jaleszczan

Hi, I work in neonatal unit for babies > 33 hbd so I don't have experience with preemies less then 32 weeeks, but from our annual polish neonatal meetings I know from friends working in NICUs with very small babies, sucrose is used in procedural pain menagement in at least 10 NICUs with good results. I don't remember any discussions about increased risk of NEC related to sucrose using. And yes we commonly use sucrose for agitated 33 weekers and older neonates during medical procedures - USG examination, heel stics, laboratory blood draws, tape removal, eye examination and others. In my unit we use 20% sucrose and it works. I know, in GB 33% sucrose is used, but we have 20% sucrose in bottles, so we tried this solution and it worked. Treatment starts 2 minutes before painful procedure. 1-2 drops of solution is administered oraly (preferably on tongue) every 30 second before, and during procedure. It is important to use no more than 1-2 drops at once, because we noticed that if procedure was extended, our patients were after so happy and sweet that they didn't want to suck their mothers for few hours, despite the fact that in every case serum glucose level was normal. In USG exams we use sucrose with the same protocol, but we don't start it before exam, but only if baby is fussy or agitated during exam. Usually few drops is enough to finish exam in peace . 1.Gal P, et al.: Efficacy of sucrose to reduce pain in premature infants during eye examinations for retinopathy of prematurity. Ann Pharmacother. 39:1029 2005 2. R. Slater, L. Cornelissen, L. Fabrizi, et al.: Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomized controlled trial. Lancet. 376:1225 2010 There are more articles at: http://www.ncbi.nlm.nih.gov/pubmed/?term=sucrose+pain best,

If you are advanced in sonoography, all you need is to print yourself pictures of artefacts, and try to do USG examination. I use usualy linear probe 5-12 MHz with settings for thyroid gland. If you are beginer it may be moore difficult, but it really is very easy exam. I like it very much. In my unit we almost don't do Xrays this days. We check our preemies during wentilation every day, secon day or third day - depends from patient's condition, Even my nurses know the pictures now, and it help them in making decisions about changing positions, physiotherapy and so on. Practical considerations: in pneumonia usually in first exam it looks better than child shows in Siverman scale. Exam have to be repeated next day, and next day. It will progress even during ATB treatment. Very often we see consolidations and brochograms 2-3 days longer after patient's clinical improvement is seen. Usually it correlates with pO2 wchich is slightly lower than it should be. In RDS you will see white lungs - many, many B artefakts wchich are marks of "wet lung". In TTN first exam may be very similiar. If you see many pictures it will be easier to see the difference between RDS and TTN. At the begining we checked our USG findings in Xray exam, we don't do it anymore. Just do USG exam.

Hi, I'm in agreement with Irubin. Apgar score was designed for all newborns including preemies. But in the times of V.Apgar preemies were more than 30 Hbd, and 30 HBD was considered extremely immature. But the discussion is about term newborn. If child's spontaneous breath is not sufficient eg. baby doesn't cry loudly or breathing regulary - it means not quite good quality of breathing. So the easiest approach: Baby doesn't need my help - 2 points, needs any help (including oxygen, but we don't start with oxygen in term newborn i Europe -ERC 2010) - 1 point, needs ventilation including 5 initial breaths and after it still needs ventilation on the end of 1 minute after birth - 0 points. But as I know there are neonatal units using quite different approach. Best for all, have a good day