ammar

yes we do it for high and low flow cannula and for all other kind of NIV thee is severe kinds of Fand P heater, sometimes yhe sevo do it automatically and other times you should define temperature and minimal différence of the gradient between proximal and distal point

thanks for the link

extubate him to NIV nowwwwwwwwwwwwwwwwwwwwwwwww

echocardiographic assesment if PCA: dobutamine + ibuprofène if not PCA, Lv dysfunction: dobutamine if No PCA and good LV dysfunction : NS 10-20 ml/kg over 40-60 mn and HSHC 4-5 mg/kg/j in IV route

congratulations and happy birthday to us

On the Stephanie machine, you have the most used modes of ventilation that you need (conventionnel, HFO, Volume modes ...) with well graphical representation. problems concerns: Hmidification++++++++++++++++, the lenght of the circuit, setting of alarms and complicated materiels to be cleaned. We used also the SLE2000+, less than modes of ventiation, trigerring ventilation go fail usually, frequently rearming of alarm and HFO less effective than STE or sensor medics.

all kinds of mode ventilation on the LEONI+ are limited and controlled pressure. But you have the possibility to use the option (if it is installed on the machine!) of Guarented Volume. you set the desired volume and you set else the high inspiratory pressure limit. So the machine will try to give the fixed volume with the minimal pressure that can never be more than the limit set.

We use a solution that the name is SULFANIOS (i did not have the regular composition now) and that was apprved before use by the manufactoring societies of our incubators. many parts of the incubator are treated alone in the "autoclave" and cleaned before with the same disinfectant.

We use Orogastric tubes that will be changed once a dsay. A verification of the placement must be done before every enteral feeding. for fixation we use the same materiel used to the tracheal tube.

we use in case of alveolar desease PEEP with a value that depends directly to FiO2. So if patient O2 requirement is high, >40-45%, you need to use PEEP>5 cm H2O, and in neonate (preterme, Weight dependent) you can use 7-8 cm H2O. When you have not Lung desease (PPHN....), PEP is Usually 0-2 cm H2O. you must control the effect of PEEP, 30 mn after change and without aspiration to make Sure that there is not ALS (PX, PM, PPC, IE or overdistension). Other thing, you must care to the hemodynamic effect of PEEP in newborn with hypotension.

Thank you Hady I think that the idea is very good and original. but i have some interrogations about why the use of theophylline as control group the total number of patient is little the outcome included in the study period (time) is very short the difference (statistics) is very little and perhaps not exist if number of patient was slightly higher than 42 preterms.

Hi we recieve frequently newborns of diabetic mother for respireatory distress of various causes. Echographic assessing shows frequently signs of hypertrophic myocardiopathy with a variable alteration of the Left ventricular function. I would like to ask about prescription of Propanolol in this patients (Indication, acess, posology, therapeutic period and contre-indications). Thanks Khaldi ammar Children's Hospital of Tunis PICU

Hi I would like to review with you, what kind of central vascular acess in neonates in managing preterm or term infant with severe RDs/PPHN. sometimes we have difficulty to make central un ombilical venous KT, so we remove it immediatly and we place either jugular or femoral acess for term neonate and Epicutaneocava KT in preterm. But as you know, especially in term neonate with severe PPHN, the time of catheterism is a usual occasion for oxygenation loss. So what do you do in such situation. Thanks Khaldi Ammar Children's Hospital of Tunis PICU

Darya, we used it for 2 years for children's with septic shock. but not in neonate, we use Noraml Saline.

Thank you very much Jack and Stefan. i will give you results about prevention. Your idea? Jack is very useful regarding our situation. I will write some clear words to my collegues. Thank you again.

Hi I think that when there is not enough argumentation of acute infection such as new clinical signs, inflammation (Procalcitonine or CRP) you have not to treat colonisation. the quality of the bacteriological sample especially the dilution is important for reading correctly the result (amount of P.A. in CFU/ml). Ammar Khaldi Children's hospital of Tunis - Tunisia

Hi how and which posology of vitamines do you use for TPN of the preterm, especially the Vitamine D. thanks

Hi I would like to ask you about your practice in using intravenous lipids and jaundice: Is there difference between the various formula of lipids Which value of Bilirubinemia that formely contre-indicated use of lipids Using Phtotherapy it is allowed with use of protected solution of lipids Thanks

Hi I would like to discuss about the type of artificial enteral feedings (which formula) used in preterm < 1500 grs of weight. here at our unit, when there is not maternal milk, we begun with hypoallergenic formula and we convert it slightly to preterm formula when a total apport of enteral feeding of 150 ml/kg/day is achieved. is that a good thing? Thanks AMMAR KHALDI CHILDREN'S HOSPITAL OF TUNIS, TUNISIA

Hi Sometimes we recieve neonates from others institution at few hours of postnatal age and we discover that they had recieved a great volume of H2O usally as 10% glucose and electrolytes. glycemia is frequently more than 2 g/l (> 11 mmol/l) with natremia > 140-145 mmol/l. have we reason to restrict fluid or electrolytes for him the first days and treat deshydratation at day 3 or 4. have you experience with such iatrogenic problem. thanks

Hi I ask for actual practice in managing circulatory failure in term and near term newborn. It's very intersting for us because there is not clear protocols like infants or children or aults. The two situations where i need to have your opinion are: 1 - a term neonate with severe respiratory failure and neonatal infection. echocardiography shows PPHN. 2 - a term neonate without severe respiratory distress but with intractable septic shock. thanks

Hi JACK we never used sodium acetate in our practice of TPN because it is not diponible at our hospitals. I would like to know is that absolutely necssary and what harm we made to our premies.

There many papers about this. for our interst i give to you exemples to neonatal experience: *Plasma volume expansion by medium molecular weight hydroxyethyl starch in neonates: a pilot study. Pediatr Crit Care Med. 2003 Jul;4(3):305-7. * Hydroxyethyl starch 130/0.42/6:1 for perioperative plasma volume replacement in children: preliminary results of a European prospective multicenter observational postauthorization safety study (PASS). Paediatr Anaesth. 2008 Jul 21. And for physiopathological aspects: * Effects of whole blood, crystalloid, and colloid resuscitation of hemorrhagic shock on renal damage in rats: an ultrastructural study. J Pediatr Surg. 2003 Nov;38(11):1642-9.

Hi sometimes when usal values of PEEP and flow are not sufficient to ovoid apnea and bradycardia, baby’s mouth is kept closed during nasal CPAP by using soft chin strap or blocking mouth at prone position by header.

Hi Darya. there is very interesting papers in PUBMED. but absolute conclusion is not possible now because very side effects are thinked to be just for physiologic studies and not real human studies. However it is greatly and wide admitted that the safe volume expander in human, particulary in neonates remains physiologic solution.