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thank you JACK. it is useful.

HI, i did not find something about practical thing like this. but I will report what we do in our unit. we begun perfusion with solution at high dilution to make acces of the patient to drugs rapid. So afater for changing lines, we use other lines and we arrest slowly the old syringue and we monitor the volume of perfused drugs that is viewed on pumps. we keep syringues for 04 days which is generally sufficient for treating shock in the most patients.

Hi, out of extreme life threating situation, we use Midaz. + Fentanyl/or sufentanyl, in rare cases we adjust atropine.

Hi, in aour NICU, we use insuline at first day of life if glycemia is > 1.7 g/l and there is glucosuria. at day one of life we reduce G to the minimal.

Hi we calculate osmolarity for central or peripheric solution and we try usually to make it inferior to some limits (300 mosmol/l for the peripheric one and 800 for central one).

Hi we use commonly lactate with other parametres and not alone to identify signs and risks for: * septic risk (early or late onset sepsis) * circulatory insuffisancy * ischemic-hypoxemic encephalopathia of the term newborn * response to ressucitation the cinetic of values is very important but i can't say to you which valus is the define marker.

Hi, You should initially identify why your patient had lost 24% of his BW. So you must recognise condition of pregnancy (hydramnios +++), humidification (%), fluid regimen at day one (ml/kg/day, peripheric or central KT, Na+, K+), glycemia, natremia and Urinary Na+, K+ (blood and urinary), HCO3- and urea/creatinemia, diuerse (ml/kg/day). the only one patient that was managed with 270 ml/kg/day at day 3 had a Bartter syndrome. i think there is no relation between this and TPN with L and P. In our unit, we begin at 2 gr/kg/day of P rised to 3 and 3.5 at day 3. we introduce slowly L at Day 2 at 1 g/kg rised to 3 g/kg at day 5.

Soory because is perhaps to later to give you my opinion but i will do it. if cardiovascular instability is controlled, we use generally morphinic product (morphine, fentanyl...) or nabulphine at analgesic doses. paracetamol is also a good choice after VitK1 supplementation. we do not use Ketamine in preterm because there is not information regarding pharmacocinetics and pharmacodynamic and it is not recommended, hemodynamic instability is also another contre-indication for using it.

dear cihanber, we used it recently in one case of CDH with a sequellar PPHN after chirugical cure of the defect. the patient was on HFOV (MAP=18, FiO2=50%) and iNO at 10 ppm. we weaned up the patient at day 16 after chirurgy. Echocardiography before and after 3 days of Sildenafil was not very different. But we will begun in few days a prospective work about it. my personan opinion that if when there is not A LOOSER, we must search greatly A WINNER! I will give you further information about if you like.

Dear all that replied to my question, thank you very much. I can affirm to you that we recieve 1-2 patients with such pathology weekly. we use monitored iNO therapy. in all cases we try to use 20-80 ppm if there is no response for < 20 ppm. but we have not a response in the majority of cases (when that does'nt work at 20 pmm, that will not work at 1000 ppm! you can be sure because we are a very big users of INO and HFOV). we use épinephrine usually rather than norepinephrine in such situations but we are not sure that this is the best choice (neurologic outcome). so can you answer me is there any difference in neurologic outcome between epinephrine and norepinephrine use and thank you very much

In our Tunisian PICU, especially at the children's hospital, i think that we have a very good experience with HFOV in different situation (respiratory failure of the term and near term newborn, in infants and child and in preterm infants). for many yeras, exogenous Surfactant was not used for financial reasons (?), so we ventilated our preterm patients frequently by HFOV with an early rescue use and sometimes as elective use. I think that we had no problem in term of complication particulary in neurological one. Since a few years, we use surfactant as soon as possible and use of HFOV had been a rare event. we think that using HFOV electively before Surfactant therapy is not recommended especially where you read recent papers of meta-analysis (Thome +++++).

dear Rennee, in our unit, we use brest milk of the natural mamma in the majority of cases. some times where this is impossible to do it, we use a formula for preterm with 10-13% concentration. after initialisation of gastro-duodenal feeding, and after making sure that there is not enteropathy, we try to use a higher concentration: progressively from 13 to 20%. for preterm with brest feeding, we use a solution of eoproteine to concentrate 2-4%.

dear collegues, is there any one who use PICCO monitoring for sick neonates with respiratory failure or hypotension? wich charts of normal values for the different parametres calculated or measured by the device.

dear collegues, Some times we recieve neonates with severe hypoxemic failure due to various causes without infection and with intractable shock due to PPHN despite central venous cath., dopamine (20ug/kg/mn), dobutamine (20-30 ug/kg/mn), 4-6 fluids boluses of 10-20ml/kg, inhaled NO, sedation and effective mechanical ventilation. echocardiography shows frequently signs of PPHN. the question that i would like to answer is that what should we use after: epinephrine, norepinephrine or other thing?

Dear friends, I'm very happy to join this beautiful forum. we are great users of HFV ventilators (SM 3100 A and B, Stéphanie, SLE and the BBL 8000) and we will conduct a work about the efficiency and safety of this ventilators. I ask if some one have a reference of a device that make monitoring of tidal volume possible at the distal point of the circuit and thanks.

dear aymen, I can send to you our protocol that we are using in the children's hospital at the intensive pediatric care unit since 2001 if you like. contact me at : ammarkhaldi@yahoo.fr