Schumz

@ali We have recently started using LISA and we had a lot of disussion on what to use as premedication. ...the choices were propofol, fentanyl, morphine etc After much discussion we agreed on Fentanyl! I will have to double check if we give anything else along with it! We have developed a guideline ...which includes which baby, when and how! Only by consultants or under their supervision by senior trainees...Hope that helps.

@bimalc thanks for your reply. Yes we have the facility to do Echo in our unit but in a sick infant I was wonedring if it is of some use when monitoring continuously. I agree with you trend rather than spot check is required. The normal values for neonates only studied in 2 studies 1992 by Skinner and another one in 1980 which quote a range from 4-6 for healthy term infants. Most (49/62)babies studied by Skinner had a congenital heart disease and rest had RDS..it was an interesting read

Guys I need your expertise and knowledge about use of CVP monitoring in a sick neonate... The normal values range in between 4-6 in children (as per the literature...) How much do we rely on this measurement? Are there any normal values in preterm infants or non-immune hydrop babies?

@alexscriven I agree with pooling data ...would look into it !

Thank you all for your comments. I agree @Stefan Johansson regarding babies who have been ventilated we don not extubate either. @ashok we get an MRI in the first week, usually after rewarming is completed.

Thank you ...I thought so and did the right thing!

Guys do you ventilate, SVIA (self ventilating in air) babies just for cooling? If not what strategies do u use for making them comfortable?

Just to let you know baby's comgestion settled on its own ...waiting and watching was a good idea indeed.

Thank you for your comments. @Stefan Johansson and @Francesco Cardona yes he had a probable seizure but no further seizures. CFM for 48 hours all satisfactory. Baby is now extubated and we are normalising his care. I think waiting and watching worked.

Dear all A little bit of brainstorming is needed. We had a term baby deliver SVD. No risk factors for sepsis. Cord around the neck at delivery noted. Baby at birth did not require any resuscitation and was with mum in the postnatal ward. Had a 25 ml feed. Asked to review by the neonatal team due to facial congestion and low temp. Temp was normal on the review but grunting and facial congestion was noted straight away brought to nicu at 8 hours of age due to oxygen requirement. Soon needed ventilating and curosurf. Post ventilation oxygen requirements came down to air. Blood gases were satisfactory. PH>7.25 BE and Lactate WNL. Noted to have abnormal movements at 11 hrs loaded with phenobarbitone and CFM was commenced. No further clinical or subclinical seizures. However the baby's facial congestion is so bad that the face looks purple (as if strangulated) in comparison to the body (which is probably normal colour but looks pale if you look at the face) Bloods including platelets, coagulation and hematocrit are normal. I don't know... could be my perception, it seems that the facial congestion is getting worse. Head scan is normal. No obvious stroke (but limited study). Mild periventricular flare. Do I need to worry and investigate further???? but what ???? I'm thinking could there be a clot in the neck vessels? It might be just secondary to cord around the neck but wanted to share ...am I missing something! Your comments are appreciated.

All of the above as @hamid. Bowel loops very distended. There is no NG tube in this radiograph!

Thank you for your detailed comments. The baby did receive surfactant as part of the normal practice. Oxygen requirement was 26% when I got handed over the baby. As mentioned in the first instance ...I couldn't understand those settings at all and thought maybe I do not know the intricacy of HFOV this may be a strategy. But because I was uncomfortable, I read and found out, mostly what that you guys have mentioned above. This has given me so much clarity... cheers to all the gurus' (You all). Much appreciated.

Absolutely wonderful insight. Many thanks for your comments @Tanyah Very useful, read the article ...some important key take-home messages, many thanks Thank you

In our unit, the nursing staff prepare antibiotics and also attach IV to babies. Pharmacy check dosing, prescription and are responsible for preparing TPN.