satyen75

A very interesting. article..was there any comparison of mortality as outcome.

done.

When a baby has gross edema and skin is extremely tense and breaking at many points and making many points vulnerable to pressure necrosis, what is the best way to care for the skin in these circumstances ? Kindly send some references also. I will also appreciate if some skin care guidelines of Neonate are also shared .

missed it. any recordings ?

We also are not doing routine marker studies in central line. If there is persistent infections especially candida or GNB we do send a tip culture while replacing the central line .

Nice thought provoking question and what we follow is till the baby is a neonate ( not completed 44 wks ) we follow the neonatal 3:! ratio only. However if the baby needs prolonged ventilation and chest compression and especially for babies who are more than 28 days old even in preemies we switch to 15:2 in case the 3:! is failing.

Hi Flavio. We are not doing routine evaluation for all babies but if there is breastfeeding and latch problems then that baby is evaluated by a pediatrician only for the tongue tie. Very rarely frenulotomy is advised if it is very sever and that too is done by Pediatric Surgeon. Not sure what are the benefits of this . We do not tend to do the procedure as early as 48 hours. Regards Dr Satyen K Hemrajani Neonatologist, Jaipur, Rajasthan, INDIA

hi mark. Nice paper. Can u share the link to see this paper.

thanks.

When placenta is delivered then also the blood in placenta can be transferred into the babies so it should be continued. Although not recommended. the only medicolegal issue can be if the baby was needing resuscitation and DCC was continued so always see and document that in the notes.

done and all the best.

Hi Akash, Just learnt that there are some breathing system filters that can be applied on the expiratory limb. However, they are off label in neonates, they are for single day use only and it adversely affects the compliance and resistance of the circuit and increases dead space and can adversely effect the ventilation and the baby also. So rather than thnking about contamination of the enviornment we must save our babies and the lifes of life supporting system i.e. ventilators. So no clear solution yet. Regards Dr Satyen

WIll have to learn sweedish to go through that . That seems more simple than managing COVID 19 in neonates 😃

Hi Kindly see the page no 6 of the article under subheading of Isolation . It is mentioned that suspected or confirmed cases are suggested to be kept in Incubator. I have highlighted this for you in the attached article. atm-08-03-47.pdf

Hi , The chinese expert group has given a consensus statement on Perinatal and Neonatal management for prevention and control of 2019 nCOV infection in Feb 2020 in Annals of Translational Medi Here is the link to the said article. http://atm.amegroups.com/post/view/chinese-expert-consensus-on-the-perinatal-and-neonatal-management-for-the-prevention-and-control-of-the-2019-novel-coronavirus-infection-first-edition. Regards Dr Satyen Jaipur, Rajasthan, India

The table is really helpful but what exactly do we mean by paucisymptomatic mother is not defined very well. Also, the drugs that are being used will not have much data on breastfeeding as some are antiretroviral drugs where the breast feeding is already not promoted in the western world . Very dynamic topic on research would be to look at the drug levels of these drugs in breast milk of mothers being treated with these drugs.

Hi Akash, SImple solution would be try and keep the babies in negative pressure isolation rooms and full PPE for the staff taking care of these babies. IF negative pressure is not avaialable then exhaust fans may help in removing these aerosols from the nicu. Cheers .

thanks that is very helpful in this time.

thanks but what is the role of alternate day azithromycin. The TR jet is of 35 mm of Hg ( 38 weeks of Corrected gestation) and the paed cardiologist say there is no pulmonary hypertension . What will be your take : to give sildenafil or not?

Nice summary . Thanks stefan for sharing.Any new medication or strategy for BPD management as we are stuck with a 25 weeker baby now almost 38 weeks corrected gestation age with severe BPD , ROP , Osteopenia/metabolic bone disease of prematurity. Strangely this baby has a very high VITAMIN D Levels. We are providing inhaled furosemide, budecort, vitamin A ( oral) , Caffeine, hicalorie formula ( 150 Kcal/day) . What is the role of tracheostomy in such cases? Suggestions are welcome.

Which neurological exam is currently folllowed by forum members for babies examination before disharge and why ? Have seen dubowitz examination and feel that will be most acurate.Kindly share your thoughts.

Yes , I do feel that is the case. Maybe the anatomy is also slightly malformed and it will need more pathological details .

Yes, adhesion happen leading to second or third surgery due to the obstruction they produce. So i want to know what is the reason in some baby they are abundant and recurrent whereas in some it is negligible. ? If we know this may be some method can be looked for reducing the recurrence and chances of second surgery due to adhesions.

I have been intrigued by 2 cases of adhesions , One in a patient operated for ileal atresia and the other with NEC. What is the pathology behind this? Does the type of intestinal surgery or any defect ( vascular , chemical , duration of surgery) affect occurence of adhesions? Is there any way to protect it during surgery ? And any ways to conservatively manage and till when surgery can be delayed? Kindly post your opinions and evidence for this.

Yes, It is not pathognomic of NEC . A holisitic picture if it fits along with Xray should be considered to label NEC.