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readytotaxi
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 5:28 pm

How terrible for the family.

http://www.standard.co.uk/news/trans...eathrow-to-hong-kong-a3228636.html

"Chinese media reported the four-month-old fell unconscious on Sunday afternoon while travelling with her parents on Cathay Pacific flight CX256"

[Edited 2016-04-19 10:41:30]
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Amiga500
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 5:36 pm

Shit. Heart goes out to them.
 
richcandy
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 5:41 pm

Thats horrible. The parents must be devastated
 
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DocLightning
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 8:06 pm

Ugh. SIDS case, maybe. Awful.
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Flighty
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 8:37 pm

Terrible. Sad case.

My mom was an a DL flight some years ago when a baby ate some peanuts, and unexpectedly was allergic. Trouble breathing. She is a doctor like DocL and examined the kid, and found the kid to be safe, the reaction subsiding. Point is, the airline was laser focused on the safety of the child. Head FA and CA were ready to divert the 767 back from the Pacific to Seattle just like that. Zero hesitation. That always impressed me.

Airlines do whatever they can. Sad day.
 
usflyguy
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 8:57 pm

Wow! Very sad for the family. Tough for the crew members as well. Possibly the last flight for some of them as medical events involving kids tend to be much harder to recover from than those involving adults. Hopefully, they are provided the assistance that they need in dealing with the situation.
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bennett123
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 9:41 pm

Is there a minimum flying age for babies?.
 
ZaphodHarkonnen
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 9:48 pm

  Very stink. Will wait for a corner's report before saying anymore.
 
slider
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 9:54 pm

How awful.   I cannot fathom that, as a parent. Heartbreaking.

Quoting bennett123 (Reply 6):
Is there a minimum flying age for babies?.

I don't think so. My kids were both flying before 3 months old. I guess it depends on whether the parents want to go through the slog of bringing babies on the plane and all that.
 
9w748capt
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 10:19 pm

Damn - the article mentions a GI illness - so maybe the baby got severely dehydrated - leading to electrolyte abnormalities - then who knows what. I can only speculate. So unbelievably sad! Heart goes out to the family.
 
N415XJ
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 10:20 pm

Quoting DocLightning (Reply 3):
SIDS case, maybe.

You're the Doc here, so maybe you can clue me in, but I thought SIDS only happens when the baby is asleep/in their crib. Do babies really just keel over and die all of a sudden despite appearing perfectly healthy the moment before? If so I can't imagine anything more traumatizing and awful for a parent to go through.
 
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DocLightning
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 10:30 pm

Quoting Flighty (Reply 4):

My mom was an a DL flight some years ago when a baby ate some peanuts, and unexpectedly was allergic. Trouble breathing. She is a doctor like DocL and examined the kid, and found the kid to be safe, the reaction subsiding. Point is, the airline was laser focused on the safety of the child. Head FA and CA were ready to divert the 767 back from the Pacific to Seattle just like that. Zero hesitation. That always impressed me.

1) People operating aircraft are humans. They are not likely to be cold-hearted enough to ignore a passenger in distress. Many are also parents and would want their child cared for in such a situation, too.

2) No airline wants to be sued for negligence for refusing to divert for a medical emergency, irrespective of how warm or cold-hearted the crew and/or executives are.
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ZaphodHarkonnen
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 10:37 pm

Quoting N415XJ (Reply 10):
You're the Doc here, so maybe you can clue me in, but I thought SIDS only happens when the baby is asleep/in their crib. Do babies really just keel over and die all of a sudden despite appearing perfectly healthy the moment before? If so I can't imagine anything more traumatizing and awful for a parent to go through.

I'm pretty sure that while SIDS usually occurs during sleep there is no requirement that it has to happen during sleep. So it is entirely possible that an infant that was fine one moment could die shortly after. Though very very unlikely.
 
9w748capt
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 10:39 pm

Quoting N415XJ (Reply 10):
but I thought SIDS only happens when the baby is asleep/in their crib. Do babies really just keel over and die all of a sudden despite appearing perfectly healthy the moment before?

Thankfully babies don't usually do that, but crazier, sadder things have happened. The "found dead in crib" story is the classic SIDS story, but usually it's often not that simple. Who knows - maybe the baby had an underlying metabolic disorder of some sort that manifested itself at the worst possible moment.
 
pasu129
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Young Baby Dies Inflight LHR-HKG On Cathay

Tue Apr 19, 2016 10:53 pm

Condolences to the family. Very sad to hear.
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Flighty
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Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 12:00 am

Docl yes and they were smart enough to grasp their proper course of action. Diverting a pacific flight might be a 200-300k decision. Not counting the inconvenience (1 day?) of 200 people. It was 1 hour out towards Asia so a loaded 767 would probably have to dump tanks. As you can imagine, slightly nerve wracking call, because nobody except a professional really can vouch for the condition of a baby. A pilot is not going to own that. But it worked out.

When things are a definite go back, bet numerous individuals spring to action. Tower, ground, crew. Things like that make me proud (of the effort.). But it doesn't always work out.
 
Viscount724
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Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 12:41 am

Quoting bennett123 (Reply 6):
Is there a minimum flying age for babies?.

7 days on AC per their website.
 
B2468
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Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 1:17 am

Wow, I don't have any children, but I can't imagine the heartbreak a couple feels when they lose their infant child, and as others have said above, it's got to be traumatic to not just the crew, but also the nearby passengers, especially when it is so young a child. Being in an aircraft, there is only just so much anyone can do (and crew and pax have done some pretty incredible things up there medically) I can't imagine how I would feel if a family sitting nearby just lost their child, pretty much right in front of them. I hope I never find out.

Condolences to the family, and my thoughts are with the crew and nearby pax as well.
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ltbewr
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Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 1:22 am

I wonder what the procedures would be, with a minor that has died on a flight, if Hong Kong would issue the death certificate, how it would be worded and if Hong Kong would do or require an autopsy or a parent could reject it ?
 
jacobin777
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 1:34 am

Quoting bennett123 (Reply 6):

Is there a minimum flying age for babies?.

Our pediatrician told us "no flying domestically until the kids are 3 months old and no flying internationally until the kids are 6 months old". That is what we did.
"Up the Irons!"
 
BMI727
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 1:45 am

Quoting bennett123 (Reply 6):
Is there a minimum flying age for babies?.

I took my first flight at two weeks old. My parents brought me straight to the airport from the hospital where I'd been back in with jaundice.
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BN727227Ultra
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 2:17 am

Terrible. Shuddering just thinking about this.
 
cpd
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 2:54 am

Quoting B2468 (Reply 17):
Wow, I don't have any children, but I can't imagine the heartbreak a couple feels when they lose their infant child, and as others have said above, it's got to be traumatic to not just the crew, but also the nearby passengers, especially when it is so young a child. Being in an aircraft, there is only just so much anyone can do (and crew and pax have done some pretty incredible things up there medically) I can't imagine how I would feel if a family sitting nearby just lost their child, pretty much right in front of them. I hope I never find out.

Condolences to the family, and my thoughts are with the crew and nearby pax as well.

This must be one of the most horrible things that could ever happen. For the parents, the crew, those nearby. It'd just be dreadful.   Condolences to the family and all those affected.  
 
GatorClark
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 4:49 am



Quoting bennett123 (Reply 6):
Is there a minimum flying age for babies?.

WN policy seems to indicate a minimum of 14 days old:
https://www.southwest.com/html/customer-service/family/baby-on-board-pol.html

AA policy specifically says minimum of 2 days:
https://www.aa.com/i18n/travelInformation/specialAssistance/childrenTraveling.jsp

DL policy is Physician's letter of approval for less than 7 days old:
http://www.delta.com/content/www/en_...special-travel-needs/children.html

UA says nobody under 7 days old.
https://www.united.com/web/en-US/content/travel/specialneeds/infants/default.aspx

[Edited 2016-04-19 21:55:03]

[Edited 2016-04-19 21:55:41]
 
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DocLightning
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 5:46 am

Quoting N415XJ (Reply 10):

You're the Doc here, so maybe you can clue me in, but I thought SIDS only happens when the baby is asleep/in their crib. Do babies really just keel over and die all of a sudden despite appearing perfectly healthy the moment before? If so I can't imagine anything more traumatizing and awful for a parent to go through.

I don't know the details. It turns out that an airplane flight is often a "good" set-up for SIDS because often infants must co-sleep with parents and do not have access to a flat sleeping surface. If they can get a bassinet, that reduces the risk.

I did not hear (and maybe there is an update I missed) that the infant abruptly lost consciousness and died.

Quoting jacobin777 (Reply 19):

Our pediatrician told us "no flying domestically until the kids are 3 months old and no flying internationally until the kids are 6 months old". That is what we did.

I want them to have had their first round of vaccines at a minimum. I advise waiting until after the second round, which is at 4mo in the U.S.
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nclmedic
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 3:47 pm

Terribly tragic case for all involved.

I've been asked a few times as doc to offer assistance on flights, but never to a child. Even with ground assistance, you're often very isolated up there as a medic, and a lot of the kit you'd rely on in a hospital isn't available.
Flying back from JFK-LHR a gentleman had a cardiac arrest and unfortunately didn't make it. We were mid-atlantic so there wasn't much else we could do but continue to Heathrow. I'm still amazed that then, as a doctor 1 year out of med school, I was the only person to offer help.   

I hope the family are able to get some closure following the coroner's investigation. So sad.
 
jacobin777
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 4:49 pm

Quoting DocLightning (Reply 24):
Quoting jacobin777 (Reply 19):

Our pediatrician told us "no flying domestically until the kids are 3 months old and no flying internationally until the kids are 6 months old". That is what we did.

I want them to have had their first round of vaccines at a minimum. I advise waiting until after the second round, which is at 4mo in the U.S.

Interesting....I guess your recommendation is more prudent than our pediatricians recommendation (which we respect a lot) and something which we would highly consider if we decided to have more kid(s).  
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 5:11 pm

Quoting jacobin777 (Reply 26):

Interesting....I guess your recommendation is more prudent than our pediatricians recommendation (which we respect a lot) and something which we would highly consider if we decided to have more kid(s).

Well, it's a recommendation, which is allI can make. But if we have to fly across the country to adopt a newborn then we're going to need to fly back with the newborn who has had nothing more than HepB. Sometimes there are extenuating circumstances and we as physicians need to be sensitive to those.
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United787
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 5:32 pm

Quoting DocLightning (Reply 24):
I want them to have had their first round of vaccines at a minimum. I advise waiting until after the second round, which is at 4mo in the U.S.

That is what our pediatrician told us too. I am always surprised to see people out and about with new born babies, too dangerous for me.
 
jacobin777
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 7:11 pm

Quoting DocLightning (Reply 27):
Well, it's a recommendation, which is allI can make. But if we have to fly across the country to adopt a newborn then we're going to need to fly back with the newborn who has had nothing more than HepB. Sometimes there are extenuating circumstances and we as physicians need to be sensitive to those.

  

Quoting United787 (Reply 28):
That is what our pediatrician told us too. I am always surprised to see people out and about with new born babies, too dangerous for me.

We were very cautious with our newborns. My in-laws came to visit for a couple of months and they had to get their various shots. There was no way in bloody 'ell were they able to stay with us without their shots.

A little common sense goes a long way.

[Edited 2016-04-20 12:11:46]
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747400sp
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 7:42 pm

This is sad to read, I hope the parents will find peace down the line.
 
Birdwatching
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 8:45 pm

My son's first flights were when he was a month old, and then some super long haul intercontinental flights as he was 4 months. He loved it, must be better than first class in that bassinet.

Anyway, what a sad incident. Rest in peace little traveler.

Soren   
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ubeema
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 9:13 pm

Quoting DocLightning (Reply 24):
I want them to have had their first round of vaccines at a minimum. I advise waiting until after the second round, which is at 4mo in the U.S.

I am with you and others here. We did not allow our baby to fly until she had at least two rounds of vaccination. Besides she was born at 31 weeks as such her immune system was quite deficient within months of birth.

Looks like the crew and all involved tried their best in this case. Rest in peace little traveler.
 
ZKCIF
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 9:22 pm

The youngest flier I've seen was 6 days old. That was in New Caledonia. a mom gave birth in Noumea and flew home on Air Caledonie from Magenta to Mare. A good age to start. and ATR72, not just some banal 738 or 320. i felt envious  
 
9w748capt
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 9:52 pm

Quoting United787 (Reply 28):

That is what our pediatrician told us too. I am always surprised to see people out and about with new born babies, too dangerous for me.

Why? Newborns are exposed to millions of pathogens the instant they're born. Hospitals are arguably the dirtiest places in the world. We don't have kids yet but if I had to choose between taking my newborn for a walk outside vs being in a hospital room, we'll that's a pretty easy decision.

I don't know that having a set of vaccines really matters. Most of the organisms we vaccinate at 2 and 4 months against cause disease rather infrequently (other than pertussis in California), and a healthy term newborn will have some degree of passive immunity from the mother until 6 months of age. Of course for preterm babies (like the poster above), I'd definitely be extra careful.

I don't know that there's any evidence showing its safer to fly at 6 months vs 4. Would be curious to read any studies looking at this.
 
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ssteve
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Wed Apr 20, 2016 11:46 pm

Since fever in an infant under 3 months of age means admission to the hospital, its nice to avoid infectious disease for that reason alone.

That said, my son flew at 7 weeks of age. It was Christmas, and all the family was not where we live. You know it's not ideal, but...
 
flymia
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Thu Apr 21, 2016 12:57 am

Quoting DocLightning (Reply 11):
1) People operating aircraft are humans. They are not likely to be cold-hearted enough to ignore a passenger in distress. Many are also parents and would want their child cared for in such a situation, too.

Of course, and I am surprised anyone is surprise that a flight crew would put a human's live before a flight. Flights have even diverted for dogs in the cargo hold for flights that had pressurization or heating problems, and I have no problem with that, it should be expected really.
"It was just four of us on the flight deck, trying to do our job" (Captain Al Haynes)
 
9w748capt
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Thu Apr 21, 2016 1:16 am

Quoting ssteve (Reply 35):

Since fever in an infant under 3 months of age means admission to the hospital,

Not accurate at all. Full workup and admission is only needed in babies under one month. We send home febrile two month olds all the time i.e. every baby who spikes a fever after their two month vaccines.

[Edited 2016-04-20 18:17:27]
 
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ssteve
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RE: Young Baby Dies Inflight LHR-HKG On Cathay

Thu Apr 21, 2016 3:25 am

You're right, IANAD. I was probably transposing "spinal tap" and "admission"... in any event, to be avoided.
 
rocketPower
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Re: Young Baby Dies Inflight LHR-HKG On Cathay

Fri Jul 15, 2016 1:28 pm

Not what I want to read two weeks before bringing my infant on board YYZ-NRT... condolences :'(
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DocLightning
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Re: RE: Young Baby Dies Inflight LHR-HKG On Cathay

Fri Jul 15, 2016 4:57 pm

9w748capt wrote:
Quoting ssteve (Reply 35):
Since fever in an infant under 3 months of age means admission to the hospital,
Not accurate at all. Full workup and admission is only needed in babies under one month. We send home febrile two month olds all the time i.e. every baby who spikes a fever after their two month vaccines.[Edited 2016-04-20 18:17:27]


At every center where I've worked, 60 days is the cut-off. Under 30 days we always admit. 30-60 days, we do a full sepsis workup including lumbar puncture. If the child is well-appearing and all labs (including CSF cell count) are normal, the infant is given 50mg/kg of ceftriaxone intramuscularly and discharged home with close follow-up within 24 hours for a second dose. If that cannot be arranged, then the infant is admitted. Where I did residency, ANY febrile infant 100.4F or above under 60 days was admitted.

From 60-90 days, only ill-appearing infants are worked up.
9w748capt wrote:
Why? Newborns are exposed to millions of pathogens the instant they're born. Hospitals are arguably the dirtiest places in the world. We don't have kids yet but if I had to choose between taking my newborn for a walk outside vs being in a hospital room, we'll that's a pretty easy decision.


Hospitals are not the dirtiest places in the world. Yes, there are some horrible pathogens there, but there is careful screening, sterilization, and monitoring. My main concern is pertussis. Pertussis is airborne and when you sit with 350 of your closest friends in a small tube where 50% of the air is recirculated, I think worrying about an airborne pathogen like pertussis is quite reasonable.

And yet sometimes babies are born far from home and need to be flown home. Sometimes, babies have to fly for other important reasons. Needs must. But taking your two-week-old on a Hawaiian vacation is not important (nor is it likely to be a very relaxing vacation).
-Doc Lightning-

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9w748capt
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Re: RE: Young Baby Dies Inflight LHR-HKG On Cathay

Thu Aug 04, 2016 12:30 am

DocLightning wrote:
At every center where I've worked, 60 days is the cut-off. Under 30 days we always admit. 30-60 days, we do a full sepsis workup including lumbar puncture. If the child is well-appearing and all labs (including CSF cell count) are normal, the infant is given 50mg/kg of ceftriaxone intramuscularly and discharged home with close follow-up within 24 hours for a second dose. If that cannot be arranged, then the infant is admitted. Where I did residency, ANY febrile infant 100.4F or above under 60 days was admitted.


You're free to practice however you'd like - certainly it's not a requirement to follow current evidence-based guidelines. Full sepsis workups are still not required in 29-60 day old febrile infants. Partial - sure - but most infants do not need LPs and antibiotics. And I'm sorry but giving a newborn 50 mg/kg ceftriaxone to presumably cover for meningitis and then discharging home makes zero sense. That's not even a meningitis dose - at least give 100 mg/kg if you're that worried.

A new guideline for febrile infants is in the works, and will recommend even fewer studies/labs than what's currently done by most.
 
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DocLightning
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Re: RE: Young Baby Dies Inflight LHR-HKG On Cathay

Thu Aug 04, 2016 4:46 pm

9w748capt wrote:
You're free to practice however you'd like - certainly it's not a requirement to follow current evidence-based guidelines. Full sepsis workups are still not required in 29-60 day old febrile infants. Partial - sure - but most infants do not need LPs and antibiotics. And I'm sorry but giving a newborn 50 mg/kg ceftriaxone to presumably cover for meningitis and then discharging home makes zero sense. That's not even a meningitis dose - at least give 100 mg/kg if you're that worried.

A new guideline for febrile infants is in the works, and will recommend even fewer studies/labs than what's currently done by most.


Our current guidelines fall within the range of most Pediatric centers and evidence-based guidelines. As the new "step-by-step" method is developed, we will change our practice.

The point of the 50mg/kg dose with discharge and close follow-up is that meningitis has been ruled out by the LP showing fewer than 7 WBC. Thus, meningitis is not the issue, but possible sepsis is.
-Doc Lightning-

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9w748capt
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Re: RE: Young Baby Dies Inflight LHR-HKG On Cathay

Sun Aug 07, 2016 12:52 pm

DocLightning wrote:
9w748capt wrote:
You're free to practice however you'd like - certainly it's not a requirement to follow current evidence-based guidelines. Full sepsis workups are still not required in 29-60 day old febrile infants. Partial - sure - but most infants do not need LPs and antibiotics. And I'm sorry but giving a newborn 50 mg/kg ceftriaxone to presumably cover for meningitis and then discharging home makes zero sense. That's not even a meningitis dose - at least give 100 mg/kg if you're that worried.

A new guideline for febrile infants is in the works, and will recommend even fewer studies/labs than what's currently done by most.


Our current guidelines fall within the range of most Pediatric centers and evidence-based guidelines. As the new "step-by-step" method is developed, we will change our practice.

The point of the 50mg/kg dose with discharge and close follow-up is that meningitis has been ruled out by the LP showing fewer than 7 WBC. Thus, meningitis is not the issue, but possible sepsis is.


I'm sorry, but no they don't. It is not standard of care to do LPs and give abx in ALL febrile neonates 29-60 days of age. It just isn't.

And again - if you really think that 6 week old is either bacteremic or meningitic (7 is not a reliable number btw), are you really going to send them home?

Like I said - you're free to practice however you'd like. Certainly not my place to tell you how to do things.
 
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DocLightning
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Re: RE: Young Baby Dies Inflight LHR-HKG On Cathay

Sun Aug 07, 2016 6:23 pm

9w748capt wrote:
I'm sorry, but no they don't. It is not standard of care to do LPs and give abx in ALL febrile neonates 29-60 days of age. It just isn't.


Tell you what:

You can call up the directors of the Pediatric Emergency departments at:
*UC Davis
*UCSF <--my fellowship program
*Children's Hospital of Oakland
*Jacobi Medical Center (Bronx, NY) <--my residency program
*University of Michigan Medical Center <--my medical school

And you can tell them that. Because those are the people who I contacted when we came up with the guidelines for our center.

What exactly are your credentials?
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan
 
9w748capt
Posts: 1623
Joined: Sat Feb 02, 2008 10:27 am

Re: RE: Young Baby Dies Inflight LHR-HKG On Cathay

Mon Aug 08, 2016 5:01 am

DocLightning wrote:
9w748capt wrote:
I'm sorry, but no they don't. It is not standard of care to do LPs and give abx in ALL febrile neonates 29-60 days of age. It just isn't.


Tell you what:

You can call up the directors of the Pediatric Emergency departments at:
*UC Davis
*UCSF <--my fellowship program
*Children's Hospital of Oakland
*Jacobi Medical Center (Bronx, NY) <--my residency program
*University of Michigan Medical Center <--my medical school

And you can tell them that. Because those are the people who I contacted when we came up with the guidelines for our center.

What exactly are your credentials?


Well I don't know as many ER directors as you do - and you've been clearly doing this longer than I have. But both at the Children's Hospital of Wisconsin (my residency program) as well as in Oklahoma (where I'm a hospitalist), 29-60 day old febrile infants do not routinely get LPs and antibiotics. If they're ill appearing or high risk, then of course - but not all. In a cursory google search, I found clinical practice guidelines from Seattle Children's, CHOC, and Children's Mercy (Kansas City) that advocate our same approach.
 
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DocLightning
Posts: 21480
Joined: Wed Nov 16, 2005 8:51 am

Re: RE: Young Baby Dies Inflight LHR-HKG On Cathay

Mon Aug 08, 2016 5:09 am

9w748capt wrote:
Well I don't know as many ER directors as you do - and you've been clearly doing this longer than I have. But both at the Children's Hospital of Wisconsin (my residency program) as well as in Oklahoma (where I'm a hospitalist), 29-60 day old febrile infants do not routinely get LPs and antibiotics. If they're ill appearing or high risk, then of course - but not all. In a cursory google search, I found clinical practice guidelines from Seattle Children's, CHOC, and Children's Mercy (Kansas City) that advocate our same approach.


Then what you are learning is that this is a highly controversial topic. There are risks and benefits to each approach. Nobody ever wants to miss a septic baby. Similarly, nobody wants to unnecessarily expose an infant to broad-spectrum antibiotics, invasive procedures, and a hospital admission. That's why Seattle, CHOC and Children's Mercy do it differently than UCSF, CHO, UCD, JMC, and UofM.

There is no single globally agreed-upon approach to febrile infants 0-29 and 30-59 days. And the reason is because the risk/benefit equation is not clear and it's a moving target as we decrease the risk of sepsis with vaccination (which protects prevaccinated children by reducing their contact with these pathogens).
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan

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