Mo7

Does albumin effectively address Hypoalbuminemia? My assumption is it pertains to the attempt to transfer fluids into the intravascular compartment for patients experiencing leaky capillaries and low blood pressure, correct?

We used to add protein to MOM or DHM but it is not a common practice in the UK, do you have any examples? From my experience, any total fluid intake above 150ml/kg/day is associated with increased FiO2 requirement even with the use of diuretics. This is why, most CLD bundles concentrate fluid intake or limit intake to 120 - 150m.

Check this one, while it is for paediatrics, but it has good learning modules https://www.openpediatrics.org/simulators

I'm seeking advice and insights from others on the following issue: How do you manage a four-week-old premature baby with evolving or established chronic lung disease (CLD) who is still on invasive ventilation or non-invasive ventilation (NIV) and requires a significant amount of FiO2 (>40%)? The baby's weight gain has been poor, necessitating an increase in the total fluid intake (TFI) up to 180ml/kg/day of Mom Own Milk (MOM) and fortifiers, as well as the use of diuretics. In my experience, and based on most cases of CLD, these infants benefit from fluid restriction (<150ml/kg/day), which typically leads to a reduction in oxygen requirements. I usually supplement nutrition by adding preterm formula or high-energy formula to the TFI. However, I'm wondering if there are other ways to increase the nutritional value of (MOM+F) without using formula milk. adding Proteins? Thanks, Mo7

Interesting topic, but I check this case report we published 🙂 https://pubmed.ncbi.nlm.nih.gov/30413439/

Hi Dirk, I think all these studies state association rather than causation, as PTX is common in term infants even in those who do not have RDS or need resuscitation If the baby has significant work of breathing then CPAP is required to keep the lung open, giving oxygen won't cut it and intubation is worst than CPAP If the baby does not have work of breathing but is hypoxic, LFNC should be enough I hope this is helpful

Thanks Stefan, You are right regarding azithromycin , which I think it is still in the experimental phase, and should be confined to research setting. But I was completely puzzled when I came across this practice without proper counselling. Thanks for the twitter thread, Cheers

Hi everyone, recently I have noticed a practice that is creeping in when it come to the prevention and the management of BPD. It is the use of Azithromycin and Hydroxychloroquine in BPD. While there are three RCTs for the use of Azithromycin, two with positive outcome and one with negative outcome when it come to BPD, it is still an experimental drug. I can not find any articles or studies on the use Hydroxychloroquine in BPD. My concerns are these drugs are experimental at best and by trying them without proper parents counselling which can lead misleading hope for parents and increase risk of side effect and complication without tangible benefits. If any has any experience with these two drugs, please let me know. Yours

Prophylaxis usually does not work ! what outcome you are looking for?

We do have the CDC definition in infant less one year, however it can not be applied to the prem with evolving chronic lung disease. It includes clinical, radiological, and microbiological aspect for the diagnosis. Most of these can be applied early to the ventilated prem with BPD. in addition, it is recommended to use a Blind protected catheter for sample collection. Sadly, it is a common cause to start antibiotics when lung condition does not improve or get worst, we start looking for causes and ET aspirate is the easiest source to justify antibiotics.

Hi guys, what is your approach to Ventilation Associated Pneumonia VAP? What is your definition? Do you routinely send ETT aspirations for culture? And do you use blinded end catheter? Do you treat colonisation? I am asking because it is a source of continuous excuse to keep babies on antibiotic with no clear benefit very interested in hearing your thoughts

Not in UK or Ireland. In a unit in Canada we tried it but it led to temp stability and the machine working harder to keep temp within the target range