Recommendations from Port Said seventh neonatology conference

 

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It’s crucial  to develop new “prescriptive” standards describing normal fetal and preterm neonatal growth over time and newborn nutritional status, and to relate these to neonatal health risk.  The primary objective is to produce a set of international Fetal and Newborn Growth Standards (fetal growth, birth weight for gestational age and postnatal growth of preterm infants) for practical applications in clinical use and for monitoring trends in population. (from Dr Leila Cheikh Ismail, Oxford university, UK talk: The INTERGROWTH-21ST Project- Concepts, Methods and Results

 It’s recommended to vaccinate preterm & low birth weight infants who are medically stable against all routine vaccines in same dose & timing as full term infants. It’s recommended also to provide pneumococcal vaccine (2 m of age), Rotavirus vaccine (between 6 weeks and 14 weeks of age), influenza vaccine (beginning at 6 months of age) & 2 doses of vaccine administered 1 month apart for first time vaccination. (From Prof Ahmed Amr Abbassy, Alexandria univ talk: Immunization in practice)

 Targeted O2 saturation and proper FiO2, CPAP use in delivery room & when indicated surfactant, delayed cord clamping, sustained inflation and value of PEEP is to be stressed.Changes in concepts & delivery room equipment should be considered. (From Prof Mohamed Khashaba, Al Mansoura univ talk: Neonatal resuscitation guidelines 2016)

Kangaroo mother care improves cerebral blood flow & is recommended for preterm care. (From Prof Afaf Korraa Al Azhar univ talk: Impact of Kangaroo mother care on cerebral blood flow of preterm neonates  

 It’s recommended that appropriate measures and education be made available to everyone who prescribes or administers medications in the NICU and that members be proactive in participating in the development and implementation of safe medication practices in the NICU.  (From Prof Osama Arafa, Port fouad hospital talk: Common medical mistakes in N I C U)

The use of synchronized nasal intermittent positive-pressure ventilation SNIPPV as primary respiratory support is beneficial in reduction of mortality and morbidities like pneumothorax, NEC, and BPD. From dr  Nesrin Handoka, Port Said univ talk: Noninvasive ventilation for RDS in preterm infants)

 After either cardiac arrest or head trauma, ventilation of the comatosed patient to achieve normocapnia is warranted. Routine hyperventilation may be detrimental and should be avoided. With restoration of cardiac output, metabolic acidosis usually corrects over time. The use of buffer therapy is also not indicated and should be used for specific indications only (From Prof Ahmed El Sawah Al Azhar univ talk: Post Resuscitation Guidelines   

 Since a significant numbers of patients are harmed from their health care either resulting in permanent injury, increased length of stay in hospitals or even death, a recommended ongoing training & orientation of the medical team for those errors. (From Prof Mohamed El Kalioby, Suez Canal univ talk: Patient Safety in NICU

 Most of skin conditions in neonatal period are benign and some are potentially life threatening. It is important to identify them and decide which of the following skin conditions requires medical intervention. (From Prof Amal Gomaa, Suez canal univ talk: Neonatal skin in health & disease)

 Management of cholestasis is mostly supportive, consisting of medical management of complications of chronic cholestasis like pruritus and nutritional support for malabsorption and vitamin deficiency. (From Prof Tarek Barakat, El Mansoura Univ talk: Neonatal Cholestasis: clinical approach)

The neonatal dermatological emergencies are a diagnostic and therapeutic challenge. A wide range of dermatoses such as infections, genodermatoses, metabolic disorders and vascular tumors may require emergency care. The clinical presentation also varies from generalized involvement of skin to localized disease with or without systemic symptoms. (From Prof Hany Abu El Wafa, Al Azhar Univ, Damietta talk: Neonatal Dermatological emergencies)

 Diamond Blackfan Anemia (DBA) is a rare condition that usually becomes symptomatic in early infancy. Yet it must not be excluded from differential diagnosis of cases of anemia. (from Prof Maha Yousef Al Azhar univ talk: Severe early onset anemia…case presentation

Genetic factors contribute to at least 40% of all congenital anomalies. Recognition of the environmental factors lies in the potential for prevention. Main diagnostic and differentiating clinical feature to reach a diagnosis will be discussed. (From Prof Mohamed El Sawy, Ain Shams univ talk: Congenital anomalies, clinical approach)

 Advocate for infants if they are exhibiting pain cues

-Integrate research studies and research findings into practice

-Develop hospital protocols to provide fair and effective pain control to neonates. (From Prof Amina Abdel Wahab, Suez Canal univ talk: Neonatal pain, assessment & management)

 Paracetamol could offer important therapeutic advantages over non-steroidal anti-inflammatory4drugs (NSAIDs) (indomethacin and ibuprofen) as paracetamol has no peripheral vasoconstrictive effect, can be given to infants with clinical contraindications to NSAIDs, and appears to be effective. Further research is required to assess the efficacy and safety of paracetamol to close PDA in reterm babies before recommendations for practice can be stated. . (From Prof Alaa Sobeih, Cairo univ talk: Paracetamol: Safety and efficacy in PDA closure in preterm babies

 The primary objective is to produce a set of international Fetal and Newborn Growth Standards (fetal growth, birth weight for gestational age and postnatal growth of preterm infants) for practical applications in clinical use and for monitoring trends in populations (From Prof  Leila Cheikh Ismail, Oxford univ, UK talk: Incorporation of The New International Postnatal Growth Standards for Preterm Infants into the child health development record) 

Errors of commission or omission is not well looked among our practice at NICU. The spectrum of  reported errors runs from near miss to sentinel events. Incidents reporting must be encouraged to learn from our mistakes .Initially fully confidential reporting system have be applied. (From Prof Safaa El Meneza, Al Azhar univ talk: GIT problems, are we aware of it all?)

Ingestion of caustic agents and foreign bodies by children is not uncommon, sometimes potentially serious event. The gold standard of safely assessing depth, extent of injury, and appropriate therapeutic regimen is esophagogastroduodenoscopy. For retrieval of ingested foreign body, the timing of endoscopy depends on; clinical evaluation, type, size, shape, time of ingestion anatomic location of this foreign body (From Prof Tarek Barakat El Mansoura Univ talk: Guidelines of Acute caustic injury and foreign body ingestion in children)

 Clinicians should use the term BRUE to describe an event occurring in an infant <1 year of age when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following:

1.               cyanosis or pallor

2.               absent, decreased, or irregular breathing

3.               marked change in tone (hyper- or hypotonia)

4.               altered level of responsiveness

From Dr Osama Hussein, El Nasr hospital, Port Said talk:Brief resolved unexplained events (BRUE)