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OBJECTIVE: To compare the clinical endotracheal tube (ETT) depth after initial stabilization of infants with congenital diaphragmatic hernia (CDH) to weight and gestational age-based depth estimates. STUDY DESIGN: This retrospective analysis included 58 inborn infants with left-sided CDH. We compared a standard anatomic ETT depth calculated from initial chest radiographs and the clinical depth of the ETT after adjustments to predicted depths using weight and gestational age-based estimates. RESULTS: The standard anatomic depth was deeper than age (1.29 cm ± 1.15 standard deviation, p<0.001) and weight-based (0.59 cm ± 0.95 standard deviation, p<0.001) estimates. The clinical ETT depth was also deeper than age (1.01 cm ± 0.77 standard deviation, p<0.001) and weight-based (0.26 cm ± 0.50 standard deviation, p<0.001) estimates. CONCLUSION: Established strategies to predict ETT depth underestimate the ideal depth in infants with left-sided CDH. These data suggest utilizing caution during initial ETT placement based on standard depth estimates for patients with CDH.
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We present the case of a term-healthy neonate who developed hematemesis while being admitted at the newborn nursery. The infant was found to have gastric ulcers with duodenal eosinophils. The condition was conservatively managed and the symptoms, including ulcers, resolved with time; however, the etiology of the ulcers is still unknown.
Assuntos
Recém-Nascido Prematuro , Cordão Umbilical , Constrição , Parto Obstétrico , Feminino , Humanos , Lactente , Recém-Nascido , GravidezRESUMO
The rarity and complexity of conjoined twins creates a challenge for prenatal planning, delivery resuscitation, and postnatal management. The modality of simulation offers a safe practice environment for a multidisciplinary group consisting of neonatal providers, nurses, respiratory therapists, and surgeons in which to identify and address clinical decision making, procedural, and behavioral plans related to routine and emergency care of these patients. Simulation-based clinical rehearsals (SbCR) provide a unique opportunity to prepare for rare, complex, and patient specific clinical procedures and scenarios. This primer serves as a revisable tool that promotes the development of proper timing, technique, and confidence to allow for an optimal setting for delivery of safe care to conjoined twins. We describe the development and implementation of a simulation approach to all stages of care from the antenatal life, NICU care, to preparation for postnatal separation of conjoined twins.