roserporta

Hi everybody. Which drugs/ doses/ rotation of sedatives do you use in extremely preterm infants on prolonged mechanical ventilation. We commonly use non-pharmacological strategies, fentanyl and dexmedetomidine, but after 1-2 weeks, they trend to tolerate them and need a progressive increase... We're managing now a 24weeker on HFOV wiht a severe pulmonary emphysema (after RDS and pulmonary hemorrhage on firts days), The weaning is not possible, and she is needing high doses of fentanyl and dexmedetomidine + extra bolus of fentanyl. Would anybody use benzodiacepines? Or rotate to morphine sulfate?

Hello, in Spain, www.e-lactancia.org is the most used

Hi, NO, I wouldn't exchange. Direct bilirrubin is not neurotoxic. I would focus on an urgent work up for cholestasis is needed.

Yes ! sounds great! Vienna would have been my first 99nicu meetup attended. So I'm in the mood for a 2022 meeting in any european city.

What about Clamp -> LUNG ULTRASOUND --> PULL?? As neonatologists got trainned in performing point of care LUS to abandon the practice of X-Rays is a reality. I

We're stopping at 36-48 hours, but trying to move for shorter period in those babies with low suspiction, with difficulties to obtain a new iv access... I'm firmly convinced that 24-36 hours is the best approach

We screen all the under 1500g on the first days.

Great!, Thanks to the Topic Champions. Just a suggestion to be added: the first neonatal described in Spain: postpartum trasmission, 1st RT-PCR test negative on day 7th in asymptomatic phase, turned positive on day 9th. https://www.analesdepediatria.org/es-pdf-S1695403320301302. So not rely on a single negative test in high-risk newborns under investigation! Best wishes to everybody. Keep safe and strong minded Roser Porta Hospital Dexeus Barcelona, Spain 1stcaseNeonatalnfectionSpain.pdf

Of course, the only possible decision. It's a pity but it's necessary. Let's meet in 2021

Satyen75: we've also recently encountered high 1-25 colecalciferol (D-Vitamin) levels i a former 26 weeker now being discharged with home oxygen therapy. No signs of permaturity rickets at present, but he needed extra phosphate 1 month ago. Could they be explained by a peripheral resistance to D3 Vitamin?

We've been using remyfentanil previous to LISA, but we've experienced some undesirable side effects (apnea) needing naloxone to revert. Previously we used small doses of propofol, but it has been abandoned due to the concerns about its neurotoxicity...This was the last topic of discussion in the last session of Catalan Neonatal Studies Group...a lot of variability in practice, fears, lack of evidence and safety data... What about bolus of dexmedetomidine? Seems safe but still few studies..

As 100 FiO2 is no longer recommended to start bag and mask ventilation in neonates, it seems not reasonable to use corrugated tubes attached to the ambu to increase FiO2. I make myself the same question that you. A well known colleague currently working in Melbourne conducted an interesting study about this topic. You can read the paper : Arch Dis Child Fetal Neonat ed 2010;95(5): 315-19. I can send the full text to you if you have not free access to it. Roser Porta. Barcelona. Spain

And also: - the New England Journal of Medicine. Some of the most interesting randomized controlled studies are published here. -The Cochrane colaboration, Neonatal Group, Interesting EBM look about most frequent interventions used in neonatology.