dr mir

hi sameh sorry as i work in a differrent city far from where this happaned i dont know the details of that specific hospt or nicu,but where i work in the public hospital there is senior and a junior doctor with 2 nurses 5 days a week in the mornings and only one nurse in the evenings and nights for 10 nicu patients along with the out door patients/ emergencies/ referrals from labor room. nurse babby ratio has diurinal and day to day variation ranging from one nurse for 10, to one nurse to 5 patients. baby stealing and baby changing incidnts happen all over the country.have not noticed any rats inside our unit ? but cats do frequent in the gen ward .we dont unnecessaryly help each other, we dont even mind our own buisness too well.in the private sector some centers are better than others,where i work in a private nicu there are 2 to 4 staffing for 8 to 10 patients 2 nurses ,one paramedic one wardboy and a doctor depending who is taking a off and when ,though i hv seen rats outside the building and caught in the traps too. a dr once shared this with me that he over heard the father of premature baby say to the nurse that "sister will you please close the incubator door that cat may not run away with my baby" this happened in tertiary care teaching hospt?!!?

a rat in the holy family hospital in rawalpindi the twin city of pakistan capital climbed up the cot in the nicu and nibbled the face of the baby esp around the face and nose which looks badly wounded.these rats are found all over the country hospitals where they live in the open drainage systems and may undoubtedly feed on human surgical wastes which is not systematicly disposed in most hospitals.they grow to very large sizes and large numbers.govt took action against doctors and midwife.

one of the first things i come on line is to check on 99nicu .today while checking out 24 weeker i saw the small post of congrats by me on >5000 to you,it made me feel very happy and also gave the realisation of what a grate work you are doing and that usu we take it just as an other website while on 99nicu.congrats and thanks is too small.by the way whats the count now

hi this is very important topic .we have just 2to4 ventilators in our city in two different private hospitals .as most pediatricans work in public hospt and there arent any vents we dont attempt intubation because post intubation bagging cant be continued manualy for long,therefore intubation has now almost become out of practice. ido understand that spontaneous breathing can occur followed by extubation.my queston is that under these circumstances what is the role of nebulised surfactant and how is it used exactly in prematures followed by some fom of manual cpap.thanks

thank u for the advice, we dont have any comercially available different types of nasal prongs, we just go along with prongs which fit best to prevent nasal leak,we use simple under water in a bottle or drip with a circuit made of oxygen tubing .any other idea about a device will be helpfull and most important nursing aspects are prevention of leaks, o/g tube left open, n/s nasal drops ,spo2 and resp rate monitoring along with gen nursing care. plz do inform of other sugesstions

we use boluses, very few pts once recieving bicarb ever have a chance ,most dont improve esp critical patients, though we had to use it in a few with renal failure when the results were bettter clinically,

hi we are buying a fennon bubble cpap its going to be the first one in our city. currently we use manual cpap that too after a long disscusion on 99nicu where others were also using the manual cpap. our experience with manual has been good . we just know things theoretically about mechanical cpap ,we use respiratory rate ,resp distress(recessions ,nasal flaring ) spo2 as parameters we dont have abg, fio etc .our efforts are towards making a start.plz do share anything that may help .thanks

thanks

glass is not ideal because the lipids in the milk stick to walls of the container plastic is most commmonly used

congrats

congrats

i think a normal eeg at one month age is the best guide for early withdrawal or seizure free period of first nine months and weaning first one drug then second so on. outoweanig is new to to me and makes a lot of sense thanks stefan

we are using a chart form the book practical neonatal care by lalitha krishnan page 19 it is age and wt based

never had any falls but near falls could happen esp when someone forgets the latch and a hungry baby kicks the door or a baby is left unattended on a table or couch esp left ther for iv or other procedures

hi what abt feeds,any metabolic work up,family history, any deaths and autopsies ,nicu and staff cultures should be done we had a similar situation wth neonatal deaths after burkhelderia cepcia pt, we closed the nicu and took measures

risks groups are quite the same along with others having signs and symptoms kindly inform tha since we do nt have pharmacy or comercially availabla solutions between 10./. and 25./.dextrose, we make dilutions from 25./. dextrose when reqrmnts abv 8mg/kg also because we arent familiar wth central lines plz guide

hi jack u r adressing avery imp topic unfortunetly we have nt reached that levl yet though we live in aearthquake prone and each year thr r sig shocks our evacuation plan mainly consists of running out the buildings with the patients following behind if they can later the beds may be brought outdoors and sifted back in whn the panic decreases .do post the protocols .

hi ithink you dont need to pay. utube has many good videos and are free for download,there are many such videos about other topics also.

the practice to add oil in milk for malnaurished is well known and also milk fortfiers but for premies is questionable caution in these cases is important. question is how many calories per oz is permissible and what source of calories. kindly enlighten

there are no practiced guidlines our hospitals have no written ones basically usu an attempt at cpr is made pts are admitted most decissions are made on emotuonal basis have never seen orders for do not attempt resuscitation.most collegues do understand and agree with the probable outcomesand also there is usu a junior or pg student who needs ti learn about cpr.a pot will be usefull. dear jack please post the preterm outcome table

little information for skin condition can u place apicture may not be cutis aplasia a fungal infection will be easily diag by dermatolgical oppinnion

1ebm,2 donor ,3pre m frmla

i think you should emphesize on the pre and post op management.and when to suspect it .surgery is done to reduce the gut from thorax back to abdomen and to close the diaph defect

here most pts are not on antenatal care therefore exact gestational age is not informed and few pts are AGA. we assess on examination. and admit on clinical status but preterms and SGA are offered admission if space is available.