AntoineBachy

Dear Colleagues and Neonatology Experts, We are currently rewriting our internal protocols regarding bacteriological screening and CMV management of maternal milk (MOM) for hospitalized preterm infants. While our primary goal is maximum safety, we are guided by the principle of non-maleficence (Primum non nocere). This creates a complex clinical challenge: how do we protect the infant from potential pathogens (infection risk) without causing harm by destroying vital bioactive and immunological components through over-processing (nutritional/developmental risk)? Furthermore, we must avoid the harm of unnecessarily discarding precious breastmilk—a practice that exhausts resources and can lead to "pumping fatigue," discouraging mothers from continuing their lactation journey. We have observed that practices vary widely between centers and countries, often based on historical habits rather than robust data. We are seeking a secure yet pragmatic solution and would value your insights on the following: Patient Selection & Duration: Do you perform systematic bacteriological controls on MOM for specific populations (e.g., all VLBW, or only those <28 weeks, none of them)? For how long do you continue these controls (e.g., until a specific post-natal age)? Frequency & Uncertainty: How often do you test the milk (weekly, every batch)? More importantly, how do you manage the "window of uncertainty" between controls? Bacteriological Thresholds: How do you pragmatically define "acceptable" milk? The CMV Challenge: For CMV-seropositive mothers, do you mandate Holder pasteurization? If so, for which gestational age groups and for what duration ? Resource Management: How do you ensure your protocol doesn't lead to excessive milk disposal or discourage the mother's involvement? We look forward to hearing about your center's experience, the evidence-base you utilize, and how you navigate these "grey areas." Thanks in advance for your valuable contributions.

Any sign of dysautonomia (temp control, Heart rate, ...) or hirschprung ? Hypercapnia? Would consider Ondine syndrome in DDx Bookshelf_NBK1427.pdf

does anyone have experience on bumetanide in anuric neonatal AKI, non responding to furosemide ? is there any gain/side effect compared to furosemide ? thank you in advance for your comments

PCR on dried blood spots from neonatal screening if available but low sensitivity hearing test...

Hi everyone, I would like an update on this topic 😉 Have you heard about more accurate point-of-care glucose measurement devices? Any experience with Nova StatStrip or other device? Regards Antoine

Hi everyone ! CMV controversy again - who performs systematic CMV screening in pregnancy? - does anyone give antiviral drug (valaciclovir) during early pregnancy in case of maternal primary infection, in order to prevent vertical transmission? https://www.sciencedirect.com/science/article/abs/pii/S0140673620318687?via%3Dihub

Thanks for nice video and sharings. We were recently looking back to our less than 26 weeks population. Unfortunatly we have to confess that only a few finaly managed without invasive ventilation at some point (eventhough they recieved LISA or INSURE). We have undoubtely much better results with LISA in the 26-28 weeker population. How do you succeed to avoid invasive ventilation even in the smallest children? Could you share your "golden hour" management protocol? Do you have tips in order to keep constant CPAP pressure anytime during this period (transfer, ...)? Do you have readings to advice? thanks in advance for sharing experiences

0.2 mg/kg seems to work well (but based on our small experience ...)

We use mivacurium for semi-elective intubation.

thank you for your reply. despite feeling powerlessness i'm not alone stay safe, stay strong!

What about outborns? Do you have special protocol for referrals or for aEEG evaluation ? Do you use other criteria than those for hypothermia inclusion (lower thresold)? Do you use other tools (further ABG; telemedecine, ...)? It seems to me that we sometimes miss opportunities for cooling when babies are in referring units and that the neurologic evaluation (according Sarnat or Thompson score) is made by less experienced people. aEEG is sometimes not available there and you don't have access to the clinical status of the patient. last case: spontanous labour, term baby, vaginal delivery, meconium stained liquid APGAR 1-5-7 - Mask ventilation less than 5 min (no intubation, no chest compression) cord gas 6.92 BE -20 lact 14 mild resp distress - CPAP according to physician : no sign of encephalopathy (thompson score 1 - sarnat 1) seizures at 10 hour of life - pheno/pheny/keppra/midazolam bilateral basal ganglia lesion on MRI but unfortunatly not referred for hypothermia... thanks for your experiences

To Ingrid de Jong Which device do you use to provide cpap (and where is the delivered pressure maesured)? Do you use it for nasal ventilation ? How do you manage secretions/nasal succioning with the tape? Don't you have skin trauma with the tape. I'll be more than happy to try this way of delivering cpap

We usually don't use any sedation for LISA. If the baby is big and vigorous, I prepare some remyfentanyl and use it only if needed.

We do see sometimes such reversed pre/post ductal saturations in our NICU in children without any heart defect. It is usually below 5%. Unfortunately I haven't find any explanation yet.

Hi everyone, I would like to get some enlightment on pratical aspect of the metabolic bone disease of prematurity or neonatal osteopenia. I have tried to find some reviews but I must confess that, in clinical situation, i am sligthly lost. - Do you perform systematic screening? To whom? How? - How do you diagnose this condition? Based on x-ray, ALP, Ca / P serum, urine Ca / P? - How do you treat? For how long? How do you monitor treatment? and... do you have a nice guidelines for dummies? 😉 Many thanks in advance. Antoine

Excellent topic again! A lot to discuss about. In the same vein, do you have skin-to-skin experiences when your mom is in ICU? that she is in a state of coma? We do practice skin to skin but adult intensivists are not very sensitive to these practices and are anxious about the risk of infection (multiresistant bugs). Do you have knowledge of any articles in this regard? Many thanks in advance for your comments, thoughts and opinions.

Many thanks to all of you. Those informations are of huge value. I couldn't have find these in any review or article. I never heard before about Biatin Alginate or sodium chloride cleansing for example. I feel also better to kwow that i'm not alone to be in trouble with skin care in those baby's 😉 There is nevertheless already many publications on this subject (e.g. some uses chlorexidine 0.2% with good results for < 26 weekers http://fn.bmj.com/content/103/2/F97) but i couldn't find anything on sodium chloride cleansing or general skin care (e.g. ECG leads, SpO2 probes, NIRS). Does any of you have any reference that i could submit to my team? I would anyway be pleased to read or even to modestly participate to an RCT (multicentric i guess due to the small number of those tiniest baby). regards Antoine

We recently had unpreprared 23+6 twins who suffered severe skin lesions due to electrode pads. We had to completly remove those for few days. They also had skin burns from antiseptic chlorexhidine prep (which is unfortunatly well known). What are your protocol or tips for managing skin care of the extremly preterm infant? Thank you in advance

we also plot them on fenton growth charts. Has any of you experience intergrowth charts?