lukaswisgrill

Hi Gustaf, We do it not routinely at our wards, but we did it quite recently in an extreme premature infant with a corrected age of 35 weeks. We found it quite helpful and we were able to reduce the blood sampling. We did it together with our pediatric diabetes team. They have a lot of experience with such devices, but not infants. So it was quite tricky for us how to handle low and high alarms, so they wanted always a blood-based control if the sensor showed an alarm in both ways (I think it was <50 mg/dl and 200 mg/dl) - sometimes this occurred 4-6 times a day. Overall, I think it was positive for the baby since we could reduce the blood draws. However, in some low alarm cases, the sensor and the blood draw results were not comparable (even lower or sometimes higher). From my perspective, CGM is an innovative and promising technology that offered us some advantages in this case. Nonetheless, I advocate for a cautious approach towards its routine use in neonatal care, given the limited studies and practical experience in this specific cohort. I am curious to learn if others have integrated CGM into their regular neonatal care practices and would greatly appreciate insights or experiences from those who have. I would also like to hear some reports! Best, Lukas

Hi, according to your patient history, it is not really possible to diagnose cCMV. If you have DBS and it is positive - fine - you got it, but you also have a chance that it is false-negative (Sensitivity about 84%, but this seems to be highly variable depending on the lab technique, etc.). A urine sample within the first 21 days (better 14d) would be the optimum. Maybe this reference can help you a little for the future: https://pubmed.ncbi.nlm.nih.gov/29140947/ The hearing test would be interesting as mentioned previously - any update from the patient?

Dear 99ers, I would love to hear your different guidelines/approaches/opinions on perioperative antibiotic prophylaxis in preterm and term infants. This is something i would definitely like to improve in our institution. So far, I found no real evidence or guidelines, especially for premature infants. I know various approaches from different departments in Austria, but it would be interesting to have a more international view on this topic. Every comment/reference/expertise on a certain part of this topic (e.g. AB-prophylaxis for cardiac patients, premies, gastroschisis, etc.) is helpful to gather information on this relevant topic. Do you change the regimen also for chronological age? (e.g. < 72 hours after birth and >72 hours after birth). Do you take MRSA colonization into account - other colonizations as well (e.g. ESBL colonization in the gut when operating on the gut itself?). Your help would be highly appreciated! Best, Lukas

Might be an interesting approach, at least for EOS (https://pubmed.ncbi.nlm.nih.gov/30169482/). We currently have the 48 hours EOS scheme for both, preterm and term infants....hope to reduce the hours of unnecessary antibiotics soon. Concerning the vote: I would not even start antibiotics if an infant is well and asymptomatic (except there are red-flags in the patient history and elevated laboratory parameter - we for example use CRP+IL-6) 🙂 I like the perspective from Joseph Cantey on this topic as well: https://pediatrics.aappublications.org/content/140/4/e20170044. I'm always wondering that everybody talks about EOS, but I'm much more concerned about LOS....would you do the same in an 600 gram infant at 25 weeks GA at the 9th day of life with suspected sepsis and negative culture at 36 hours?

Hi, your story and setting sounds quite good. We don't use the Drager, but we use the Accutronic "Fabian" with HFOV + VG and it works great - especially for ELBWI. To me personally, the settings are quite low and I would attempt to extubate the baby (but I don't know any other facts - just from your respirator settings). We never go above 15 Hz in our center (as far as I know), so I cannot help you with that answer .... but I would interpret it as a sign - if you thinking of more than 15 Hz --> extubate ;-) But it is an very interesting question, maybe we get a good answer and learn something today!

Hello 99ers, how is your experiance with iNO via nCPAP in premies? Do you use it at your ward? We got some good and bad experiances at our Department and i would like some unbiased experiances/opinions from your side before i tell our stories 😀 Best, Lukas

different feeding regimens- How much and how fast/slow, gastric residuals