tarek

i miss 99nicu 

since i change my practice to UK i missed manythings, i am still couping with the new shift. 

Is it normal to take such a time 8 months now😩

really a wonderful topic i do like to learn how to use it 

I was doing LP for a 2 day old full term 40+3 and we used sucrose to give some relief just before the procedure. For my self if feel that sucrose do not add any thing for such situation. 

they still feel the pain but deviate their attention same like when you put a dummy or your finger they will start to suck and stop crying. 

i am confused

😟😟

POCUSNEO Canada is pleased to announce the first e-workshops in advanced hemodynamics
starting from
1️⃣5️⃣ August 2️⃣0️⃣2️⃣0️⃣

https://pocusneo.org/e-workshops/

https://pocusneo.org/e-conferences/

Yasser Elsayed (University of Manitoba) 
Muzafar Gani (McMaster University) 
 

Emailing E-conference Flyer final R.pdf

thanks @yangw126

thanks @Jose Ramon Fernandez very nice consensus

thanks @amirmasoud2012 for the very important question

thanks @Stefan Johansson for the amazing group

can i join this membership what is the requirements for joining

i know Dr  Mohamed El-Dib very well

🌹🌹🌹🌹

Thanks @spartacus007

it is a nice approach. 

is there is time frame for follow up shall i depend on clinical evaluation only

rule of serial x rays

the problem is tension pneumothorax can happen within seconds 

nice question

we do practice rectal stimulation by feeding tube or sometimes glycerine suppositories or rectal wash out by NS 

we are starting with 80 ml/kg/day with sodium monitoring 

we are not adding sodium in the first 24 hours 

their juxta glomerular apparatus is very sensetive they can not deal with sodium 

even some literatures is saying no need to add sodium in first few days 

In our unit we are not cutting the tube but we did  not do any study to check which is better to cut it or to leave it .

Please respond to the poll and share your practise.

I can appreciate Dilated bowel loops no portal vein gas no pneumatosis 

any Gastric Residual, vomiting, bloody stools 

check for electrolytes esp Na 

Do CRP, blood Cs start antibiotics according to your antibiogram

serial x ray follow up

blood gas to check for metabolic acidosis

CBC monitoring to check for further drop of platlets 

regarding pedia surgical consultation 

in NEC I & NEC II they have no rule but if you can involve them if you have suspecion 

NEC III THEY SHOULD INTERVENE EITHER PUTTING A DRAIN OR TAKE THE PATIENT TO OR 

Treat the patient as a whole and do not treat the x ray

@Dr.Smah

Do you mean acute management in nicu for babies whom there mothers are smokers..? 

every time I check my email and find 99nicu in the list I feel too much excited every time I visit this site I gain new information and add new knowledge 

thanks @Stefan Johansson and all 99nicu members

love you all❤️❤️❤️❤️❤️

@Sutirtha Roy

waaaaw very nice👌👌👌👌👌

thanks a lot 🙏🙏

what is your target PCO2

@Stefan Johansson

yes you are right thanks

from your phone just go for options and ask desktop site

how to register

@rehman_naveedWhat i mentioned is the latest recommendation from AHA 2015 i will try to post it

@rehman_naveed

Regarding Q2 in cardiology

The answer and critique need review ventricular tachycardia with pulse so stable ( normal BP normal CRT ) so medication here we can consider adenosine then expert consultation.

Ventricular tachycardia with pulse unstable ( low BP , prolonged CRT ) so sybchronized cardioversion starting with 0.5 j/ kg

Pulseless Ventricular tachycardia same as VF management is defebrillation start with 2 j/ kg

Waaaaaw

Thank you for sharing

Jazak Allah Khayra

The placental circulation brings into close relationship 2 curculation systems: the maternal and the fetal

in severe abruptio

the mother will present with shock and fetus may die

detection of fetal blood in a maternal bleeding is worrisome

 The clinical manifestations and prognosis depends on the amount of fetal blood and the rapidity with which it occurs

see the attached study

25-30.pdf

If you from the history that there is antepartum hemorrhage and you have the time to arrange O -ve PRBCs

It will be more superior than NS

If the baby deliverd and resuscitation was required and O- ve blood not there you will give 10 ml/ kg NS over 5-10 minutes 

In side nicu after stabilization of the baby you can arrange for cross matched PRBCs if the baby us really anaemic

I like the european consensus in management of CDH really it is very nice and helpful

#### also there is new modality which we are trying to use it which is applying VG with HFOV(1-3 ml/kg)

CDH EURO Consortium Consensus.pdf

 According to NRP textbook

What are the limitations of a laryngeal mask?

Laryngeal masks have several limitations to consider during neonatal resuscitation. •The device has not been studied for suctioning secretions from the airway.

•If you need to use high ventilation pressures,air may leak through the seal between the pharynx and the mask, resulting in insufficient pressure to inflate the lungs. •Few reports describe the use of a laryngeal mask during chest compressions. However, if endotracheal intubation is unsuccessful, it is reasonable to attempt compressions with the device in place.

•There is insufficient evidence to recommend using a laryngeal mask to administer intratracheal medications. Intratracheal medications may leak from the mask into the esophagus and not enter the lung. 

•Laryngeal masks can not be used in very small newborns.

Currently, the smallest laryngeal mask is intended for use in babies who weigh more than approximately 2,000 g. Many reports describe its use in babies who weigh 1,500 to 2,000 g. Some reports have described using the size-1 laryngeal mask successfully in babies who weigh less than 1,500 g.

This study by Prof Kary Roberts in USA

Laryngeal Mask Airway for Surfactant Administration in Neonates:A Randomized,ControlledTrial

Unfortunately We never have it in our hospital 

I enjoyed the discussion although we know that the benifit is less or even no benifit still many are using H2 blocker or proton pump inhibitor even some are using metoclopramide

The first 5 days postop NGT or OGT is mandatory then gastrographin to be sure that there is no leak 

after that depend on GA and when we will start oral feeding