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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question
Why IVF is given in preterm babies for first 2 to 3 days - why 10% dextrose is preferred over 5% in preterm babies?
Answer
GI motor activity is present before 24 weeks, but organized peristalsis is not established until 29-30 weeks and is facilitated by antenatal corticosteroid treatment. Coordinated sucking and swallowing develops at 32-34 weeks. By term, the fetus swallows about 150 cc/kg/day of amniotic fluid, which has 275 mOsm/L, contains carbohydrates, protein, fat, electrolytes, immunoglobulins and growth factors, and plays an important role in development of GI function. Preterm birth interrupts this development. Even if nutrients are provided parenterally, lack of enteric intake leads to decreased circulating gut peptides, slower enterocyte turnover and nutrient transport, decreased bile acid secretion, and increased susceptibility to infection due to impaired barrier function by intestinal epithelium, lack of colonization by normal commensal flora and colonization by pathogenic organisms. For fat digestion, the newborn depends on lingual lipase, which is stimulated by sucking and swallowing and by nutrients in the stomach but not the small bowel. The method of feeding depends on the weight of the infant. For INFANTS WEIGHING LESS THAN 1500 G AT BIRTH - Start with an intravenous infusion of maintenance fluid only on day 1. From day 2 tube feeds are gradually introduced and intravenous fluid is gradually stopped over a number of days. For INFANTS WEIGHING 1500G OR MORE AT BIRTH , milk feeds can be from birth and usually do not need an intravenous infusion. Preterm infants need higher calories before they gain weight. This requires fluids of up to 180 ml/kg/day of standard fluids. Instead of increasing the volume of the fluids, however. Back to All Questions

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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

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