Dr Vira

Kindly go through the recent article from ADCFN december 2018 ( meta-analysis - hypothermia in mild encephalopathy) - The paper also mentions that almost 3/4th of UK centres treat mild HIE with cooling, but for a lesser duration of time ranging from 24-72 hours. PMID 30567775.

Thank you for clarifying.

Thanks for your reply Dr Naveed. Just one thing. In HFOV, CO2 elimination is directly proportional to Vt square X hz. So change in amplitude (vt) will affect the CO2 more than the change in frequency ( Ref - Goldsmith). Also, if we strictly go by books which I do, for RDS, the usual frequency suggested is 8-10 Hz and for obstructive physiology like BPD & MAS, it is 6-8 ( Ref - Goldsmith). I did hear one speaker in a recent forum like you, suggesting that this frequency is too low. Thanks again for the wonderful book. Regards

Dear Naveed I thoroughly enjoyed solving the MCQs. I am yet to finish it though. I have a query. Q31 . It is mentioned the right answer is increasing the frequency. But as a rule , in HFOV frequency is disease specific & not altered. In the book Goldsmith, it is written that for severe hypocarbia, amp should by decreased by 5-10 & in not so severe hypocarbia by 2-5 cm . So the most apt answer to this question might be decreasing the amp by 6? Regards Viraraghavan V Ramaswamy MD, DM (Neonatology), DNB (Neonatology), Intern Neonatology (OUH, Oslo)

Hello Stefan It is available online. http://www.pediatrics.org/cgi/doi/10.1542/peds.2013-0420. Just one doubt. Is it possible to share articles in this forum? or is there is an issue of copyright infringment? Regards

My reply is loosly based on AAPs policy statement. 1. All babies less than 1500 gms are screened after 4 weeks with Ca ALP PO4. If the screens are normal, the tests are repeated till ALP values stabilise. Screening Xray am not sure. 2. A combination of ALP more than 800-1000 IU/L & PO4 less than 4 mg/dl is highly suggestive of OOP. X Ray evidence can be collaborative 3. Treatment is by increasing the calcium & PO4 intake, either enterally or if not feasible parenterally. Normal vitamin D requirements should be supplemented. If 25(OH)D is low, Vitamin D therapeutic doses can be given. Please do go through AAP Policy statement. The chapter in Fanaroff & Martin is almost same as that of AAPs recommendation. Regards Viraraghavan V Ramaswamy MD, DM (Neonatology), DNB (Neonatology)

There is an extensive article by AAP on analgesia in newborns available in their website. All the recommendations are given there. Routine sedation is not warranted in ventilated neonates & is associated with bad outcomes (Ref- A metaanalysis which includes NEOPAIN study). An infant fighting the ventilator is most likely due to inadequate ventilation & sedation would mask away these signs & further worsen gas exchange. Rather adjusting the ventilator settings is a better way of dealing with it. Finally if you do plan to sedate, always avoid midazolam & prefer fentanyl as first choice.