Yes Vickie- absolutely right- it's funny how we fall back to using one....(Obviously same principal since 0.167/24 = 1/144). I think I always found it easier to remember a whole number rather than decimal points. Thanks so much for mentioning this though- should also be in everyone's bag! Thanks for continuing to watch!!!
Ha! Ayesha! That's a glowing review if we ever heard one! Thank you so much! We're not planning on stopping any time soon- it's been really fun for us to connect with like-minded people all over the world! Thank you for your loyalty!!!!
Hi, Dr. Tala. Your video lectures are very helpful especially to me who is currently a pediatric resident. Looking forward to more of your lecture videos. Please keep them coming. Thank you. 🥰
That makes us SO happy!!!! Thank you so much- the idea of making anything easier is what we live for! Ha!!! We just filmed something on equations and numbers in the NICU including calories so hopefully that will cover it? If not we’ll film what you were looking for!!! Thank you!
Thank you Tala. Your videos have been so inspiring and have so much simplified neonatal medicine. Kindly make video series on details of SIMV and SIPPV in neonatal practice. Please make as practical as possible. Thank you.
Hello- we're so glad these videos have been helpful. We shot a couple of videos on basics of ventilators - and Dr. Sridhar and I had a chat about different usage of machines in the NICU. Maybe start there? But we will be giving more practical tips soon (once we figure out how to film it). Thank you for being here!
Hello!!! Yes! Another excellent way to do it! (Again similar principal because 24/144 = 1/6). I think it's what we all become used to. Hopefully everyone will pick one method and become comfortable calculating the GIR often. Thanks so much for continuing to watch and for sharing this formula :)
NICU RN here, this video was SO helpful! Would you be able to create a vid on glucose management for hypoglycemia, ie, how dextrose boluses are determined, steroids, glucagon, etc? thank you!!!
Hello Aasma! Thanks so much for your lovely lovely words! I think we've been wary going over hypoglycemia because the numbers change all the time- but we've just started on a TPN/fluids/ feeds etc series, so now is definitely the time to do it. Thanks again so much for subscribing and for taking the time to comment :)
Dr Tala your videos are really helpful.I am RN from india working in NICU. I learnt a lot from your videos. I'm glad that I discovered this channel. Thanks a ton. Just one request,could you please do a video on iontropes and it's calcultion for newborns?
Hello Melgy! We're so glad you're finding these videos helpful-and we're so glad you found the channel too :) We are planning a video on inotropes soon- and we'll definitely include the calculation in it too. Thanks so much for your suggestion.
Interesting Point...Even if Microprimie has RBS level of 400 we dont have to decrese GIR below 4 mics. In such case continue GIR of 4 mics and add Insulin infusion to control sugar levels !!! I got it right Dr Tala ?
in fact I used to calculate the rate of infusion in different way since we lac almost the infusion pump and micodrops and so in If baby 3kg ' need 100ml /kg/ day =3C100=300 ml /day I divide it over 24 hours = approximately 13 ml /hour I divided it over constant figure 3 so I will give him 4 drops / minute But your calculation is more precise and my one is more quickly.
Yes! Thank you Nabeela for a great suggestion. We need to do a video on inotropes generally- so we will definitely include this. Thanks so much for subscribing too.
Excellent question Selsabil! I should have mentioned this! The equation applies to the glucose concentration in any fluid running. So treat D10 1/4NS the same as D10 for the equation, and the same as TPN with D10 in it. Thanks for brining this up!
Hi Tala! Have you done a video on hypoglycaemia? I don’t see it in your video list here. I would love to see a review on hypoglycaemia in term or near term babies. Thank you always for your excellent videos!
Hello Alison! Not yet! But we're planning on doing one wth the whole fluid and electrolyte series we're currently in. Thank you as always for your excellent comments!!!
Hi Gaitree! Yes - we definitely need to do some renal related videos- We had AKI on our list but nothing about renal function or GFR. Thanks so much for letting us know!
I think I found a new favorite channel :) Thanks for the amazing content. I am wondering which babies exactly will need iv glucose. Just any baby below a certain gestational age? Or just in certain diagnoses? At some point patients will be able to feed enterally, so I‘m asking myself how it is decided who gets iv glucose. Fluids in the NICU are a very fascinating topic. I‘d love it if you did a video on the topic in general. There are certainly some issues to make clear for newbies like me (starting my nicu rotation in september) like the tonicity of the fluids used, sodium and potassium content...
Hello Cristoph! Thanks so much for your lovely words and for subscribing. We definitely need to do a talk on fluids and eletrolytes. It's such a vast topic that we've found it a little intimidating to start- maybe we'll start with a 101 type lecture - the basics...and then go from there- we promise we'll get around to it soon though! So- when to start IVF is a bit of a grey area. If the infant is younger than 34 weeks, you're probably going to have to start IVF because with trophic feeds, there's a good chance the infant would become hypoglycemic. (Obviously the younger the babies the higher the fluid needed to account for all their insensible losses) In the late preterm/ term babies starting fluids would depend on their clinical status. Is there any reason you wouldn't want to stress out their gut? Do they have severe metabolic acidosis? Hypotension? Gut issues? Are they hypoglycemic? In babies admitted to the NICU, even if they can't eat PO, there is a good chance they would do OK with small amounts of garage feeds. So like a term baby admitted for TTN, you don't necessarily have to start IVF, you could just start with garage feeds of 25-30ml/kg/day. (This sounds tiny, but think how little term babies get from their breast feeding mothers!) Does this all make sense?
@@TalaTalksNICU I'm new to this channel.nice contents. One doubt, for a term baby if we feed it is 20_30 ml per kg .At the same time if it is iv 60 ml per kg. Why such a disparity
thanks for this nice informative video 👌 its a bit surprising for me that if you still have the guidelines for inserting a central line if the glucose concentration is more an 12.5%. i wonder if there is any evidence that concentration for example 15% dextrose in peripheral line do harm for example phlebitis or something else and we can take the risk of central line to avoid the harm of concentrated dextrose in peripheral line
Hello Doc Pedia! Great point! yes since higher dextrose concentrations are hypertonic, then the higher the dextrose is, the more likely the solution will cause phlebitis and thrombosis. So yes, max peripheral dextrose we use is 12.5 and above that it needs to go into a central line.
If i want to manage a term newborn with a GIR of 6mg/kg/min on 1st day of life with 10% dextrose... How shall i proceed furthur. Plz make it furthur simpler for me.. As this topic is always a bit confusing for me and your teaching is awesome.
OK- first- sorry this is a bit late- lots happening recently! So for a term newborn- let's calculate his ml/kg/day if he is on D10W, and he is on a GIR of 6mg/kg/min. Since [dextrose concentration] X [ml/kg/day] / 144 = GIR So GIR x 144 / [dextrose concentration] = [ml/kg/day] So for your baby he must be getting: 6 x 144/ 10= 86ml/kg/day of the D10 fluids Normally a full-term newborn gets around 60-70ml/kg/day so this is already on the higher side. But if the sugars are still low- we can increase the volumes up to 100 or even 120ml/kg/day. If you just have a PIV- you can given up to D12.5, so this can raise the GIR more. But ultimately- if you're still needing much higher GIRs- it would be better to place a central line so you can get the sugars higher without overloading the kid. If your sugars are normal and you want to start weaning the fluids- we do this pretty arbitrarily. For example, I'd write an order that says- check the sugars Q 3hrs, and if sugars >70, wean IVF by 2mlhr and if > 60, went by 1ml/hr. There's trial an error in that part. At that point you'd want the baby to be eating. Does this all help???
Excellent questions Bincy- normally we're only calculating GIR from the fluids. (Because it's so high or so low that we're concerned. In these cases very often the infant is NPO). But if you did want to include it, then term formula has about 7g carbohydrates (usually lactose) in a 100ml- so close to a D7. Hope this helps!
Hello! So here we just have to solve for X (X being GIR). So let's say we want a GIR of 6 and we're running the fluids at 100ml/kg/day then: 6 X 144/ 100= 8.64 So you'd need D8.4 to get that GIR. Does that make sense?
Thanks alot doc Tala , Can I keep GIR below 4 mg per kg per min in specific situation such as hyperglycemia with renal insufficiency ( restricted fluid because of edema) ????
Hi Ahmed! Really GIR should never drop below 4mg/kg/min because that is what the brain needs. When fluids are restricted, you need a higher GIR if anything too, to make sure the infant is getting enough calories. It's always hard figuring out what the right thing to do is in these situations- but generally err on a central line with higher calories!
Hi Dr Tala! I’d like to ask if you guys also incoporate calcium gluconate for preterm infants in their initial IVFs? Do you also add aminosteril after 24hrs once the baby has passed out stoll and urine output? 😃
Hello! generally we only calculate GIR for when we're giving IVF. (When we feed babies, the sugar is not being absorbed continuously and at the same rate). But for a rough calculation- there is about 7 grams of sugar for every 100ml of breast milk/ term formula. (So around D7).
Hello! There is about 7g lactose per 100ml milk (obviously dependent on milk), so really it is D7. Because we're not sure exactly how quickly the milk (and sugar) is being absorbed, we don't normally calculate the GIR when infants are on feeds. (But I agree- sometimes I want to know when kids are on a combination of feeds and IVF).
Hello Selsabil! We hope you are well-sorry this is a bit late. Normally formulas have about 7g of carbohydrates per 100ml, so about D7. But really- we very rarely need to include the feeds in the GIR. Is there a scenario you can think of where you would need to?
Thanks tala for your answer🥰 ..my D2 iugr 2kg baby on full oral feeding had frequent blood sugar around 45 so I replaced half of amount of feeding by IVF but it didn't work and I didn't know how to calculate the GIR so I kept him NPO😓 and I played on the contration
Hi Selsabil! What we sometime try in these situations is increasing calories of the feeds- so to 24 kcal/oz. If the infants are not fully PO then occasionally we’ll prolong the gavage time- so in a premie if you give the feeds over 90 minutes instead of 30 minutes that can sometimes help.