selvanr4

thanks a lot.

Do you use any method ,traditional or otherwise , which will not allow the head shape of preterm to become plagiocephalic? Does keeping the baby on floor mate help in getting good shape ? do you use appliances to get back a normal shape ?

We sometimes end up having a baby who has had HIE , now presenting with obvious delayed developement. The concept of early stimulation is well known We have not had practical experience in treating these children. I know the various institutions which claim absolute recovery. If a member of 99 nicu has had the experience please share with us your knowledge.

Thanks for the inputs. Baby took nearly 5 days to settle down. Mother didnt have confidence in her ability to feed. We counselled her by being with us for a day. Now she is feeding and the baby is gaining weight. She is asking me when she can join her husband in USA! dr.r.selvan

In our small unit of one neonatologist working , nurses do the work. We will help them if they can't get the sample.

Thanks for the suggestions. I will update the developements dr.r.selvan

My list has 1. Herpes simplex 2. CMV 3. Respiratory viruses 4.entero virus 5. parvo virus. I would like to look out for atypical organism. Please suggest me the best diagnostic methods. selvan.dr.

We have 60 % non culture proven sepsis in newborns. I doubt that many of them might have viral sepsis. None of the studies from india haveidentified the viral etiology.Hence our aim is to organise a study to find out the other etiologies of neonal sepsis.I need experts help in formulating, diagnosing and proving this. I request the advice from the learned . Thanks dr.r.selvan Erode, India

In your opinion what is the safe HB at which to send the newborn home ?. This question arose because we had few newborn who had persistently low HB since birth. We try to keep the haemotocrit to above 45 in sick newborns. Does the same applies here? dr.r.selvan Erode, India

We had a neonate born to rh negative mother. Baby developed hyperbilirubinemia. needed 2 exchange transfusions and 3 top up packed cell transfusions. We send the baby at 13.9 gm%. Has returned back on day 30 with HB of 5 gms%..Now we needed to give packed cells. Our fetal medicine consultant says that she has seen this happen frequently when the final HB is high. She feels that the hypoxic drive for erythropoitin is gone and hence the lavel is low. Marrow sleeps off. Her advice is to keep HB around 10 gms%. Give me your feedback? dr.r.selvan Erode, India

baby has lost 1 kg weight. Now has regained around 500 gms with iv fluids. Icterus has come down with phototherapy and fluids. Mother has been advised not to use breast milk. One case report i have seen in indian pediatrics on breastfed baby getting hypernatremia. I would like to whether stopping the milk is evidence or practice based? ---------------------------- Selvan.R Erode, India

My cousin's granddaughter has been diagnosed to have hypernatremia on 21 st postnatal day. The mother's breastmilk sodium is 45 .If the mother wants to breastfeed the baby how to go about after sodium becomes normal? Till what level we ask the mother not to breastfeed and supplement with formula? If the mother doesn't have mastitis what is the reason for high sodium in the milk? thanks selvan.r

Thank you.It's useful dr.r.selvan

Hello, Does use of LED phototherapy brings down bilirubin level faster than doble surface or blue light phototherapy? What is the preference in your unit? dr.r.selvan

Thanks sir, All complicated problems have simple answers. The trouble is to find them out and you have shown the way out . Simple and useful . dr.r.selvan

That's great. Please send me the chapter. bye selvan

Daer Dr.Naveed, i have seen the discussion on the nicu-net frequently. Please see the links. http://www.nichd.nih.gov/cochrane/Pilley/PILLEY.HTM http://pediatrics.aappublications.org/cgi/reprint/113/5/1469 You can browse the groups site for further references. dr.r.selvan

A big Thank you to Stefan who has been instrumental for the upkeep and success of 99nicu

Hello, I would like to know the place of recombinant erythropoietin in the management of anemia of extreme preterms (28 weekers). When do we start , whether to wait for the response to iron or red cell transfusion? Do we have a well validated guideline? Because most of the books are not categorical. thanks dr.r.selvan

We had a preterm born at 32 weeks readmitted at 35 weeks with serum bilirubin of 32 mgs. Our pediatric surgeon did the cut down of umbilical vein and helped us to cannulate. We could only do 10 ml two alliquotes exchange. Though we could push in blood it was difficult to withdraw blood. We adjusted recannulated and nothing worked. It was late in the night. We could not call him again at 11 pm. So we cannulated the saphenous vein at medial malleolus and tried peripheral exchange. Though it worked and we could exchange 230 ml for this 1.4 kg baby, fingers hurt till next day. What you do in this situation when you don't have help available and scary about central vein placement ? P.S. Can any one teach the fine art of central veIn cannulation in this tiny tots or any we based learning modules? thanks, dr.r.selvan

A double volume exchange transfusion will reduce the bilirubin load by atleast 40% and help in removing the antibodies. IVIG is a good add on early

Is there a contraindication exists for applying local anesthetic cream before inserting needle for blood collection? it will definetly reduce the pain of big needle prick for the donor. I know there is no contraindication to use local anesthetic cream for day to day IV & blood collections. I want to know why this denial for the donors? dr.r.selvan

I would like you to clarify your statement Sir. Does your observation states that asphyxiated babies get hyperbilirubinemai & sepsis rarely? i am eager to know. thanks selvan.r

Hello, Thanks a lot! Really useful dr.selvan rathinasamy

Thanks. The question came because the donor was clinically normal, Non icteric. His Hbs Ag, Screen for HCV were negative. When the tests were done the lab technician noticed yellowishness of serum and she did the serum bilirubin which was above normal. Do you screen your donors for HEV and HAV also? thanks selvan.r