NN Q KZN

 #############################

I would like to know what the forum members feel regarding these two scenario: 

1. Term infant with signs of PPHN, CXR: dark lung fields ( idiopathic/primary PPHN), well expanded, on HFOV, ECHO: PPHN. Preductal sats in the 70s-80s. Do you give surfactant or go straight to iNO? There is expert opinion that giving surfactant in these situations worsen the clinical situation. Please share your experience/available literature. 

2. Term infant with GBS positive mother. She was started on GBS prophylaxis as per ACOG guidelines when she was in labor and she gets one dose and miss subsequent two doses, prolonged labor. Last dose of antibiotic was given 8-12h ago. Baby is well on exam, no chorioamnionitis diagnosis by OB. Mother request early discharge at 24h. Do yo consider this as adequate IAP and discharge baby or watch baby for 48h as per AAP guidelines? Also, another case of mother receiving AIP 3h prior to delivery and she request discharge at 24h. Please share your practice. Thank you

#######################

For #1 - from a pathophys view (decreasing pulm vascular resistance is the key goal) so iNO would certainly be my option.

For #2 - given a completely well infant at 24h, we would be OK with discharge at 24h.

##########################

2# if mother received B. Penicillin or Ampicillin or cefazolin more than 4 hes before delivery is considered adequate prophylaxis. 
observation can be enough for 24 hrs if parents are well educated regarding warning signs and have immediate access to clinical services.

1# first of all is ensure adequate recruitment with adequate ventilation then consider surfactant if fio2 requirements still high.

2# to check how much is pulmonary pressure and cardiac function before starting iNO.

if adequate myocardial function, can start iNo. If not don’t give.

start inotropes to increase your Systemic pressure above pulmonary pressure.

adequate sedation and pain management and minimal handling 

#############################

For #1, you answered yourself dark lung fields, so no RDS, hence no surfactant, looks like vascular phenomena rather than parenchymal as your scenario. Treatment lung protective strategy, and pulmonary vasodilation.

for #2, adequate coverage, can be discharge with follow up

################################