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Alexander Rakow

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About Alexander Rakow

  • Rank
    99nicu Ambassador

Profile Information

  • First name
    Alexander
  • Last name
    Rakow
  • Gender
    Male
  • Occupation
    Consultant Neonatologist
  • Affiliation
    Imperial College Health Care NHS Trust at Queen Charlotte´s and St Mary´s Hospital,
  • Location
    London, UK

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  1. Dear Fernando we usually use frequent (up to hourly) saline 0.9% nebulizer in the first place, some advocate hypertonic saline but I have no experiance with that in neonates. In severe cases we have used Acetylcystein (ACC Sandoz®, ACC eco®), Ecomucyl®, Fluimucil®, Mucostop® und Solmucol®) nebulized with good effect. A good physiotherapist is worth a lot in these infants. Make sure you have checked all the rare differential diagnosis for severe hypersecretion like CF, ciliar dysfunction, neuromuscular diseases and congenital airway abnormalities. All the best and merry Christmas Alexander Rakow
  2. No, your bloodgas will Look better, but no effect on outcome, in fact Babys cardiac function might be impaired.
  3. Agree with the above, but you explicitly described your shock situation as caused by a sepsis and in that case you probably would have to consider that clotting is going to be deranged. So FFP and PLT might be necessary but as mentioned, maintenance as usual G5-10%. One other thing is the choice of inotropes. Most established inotropes are Dopamine, Dobutamine and Adrenalin and most of the time in this order. Unfortunately the main reason for initiating these drugs is still low blood pressure which , as we all know, is a very poor predictor for organ perfusion. I would like to bring to your mind that Milrinone can be of great benefit in patients with so called “cold shock”, patients with poor peripheral perfusion and impaired diastolic function. The myocardium is suffering from sepsis as well, and just constricting the periphery in order to have a better blood pressure does not make thing easier for the heart.
  4. For infants below GA of 28 weeks the delivery room temperature should be 26° C at least (ILCOR). Hyperthermia is definitely not good for any child. I have recently been to Vietnam with an average temp inside of about 32-36°C and have just asked that question to one of the Peadiatricians working with Neonatal Care. They have not observed abnormal high core body temperatures in there infants despite high environmental temp. What about doing a little observational study? Just check you infants core temperature. All the best Alexander
  5. Dear Fernando, to be honest, not in neonates. I do have some experience on Simdax in PICU patients mainly above the age of 3-4 years. We kept these patiens on PICU for a few hours, sometimes for a day during the first treatment just to make sure that they would not get too hypotensive, tachycardic or arrythmic. All the patients I remember were pure cardiology patients. Performing ECHO myself, I was always deeply impressed by the effect of Simdax. You could give it a try (depending on the diagnosis) but make sure you have your cardiologist on board. Have you considered Milrinone? All the best Alexander
  6. Excellent presentation, I particularly like the comments on the need for publishing negative data, as it concerns my own research to a great extend.
  7. At our unit, or even the one I previously worked for, the initial treatment would focus on the underlying reason for PPHN, if there is one and the optimization of PH, CO2, O2, and blood pressure. Next step would be the use of NO if available. In addition or in the more chronic phase Sildenafil would come in probably even Illoprost would be tested.
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  12. You can buy this book from Amazon.com. 99nicu is a partner of Amazon and a purchase using the link below, results in a small portion of the order value being paid back to 99nicu. At no extra cost for you. Click here to order this book through Amazon.com!
  13. You can buy this book from Amazon.com. 99nicu is a partner of Amazon and a purchase using the link below, results in a small portion of the order value being paid back to 99nicu. At no extra cost for you. Click here to order this book through Amazon.com!
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