RESUMO
INTRODUCTION: Breast milk is the best food for preterm infants. Due to their inadequate suction- swallowing action, the administration of expressed breast milk should be done with an orogastric tube. There is little information available regarding the microbiological safety of expressed breast milk. The aim of this article was to evaluate if there were any differences regarding the contamination of breast milk obtained at a healthcare facility versus at home. METHODS: Cross-sectional study that analyzed pairs of breast milk samples (one obtained at home and the other one at a healthcare facility, the same day) from mothers of hospitalized newborn infants with a gestational age =35 weeks. Samples with over 105CFU/mL of mesophilic aerobic bacteria, or with the presence of Escherichia coli, Staphylococcus aureus, Streptococcus faecalis, enterobacterias, Pseudomonas, Salmonella, fungi, and yeast were considered contaminated. RESULTS: A total of 280 breast milk samples (140 pairs) from 53 mothers were analyzed; 139 samples (49.6%; 95% CI: 43.6 to 55.6) were contaminated; contamination was significantly more frequent in the samples obtained at home than in those obtained at a healthcare facility (59.6% versus 39.6%; p = 0.0008; OR 2.25; 95% IC: 1.36 to 3.7). CONCLUSION: Half of the breast milk samples had bacterial growth, which was more frequent in the samples obtained at home than those obtained at a healthcare facility.
Assuntos
Instalações de Saúde , Leite Humano/microbiologia , Estudos Transversais , Feminino , Humanos , RiscoRESUMO
BACKGROUND: Although error could be present in almost every medical practice, they are more frequent and potentially more dangerous in neonatal intensive care units (NICU). OBJECTIVE: To determine prescription error rate of intravenous drugs in a Neonatal Intensive Care Unit (NICU), and to describe type of error (dose, dilution, and interval) and medication (antibiotics, inotropics, or analgesics). METHODS: Observational study including medical records of patients hospitalized in a NICU, receiving any of the above mentioned drugs. Each prescription was compared with one provided by a specific software. Prescription error was defined as >10% of difference between both values. RESULTS: 362 prescriptions from 82 patients were analyzed. An error was observed in 42.5% (95%CI 37.4 - 47.8) of all prescriptions, including 148 (96.1%; 95%CI: 91.3-98.4) antibiotics prescriptions, 5 (3.2%; 95%CI: 1.2-7.7) inotropics prescriptions and 1 (0.7%; 95%CI: 0.01-4.2) analgesics prescriptions. Prescription errors were due to frequency error in 53.8% 95%CI: 45.6-61.8 of cases and to volume error in 46.1% (95%CI: 38.1-54.3). CONCLUSION: Almost half of the intravenous drugs prescriptions included an error, being more frequently related to interval, followed by dosing; no errors in dilution were detected. Using prescription software could improve patient's safety.
Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Antibacterianos/uso terapêutico , Argentina , Cardiotônicos/uso terapêutico , Humanos , Recém-Nascido , Erros de Medicação/classificação , Estudos RetrospectivosRESUMO
Introduction. Breast milk is the best food for preterm infants. Due to their inadequate suction- swallowing action, the administration of expressed breast milk should be done with an orogastric tube. There is little information available regarding the microbiological safety of expressed breast milk. The aim of this article was to evaluate if there were any differences regarding the contamination of breast milk obtained at a healthcare facility versus at home. Methods. Cross-sectional study that analyzed pairs of breast milk samples (one obtained at home and the other one at a healthcare facility, the same day) from mothers of hospitalized newborn infants with a gestational age =35 weeks. Samples with over 105CFU/mL of mesophilic aerobic bacteria, or with the presence of Escherichia coli, Staphylococcus aureus, Streptococcus faecalis, enterobacterias, Pseudomonas, Salmonella, fungi, and yeast were considered contaminated. Results. A total of 280 breast milk samples (140 pairs) from 53 mothers were analyzed; 139 samples (49.6%; 95% CI: 43.6 to 55.6) were contaminated; contamination was significantly more frequent in the samples obtained at home than in those obtained at a healthcare facility (59.6% versus 39.6%; p = 0.0008; OR 2.25; 95% IC: 1.36 to 3.7). Conclusion. Half of the breast milk samples had bacterial growth, which was more frequent in the samples obtained at home than those obtained at a healthcare facility.
Introducción. La leche materna es el mejor alimento para los prematuros. Debido a su inadecuado mecanismo de succión-deglución, la administración de leche materna extraída debe realizarse mediante una sonda orogástrica. Se dispone de escasa información sobre las condiciones microbiológicas de seguridad para la leche materna extraída. El objetivo del presente trabajo fue evaluar si había diferencia en la contaminación de la leche extraída en la institución y en el domicilio. Métodos. Estudio transversal que analizó pares de muestras de leche (una extraída en el hogar y otra en la institución, el mismo día) de madres de neonatos internados, de edad gestacional = 35 semanas. Se consideraron contaminadas las muestras de leche que tenían más de 105 UFC/ml de aerobios mesófilos, o presencia de Escherichia coli, Staphylococcus aureus, Streptococcus faecalis, enterobacterias, Pseudomonas, Salmonella, hongos y levaduras. Resultados. Se analizaron 280 muestras de leche (140 pares) de 53 madres; 139 muestras (49,6%; IC 95%: 43,6 a 55,6) presentaron contaminación, que fue significativamente más frecuente en las muestras obtenidas en el domicilio que en las obtenidas en la institución (59,6% contra 39,6%; p= 0,0008; OR 2,25; IC 95% 1,36 a 3,7). Conclusión. La mitad de las muestras de leche materna presentaron contaminación, la cual fue más frecuente en las obtenidas en el domicilio.
Assuntos
Feminino , Humanos , Instalações de Saúde , Leite Humano/microbiologia , Estudos Transversais , RiscoRESUMO
Introduction: Newborns of Gestational Age (GA) ³ 37 weeks are considered to be full-term, but they might show increased morbidity. Objective: To evaluate morbidity risk between newborns 37-38 weeks GA vs those over 39 weeks. Patients and Methods: Cohort study of all children born at a private clinic in Buenos Aires between January 1, 2006 and July 31, 2007, product of simple pregnancies and without major congenital abnormalities. A total of 1829 children met the criteria, among which 823 (45 percent) were 37-38 weeks GA, and 1006 (55 percent) were 39 weeks or over. The following parameters were recorded: birth route, maternal history and morbidity. Morbidity included at least one of the following: respiratory distress > 2 hours post-birth, use of intravenous solutions, jaundice and use of antibiotics. The association between morbidity and GA was evaluated using Chi-square, and logistical regression was used to evaluate the relationship between newborn morbidity and GA, birth route or maternal hypertension. Results: Newborns of 37-38 weeks GA showed higher incidence of each component of morbidity: respiratory distress (OR = 2,55 IC 95 percent = 1,70-3,82), jaundice (OR = 2,24 IC95 percent 1,72-2,29), antibiotic use (OR = 2,31 IC 95 percent= 1,15-4,69) and IV use (OR = 2,29 IC95 percent = 1,57-3,33). Multivariate analysis showed that GA 37-38 weeks (OR= 1,89 IC95 percent= 1,31-2,71) and a C-section (OR = 1,65 IC95 percent = 1,18-2,32) constituted independent predictors of morbidity. Conclusion: In this experience, a gestational age under 39 weeks increases morbidity risk.
Introducción: A pesar de considerarse recién nacidos (RN) de término a aquellos con edad gestacional (EG) ³ 37 semanas, aún dentro de este grupo, los de menor EG podrían presentar mayor morbilidad. Objetivo: Evaluar si existen diferencias en la frecuencia de morbilidad entre recién nacidos de 37-38 semanas de EG y aquellos de EG ³ de 39 semanas. Pacientes y Método: Estudio de cohorte incluyendo todos los RN de una institución privada de Buenos Aires, nacidos entre 01/01/06 y 31/07/07, con EG ³ 37 semanas, producto de gestas simples y sin malformaciones congénitas mayores (n = 1 829). De ellos, 823 (45 por ciento) tenían EG 37-38 semanas y 1 006 (55 por ciento) EG > 39 semanas. Se registró vía de nacimiento, antecedentes maternos y morbilidad (presencia de al menos una de las siguientes condiciones: dificultad respiratoria > 2 horas del nacimiento, aporte de líquidos intravenosos, ictericia y uso de antibióticos). Se evaluó asociación entre morbilidad (en general y para cada uno de sus componentes) y EG por medio de Chi cuadrado y se utilizó regresión logística para evaluar asociación entre EG, vía de parto (cesárea o vaginal), hipertensión arterial materna y morbilidad. Resultados: Los RN de 37-38 semanas presentaron mayor prevalencia de cada componente de morbilidad: dificultad respiratoria (OR = 2,55 IC 95 por ciento = 1,70-3,82), ictericia (OR = 2,24 IC95 por ciento 1,72-2,29), uso de antibióticos (OR = 2,31 IC 95 por ciento = 1,15-4,69) y accesos vasculares (OR = 2,29 IC95 por ciento = 1,57-3,33). El análisis multivariado mostró que EG 37-38 semanas(OR= 1,89IC95 por ciento= 1,31-2,71) y el parto por cesárea (OR = 1,65 IC95 por ciento = 1,18-2,32) constituían predictores independientes de morbilidad. Conclusión: En recién nacidos de término, la EG < 39 semanas incrementa la morbilidad.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Idade Gestacional , Nascimento a Termo , Argentina/epidemiologia , Peso ao Nascer , Estudos de Coortes , Cesárea/estatística & dados numéricos , Doenças do Recém-Nascido/mortalidade , Hospitais Privados/estatística & dados numéricos , Icterícia Neonatal/epidemiologia , Insuficiência Respiratória/epidemiologia , Análise Multivariada , Prevalência , Medição de RiscoRESUMO
La alimentación a pecho es un facto frecuentemente asociado con ictericia en los primeros días,pero aún no están claros los mecanismos implicados.Objetivo.Investigar la relación entre el contenido de grasa en la leche humana,medido por el crematócrito y la ictericia temprana en recién nacidos de término.Población y métodos.Se incluyeron 279 neonatos sanos con los siguientes criterios:>37 semanas,parto espontáneo,Apgar>6 al minuti,>2500g,peso adecuado,sin enfermedad hemolítica ni otros factores de riesgo para ictericia y alimentados exclusivamente a pecho.Se dividieron en dos grupos:114 con ictericia(entre 24 y 72 horas de vida)165 sin ictericia(controles)La leche fue recogida a media mañana entre las 44 y 60 horas de vida.Una alícuota se colocó en tubos capilares para evaluar la tapa de grasa con la técnica de crematócrito.Conclusiones.Nuestros resultados sugieren que un mayor contenido de grasa en la leche humana del segundo día de vida se relaciona con una frecuencia más alta de ictericia temprana en neonatos de término sanos