kpsanghvi

How long should one wait for a baby to come off nasal prong O2 post 36 weeks CGA

We dont. Very interesting observation. But can a newborn be sensitized by the Rh antigen of the mother. I dont think so.

Milrinone is a vasodilator. Useful in PPHN. If 2-D Echo is not available then it will be dangerous to use it in hypotension. Dopamine or epinephrine is better bet. Now epinephrine is increasingly preferred to Dopamine

Most of the time this prolonged PT/PTT is due to sepsis induced DIC. I see no harm in repeating a dose in addition to the FFP. But giving it for 3 days is more convention then evidence

Has anyone used ketamine. I have never used it but the thought keeps on coming to my mind and would it be a better alternative

Lactose from milk is cleared first pass by the liver after absorption from the intestines and converted to fats. Therefore it does not stimulate insulin secretion hence it does not cause rebound hypoglycaemia unlike sugar or dextrose solutions. Therefore milk should be the preferred enteral feed esp in IDMs

Thanks everyone for the reply. I would like a question again. Is there any reference or study to tell us that " For how long can we store breast milk after fortification". Yes 'nursignicurn' from US has replied that they store for 24 hours and Neon8al from UK has replied they don't store. I would like to know the policy of other units. Thanks once again

Namaste What are your policies regarding feeding of the preterm of newborns specifically pertaining the following questions. When to start feeds (LBW/VLBW/ELBW) ? What should be the initial volume of feeds and volume of increment ? What to feed (EBM/Donor milk/Preterm formula) ? When to add HMF ? How long do you store the milk after adding HMF ? Where do you store it? How do you define feed intolerance and how do you tackle it ? Any other information on feeding of the preterm newborn Would be obliged if you could provide references ? You can send me an answer to my directly on kpsanghvi@hotmail.com

Nebulized surfactant is still experimental so as of today the only recommended route of administering surfactant is endotracheally. May be in a few years time we will have nebulized surfactant. IF there are no ventilators you can use INSURE and even if surfactant is not available just use plain CPAP and you will be able to save many preterm newborns

Would you call prophylactic surfactant given in delivery room with CPAP as INSURE. My understanding of the term INSURE is that it is used only in established RDS

Thanks once again Stefan

Thanks Stefan for the information. A few more queries - Have you had any cases of respiratory depression after using fentanyl and pentothal and if yes have do you use naloxone to reverse it or put the infant on the ventilator? Also what doses of Fentanyl and Pentothal do you use? Have you ever tried using only Fentanyl? With the advent of MIST ( Dargaville 2011) do you think there will be any need for sedation analgesia before administering surfactant ?