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Akash Sharma

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About Akash Sharma

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    AIIMS New Delhi
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    New Delhi

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  1. @kstempn and @livesynapseWhatever the amount of intake may be (even as low as 10-20 ml per kg) the intake has to be accounted for in the total daily intake. ( for fluids as well as for calories) If you are using a milk analyzer the amount of calories and proteins being administered can be adjudged accordingly. Otherwise a standard calorie intake of 65 cal/100 ml for breast milk can be taken. We have our own unit data showing lesser calories so we take that. Hope this helps.
  2. Though there is a protocol in place to premedicate with fentanyl for elective intubation and INSURE in the unit, not really sure how to go about it if the baby does not have a iv line in place and requires surfactant but not iv fluids. Most of our babies would be started on full feeds if there are no contraindications(aggressive enteral nutrition). Should a iv cannula be inserted for administering analgesia before INSURE!? and then removed.
  3. Thanks for sharing your views @Stefan Johanssonsir. What growth charts does your unit follow for extreme preterm and very preterms as norms. I would like to cite the article by Villar etal for the purpose of discussion about what postnatal growth standards to follow for preteen babies. "Villar J, Giuliani F, Barros F, et al. Monitoring the Postnatal Growth of Preterm Infants: A Paradigm Change. Pediatrics. 2018;141(2):e20172467. doi:10.1542/peds.2017-2467". Even after the Intergrowth 21 data the growth of less than 32 weeks babies still remain unanswered. By selection of an appropriate comparator only one can conclude whether increment in calorie and protein intake should be done or not. Currently we use Fenton's charts for the same. (which I feel isn't the right way to about it)
  4. It is not uncommon to have extreme preterm babies being under weight and stunted at 36 or 40 weeks PMA. Our standard of care for postnatal nutrition has traditionally been to provide nutrients which matches fetal accretion rate. But is it really wise to give the same quantity of nutrients. Preterm birth and exposure to postnatal life in itself would cause epigenetic changes in how a neonate shoudl. Metabolize and assimilate the nutrients administered. So what really constitutes as EUGR. Is it only the 10 th centile at 36 weeks and 40 weeks PMA or is it standard deviation scores below expected (like 1SD below the 10 th centile - considering that some amount of postnatal growth restriction is acceptable and expected due to the loss in the first 2 weeks ) For us its a complex issue of allowing the neonates to grow at their own centile (even below the 3 rd centile) as providing excess nutrition for catchup might result in more fat mass instead of fat free mass. (ultimate goal being adequate and appropriate body composition, linear and mass growth) On a bigger picture the question that needs to be answered is - Should EUGR be determined by a statistical definition alone based on anthropometric parameters OR should it be based on the adverse body composition analysis and neurodevelopmental outcomes at a prespecified time (which is obviously more difficult)
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