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 ?
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.
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!!!
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!
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.
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!
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???
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.
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?
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).
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 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.
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).
Nice Review! I also like the equation:(Conc x ml/hr x 0.167)/kg
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!!!
a trick : watch series at flixzone. I've been using it for watching loads of movies during the lockdown.
@Malcolm Winston Yup, been watching on Flixzone for months myself =)
Please don’t ever close your channel ... this channel is my lifeline
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!!!!
@@TalaTalksNICU Im working in the UK as well :) thats another reason its so helpful
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. 🥰
Hello Dr. Licup! Thanks so much for checking the videos out and for giving us the positive feedback. We hope you enjoy your time in the NICU :)
So simple ,very beneficial ,
Thanks Dr Tala
So glad you thought so- thanks so much for letting us know!
Working as an RN in NICU. Thank you Dr Tala and team, your videos are so helpful.
Thank you so much Rene for your work, and for watching! Let us know if there are any videos you would like to see! Thanks again!
Excellent video, I’m preparing for my specialty nurse exam 🥰
Oh that’s great! Hope these help! Thanks so much for being here and GOOD LUCK in your exams :)
As a dieteic intern, this helped me out so much! Thank you!
We’re so happy Santiago! And thanks for letting us know! Good luck on your studies :)
YAY! New video! I start my NICU position this Friday :) so absorbing all these helpful nuggets
Angie- you're so sweet! You are going to be such a great addition to the NICU. So happy these are helpful! We hope you have a great first day :)
Great video! So many things have become so easy because of this channel. Can you please please please do a video on calorie requirements in the nicu??
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!
In egypt we use this calculation
Gc*rate of fluids divided by 6*body weight
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.
Hi Tala, if you can speak about TPN, we be very helpful
We made three videos on TPN- if you go to the Home Screen you can find them there! Let us know if there’s anything we’re missing!
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 ?
YES! An excellent, very important point! And I should have emphasized
that more in the video. Thank you so much!!
Thank you so much 🎉😊Waiting. For more videos 🎉😂. Amazing 🤩
Thank you so much for commenting!! So happy you’re liking these videos :)
Thanks so much for the information .
For the first example , the weight of the baby wasn’t given, like the second example
Hello Naomi! In the first example the fluid per kg per day was given so you don’t need the weight to calculate it. Does this make sense?
Great video! Can you make a video on how to calculate dopamine infusion?
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.
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!!!
Thanks tala ..I liked it soooo much
My question is: do we apply the same equation if the baby is receiving D10 1/4 NS FOR example?
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!
Thanks 😊
Very nice dr tala.
Thanks so much Salman!!
It's really nice explanation.good job
We really appreciate your positive feedback-thanks so much for watching and commenting :)
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.
Oh that's interesting- we generally run fluids over an hour (unless it's a pressor and then we calculate per minute). Every place is different!
hi mam how are you,today good topics very nice.mam i needed nrp and pals vedio.
Hello Jessy- thanks for your suggestions. We are figuring out how to do NRP videos without infringing on any copyrights! Stay tuned!!!
Hello. Please could you do a video on eGFR and AKI in newborns? Thank you.
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!
That's was so informative. Thank you
Thank you so much for taking the time to comment :)
Can you speak about umbilical view and artery insertion
Hello! yes this is a great idea! We'll plan on walking through the insertion. Thanks for the suggestion!
Its absolutely clear now, thankuu
We're so happy! Glad it helped :)
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???
@@TalaTalksNICU thanks a lot❤ .. Its very easy now
144 or 1440 in denominator.. Bit confusion medam
I know it is an old video, but need to ask:
When is the best time to do the first RBS test in high risk groups?
Answered below! Sorry took time!
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.
Good information. If baby receiving oral feed (ebm or formula )in addition to iv fluid whether it will add to calculate GIR.
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!
@@TalaTalksNICU Thank you.
Thank you very much
Thank you so much for watching- and for taking the time to comment Dr. Abdulla
How to make GIR of 6 or 8 ,we know the wt,fluid per kg per day?
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?
Well done 👏✔👍
Thank you so much for continuing to watch!!
how do we calculate GIR if the baby is on half feeds and half fluids? kindly reply me. Thanks in advance.
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).
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!
Consider Insulin if sugars more than 12mmol but maintain minimum GIR to 4mg/kg/min
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? 😃
More excellent questions! It depends how preemie the babies are. If they're
ما شاء الله. بارك اللة فيكم
THANKS
Great and compact
Thanks so much Azam, we value your loyalty!!!
Hi tala, I fall in the question of calculating the GIR for my baby who s on milk and IVF ... is there an equation ?
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.
I want to know the GIR when baby have milk beside dextrose
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).
@@TalaTalksNICU thank you soooo much
Good
Thanks so much for watching!
Useful
Great! Thanks for subscribing and for taking the time to comment :)
@@TalaTalksNICU Hi doctor Tala I am working in an NICU all of your talks are very nice and simplified to understand.
Thank you
Thanks so much for watching and for letting us know they are helpful. We hope you are enjoying the NICU!
Good
Thank you!