ali

Truly well deserved, an absolute pleasure to have been an ANNP student under Vicky’s tutelage. 🥰

Good afternoon 99ers, With a more focussed approach to starting Fortifier, we are encountering the challenge of adding Anti Reflux (AR) (alginate) supplements at the appropriate juncture. Does your Unit add Fort & AR in the same feed or do you work out a feeding regime that keeps these supplements separate? How early (ml/kg/day) are you introducing Fortifier? Thank you for your thoughts/opinions All the very best Al

Many thanks for all your responses, wide variation in approaches. 👍 Ali

Hi 99ers, Who delivers Chest Physio to your population. Is it provided as ad hoc provision by the Nursing team or on a more formal basis by Unit Physios. In particular I would be keen to hear from my UK colleagues. Many thanks Ali

Hi 99ers, Do you regularly use Budesonide nebs in the preterm population? If so what guides your use ( FiO2, mode of support, CXR changes ) and if so what is the length of the course (days or weeks). Not sure the evidence is there but it is becoming more prevalent. Thanks, have a good weekend 👍 Ali

Hi everyone, Very much appreciate if anyone can share a Unit guideline on the making up of SMA fortifier, particularly to improve the consistency without over mixing and damaging the breast milk. Feel free to respond here or message me. Thanks Ali

Hi Kedar, would you mind highlighting the literature you refer to. I am curious as we tend to continue TPN until we reach 120ml/kg of enteral feed. Many thanks Al

Hi Emily, are any UK units currently using the Concord platform? Thanks Ali

Fantastic Paper, Fantastic Title 🙂thank you Pototo!!

Hello everyone, Within our tertiary centre we are becoming increasingly aware of the challenges of hypophosphatemia and Vit D supplementation in our ELBW. Would anyone be kind enough to share their experiences and/or guideline in regard to MBD? Many thanks 99ers Alistair

NAS !! I've been thinking a lot about NAS!! No, not Lil NAS X (although lime green scrubs.....) but SSRI/SNRI NAS 🙂 We are experiencing more admissions of infants being scored under the NAS (Finnegan Score) for maternal SSRI/SNRI use, but is this really the most effective scoring tool to use?. Would really like to hear other members thoughts and experiences on this topic, and what pharmacological approach is being administered? All the best Al

Hi 99ers, Those LBW preterm infants with PICC lines for parenteral fluids, do you perform routine CRPs/infection markers in the otherwise well appearing infant? Many thanks Al

Hi Everyone, Regarding Golden Hour, if IV access is proving difficult would you consider IM Abx to ensure they have been given within the hour? Thanks Al

Hello everyone, We have recently taken delivery of SLE6000s and with them the ability to deliver nasal HFO. I would be extremely grateful to hear from anyone who has experiences of its use, any issues, the type of respiratory physiology it suits, size of infants etc. Many thanks Al 😊😊

Thank you Stefan. A Happy & Safe 2022 to you and all the 99ers around the globe, as well as the infants and families that we have the privilege to support. Best wishes always Alistair

Hello 99ers, I have recently encountered a difference of opinion as to the factors that dictate the approach to removal of chest drains. One train of thought is that when there is no bubbling or swinging then clamp leave for a period of time, CXR and blood gas and then remove. Another is to simply clamp, leave for a set period of time and if the infant remains clinically stable then remove. Also do you have a set approach of using pig tail or straight as first line use for air leak? Appreciate thoughts on approach and any evidence to support. TIA. Many thanks Alistair

Dear 99ers, I would be interested (perhaps even worthy of a Poll) to find out if when an infant is on the DART regime whether clinicians lengthen or tailor the course of Dexamethasone (a longer tail so to speak), and what influences that decision (ie a 2nd course, X ray changes, FiO2). Thank you for your thoughts and opinions. Take care, and fingers crossed for COP26. We are all working hard to improve the outcomes for the coming generation - let’s hope they display a similar commitment 🤞 Best wishes Al

Good morning 99ers, I would be extremely grateful if anyone has experience or a protocol on the use of anakimra in neonates. Thank you Al

Hi 99ers, Following completion of aEEG tracing how are you storing the information. We used to physically download onto disc, but with onset of flash drives wondered how it was now being stored given it’s potentially Medico legal ramifications. TIA. Please keep safe. Kind regards Alistair

Hello Everyone, A shout out to any Units that utilise a Neuro Care Bundle for your extreme premmies and/or HIE. Would you be kind enough to share or send me a PM on your approach please? Many thanks Alistair

Hi Everyone, Given the infants remain servo controlled in either jacket or mattress and central lines can be visualised (provided no coagulopathy) it seems extremely harsh to ask a parent to not be able to hold their child for almost four days (if you include rewarm period). A study into aEEG response to cuddles might reveal some interesting results?? https://pubmed.ncbi.nlm.nih.gov/30721531/

@Andrej Vitushka, @Vicky Payne, Hi, we don't have NIRS, but there is clearly a growing interest in it's validity and use in HIE & TH (neurodevelopmental prognostication) and end organ perfusion in the face of a HsPDA. One of our Consultants is keen to examine it's use on the Unit. We have gone full circle and use Transcutaneous monitoring on most of our babies, including Transport, it had gone out of favour (for no valid reason) in the face of EtCO2 capnography. I am sure the circle will turn again🙄. Kind regards Alistair

Hi 99ers, Although as a Unit we have an extubation guideline that needs to be observed prior to extubation I am intrigued to know if a guideline or list of interventions attempted (increase of CPAP pressure, maximum FiO2 requirement, CO2, permissive hypercarbia) before the decision is made to reintubate. Many thanks for your thought and opinions. Please all stay safe. Best wishes Al

Many thanks for the link. Kind regards Al 🤗

Hi Bimalc, I have messaged you. Thanks Alistair