JACK

Thanks for the link.

Does anyone have experience in using Keppra/Levetiracetam in neonatal seizures ?

"atraumatic lumbar punctures : - defined as red blood cell [RBC] count < 1000/mm3" Ref: http://www.ncbi.nlm.nih.gov/pubmed/8866797 Ref: http://www.medscape.com/viewarticle/738182 "Traumatic LPs were defined as CSF specimens with 500 RBCs/mm" Ref: http://www.ncbi.nlm.nih.gov/pubmed/12612231 Also this is a nice read: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730657/?tool=pubmed

CSF is normal

Relevant here: http://www.ncbi.nlm.nih.gov/pubmed/21303729 http://content.karger.com/produktedb/produkte.asp?DOI=000322848&typ=pdf

Good to see so many informative responses. We have been computing Inotrope (Dopamine, Dobutamine, Adrenaline) Dilutions based on weight.....E.g., Dopamine: For a baby weighing x kgs, we used to add 3 times x of Dopamine (mg) to Dex 5 to make a total of 25 mL and then the infusion was 0.1 to 1 ml/hr ( corresponds to 2 to 20 mcg/kg/min)...SO if weight is 1 kg , we add 30 mg Dopamine to Dex 5 to make total of 25 mL and so on. There were similar formulas for DObutamine and Adrenaline. All preparation is being made in the central IV Room. All dilutions are made by a Microsoft Excel based formula depending upon the weight. Majority of the time a baby getting inotropes will have a central line. The doses we use are 2-20, 4-40, 0.1-1 mcg/kg/min of Dopamine, Dobutamine, Adrenaline. We rarely use adrenaline except in the unresponsive shock cases. We always try hydrocortisone prior to using adrenaline infusion. We frequently use Dopamine plus Dobutamine co-infusion. There are now dissenting voices in the unit who feel that changing dilution based on weight may lead to errors in calculation though that has not happened so far. Also some feel that in babies of good weight ( eg 4 kg plus ), our existing calculations will give rise to a very concentrated final solutions, and would prefer not to exceed the upper levels as stated in neofax. This is the current debate in our unit. Should we just continue the existing system, which has worked so nicely and which everyone is used to? Is there any danger of infusing concentrated inotrope solutions or should there be an upper limit of concentration ? Will using pre-mixed bags, make it difficult to control fluid intake ?

We are in process of revising our policies on intropes infusion Can I ask my colleagues to share their practice policies regarding the following: 1 - What dose range do you use for Dopamine, Dobutamine and Adrenaline infusion ? 2 - Do you use combination of Dopamine and Dobutamine routinely ? Do you have a fixed ratio for these two inotropes ? 3 - What dilution do you use for Dopamine, Dobutamine and Adrenaline infusion ? 4 - DO you have fixed concentration for these drugs or do you use different concentration based on weight ?

Stefan,... is it possible to get the videos onto youtube under our channel....? I think the current website hosting the videos will expire in one year

I agree with you sudershan.kumari regarding the effect of good infection control and decrease in ROP. Even we have noticed that when fungal sepsis incidence decreases, ROP prevalence also decreases. Is it a direct effect or secondary to sepsis prolonging ventilation and oxygen exposure, I am not sure. (There are some published studies Ref05 Ref06 Ref07 Ref08 Ref09 Ref10 Regarding minimizing blood transfusion and its effect on reducing ROP incidence, I thank you for raising this point. I think so long as no harm is proven from restrictive blood transfusion policy, this could be another addition to ROP minimizing strategy. ( Ref01 Ref2 Ref03 Ref04 Ref05 )

I think the answer will depend on the competency of the 'baby' nurse in the delivery room in neonatal resuscitation. If the 'baby nurse' (the nurse handling the baby in the delivery room) is competent to initiate neonatal resuscitation in case of a depressed baby, then the doctor may not be needed. However if the 'baby nurse' is not trained in neonatal resuscitation then it may be risky.

Another resource https://online.epocrates.com/ While showing drug information, the Safety/Pharmacology tab shows Breastfeeding and Pregnancy safety

I assume like other big NICUs out there with decreasing mortality of preterms (especially the extreme preterms), the incidence of ROP continues to increase...with some cases progressing to threshold disease requiring laser photocoagulation. Though ROP seems to be more prevalent in our extreme preterms with CLD (Chronic Lung Disease) - (anecdotal opinion), we also have plenty of preterms who had a short ventilation with quick weaning and a relatively smooth course who also ended up developing threshold ROP. Our main ROP prevention strategy aims at oxygen therapy - avoidance of exposure to high SpO2. I wanted to know how my colleagues in other NICUs around the world are minimizing ROP incidence in their NICU graduates. What strategy other than evidence based oxygen therapy are they trying in their NICUs ?

@Stefan: Thank you for the advice. The problem is that many of the staff (senior to junior) appear to be skeptical of the usefulness of this modality of treatment. Also the nursing staff appear to be put off by the fact of the added manipulation necessitated when applying the head cooling apparatus. Then there is the overall inertia against adopting a "new" treatment. I think it will take time and more time !!!

It would be nice to find out practices around the world regarding Head Cooling / Total Body Cooling for Birth Asphyxia. I have added a poll for this post. As for us, we do have the Olympus Head cooling apparatus but use it rarely. Maybe it is because we (the doctors and nurses ) are not comfortable with it. Seems to be related more to initial resistance while adopting a new technology rather than the equipment itself...which is remarkably simple to use.

@wackdi Thanks for the link....

For all those having an Iphone in their NICUs don't go near an ECG machine !!! http://www.epocrates.com/dacc/1106/iPhoneECGbmj1106.pdf

Thanks Stefan for the link.... That led me to further nice reading http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746859/?tool=pubmed http://www.earlyhumandevelopment.com/article/S0378-3782%2807%2900160-0/abstract http://adc.bmj.com/content/94/8/621.abstract http://adc.bmj.com/content/94/7/562.1.extract

Is there any safe minimum weight/corrected gestational age for preterm babies to fly in airplanes? (Preterm with no chronic lung disease. ) Any references ?

How about this: http://www.gopreemie.com/site/products-5.html

You are welcome ;-) I just re-read your initial post...I think you wanted figure of 8 in V/P loops.....I totally missed that part of the question ! Actually unilateral diaphragmatic paralysis is frequently faced by cardiothoracic surgeons in the post op period.....I wonder what is their approach Do they do surgical plication for these cases? I quote from SURGERY FOR CONGENITAL HEART DEFECTS BY D. MACRAE AND J. LAROVERE

I assume you are referring to this: Taken from various sources Cant get a simpler explanation than that ;-) ! To understand more http://www.jmargolin.com/mtest/LJfigs.htm http://en.wikipedia.org/wiki/Lissajous_curve http://www.viasyshealthcare.com/smc/Products/Diagnostics/PDF/KonnoMead.pdf

Neonatal Handbook http://www.rch.org.au/nets/handbook/index.cfm?tabnav=all

More helpful links http://www.nature.com/jp/journal/v31/n5/full/jp201113a.html http://www.medscape.com/viewarticle/741841 http://cpj.sagepub.com/content/46/6/547.abstract

@Sutirtha Roy Nice resources !

This may be helpful http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2010.03071.x/full