sudershan.kumari

thanks for posting videos, they are very good for traiming doctors and interpretation of us thamks sudarshan kumari

my concern with feeding plan are two 1. bottle feeds, i feel bottle has no role in infant feeding, instead spoon, cup , breast feeding directly or paladay feeding are used by us for weaning from tube feeds. if baby is sucking well at brest and has no problem, shold we add formula milk or not when weight gain is not adequate and bay is well

laser is done in nicu itself in our hospital

the programme is good and practical too. as it is not feasible for all to attend the conference, is it possible to download all the lectures after the conference on nicu 99 for benefit of neonatologists who can not make to attend the confernce.

In case seizures do not recur, i withdraw znticonvulsants before hospital discharge, depending on duration of hie and neurological examination.if hie gr2 lasts less than 5 days and neonates are well, i withdraw aed if ultrasond skull and neonatal neurological examination are normal.in case of abnormality in cranial ultrsond or neuro examination, i continye aed for 3 months, get an eeg done if normal aed are tapered. in case of abnormality of neuro examination/mri aed are further continued.

i suggest you go to national institute of nutrition t hyderabad, library there will be helpful as lot of work has been done there

I agree with dr Gopan on csf value,but a gram stain slide of csf is somtime a valuable addition, in early meningitis, there may be organisms , with normal csf values and cells very few. Clincal evidence of meningitis may be difficult to evaluate in small babies, a cranial ultrasound before attempting lp may be helpful too.

I would like to know the appropriate age for doing OAE in neonates for hearing screening. We have recently started cheking neonates in nicu and normal neonates in postnatal wards for hearing by oae.The person who checks fpr oae will do for all neonates in nsy irrespective of age, as early as 6 hrs of age. I have noted that at age <24 hours more reports are interpreted as refer than when done later. I came to know that right age for normal vaginal births is >24hrs nd cesarian births>48 hrs of age. What is the practice at other units and what is the most suitable time for doing oae

we have a marked reduction in rop in preterm nicu graduates over last 10 years Earlier it was noted that rop was associated with oxygen use, blood transfusions,and sepsis specially fungal. With policy of keeping oxygen use to a minimum , reduction of blood transfusions and infection control measure the incidence wea significantly reduced.

Once the child is hemodynamically sstable with dopamine and or other ionotopic support, we start enteral feeds, they are increased gradually depending on neonate,s tolerance. No problems are encountered of feeding with baby on inotopes in our unit.

Jn 2009 issue of curosurf newsletter "curoservice.com .newsletter" slide section,has an update by Rangaswamy Rmanathan on ROP "Third epidemic of Retinopathy of prematurity, a neonatologist,s vision". I feel it should be read by all neonatolgist,s , he emphasized tha hyperoxia at birth may be one important the cause of rop and delivery rooms should have o2 aor bleners for resuscitation, which most delivery rooms to my knoledge in devloping countries do not have.

I woulg like to know the opinion and experience of others in method of tube feeding in nicu. 1 . Tube feeding oro-gastric, tube is removed every time after feed. 2. onasogastric feeds, tube remains ther. 3. orogastiric, tube is passed from mouth ,is fixed on face and intermittent feeds are givem by nursing staff. Ihave seen some units are very comfortable with this method ,but fear is of displacing the tube with some activity. thanks

Thanks for slides of hot topics neonatology 2007 . It was really useful, as it is not always possible to attend these meetings

It is a good idea to make web community a baby friendly website. In INDIA we have many hospitals recognised as baby friendly hospitals , adhereing tp WHO 10 ateps of breast feeding. Gone are the days when new born,s father walked in hospital with afeeding bottle and milk tin. Most hospitals in Delhi, have discarded baby feeding bottles, even the vlbw nicu discharges are sent home on breast/ spoon/cup feeding, which is ensured by staff before discharge home. Temporary mother infant seperation even for a month does not affect breast milk feeding, if the nicu staff is motivated and in turn can motivate the mother too

I came acrross an article that neonates exposed to xray abdomen had 1:500 chance of developing malaignancy later, 3 times more that of c skull. Xray chest is the most often radiological intervention in nursery, for individual nicu baby, the number increases with ventilation, respiratory failure and development of complictions of ventialation;pneumonia, chronic luhg disesase, and air leak etc.Small size of neonates, a part of abdomen is mostly exposed to radiation. I would like to know, if there is any method to prevent radiation to abdomen while taking xray chest.Also what about preventing radiation to other babies in nicu. Any studies?

In one of the nicu where i am working as a visting consultant , the practice has been to insert orogastric tube, and leave it there and fixing with micropore tape on face. The nursing staff and residents feel very comfortable and so are babies. As soon as sick babies show sucking activity ., spoon feeds are statred . This nicu has mothers participation for spoon feeding ,chnging napkins and stimulation . May be other units can try it, as orogastic tubes do not interfere with breathing

We have nicu for extramural births , as this children,s hopital has no maternity unut attached. Mother or mother figure (grandmother, aunt,etc)are allowed free access to nursery. They also help in baby care,comfort, changing napkins and stimulation when stable. This practice not only contains infection in nicu, it also promotes breast milk use in nicu ,mother's confidence in handling small and neonates recovering from sickness. Even these babies are discharge earlier from nicu , once the baby has started gaining weight and free from problems . However , mostly we allow one relation at atime, mothers can stay 24hrs in mother's area, or stay as long during day time at family's convenince.

"Value of prenatal ultrasound in neonatology " in our set up includes 1 congenital defects :cardiac,brain ,lungs, intestinal obstruction, limb ,renal malformations ,and skeletal dysplasias etc. Often the obstetrician does not get mother checked for cardiac defects, and they turn out to be an emergency for us. congenital diphragnatic hernia, fetal ascites, etc need some antenatal management depending on the facilities at center. cardiac arrythmia has been treted by giving dugs to mother at our center the most frequent usefullness is for diagnosis of intrauterine growth retardation ad type, and dopler for blood flow in fetus -umbilical vand cerbral vessels, it helps to time the delivery. Also the qrstion ariese who is doing it . If the person doing is not good at detecting abnormalities at ultrasound, they are missed,eg down syndrome, cardiac malformations etc How many ultrsounds is another debatable question,I personally feel 3 should suffice, 1 am satisfied if the last ultrsound is done near term , as sometimes, congenital malformations may be seen later.

Viewing the xrays it seems that there is cardiomegaly. This may be due to intrauterine hypoxia or myocardial ischemia. In next cases, estimation of cpk, cpk-mb, cardiac andtreponin may be helpful. Try getting echcardiography early if possible, reduced left ventricular ejection fraction or pulmonary arter hypertension may be the etiology in some cases, if all other tests for sepsis are negative.

I have never encountered a feeding problem due to tongue tie. We do not cut it ,and leave it as such. Only when there is speech problem later in infancy mostly on insistence of parents ,a cut is given by a surgeon ,which is very infrequent in my practice . If the tonuge can protude upto or beyond lips , there is no cause for conern for speech problem too.

I seek help from members for managing head deformity in 6 months old baby. It was a preterm 1500gm at 32 gestation, cs done for iugr. the infant has deformity head depressed on oneside and prominent on other . now the metopic suture is also prominent. it seems whole head is rotated by 30 degrees. Head growth is normal but parent are wprried about further increase in deformity and cosmetic regions.i had read an article on craniostenosis where they mention putting specail helmets for head , can any body tell me where to get them OR how they managed similar cases

what about increase in head sizre and state of fontanels, specially anterior fontanel. in case of increased cs pressure, csf drainage might be helpful by reducing intracranial pressure

in a 9 year prospective study of rop in our unit, we noted that all neonates <36 weeks of gestation , irrespective of birthweight should be screened for rop, beginning at 32 weeks of gestaion till term gestation.14 of our babies had birth weight >2000gm and gestation >34 weeks, 30% with a bwt of >1500gms. So our policy is to screen all neonates <36 weeks of gestation.

sick babies are not given bath in our nursery till they are stable, Only they are cleanes with swabs or wer sqeezed towel . At times even after morning routine in nursery with swabbing even a stable babies become unstable ,this is more often in morning shift , then even swabbing is with helsd for that baby.

There has been an increasing incidence of fungal infections in nicu babies . I would like to know from members incidence of fungemia in their units, and whether prophylactic antifungal therapy is stared empirically or they wait for isolation of fungs+ from blood culture or colonisation from surface.