Francesco Cardona

We use the WHO Child growth charts standard http://www.who.int/childgrowth/standards/en/

We usually only use it late. Our indication is a combined parameter of hematocrit and respiratory oxygen (FiO2). We use Epoetin beta. I would consider our use of blood transfusions as liberal.

We are revising our guidelines for arterial lines. Currently we add heparin and lidocain to our arterial flush and run it with 0.5ml/h to 1.0ml/h. 

How do you handle intraarterial lines and are you aware of any literature on the subject?

We are having discussions about the hemodynamic effects of HFOV. Do you believe there is a threshold where one has to expect cardiovascular compromise if you turn up MAP on HFOV? How best to counter this? Or would you consider this a contraindication for HFOV?

Very interesting indeed!

We use Infloran (Bifidobacterium bifidum & lactobacillus acidophilus) in our ELBWs

Interesting point Agnieszka. I have heard this argument as well, but do you know of any evidence for this hypothesis?

Still I find it surprising with all the lack of evidence but possibly wide spread use, that no one has come up with a study so far (neither in adults or newborn..)

This is the only study I found (in adults), but I cant see if the study really ever started: http://clinicaltrials.gov/ct2/show/study/NCT01377337

Here is a guideline to prevent procedural pain by Italian Society of Neonatologists: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688676/

or here a more general review on pharmacological options for treatment: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672765/

Hi Urban, do you have some references on the CPAP weaning by pressure?

Antenatal ischemia may sometimes also present as calcifications of basal ganglia, but TORCH, esp. CMV seems the most likely diagnosis.

Hi Leonora,

I have no personal experience with surfactant by Richet. What you want to look at is studies done with the alternative Surfactant (bio-equivalence studies). Only then can you be sure that you will experience the same effect you know from the old surfactant. Often companies selling the new product will be helpful to show you the corresponding studies.

Regards

I also believe it is tricky to identify the baby with moderate HIE. We also like to use the aEEG for additional information beyond neonatal neurologic exam. In general we have become more willing to offer hypothermia to more babies in accordance with the latest trial. In a few cases we have also treated babies beyond the first 6 hours of age, but most of the time we would have the babies at our ward early enough to initiate treatment for babies born outborn.

Interesting point. There is no explanation nor citation though in the recommendation.

Here is what I found so far on the subject:

http://bjo.bmj.com/content/86/10/1127.short

Of the eligible infants surviving 28 days, 276 (91.7%) of 301 infants with birth weights ≤1500 g and 162 (52.3%) of 310 infants with birth weights between 1501 and 2500 g were screened for ROP. 10 (3.9%) of the 310 infants with larger birth weights developed stage 1 or 2 ROP. Two (0.6%) of the 310 infants with larger birth weights developed stage 3 ROP. These two infants progressed to threshold ROP and required treatment.

http://www.ncbi.nlm.nih.gov/pubmed/9651410

This probably was before the last recommendation was published, arguing that no cases of severe ROP would be missed if cut-off for gestational age or birth weight would be lowered

http://www.ncbi.nlm.nih.gov/pubmed/23644237

Conclusion: The majority of patients with BW greater than 1500 g developed mild ROP. However, advanced ROP with poor visual outcome was also encountered in some patients.

I found this article in "Neonatology Today" helpful:

http://www.neonatologytoday.net/newsletters/nt-apr12.pdf

It has been written by Howard Stein who has published a few papers on the subject as well!

Hi Ommyar,

In this study by Cobb et al. they found that if babies had >40% of their feedings as residuals, risk for NEC was higher. http://pediatrics.aappublications.org/content/113/1/50.abstract

In another paper (I cant find the citation..) the authors found that only residuals that were green/bilous had any impact on the clinical situation of a baby.

You might find some useful information on these sites:

Useful websites for further information include:

Clinical Quality Indicators - http://www.ic.nhs.uk/cqi

Agency for Healthcare Research and Quality - http://www.qualityindicators.ahrq.gov/

Care Quality Commission - http://www.cqc.org.uk/

Health Care Commission – http://www.healthcarecommission.org.uk/

International Council of Nurses - http://www.icn.ch/

From our facebook page, Spalchen Sponbo asks: [h=5]What are the indicators to check the quality of of neonatal care in a NICU ?[/h]

We always disinfect before and after use with topical disinfectants.

http://www.cdc.gov/hicpac/Disinfection_Sterilization/17_00Recommendations.html (I would say 4.b applies in this case)

As mentioned in the CDC recommendation it is unclear if this is sufficient if stained with blood or multi-resistant germs.

Do you mean 17mg/dl of total calcium? That corresponds to about 4.25mmol/l in SI units. Do you have any indication on the cause of hypercalcemia? How is the babies kidney function? Is calcium excretion in urine high or low? Any clinical symptoms (vomiting, polyuria or dehydration, irritability?

We rarely see hypercalcemia in our neonates, so I have no experience about calcitonin. I remember using Etidronate once.

I wish everyone a great 2013 as well!

Anyone going this year?

http://www.hottopics.org/

Our new poll for November is out. We are curious about your answers!

Also check out the editorial article (here)

Evacuation was necessary from NYU neonatal unit during "Sandy"

Interesting post:

http://runningahospital.blogspot.co.at/2012/10/evacuation-practice-can-help.html

Thanks Georg for the information. I added your conference in our calendar as well.

Can you verify the contact email address?

We use Sildenafil as well in selected patients. I would be curious to know if you make a difference if the child is premature or not.