Tamimi

We often use intranasal midazolam for MRI sedation, including in non-ventilated infants. Non-pharmacological methods like swaddling and feeding are sometimes insufficient. Radiology had suggested intubating all infants for MRI, which we felt was impractical and not fair for the babies. Intranasal midazolam has been our compromise. Generally, it’s effective, but we’ve noted occasional myoclonus. Providers should be aware of this and not overreact. In one case, an infant became overly sedated and required PPV. It’s important to have clear protocols—e.g., initiate PPV for desaturation and consider activating the rapid response team as needed.

Thank you for bringing up the topic that is very dear to me. Yes we routinely use ultrasound for ECC insertion and peripheral arterial line. We use every now and then if the nurses are not able to secure a peripheral access.it’s done by a doctor in the unit that is interested in vascular access. Trainees are still learning it and it’s very steep learning curve although looks in theory very simple. In regards to the access that you’ve posted. Yes I have experience with it with it. It was not good. In theory it sounds very appealing, but in reality, the metal cannula is soft and kind of pliable. I noticed that once I prick the skin and I have the needle under the skin and I tried to maneuver it left and right it bends I think because of the length that makes it bendable . But that’s my personal experience. I haven’t read any literature about this. I hope this helps.

only if you're ok with loosing the line. If your asking this question then probably you don't have a PIV meaning the baby has difficult access. Then you will probably waste your only access. catch 22

There is the maneuver done on HFOV in the IN-REC-SUR-E trial. could be adapted to CMV shouldn't be much different. I don't think there is a solid recruitment maneuver out there for the neonatal population. None of the parameters (LUS, dyn Cyn changes) have been widely accepted yet. Simply put... I don't think we really know what's the optimal PEEP and how to set it.

Rv dysfunction and with hypoxia ultimately lv dysfunction. Reduced blood flow to the lungs leading to reduced blood return from the lungs to the left atrium and then ultimately low LVOT. Having a PDA with right to left shunting supports systematic flow. If it’s becoming restrictive or closes then hypotension can occur

for scenario 1 I would say iNO and no surfactant. The description of CXR does not imply RDS and or secondary surfactant deactivation disease processes. Therefore surfactant may not help.

We don't have a max weight cut-off. We do use low dose sedation though. 0.5 mcg/kg fentanyl. In most cases it does not cause apnea and babies are fine with some stimulation and increasing the PIP on NIPPV. I find the difficulty with the bigger ones is that they are fully awake while you have to do the procedure.

Depends on what indications your askig about. For RSI its Succinylcholine. We don’t routinely paralyze the babies unless we have to. The choice would be roc. I think we started to understand the importance of spontaneous breathing and how it help recruitment and improving V/Q mismatch.

We use a D20 solution with the insulin. I don’t remember the concentration off the of my head

Its great that alot of units are adopting it. I think the important things to sort out when starting LISA is having a clear criteria for weight and GA and pressure cut off. Also to discuss seduction options including low dose opioid vs none. also choosing the appropriate methods including maybe the Hobart methods using the angiocath that may be easier for operators.

I have contacted the company before. They said it's not designed or licensed for newborns and I have not come across anyone that have used it before.

I think it's fairly reasonable to attribute the baby's seizures at 12 hours to an etiology other than HIE. The cord gas is ok and also the gas at 1 hour can be attributed to the resuscitation YES. But it could be also respiratory as you have not mentioned the PCo2. And again regarding the gas at 1 hour of life... It's not that acidotic to start cooling ( Looking at the CPS statement of 7.15) I think guidelines are made for those situations ...to help when things get blurry. Sticking to it as is the right thing for me until an alternative approach has established evidence behind it.

I agree with Martin And regarding the values for a ventilated baby... Usually a minimum of 7.25 with a pco2 of 45-55 and not to exceed 75 as it is associated with a poor neurodevelopmental outcome. These values are independent of gestational age and weight.