nashwa

I will do @Stefan Johansson , but in your opinion , is this case inspissated bile syndrome???

No dysmorphic features, no other organ involved also, neoborn blood screening is normal. My question is , Is it possible that inspissated bile syndrome happened in first 24 hours ??? Unfortunately no direct bilirubin done in first day , only done at 24 hours and it was high . Any suggestions ???

We have term baby mother blood group was O positive , antibody negative. Baby was A positive, antibody test positive . Serum bilirubin at 6 hours was 130 mmol/L .started on intensive phototherapy , but serum bilirubin still high was 160 at 10 hours At 24 hours ,serum bilirubin was 220 but direct was 190 mmol/L. Retic count was only 7%. Liver enzymes 3 fold more Gamma GT was 80 then 110 HB was 15 grams .not much changed over first 3 days. US abdomen showed mud in gall bladder. Is this case cholestatic jaundice from start or may be was indirect then becomes direct ?? Inspissated bile syndrome Especially normal colour if stool. TORCH screen are negative Now baby is 1 month old , still direct hyperbilirubinemia, high liver enzymes, US abdomen is normal gall bladder and bile duct

If preterm baby already given caffeine loading and on maintenance, after 4-5 days want to extubate him , is it enough for him that he already on caffeine maintenance or shall we give him extra dose of caffeine 1-2 hours before extubation to prevent failure of extubation

@Francesco Cardona Can you share full text of this study Sent from my Redmi Note 9 Pro using Tapatalk

Thanks, any other suggestions?? Sent from my Redmi Note 9 Pro using Tapatalk

In case the mother serology unknown, what are you doing in case of extreme premature babies than 1000g?? Are you give HBIg and vaccine to these babies within 12 hr Sent from my Redmi Note 9 Pro using Tapatalk

You are not give Napo4 in TPN ??? Sent from my Redmi Note 9 Pro using Tapatalk We usually start Napo4 1mmol/kg from 2nd day in TPN Sent from my Redmi Note 9 Pro using Tapatalk Sent from my Redmi Note 9 Pro using Tapatalk

Any evidence for that ???? Sent from my Redmi Note 9 Pro using Tapatalk

We usually start by 100ml/kg /d and increase by 20. We are using humidity of 90 %in incubator.this problem usually happens in first 3-5 days Sent from my Redmi Note 9 Pro using Tapatalk

Even we use half NS in flushes arteriaine , still S.Na is high and associates with hyperchloremia, Cl sometimes rise to 120mmol , Na to 155, what else we should use to overcome this problem Sent from my Redmi Note 9 Pro using Tapatalk

In extreme premature babies , we are facing problem of hypernatremia in first days of life because of arterial line flushes even we use sodium 0.45% Sent from my Redmi Note 9 Pro using Tapatalk

Thanks for reply, in SiPAP usually it is 9/6 or 8/5...so it generate only pressure difference of 3, but in NIPPV it should be 20/5. In Medin CNO it only generates 15 /5.. That's mean it generate only pressure difference of 10... That's right

I want to ask if any one use medin CNO machine, NIPPV mode offers high pressure like generated by ventilator NIPPV or only 3 more Peep pressure like BiPAP Sent from my MHA-L29 using Tapatalk

I noticed all extreme preterm babies 23-25weeks usually have a metabolic acidosis in first 72 hrs.. as a practical point any one can share his experience for given Nahco3 even with half correction, Sent from my MHA-L29 using Tapatalk

We are giving fentanyl 4mic/kg and atropine 20mic/kg in elective intubation But I read that remifentanil is ultra short acting and used in INSURE??? any one use it?? Sent from my MHA-L29 using Tapatalk

Erwazny, you are doing INSURE with extubation immediately even in ELBW babies, is it working in babies less than 1000 g. No need for MV for theses babies!!! Sent from my MHA-L29 using Tapatalk

Stefan, yes I mean the recent European guidelines of RDS. It was written that they give surfactant once Fio2 is 30 %or more for all babies. It is different than previous guidelines. Also in recent one, it suggests CPAP for all babies in delivery room for stabilization including Ex preterm. For INSURE technique, I want to ask about who practices extubation immediately after given surfactant?? What is criteria for keeping babies for some time on MV?? Sent from my MHA-L29 using Tapatalk

Any suggestions?? Sent from my MHA-L29 using Tapatalk

Any one follow a recent recommendation of European guidelines for RDS management and practice INSURE technique in ELBW, How much it working?? What is average time taken to extubate babies??, how many doses of surfactant needed?? Sent from my MHA-L29 using Tapatalk

Thanks all for your comment, but still I want to know if you plan to do INSURE technique, are you giving premedication or no, and what is average duration on mechanical ventilator or you extubate immediately regardless the gestational age ?? Sent from my MHA-L29 using Tapatalk

Can I know average duration on ventilator after INSURE?? Does it affect by given suxamethonium?? Sent from my MHA-L29 using Tapatalk

What is dose of fentanyl?? Sent from my MHA-L29 using Tapatalk

You use fentanyl only??? Sent from my MHA-L29 using Tapatalk Which premedication you give??? Sent from my MHA-L29 using Tapatalk

In our unite we routinely give premedication to all elective intubation, but I wondered about given medication before INSURE, is it needed. Because I think it prolong duration on mechanical ventilation. We are not able to wean baby quickly. We give usually atropine, fentanyl and suxammethonium Sent from my MHA-L29 using Tapatalk