Dr Ashish Jain

We have done the supplementation with 3 % Nacl , and works well . WE mix n EBM and give. Perceiving that this would not taste good we prefer to give 4 hrly instead of 6 hrly . Would be interested to know , what s the avg time experience for the correction . (Usually it takes between 1 to 3 weeks ,,,,,is t the same for others ) Also, what is the wait time period on which the dose is increased ( 1 day or upto 72 hrs)

Dear Satyan and Akash , I still would have serious doubts in the fact and the possibility of a ventilated baby with Flows 8L and the tidal Volume less than 15 ml , generating the aerosols to stay undedicated and contaminate the environment to the level of concern . May be with HFO in some vent that use >30L flows this may be a issue . Also , as you can see the filters also need a flow of 30L/Min to be optimally functioning , or it is upto 30L is not clear. Better would be to attach the exhalation port with some ...connector to underwater seal with Sodium Hypochlorite ...just a thought Regards

Dear Satyan and Mike Sukumar , What decides the separation and care of the Neonate in the Neonatal Unit would be in 2 situations (1) If the baby is unwell / or the (2) Mother is unwell . In all other situations irrespective of the COVID ( Suspect or confined) status of the other , the baby may be roomed in with the mother 6 feet apart and cared by a NON-Covid Attender who can also feed EBM / or the Mother may feed with recommended drops;let and Contact precautions . As far as the baby who comes to Neonatal unit for his sickness , on admissions all the neonates will be suspect ( irrespective if they are born to COVID positive or Suspect Mother , so they are cared in the suspect area . They only move away from this area to Positive area when the results of neonates are positive and mother is positive ( that again is a rarity) , hence positive / suspect not possible at admission. As the Neonate other wise not on Vent/ CPAP do not generate the aerosol / the Incubator makes no sense amnd can be cared as other babies are cared . Only the hoods of various seizes can be used for aerosol generating procedures egg, Intubation / suction etc Some of these are prepared indigenously ( attached Photographs)

EOS : Early onset Sepsis

The PCT as an Acute phase reactant raises far early than CRP ( within 24 hrs) , but may be after 6-8 hrs . Moreover, the levels have less variability with the regard to the birth weight and gestation , with some studies also confirming its role in prognosis when done serially ( See Neopins) . Hence , this may be better than CRP for the EOS obviously. For now , a negative PCT that persists has a strong NPV and the antibiotics may be stopped /May see the Neopin trial and the Commentary. But remember to look at the nomograms at different age / rather than use only one value

Thanks quite Helpful

Dear Akash I wonder if aerosol is a issue in Invasive Neonatal Ventilation . Is there Evidence for it . May be a issue with NIV and the Nebulisation Guide me

looking at Dr Asma Comment , Than why should it develop after 2 weeks ( if its a Neurocutaneous Marker)

This is near to something that was used in the LESS MAS trail . However , after the metaanalysis published by Natarajan et al , even the bolus surfactant shown have similar results . Are other NICU using the Bolus Sf for MAS as of now (especially the atelactic ones)

Piperacillin+Tazo along with Meropenam ... Metro only if perforation

Might as well look for the pre-sacral gas specifically .

what dose

Also consider congenital miliria rubra if the baby has fever and the baby has no other symtamatology of sepsis

one should look at the literature as to how many of the IV cannulas inserted for (non sepsis) indications are really infected. Before one , proposes that the cannulas are always infected. We all keep cannulas (and no antibiotics) at so many occasions. If they are so commonly infected then all babies with IV cannulas shoiuld be getting antibiotics (? prophylactic). yalsaba may have a point.

dear dr jaideep, we have used cloram a couple of times on the babies with no detectable causes of apnea and not controlled even on 2.5 mg/kg/dose 8 hourly of theophyline 9caffiene is not available in india) The problem is that the effect rapidly weans off in 48 hours and than again the same state. we have observed hypertension in the upper range , but did not experience the Gasping syndrome often described

I dont think the tidal volume in a hfov can be measured at the distal end

Please look into the new metanalysis by Dr Girish despande published in lancet, it ais a good one with benefits in NEC , Mortality, Time to attain full feeds, but nmany of the issues still are to be answersed as to the type, dose, frequency of the probiotic to be used.

What is the neonatl reanimation program ?

Have you looked for the causes for fault positive causes for the investigation