Vicky Payne

There has been a recent narrative review of cooling outside of "standard" criteria here: https://www.sciencedirect.com/science/article/abs/pii/S1355184118301595 I agree with above comments- I think given need for resuscitation at 10 mins (ventilated) and evidence of encephalopathy on clinical assessment (+/1 aEEG/CFAM) then we would have cooled on admission. We generally do not cool > 6 hrs but have on occasions, including late preterms. We had an interesting situation a few years ago where a baby ended up being resuscitated after an unplanned extubation (ex-preterm, difficult to get chest movement, difficult to intubate, long period of bradycardia and poor oxygenation) and there was a decision made to cool. What happened in your case?

I really liked this blog post! I guess many of us have seen devastating cases of post-transfusion NEC that stay with us and therefore add "bias" to our judgements on this topic. There are still questions though right? Like the severity of the anaemia (how low do we leave the Hb and is that threshold different for certain babies?), the duration of anaemia (how long do we leave it before we transfuse?) and then, if the mechanism is a re-perfusion injury post-transfusion, how do we prevent it?!

Thanks for the share- this had been on my to-listen list. The article is an interesting read as well (link below). I am interested in the Staffing Models of high performing NICUs which include: "Neonatologists rounded on fewer patients, less nurse turnover, better nurse: patient ratios and neonatal nurse practitioners rounding on VLBW infants" Definitely someone for next years line up 😉 https://fn.bmj.com/content/104/1/F13?rss=1&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A bmj%2FqEtm %28Archives of Disease in Childhood - Fetal and Neonatal Edition current issue%29

Of course! I have attached a publication of the work done at Southampton, which includes the nutritional assessment tool- I do not think there is anything there that would be too surprising, but it does mean that our late preterm/term infants do not get stuck on the same feed increases as ELBW, or really slow establishment of feeds. The nurses use this tool on Monday night shifts, ready for our nutrition ward round on Tuesday mornings. This specialist ward round comprises of Consultants, Neonatal pharmacist, Dietitian and surgical representatives. Hope it is helpful. 🙂 My question back to the group: How do people feed babies (or not!) with HIE undergoing Therapeutic Hypothermia.......??? Johnson_et_al-2015-nutritional screening tool.pdf

Hi Karsten, In Southampton, UK, we have a nutritional screening tool (high risk, medium risk, low risk) which guides us for increasing feeds. ELBW infants would be increasing between 10-20mls/kg/day of EBM. We usually start colostrum as available, then 0.5ml/ 4 hourly, increasing in 10-20mls/kg/day volumes. We are trying to start breast milk fortification at 100mls/kg/day though mostly at 120mls/kg/day. I hope this is helpful. Speed of Increasing Feed trial results later this year may also help guide practice. 🙂