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NICU

Do neonates produce CO2?

4 May, 11 | by Bob Phillips

Well, I know that they do to some extent, but do they do it enough to make those expensive little burp-detector kits turn yellow when you intubate correctly? They do in grown ups, and in proper children with big breaths, but what about teeny tiny children?

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I can’t intubate .. can I have a mask?

23 Feb, 11 | by Bob Phillips

Not to obscure your deeply shamed face (I know, I’ve had it happen …) but a laryngeal mask, one of those disturbing bits of equipment anesthetists use when the operations’s not long enough to enjoy a nice cup of tea during an operation.

Can an LMA be a reasonable choice in neonatal resuscitation?

Squiggly lines and tea leaves

13 Jun, 10 | by Bob Phillips

My grannie-in-law knew a lady who would look at your tea leaves and tell you the future (younger readers – see here – tea is not always bagged & tagged).

I had a similar experience with a neonatologist who would look at the seismograph attached to a babies head and declare the child needed more (or less) phenobarbitone.  Exactly how the dose alterations were related to who’d just knocked the incubator, and what they did for the babe, I have yet to understand. But there is a London doctor who is reviewing just how much those ‘cerebral function monitors’ really do tell clever tiny baby docs anything at all. more…

Q: Can a quick ultrasound save an UGI contrast series?

29 May, 10 | by Bob Phillips

A bit of greenish vomiting, not feeding so well and some concern that the newborn in front of you has volvulus. So do you really need to go through the hassle and pain of organising a contrast upper GI series, especially as the parents are already worried about getting feeding established, or could normally placed vessels on an abdominal USS help you out? more…

Q: Should very prem babies be given CPR?

21 Feb, 10 | by Bob Phillips

So it’s all ethical stuff at the moment. Does the following question reach a point where evidence no longer has a role?

“A premature baby born at 24 weeks gestational age is admitted to the neonatal unit having been born apnoeic, floppy, blue and without a heart rate. After cardio-pulmonary resuscitation (CPR) with adrenaline in the delivery room, a heart rate was noted. Is CPR in these infants inappropriate? What is the chance of survival and risk of disability?

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Q: Glycerine to prevent neonatal feed intolerance?

18 Jan, 10 | by Bob Phillips

Dog without constipationNow, I am sadly passionate about constipation and the need to treat it effectively. Some would say this obsession is a bit too much to be healthy. But even I would only go so far as to say that effective evacuation only makes you feel better, rather than make a huge difference to whether you put weight on or not. But perhaps I am not going far enough more…

Q: Caffeine and prematurity

4 Jan, 10 | by Bob Phillips

Bulgarian coffee saying 'Happy Life'Now, it’s been a while since I scared myself by visiting a NICU, but I do recall the liberal use of caffeine by the resident medical and nursing staff, both for themselves and their tiny patients. There have been may things said about the delightful methylxanthine (including this, this and this) but did you ever think it could protect neonatal brains as well as keeping them breathing?

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Confused by confounding.

13 Feb, 09 | by Bob Phillips

Abdominal radiographSometimes we are in situations where we think that something causes problems, and we can’t do a trial randomising one group to get something which we think causes problems! How do we then go about finding out – how to we avoid the problems of ‘confounding’ – and what is that anyway? For example, think about necrotising enterocolitis. Which babies develop NEC? more…

Q: Does nephrocalcinosis mean problems for neonates?

25 Jun, 08 | by Bob Phillips

USS of nephrocalcinosisWhat do you do if, accidentally, you scan the abdomen of a neonate and find nephrocalcinosis? Book them in for a transplant in a couple of years? Annual serum electrolytes, blood pressure & isotopic GFR measurement? Pretend you hadn’t seen it?

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Question: ECMO – any benefit for neonates?

10 Dec, 07 | by Bob Phillips

ECMO kitDoes extra-corporeal membrane oxygenation improve survival for severely unwell neonates with Congenital Diaphragmatic Hernia?

A neonate on the intensive care unit with an isolated congenital diaphragmatic hernia is failing on conventional ventilation. There are no exclusion criteria for extra-corporeal membrane oxygenation (ECMO). Should the neonate be transferred for ECMO?
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