norbertteig

There is anectodal evidence that phenytoin should not be given via PICCs as it may enhance the risk for catheter occlusion and the same may be true for etoposide (not the typical NICU drug, I know...). Additionally very high concentrations of IV dextrose (40%) should be avoided for the ssame reason.

Certainly the reason for hypernatremia during the first days of life in these infant is excess of free water loss (transpepidermal), so besides plastic bags and high humidity 100 ml/kg/d free water (dextrose) is a reasonable starting point. Additional infusion of sodium,however, often cannot be handled by these infants. Therefore we have changed our infusion policy for umbilical artery catheters (formerly with isotonic sodium chloride at 0.5 ml/kg which sums up to 3.4 mmol sodium/kg/d in a 500 g premie) and now use a isotonic sodium-free mixture of sterile water and amino acids 10% (7 ml Aminovenös infant 10% + 13 ml sterile water + 12 U Heparin) which was published by a group from Kansas (Jodi Jackson et al, Pediatrics 2004;114:377) and was shown to not increase hypososmotic hemolysis. Since we have introduced this regimen we have had only few tiny preterms with significant hypernatremia during the first week of life.

Hi there, In my experience (and to my knowledge) there are neither cinicial nor scientific data that would support the use of steroids in laryngomalacia. Though all cases of laryngomalacia improve with time, the time interval is quite long (at least several months) and just waiting is no reasonable approach in patients with the most severe forms needing a tube for maintaining respiration. There are some ENT surgeons that try to stiffen the larynx by laser treatment ("trimming") and we have seen at least two patients in whom tracheostomy has been avoided by this method. Before considering surgery, however, I would repeat the endoscopy. We have seen several newborns with a prima vista diagnosis of severe laryngomalacia who ultimately went out to have alternative diagnosis (for example vocal cord paralysis (which may be difficult to be diagnosed by an unexperienced observer) or larnygotracheal cleft). Another point ist, that laryngomalacia and tracheomalacia are two totally different entities and treatments for tracheomalacia (e.g. aortopexy) are of no value for laryngomalacia patients. Would be nice to be informed on the further developemnt of Your patient. ______________________________________________________________________ Norbert Teig, MD Children's Hospital Ruhr-University Bochum, Germany