juan carlos vidal

Dear colleagues, I fully agree with the initial reflection. We are facing a population of premature infants that challenges established paradigms and forces us to be more analytical and less dogmatic. The heterogeneity of this group is such that generalizing or applying evidence from populations of a higher gestational age is, at the very least, risky. The lack of a clear consensus, and the observation that world-renowned reference centers achieve excellent outcomes with disparate ventilation strategies, puts us in a complex yet interesting position. It pushes us toward what many have mentioned: the importance of benchmarking and, fundamentally, of building our own solid and measurable experience. Faced with this reality, in our unit, we have opted for an approach based on prudence, accumulated experience, and, above all, on building our own evidence. I wanted to share our current protocol to help enrich this discussion: Our approach is structured as follows: Initial Management in the Delivery Room: We proceed with elective intubation in the delivery room to secure the airway and optimize the transition in a controlled manner. First Phase of Ventilation (Day 1): We begin with Conventional Mechanical Ventilation (CMV) in SIMV mode with Pressure Support and Volume Guarantee (VG). This modality allows for a safe initial adaptation, letting us closely monitor lung mechanics and ensure a consistent tidal volume. Transition to HFOV: Once the patient achieves satisfactory cardiorespiratory adaptation and we consider the most critical phase of the transition to be over, we proceed to switch them to High-Frequency Oscillatory Ventilation (HFOV), also with the Volume Guarantee (HFOV-VG) option. With this, we aim for a more lung-protective strategy for the subsequent phase. This phased approach allows us to manage the initial transition with a modality that our team masters and feels confident with (CMV-VG), and then to capitalize on the benefits of HFOV once the patient is more stable. We understand that this is "our" current path and it is under constant evaluation and analysis of our outcomes. We do not claim it to be the only valid one, but rather wish to contribute our experience to this much-needed discussion. It would be extremely enriching to learn about the strategies being implemented by other units. What approaches are you following? Have you had different results with other ventilation protocols? vafo vg preterm ingles.pdf

Thank you all for your input on this topic. My question revolves around the current guidelines and practices for pharmacological closure of a patent ductus arteriosus (PDA). We understand that prophylactic, early, or asymptomatic pharmacological closure offers no benefit and can even be detrimental. However, recent meta-analyses suggest that treating a PDA with hemodynamic clinical signs before 14 days of life increases both mortality and the risk of bronchopulmonary dysplasia. This evidence seems to point towards a scenario where pharmacological closure might never be indicated. Given this, I'm curious: In your units, what is your approach when managing an infant under 28 weeks of gestational age , specifically between 3 and 14 days of life, who presents with both echocardiographic evidence and clinical signs of a hemodynamically significant PDA (hsPDA)? It feels like the current data leaves us in a challenging position regarding the optimal timing and indication for pharmacological intervention. Any insights into your unit's protocols or recent experiences would be greatly appreciated.

Hello everyone! I'd love to hear your thoughts on the management of hemodynamically significant patent ductus arteriosus (PDA). This new article and its recommendations have left me with many questions. before the releae of these news recommendation , in our service, we only treat hemodynamically significant PDA within the first 7 days of life, primarily in patients under 28 weeks' gestational age. We know that the efficacy of medical treatment drops significantly after this age. Our approach is to opt for surgery only if the PDA doesn't close after two series of medical treatment, and we try not to delay the surgical intervention too much. I'm very interested in learning about your management strategies. jamapediatrics_buvaneswarran_2025_oi_250021_1747406474.87605.pdf

Hello group, We continue discussing in our hospital when we would have to suspend phototherapy, According to AAP 2 to 4 mg/dl below the threshold value of the day of start of treatment, this could be good as a reference for patients older than 48 hours, but If we take patients who are admitted within 24 hours of life with values of 8 to 10 mg/dl, not so much What strategy or what values do you use in your hospitals to discontinue phototherapy?

Hello group, someone has it protocolized, could you upload it, or comment on how you do it, nebulize puff dose, time. A local treatment rather than a systemic one proposed by DART would seem interesting.

HELLO GROUP, I TALK ABOUT WHAT WE DO, FORTIFIED HUMAN MILK PROVIDES APPROXIMATELY 0.5 A 0.8 G OF PROTEIN EVERY 20ML, WE TRY TO LOWER THE PROTEINS OF THE NPT SO THAT THE TOTAL CONTRIBUTION OF PROTEINS BETWEEN ORAL VIA AND NPT DOES NOT ADD MORE THAN 4MG, THE SAME WITH THE FLOW OF GLUCOSE AND LIPIDS, WE SUSPEND NPT WHEN THEY REACH 100ML/KG THROUGH THE ORAL ROUTE. AND WE COMPLETE THE CONTRIBUTION WITH A PHP OF GLUCOSATE.

Hello group, very interesting how the care of premature babies in Japan is presented, surely with a lot of experience and very good results. I really liked reading the experiences of other nicus and doing a benchmark and getting new ideas. It really caught my attention how they emphasize glycerin enemas. Does any of you do it? Could you tell me your experience?

thank you very much, I feel very identified with your words, from the literature to the patient's bedside there is often an abyss, and often there are no diseases but only patients and their circumstances. equally, evidence is the best tool we can have, but we have a lot to learn from these immature children

hello to the group, we need opinions on the hydro-electrolyte management in children under 28 weeks. we have problems to regulate the weight loss and not to exceed in volume. What volume do you start with? How much weight loss do they tolerate? How much sodium do they provide in this first week? How do you manage patients with high diuretic rhythms that give basal needs greater than 200 ml/kg ? do you replace it ? When a patient loses more than 15% of weight, what strategies do you use to regain it? thank you very much

hi sujatad. i tell you from my experience, in the mode of hfov + vg in drager ventilator. in this mode the idea is to set frequency (according to compliance) and Mean airway pressure, the ventilator varies the amplitude. to reach a preset tidal volume (1. 5 ml/kg), ventilation in this modality is equal to fr * vt (amplitude)², where both frequency and amplitude increase the minute volume, but as the amplitude is exponential there is a moment where the frequency increase shortens the inspiratory time so much that the amplitude does not reach the set value, and at that moment it is more efficient to lower the respiratory frequency. you see this because the dco2 decreases and it is not modified with amplitude increase. So, in very premature patients with short time constant, you can use this modality as lung protection, as long as you agree to tolerate permissive hypercapnia, since with a minute volume between 1.5 and 2 /kg it will be just right. you start with the highest frequency that allows you to maintain a constant tidal volume (approx 1.5 ml /kg) with the lowest amplitude. each ventilator has a different power, in the drager you can use frequencies in very small preemies from 12 to 15 hz. Therefore, it is a relative truth, since there will be times when the increase of the Fr lowers the PCO2 and other times when it increases it.

hello group, I would like to know how your institutions deal with the administration of iron after transfusion.

thanks for the articles, my idea is to use the canula ram in the delivery room and as intra hospital transport, I read in other articles that need to use higher pressures to reach a cpap effect in the larynx, approximately 7 / 8 to reach 4 / 5 gracias poto por los artículos.

Hello everyone, could anyone share their bibliography or their experience in the use of ram cannulas?

hello thank you very much for answering me, the population are patients under 1000gs who for sepsis, nec, dap remain with npt for more than 10 days what strategy in the npt assembly with respect to lipid glucose proteins can prevent cholestais, and even during cholestasis that npt could use

Hi everybody how are you Lately we are seeing an increase in neonatal Cholestasis associated to parenteral nutrition, they could help me with some strategy to prevent it. thank you the population are patients under 1000gs who for sepsis, nec, dap remain with npt for more than 10 days what strategy in the npt assembly with respect to lipid glucose proteins can prevent cholestasis, and even during cholestasis that npt could use