Nathan Sundgren
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Less Invasive Surfactant Administration Tips
Nathan Sundgren replied to Nathan Sundgren's topic in resuscitation
Do you have a max weight? We tried on a larger baby over the weekend and encountered more difficulty probably for multiple reasons. Is there a weight you have found that is too big for this procedure (assuming they are truly surfactant deficient)? -
Less Invasive Surfactant Administration Tips
Nathan Sundgren replied to Nathan Sundgren's topic in resuscitation
@Florian I would love to use the catheters you are talking about, but they are not available in the United States. I specifically spoke to a Chiesi rep and they don't see making the effort to get FDA approval here anytime soon. @M C Fadous Khalife Glad you liked it. -
Less Invasive Surfactant Administration Tips
Nathan Sundgren replied to Nathan Sundgren's topic in resuscitation
Thanks for the feedback @dj 188 and @Tamimi . We do have clear guidelines on pressure settings and we are targeting above 30% FiO2 to make sure the surfactant is early rescue and not late. I have not wanted to necessarily limit weight or GA, but we recognize the biggest benefit is likely in the <1500 gram, and technically easiest in something larger than the sub 500g babies. I too wish we could get the surfcath. Drawing the line on the angiocath is my least favorite part of the whole thing. -
So I've seen LISA done once, I've now done it once, next is to roll it out unit wide in our NICU. See one, do one, teach one, right? I'd like to hear from those of you that have been doing LISA/ MIST for a while now. What is the best tip you have? What do you know now that you wish you had known when you first did LISA? What barriers to implementation did you have when you started? Any feedback is welcome. Also, I made a video for our nurses and respiratory therapists to just introduce the idea. Not too in depth, but something to get our education rolling. See what you think.
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Steroid Treatment - How many times is too many?
Nathan Sundgren replied to ali's topic in drug treatment and analgesia
Tough question, but something we see in various shades of similar. I would personally try the 2 rounds of steroids as in the scenario, but I would strongly hesitate for a third. I would probably tolerate a lower sat goal to keep the baby off 100% oxygen, fluid restrict more, and then wait. Grow, grow, grow. If I had to intubate (for whatever reason I "had to") I think I would focus on growth for several weeks before possibly trying the third round of steroids to extubate again. This is, of course, based on as little EBM as I can imagine, and faced with the actual circumstance I would probably -
https://journals.lww.com/pidj/Abstract/9000/INTRAUTERINE_TRANSMISSION_OF_SARS_COV_2_INFECTION.96099.aspx A case report of likely vertical transmission as well.
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Sorry. The link does not work for me.
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Final video version now public on YouTube. Please share with interested colleagues.
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@olamedmac what a privilege to have you respond to this thread. Thank you. I will definitely make some revisions based on your suggestions. I was nervous about the Aristotle quote, since his work is all Greek to me, but I thought I had it from a reputable source that it was true. Your suggested quote is many times better. I really thought I had the Erasmus - Charles Darwin connection correct, but I should have double checked my facts there, too. I will also fix this. As you said, deciding which articles to include does get tricky as I was really working hard to keep the video to 15-20 mi
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I wanted to let the 99nicu community have the first look at my latest video. It is based on a ground rounds talk I gave on delayed cord clamping several months ago. I updated it and added lots of animation. You can find the video by following this link: https://youtu.be/6qA3CVGp5Sw The video is not public, meaning you can not search for it, but you can follow the link to view it. I'd appreciate any thoughts on the video, especially mistakes you see or if you felt anything I said was misleading about the evidence. Post your comments to this forum and I will respond. I'm hoping to make the
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A big thanks for sharing. I hope it is helpful to many of you. Follow the You Tube channel - TexSun NeoEd - if you like it. You never know when I might put something else up.
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We talk about it. I want to get there, but one not so great experience makes me hesitant. If we are doing INSURE in our delivery room, I don't think it is practical enough and leans more to emergent in those cases. But if we are admitted in our unit, then I think it is the best. I'm convinced its better for babies getting intubated in general, but not consistent in my practice yet. FYI, we don't routinely use muscle relaxant and our standard is atropine and fentanyl.
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I am not aware of any research on this specific subset receiving DCC. I think the problem is well put by Alex Scrivens above. If the placenta is detached from the uterus and oxygen supply is gone, we cannot leave an asphyxiated baby for 60 seconds with no resuscitation effort. Might they still benefit from the volume transfusion from the placenta? Maybe, but then our only option is to be scrubbed in with the OBs and resuscitate on the intact/ open cord. The data for this is intriguing, but I am not sure it is ready for wide spread adoption. The other situation is where there was an abrup
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This is an interesting dialogue. I just had a long disuccussion about fluid management from the delivery room with our neonatal response team nurses. They see quite a bit of variability from our physicians. When we talk about fluids on the first day, we are usually thinking of so much more than just the dextrose/ nutrition containing fluids. We have to consider the "to keep open" fluids running in additional lumens of our UVC and UAC lines. Premature babies are often on antibiotics the first 2 days. Some get saline boluses or blood products. It is very easy to give 20-40mL/kg/d of fluid above
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We also start on AC-VG. We bring the ventilator into the delivery room and once intubated, get them on to volume ventilation and avoid as much t-piece or bag ventilation as possible. Initial settings are PEEP 5-6, 4-5mL/kg tidal volume, back up rate of 40, and iTime 0.3. We set PIP max at 3-5 cm H2O above the working PIP on the ventilator for the set tidal volume. If PIP to achieve these volumes is going above 28 or we are unable to make our target CO2 (50-70), we switch to HFOV. We are probably pretty quick to go to ECMO if needed, but we also have a fetal center doing fetal endoscopic trache
