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Khaque

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Khaque last won the day on March 14

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About Khaque

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    Member

Profile Information

  • First name
    khalid
  • Last name
    Haque
  • Occupation
    Consultant Neonatologist
  • Affiliation
    St. Helier University Hospital
  • Location
    Carshalton, England
  1. Dear Stefan, Wonderful study. Did you also measure lactate levels? Khalid
  2. I respect Dr Cardona's views and am aware of Tirvidi's paper. In our experience of over 30 years we have found it useful even in the very preterm and with newer generation of lights.
  3. There is considerable difference of opinion amongst clinicians and in literature whether CSF should be examined every time a ‘sepsis work-up’ is performed. Due to low rate of meningitis (1% of over 9000 blood culture positive infants [Harmony P et al 2006]) many authors do not recommend routine lumbar puncture in the absence of a positive blood culture or localizing findings [Wiswell T 1995, MacMohan P 1990]. Current opinion varies from including CSF examination in every ‘work-up’, to examining the CSF when there are clinical features of meningitis or examining the CSF only when there is a positive blood culture. Data however suggests that as many as 38% of culture-positive meningitis in neonates had negative blood culture taken at the same time! [Harmony P 2006]. This may have to do with the problems associated with blood culture as enumerated earlier rather than true dichotomy between blood and CSF culture positivity rates. Never the less meningitis can only be diagnosed or excluded if CSF is examined! We would always do an LP for LOS but defer to clinical history and condition of the baby for doing an LP for EOS.
  4. It has long been recognised that phototherpy increases the chances of opening the duct or delaying its closure. This is thought to be due to the effect of phototherapy on ductal prostaglandins. As simple, cost effective and evidence based way to prevent this is to cover the ductal area with a reflective (tin foil) material. [see Jack Sinclaire's book on evidence based neonatal medicine)
  5. Book Review: Hematology, Immunology and Infectious Disease Neonatology Questions and Controversies Robin K. Ohls and Mervin C.Yoyder Saunders- Elsevier 2008: ISBN: 978-1-4160-3158-1 Series Editor: Richard Polin Hard Cover. 294 pp, $78. This is the latest in the ‘Neonatology Question and Controversies’ series. Its sixteen chapters have been written by experts from United States, Europe and Australia with first eleven addressing issues in neonatal immunology and hematology while the remaining chapters address various infection related subjects. The earlier series had been very popular with neonatal clinicians thus I was looking forward to receiving my copy. However, going through it for this review I was a bit disappointed. I have no concern about the subjects chosen which have been written by ‘experts’ and edited succinctly. My concern is that the aims of 1) addressing controversial topics and advances in the field head on, 2) serve as a bridge between the latest cutting-edge research and its application to clinical practice have not been met. The book starts with “ Stem Cell facts for Neonatologists”….I found this chapter fascinating and informative but it is not written in an user friendly manner thus, I suspect that the chapter would be of little use to a jobbing neonatologist. This is followed by an excellent, very useful and practical chapter on Thrombocytopenia. I found it a wonderful mix of information about recent advances and pragmatic advice on frequently faced clinical problems. There is then considerable duplication between the chapters ‘The Role of Leukocyte Colony Stimulating Factors in the Neonatal Intensive Care Unit’ and ‘Practical Approaches to the Neutropenic Neonate’ with a few differing messages. After reading the chapter on ‘Why, When and how Should We Provide Red Cell Transfusion to Neonates?’ I was none the wiser except for reinforcing the view held by many neonatologists that deciding when to transfuse red cells to preterm infants remains problematic. The algorithm offers a pragmatic approach (with little evidence and there are many similar or perhaps better approaches available in literature) and the hematocrit values in the algorithm differ from those given in table 4-7. Whilst the chapter on ‘Controversies in Neonatal Thrombotic Disorders’ offered useful information but nothing that is not available in standard text and I was sad not to see any discussion on the controversies on the diagnosis and treatment of DIC. The chapters on ‘What Evidence Supports Dietary Interventions to Prevent Infant Food Hypersensitivity and Allergy?’ and ‘Toll-like Receptor Responses in Neonatal Dendritic Cells’ provide deep insight into new and useful information which would improve neonatologists understanding of the subject. I found the ‘Maternally Mediated Neonatal Autoimmunity’ and ‘What Insights into Human Cord Blood Lymphocyte Function Can Be Gleaned from Studying Newborn Mice’ as highlights of the book. They are well written are highly informative and improved my understanding of the complex immune interactions between maternal and fetal immune systems and how lessons can be learnt from studying mice in our battle against infection. Chapters on ‘Influence of Passive Antibodies on the Immune Response of Young Infants’ and ‘Neonatal T-Cell Immunity and its regulation by Innate Immunity and Dendritic Cells’ were a good read but once again I did not find anything new that those interested in the subject do not already know…I suspect that will always be a problem in a book like this because of the rapid pace of change and advance in the field. The two chapters I enjoyed most were ‘Breast Milk and Viral Infections’ and ‘Control of Antibiotic-Resistant Bacteria in the Neonatal Intensive Care Unit’. They are well written, balanced between what we know and what we should do. Sensible advice is given. My greatest disappointment was with the last two chapters ‘Neonatal Fungal Infections’ and ‘Effects of Chemoprophylaxis for Neonatal Group B Streptococcal Infections on the incidence of Gram-negative Infections and Antibiotic Resistance in Neonatal Pathogens’. They neither discuss the controversies which abound in these two area’s nor give any recent advances or any information that is not is already in the public domain. In summary, I have mixed feelings about this book. I think it would be nice to have in a hospital’s library but I would not invest in it for my personal collection. Khalid Haque Professor of Neonatal Medicine
  6. Whilst the causative organism is an important factor in determing the duration of antibiotic therapy; for example some treat Gram neg organisms for longer than Gram pos organism. There is supportive animal/laboratory evidence for this but I am not aware of any human studies directly comparing duration of therapy according to pathogenic organisms. Indeed the vehicle in which antibiotic is delivered is important as the pH may affect the antibiotic efficacy and concentration equally the constitution of the antibiotic solution is important therefore we should follow the manufacturers guidelines
  7. Dear Bungert and Amira, Thanks for your interest in this thread. Indeed CRP is neither highly specific or sensitive but it is a marker most frequently available. It should be used with caution and recognising its limitations. I am not sure that I would use CRP as a 'sign of infection' nor would I support 'prophylactic antibiotics, for NICU admissions in general.
  8. Dear Stefan, A wonderful idea as there are so many, many questions with no evidence based answers e.g, best diagnostic tests to diagnose neonatal infections, best antibiotic therapy, duration of therapy (culture proven, culture negative but lab and clinical sepsis, ideal monitoring and duration of follow-up. The problem is that 100 patients wont do. As you know just to see the difference in mortality with adjuvant IVIG therapy (INIS study) we needed 5000 infants to get a study with adequate power. Regards Khalid
  9. Whilst we have been using IVIG to treat neonatal sepsis since 1986 but you may consider us biased as we were one of the first to publish the benefits of adjuvant IVIG therapy in neonatal sepsis. Since then there have been a number of studies supporting the use of IVIG (particularly IgM-enriched IVIG) in neonatal sepsis. Cochrane analysis has also shown benefits though the number to treat was 11. The INIS trial has recently finished and its report is eagerly awaited. For dosage, indications please refer to publications on the subject.
  10. Dear Jasim, If you can give me your e-mail address we can certainly discuss the feaseability of doing this work at King Faisal Khalid Haque
  11. Dear Stefan and Jasim, I have done some work on this previously and have submitted a research grant application but in the current 'ecnomic crunch' I suspect funding for research is even tighter.
  12. To Jack: For whatever reason you are compelled to give some babies a shorter course and some babies a longer one. If other things being equal have you found a difference in outcome? As for 'some thing clearer', there are numerous references suggesting a shorter course (4-5 days) is as good if not better than a longer course of 7-10 days. It is estimated that it takes about 7-10 years for practice to change after evidence is produced. With costs and antibiotic resistance on the increase we must reflect on the evidence and our practice.
  13. Should have quoted this earlier; “ Beware of those who have found the truth, follow those who seek it.” Hijikata 13th Century
  14. As suspected most of us are creatures of habit and do what either we have been taught or what is in textbooks. I am surprised at the dogmatic statements of the number of days they give antibiotics for but provide NO evidence for their practice. I do not buy the cost argument it seems un ethical and would urge none of us to decide the duration of antibiotic therapy that way. Khalid Haque
  15. My question Stefan really is how did you come to the decision to use 10 or 7 days in the firat place? Dogma!, Textbooks transmitting the same message from one edition to another! or through evidence? Khalid Haque