Helmut

we did two prospective studies with heparin for other raisons but none had a proven heparin induced thrombocytopenia

Thanks for your support, Helmut

Dear colleagues, with a short survey we would like to provide a world-wide overview of the procedures within the Second Golden Hour of transport from the delivery room to the NICU. While a lot of research has brought better understanding of the immediate postnatal period during the so called First Golden Hour of Life the time following with transport to and admission onto the NICU is still a black box. In a local study we showed that procedures during this time period are done contrary to current understanding of neonatal physiology and with relevant interpersonal variation (BMJ Ped 4:e000602, https://doi.org/10.1136/bmjpo-2019-000602). To improve our understanding and care for this time of transport to and admission onto the NICU we hereby kindly request neonatologists to complete this survey which should take less than 15 minutes. The results would allow to generate relevant questions for future prospective trials. The link to the survey is: https://www.umfrageonline.com/s/175a5bb The QR code for access to the survey is shown below. Please contact helmut.kuester@med.uni-goettingen.de in case of any questions. We greatly appreciate your time and response. Thank you! All the best Helmut Küster, MD

Considering hygiene you should not do it, but I do it 1. if I need a blood culture and the line may be responsible for the infection, 2. if I need blood and the PICC line is about to be withdrawn, 3. in emergencies. The technique is to withdraw with a 1 ml syringe using a constantly changing negative pressure of 0,5 ml maximum. Stop if the blood column does not move constantly (and slowly) and immediately flush with a prepared saline syringe. It works 90% of the time. Erythrocytes are a lot smaller (7,5µm) than the inner diameter of a PICC line (28G = 1Fr has 0,17mm = 170µm). A study has shown that you can give blood via a PICC line without hemloysis (Pediatr Crit Care Med. 2004 Jan;5(1):69-74. PMID: 14697112). See also nice experiments in https://chartermedical.com/wp-content/uploads/2015/09/TexasChildrensPDF.pdf. There it is stated that you should not do it with platelets because of clotting. In an emergency we gave 80 ml FFP via 28G PICC line with no problems. It needs a pump with pressure cut of set to max - you can not do it by hand.