Dr Aziz Ur Rehman Ajmeer

14/01/2025

25/11/2024

20/11/2024

20/10/2024

05/10/2024

11/09/2024

11/09/2024

30/08/2024

18/08/2024

NaHCO3 is a very useful medicine which should be used very carefully in the management of metabolic acidosis and used in the right way at the right time.
Treatment of metabolic acidosis includes (Stepwise):
1. Identify the cause of metabolic acidosis and treat the cause first
2. Optimise Ventilation to keep PCO2 in normal range (35-45 mmHg)
3. Oxygenate the baby to keep SPO2 between 90 and 95% (PaO2 70-90 mmHg)
4. Good tissue perfusion by appropriate volume resuscitation and use of inotropes if required.
5. pH down to 7.20 is well tolerated. If pH remains less than 7.2 in spite of all above measures, then use NaHCO3 as slow IV infusion over two to four hours; sometimes longer.
6. Always do half correction, use half strength NaCO3 (4.2%) by mixing 50:50 with NS or D5W, infuse through central line if present to avoid , monitor BG and Electrolytes (particularly Na & K).
7. NaHCO3 infusion corrects pH only in ECF. To achieve equilibrium with ICF takes time. Be patient.

14/08/2024

*Rationale for fortification*
●Preterm miss the placental transfer of nutrients (stores for use in postnatal period made in the last trimester ,critical period for brain grwoth )
●Human milk doesnt provide sufficient nutrients to vlbw at the usual feeding volumes should be supplemented witj protein,calcium, phosphate.
~Insufficient intake will lead to extra uterine growth retardation and poor neurocognitive outcome.
The objective of fortification is to increase the concentration of nutrients to the levels that at the recommended feeding voulmes (135_200ml/kg/day)preterm receives amounts of all nutrients that meet the requirements. Nutrient req are defined as intakes that enable the infant to grow at the same rate as a fetus.
●Types of fortifiers
•Mutlinutrient(carb,pro,lipid) can be derived from bovine ,human
•Single nutrient

●Methods/Practices of Fortification
•Standard fortification.
Add standard fixed amount in 100 ml Human milk start at feeding volumes 50-100ml/kg/day

•Individualised Fortificiation

•Adjustable fortification starts as standard fortification when the baby is at volume of 50-80ml /kg/day BUN is done twice weekly is less than 10mg/dl protein is added in the levels uptil max of 1.2g/100 ml of Human Milk reduced if BUnlN 16mg/dl

•Targeted fortification
Needs bed side milk analyzer, expensive
Protein achieved at 3.5g/kg/day

•Fortified Boost
HMF mixed in 5-10ml EBM then breastfeeding

~ESPGAN reccommends HM for all babies less than 1800 gm babies
~HMF continued uptil 4 weeks past their due date or gaining 250g/kg/wk

(Specially for Neonatologist)