Monday, July 6, 2009


I've just spent several hours going over a Pediatrics and Review article about incontinence. I spent some time pondering it because the general message seemed to be that a lot of incontinence is secondary, you work it up with a urine analysis and culture, and you treat most secondary incontinence with behavioral modification and a bowel regimen. In the end, though, it goes off the deep end talking about various types of daytime wetness (no longer called diurnal enuresis), and how some of them can progress to eventual renal failure.

Finally, I looked up the renal section in my trusty board review book...and it's not even mentioned. Must not be important on the boards. Still, a lot of parents come in for incontinence involving stool or urine or both. So it was useful. I think that in the future, I will a) do an H and P b) get a u/a, urine culture, and voiding bladder ultrasound to look at the postvoid residual, c) work the child up further if the postvoid residual is significant.

Abbreviations: U/A, UCx, PVR

Saturday, July 4, 2009

NICU Levels

While rounding with our Intermediate Care Nursery attending:

Which babies belong at which of our 3 nurseries (Neonatal Intensive Care Unit, Intermediate Care Nursery, Newborn Nursery)?

Generally, babies less than 34 weeks gestation go to the intensive care unit (Level III).

Between 34-37 weeks babies will go to a Level II feeder and grower unit, some CPAP may be allowed depending on the institution guidelines. Healthy late preterm babies may go to a Level I nursery at some institutions.

Healthy babies will go to a Level I unit. Some institutions may allow babies requiring a little oxygen to transition in a Level I unit.

Basically, each institution will have slightly different guidelines and levels of comfort. Assess the unit's ability to handle your patient and act accordingly.

Further Clarification:
1. Levels of Neonatal Care: PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1341-1347 (doi:10.1542/10.1542/peds.2004-1697)

Abbreviations: NICU, ICN, NBN, preemie