bluetoothbuddha

We use a T-piece resuscitator (NeoPuff, Fischer and Paykel) for all preemies, not only those in the group in question (32-36 weeks GA). We did try SLI a few times, but many in my team were not happy with it, and in all probability we were not doing it right either! We also don't regularly use nasal CPAP in the delivery room, but hook them on to the NeoPuff, which we use in short bursts, especially during transfer to the NICU, where the babies can be put on nCPAP or heated and humidified high flow oxygen via nasal canulae, as the case might be. So, in effect, all preemies get the T-piece transfer to our NICU, where the ones with grunting and retractions get nCPAP, and the others get HHHFNC oxygen. Both are weaned or upgraded to mechanical ventilation according to their response, following the standard protocols.

In response to one of the above comments, we have tried IV Pulmosil in our unit a couple of times, with good results and no immediate problems. Too early to say how it compares with oral sildenafil, though, which is tried and tested, and most important, cheap! IV sildenafil dosage that we used was 0.4 mg/kg over 3 hours, followed by 1.6 mg/kg/day. Word of caution about concomitant use with iNO. A study by Shekerdemian et al on piglets with meconium aspiration said that combined use resulted in worsening oxygenation and hypotension. (However, a more recent, multicenter study by Steinhorn et al (2003-05) says it did not!) It was a moot point for us, though, as our unit has no iNO...