Hamed

Thanks a lot @Francesco Cardona True, the freqency is 12Hz. I am with you on not to worry about developing atelectasis, hyperinflation could be a higher risk, and using Sighs could ptobably prevent atelectasis. Yes, you are correct the infant is on volume-guarantee. Thanks @Stefan Johansson that is close to what we are on 1:1 at 12Hz.

@tarek Hi Tarek, would you like to join this talk?

Hi everybody, I would like to ask about the I:E ratio in an HFO-VG setting in case of ELGANs. Do you use an I:E ratio of 1:1 or 1:2 in HFO-VG on the VN800 for ELGANs 22-23 wks below 500g BW? Also would you worry of causing atelectasis using an I:E ratio of 1:2 when the infant is on low MAPs like 8 or 9 cmH2O, Frequency of 12Hz at DOL10 ?

@Radhika Maddali thank you, yes you are correct, These are the indications and the patient developed liver dysfunction HSM, ascites in the 1st week of life as stated (these manifistations could justify useing Cytarabine treatment, if we had detectsble blast cells in the blood sample). Later on developed thrombocytopenia and coagulopathy. The main idea of concern and debate was at this stage could we treat with cytarabine in the absence of blast cells in the blood? Can we justify it? 2nd week of life respiratory distress developed requring nCPAP with FIO2 of 0.3 to 0.35.

@kathryn Beardsall Thanks for asking. Symptoms of TAM started within first week of life.

Any experience with a case of A 21 trisomy, with clinical manifestations of transient abnormal myelopoiesis (TAM) but no blasts detected in the blood? Experiencing a case of late preterm, 21 trisomy, IUGR, serologically -ve for HSV, CMV and Parvovirus infections, anemia, hepatomegaly, elevated transaminase by 10 folds, serum T. bilirubin reaching 15 mg / dl and ascites. Did this scenario justify treating with low-dose cytarabine?

In our unit, we add MCT oil 0.5 ml/feed in case of VLBWI and LBWI after reaching full feeds with full fortification if not gaining weight according to their growth curves. Special cases, if a preterm with PDA we do a mild restriction of fluids 120 to 130 ml/kg/d and increase caloric intake with addition of MCT oil 0.5ml /feed. We do not use olive oil at all, according to my understanding olive oil is a LCT, not a MCT. @agoz do you use olive oil in your unit? It would be interesting to know more about it.

@agoz this is a nice subject to discuss, thanks, In our unit if the newborn was born inhouse, we give antibiotics to patients with TTN only if there is an indication for administrating antibiotics beside TTN. i.e. TTN is not an indication per se for administrating antibiotics. However, for patients born in other hospitals or maternal centers and transferred to our unit we do administer antibiotics for 48hrs ampicillin and gentamicin until we receive culture results of no growth. @manuel perez valdez In our unit our main target of treatment in decrease WOB by mostly nCPAP (with a PEEP of 6cmH2O) or less commonly HHHFNC (with a flow of 8 L). Oxygen supplementation only to keep saturations (SpO2) within the target range for GA. If FIO2 needs increases reaching to 40% or above besides giving a nCPAP of 6cmH2O, or high pCO2 causing respiratory acidosis, we would consider Biphasic nCPAP 10/6 or NIPPV or intubation and surfactant.

Thanks a lot @HickOnACrick for sharing this case and updating us on it. I am looking forward to hear further updates whenever you can. I have a concern about initial placing a resp. distress case on HFNC less than 8LPM. Is 5 LPM the standard starting flow used in your NICU? The pressure given by the HFNC is variable, but in our NICU we usually consider it is about 1 to 1.5 cmH2O less than a nCPAP with the same PEEP figure, and thus using a HFNC of 5 L would possibly give a PEEP of 3.5~4 cmH2O. Would you please let us know how were babies nearby this case or infants cared by the same nurses caring for this one managed?

Any advice for diagnosis and management of case with Bronchopleural fistula? (and if the Bronchopleural fistula was in case of ChILD would your management differ)?

Here the government officially recommended using any type of masks a starting from 1st week of April. As for health workers, hospitals recommending using surgical masks a couple of weeks earlier, and for workers to limit the number of masks they use/day. This week putting on surgical masks in hospitals was strengthen. N95 masks and other PPEs are only to be used in our NICU if a "confirmed" COVID-19 infected mother was to give birth, which we still didn't experience, and their use are limited to the NICU members who resuscitate this newborn.

Only when showing post-extubation stridor agree with @bimalc Although, @Pototo I would like to know did you mean Racemic epinephrine (before or after extubation)?

@Lenks I do agree with @bimalc, as many of these cases are transient and seem to resolve spontaneously without any specific treatment. In case high Ca intake is suspected to be the cause of hypercalcemia, discontinuing powdered human milk fortifier or preterm formula to first stop this extra intake and closely monitor serum calcium levels without immediate further evaluation. Additionally consider temporarily discontinuing vitamin D supplementation if providing. In case spontaneous correction of serum Ca doesn't take place further invitations as mentioned above with adding renal ultrasound when hypercalciuria is present.

Routinely, we would confirm umbilical lines with a cross table lateral view additionally to the AP view. Although, in the X-ray kindly presented here I do agree with @bimalc the UVC is mal-positioned and no need for a later view. This UVC could be pulled back to be 2 cm below the level of the base of the umbilical stump = (2 cm + length of the umbilical stump) and be used as a low line = (as a peripheral line) /Or if still a central line is indicated a PICC could be placed. I would revise the need of a central line in this infant. In the scenario if this infant was just being resuscitated after delivery and this UVC was just placed in and still the area around the umbilicus is sterile, trying to replace this UVC with a new one, the new UVC will usually follow the track made by the first one. Another way is, if the opening of the umbilical vein could accommodate passing another UVC through without removing the first one, the new UVC could pass in the correct direction. A gentile pressure on the liver downwards and medialy would facilitate passing the UVC in the proper direction.

Same here in Japan, as well as in our unit in Canada, no special management for preterm infants of smoking mothers. Although we have a concern towards smoker parents when they visit their babies in the NICU, we do ask them not to smoke before coming to the NICU and to wear newly washed cloth which doesn't have smoking smell in them.