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PSV is the worst choice for VLBW babies

@Hamed Thanks a lot You are always embressed me with your nice and valuable comments. Regarding AC for 3 days then HFOV really it surperized me a lot You are doing this for every ELGAN on ventilator or selected cases And what is the rationale behind this @Zsofia Dombi Thanks for sharing May i ask you is there is any hyperinflation in the x ray And what is your protocol regarding starting hydrochlorothiazide or dexamethazone for such cases

WHO recommendation with delayed cord clamping even for 3 minutes NRP guidlines latest edition with delayed cord clamping from 30 -60 seconds In preterms: Decrease incidence of IVH Decrease incidence of NEC Reduce need for transfusion Avoid hypovolemic hypotension For full term Studies showed that improve iron stores in first few months The American college of obstetrician and gynacologists recommend delayed cord clamping in there commite meeting in 2016

Diaphragmatic disease usually manifests as elevation at chest radiography. Functional imaging with fluoroscopy (or ultrasonography or magnetic resonance imaging) is a simple and effective method of diagnosing diaphragmatic dysfunction, which can be classified as paralysis, weakness, or eventration. Diaphragmatic paralysis is indicated by absence of orthograde excursion on quiet and deep breathing, with paradoxical motion on sniffing. Diaphragmatic weakness is indicated by reduced or delayed orthograde excursion on deep breathing, with or without paradoxical motion on sniffing. Eventration is congenital thinning of a segment of diaphragmatic muscle and manifests as focal weakness. see the video E51_DC1_Movie4.mp4

@Andrej Vitushka There is By flouroscopy

I think this isveventration of the diaphragm and not diaphragmatic hernia There is no problem to start feeding as we can see all the gut below the diaphragm If you are not going to operate now and patient RR is showing tachypnea start with OGT according feeding protocols regarding his weight If he is tolerating this eventration and not tachypnic start oral feeding if his wt> 1.5 kg and increase gradually Dig for the history as it may be traumatic delivery Check his moro reflex nicely to r/o Erb's

What about his ECHO finding still have severe PHTN or improving from last ECHO If he is improving wait and see continue your weaning trials X ray chest is there is improvement in the hypoplastic side take care of sildenafil as some times causing lung collapse Just be patient

@rehman_naveed http://neonatal.cochrane.org/what-has-cochrane-neonatal-done-babies-download-site

Thanks too much Naveed I was following what i will post now because this was very big dilemma and i find this helpful for me If you kindly read it and give me your valuable comments https://uichildrens.org/health-library/fluid-and-electrolyte-management-newborn

@bimalc One of my friends in Minnesota i discussed this issue with her they are starting with 80 ml/kg and checking of sodium ,uop and adjust ivf accordingly so not all in US starting with 100 ml/kg And i am in favour of restricted intake initially and adiustement according UOP ,Na and Urea More fluids more IVH PDA and pulmonary hge So the most important is follow up and adjust accordingly allowing for physiological wt loss in the first 5 days

Thanks a lot @Hamed really its great help Thanks a lot @Stefan Johansson

The most important is that the patient should get benifit from our writing Interpretation of patient condition to good assessement and planing for the coming 24 hours

IVH and ELBW It is really a bad experience having a 600 gms baby with IVH grade 3 or 4 What is your best practice to minimize the risk of IVH? Management of hypotension and risk of IVH Intubation and IVH who should intubate it is not always the most expert will be there Delayed cord clamping really we should not miss its benifits Painful procedures and IVH is it helpful to give morphine before any painul and irritant procedure like suctioning PDA and IVH should i give prophylactic endomethacin in first few hours of life

Transfusion guidlines in neonates Ultrasound chest and TTN diagnosis(double lung point) Prevention of IVH in ELBW

Sorry for delay i did not see the reply First you should be a provider NRP provider after that you will do the instructor course Regarding travel i think is not difficult I will ask my Boss for the course and i will let you know about her reply

Really i wish i could attend this conference Please,Can you tell me how much it will cost for 3 days

Hello Aymen I am NRP certified instructor in SNRP Saudi neonatal resuscitation program It is one day course Fees 500 Saudi Ryals for doctors 400 SR for sisters This for MOH doctors and sisters

Dear Aymen very good question One of the important web sites that i think helped me a lot to improve myself and my practice is NICUniversity you will find what you want . And may Allah bless you and all people in Lebya

Very good shift although whatsapp is also very good alternative

Thanks a lot for the very valuable effort and every day practice problems. I think how much is the bicarbonate and how much is the bicarbonate deficit will give a clue for the prognosis and outcome more than the pH . What is ur opinion regarding this

When discussing asymmetrical IUGR with parents emphasis should be placed on the preservation of brain growth and that body weight will catch up As well as categorising by weight it is important to clinically assess the newborn infant to ascertain whether it is small for gestational age or exhibiting signs of intrauterine retardation. The causes of IUGR should be considered and the consequences of IUGR predicted and managed appropriately (e.g. hypoglycaemia, hypothermia, polycythaemia). 😃😃😃 In nursing the extreme preterm it is important to be aware of the complications of prematurity, which include poor temperature and fl uid regulation and cardiorespiratory immaturity as well as the complications of intensive care such as excessive inappropriate handling, pain and infection. 😉😉😉😉 The skin of a preterm infant is thin and easily damaged and may remain relatively alkalotic. It therefore forms a limited mechanical and immunological barrier as well as providing poor insulation, which is why care must be taken when handling the infant to prevent further skin breakdown.

We trried this hundreds of time together with midazolam and always be ready with naloxone as antidote The good thing is that there is one article about giving naloxone to minimize reintubation in patients given fentanyl as premediction before INSURE 111071

I like to share this article about neonatal pain management I consider it amazing I hope you will enjoy it Neonatal pain policy.pdf