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livesynapse last won the day on March 13 2017

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About livesynapse

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    Hospital Base Puerto Montt
    Clinica Alemana Puerto Varas
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    Puerto Montt, Chile

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  1. Stubborn PDAs despite prophylactic indomethacin!

    My unit is starting to think about prophylactic paracetamol in babies who weigh less than or 800 g. Any thoughts?
  2. Parenteral nutrition in premier >1,5 kg

    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.
  3. When parents are rude in the NICU

    This is very true. Also, keep in mind that rude criticism by senior MDs to junior staff during rounds has pretty much the same effect in impairing team performance.
  4. 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.
  5. Heparin Lock

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

    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.
  7. HFOV noninvasive

    Bubble nCPAP 2.0
  8. Persistent pulmonary hemorrhage in a preterm

    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.
  9. NRP 7th edition

    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.
  10. ELBW protocol

    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...
  11. Probiotics in NICU - safe preparation guidelines?

    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
  12. News about Probiotics

    Thanks for the great update! In our tertiary unit in Puerto Montt, Chile, we were using Biogaia ® but we stopped doing so after the Solgar report, plus Dr. Josef Neu's recommendation to wait for more studies in http://www.eneonatalreview.org/newsletters/2014/volume10_issue01.html We still use it in selected cases, usually >1500 g babies, but we are still not sure which preparation is safer: Biogaia comes in liquid form, but there are others that are in powder form... Should these be reconstituted in sterile water? What is the appropriate dose? Refrigeration? We really wish we could start safely using probiotics again!
  13. Parenteral nutrition, enteral nutrition and MEF

    What is usually done is to not consider MEF in the total daily intake because tolerance is iffy and availability is also uncertain. Once the amount of BM exceeds MEF, it should be included in the fluid balance. Any comments?
  14. Probiotics in NICU - safe preparation guidelines?

    We were beginning to use Biogaia ® based on Spanish recommendations: (Nutr Hosp. 2014;30:329-337), but recently, in Miami Neonatology 2014 (the conference), Dr. Josef Neu said that more RCTs were needed; that there were many strains of probiotics and we could not be sure which to use. He also mentioned that they were manufactured as food supplements, thus not as safe to use as FDA approved medication. We have stopped using them now, but our team will rethink the issue shortly. It'd be great to hear opinions about this! Patricia Alvarez Cantwell Attending Neonatologist Hospital Puerto Montt Chile