POJ

On newborns and even in fullterm babies my experience is that we too often go through the bone ending on the other side, in the muscle. While trying to prevent that, the needle will not reach the bottom and I´m happy to find I correctly reached the bonemarrow. But now I´m ending up in a new problem: The fixation stays unstable! M yguess is that the needle is too long even for fullterm babies .

We are as routine using ECG from start in monitoring even on extremely preterm babies apart from the one < GW 25. The smaller ones will du to fragile scin be monitored with ECG after a couple of days/week.

In Linköping we have developed a structure on how to do this in deliveryroom on ELBW less than GW28. It works pretty well if you manage to deal well with the logistic. Receive on the foot-end of deliverybed between the legs of the mother, put the baby in a nest covered by plastic, using a mobile Neopuff with humidified warm gas, Starting with CPAP only awaiting the respond of heartrate and spontaneous breathing, ventilating only if bradycardia, delayed cordclamping. Incubator Close to the bed, connected to mobile CPAP/Ventilator. If intubation immediate Surfactant instillation. We have planned to enhance it into all Babies less than GW32 (33?). Working on a video on it. Apart from a mobile neopuff, an incubator in Place and a mobile CPAP/ventilator you don´t need any extra equippment. But a well trained team and clear logistic is crucial (protocol). /Per

Poland?

Apropriate size for umbilical artery catheter in preterm baby less than 1000g? I normally use fr 3 or 3,5 for babys less than 750g and Fr5 for the rest unless cirkulationproblems occur in the legs. We have had lots of NEC among babies 750-1000g in this year and wonder if there is a correlation to this. What is your experience?