JACK

Thank you for contacting us. We usually do not give medical advice nor counsel in this forum. However we will try our best to help you and your baby. From your post, I see that your baby has received therapeutic hypothermia which is the current standard practice in neonatology for management of Perinatal Asphyxia cases. Other than supportive care and careful follow-up and early intervention if any neurological sequlae are detected, currently there is no other evidence based therapeutic intervention specific for perinatal asphyxia. Your neonatologist and the pediatric neurologist are the best persons to guide you regarding this matter. If you have any further querries, please do ask us. Though I remind you again that your doctors in your unit are the best persons to answer your querries as they have the case in front of them and know all the case details We wish you and your baby all the best.

Lucky baby !!! Volpe does mention in his follow up that babies can improve spontaneously. But even if the IVH improves, the case remains a high-risk case and needs close follow up for early detection of neurodevelopmental delay Also a MRI at term equivalent age will be a very important prognostic tool

Also keep an eye on Neoreviews and Clinics of Perinatology

Reculture...Start Ampho-B...Get an Echo done....

http://www.npr.org/blogs/health/2013/08/23/214800726/another-study-of-preemies-blasted-over-ethical-concerns

This is regarding the Fonterra recall of its batch of ?Botulism tainted products. - http://online.wsj.com/article/SB10001424127887323681904578646952552857298.html --- http://www.aljazeera.com/news/asia-pacific/2013/08/201383044280669.html -- http://www.stuff.co.nz/business/farming/dairy/9004324/Fonterra-products-whipped-off-Chinese-shelves Has it affected you ? It seems to have already affected Saudi Arabia - http://www.arabnews.com/news/460297 Could members post in this thread if they become aware of new developments in this story

Are you referring to these - http://calsprogram.org/manual/volume3/Section20/08-NRP7RespDisSyndScoringSys13.html http://www.pediatricsciences.com/ojs/index.php?journal=jps&page=article&op=view&path%5B%5D=383 ?

I wonder what our ophthalmologist colleagues will think if we start sending them 2 kg babies for ROP screen ?

Hello dear colleague. Yes there are no boundaries between healthcare and business practices in other fields. You should be looking towards six sigma and lean processes. Doing a six sigma Green Belt course would be highly recommended. Before you can start to "cut back", start measuring and collecting data. Later start analyzing and then you will get your areas of focus. Also have a look at these: 1. Spitzer AR. Pay for performance in neonatal-perinatal medicine--will the quality of health care improve in the neonatal intensive care unit? A business model for improving outcomes in the neonatal intensive care unit. Clin Perinatol. 2010 Mar;37(1):167–77. 2. Profit J, Zupancic JAF, Gould JB, Petersen LA. Implementing pay-for-performance in the neonatal intensive care unit. Pediatrics. 2007 May;119(5):975–82. Best Wishes and Keep us updated !

How do you decide what setting of the incubator temperature and humidity is to be done for the patients? I found this very fascinating: http://www.draeger.net/local/US/heat-balance/index.jsp#optimize http://www.draeger.co.za/media/10/08/52/10085278/heatbalance-9066509-br-en.pdf

The Image library from the Atlas of Neonatal Procedures - 5th ed ( 2013) is available at: http://thepoint-review.wkhpe.com/SRC/MacDonald_5e_Solution/Image_bank/image_bank.htm

AAP-2013 has pushed the weight and GA limit upwards for sick babies ! Babies with weight 1.5kg to 2 kg with "unstable clinical course, including those requiring cardiorespiratory support and who are believed by their attending pediatrician or neonatologist to be at high risk for ROP"......do ROP screen

Why should we restrict fluid ?

http://rtmouthbreather.files.wordpress.com/2009/11/high-flow-formulas.pdf This link should give you a nice explanation

I just wanted to link to the 2013 Guidelines for ROP Screening issued by AAP http://pediatrics.aappublications.org/content/131/1/189.long Has anyone modified practice after the new guidelines have come out ?

The NICE-2010 Guidelines recommends 20.4mg/dL (350 umol/L) for starting phototherapy. Do you think it is too high ? Will you be comfortable waiting till 20.4mg/dL for starting phototherapy ?

http://www.epocrates.com/ The good part about epocrates is they have apps for all sort of mobiles and allow off-line functioning...so it is really an excellent tool.

I wanted to know which graphs/charts are you using in your unit to decide for phototherapy (Single / multiple ) or exchange tansfusion ? Are you using weight based or Gestational Age based charts ? Are you using the NICE guidelines ( http://guidance.nice.org.uk/CG98/Guidance/pdf/English ) ? For a term neonate 3,5 kg - 4 days old what is your cut of for starting phototherapy ? Thanks

http://jac.oxfordjournals.org/content/62/5/889.full http://jac.oxfordjournals.org/content/62/5/889.full.pdf#page=1&view=FitH http://www.ncbi.nlm.nih.gov/pubmed/22381665 http://www.jmedicalcasereports.com/content/3/1/7389 You should find these relevant. I would not use oral antibiotics in a sick neoante. I would hunt for alternative parenteral antibiotics. Best wishes Keep us informed

I wanted to ask regarding your experience using the HFOV mode in the Fabian Ventilators. How does it compare to Sensormedics 3100A ? We only have the sensormedics 3100 but are looking at Fabian. Thought I would take the experience from the 99nicu community. Thanks

http://www.sswahs.nsw.gov.au/rpa/neonatal/html/newprot/uvc.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043016/

I will keep posting links as I keep getting them. http://radiology.rsna.org/content/219/3/645.full

Is it possible you can post Xrays. Free air in the abdomen......Stop all Feeding...Urgent PEDIATRIC SURGERY consultation....Free air...bowel perforation until proved otherwise

Fires and Burns is a real possibility -- http://www.patientsafetysolutions.com/docs/March_2009_Followup_on_the_Minnesota_Bassinet_Fire.htm -- http://articles.timesofindia.indiatimes.com/2009-02-01/chandigarh/28015427_1_manju-wadwalkar-phototherapy-units-electrical-wiring -- https://www.ecri.org/Documents/ECRI_Institute_HDA_H0045_Warmer_Hazard.pdf -- http://www.allinahealth.org/ahs/news.nsf/page/Mercy_Hospital_Executive_Summary_Final.pdf/$FILE/Mercy_Hospital_Executive_Summary_Final.pdf