kishoreyv17

Routinely not needed to give extra loading dose. But, there is a variation of practice in maintenance dose between 5-10mg/kg/dose of caffeine citrate. And some units go higher than 10mg/kg/dose. Caffeine in preterm.pdf

Increasingly, we are finding long term morbidity and educational difficulty. Where do we draw the line for such ELBWs?

I would suggest you can do the HIV and Hep B screening for the mother at admission and if you get the results in 24-48 hours, you can use that to make your decision.

At our unit, we routinely screen and start antibiotics if there are 2 risk factors. Prolonged rupture of membranes is 1. The others we look out for are fever in the mother more than 38C, premature onset of labour, positive GBS on HVS, features of chorioamnionitis (fetal tachycardia, maternal tachycardia, foul smelling liquor). Remember, most investigations are not helpful in the first 24 hours of the illness.

Our microbiologist does not suggest monotherapy in neonates. Possibility of resistance. Also, aminoglycosides have synergisitic action with meropenem.

Ampicillin and Gentamicin in our unit, 2nd line is Cefotaxime and amikacin (level 3 unit in India).

We usually stop using the bag once the baby's temperature is stabilised in the first 24 hours. But, we place them in a incubator with skin temperature monitoring and use humidity as per the baby's gestation.

Please include me kishoreyv17@yahoo.co.in

I would look at other risk factors for neonatal sepsis, like PROM more than 18 hours, maternal fever more than 38C, prematurity, suspected chorioamnionitis and the baby's condition at birth. If there are other risk factors or any clinical concerns, I wold do blood cultures and start antibiotics, otherwise wait and watch.

We have a 32 week gestation 1.6kg baby referred from another hospital at 60 hours of age. No antenatal steroids given. CXR on day 1 and 2 show established RDS. On arrival, baby on SIMV 24/5 rate 50/minute Ti 0.35 FiO2 60%. Would you suggest surfactant administration at this age? Cost of surfactant is a big issue and I would give only if it is likely to be beneficial. Please opine.