selvanr4

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

Published by Ballantine Books available in USA for $25. Mark Sloan M.D is a pediatrician of 25 yrs of experience and fellow of AAP practising in nothern california region.In his book BIRTH DAY ,he refreshingly looks at the science of childbirth and explores the history and the wonder of childbirth. His book is arranged in 4 parts having 10 chapters. As neonatologists we are trained in identifying and treating the diseases of neonate in day to day practice.We have not been exposed to the history of neonatal medicine and hence we do not know how some treatments have become established and some have vanished. This book fills in the gap and lets us to know about evolution of childbirth, the changes in the first five minutes after birth and the origins ,the future and it's latest popularityof Caesarian birth ,the rise and fall of twillight sleep, nitrous oxide and the ubiquitous epidurals to help ease the labour pains. I was surprised to know that fatherhood brings out paternal hormones helping them in their emotional evolution of becoming a father.The truth about the five senses of the unborn and the newborn is not dealt in our text books.Birthday updtes us on the truth about light entering the womb,the hearing and the loudness in the womb, the smell and the vision of the unborn.The newborn reflexes and it's usefulness in breastcrawl is illuminating. The chapter on infant origami is delightfully written about why the newborn looks the way we see, the differences between them and older babies.He takes us on a tour of newborn's body -the springy skulls,hairy ears, innies and outies( on the shape of umbilicus) and the controversial circumcision. He has given 12 pages of notes on the concepts mentioned and it's sources which are excellant.As mentioned in the book, this is one pediatrician's meditation on the hiding-in-plain-sight marvels of human birth.I learnt the history of childbirth in an interesting way by reading through. i recommend this book to pediatricians and neonatologists of all countries . Dr.Selvan Rathinasamy neonatologist &Pediatrician Lotus Hospital 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

We get into a tight corner when we have a sick septic baby who is going downhill even with good cover. And we get a C&S report of Suction tip or ET Tube pointing to another bug and some other sensitive drug. How can we differentiate colonisation from infection with the bug in these situation? Your input is valuable. selvan.r

When the neonate presents with scelerema the prognosis is guarded.Do you treat with antibiotics, FFP ,IV gamma or with exchange transfusion? We recently admitted 2 noenates with septic shock who presented with scelerema witin 36 hrs after birth. Bactec c&s grew organism and hence antibiotics were started along with ionotroes. Both of them went downhill and while the were on ventilator, Double volume exchange was done. It helped both the babies. Please share your views dr.selvan Erode. India

Thanks for the articles. how do you avoid this or do you do anything for the opened up pdA thanks selvan.r

hello, we have noticed that when phototherapy is used on day 3-4, we get PDA opening and new murmur. Any coincidence? have you come across this ? selvan.r.dr ERODE,INDIA

thanks

we had a newborn referred with meconium aspiration and deep asphyxia. baby reached the hospital dead. He breathed his last on the way to hospital. He has vitiligenous patches like his father. Any connections with the outcome of the baby?

this baby underwent detailed opthal exam. had heterochromia iris, pigments in fundus. BERA will be done to r/o deafness later. opthal felt waardenburg is the likely diagnosis sorry for the delay.

we use midazolam in a dose of 0.1 mg/kg sos ,when the baby fights . we do not use paralytics . Is it so for others?

thanks a lot for the information. indeed i could get more information after seeing your article. both the babies are well and thriving and now in their homes. thanks selvan.r

we have chikungunya infection as epidemic right now with dengue . no lotion was applied . i am posting other photos selvan.r. india

yes, i will be pleased to do.

In our set up, we are using only the peripheral lines ( No central line). We encounter difficulty > 7 days of NICU care. When we called to help, it's really difficult to get a line . Do you have any easy way for starting a peripheral iv line ? any good old advice from experience?. Thanks dr.r.selvan India

i searched the pubmed and found out an article on one model which will help the physician. It shows that only little is known about it and the research is limited. Why don't we try to put in our thoughts an d write a paper and send it to ADC of ACTA?. It will kindle discussions and might bring out a model ( not manual as pointed out by stefan )which will help every one. any support? selvan r Erode. India