe in 10% of cases.

Our prefered dose is 5mcg/kg - and we only rarely have to give an additional dose. We inject it over half a minute. What we do see is hypotension sometimes a few hours after intubation that we believe is also a side-effect from giving fentanyl.

I believe if it is just glucose you would like to measure you are best of with the available kits also used in diabetics.

If you are interested in all the other stuff - then you probably have to resort to conventional microdialysis.

Try this link:

http://www.academyofneonatalnursing.org/WritingCenter/EBPforSuctioningIntubatedNeonate.pdf

link seems to be broken now. i was not able to read the article

Just returning from hottopics. There was a good session on global neonatology. The helping-babies-breathe initiative was described in some detail. Seems like they have really made strides in helping that neonates in middle and low income countries receive better perinatal care.

For more information look up:

http://www.helpingbabiesbreathe.org/

For live updates - follow me on @pubneo

I will try to blog a review of the conference here later ;-)

Are there any papers on actual costs for either CPAP or HFNC?

You might want to read this article published in the NEJM this year:

http://www.nejm.org/doi/full/10.1056/NEJMoa1300071

they used HFNC right after extubation and showed that it was equally effective as CPAP to keep infants from being reintubated.

From the methods section:

 

 

Infants in the nasal-cannulae group were treated with the Optiflow device, which included the MR850 humidifier and binasal infant cannulae (Fisher & Paykel Healthcare). Infants were fitted with prongs that maintained a leak at the nose, with the aim of occluding approximately half the nares. The device includes a pressure-relief valve that limits circuit pressure to 45 cm of water. The starting flow rate was based on the size of the prongs used, with 5 liters per minute for “premature” or “neonatal” prongs or 6 liters per minute for “infant,” “intermediate infant,” or “pediatric” prongs. Flow rates were altered at the physician's discretion in a stepwise fashion, with mandated limits between 2 liters per minute and the maximum recommended for the prong size: 6 liters per minute for “premature” and “neonatal” prongs, 7 liters per minute for “infant” or “intermediate infant” prongs, and 8 liters per minute for “pediatric” prongs. For infants who were weaned to 2 liters per minute and who had a fraction of inspired oxygen of less than 0.3 for more than 24 hours, treatment with the high-flow nasal cannulae could be stopped, although such cessation of therapy was not mandatory, and earlier cessation was ordered at the discretion of the treating team if the fraction of inspired oxygen was less than 0.3.

Hot Topics are coming up!
 
This year's topics include:

• Genomics
• Oxygen Targets
• Clinical Pearls
• News from the NIH
• Advances in Preterm Nutrition
• "Green Apples & Rotten Apples"
• Results of the TOBY Children Study

Anyone going?

More information:

http://www.hottopics.org/

It would be interesting to see how this poll would be answered today - after the ERC guidelines recommend using 21% now when initiating resuscitation after birth.

Thanks for your answers. Any other arterial flush compositions used?

Another question: I was recently asked how we can return the blood drawn as waste before obtaining samples. Especially for the very preterm this will be quite a big volume of blood withdrawn. We currently return this blood via a venous line. Any thoughts about doing this via an arterial line? I would be concerned about possible clots developing while blood is drawn into the syringe.

Have you heard about this device? 

http://www.odondevice.org/

This could be an interesting device for obstetrics:

http://www.youtube.com/watch?v=fFEFkAnL93A&feature=youtu.be

It is currently being endorsed by WHO who want to study it in ressource poor settings.

http://www.who.int/reproductivehealth/topics/maternal_perinatal/odon_device/en/

Lidocain?

The idea is to reduce arterial spasm.