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Everything posted by JACK

  1. Nice informative articles Of course everything changes so fast - Always check online for updates Neonatal Resuscitation and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection (https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0040-1709688 ) ( Full test access is free Also some nice resource - updated continuously ( https://www.allthingsneonatal.com/category/covid19/ ) Keep checking online - things get outdated within days in this Pandemic
  2. Universal masking - has pros and cons. You will find those who swear by it and those that find fault in it. Nice perspective here: https://www.nejm.org/doi/full/10.1056/NEJMp2006372 But just a personal viewpoint - i often see that those who wear face masks throughout the shift often tend to touch their faces more.
  3. Thanks for the information. Just out of curiosity, will it be sub-optimal or even harmful to run the fabian at flows of 20 like the sensormedics3011A. And if the I:E ratios were set at 1:3 or 1:2 instead of 1:1 would it affect ventilator performance with effect on patient respiratory function? BTW, a nice comparison: http://www.prhoinsa.com/images/pdf/sle/bibliografia/Harcourt_Comparison_8_HFO_ventilators_2014.pdf Harcourt, E.R., John, J., Dargaville, P.A., Zannin, E., Davis, P.G., Tingay, D.G., 2014. Pressure and flow waveform characteristics of eight high-frequency oscillators. Pediatr Crit Care Med 15, e234–240. doi:10.1097/PCC.0000000000000111
  4. Dear fellow 99nicu members, A warm Hello ! Having been used to the settings on the 3100A, I was wondering how do you set the HFOV in the fabian acutronics? In the 3100A sensormedics, we were setting Bias Flow at 20 L/min, I:E at 1:2 ( 33%). However the fabian HFOV can work from 8 till 20 L/min of Bias flow. What is your usual starting Bias flow and where is your comfort zone ? Also since the Fabian can accommodate I:E of 1:1, 1:2 and 1:3 , what do you usually start with?
  5. NRP - 7th edition is here !!! http://pediatrics.aappublications.org/content/early/2015/10/13/peds.2015-3373D.full.pdf+html Pediatrics-2015-Perlman-peds.2015-3373D.pdf
  6. http://www.ncbi.nlm.nih.gov/pubmed/?term=chlorhexidine+neonate+injury
  7. @matok..The packaging is to blame. Even I thought they were eye drops...because they look like eye drops.
  8. Excellent blog. Rude behaviour is detrimental to patient safety and to patient outcome. It builds obstacles in effective communication within the NICU team. I think we have to take lessons from the airline industry about communication strategies. Crew Resource Management and removing hierarchy while communicating is very important. http://psnet.ahrq.gov/public/02-dunn.pdf Motivated staff are a great resource for achieving optimal patient outcomes .http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/implement/teamwork.pptx Rude staff are usually disruptive to the NICU staff. Staff with attitude issues should initially be politely counseled. If still no change in behavior will necessitate disciplinary action and ultimately removal for the team. A single rude disruptive person is enough to upset the whole NICU team.
  9. Dear fellow 99nicu-ites ! A Warm Hello !! I wanted to know how many of you are using chlorhexidine in your NICUs? In what form? What packaging? At which steps in the newborn care? Any contra-indications for use? Do you use chlorhexidine alone or with isopropyl alcohol ? We are using chlorhexidine swab sticks while inserting central lines. We recently came across chlohexidine wipes but do not know if they have a role in NICU. I was alarmed when I read this :Doctors-warned-using-antiseptic-wipes-premature-babies-infants-suffer-burns-effects Have you come across such burns in your unit? What precautions do you take?
  10. Hello Stefan... am back after a short (!!!) break Great resource. Use the link - bit.ly/whonicu to track how people are downloading it to see details - bit.ly/whonicu+ Will study it and get back
  11. Is anyone implementing the Neo-BFHI in their units ? http://www.ilca.org/i4a/pages/index.cfm?pageid=4214 http://www.ilca.org/files/resources/NeoBFHI_Core_Document.pdf Nyqvist KH, Häggkvist AP, Hansen MN, Kylberg E, Frandsen AL, Maastrup R, Ezeonodo A, Hannula L, Koskinen K, Haiek LN. Expansion of the ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations for three guiding principles. Journal of Human Lactation 2012;28(3):289-96 Nyqvist KH, Häggkvist AP, Hansen MN, Kylberg E, Frandsen AL, Maastrup R, Ezeonodo A, Hannula L, Haiek LN. Expansion of the Baby-Friendly Hospital Initiative ten steps to successful breastfeeding into neonatal intensive care: Expert group recommendations. Journal of Human Lactation 2013; 29(3):300-9.
  12. There has been a recall in the world of probiotics http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm423277.htm Is this the same one used in the proprems study ?
  13. Apgar10 ..those are valid points. But sadly I believe this happens everywhere . The end-users are not consulted. However everything is not lost. Good policies, some rearrangement can always make your NICU very nice !
  14. Whatever side we take...the most important point to remember is that ventilation should be excellent when using Bicarbonate...if ventilation is not optimal...then the CO2 released from Bicarb in vivo goes nowhere and paradoxically leads to increased acidosis !!!
  15. Have a look here: http://www.ncbi.nlm.nih.gov/pubmed/23537928 Looks encouraging for breast feeding but speech benefits are still to be proved Also http://www.ncbi.nlm.nih.gov/pubmed/24937906 shows office frenotomy to be satisfying to the parents...(isn't that the new motto...CUSTOMER SATISFACTION !!!!....but is it all about the parents...how does the baby feel ????) Nice opinion: http://fn.bmj.com/content/99/3/F178.extract
  16. If I am to use Probiotics in my unit...how do I counsel the parents ? DO I need a parental consent ( like for steroid use in neonates) ? If during counselling or consent process....how safe do I tell them that probiotics is ? Also are all probiotics available in the market the same?...do theyhave the same organisms ..the same strain...the same concentration?....can I generalize the findings of a study done with probiotic Brand A to probiotic Brand B ? Or should I stick to Brand A...the one that was used in the RCT ? (hey...nothing personal.....just trying to give constructive criticism... ) (In the past one year we had one surgical NEC in 95 babies with birth weight less than 1.5kg)
  17. Also I found these templates invaluable in designing our local follow up checklists http://www.priorityhealth.com/provider/clinical-resources/dev-screening
  18. I assume VAFO is Ventilação de Alta Frequência Oscilatória. = HFOV For nasal CPAP we are sticking with plain old CPAP. No nasal SIPPV....also not tried HFOV. I belive there is lot of talk about use of high flow nasal canula in Europe ?
  19. JACK

    MCQs

    https://www.us.elsevierhealth.com/media/us/samplechapters/9780443070709/Chapter%2002.pdf
  20. I cannot over emphasize how much a resucitation program can make a difference in reducing mortality and morbidity in the neonatal period. As much as possible health care workers dealing with neonates at delivery, should have neonatal resusciitation training.
  21. Should I use Probiotics if my NICU population has a very low incidence of NEC ? What if using breast milk plus other non-specific measures, we could decrease NEC incidence....then is it still ethical on my part to expose my babies to probiotics ? Has the use of probiotics in these immunocompromised population been proven to be safe over a prolonged period of time ? Or is the weight of the evidence still of a short duration and awaiting more long term studies ? But do we still need long term studies? Let me rephrase my concerns.....what is the minimum NEC incidence rate in my NICU at which I should consider probiotics use in the unit ? (.... typed in a reflective mood ! )
  22. What do you think of this paper: International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960932-6/abstract http://www.newscientist.com/article/dn26167-all-newborns-should-be-similar-size-in-ideal-conditions.html
  23. Looks good. Ideas are evidence based. Will definitely vote for both. I had lot of trouble trying to view the videos. Is it possible that you can upload these videos to youtube ?
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