Morbilidad y mortalidad por enfermedad de la membrana hialina en el Hospital General Docente Dr Agostinho Neto, Guantánamo 2016-2018 / Morbidade e mortalidade por doença da membrana hialina no Hospital Geral Dr Agostinho Neto, Guantánamo 2016-2018 / Morbidity and mortality due to hyaline membrane disease at the Dr Agostinho Neto General Teaching Hospital, Guantanamo 2016-2018

Introducción: la enfermedad de la membrana hialina es un problema de salud en la etapa neonatal. Objetivo: caracterizar a los recién nacidos ingresados en la unidad de cuidados intensivos neonatales del Hospital General Docente Dr Agostinho Neto por enfermedad de la membrana hialina durante los años 2016-2018. Método: se hizo un estudio observacional, descriptivo, prospectivo y longitudinal de 163 recién nacidos que ingresaron en la unidad. Resultados: el 16,4 por ciento de los neonatos ingresados en dicha unidad tenía esta enfermedad y la letalidad fue de 11,0 por ciento. La mayor proporción de éstos eran varones (55,8 por ciento), tenían entre 31,0 y 33,6 semanas de edad gestacional al nacer (28,2 por ciento), pesaron entre 1500,9 y 1999,9 g (27,0 por ciento), tuvieron un Apgar a los 5 minutos de nacidos entre 8 y 10 puntos (58,9 por ciento) y estuvieron en la unidad de 7 a 14 días (40,4 por ciento). El 93,3 por ciento se trató con fármacos inductores de maduración pulmonar y 100,0 por ciento con surfactante y ventilación mecánica convencional (100,0 por ciento). El 84,7 por ciento presentó complicaciones y el 55,6 por ciento falleció por hemorragia intracraneal (55,6 por ciento). Fue común que las madres tuvieran edad entre 19 y 35 años (76,6 por ciento), fueran cesareadas (65,0 por ciento) y presentaron complicaciones relacionadas con el embarazo (82,2 por ciento). Conclusión: la letalidad fue superior en la medida que disminuye la edad gestacional y el peso al nacer, en los que no fueron tratados con fármacos inductores de maduración pulmonar y que presentaron meningoencefalitis(AU)

Introduction: hyaline membrane disease is a health problem in the neonatal stage. Objective: to characterize the newborns admitted to the neonatal intensive care unit of the General Teaching Hospital Dr Agostinho Neto " due to hyaline membrane disease during the years 2016-2018. Method: an observational, descriptive, prospective and longitudinal study of 163 newborns who entered the unit was made. Results: 16.4per cent of the infants admitted to this unit had this disease and the lethality was 11.0per cent. The largest proportion of these were male (55.8per cent), were between 31.0 and 33.6 weeks of gestational age at birth (28.2per cent), weighed between 1500.9 and 1999.9 g (27.0 per cent), had an Apgar after 5 minutes of birth between 8 and 10 points (58.9per cent) and were in the unit for 7 to 14 days (40.4per cent). 93.3per cent were treated with pulmonary maturation inducing drugs and 100.0per cent with surfactant and conventional mechanical ventilation (100.0per cent). 84.7per cent presented complications and 55.6per cent died from intracranial hemorrhage (55.6per cent). It was common for mothers to be between 19 and 35 years old (76.6per cent), to be ceased (65.0per cent) and had pregnancy-related complications (82.2per cent). Conclusion: lethality was higher as the gestational age and birth weight decreased, in those who were not treated with pulmonary maturation inducing drugs and who presented meningoencephalitis(AU)

Introdução: a doença da membrana hialina é um problema de saúde no estágio neonatal. Objetivo: caracterizar os recém-nascidos internados na unidade de terapia intensiva neonatal do Hospital Geral de Ensino Dr Agostinho Neto por doença da membrana hialina durante os anos de 2016 a 2018. Método: estudo observacional, descritivo, prospectivo e longitudinal de 163 recém-nascidos que ingressaram na unidade. Resultados: 16,4 por cento dos lactentes internados nessa unidade apresentavam essa doença e a letalidade era de 11,0 por cento. A maior proporção deles era do sexo masculino (55,8 por cento), tinha entre 31,0 e 33,6 semanas de idade gestacional ao nascer (28,2 por cento), pesava entre 1500,9 e 1999,9 g (27,0 por cento), apresentou Apgar após 5 minutos de nascimento entre 8 e 10 pontos (58,9 por cento) e permaneceu na unidade por 7 a 14 dias (40,4 por cento). 93,3 por cento foram tratados com fármacos indutores de maturação pulmonar e 100,0 por cento com surfactante e ventilação mecânica convencional (100,0 por cento). 84,7 por cento apresentaram complicações e 55,6 por cento morreram de hemorragia intracraniana (55,6 por cento). Era comum as mães ter entre 19 e 35 anos (76,6 por cento), cessar (65,0 por cento) e apresentar complicações relacionadas à gravidez (82,2 por cento). Conclusão: a letalidade foi maior com a diminuição da idade gestacional e do peso ao nascer naqueles que não foram tratados com fármacos indutores da maturação pulmonar e que apresentaram meningoencefalite(AU)

Presión positiva continua en la vía aérea comparada con la respiración mecánica asistida en prematuros de 28 a 32 semanas de gestación con administración precoz de surfactante pulmonar / Nasal CPAP versus mechanical ventilation in 28 to 32-week preterm infants with early surfactant administration

Introducción. La presión positiva continua en la vía aérea ( Continuous Positive Airway Pressure , CPAP) es útil en prematuros de 28 a 32 semanas de gestación con síndrome de dificultad respiratoria, pero no se ha precisado si es mejor que la respiración mecánica asistida después de la administración precoz de surfactante pulmonar. Objetivo. Comparar la incidencia de eventos adversos en prematuros de 28 a 32 semanas de gestación con síndrome de dificultad respiratoria atendidos con surfactante y respiración mecánica asistida o CPAP de burbuja. Materiales y métodos. Se atendieron 147 neonatos con respiración mecánica asistida y 176 con CPAP, ninguno de los cuales presentaba asfixia perinatal o apnea. Resultados. La incidencia de fracaso de la CPAP fue de 6,5 % (IC 95% 11,3-22,8 %). Fallecieron 29 pacientes, 7 de los cuales habían recibido CPAP (4,0 %) y, 22, respiración mecánica asistida (15,0 %; p<0,001). El riesgo relativo (RR) de morir de quienes recibieron CPAP, comparado con el de quienes recibieron respiración mecánica asistida, fue de 0,27 (IC 95% 0,12-0,61), pero, al ajustar por los factores de confusión, el uso de CPAP no implicó mayor riesgo de morir (RR=0,60; IC 95% 0,29-1,24). La letalidad con respiración mecánica asistida fue de 5,70 (IC 95% 3,75-8,66) muertes por 1.000 días-paciente, mientras que con CPAP fue de 1,37 (IC 95% 0,65-2,88; p<0,001). La incidencia de neumopatía crónica fue menor con CPAP (RR=0,71, IC 95% 0,54-0,96), al igual que la de hemorragia cerebral (RR=0,28; IC 95% 0,09-0,84) y la de sepsis (RR=0,67; IC 95% 0,52-0,86), pero fue similar en cuanto a escapes de aire (RR=2,51; IC 95% 0,83-7,61) y enterocolitis necrosante (RR=1,68; IC 95% 0,59-4,81). Conclusión. La incidencia de neumopatía crónica, hemorragia ventricular y sepsis es menor con el uso de CPAP.

Introduction: Continuous positive airway pressure (CPAP) is useful in low birth weight infants with respiratory distress, but it is not known if it is a better alternative to mechanical ventilation after early pulmonary surfactant administration. Objective: To compare the incidence of adverse events in 28 to 32-week newborns with respiratory distress managed with mechanical ventilation or CPAP after early surfactant administration. Materials and methods: In total, 176 newborns were treated with CPAP and 147 with mechanical ventilation, all with Apgar scores >3 at five minutes and without apnea. Results: The incidence of CPAP failure was 6.5% (95% CI: 11.3-22.8%); 29 patients died: 7 with CPAP (4.0%) and 22 with mechanical ventilation (15.0%, p<0.001). The relative risk of dying with CPAP versus mechanical ventilation was 0.27 (95% CI: 0.12-0.61), but after adjusting for confounding factors, CPAP use did not imply a higher risk of dying (RR=0.60; 95% CI: 0.29-1.24). Mechanical ventilation fatality rate was 5.70 (95% CI: 3.75-8.66) deaths/1,000 days-patient, while with CPAP it was 1.37 (95% CI: 0.65-2.88, p<0.001). Chronic lung disease incidence was lower with CPAP than with mechanical ventilation (RR=0.71; 95% CI: 0.54-0.96), as were intracranial hemorrhage (RR=0.28, 95% CI: 0.09-0.84) and sepsis (RR=0.67; 95%CI: 0.52-0.86), and it was similar for air leaks (RR=2.51; 95% CI: 0.83-7.61) and necrotizing enterocolitis (RR=1.68, 95% CI: 0.59-4.81). Conclusion: CPAP exposure of premature infants with respiratory distress syndrome is protective against chronic lung disease, intraventricular hemorrhage and sepsis compared to mechanical ventilation. No differences were observed regarding air leak syndrome or death.

Incidencia y evolución de membrana hialina en menores de 35 semanas según crecimiento intrauterino / Incidence and evolution of hyaline membrane in newborns under 35 weeks of gestational age according intrauterine growth

Introduction: It is thought that intrauterine growth restriction induces respiratory maturation. The information varies if the studies consider analysis based on birth weight or gestational age. Objective: The goal of this study is to compare the incidence and evolution of hyaline membrane disease (HMD) between small and adequate premature babies under 35 weeks of gestational age (< 35 wGA) based on data in the literature. Patients and Methods: Two databases were created and analyzed: a) 2 022 newborns < 35 wGA admitted to the Service, whose incidence of HMD was calculated, and b) 733 newborns < 35 wGA with HMD and treated with surfactant, to describe the evolution. Results: Analysis of GA group shows a higher incidence of HMD (35.2 percent) among small for GA, and less (29.1 percent) among those who are not small for GA (p: 0.026). If a subset is formed for the newborns < 1 500 g in birth weight, those small for gestational age have a lower incidence (47.5 percent) than those adequate for GA (60.7 percent). Logistic regression analysis for discharge with oxygen of newborns with HMD shows association with lower z score for birth weight, corticosteroid use and oxygen dependence at 36 weeks. Conclusions: Preterm newborns small for GA show a higher incidence of HMD and oxygen dependence when comparing for GA.

Introducción: Tradicionalmente se ha considerado que la restricción de crecimiento intrauterina produce maduración respiratoria, pero la información es diferente según si los estudios consideran el análisis por grupos de peso de nacimiento o edad gestacional. Objetivo: El objetivo de este análisis fue comparar la incidencia y evolución de membrana hialina, de los prematuros menores de 35 semanas de edad gestacional según fueran pequeños o no para edad gestacional. Pacientes y Método: Se analizaron dos bases de datos: 2 022 menores de 35 semanas hospitalizados en el Servicio para determinar incidencia de membrana hialina y 733 menores de 35 semanas tratados con surfactante con diagnóstico de membrana hialina para comparar evolución de ésta. Resultados: El análisis por grupos de edad gestacional muestra una incidencia de membrana hialina mayor, de 35,2 por ciento, en los pequeños para la edad gestacional, y de 29,1 por ciento en los no pequeños (p: 0,026). Si se analiza sólo menores de 1 500 gramos de peso de nacimiento, el grupo pequeño tiene una incidencia menor, de 47,5 por ciento, y los no pequeños de 60,7 por ciento. El análisis de regresión logística para alta con oxígeno de los que tuvieron membrana hialina, muestra asociación con menor puntaje z de peso de nacimiento, uso de corticoides y dependencia de oxígeno a las 36 semanas. Conclusiones: El recién nacido pretérmino pequeño para edad gestacional tiene mayor incidencia de membrana hialina y evoluciona con mayor dependencia de oxígeno al comparar por edad gestacional.

Estrategia de intervención para disminuir la mortalidad por Síndrome de Dificultad Respiratoria del recién nacido en Maternidad Provincial, de Matanzas / Interventional strategy to diminish mortality by Respiratory Distress Syndrome of the newborn at the Provincial Maternity Hospital, of Matanzas

En la presente investigación se expone una estrategia de intervención dirigida a disminuir la mortalidad por Síndrome de Dificultad Respiratoria del Recién Nacido, en el Hospital Provincial Ginecobstétrico Docente Julio Alfonso Medina, de Matanzas. Sobre la base de la propia experiencia de los autores y mediante la aplicación de métodos científicos, basados en la literatura internacional actual, se presenta el resultado de un minucioso estudio de 48 recién nacidos que padecieron la enfermedad y que fueron tratados en la Unidad de Cuidados Intensivos Neonatales de esa institución hospitalaria durante los años 2006 y 2007. Las acciones estratégicas que se dan a conocer como resultado de la investigación, unido a las recomendaciones ofrecidas por los autores, constituyen una herramienta imprescindible para emprender un mejor manejo con los pacientes que padecen la enfermedad. Apoyados en el uso de una secuencia correcta del CPAP y del surfactante porcino cubano denominado SURFACEN, se dan a conocer nuevos enfoques en el tratamiento del Síndrome de Dificultad Respiratoria del Recién Nacido. Se propone el nuevo término de Enfermedad Pulmonar por Inmadurez Congénita (EPIC), para designar esta patología en lugar del término anatomopatológico de membrana hialina...

In the current investigation we expose the interventional strategy to diminish mortality by Respiratory Difficulty Syndrome of the Newborn, in the Provincial Gynecoobstetric Teaching Hospital Julio Alfonso Medina, of Matanzas. On the basis of the authors' proper experience and applying scientific methods, taking into account the current international literature, we present the results of a detailed study of 48 newborns who suffered the disease and were treated in the Neonatal Intensive Care Unit of this institution during 2006 and 2007. The strategic actions resulting from our investigation, together with the recommendations offered by the authors are indispensable for a better management of the patients suffering the disease. We offer new approaches in the treatment of the Respiratory Distress Syndrome of the Newborn on the basis of the usage of a correct sequence of the Continuous Positive Airway Pressure and the porcine Cuban surfactant called SURFACEN. We propose the new term Pulmonary Disease by Congenital Immaturity, to denominate this pathology in the place of the anatomopathologic term of hyaline membrane...

Prevención del neumotórax por barotrauma en los neonatos con enfermedad pulmonar por inmadurez congénita / Preventing pneumothorax by barotraumas in newborns with pulmonary disease caused by congenital immaturity

En el presente trabajo se expresan las causas y la fisiopatología de los neumotórax que se producen por las altas presiones usadas durante la Ventilación Artificial en los neonatos portadores de Enfermedad Pulmonar por Inmadurez Congénita o Enfermedad de la Membrana Hialina por déficit de surfactante endógeno y se proponen un grupo de acciones para el período pre- natal y postnatal que utilizadas sistemáticamente pudieran contribuir a la disminución de la incidencia de esta entidad y a la larga a disminuir la morbimortalidad debida a esta grave complicación propia de esta etapa de la vida.

In the current work we report the cause and physiopathology of pneumothorax produced due to the high pressures used during mechanical ventilation in newborns with Pulmonary Disease for Congenital Immaturity or Hyaline Membrane Disease caused by deficit of endogenous surfactant. We also propose several actions for the pre-and postnatal periods that used systematically would contribute to diminish the incidence of this entity and, at the end, to reduce morbidity and mortality due to this serious complication typical of this life period.

Comparison outcomes of surfactant therapy in respiratory distress syndrome in two periods.

BACKGROUND: Exogenous surfactant replacement therapy has been a part of the routine care of preterm neonates with respiratory distress syndrome (RDS) since 1990s. In Thailand, the utilization of surfactant replacement therapy had been limited due to the high cost until the National Health Insurance Policy began in 2003 which covered the cost of surfactant. Nowadays surfactant replacement therapy is more frequently used at Queen Sirikit National Institute of Child Health, so the authors were interested in evaluating its use in RDS. OBJECTIVES: To compare the outcome and complications of surfactant replacement therapy in newborns who were diagnosed with moderate to severe RDS during two times period. STUDY DESIGN: Retrospective study. MATERIAL AND METHOD: The data of infants who were diagnosed as moderate to severe RDS and treated with surfactant at Queen Sirikit National Institute of Child Health between January 1st, 2003 and December 31th, 2005 were reviewed. The outcome of this study (Group II) was compared to the previous study conducted in 1999-2002 (Group I). The complications, mortality rate, association time of start surfactant and duration of ventilation were reviewed. RESULTS: The data of ninety-one moderate to severe RDS patients who received surfactant replacement therapy were reviewed. The mean birth weight and gestational age in this group were 1250 +/- 435.57 gm and 29.38 +/- 2.2 week less than in the first group 1,344 +/- 452.37gm and 29.69 +/- 2.61 week. The second group showed statistical differences in antepartum hemorrhage (4.4%) and pregnancy induced hypertension (PIH) (17.6%) while the first group had 33.3% ofantepartum hemorrhage and 3% of PIH. In neonatal conditions, there were statistical significant differences in anemia 28.6% in group II compared to 9% in group I and patent ductus arteriosus 67% in group II compared to 39.4% in group I. Surfactant was given earlier in life (4.75 +/- 2.76 hours) in the second group compared to the first group (7.21 +/- 4.92 hour) and the overall duration ofpatients on mechanical ventilation in Group II (6 days) was shorter than in Group I (16 days). This was especially more evident in patients who received surfactant within the first six hours of life. The immediate complication, pulmonary hemorrhage was found in more cases in Group I (33.3%) than in Group II (12.1%) but bronchopulmonary dysplasia (BPD) was found to be a late complication in more cases in Group II (46.1%) than in Group I (21.2%). The mean length of admission was longer in Group II (61.23 +/- 41.08 days) compared to Group I (38.5 +/- 23.48 days) and the mortality rate in Group II was 18.7% (17 cases) lower than Group I 33.3% (11 cases). CONCLUSION: Surfactant therapy in moderate to severe RDS can shorten the duration of ventilation and decrease the mortality rate, but has no effect in decreasing the incidence of chronic lung disease. Nevertheless the earlier the surfactant therapy is started, the higher the survival rate.

Estudio controlado del tratamiento de la enfermedad de membrana hialina del recién nacido pretérmino con surfactante pulmonar exógeno (porcino vs. bovino) / Treatment of hyaline membrane disease in the preterm newborn with exogenous lung surfanctant. A controlled study

Introducción: La enfermedad de membrana hialina (EMH) por deficiencia de surfactante pulmonar en el neonato prematuro es una causa importante de morbimortalidad. El surfactante pulmonar exógeno ha revolucionado el tratamiento de esta entidad en países desarrollados, aunque este beneficio ha sido menor en países en vías de desarrollo. El surfactante porcino de manufactura cubana es económico, y su uso comparado con otros surfactantes es desconocido. Material y métodos: Se llevó a cabo un estudio prospectivo, controlado, aleatorizado, abierto, en 44 recién nacidos prematuros con EMH. Un grupo recibió surfactante bovino (SB) (Survanta), y el otro surfactante porcino (SP) de fabricación cubana (Surfacen). Se evaluó la respuesta en variables de oxigenación y ventilación, días de oxígeno suplementario, ventilación mecánica, incidencia de complicaciones, tiempo de hospitalización y mortalidad. Resultados: 23 pacientes recibieron el surfactante bovino, y 21 el porcino. Los dos grupos fueron similares clínicamente y en sus patrones de respuesta de oxigenación y ventilación, con una tendencia a mayor incremento inicial en la oxigenación en el grupo tratado con SP. La incidencia de complicaciones fue similar en los dos grupos. Fallecieron 10 pacientes (47.6%) en el grupo SP, y 12 (52.2%) en el grupo SB (p>0.05). Conclusiones: El surfactante porcino tuvo efectos clínicos similares al bovino en las variables de oxigenación y ventilación estudiadas; no hubo diferencia significativa en complicaciones y mortalidad. El surfactante porcino es una alternativa efectiva y de menor costo que el surfactante bovino para el tratamiento de la EMH.

Background: Hyaline membrane disease (HMD) due to lung surfactant deficiency in the preterm newborn is an important cause of neonatal morbidity and mortality. Exogenous lung surfactant has transformed HMD therapy in developed countries, but an equivalent benefit has not been accomplished in developing countries due to a variety of factors. Porcine surfactant developed in Cuba is an inexpensive alternative to other surfactants, and its use has not been studied in our settings. Methods: A randomized, open, prospective and controlled trial was undertaken in 44 preterm newborns with HMD diagnosis. One group received bovine surfactant (BS) (Survanta) and the other Cuban porcine surfactant (PS) (Surfacen). The following clinical response variables were evaluated: oxygenation and ventilation indexes, days with supple mentary oxygen, days with mechanical ventilation, incidence of compli cations, time of hospitalization, and mortality. Results: 23 Patients received bovine surfactant and 21 the porcine type. The two groups were clinically similar, with patterns of oxygenation and ventilation response that were the same between groups, with a tendency to higher initial oxygenation increase in the PS group. The incidence of complications was similar between groups. Ten Patients (47.6%) died in the PS group, versus 12 (52.2%) in the BS group (p>0.05) Conclusions: Porcine surfactant had similar clinical effects than bovine surfactant in the oxygenation and ventilation variables, with no significant differences in complications or mortality. Porcine surfactant is an effective and lower cost alternative to bovine surfactant in the treatment of HMD.

Continuous tracheal gas insufflation in preterm infants with hyaline membrane disease. A prospective randomized trial.

In mechanically ventilated neonates, the instrumental dead space is a major determinant of total minute ventilation. By flushing this dead space, continuous tracheal gas insufflation (CTGI) may allow reduction of the risk of overinflation. We conducted a randomized trial to evaluate the efficacy of CTGI in reducing airway pressure over the entire period of mechanical ventilation while maintaining oxygenation. A total of 34 preterm newborns, ventilated in conventional pressure-limited mode, were enrolled in two study arms, to receive or not receive CTGI. Transcutaneous Pa(CO(2)) (tcPa(CO(2))) was maintained at 40 to 46 mm Hg in both groups to ensure comparable alveolar ventilation. Respiratory data were collected several times during the first day and daily until Day 28. Both groups were similar at the time of inclusion. During the first 4 d of the study, the difference between peak pressure and positive end-expiratory pressure was significantly lower in the CTGI group by 18% to 35%, with the same tcPa(CO(2)) level and with no difference in the ratio of tcPa(O(2)) to fraction of inspired oxygen (245 +/- 29 versus 261 +/- 46 mm Hg [mean +/- SD] over the first 4 d). Extubation occurred sooner in the CTGI group (p < 0.05), and the duration of mechanical ventilation was shorter (median: 3.6 d; 25th to 75th quartiles: 1.5 to 12.0 d; versus median: 15.6 d; 25th to 75th quartiles: 7.9 to 22.2; p < 0.05) than in the non-CTGI group. CTGI allows the use of low-volume ventilation over a prolonged period and reduces the duration of mechanical ventilation.

New-born infants with severe hyaline membrane disease: radiological evaluation during high frequency oscillatory versus conventional ventilation.

OBJECTIVE: The aim of our study was to determine the impact of treatment with exogenous surfactant (ES) and high frequency oscillatory ventilation (HFOV) on the radiological appearance and clinical course of hyaline membrane disease (HMD) in new-born infants. MATERIALS AND METHODS: New-born infants (18) (median weight, 1010 g) with severe HMD (stages 3.5 and 4) who were treated with ES and HFOV were matched by birth weight and severity of disease with 18 new-born infants treated with ES and conventional mechanical ventilation (CV). Chest radiograms taken on days 1, 2/3, 4/5, 7, 14 and 28 were analyzed to check for the severity of generalized parenchymal opacities (GPO), local opacifications, pulmonary interstitial emphysema (PIE), gross air leak, general and localized overinflation, bronchopulmonary dysplasia (BPD) and clinical variables such as survival rates, duration of mechanical ventilation, mean airway pressure and inspired oxygen concentration. RESULTS: At 4 weeks of age, new-born infants treated by HFOV had less severe GPO (median degree 1.5 vs. 3), less PIE (1 vs. 7 patients) and fewer signs of BPD (median BPD degree 1.5 vs. 2.6). The incidence of pneumothorax and of local opacifications were similar in both groups. New-born infants on HFOV had a lower mortality rate (5 vs. 13), needed fewer days of mechanical ventilation (median 15 vs. 23 days) and lower inspiratory oxygen concentrations (median FiO2 0.38 vs. 0.64). CONCLUSION: In new-born infants with HMD, treatment with ES and HFOV resulted in a favourable radiological and clinical outcome as compared to treatment with ES and CV.

Morbimortalidad en recién nacidos prematuros menores o iguales a 1000 grs. en quienes se utilizó surfactante pulmonar / Morbi-mortality in premature newborns under 1000g of weight who were given pulmonary surfactant

Objetivo. Determinar la morbimortalidad en recién nacidosprematuros con peso de 1000 gms o menos, que cursaron con enfermedad de membrana hialina a los se les aplicó surfactante pulmonar en forma terapéutica o profiláctica. Diseño. Estudio retrospectivo, descriptivo realizado en una Unidad de Cuidado Intensivo Neonatal. Población. Todos los recién nacidos prematuros menores o iguales a 1000 gms. que nacieron en el período comprendido de noviembre de 1991 a marzo de 1997 y a quienes se les aplicó surfactante pulmonar. Metodología. Revisión de expedientes clínicos y de los libros de la Unidad Neonatal para obtener información de morbilidad y mortalidad. Al obtener los datos se efectuó un análisis descriptivo de los mismos.Resultados. Se obtuvieron 34 expedientes. El sexo predominante fue el masculino (53/100) y el grupo de mayor mortalidad (54/100).Los pesos al nacimiento con mayor incidencia fueron entre 701 a 800 gms. y la edad gestacional entre 27 a 28 semanas. La mortalidad fue mayor en los recién nacidos con pesos entre 701 y 800 gms. Las complicaciones observadas fueron principalmente por prematurez que por el uso de oxígeno, ventilación mecánica o el uso de surfactante, tales como hipertensión pulmonar, hemorragia intraventricular y enterocolitis necrotizante. El 36/100 de los pacientes sobrevivió con terapia profiláctica o de rescate.Recomendaciones. Seguir aplicando surfactante artificial en todos aquellos recién nacidos prematuros con enfermedad de membrana hialinaya sea en forma profiláctica o de rescate.

Asociación de ruptura prematura de membranas con morbilidad y mortalidad perinatal tipo I / Association of premature rupture of the membranes with type I perinatal morbidity and mortality

Para determinar la asociación de ruptura prematura de membranas con la mortalidad perinatal I, su incidencia y la de las principales enfermedades relacionadas con ella, se realizó un estudio de casos y controles en el Hospital General de Zona con Unidad de Medicina Familiar Núm. 1, Instituto Mexicano del Seguro Social, Durango, Durango, de octubre de 1994 a febrero de 1995. Fueron considerados casos los recién nacidos que cursaron con morbilidad por ruptura prematura de membranas o que fallecieron en el periodo perinatal I. Los controles fueron recién nacidos sanos que se encontraron vivos al final del periodo perinatal I. Se registraron 2550 partos, 110 recién nacidos con antecedentes de ruptura prematura de membranas (4.31 por ciento), 17 neonatos con enfermedad (0.66 por ciento) y 66 defunciones (2.58 por ciento). Se encontró antecedente de ruptura prematura de membranas en 82.3 por ciento de los neonatos enfermos y en 4.5 por ciento de los fallecidos. La ruptura prematura de membranas estuvo asociada con la morbimortalidad con una razón de momios de 6.89 (ic 3.72-12.64). El síndrome de membrana hialina fue la enfermedad más frecuente (11.8 por ciento de recién nacidos con ruptura prematura de membranas). La principal causa de enfermedad y muerte estuvo relacionada con la prematurez y el bajo peso al nacer

Hyaline membrane disease (HMD) therapy in Latin America: impact of exogenous surfactant administration on newborn survival, morbidity and use of resources.

Impact of surfactant administration, on neonatal mortality, morbidity and resource use, was assayed in a historically controlled study in 19 NICUs from 5 Latin American countries. Data from clinical records of infants with HMD were retrospectively reviewed for the previous 2 years (PRE phase n = 666 cases), and prospectively in cases that received surfactant (SURF phase, 348 cases). Birth weight stratified relative risk, with 95% confidence interval (RR +/-95% CI) for death, in the SURF as compared to the PRE was 0.60 (0.49-0.74), 0.79 (0.68-0.92) and 0.82 (0.71-0.94), for days 7, 28 and at discharge, respectively. At all ages mortality was significantly lower during SURF. Significant increases were observed in the occurrence of pulmonary interstitial emphysema, pulmonary hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, intrahospital infection and necrotizing enterocolitis. Resource use increased significantly. It is concluded that the use of surfactant in the region is an important advance, and the efficacy of management of the late complications of the very premature and labile HMD survivors must increase. More attention should be given to thermal regulation, nutrition and management of infection in the survivors, before a more marked effect of surfactant can be seen.

Subependymal caudothalamic groove hyperechogenicity and neonatal chronic lung disease.

Chronic lung disease is associated with several poorly defined risk factors for impaired cerebral development. Late neonatal onset of subependymal hyperechogenic areas in the caudothalamic groove has been reported in association with dexamethasone treatment and postnatal cytomegalovirus infection. We reviewed charts of 18 patients who developed subependymal hyperechogenicity beyond the first week of life, as well as charts of 79 patients belonging to a prospective surfactant study group. Thirteen of the 18 patients with subependymal hyperdensities had been treated with surfactant and were all found in the subgroup with chronic lung disease. In the surfactant-treated patients who did not develop chronic lung disease, we could not find any patient with subependymal hyperdensities. From the remaining five patients with ultrasound lesions, but who were not treated with surfactant, three had developed chronic lung disease. There was no evident association with dexamethasone treatment or cytomegalovirus infection. Our results support the idea of an association between chronic lung disease and the described echographic lesions in the caudothalamic groove, but the nature of the link between them is still unclear.

Surfactant therapy prior to the interhospital transport of preterm infants.

The risk-to-benefit ratio of surfactant treatment of outborn preterm infants prior, as opposed to after, transportation to a perinatal center is not known. The objective of this study was to document current practice and to examine clinical outcomes in North America. In phase I (December, 1991 to January, 1992) questionnaires were distributed to 114 perinatal centers in the United States and Canada. The centers returned 98 surveys. Over half (50.5%) of the centers report giving surfactant rescue prior to infant transport, but only a minority (9.5%) of the centers report doing so for prophylaxis. In phase II (January, 1992 to December, 1992), clinical outcomes of surfactant-eligible babies requiring interhospital transport at a university hospital were evaluated to determine which infants ultimately received surfactant and when. The infants were compared between groups and did not differ significantly in gestational age, birthweight, sex type, number of multiple births, five-minute Apgar scores, or whether antenatal steroids were used. In phase II, the 66 consecutive, ventilator-dependent, outborn infants with average, and median, gestational age of 28 weeks were compared. The infants receiving surfactant prior to transport, when compared to the infants that got it after transport (9 hours later), did not do any better. There was 6% more survival without bronchopulmonary dysplasia in the group receiving surfactant after transport (65.2% versus 59.3%, p = 0.665). The infants receiving surfactant after transport were off the ventilator sooner (95% C.I. 6.0-28.7 versus 11.8-25.9 days) and discharged from the perinatal center earlier (95% C.I. 37.8-70.8 versus 47.9-69.0 days). Furthermore, arterial blood gases before and after transport reveals that there were no short-term advantages in administering surfactant prior to transport when compared to waiting for reevaluation at the perinatal center. These findings suggest that surfactant can be used safely prior to the interhospital transport of preterm infants, but this treatment does not seem to confer benefit over waiting for reevaluation, and possible surfactant treatment, at the tertiary perinatal center.

The lungs in immature infants: how important is surfactant therapy in preventing chronic lung problems?

Seventy-five premature infants weighing between 600 and 3200 g were studied over a period of 1 year. All of the infants received surfactant therapy for hyaline membrane disease immediately after birth and, thereafter, up to four doses every 6 h. The roentgenographic findings in all patients were documented at birth and at 2 days, 7-10 days, and 21-28 days of life. Larger babies responded to surfactant therapy better than did smaller infants. The smaller infants, even after initial clearing, were prone to develop pulmonary edema and the bubbly lungs of bronchopulmonary dysplasia. These data suggest that small infants, while initially responding to surfactant therapy with clearing of their lungs, are still at considerable risk of developing chronic lung disease in the form of pulmonary edema and bronchopulmonary dysplasia. An explanation is offered for why this occurs; at the same time it is suggested that, in view of our findings and those in the literature, the problems of pulmonary edema and bubbly lungs be more clearly separated.

Assisted ventilation for hyaline membrane disease.

OBJECTIVES: To study the outcome and complications of assisted ventilation in neonates with hyaline membrane disease (HMD). DESIGN: Retrospective study. SETTING: Hospital based. SUBJECTS: Seventy five premature neonates with HMD needing assisted ventilation born over a period of five years. MAIN OUTCOME MEASURES: Survival rate among those ventilated and complications of assisted ventilation. RESULTS: Survival on assisted ventilation improved from initial 22.2% in 1989 to 77.8% in 1993. Of 19 babies weighing between 750-1000 g, 8(42.1%) survived. Twelve of 27 babies (44.4%) with a gestation of less than 28 weeks survived. Survival rates in babies with gestation of more than 33 weeks was 94%. Intraventricular hemorrhage was the leading cause of death in 52% babies. Nosocomial infections were common and occurred in 50.6% of infants on ventilation and accounted for one-third of deaths. Pneumothorax occurred in one-fifth of babies and was responsible for 3 deaths. Pulmonary interstitial emphysems was observed in 6 babies. Six babies developed bronchopulmonary dysplasia while 7 had retinopathy of prematurity. CONCLUSIONS: Outcome of neonates needing assisted ventilation for HMD has shown consistent improvement over the period of study. Nosocomial infections continue to be a major complication of assisted ventilation in neonates.

Radiological incidence and course of bronchopulmonary dysplasia in 100 consecutive low birth weight neonates.

Bronchopulmonary dysplasia (BPD) is an important cause of chronic respiratory distress in low birth infants. The radiological incidence and course of BPD were assessed in 100 consecutive low birth weight infants. Chest radiographs were examined on admission, at the ages of 3 days, 7 days, 2 weeks and 4 weeks and at later follow-up until the examinations were normal. Twelve of the children died. The severity and typical radiological abnormalities of BPD were assessed. Among the children alive, there were 26 with BPD (29.5%). The BPD incidence was highest between the age of 2 weeks and 3 months (18-21%) declining to 3.4% at the age of 12 months. Radiological evidence of BPD was already seen at the age of 2 weeks in 16 of the children. Most cases (73%) had their maximum BPD score at the age of 1 to 3 months. The normalisation of the chest radiography occurred predominantly in the age between 3 and 6 months. The most frequent underlying condition in BPD was hyaline membrane disease in 81%.

Ventilacion en recien nacidos asficticos : Mortalidad y mortalidad / Asphyctic newborn ventilation: morbidity and mortality

Se efectuo un estudio descriptivo, transversal y prospectivo que tuvo como finalidad conocer la mortalidad y principales complicaciones de la ventiloterapia en recien nacidos (RN) asficticos ingresados en el Servicio de Neonatologia del Hospital Maternoinfantil Docente "10 de Octubre" en el periodo de un ano. Se ventilaron 28 neonatos con conteo de Apgar inferior a 7 puntos al minuto de vida; dichos neonatos presentaron un elevado indice de prematuridad y bajo peso al nacer. Las complicaciones observadas atribuibles a la ventilacion artificial fueron las infecciones, la atelectasia, el sindrome de fuga de gases y la displasia broncopulmonar (DBP). La mayoria de los neonatos asficticos se ventilaron en el intervalo de menos de 3 dias. La asfixia primaria y la enfermedad de membrana hialina (EMH) fueron las primeras causas de muerte