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A cordial greeting from Ecuador. I would like to know if anyone has experience with the simultaneous administration of budesonide and surfactant to decrease the incidence or severity of bronchopulmonary dysplasia. Sincerely, Fernando Agama C. Neonatology Unit Enrique Garces Hospital Quito, Ecuador

At our institution, after initial stabilization and resuscitation, we use pressure-triggered nIPPV at relatively high rates 60 per minute or higher, maintaining a 1:1 I/E ratio, with variable PIP, according to chest expansibility and blood gases, and PEEP of 6-7. Later we went to CPAP according to the evolution in the following hours. We also used RAM cannulae with the spouts fixed with hydrocolloid tape around the nasal grits.

Good afternoon, a cordial greeting to all. I would like to ask if anyone knows of any application to calculate the humidity of neonatal closed incubators that runs on an android or windows operating system. The one we know of is from Dräger and runs only on the iOS operating system. Thanks in advance. Sincerely, Fernando Agama C. Unidad de Neonatología Hospital General Enrique Garcés Quito-Ecuador

Please, I would like to know what experiences you have with the use of erythropoietin to treat perinatal ischemic hypoxic encephalopathy. Sincerely, Fernando Agama C. Unidad de Neonatología Hospital Enrique Garcés, Quito-Ecuador

It is evident that intubation generates a feeling of discomfort in the child who undergoes this procedure. For the method IN.SUR.E. We started using fentanyl, but the results were not good. Currently, we are not using any medication for that procedure, although we are aware that the procedure is annoying for the baby. Fernando Agama C. Unidad de Neonatología Hospital Enrique Garcés Quito-Ecuador

Yes, HFOVn. In our medical service, we have not yet begun that experience. But we have some interesting references: Yoder, B., Albertine, K. and Null Jr., D: High-frecuency ventilation for non-invasive respiratory suppert of neonates in Seminars in Fetal & Neonatal Medicine, xxx (2016) 1-12 (in press). Mukerji, A., Singh, B., el Helou, S., Fusch, C., Dunn, M., Belik, J. and Shah, V. Use of Noninvasive High-Frequency Ventilation in the Neonatal Intensive Care Unit: A Retrospective Review in Amer J Perinatol 2015; 32(02): 171-176.

Best regards from Ecuador. I wonder who has experience with HFOV noninvasive Fernando Agama C. Unidad de Neonatología, Hospital Enrique Garcés, Quito-Ecuador

Hello, warm greetings from Ecuador. I consulted about the practical utility of Near-Infrared Spectroscopy (NIRS) in monitoring and surveillance of children hospitalized in the NICU. Sincerely, Dr. Fernando Agama C. Neonatología del Hospital Enrique Garcés. Quito-Ecuador

Thanks for responding for all. Unfortunately there is no intravenous cotrimoxazole Ecuador. Any experience with the oral preparation? Atentamente, Fernando Agama C.

Hello, an affectionate greeting. I would like to know if anyone has experience with the use of Sulfamethoxazole + Trimethoprim in newborns. In our NICU we have a blood culture which grew Stenotrophomonas Maltophilia that is sensitive to this product. Sincerely, Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Hi all, a friendly greeting. I wonder what their experience with handling oxygen therapy with high flow nasal cannula at any neonatal respiratory disease as transient tachypnea of the newborn, hyaline membrane disease, pneumonia and meconium aspiration syndrome. Sincerely, Dr. Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Thanks for taking the time to respond. We have also come to use the 0.9% saline Similarly, our best wishes for a Merry Christmas and a better 2013. Sincerely, Dr. Fernando Agama C. Unidad de Neonatología. Hospital "Dr. Enrique Garcés" Quito-Ecuador

Hello, a warm greeting. I would like to know if anyone has experience with mucolytic medication to manage excessive bronchial secretions in a newborn. If so, what mucolytic used medically? Sincerely, Dr. Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Hello, a warm greeting: Thanks for taking time to respond. Actually, if we used milrinone in infants. But I had heard that the drug levosimendan was very effective for older pediatric patients, particularly those undergoing cardiac surgery. Sincerely, Dr. Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Hi, thanks for taking the time to respond. 1) This machine has given cycling problems? 2) They have had problems with hoses circuits? 3) What type of humidifier use? 4) What ventilaciíon Modalities of use more often? 5) How about control tidal volume during HFOV?

Hi all: I would ask if anyone has experience treating cardiogenic shock or heart failure in infants with levosimendan. Sincerely, Dr. Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Hi all: In our Neonatal Unit We have a new Babylog VN500. Someone who has experience with handling? Thank You. Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Guadalupe (“Lupita”): She is a two and half moths old baby, Who was born in our Hospital “Dr. Enrique Garces” located in Quito Ecuador on November 06 of 2011, product of the second gestation to a healthy mother of 27 year old and a father of 34 years of age, both with no significant medical history records but apparently they are distant cousins. Our patient, initially, presented following an uncomplicated delivery weighing 2000 g, height: 42 cm and a good Apgar score (7’ – 8’) and good adaptation to the extrauterine environment; at the age of 48 hours the newborn presents hypotonia, poor respiratory effort, and hypoxemia that required ventilatory support. Laboratory work up and radiographic evaluation initially suggests an intrauterine infection such as pneumonia, so antibiotic treatment was started. But since then after several attempts to weaning the mechanical ventilator all failed. Despite the infectious process was controlled, metabolic disorders were ruled out, STORCH was all negative, neurologic evaluation was normal, TAC with no abnormality, we have the strong suspicious that our patient got Ondine's syndrome also called congenital central hypoventilation syndrome (CCHS) or primary alveolar hypoventilation, because we notice that the apneas are present when she fall sleep deeply on a sleep stage REM, and all respiratory functions decline dramatically, presents hypoxia, the pCO2 reaches very high levels (over 70 mmHg) without any patient response; at that moment is when the patient needs ventilatory support. This way Lupita has been living this two and half month with chronic ventilatory support….. The diagnosis was purely clinical and by exclusion. In our country not available genetic testing. Dr. Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés Quito-Ecuador

Kind regards to all. In the NICU of our hospital in the city of Quito, we hospitalized 72 days for a girl who have diagnosed a Congenital Central Hypoventilation Syndrome (‘Ondine’s curse). Almost every day of his life has been connected to a mechanical ventilator. We want to know if anyone has any suggestions as to its management. Sincerely, Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Thanks for the information. We hope it is useful to us. Sincerely, Dr. Fernando Agama C. Unidad de Neonatología del Hospital "Dr. Enrique Garcés" Quito-Ecuador

Greetings to everyone. In a Neonatal Unit of my country, Ecuador, in the city of Guayaquil, a septic outbreak has occurred caused by multidrug-resistant Serratia marcescens. Any suggestions for handling and treatment? Sincerely, Dr. Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Hello everyone. I am writing to ask if anyone has experience with handling maldextrin as a nutritional supplement for preterm infants. Sincerely, Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

All I can say is that you are very lucky. Fernando Agama C. Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito-Ecuador

Hello, a warm greeting to everyone. I would ask if anyone, anywhere, has experience with handling of the new mechanical ventilator for newborn of Dräger: Babylog VN500 Thanks Fernando Agama Cuenca Unidad de Neonatología Hospital "Dr. Enrique Garcés" Quito - Ecuador