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 ?

Namaste Netters Do you have different or modified INSURE protocols different from what is published by Bohlin et al 2007 or by Dani et al 2004 The questions I would like to ask are What are the indications? Do you use any pre-medication? Fraction of volume of surfactant delivered? Post medications for reversal? How long do you bag after administration of each fraction? How long do you bag after administering the complete dose before reinstituting nCPAP How do you control pressures during administration

Just to add - If we ventilate on Pressure Control modes (with AC or SIMV) to maintain normal gases one needs lower PIPs but the moment one switches over to volume guarantee the PIP goes higher. So are you actually causing more barotrauma (higher PIP) and more volutrauma (higher tidal volume) in the VG mode then in the Pressure control modes. So is volume targetting causing more harm or should we target at lwer tidal volumes. This has been my experience with the Draegger Babylog 8000+ for the past 5 years. Would love to have know your experiences and opinions

We use ICE protocols

Is there a study anyone knows which has conclusively proven that the incidence of complications is higher with UVC as compared to PICC. If not then why are we in a hurry to remove the UVC. IF you use an UVC then what is the longest duration would you keep it.

You are welcome

We have a very simple way of doing it. No calculations or formulas required The basic strengths of Dextrose available in India are 5%, 10% and 25%. We add EQUAL quantities of 5% + 10% to get a strength of 7.5% Dextrose 25% + Distilled water to get a strength of 12.5 % Dextrose 5% + 25% to get a strength of 15 % Dextrose 10% + 25% to get a strenght of 17.5% Dextrose Its only for 20% that we use 25% Dextose and Distilled water in a ratio of 4:1

We usually withdraw 1 ml from an arterial line and return it after the sampling. Sampling is done from the UVC only if there is no arterial line available in which case we are a little more generous and would withdraw 1.5ml. But all presampling aspirates are returned followed by a flush of 0.5ml to 1ml of NS

We place it and aspirate. If secretions are aspirated it is assumed to be in the stomach. No auscultation or litmus testing for us

I have seen leukemoid reactions 4 times in the past 20 years in non-Trisomy 21 babies. TLC > 50k. DLC Polys > 75-80. On three occasions it was gram negative septicemia. In one infant I remember, the counts were 20k in the morning and rose to 45k after 6 hours. In another active baby the count went on increasing over a couple of days (despite being on antibiotics) and eventually the blood culture grew Gm negative bacilli (Can't remember the bug). Only one child had unexplained high counts which settled down over a period of one month

It is not ROP and BPD in full term infants which has led to the recent recommendations to start resuscitation in Room Air but damage to neurons caused by Free Oxygen radicals