kpsanghvi

Fentanyl + Midaz

Hi All If the Australians and Canadians have stuck their neck out (About starting resuscitation in Room air) why aren' t the Americans doing it. Are there any guidelines from the European countries. I am still not convinced about not doing oropharyngeal suctioning at the perineum based on just 1 study. If at all it saves times after the child has been delivered. Would like your comments

Thanks to all of you We have bought a Babylog 8000 plus. Shall trouble you again if I am in trouble. Regards K P Sanghvi

Hi Stefan Thanks for the reply but What I am interested to know is do you routinely use MCT oils in premies. If I am using a 80kcal formula at 180 -200 ml/kg/day or EBM fortified with HMF it boils down to almost 140-160 kcal/kg/day. 1) Do I further need to boost up the calories by adding MCT ? 2) With MCT I have seen chubbiness in the cheeks. My question is - Is that adipose tissue required ? Regards K P Sanghvi MD Mumbai India

We almost always never use bicarb in neonatal resuscitaion or during normal care unless we document metab acidosis which does not correct even after fluid therapy and if the pH < 7.2 or ABE is > -10.

Till what birthweight/gestatinal age do you extubate to CPAP. Our policy is to extubate to CPAP only if the infant is < 2 kg. When we extubate to CPAP esp the VLBW we use starting pressures of 5-6 and then decrease by 1 cm per day and wean off at CPAP pressures of 3 cm In ELBW it is 1 cm every alternatel day. Of course we keep a check on ABGs and may speed up or delay the weaning accordingly

i have reservations about the ability of a newborn over compensaing metabolic acidosis especially if there is no tachypnea. I would look for metabolic derangements or frusemide use. Sorrry I have entered this discussion toooooo late

Try ruling out a GERD in such infants.

'Sucking out the mouth and nose is not necessary' is different from saying do not do it. From the abstract it is not clear which suction are they talking about. Is it suction on perineum after delivery of head in meconium stained liquor only or not to suction any baby and clear its airway after delivery. As for starting resuscitation in room air is a bold step and contrary to the AAP guidelines.

We generally start with 1ml hour in ELBWs on day 1 and then increase by 1ml/hour/day till we attain 180 ml/kg/day. Never used continous feeds and have not had problems with GER. We aspirate very 6 hours. K P Sanghvi

Hi All I would like to know if you use MCT oils in VLBW infants. If, yes what are your protocols. Personally I am not a big fan of MCT oils and would use it only if I am not achieving enough weight despite EBM feeds of 200 ml/kg/day fortified with HMF and all investigations normal. Hope the New Year brings the best for you Dr K P Sanghvi Neonatologist Mumbai India

Hi Stefan Sponsorship would be the best option. Regards K P Sanghvi

No need unless the infant is vomiting whether there is MSL or not. Regards K P Sanghvi

We are in a process of buying a hybrid ventilator (CMV + HFOV) for our NICU/PICU. We have narrowed our choice to the Draegger 8000 or SLE 5000. The only problem with the Babylog is that its high frequency does not support babies more than 3 kgs where as the SLE 5000 can take children upto 30 kgs. Does anyone has the experience and can advise. Dr K P Sanghvi MD Neonatologist Prince Aly Khan Hospital Mumbai

Dear Dr Nazarkandla PIH does decrease the incidence of RDS but does not guarantee prevention of RDS. I generally ask the OBS to use an additional dose of antihypertensive or insulin as the case may be but I insist inspite of their resistance. K P Sanghvi

Hi Stefan No I could not find out the cause of his hypoalbuminemia. since the infant was thriving welland there was no recurrence I left him alone. I shall repeat the investigations after a month.

Dear Stefan Thanks for the reply. This child was a male child and after albumin transfusions his s-albumin increased to 3 gm%. All edema distress subsided. And was thriving well on breast feeding.

Have a full term newborn (uneventful antenatal period, well nourished mother) LSCS B.Wt 3.3 kg, mild resuscitation required at birth (Bag & Mask) APGAR's 6/10 & 9/10 needing ventilation with 22/6 FiO2 50%. CXR showing a little fluid. 2-D ECHO Color Doppler Normal. No apparent obstructive lesion on direct laryngoscopy. Developed generalized edema on day 3. s-Albumin 2gm% and s-Calcium 5.6 mg% with with normal LFT, normal RFT, No urinary loss of proteins, no ascites or effusions. No sepsis. The child is on full orogastric tube feeds since day 3 of life. Cannot not figure out the cause of the Hypoalbuminemia.

The CDC definition of LOS is > 48 hrs We generally use Vancomycin & Piperacillin + Tazobactum Funny but true but we hardly see any sepsis once the baby is off the ventilator

Hi All I have encountered stiff resistance from obstetricians when it comes to using antenatal steroids in mothers who are 1) preeclamptic or uncontrolled hypertensives because it may push up the BP further and 2) Diabetics it may increase the hyperglycemia Would like to know your views

Thanks for the info. The infants platelet count is now 68,000/mm3

Hi Stefan Thanks for the reply. I have used IV IgG. I shall get back to you once I get the platelet count. (Patient is discharged) The query of starting immunisation is still unanswered.

Hi All I have a newborn with Congenital Rubella Syndrome (IUGR, Cataract, Small ASD, PDA, Thrombocytopenia, Periventricular Calcifications, Sensorineural deafness, Rubella IgM +ve). I would like to know how long does the thrombocytopenia last. How do I treat it? (Platelet transfusions v/s IV IgG). When do I start immunisation?