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This is a matter of prudential judgement. Of course these lines should come out, when they are no longer needed. The sooner the better but this varies with the clinical condicion of the baby, gestacional age, feasability of placing a PICC etc. One issue of UVC lines is that they tend to migrate, so close follow up specially with ultrasound is necessary. Thank you for your comments

Thank you Mark for the interesting paper. We also see migration of UVC's is common. specially inward migration. Since many babies are on NCPAP, I don't know if the expected increase in the abdominal pressure, could have something to do with this. It is necessary to check the tip of the catheter periodically, preferably by ultrasound. How many days you keep the UVC in place? greetings. I added another paper migration uvc.pdf

another point of personal interest is highlighted by Bernhard: the frequent of rectal enemas in these babies. Are there any data to support this practice? Thank you

We all are aware ,that babies with severe IUGR have a higher risk of NEC, but I think,according to our experience,that this is probably a different type of NEC with different epidemiology and pathophysiology. for example,the onset of the disease tends to be very early, when the baby is NPO or in minimal enteral feedings. I have the impression enteral nutrition does not play a major role in these cases,as in "classical" NEC. we do not have a special protocol for these babies. in the studies of slow vs fast feeds advancements, babies with severe IUGR are frequently included. there is a single study that I remember where they compare IUGR infants with a control group, with the same feeding protocol. the incidence of nec was not different. Greetings

Is there any evidence that we should not use less than o.45% saline? we use 0.22% in very small babies during the first days of life