Aymen Eshene

thanks for your help.i will send you a message my adress is jonekeda@gmail.com

its better to adopt more aggressive managment i.e starting antibiotic early as R.D ( deterioration can be rapidly ). anyway follow your local giudlines and adjust accordingly .

hi every one i want to ask you about some areas in the managment of preterm baby : 1- developmental care : whats the advices should be given ?? do you make eye cover ?? how you protect the ears ? what about positions inside incubator ?? 2- skin care : do you apply some oil for moistoring ? is there aby evidence support this practise?? 3- we dont have TPN ?? so whats other options might help ?A.A infusion ?? whats the evidence ?? 4- kangaroo care and Ncpap ? is it ok and what limitation ? thanks in advance.

last update about my baby : grade 4 IVH , shunt insreted , complicated by sever meningitis . passed away 2 days back , we couldnt help , meningitis was very aggressive . by the way : his name was : Rostom ( persian name ) . may allah support his family .

hi .. i have questions to ask regarding uptodate -evidence based - fluid therapy in any sick ( especialy ventilated babies ) .. what we do in our unit is to push fluid by 30 cc more everyday for stable babies (60 -90-120 in 1st 2nd 3rd day: Term baby ) and to advance by 20cc in sick ventilated babies ( 60-80-100 in 1st 2nd 3rd day:Term baby ) . ive read articls about the proved benifits of fluid restriction ( esp ventiated babies ) also (this was very interesting) ,that if you delay Na supplemantation until after baby loss wt ( physiological expected ) and then add Na , this practise associated with better outcome . in our unit : we use 10% dextrose in first day , after that from the second day we add Na ( 1/2 10% dextrose saline ) .. so :: whats your policy in fluid restriction ? do you check B.wt daily and star Na when you see falling in wt ? how could i apply this uptodate knowledge?? thanks in advance .

iam also interested katraz2004@yahoo.com

hello every one regarding the initiative from AAP , STABLE program , i know its designed mainly for (pre-transportation/ post resuscitation) of sick infant .. S point for sugar .. so if newly delivered baby was sick and resuscitated , its not uncommon to have low blood sugar in the first hour of life , and usualy we dont intervene to correct sugar immediatly after birth as long as its above 25mg/dl . so anyone have idea about at what level i should manage ? is i go strictly with STABLE program??? thanks

hi .. i dont know if iam in the right place to post my questions .. my friends .. whenever i come across a critical baby ,and with limitted facility , i feel sad that a lot of babies in my country died without knowing what was the cause ! working in neonate in libya (third world ) is a bit difficult , its annoying to face problems daily with no tools to stand up against them. here : frequently , we are presuming diseases rather than diagnosing them. for example : RDS with no improvment after surfactant , and with no echo technology , we presume PPHN as the main culprit and starting mg-sulphate is the next step (most of the time ). i want to ask : have any one been in such a situation ? is there a helpful equations help to differentiate (for example) :lung parynchema problems from V/Q mismatch ? i opened Gomela : there is a lot of equations but difficult to apply . sorry if i couldnt convey my thought clearly , but please if you have some ideas to help in this difficult situation in general and also to that example posted above. thanks.

is it offered for the oversea countries ?? iam from libya and iam looking foreward to have a jop in USA. THANKS.

Screen for TORCH infection .

less fluid steroids lasex vit.A D feeding monitoring u ,e , urine for RBC . over one week and reassessment accordingly .

thanks for asking this important question . we dont restrict fluid but Multicenter randomised trial proved that less hydration is better than more hydration in terms of decreasing morbidity and mortality . its better not to push fluid by 30cc daily , insteasd 20 is ok as long as you keep u,e,body wt normal. also practicaly: more fluid more odema more risks PDA, more difficult line ,and finaly theoritical risk for SIADH

ruleout hypoxia and hypercarbia and if simple measures fail we give low dose sedation .

sadly we dont have NO in our unit . we do use mgsulphate with dop/doput, to maintain syst.circuation. about sildenafil .. we get used not to use it , really iam impressed with your success rate with this drug , any study to support its use??? thanks

we are using sterile water .

thanks for posting your case here i see a little displacement of main airways toward lt, with that -black- representing tha air highly suggestive of pneuomomediastinum . make sure baby recieved proper ventilation , if on cpap start ventilation if his distress score is raising no need for drain in these cases . thanks

hello every one , just now i recieve my friends baby inv ,it shows : 1- urine ketones negative 2- plasma ketones negative 3- Acth 21pg/ml' normal ' the range 2.7 --- 63.3 4- cortisol 225.5 ' very high ' the range 24.6---171.5ng/ml 5- growth 50ng/ml. ' high ' the range 0.21---17.8ng/ml 6- insulin 2.12ui/ml. normal range 2.6---24.9 7- acid base status : normal , no met.acidosis. 8- lactate : on ABG paper 2mmol . so , whats your intrepetation ? what can i see a normal counter-regulatory response , so should we look for another area for the diagnosis ? waiting for helpful tips . thanks .

thanks for replying we attributed the hypo-hyper attack initialy to sepsis , but as the baby getting better , we expect to see a normalaization in his sugar profile . i categorize the baby as a case of persistent hypoglycemia since his glu.req above 12mgper kg per min more than 6 days now : 1- taking 180cc/kg/day IvF 15percent dextrose concentration . 2- trophic feeding 5cc/kg/day, EBM . yesterday i got an advice from endocrain dep and i sent some (but not all) of the inv.listed above i will write them down here. thanks for every one

hello to everyone >> i will write to you a story of my friends baby ,, whose i follow closly during his admition to neonatal ICU B/O nadia , male , delivered via s.section .at preterm age 34 weeks gestation ,b.wt 1.850 A.SCORE :4 8 9 . Baby delivered through meconium stained liquor . ill . o2 given via ambibag cord ABG sever metabolic acidosis .baby was drowzy weak cry , tachycardia , ivf resusc.given antibiotic started and after 2 hrs NCPAP because sat was 83 . initail diagnosis was sepsis ( possible listeriosis) ampicillin gentamicin given . inv initialy platlet40 crp positive 82mg prolonged pt and aptt platlet transfusion given , FFP given and respiratory status was ok ( clinicaly ,sat, ABG ) was normal . after a 6 days of intensive care : platlet raised , pt ptt normal , crp down to almost negative values . what i want to ask you is :: on admition blood sugar was 15mg/dl (explained ) and to manage concentration of fluid raised to 15percent through UVC . now baby aged 12 days : still has fluctuation blood sugar > and what surprise me is blood sugar at morning normal .. drop slowly slowly so at 4:00 or 5:00pm every day on the last three days to become 30mg, 25mg and even lower . and become higher at night reach up to 250-300mg clinicaly : baby looks pale , OFC 31.5 not increasing , R.R 65 H.R 135-145 .blood pressure on borderline of high reading . now he is awake ,conscoius , taking trophic feeding . CNS : OFC 31.5 not increasing ,Normal tone ,full ant.font Genitalia : A little dark .male .normal . Other syst.normal investigation over the course of managment : normal urea and electrolyte ,normal calcium , normal LFT , no more abnormality on ABG since acute illnes (the first two days was acidosis :explained by abnormal perfusion which improved on dopamine ) so do you have any helpful points : any idea about high readings at night and low in the evening time ? please write any helpful point help me in rearrange my plane . note : parent has history infertiltiy 5 years with no cause identified . ULTRASOUND HEAD not done ( no facility)

hi every one >> i have introduced myself here in this amazing forum ,, once again .. iam a young dr from libya .. working in small neonatal intensive care unit . we are looking forward to make our services optimum ,, we are far from the target but hopefully on the right tract nowadays , i became a leader of group (registrar) . and i want to have a clear vision and ways to organize two thing very important : INFECTION CONTROLE / AND DEVELOPMENTAL CARE . do you have anything to help me ? we r thinking of make in each group , one dr responsible for applying infection control measures , and some one else responsible for developmental care >> i hope i explain my question in good way .. all i want is to share your experience with me, how your people overcome these challenges ? (( you know what i purchase from internet ? audiometry and light meter .. as apart as assessment to our unit design .. but i found myself in the middle of no where .. i just need a map and clear , easy to apply advice's . thanks alot .

Hello I am a pediatrician )NICU) from Libya, I would like to ask about some important things to this specialty We are still in Libya at the beginning of the road in this specialty and missing a lot We do not have a great attention to international standards and we still , I mean, most of the doctors , do not know how to evaluate our situation and where to begin. My questions is .. What kind of methods and fundamentals of how to set up research or evaluation and what the important issues that we must be covered For example .. How to assess how to assess our building structure( intensive care unit )and their relationship to diseases ? ? How do I assess dr-pt relationship and degree of satisfaction? .. but how do I start? I hope I explained my questions enough .

in our unit,, we use auscultation method , and sometimes we advice also for x ray in any concerns about the placement

thanks for replying : Serial crp is negative , bl.p is normal . is there any direct link between c02 and meningitis >>> i failed to get rid of co2 >> although pip/peep12/5 >> and sat.is satisfactory 95-94

hello every body .. i need some help in managing preterm baby 35 weeks gestation .. and here is the story baby delivered at preterm 35 weeks , to 31 weeks old mother , there was history of leakage 3 days prior to delivery . delivery was by c/s (variable deceleration ) . apgar 9 10 10 . b.wt2.200 i admit the baby to NICU .. ampicillin and claforan started 1hr later baby got apnea ,desat70..and it wasn't responded to touch , improved by manual baging . over the next minute observation .. baby has no spontenous breathing .. baby connected to M.V , UVC inserted , X RAY( ordered normal heart shadow , no pulm.infiltrate , not HMD) . although on low setting vent . saturation 95 , heart rate 140-130. baby has low baby and dopamine started . i follow the vent. by ABG .. and here is the problem ALL co2 is high .. 140 120 80 64 90 again .. ett tube changed . level is optimum , and i achieve 95 sat with only pip/peed 12/4 . any point to help me please .. i couldn't find an explanation .

hi ... in our NICU ... WE JUST use it when PH is less than 7.0 and just 1/3 or 1/2 correction .. but for your reading .. i would like to give N/S 10 cc/kg and repeat ABG after 1hr