JACK

I remember one very resistant SVT in one newborn with CCF. At last it responded to Digoxin.

Recently we had a case of a neonate with neuroblastoma. He was incidentally picked up on a Chest X-Ray done for some other reason at age of one hour. The strange mediastinal shadow in the Chest X-Ray turned out to be neuroblastoma stage 3 on further investigation. What about my colleagues out there, how often do you get neuroblastomas in the neonate?

We tried Fluconazole prophylaxis in our unit in all VLBW babies. We did not get any reassuring results. The intervention which revealed some success in controlling our incidence of candida septicemia was restricting the use of Intralipid to deserving babies only. The decrease in the use of intralipid led to decrease in the candidemia incidence. Now intralipid use is restricted to ELBW babies in which we have difficulty in establishing feeding . We found this simple measure caused a dramatic decline in our fungal sepsis rates.

Interesting case. Could you update us about the case.Could you kindly describe her facial dysmorphism.

I also think that just cross matching the blood with that of the baby's may be hazardous in a setting of hemolytic anemia. It is essential also to crossmatch it to that of the mother also, to make sure that you will not add to the hemolytic process after you do the exchange transfusion.

May be you are talking of exchange transfusion of a baby with hydrops fetalis (due to hemolytic process). In which case you may be right in using Packed RBCs to decrease fluid load. However in case of Exchange transfusion in a setting of hyperbilirubinemia (with no evidence of anemia induced high output cardiac failure), I think using Prepared to order Whole Blood in the blood bank is more physiological and helps to maintain euvolemia. We request PRBCs and Plasma of the required blood groups to be mixed in the Blood Bank and also tell them what Final Hematocrit we desire. Remember most of the people in the blood bank are oriented to adult medicine and require frequent reminders about the is normal hematocrit in newborns.

The answer depends on what type of alcohol was in the preparation? Benzyl ?

Happy to tell everyone, that the baby was discharged home last week. A very emotional moment for the parents and the NICU staff. Baby had been weaned off oxygen for two weeks prior to discharge

What do you mean by metabolic acidosis? Define your cut-off range? In ELBW expect some degree of acidosis but allow a low Bicarb as long as pH is more than 7.25. However rule out all possible causes of metabolic acidosis, ensure proper hydration, rule out sepsis and of course dont forget an Echocardiography to rule out a PDA. ( I know there is no murmur but still do a Echo.) If all is well dont be very aggressive in bringing that bicarb to a level you think is normal. Sometimes things are best left untouched.

Honestly speaking in developing countries the emphasis should be in widening the reach of Neonatal services. I have worked in developing countries, and I know how difficult it is setting up a decent NICU there. In these settings a RET Cam , though a good product, will strain an already thin budget.

I so wish. No we use plain old Ophthalmologists with their funny looking headgear. (Hopefully my dear ophthalmology colleagues are not reading this!!!)

Got to the following website http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed Type ectodermal dysplasia in the search field and hit "Go" You will get more than 3000 papers to search through. Good luck

Yes it can.

I am also aware of another cause of iatrogenic femur fracture. Caused by a NIBP cuff left on the limb of a very active growing preterm. The cuff kept inflating and deflating at intervals of 15 mins and with the neonate actively moving the limb, femur fracture resulted.

Are you sure it was spontaneous? Sometimes during a difficult extraction of baby through CS femur fractures have been reported. Especially seen when the presentation is breech and the obstetrician has a difficult time extracting the baby and has to manipulate the baby a lot holding the lower limbs.

I will just update on the condition of the baby. He is now more than 5 months old. Now on oral feeding. Other than supplements , is not recieiving any medications. Is receiving supplemental oxygen 1 l/min. Is active and doing well.

I found a nice article http://www.mayoclinicproceedings.com/inside.asp?AID=1363&UID= If you go down in the article where they discuss imipenem, you will see that they had a good experience with neonates.

There are lot of literature revealing a high incidence of seizures when imipenem/cilastin is used among patients with meningitis. We frequently use imipenem in our neonates with gram negative septicemia, so long as the culture and sensitivity report shows the organism to be sensitive to imipenem. Often the neonate is too critical for a lumbar puncture. Most probably many of our neonates with septicemia may also have had CNS involvement . However we have so far not noticed nay seizure activity in any of our neonates receiving imipenem. What does this mean? One, possibility is that all the neonates who got imipenem never had meningitis...Possible! The other possibility is that seizures in neonates with meningitis receiving imipenem is a rare side effect. Anyone else out there has any such experience?

I find it strange that corn oil is preferred to coconut oil. Yes I do know that MCT oil's cost is prohibitive in developing countries, but the next best thing after MCT oil is coconut oil which is >90% MCT oil. Coconut oil is very cheap, I think there are many brands available for less than 2$ out there depending on what the purification levels are. But one thing to remember is that if coconut oil is not stored properly, after some time it becomes rancid. My preterms tolerate coconut oil and thrive well with no reported intolerance.

In HFOV, usually the tidal volume delivered will be less than the dead space. So even if you do measure it , it will not give any useful info.

We use nitric oxide very frequently in our NICU. The principal complaint with nurses or doctors is headache/lightheadedness. I did a internet search for similar complaints but most of the studies proved it safe. I think the problem is not with any leak. But the nitrogen dioxide which is released into the air from the expiratory port of the ventilator. Also the Nitric Oxide coming out of the expiratory valve/port of your ventilator will rapidly combine with atmospheric oxygen and form NO2. The problem with NO2 is that it is very toxic and most probably the symptoms which your staff are complaining could be ascribed to NO2. ( This is just an assumption, No hard data)

We have started using Sodium acetate as an additive in our TPN. It has shown to be very beneficial in neonates. A nice abstract link is as follows (http://pt.wkhealth.com/pt/re/adcn/abstract.00042223-199707000-00003.htm;jsessionid=GNySJG81pcQhGQHwc2GLMGJSnDFxkyGgbZnDvfTHGPtgtDTX9MpJ!-362743511!181195628!8091!-1) I just wanted to ask the community out there how is their experience with this additive? Any complications? What about use in nenonates with cholestasis? Does acetate conversion to bicarbonate work in presence of severe liver disease? How does the increased pH affect the ultimate Ca and PO4 stability?

Hi seems very interesting. Could you highlight the publications in journals regarding this? Any links? Thanks

We had a baby about two months back. He was a 34 week preterm baby, with massive CONG CAM of right lung with severe shift of mediatinum to the left. We had a hard time maintaining his oxygention. Within hours he was on very high pressures on conventional ventilator. Predictably developed bilateral pnemothoraces and had bilateral ICT in situ by the end of 3 hours of life. But oxygenation was still a problem . We shifted him to HFOV and then used inhaled nitric oxide to try to balance V/Q matching. That worked at dose of 40ppm. He stabilized. After few days he was "critically stable " enough to be operated and the lesion was excised by a lobectomy. Following surgery he went to act very peculiarly after 2 weeks behaving like BPD. He again developed a left pnemothorax which ultimately resolved. He could not be weaned from ventilator support , and required unconventional institution of steroids as a last ditch effort. Now he is off steroids, recovering from fungal sepsis, on tube feeds. on low parameters on conventional ventilator. He is alert , looking around. Both the baby and the doctor are waiting for the day he will be extubated. He is now a 2 month old boy.

I think sudershen is right. You just dont know which preterm baby will go on to develop ROP. The more preterm the baby is , the more you can delay to start the ROP screening program, but max of 6 weeks. If however you have a baby with GA>28weeks start it early at 4weeks. Once started even if there is no ROP, evaluate every 2 weeks. If there are signs of ROP go for weekly reviews. We had some very bad ROPs in babies 35 week GA requiring laser therapy.