Golden hour! Vitamin K! Lumbar punctures! Surfactant! Exchange transfusions! - 10K Celebration

You ASKED and we gave QUICK answers to your NICU questions- and a BONUS QUESTION! What do we care about in the Golden Hour? When do we need to tap an infant? When should we give surfactant? When do we perform an exchange transfusion? Why is vitamin K important? AND! What has changed in the NICU in the last 20 years?!
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Please be sure to give us a like, comment about future topics, and subscribe to this channel to stay up to date on all things NICU! Also, click the notification bell after you subscribe to gain your weekly NICU knowledge as soon as it's loaded!
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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*TIMESTAMPS*
00:43 What do we care about in the golden hour?
5:13 When would a lumbar puncture need to be obtained?
10:05 Is there an optimal time to give surfactant?
12:25 When does a baby need an exchange transfusion and can you describe it?
15:17 What is the major reason vitamin K is given to a newborn? Also, which babies are a greater risk of complications if the Vitamin K is declined?
17:45 What's the most important/impressive development or change in practice that you've seen during your time in the NICU?
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References:
Early or selective surfactant (colfosceril palmitate, Exosurf) for intubated babies at 26 to 29 weeks gestation. A European double-blind trial with sequential analysis. European Exosurf Study Group. Online J Curr Clin Trials 1992;Doc No 28.
Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2012;11:CD001456
Vitamin K and the Newborn Infant
Ivan Hand, MD, FAAP; Lawrence Noble, MD, FAAP; Steven A. Abrams, MD, FAAP COMMITTEE ON FETUS AND NEWBORN, SECTION ON BREASTFEEDING, COMMITTEE ON NUTRITION
publications.a...
Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

[@Jo-mp3qo]

Thank you so much for taking the time to answer my question 🥰 These are such great responses. I especially like how you've split the answer into 4 parts. Very Tala Talks of you 😀 Love it.

[@TalaTalksNICU]

Ha! Thank you Jo so much for the question! We talked about it for a long time- in fact people are still texting me with answers! ha! And I think the list thing may be a disease! ha- wish I were better with them in the rest of my life!!!!

[@carmengalindo8587]

Hi! Could you guys do a video on apnea/Brady events? Like why they happen, what’s considered an event, why do we care?

[@TalaTalksNICU]

Hello Carmen! Yes- will try to write this and film it soon ( we have a back-log of videos we're getting out- TPN, BPD, coags)- and publish it. You've been such. loyal viewer so we're definitely listening to you!! THANKS!!!

[@TheAsdfghjk123]

Can you make a video on maternal pathologies and how they affect the neonate? For example, pre E, GDM, hypothyroid

[@TalaTalksNICU]

That is SUCH a great idea for a video- we'll make it quick and as helpful as possible. Thanks so much- we hadn't thought of this- and it's so relevant!

[@naitramsingh6942]

With each new video your team continues producing amazing contents, thanks again for your knowledge and time, its always fun to learn.

[@TalaTalksNICU]

Wow- thanks so much- lovely words! So glad you're still watching :)

[@jaynesolomon680]

So Happy to see a new video post. I look forward to these uploads every week!

[@TalaTalksNICU]

Thanks so much Jayne!! We're so happy you're still watching them all. We look forward to your comments!!

[@sarbarigupta2856]

I have never before seen anyone making such simple, so so informative and easy to understand videos out of such complex topics . Kudos Dr...hoping to hear more and more from you

[@TalaTalksNICU]

Oh wow! Thanks so much for your lovely lovely comment!! We really appreciate it!

[@zubairqasimrashdi6882]

Brilliant discussion. Concise yet comprehensive. Why did I not discover this channel earlier!

[@TalaTalksNICU]

So glad you found us now! Thanks so much :))

[@heritagegirl]

I started in the NICU in 1985 and I agree with all of your points about the advancements and changes! We kept babies on the ventilator for WEEKS. Also, we used transcutaneous monitors to keep track of oxygen levels...we would have to rotate the location on the skin, and the monitor caused a red burn mark on the micropreemies...I am so grateful for pulse oximeters!! And, the head neo had us giving IV Gentamycin into the stomach via the NGT to prevent NEC. 😱 😱😱

[@TalaTalksNICU]

Hi Carrie! We're sure you have plenty of great stories!!!! Those transcutaneous monitors were a disaster- and sadly I think they affected everyone's trust of the trans-cutaneous C02 monitors- which I love!!! and yes! Gent via NG tube- actually read something about that :) Anything else we missed? (Some of the nurses have told me about the elaborate set ups they had for infants with apnea- which basically jiggled the babies from outside)....Thanks so much for watching and commenting!!!

[@user-rn5gb4vm6j]

Please . Make a common scenario about all medication and how to manage hypotension step by step for preterm baby .. please

[@TalaTalksNICU]

Hello Riah! We do really want to cover this but it's such a HUGE topic and we're still not certain exactly what the best pressers are and in which situations. We'll try to get something out soon though! Thanks so much for watching and subscribing :)

[@moraghoward5748]

Love your videos and recommend for nursing interns for initial knowledge to experienced providers as means to explain things more concisely to parents! Would you consider video on NAVA and HFJV?

[@TalaTalksNICU]

Hello! yes- we are planning videos on other types of respiratory support- we have such a back-log of requests- but we realize this is a really important one!! Thank you so much for your lovely words!

[@arifuddin6198]

Super session, thanks 😊

[@TalaTalksNICU]

Thanks so much for taking time to comment :)

[@katherinedatu2546]

I love your videos! Thank you.

[@TalaTalksNICU]

Thank you for taking the time to comment! So happy you're here :)

[@cynthiapridham2885]

Excellent

[@TalaTalksNICU]

Thank you so much Cynthia- and thanks for subscribing!

[@malikkamuki]

Please make a video of viability decision making limits , approach factors and criteria for care withdrawal if any severe outcomes. As a fellow I was asked to withdraw care in a 23 weeker with severe us based bad cerebral assessment like extensive ivh hemorrhage etc …but baby lungs were decent …so there was a lot of choas

[@TalaTalksNICU]

This is such a tough one and I’m honestly not sure how to cover it- I think I need someone from palliative care to help. In many hospitals we accept not resuscitating babies

[@malikkamuki]

Also I would recommend if you can do board style questions short questions

[@laraeb2514]

I have to agree iNO was a game changer!!! I remembered inducing alkalosis for vasodilation, using systematic vasodiolators (😬🥺)!! Also, induced hypothermia treatment for HIE ....my favorite improvement in NiCU!

[@TalaTalksNICU]

URGH! You're right! We totally should have mentioned that- cooling therapy has been an absolute game changer!!!! silly us!!! THANK YOU yes- the alkalosis and the pa02s in the hundreds!!! Wonder what we'll be shaking our heads at in future!!!

[@laraeb2514]

@@TalaTalksNICU yes PaO2s in the hundreds!!😬 and age of viability a firm 24weeks and 500+ grams. To be fair though our technology wasn't up to the task fully back then. Also, kids on TPN for weeks and not having PICCs as a standard... plus side I can still get an IV on almost anyone due to tons of practice. Lastly prenatal steroids better lungs 🫁 starting from birth makes it easier to support our little people!

[@TalaTalksNICU]

Very true about the technology. Funny how these tiny changes actually make a huge difference. So you're that IV person! After three attempts call Larae! :) You hero! Thanks again for being here :)

[@laraeb2514]

@@TalaTalksNICU I am called quite often, it's a great skill but not very fun at parties! Keep up the great work!!

[@osamaalagamawy3891]

ما شاء اللة. .....بارك اللة فيكى.

[@TalaTalksNICU]

Thank you very much Osama

[@jaynesolomon680]

Would like clarification on white and grey matter injury -pathophysiology and outcomes of injury.

[@TalaTalksNICU]

Hello- we've been kind of avoiding PVL and other forms of more permanent brain injury because it's sad and dry- but we promise we'll get around to it!!! Thanks :)

[@rekhasvlogs7457]

Maam plz make video on NRP how to do

[@TalaTalksNICU]

We promise we’re getting there!!!! Thanks for watching!

[@melishendek6472]

Hey Tala. Can you tell us some brief but important informations about Calcium and Phosphat / vit D substitution? Thanks!

[@TalaTalksNICU]

Hello! We're releasing the third part of the TPN series soon and we'll go over a little bit of the metabolism then- but yore right- we need to do an entire lecture on Ca/Phos metabolism and osteopenia etc. THANKS!!

[@drsatishparmar9422]

Last answer show your expertise as neonatologist. Love to listen you in answering mode.

[@TalaTalksNICU]

Oh wow- thank you so much Dr. Parmar! Those answers come from a few of my colleagues too :)

[@smartman9033]

Can you share references pls!

[@TalaTalksNICU]

Hello! we added a few- are there any others in particular you'd like to see? Thanks!!

[@smartman9033]

@@TalaTalksNICU Thank you I am wondering if I can get the reference for LP discussion! Especially you did mention 1/3 of CSF will positive with neg BLood Cx ! Thanks

[@TalaTalksNICU]

Yes! You're right that's an important one. Just added it. (Copy link and paste). Thanks!