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ajaymenon

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About ajaymenon

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  • First name
    Ajay
  • Last name
    Menon
  • Occupation
    Paediatric registrar
  • Affiliation
    Sheffield Childrens Hospital
  • Location
    Sheffield ,uk

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  1. There are lots of variables ,while talking about gastric residue. Depending on antenatal environment (doppler scan and maternal health /illness, medications ) how often the child is feed ( 1 hrly 2 hrly or more), tropic feeds, initiated and tolerated or not, gestation of the baby , underlying condition and interventions and medications given ( cpap,caffeine ,antibiotics, ),type of feed (breast or bottle). As mentioned before ,if the child is clinically well, with no abdominal distension and stable vital parameters ,it doesn't make sense to aspirate the tummy frequently ,and potentially injury the intestinal mucosa. Obviously a sick child with abdominal distension,fluctuating vitals parameters,and dubious blood/stool result is a different ball game altogether.
  2. I would agree with dragger ,in that if the test lungs are working ,then the machine is probably o.k. one possible explanation is that the pressure /mode used for the patient may not be appropriate for the patient.It might be a good idea to check the pressures of the bag and mask ventillation provided with a manometer ,to get an approximation of the pressures required. The inspiratory time ,fio2 , and the flow can all be altered on the machine ,and depending on the patient's condition,may need adjustments. Hope this helps .keep us posted,if you have found anything else. Regards Dr.Ajay Menon Sent from my iPad using Tapatalk
  3. Dear sanju, Stridor means an obstruction in the large airway.if nothing is found outside the airway,looking for something inside the airway (vocal cords)is the usual dictum.look at the v.cord movements,structure and anatomy.note if you can visualise any haemangioma/swelling .An important point to remember is to look for s.calcium/phosphate, vitamin D levels .Each day more and more reports about maternal vitamin D deficiency seems to be coming out. Considering the baby has improved with hydrocortisone /antibiotics might suggest an inflammation. Neonates with intracerebral bleed also presents with grunting, which sometimes can be confused with stridor. Please keep us posted about the case .
  4. looking for suggestions regarding management of a term male baby born to a primi ,with 1st degree consanguinity ,which was referred from a local hospital with history of large bullous lesions noticed at birth, all over the body including oral mucosa ,which peels easily on touch.Their is no palmar or plantar lesions though. lesion is suggestive of epidermolysis bullosa ,most likely dystrophic variety .The child is currently on ampicillin and cloxacillin combination along with acyclovir (just to cover for possible Staphylococcal /herpes).nursing care with mupirocin local application and paraffin gauze covering .Any more suggestions/update/advances on the subject welcome .Regards and happy new year to all.shall post photos soon.
  5. looking for suggestions regarding management of a term male baby born to a primi ,with 1st degree consanguinity ,which was referred from a local hospital with history of large bullous lesions all over the body including oral mucosa ,which peels easily on touch.condition is suggestive of epidermolysis bullosa ,most likely dystrophic variety .The child is currently on ampicillin and cloxacillin combination along with acyclovir (just to cover for possible Staphylococcal /herpes).nursing care with mupirocin local application ands paraffin gauze covering .Any more suggestions/update/advances on the subject welcome .Regards and happy new year to all.shall post photos soon.

  6. Dear Vj, Maintenance in the 1st few days ,typically is with 10% D alone ,without any electrolytes in a well child .however ,in your case,with hypotension presumed sepsis. The reason for hypotension might involve either a single cause or more likely , a combination of fluid loss, bleeding ,hormonal(ANP,BNP,ADH,renin angiotensin aldosterone mech:),and symp:nervous system interactions .The guide to fluids and electrolytes will depend on fluid Input /out put, hematocrit /platelets and urea/electrolytes.hope this helps !!
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