Questions related to Neonatology
I really need the advice of a neonatology specialist, since I have not been able to defend my research work on the topic "Metabolic status and markers of inflammation in prolonged neonatal hyperbilirubinemia" since 2010. During these years, I have applied more than 17 rationalization proposals on my scientific topic to practical healthcare. All laboratory tests are already successfully applied in the clinical laboratory. A lot of articles on the topic have been published in research journals, with reports published at international and republican research conferences.
I want to analyze X condition, for example, hypotension in neonatology and its association with mortality. There is no current definition of what hypotension is.
When doing a systematic review, and I want to analyze the association between hypotension and mortality, but I have to include different hypotension definitions.
Imagine that I divide all studies into two groups: One group with studies that used definition X, and another group with studies that used definition Y.
If both X and Y show association with mortality, with low heterogeneity (between subgroup), can I infer that the definition of hypotension per se is not important? What if there was a high heterogeneity, can I infer that I cannot exclude that the definition of hypotension is not important and it actually may influence mortality?
A number of families of children with a particular genetic syndrome report that their babies were full-term but they were told that they had to be approximately 6 weeks early based on underdevelopment of plantar creases, ears, nipples etc. is this possible, unusual, or simply a mistake?
The placenta is organized as fetal and maternal compartments in broad perspective. However, it is a very complicated organ where fetal and maternal bloods touch together through villous trees to exchange oxygen and nutrients. I would like to hear your ideas and experiences on what the criteria for distinguishing fetal and maternal compartments were applied in either your MR imaging studies of the placenta or histological studies of the placenta. Thank you sincerely for your opinions in advance.
99% of people with Down Syndrome say they are happy with their lives. Parents of children with Down Syndrome say they derive such joy from their children. Where is their defense to live?
1-what do you think are the most appropriate quanti and quali study designs/methodologies to investigate the relation between caffeine exposure during pregnancy and births before 37-41 weeks of gestation ?
2-what are the ethical considerations to be taken into account during this study ?
How soon can the baby be breastfed after her mother is injected quinolones? Is the time interval from quinolones injection to breastfeding associated with the T1/2 of quinolones?
Extensive stroke in MRI. First hours of life. Hemiparesis in the left hemibody.
Anti-beta-2-glycoprotein-I in elevated titers in three occasions;
Low C3 and C4.
Sidenafil is a very good drug in the management of PPHN in my experience. I have used in some cases of PPHN and the results were really good, but some studies show no beneficial effects and some show equivocal results. At present there are no guidelines for use of sildenafil in management of PPHN. What is your experiences?
Oral sucrose seems to be not sufficient; more integrated strategies like sensorial saturation or breastfeeding or a combination of oral sucrose and facilitated tucking seem more effective than oral sucrose alone
Maternal diagnosis of VZV was based on clinical symptoms and signs, positive specific IgM and IgG and positive PCR for VZV on samples from cutaneous lesions.
The newborn, was born at 37+5 weeks and IgG and IgM for VZV were tested two times in different laboratories.
No evidence of immunodeficency in mother and child.
To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing. Di Renzo GC, Melin P, Berardi A, Blennow M, Carbonell-Estrany X, Donzelli GP, Hakansson S, Hod M, Hughes R, Kurtzer M, Poyart C, Shinwell E, Stray-Pedersen B, Wielgos M, El Helali N. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med. 2014 Aug 27:1-17. [Epub ahead of print].
The association of necrotizing enterocolitis (NEC) and blood transfusion is suggested by several case series and observational studies. The few RCTs dealt with this matter so far have not confirmed such association. Nonetheless, many colleagues like to err on the conservative side, i.e. to stop feeding altogether upon blood transfusion. Do you support this approach in your practice?
An indirect evaluation of infants' acute pain can be given by using complicated pain scales, that use simultaneously several parameters. These scales have been criticised for their complexity but also for the scarce need of scoring pain during acute pain. In fact, pain scoring is useful during cronical pain, but in the case of acute pain such as during injections, tracheal aspirations, heel-pricks and so on, it has scarce utility. I argue that all these scales decontextualize pain, i.e. they assess pain without any reference to the type of painful stimulation. I believe that it is sufficient to be aware of the risk of provoking pain with reference to the type of stymulus and to the part of the body (and its state) where it is apllied to, of course, avoid it. Do you want to be sure you are provoking pain? First, consider if you are touching an area with nociceptors; second, see if this provokes a sudden reaction: this is the clear signal of pain with no need of scales: there's no need for scoring pain after provoking it, because any pain provoked to a baby is always a failure.
Adaptation is necessary for tests in different cultures. In neonatal period for assessment of behavioral state, is it necessary?
Time table and screening methods on developmental follow-ups in at risk infants vary in different countries. Some NICUs use objective screeners and others subjective tools. Is the ASQ appropriate for high risk follow-ups?
Because phenobarbitone seems to help in cardiovascular stabilization and cerebral protection by decreasing oxygen demand.
It is our clinical routine to suction the nose and mouth of the ventilated neonate after endotracheal suctioning. No evidence is available. Is it of additional value or need or just a routine?
In our unit (a tertiary care, referral center) a review over a 2 year period revealed the incidence of UVC extravasation to be 4.2%. The most common mode of diagnosis was ultrasound of abdomen with the following features.
Experiences vary, but I for one- have seen the miraculous effect of kangaroo mother care in babies who have been admitted to our NICUs and nurseries - not just pre-terms, but also those recovering from serious illnesses. There is a definite improvement in weight gain, immunity, respiratory effort and various other parameters. Do narrate your experiences and wonders you have observed with this simple but effective technique. Do you use it only in pre-terms? Or do you advise it for all babies?
What are different methods (clinical / pathological / radiological etc.) to diagnose and confirm Umbilical venous catheter (UVC) extravasation injuries?
I am currently reviewing data of umbilical venous catheter related extravastion injuries in our unit. The retrospective analysis lead to identifying large number of cases. Put together, it could easily become one of the largest published cohort of UVC extravasation injuries, till date. But still the total number of cases will be in single digit. We are specifically looking to study the possible associated factors, clinical manifestations, complications and outcome. More like a descriptive study. I wanted to have your opinion regarding what would be the best category of paper under which such research could be published?
There are some reports and a few clinical studies that illustrate a potential positive effect of music therapy on well-being, energy consumption and other short term parameters in premature neonates. Do colleagues in this network have own experience in active music , i.e. with live music (not passive music e.g. from CD)? Which kind of music, instruments or sounds has been used? Is anyone aware of studies that show a long term effect on neurodevelopmental outcome? For instance, could there be any data that might illustrate an effect on the incidence and severity of attention disorders in low birth weight children? And how about the mothers?