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amgraca

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  • Content Count

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    Portugal

amgraca last won the day on October 10 2016

amgraca had the most liked content!

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About amgraca

  • Rank
    Member
  • Birthday 01/14/1974

Profile Information

  • First name
    Andre
  • Last name
    Graca
  • Gender
    Male
  • Occupation
    Consultant Neonatologist
  • Affiliation
    NICU - Hospital Santa Maria
  • Location
    Lisboa, Portugal
  • Interests
    Neonatal neurology

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  1. Dose & administration Lidocaine should be administered intravenously and can be diluted in dextrose and normal saline solutions. Dose per kg varies according to the duration after the first maintenance dose, and depends on the body temperature when administered: Loading dose – 2 mg/kg over 10 minutes Maintenance dose for normothermic infants: The loading dose is followed by 6 mg/kg/hour over 4 hours, 4 mg/kg/hour over 12 hours, and 2 mg/kg/hour over 12 hours. Hypothermic infants: The loading dose is followed by 7 mg/kg/hour over 3.5 hours, 3.5 mg/kg/hour over 12 h
  2. PHVD tratment, now that ELVIS trial ended recrutiment. As happened with cooling, could it be acceptable that participating units could assume earlier treatment as a better treatment. I suggest to invite someone from the Netherlands with experience in "early tratment" to speak on this. Transport for hypothermia - passive vs. controlled. Most countries did not implement controlled devices on transport. Should they change their attitude? What is the evidence on this? Cooling babies with grade 1 HIE - despite no evidence on this, many units cool babies with evidence of asphyxia but mild HI
  3. aEEG is much simpler but it requires some formal training. Besides the excellent tools provided by Prof Azzopardi at his site, I think Prof. Thoresen at Bristol are providing teaching on aEEG and hypothermia regularly. I would say that it required at least one year of training of our staff to have absolutely reliable aEEG interpretation by our medical team. As this was more than 5 years ago it became easier to implement cooling according to the TOBY protocol. Concerning the therapeutic window I would say that we should stick to less than 6 hours until a neuroprotective temperature is rea
  4. Those moderate cases are sometimes difficult to decide clinically in terms of B criteria and that is the reason why we still use the aEEG criteria as was done during the TOBY trial. As most our patients are outborn, we recommend maintaining "passive" hypothermia (34-35ºC) during transport, and on arrival we monitor aEEG for a while. If it is normal voltage (alNaqeeb criteria) and we see no seizures we do not cool the baby. If aEEG is not normal voltage or if there are seizures we will cool the baby for sure. This approach is much more objective than the B criteria, and using it allows us not t
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