selvanr4

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

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

Our blood bank personnel have asked me the following questions; 1.Can we bleed a person who has a bilirubin value of above 2 mgs% ? Do we avoid blood donation from persons having serum bilirubin above the normal of < 1 mgs %? 2. Do we need to avoid blood donation from those who have recently been immunised with Hepatitis B vaccination ? if so , upto how many days ? thanks selvanr4

we use short course of steroids (dexamethasone) for 3 days at the start of sclerema management. It has not helped in all cases. I do not have a authentic reference.

In our hospital i attend all c sections. It's because of 2 reasons.1.Many of the cases are referred here with some perinatal problems.2.100 % of rpt sections want puerperal sterilisations to be done on the table. We have to take the decision whether to allow PS or not. Do you face the second situation often?

Well done. You got it at the right time kudos to the hosts and you selvan

hello, we have used levetiracetam in a dose of 10 mg /kg ,though reference says only to be used in older infants. neurologists are happy about it . they say its interaction with other drugs is minimal and dose can be hiked upto 50-60 mg/kg/dy. We have used for the baby with intraranial bleed as an addition to phenobarbiton and eptoin dr.r.selvan

Recently we had a newborn with intrauterine pneumonia having resistant seizures, apnoea and corneal edema following Intracranial bleed. We ventilated the baby, kept up fluid restricion,given anticonvulsants. Nothing worked until we started on anti edema treatment with mannitol and dexamethasone for 48 hrs. Baby impoved well, seizures controlled , recovered. Do you advocate mannitol in raised ICP ? Do you use dexamethasone? We have not used it till now. Give me your feedback and brickbats if any. dr.selvan Erode

please read this which quotes good response to exchange trasfusion; http://www.ncbi.nlm.nih.gov/pubmed/18368059

the baby has responded well. convulsions controlled and discharged

This week we had 2 babies who have received 1 mg of vit.k in the neonatal period presenting with intracranial bleed. baby.1; 39 days old, B/o V mother anemic undernourished. Baby on exclusive breastfeeds.Baby had fever due to mastitis(skin laceration due to hook injury). Developed focal fits on LT side . Both PT & aPTT prolonged.platelets normal.CT shows bleed on RT side needed 2 anticonvulsants to control convulsions. Had blood transfusion for low Hb{8gms%}. Now baby is better. Feeding well. Any clues for the reason for the Intracranial bleed? Eventhough the baby received vit.K? selvan rathinasamy Erode, India

how does Indomethacin & like drugs close PDA in the neonatal period? And why the same drugs do not act later? thanks selvan.r

We recently had a Nicu gratuate who had laryngomalacia presenting with severe stridor. He had GERD in neonatal period and he didn't ventilation. Now ,Since he was desaturaing and in resp. failure he was ventilated and trasferred to the nearby bigger city. He was found to have grade 3 subglottic stenosis. Now he is 5 months old but the consultant pediatrician did not have willing ENT to do tracheaostomy.Meantime he needed reintubation . And the parent's decided to withdraw support. What best could have been done for this Kid in a well resourced place? Thanks for time, selvan.r