mkaneta

The PALS vs NRP controversy continues but broadens. 1. When do you transfer an infant in the NICU to the PICU? 2. If the infant stays in your NICU,, at what age do you switch to PALS? 3 months? 6 months? 9 months? 3. Should Neonatologists have to learn both PALS and NRP? 5. ILCOR should put out a statement to stop confusion.

Once the the extremely premature infant is admitted to the NICU, it may be too late to ask the mother to abstain from using marijuana. THC can stay in her system and excreted in breast milk for weeks. We know that using mothers breast milk decreases the incidence and severity of NEC. Mother’s breast milk is not just for nutrition. It decreases the occurance of both NEC and surgical NEC. The later has significant increase in mortality and long term neurologic morbidity. From what I have read, donor milk does not have nearly the same protective effect. Treating or not treating the premie with mother’s breast milk. Until we have more data, what do we do? Are we causing more harm withholding mother’s breast milk for a 26 week premie? Statement from LactMed ”Because breastfeeding can mitigate some of the effects of smoking and little evidence of serious infant harm has been seen, it appears preferable to encourage mothers who use marijuana to continue breastfeeding and reducing or abstaining from marijuana use while minimizing infant exposure to marijuana smoke.”

Regarding Marijuana. The American Academy of Pediatrics states that the use in breast milk from a mother using marijuana is contraindicated. The LacMed state that it is not contraindicated. The American College of OBGyN recommends that mothers stop using marijuana but does not mention stopping mothers from providing breast milk. There is a conflict between the benefits of breast milk in premies and the potential harm. What are your recommendations?

What other chemicals or contaminants are in Probiotics? How do you know? How do you know what is on the label is really in the capsules you giving to the premie? There is no regulation in the US. There must be strict monitoring in the rest of the world for Cochrane's recommendation. Can we are assume that there is no or little downside to Probiotics. I don't think we can answer that question until we can be assured we know what is in capsule, bottle, batch.