Saidy

Hi Netter, I had couple of patients (27 and 29 weekers) who have had grade III IVH in the first week of life, they had roller coaster course, where they had severe RDS, ventilated, received surfactant therapy, and clinically septic (septic shock). They have developed BPD (moderate - severe) and healthcare associated BSI down the road. we were following IVH-III with serial cranial ultrasound, and it was showing evidence of progressive ventricular dilatation till the stage that pediatric neurosurgeon was involved. At 7- 8 weeks of PMA everything disappeared totally. How frequent did you witnessed such a scenario? Regards

So head cooling was offered after 6 hours of age and apparently with favorable outcome. How frequent did our netters offer head cooling beyond 6 hours of age and what was the outcome?

I feel sorry for those who did not full-fill the cooling criteria initially, however later on they developed repeated seizures. My observations that most of them have abnormal neurological exam. So can we initiate head cooling based on clinical assessment and we can stop at any stage if we feel that we are not dealing with HIE, i.e. give the patient the benefit of doubt.

Hi Netters, I would like to explore the head cooling criteria. the criteria of the three largiest clinical trial of hypothermia are basically evidence of fetal acidemia, low apgar scores, the need for active resuscitation and clinical signs of encephalopathy +/- CFM monitoring. Although we are following these criteria but we may miss cases of moderate HIE. for example there is an evidence of perinatal sentinle event, cord pH 7.0 and BE -12, Apgar scores 6 & 8 @ 1 and 5 minutes. no active resuscitation required but at 10 hours of age the baby developed clinical seizure ( we missed the theraputic window for head cooling) and the work up R/O the common causes of seizurs. Does this kind of senario happen in your unit? what do you do to avoid such a problem?

we had similar problem and they responded well to co-trimoxazole therapy.

What tidal volume does these settings generate?

Firstly, I will re-calibrate my ABP transducer, secondly I will make sure that the baby is well perfused, well hydrated and not acidotic with normal serum lactate level and maintaining adequate urine out put.

we do inguinal hernia repair for preemies before discharge, and our ped. surgeons would like the infant's weight 2 kg or more before the repair, and usually the surgery done under GA.