Exceso de grasa visceral asociado a severidad de COVID-19, cuantificado por bioimpedancia / Excess visceral fat associated with severity of COVID-19 quantified by bioimpedance

Hay dos tipos principales de tejido adiposo; el subcutáneo, que es menos activo metabólicamente, y el tejido adiposo visceral, que secreta constantemente citocinas inflamatorias y está relacionado a enfermedades metabólicas y cardiovasculares. Nuestro objetivo fue identificar la asociación entre el exceso de grasa visceral y la severidad de enfermedad en pacientes con COVID-19. Se realizó un estudio observacional analítico que incluyó a pacientes con COVID-19 admitidos al Hospital Carrión de Huancayo, Perú. Se utilizó la balanza de bioimpedancia para cuantificar la composición corporal, la variable dependiente fue la severidad de enfermedad. Se utilizó el análisis de regresión logística para determinar la asociación de la grasa visceral y otros parámetros antropométricos con severidad de enfermedad. Se analizaron a 120 personas con COVID-19, la edad promedio fue 50 años, el sexo masculino fue 60%. De acuerdo a los valores de la composición corporal emitidos por el equipo de bioimpedancia: La grasa visceral > 15Kg (OR 7,31; p = 0,001); la grasa corporal total > 35% (OR 5,58; p = 0,009) y el exceso de peso > 20Kg (OR 6,96; p = 0,011) fueron los parámetros asociados a enfermedad severa por COVID-19. La relación positiva entre el perímetro abdominal y la cantidad de grasa visceral fue significativo (p = 0,01). En la composición corporal, el exceso de grasa visceral es el mayor parámetro asociado a enfermedad severa por COVID-19(AU)

There are two main types of adipose tissue; the subcutaneous, which is less metabolically active, and the visceral adipose tissue, which constantly secretes inflammatory cytokines and is related to metabolic and cardiovascular diseases. Our objetive was to identify the association between the excess of visceral fat and disease severity in COVID-19 patients. An analytical observational study was carried out which included patients with COVID-19 admitted to the Carrión Hospital in Huancayo, Peru. The bioimpedance balance was used to quantify the body composition; the dependent variable was the severity of the disease. A logistic regression analysis was used to determine the association of visceral fat and other anthropometric parameters with the severity of the disease. Out of 120 people with COVID-19 were analyzed, the average age was 50 years, the male sex was 60%. According to the body composition values issued by the bioimpedance team: Visceral fat> 15Kg (OR 7.31; p = 0.001); Total body fat> 35% (OR 5.58; p = 0.009) and excess weight> 20Kg (OR 6.96; p = 0.011) were the parameters associated with severe disease due to COVID-19. The positive relationship between abdominal circumference and the amount of visceral fat was significant (p = 0.01). In body composition, excess visceral fat is the main parameter associated with severe COVID-19 disease(AU)

Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China.@*METHODS@#A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups.@*RESULTS@#Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05).@*CONCLUSIONS@#There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

Síndrome de dificultad respiratoria aguda en niños: duración de la ventilación y supervivencia / Acute respiratory distress syndrome in children: duration of ventilation and survival

Introducción: El síndrome de dificultad respiratoria aguda es una enfermedad que cursa con hipoxemia severa, poco frecuente en las unidades de cuidados intensivos pediátricos, pero con elevada mortalidad. Objetivo: Determinar la relación entre variables demográficas y clínicas con la duración de la ventilación mecánica y la supervivencia en niños con síndrome de dificultad respiratoria aguda. Métodos: Estudio retrospectivo de los pacientes ingresados en 15 unidades de cuidados intensivos pediátricos, con diagnóstico de síndrome de dificultad respiratoria aguda. Se evaluaron variables demográficas, las formas clínicas del síndrome de dificultad respiratoria aguda, duración de la ventilación mecánica y la supervivencia. Las variables cualitativas se expresaron en valores absolutos y porcentajes, las variables cuantitativas se analizaron con la prueba ji-cuadrada de Pearson y comparación de medias. Resultados: Se registraron 282 pacientes, de ellos 63,7 por ciento menores de seis años, el 54,4 por ciento del sexo masculino y el 51,1 por ciento de piel blanca. Las formas clínicas pulmonares prevalecieron (58,1 por ciento) y se correlacionaron (p= 0,022) con la supervivencia, la mediana de la duración de la ventilación mecánica fue de 10 días. Existió relación (p= 0,000) entre la duración de la ventilación y la mortalidad. Se registró una mortalidad global de 40,78 por ciento, (n= 115). Conclusiones: El síndrome de dificultad respiratoria aguda tiene mayor incidencia en los menores de seis años y en las formas clínicas pulmonares que se relacionan con una mayor supervivencia, la cual se eleva en la medida que aumentan los días de ventilación mecánica(AU)

ABSTRACT Introduction: The acute respiratory distress syndrome is a disease that evolves with severe hypoxemia, and it is not frequent in pediatric intensive care units, but it has high mortality rates. Objective: To determine the relation between demographic and clinical variables with the mechanical ventilation and survival in children with acute respiratory distress syndrome. Methods: Retrospective study in patients admitted in 15 pediatric intensive care units with diagnosis of acute respiratory distress syndrome. There was an assessment of the demographic variables, the clinical forms of this syndrome, the duration of mechanical ventilation and the survival rates. Qualitative variables were presented in absolute values and percentages, and were analyzed with the Pearson´s ji-square test and means comparison. Results: 282 patients were recorded, 63.7 percent of them were under 6 years old, 54.4 percent were males and 51.1 percent were white. Pulmonary clinical forms prevailed (58,1 percent) and were correlated (p= 0,022) with the survival rates, and the mean of mechanical ventilation´s duration was of 10 days. There was relation (p= 0,000) between the duration of ventilation and mortality. It was recorded a total mortality of 40.78 percent (n= 115). Conclusions: Acute respiratory distress syndrome has higher incidence in children under 6 years and in the pulmonary clinical forms that are related with a higher survival, which increases in the same way that mechanical ventilation´s amount of days do(AU)

Betametasona fosfato para la prevención de Síndrome de Dificultad Respiratoria (SDR) del recién nacido de pretérmino / Betamethasone phosphate for the prevention of Respiratory Distress Syndrome (RDS) in the preterm newborn

RESUMEN Introducción: El estándar para inducción de madurez pulmonar en fetos con riesgo de nacer prematuramente es la administración de 12 mg de betametasona acetato/fosfato por dos veces espaciada cada 24 horas. El uso establecido en algunos hospitales públicos en Chile es con dos dosis de 12 mg betametasona fosfato aunque no existen estudios publicados sólo con betametasona fosfato sobre la incidencia de Síndrome de Distress Respiratorio (SDR). Objetivo: Evaluar efecto de betametasona en su forma fosfato como tratamiento antenatal para inducción de madurez fetal pulmonar en la incidencia SDR debido a membrana hialina en prematuros menores de 34 semanas de edad gestacional. Comparar el efecto de betametasona fosfato con el efecto publicado de betametasona acetato/fosfato. Material y método: Análisis de incidencia de SDR en prematuros nacidos en Hospital Padre Hurtado entre 24+0 y 34+0 semanas que recibieron betametasona fosfato para madurez pulmonar y aquellos que no la recibieron. Resultados: De 1.265 neonatos estudiados, 722 completaron dos dosis (57,5%); 436 sólo una dosis (34,5%) y 107 (8,5%) no recibieron corticoides antenatales. La incidencia de SDR debido a membrana hialina en el grupo con dos dosis fue 8,7%, una dosis 25,3% y 32,7% en los no tratados (p<0,001). Para SDR severo las incidencias fueron 6,7%, 12,6% y 16,8% respectivamente (p<0,001). Conclusiones: Inducción de madurez fetal pulmonar con betametasona fosfato en dos dosis de 12 mg IM separadas por 24 horas otorga una reducción significativa de incidencia de SDR semejante a la publicada con betametasona acetato/fosfato en iguales dosis.

ABSTRACT The standard for induction of lung maturity in fetuses at risk of being born prematurely is the administration of 12 mg of betamethasone acetate/phosphate two doses separated by 24 hours. The established use in some public hospitals in Chile is with two doses of 12 mg betamethasone phosphate although there are no studies published with betamethasone phosphate alone on the incidence of respiratory distress syndrome (RDS). Objective: To evaluate the effect of betamethasone in its phosphate form as antenatal treatment for the induction of fetal lung maturity in the incidence of RDS due to hyaline membrane in preterm infants less than 34 weeks of gestational age. To compare the effect of betamethasone phosphate with the published effect of betamethasone acetate/phosphate. Material and method: Analysis of the incidence of RDS in preterm infants born at Hospital Padre Hurtado between 24 + 0 and 34 + 0 weeks who received betamethasone phosphate for lung maturity and those who did not receive it. Results: Of 1,265 infants studied, 722 completed two doses (57.5%); 436 only one dose (34.5%) and 107 (8.5%) did not receive antenatal corticosteroids. The incidence of RDS due to hyaline membrane in the group with two doses was 8.7%, one dose 25.3% and 32.7% in the untreated ones (p <0.001). For severe RDS, incidences were 6.7%, 12.6% and 16.8% respectively (p <0.001). Conclusions: Induction of fetal lung maturity with betamethasone phosphate in two doses of 12 mg IM separated by 24 hours gives a significant reduction in the incidence of RDS similar to that published with betamethasone acetate/phosphate in equal doses.

Características de neonatos com síndrome do desconforto respiratório considerando a via de parto em uma unidade de terapia intensiva da região central do RS / Characteristics of neonates with respiratory distress syndrome admitted to an intensive care unit of the central region of RS

Objetivo: Analisar as características dos neonatos com Síndro-me do Desconforto Respiratório (SDR), considerando a via de parto, admitidos em uma Unidade de Terapia Intensiva de um hospital universitário da região central do Rio Grande do Sul. Materiais e métodos: Estudo retrospectivo, realizado no período de abril a maio de 2017, através da análise de prontuários de neonatos com idade gestacional acima de 37 semanas, ambos os sexos, internados no ano de 2016 na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital Universitário de Santa Maria com CID 10 P22 ­ Desconforto (angústia) respiratório(a) do recém-nascido. Resultados: A amostra foi constituída por 40 registros de nascimentos (25 do sexo masculino), divididos em parto vaginal (n=11) e cesárea (n=29), representando 27,5% e 72,5%, respectivamente, das internações totais. A média de idade materna foi de 27±7 anos, com uma média de 7±5 con-sultas pré-natais. Durante o período de internação 65%(n=26) dos 40 neonatos necessitaram de oxigenoterapia. Conclusão:A partir dos resultados obtidos no presente estudo, observamos que a SDR representa 11% das internações ocorridas na UTIN, no ano de 2016. A prevalência, quanto ao tipo de parto, foi de neonatos nascidos de cesariana, sem a presença do trabalho de parto e com idade gestacional de 38 semanas. (AU)

Objective: To analyze the characteristics of newborns with Respiratory Distress Syndrome (RDS), considering the route of delivery, admitted to an Intensive Care Unit of a university hospital in the central region of Rio Grande do Sul, Brazil. Materials and methods: A retrospective study, conducted from April to May 2017, through the analysis of records of neonates with gestational age above 37 weeks, both sexes, hospitalized in 2016 at the Neonatal Intensive Care Unit (NICU) of the Uni-versity Hospital of Santa Maria, with ICD 10 P22 - Respiratory distress syndrome of newborn. Results: The sample consisted of 40 birth records (25 males), divided into vaginal (n = 11) and caesarean (n = 29), representing 27.5% and 72.5%, respective-ly, of total hospitalization. The mean maternal age was 27 ± 7 years, with a mean of 7 ± 5 prenatal consultations. During the hospitalization period, 65% (n = 26) of the 40 neonates required oxygen therapy. Conclusion: Based on the results obtained in the present study, we observed that the RDS represents 11% of the hospitalizations that occurred in the NICU in 2016. The prevalence, in terms of route delivery, was of neonates born caesarean, without the presence of labor and gestational age of 38 weeks. (AU)

Mortalidade no primeiro dia de vida: tendências, causas de óbito e evitabilidade em oito Unidades da Federação brasileira, entre 2010 e 2015 / Mortalidad en el primer día de vida: tendencias, causas de muerte y evitabilidad en ocho Unidades de la Federación brasileña, entre 2010 y 2015 / Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015

Objetivo: calcular taxas de mortalidade no primeiro dia de vida entre 2010 e 2015 em oito Unidades da Federação brasileira com melhor qualidade de informação, avaliar fatores associados e classificar os óbitos segundo causa básica e evitabilidade. Métodos: estudo descritivo; as taxas foram comparadas conforme características maternas e da criança; a análise de evitabilidade usou a 'Lista brasileira de causas de mortes evitáveis'. Resultados: 21,6% (n=20.791) dos óbitos infantis ocorreram no primeiro dia de vida; a taxa de mortalidade reduziu-se de 2,7 para 2,3 óbitos/1.000 nascidos vivos; observaram-se maiores taxas em NV com baixo peso, nascidos pré-termo e filhos de mães sem escolaridade; as principais causas dos óbitos foram síndrome da angústia respiratória (8,9%) e imaturidade extrema (5,2%); 66,3% das causas de óbito foram consideradas evitáveis. Conclusão: dois terços dos óbitos no primeiro dia de vida poderiam ser evitados por atenção adequada à mulher na gestação e no parto, e ao NV.

Objetivo: calcular la mortalidad en el primer día de vida entre 2010 y 2015 en ocho Unidades de la Federación brasileña con mejor calidad de información, analizar factores asociados y clasificar las causas básicas y la evitabilidad de los óbitos. Métodos: estudio descriptivo; las tasas de mortalidad fueron comparadas según las características maternas y del recién nacido (RN); el análisis de evitabilidad utilizó la 'Lista brasileña de causas de muertes evitables'. Resultados: un 21,6% (n=20.791) de los óbitos infantiles ocurrió en el primer día de vida; la tasa de mortalidad se redujo de 2,7 a 2,3 óbitos/1.000 nacidos vivos (NV); las tasas fueron mayores en NV de bajo peso, prematuros e hijos de madres sin escolaridad; las principales causas de óbito fueron síndrome de angustia respiratoria (8,9%) e inmadurez extrema (5,2%); un 66,3% de las causas de óbito fueron consideradas evitables. Conclusión: 2/3 de los óbitos en el primer día de vida podrían haber sido evitados con una atención adecuada a la mujer embarazada, al parto y al NV.

Objective: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. Methods: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. Results: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. Conclusion: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.

Antecedentes maternos prenatales y riesgo de complicaciones neonatales en productos de término de bajo peso para edad gestacional / Maternal prenatal history and neonatal risk complications for low-weight for gestacional age term newborns

Resumen Introducción: El bajo peso neonatal (< 2.5 kg o < percentil 10) se atribuye a causas constitucionales (pequeño para la edad gestacional [PEG]) o a la restricción en el crecimiento intrauterino (RCIU), con riesgos posnatales diferentes. En ausencia de una valoración fetal-placentaria prenatal adecuada, resulta difícil establecerlo. El conocer los antecedentes maternos de enfermedades gestacionales (AMEG): hipertensión arterial (HTA), hipotiroidismo, Diabetes Mellitus (DM) gestacional y otra; pudiera orientar a la diferenciación y el manejo. El objetivo de este trabajo fue determinar si la presencia de AMEG se asocia a complicaciones neonatales en productos de bajo peso neonatal. Métodos: Se realizó un estudio de cohorte retrospectivo en un grupo de 349 recién nacidos vivos de término (≥ 37 semanas de edad gestacional [SEG]), PEG, en cunero fisiológico y agrupados según los AMEG. Se determinó la frecuencia de dificultad respiratoria (DR), hipoglucemia (HG) e hiperbilirrubinemia (HBr). Resultados: El 16.6% (58/349) presentó AMEG (58.6% HTA y 41.3% hipotiroidismo, solos o combinados). Los neonatos con AMEG fueron más limítrofes (37 SEG, 55.2% vs. 35.1%; p = 0.037). Los de 37 SEG con menor peso (diferencia de ≈100 g; p = 0.028), más riesgo de HG (13.6%; intervalo de confianza al 95% [IC 95%]: −4.08-31.2) pero menos DR (diferencia de −4.7%; IC 95%: −20.6-11.05). La HG en los de 39 SEG solo se presentó en neonatos sin AMEG (diferencia 12.7%; IC 95%: 3.9 a 31.5) igual que la HBr (tres casos). Conclusiones: Indagar sobre los AMEG en un producto PEG parece ser útil en la inferencia de RCIU. Sin embargo, es insuficiente, por lo que en conjunto con otras herramientas nos ayuda a estimar posibles complicaciones y acciones preventivas.

Abstract Background: Low-birth-weight (LWB < 2.5 kg or <10 percentile) could be caused by constitutional matters or by intrauterine growth restriction (IUGR), both with different neonatal complications. Without an adequate prenatal evaluation is hard to stablish those conditions. Knowing the maternal history for gestational diseases (MHGD) such as hypertension (HTA), hypothyroidism or diabetes, among others could help clarify that difference. The aim of this work was to determine if having a MHGD is associated to neonatal complications in newborns with LWB. Methods: Retrospective cohort study, which included 349 with LWB at term (≥ 37 weeks of gestation [WG]) grouped into those with or without MHGD at a hospital nursery. The frequency of respiratory distress, hypoglycemia, and hyperbilirubinemia was determined. Results: 16.6% (58/349) had MHGD (58.6% for HTA and 41.3% hypothyroidism alone or combined). The neonate with MHGD were more borderline term (37 WGA, 55.2% vs. 35.1%; p = 0.037), and had lower weight (difference of ≈100 g; p = 0.028), had more cases with hypoglycemia (13.6%; CI 95%: −4.08 to 31.2%) but developed less respiratory distress (RD) (difference of −4.7%; CI 95%: −20.6 to 11.05%). Hypoglycemia in 39 WGA was only seen among neonates without MHGD (difference 12.7%; CI95%: 3.9 to 31.5%) just as for the hyperbilirubinemia cases (three). Conclusions: Inquiring about the MHGD on LBW term babies could be useful in the inference of IUGR, although we need other tools so that altogether can help to predict possible complications and to plan preventive actions.

Morbilidad neonatal de los prematuros tardíos en embarazos únicos: estudio de caso-control / Neonatal morbidity of late preterm: a case-control study

Objetivo: Comparar los riesgos de morbilidad neonatal entre los prematuros tardíos (PT) y neonatos de término. Método: Estudio de caso control. Se revisan fichas clínicas de partos durante el año 2007. Se excluyen neonatos con malformaciones congénitas mayores, alteración neuromuscular, embarazos múltiples y aneuploidias. Los casos corresponden a todo PT nacido durante el periodo estudiado y los controles a nacidos de término en el mismo periodo. Los resultados neonatales fueron obtenidos y los riesgos calculados usando pruebas de Chi cuadrado y exacto de Fisher. Resultados: Se identifican 1536 partos, con una tasa de PT de 7,1 por ciento (109 casos), 62 cumplieron con criterios de inclusión. El grupo control consistió en 124 partos de término. PT presentaron 2 veces más riesgo de cesárea (p=0,0094) que los de término. El riesgo de ser admitido en UCIN fue de 88 (p=0,000). Los riesgos de morbilidad neonatal fueron: SDR (OR 23; p=0,000), hipoglicemia (OR 6; p=0,014), hipocalcemia (OR 6; p=0,014), hiperbilirrubinemia (OR 28; p=0,000) y necesidad de fototerapia (OR 23; p=0,000). No hubo diferencias en la presentación de enterocolitis necrotizante (p=0,478) ni sepsis neonatal (p=0,615). La mortalidad neonatal fue significativamente superior en los PT (p=0,044). Conclusión: Los PT deben ser considerados de alto riesgo en el período neonatal. Nuestros resultados son importantes para tomar decisiones clinicas respecto al mejor momento de finalizar un embarazo con riesgo inminente de prematurez.

Objective: To compare neonatal morbidity risks between late preterm (LP) and term deliveries. Methods: Case control study. Medical records in 2007 were reviewed. Major congenital malformations, neuromuscular handicap, twin pregnancies and aneuploidies were excluded. The Study group corresponds to all LP births during that period and the control group to term deliveries in the same period. Neonatal outcomes were collected and different risks were calculated using Chi square test and Fisher exact tests. Results: 1536 deliveries with a LP rate of 7.1 percent (109 cases) were observed, 62 cases met inclusion criteria. The control group consisted in 124 single term deliveries. LP had 2 times more risk of cesarean section (p=0.0094) than term deliveries. The risk of NICU admission was 88 (p=0.000). Neonatal morbidity risks were: RDS (OR 23, p=0.000), hypoglycemia (OR 6, p=0.014), hypocalcaemia (OR 6, p=0.014), hyperbillirrubinemia (OR 28, p=0.000) and phototherapy (OR 23, p=0.000). There were no differences in necrotizing enterocolitis (p=0.478) and risk of neonatal sepsis (p=0.615). Neonatal mortality was significantly higher in LP babies (p=0.044). Conclusion: LP newborn must be considered as high risk in the neonatal period. These results are important in making clinical decisions about the better time to end pregnancy.

Taquipnea transitoria del recién nacido en el Hospital General Docente "Ciro Redondo García": Artemisa 2009 / Transitory taquipnea of the New Born One In The Educational General Hospital "Ciro Redondo García". Artemisa 2009

Entre 40-50 por ciento de los casos con síndrome de dificultad respiratoria (SDR) evolucionan como una Taquipnea Transitoria (TTRN). Se realizó un estudio retrospectivo descriptivo, con el objetivo de conocer el comportamiento de la (TTRN) en la Unidad de Cuidados Especiales de Neonatología (UCEN) del Hospital General Docente Ciro Redondo García, en el período comprendido enero 2008 hasta diciembre 2009. El universo fue 113 recién nacidos (RN) con SDR y 72 constituyeron la muestra con diagnóstico de (TTRN) por un muestreo no probabilístico. Se confeccionó un formulario y se recogieron variables relacionadas con el parto y examen físico del RN. Los datos se procesaron estadísticamente por el sistema Excel. Aproximadamente 3 de cada 4 RN con (TT) nacen por cesárea, a término, del sexo masculino, normopesos, conteo de apgar normal y tiempo de evolución inferior a 120 horas. Se concluye que el comportamiento de la TTRN en nuestro servicio resultó elevado(AU)

Among 40-50 percent of the cases with syndrome of breathing (SDR) they evolve like a transitory Taquipnea (TTRN). He/She was carried out a descriptive retrospective study, whith the objective of knowing the behaviour of the TTRN in the Unit of Special Cares of Neonatology (UCEN) of the educational general Hospital Ciro Redondo García, in the Period understood January 2008 until December 2009. The universe was 113 new born (RN) with SDR and 72 constituted the simple with diagnostic of TTRN for a sampling non probabilistic. A form was made and variables related with the childbirth and physical exam of the RN were picked up. The data were processed statistically by the system Excel. Approximately 3 of each 4 RN with (TT) they are born for caesarean operation, to term, of the masculine sex, norm weight, count of normal apgar and time of inferiority evolution at 120 hours. You conclude that the behaviour of the TTRN in our service is high(AU)

Complications among premature neonates treated with beractant and poractant alfa.

Objective. To compare the complications among preterm infants treated with two different natural surfactants. Methods. In a randomized clinical trial, 150 preterm infants with Respiratory distress syndrome (RDS) treated with exogenous surfactant, were enrolled in the study. Group A consisted of 79 neonates that received poractant (curosurf). Seventy one newborn infants in group B were treated with beractant (Survanta). Results. The mean gestational age for group A and B were 29.40±2.90 wk and 29.50±2.73 wk (P=0.82), respectively. The demographic and clinical variables were similar in both groups. The mean duration of intubation (as a primary outcome) was significantly shorter in infants treated with poractant (3.13±1.80 vs 4.06±2.7 days p=0.05). The mean duration of need for oxygen and hospitalization of patients in group A and B were 17.73±22.25 vs 19.14±17.85days (p=0.67) and 24.89±26.41 vs 29.14±23.54 days (p= 0.32), respectively. There was no significant difference between groups with respect to mortality and morbidity, including pulmonary hemorrhage, intraventricular hemorrhage (IVH), patent ductus arteriosus, sepsis, and bronchopulmonary dysplasia (secondary outcome). Conclusions. In this study, infants who received poractant had shorter duration of intubation than infants treated with beractant, without any difference in the duration of oxygen therapy or hospitalization. There was no significant superiority of poractant over beractant.

Surfactant and patent ductus arteriosus.

Objective. To investigate the relationship between surfactant replacement therapy and the development of a haemodynamically significant ductus arteriosus. Methods. All premature infants at 28-32 wk gestation with a clinical diagnosis of respiratory distress syndrome were retrospectively reviewed and subdivided into two groups; intubated, mechanically ventilated and received surfactant (Group 1); and received nasal continuous positive airway pressure alone (Group 2). The relationship between groups and characteristics of the hemodynamically significant ductus arteriosus was analyzed. Results. Seventy babies were identified of whom 35 (50%) received surfactant. Babies in group I and II were comparable for gestational age, birthweight, antenatal steroids, gender and fluid intake in first week of life. Babies treated with surfactant therapy were found to be more likely to have a haemodynamically significant ductus arteriosus (p< 0.01), larger transductal diameter (p=0.01) and increased rate of therapeutic interventions to close the ductus (p<0.01). Ventilation parameters (mean airway pressure and fractional inspired oxygen) were higher in group I. Conclusion. Neonates with respiratory distress syndrome (RDS) who were treated with surfactant replacement are at increased risk of a hemodynamically significant ductus arteriosus that requires therapeutic intervention. Whether the relationship reflects their underlying lung disease or is a direct effect of surfactant requires prospective evaluation.

Surfactant Therapy for Neonatal Respiratory Distress Syndrome: A Review of Korean Experiences over 17 Years

We undertook a multi-hospital collective study to evaluate outcomes of neonatal respiratory distress syndrome (RDS) patients treated with pulmonary surfactant (PS) over 17 yr in Korea (Group I; 1990/91, Group II; 1996, Group III; 2002, and Group IV; 2007). There were 60 neonates in Group I (16 hospitals), 1,179 in Group II (64), 1,595 in Group III (62), and 1,921 in Group IV (57). We adopted Bomsel's classification to evaluate initial chest radiographic findings, categorized RDS severities, and classified response types to PS therapy. Almost all cases were treated using a single dose in Groups I and II, but 19.5% received multiple-dose therapy in Group IV. In Group IV, Bomsel's stages III and IV composed 62.9% and initial severities of mild, moderate, and severe RDS were 23.0%, 42.0%, and 35.0%. More infants showed good response in Groups II, III, and IV than in Group I (71.7%, 66.8%, and 69.2% vs. 58.3%). Complications and mortality rate were lower in Group IV than in Groups I, II, and III (mortality rate: 14.3% vs. 40.0%, 30.0%, and 18.7%). We conclude that PS therapy in neonates with RDS had a remarkable impact on improving clinical course and outcomes over 17 yr in Korea.

Survival and outcome of very low birth weight infants born in a university hospital with level II NICU.

OBJECTIVES: Determine the survivals, neonatal outcomes to hospital discharge, and perinatal risks of death among VLBW infants born in the Thammasat University Hospital. MATERIAL AND METHOD: This was a retrospective longitudinal study. Data were colleted from medical charts of all neonates with a gestational age of more than 25 weeks and birth weight of less than 1500 grams, who were born in Thammasat University Hospital for a 3-year period between July 1st, 2003 and June 30th, 2006. Antenatal history, perinatal data, and neonatal outcome until hospital discharge were extracted and analyzed. RESULTS: Seventy-eight neonates with a birth weight between 600-1485 grams were analyzed. Survival rate of very-low-birth-weight (VLBW) infants and extremely-low-birth-weight (ELBW) infants were 81% and 52% respectively. Respiratory distress syndrome (RDS) was the major cause of death. Major morbidity was found in 35% of survived infants to hospital discharge. Unfavorable outcome was documented in infants with a birth weight < 750 grams. Perinatal risks of mortality among VLBW infants included no use of antenatal steroids (p = 0.015), gestational age of <28 weeks (p = 0.012), ELBW (p < 0.001), congenital abnormalities (p = 0.002), Apgar score at 5 minute <5 (p = 0.019), needed endotracheal intubation in the delivery room (p < 0.001), and first temperature at NICU < 35.0 degrees C (p = 0.023). CONCLUSION: Overall survival and outcome among very-low-birth-weight infants born in Thammasat University Hospital is acceptable. The mortality and morbidity in extremely-low-birth-weight infants remained high. A continuing audit of these measures should be encouraged.

Síndrome de dificultad respiratoria neonatal: comparación entre cesárea programada y parto vaginal en un recién nacido de término / Neonatal respiratory distress syndrome: comparison between programmed cesarean section and vaginal delivery in term newborn

El objetivo fue comparar la prevalencia del síndrome de dificultad respiratorio (SDR) en neonatos nacidos por parto vaginal vs. cesárea electiva. Lugar: Hospital Materno Infantil Ramón Sardá (HMIRS), Ciudad de Buenos Aires. Período de estudio: 14 de marzo al 31 de diciembre de 2005. Diseño: observacional, prospectivo, tipo cohorte. Grupo estudio: recién nacidos (RN) mayores o igual a 37 semanas de edad gestacional, de embarazo único, sin malformaciones y sin patología fetal nacidos por cesárea programada. Grupo control: recién nacidos de iguales características nacidos inmediatamente posterior por vía vaginal no instrumental. Se excluyeron embarazos dobles, menores de 37 semanas, malformados y con patología fetal. Resultados: grupo Cesárea (estudio) N= 221. Grupo Vaginal (control) N= 221. En el grupo de estudio hubo 14 SDR (14/221; 6,33 por ciento) y en el grupo control 4 SDR (4/221; 1,80 por ciento). RR: 3,50 (1,17 - 10,47). Al analizarlo por edad gestacional se observó que a las 37 semanas el RR fue 2,00 (0,20 - 19,62), a las 38 semanas 6,00 (0,74 - 48,78) y a las 39, 2.50 (0,50 - 12,45). Conclusión: los RN de término nacidos por cesárea programada tuvieron mayor riesgo de SDR que los nacidos por parto normal.

Caracterização da Síndrome do Desconforto Respiratório no Hospital Santa Casa de Maringá / Characterization of the respiratory distress syndrome in the Santa Casa of Maringa Hospital

O crescente avanço da pediatria neonatal verificado nas últimas décadas tem permitido a sobrevida de recém-nascidos em idades gestacionais (IG) cada vez mais precoces, mas a síndrome do desconforto respiratório (SDR) constitui a maior causa de mortalidade no período neonatal, com sua inciência variando inversamente com a IG. É caracterizada pelo desconforto respiratório nas primeiras horas de vida, relacionado à incapacidadedo pneumócito tipo II de produzir o surfactante endógeno. Observado o grande número de internações na Unidade de Terapia Intensiva (UTI) neonatal com SDR optou-se em realizar um estudo com o objetivo de traçar o perfil dessa patologia na UTI neonatal do Hospital Santa Casa de Misericórdia de Maringá. Foi realizada uma análise a partir do livro-registro no período de julho a dezembro de 2002. Os dados obtidos demonstraram que de 192 internações 22,92 por cento dos casos apresentaram a SDR. Destes, 29,55 por cento foram do grau III, 56,81 por cento do sexo masculino; 75 por cento nascido de parto cesárea e 29,55 por cento pesavam de 1000 a 1500g. Pode-se observar também que 27,27 por cento foram a óbito e 54,55 por cento realizaram fisioterapia. Concluiu-se que a SDR realmente apresenta uma alta incidência nas UTIs neonatais. Comparando com aliteratura confirmou-se acometer em maior número recém-nascidos dos exo masculino, de parto cesárea e com peso menor que 2000g

Síndrome do desconforto respiratório agudo / Acute respiratory distress syndrome

A síndrome do desconforto respiratório agudo (SDRA) compreende uma manifestação clínica severa, caracterizada por lesão pulmonar aguda, edema pulmonar não-cardiogênico, hipoxia refratária e diminuição da complacência pulmonar. O objetivo dos autores é revisar a literatura sobre os principais aspectos relacionados com a síndrome do desconforto respiratório agudo e com a lesão pulmonar aguda (LPA). Os autores revisaram artigos publicados em periódicos disponíveis na base de dados MEDLINE, compreendidos entre 1985 e 2002. As palavras-chaves utilizadas na busca foram: síncrome do desconforto respiratório agudo, lesão pulmonar aguda e choque pulmonar. Existem critérios diagnósticos definidos para síndrome do desconforto respiratório agudo e lesão pulmonar aguda (começo agudo, relação PaO2/FiO2 ≤ 200, infiltrados bilaterais na visão frontal da radiografia de tórax e pressão capilar pulmonar ≤ 18mmHg). A atividade endotelial é considerada o principal mecanismo no complexo de eventos patológicos que resultam na SDRA. O balanço entre fatores pró-inflamatórios e entiinflamatórios influencia na resposta inflamatória pulmonar. O objetivo da ventilação em pacientes com SDRA e LPA é manter a adequada troca gasosa e evitar a selão pulmonar induzida pelo ventilador. Ainda não há consenso quanto à melhor forma de definir os níveis de PEEP a serem empregados no tratamento da SDRA. Estudos nível II com baixas doses de corticosteróides na fase fibroproliferativa da SDRA têm demonstrado algum benefício, recebendo nível de recomendação C

Pulmonary function in infants exposed to pethidine.

OBJECTIVE: To investigate the effects of maternal pethidine administration on pulmonary function tests in newborn infants. PATIENTS AND METHOD: The study was carried out in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. The study group consisted of 20 infants exposed to pethidine within 4 hours prior to delivery. Twenty infants whose mothers received no analgesic drug or regional anesthesia were randomly selected as the controls. Narcotic related respiratory depression was determined by Apgar scores, the need for ventilatory support in the delivery room and abnormal pulmonary function measurements. RESULTS: There was no difference in birth weight and gestational age between the two groups of infants. Pethidine was given to mothers at a dose of 72.5 +/- 7.6 mg/kg with a mean drug-delivery interval of 152 +/- 61 minutes. One infant in each group had a 1-minute Apgar score less than 7, but there was no statistical difference in the mean Apgar score between the two groups. None of the infants whose mothers received pethidine required ventilatory support, but oxygen was provided to eight infants who were apparently cyanosed at birth. Pulmonary function measurements were performed at the age of 7.4 +/- 2.3 hours in the controls and 6.0 +/- 2.5 hours in the study group. There was no significant difference in respiratory rate, tidal volume, inspiratory time, functional residual capacity, compliance and resistance between the two groups of infants. CONCLUSION: Severe narcotic related respiratory depression was uncommon in this study. In the first 12 hours of life, there was no significant difference in pulmonary function of the infants exposed to pethidine. It is quite safe to allow the baby to room-in with the mother if respiratory depression is not presented at birth.