livesynapse

Hi, If the patient responded well to DART and is off the ventilator on the second day, we shorten the DART course and skip the last 4 to six tapering doses. Our second courses are very rare and separated by at least 10 days. Patricia (Neonatology Dpt. Hospital Puerto Montt, CHILE)

We use it in extreme circumstances: male preterm <700 g with no antenatal steroids who's had a vaginal unexpected birth. Sadly, ER-born extremely preterm births are becoming an issue in our hospital in the new COVID times. Prenatal care was perceived by some families as a risk factor during most of 2020.

According to Dr. Sanchez-Luna's papers, if you use HFOV and VG, you can lower the frequency in order to avoid hypocapnia. It works in the opposite way as HFOV without VG. Here's the reference: Am J Perinatol 2018;35:545–548.

I'd like to clarify that comment a bit: Chile is entering its 6th week since the first COVID19 case was detected. There are areas with a high number of cases, so partial lockdowns are being put in place for 2 to 3 weeks. Those are being lifted (or not) depending on the number of new cases on a daily basis. There is an issue with availability of testing as is the case with most LA countries, but Chile is steadily increasing PCR testing availability country-wide. Recently, universal use of face masks when outside of home was recommended and made mandatory when using public transportation on April 8. People are encouraged to use homemade or commercial cloth face masks and leave surgical masks and N95s for healthcare workers. At my public hospital, we were issued cloth masks to use outside of the hospital, surgical masks for clinical work at the NICU, and plastic gowns, face shields and N95s when there is likelihood to be exposed to aerosols. We are expecting peak contagion to hit us by the end of April-early May and are trying, just like everybody else to flatten the curve. It's still too early to tell how it will go for Chile.

Awesome! Congratulations! Great job so far.

This is great! Thanks so much. I was in Toronto for the NeoHemodynamics 2018 Conference and Workshop and one of the main take-home messages was that both transitional hemodynamics and knowledge of its physiology are key to tailoring therapeutic interventions both in preemies and term babies. The slides from the talks are available at neohemodynamics.com

We still haven´t been able to provide donor human milk in our Unit, so if we have a PT < 33 weeks GA or an SGA <p3 infant who is also <34 wks GA, we will consider either starting parenteral nutrition until the mother can produce milk or give aminoacids 10% plus 12.5% dextrose and some form of IV phosphate via peripheral vein. For us, it has more to do with maturity than birth weight. We also try to use as little formula as possible, favoring own mother's breast milk.

We are using Biogaia (R) (lactobacillus reuteri) for preterm babies who are on antibiotics and other preterm babies who don't have access to early human milk feedings. We usually start it when trophic feedings are well tolerated. The evidence in favor of probiotics is sound, and we can use it without special authorization at our hospital so we do.

No heparin. Just saline and, as long as the infusion keeps going, they don't clog. We also remove them asap.

I agree. No locks for CVCs. However, we have been able to keep them from clotting with saline at 0.8cc/h in very tiny babies in whom we really need to watch fluid intakes.

Bubble nCPAP 2.0

Our protocol for pulmonary hemorrhage includes intratracheal epinephrine, an extra dose of surfactant, and like you did HFOV. In these cases, when there is active bleeding, we treat the PDA with paracetamol: 15 mg/k/dose every 6 hours for three to six days. Good luck! Patricia Here's a link J Pediatr. 2016 May 20. pii: S0022-3476(16)30176-7. doi: 10.1016/j.jpeds.2016.04.066. [Epub ahead of print] Paracetamol Accelerates Closure of the Ductus Arteriosus after Premature Birth: A Randomized Trial. Härkin P1, Härmä A1, Aikio O2, Valkama M1, Leskinen M1, Saarela T1, Hallman M1.

The other important issue is the recommendation to use ECG monitoring if you are starting cardiac compressions. This is as important as the introduction of the pulse oxymeter back in the day, Studies have shown that auscultation and cord palpation are not very reliable to assess HR.

Hi Mike, I've been in meetings with the Japanese, and what they do is very simple (but easier said than done): Always use non-invasive ventilation, and feed early and exclusively with breast milk. Formula is not an option. Other things they have is excellent prenatal care, almost 100% of antenatal corticosteroids, and adequate staffing of their NICUS...

The evidence is piling up in favor of the use of probiotics. Do any of you have a protocol for using probiotics? My team has researched and reflected on this for a few months now, and we are ready to start using them again, so I was put in charge of the protocol. I will be happy to share my " ELBW enteral feeding protocol" plus probiotic use after I am finished, but I need help with the probiotic use part. Thanks, Patricia Alvarez Cantwell Attending Neonatologist Hospital Puerto Montt Chile