Exclusive breastfeeding and length of hospital stay in premature infants at a Brazilian reference center for kangaroo mother care

Abstract Objective: To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in pre-term infants undergoing or not the Kangaroo-Mother Care Method (KMC). Methods: A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders. Results: 115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85-109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76-0.86) compared to the non-KMC group. Conclusions: The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals.

Implementing palliative care, based on family-centered care, in a highly complex neonatal unit

Abstract Objective: To describe the causes and circumstances of neonatal mortality and determine whether the implementation of a palliative care protocol has improved the quality of end-of-life care. Methods: A retrospective observational study including all patient mortalities between January 2009 and December 2019. Cause of death and characteristics of support during the dying process were collected. Two periods, before and after the implementation of a palliative care protocol, were compared. Results: There were 344 deaths. Congenital malformations were the most frequent cause of death (45.6 %). Most patients died after the transition to palliative care (74.4 %). The most frequently cited criteria for initiating transition of care was poor neurocognitive prognosis (47.2 %). Parents accompanied their children in the dying process in 72 % of cases. Twenty-three percent of patients died outside the Neonatal Intensive Care Unit after being transferred to a private room to enhance family intimacy. After the addition of the palliative care protocol, statistically significant differences were observed in the support and patient experience during the dying process. Conclusions: The most frequent causes of death were severe congenital malformations. Most patients died accompanied by their parents after the transition to palliative care. The implementation of a palliative care protocol helped to improve the family-centered end-of-life care.

Correlation between nasal anatomical characteristics in newborns and short binasal prong dimensions

Abstract Objective: To correlate the nasal anatomical characteristics of newborns with the dimensions of short binasal prongs. Method: Observational, cross-sectional study carried out in two hospitals in southern Brazil. The authors evaluated 1620 newborns with neonatal data and nasal dimensions. To measure the dimensions of the nasal region, the authors considered the width of the medial columella, the right nostril diameter, and the left nostril diameter. These data were correlated with the dimensions of two models of short binasal prongs. Results: Of the total newborns evaluated, 807 were female (49.8%), and 813 were male (50.2%). The majority were white (96.2%). The mean gestational age was 37.4 ± 2.9 weeks, ranging from 22 to 42 weeks. The birth weight was 2946.8 ± 699.3 g, ranging from 490.0 to 4740.0 g. Most of the nasal measures were significantly larger than both prong model measurements. Conclusion: The sizes of short binasal prongs available on the Brazilian market do not match the nasal anatomical characteristics of newborns.

Percepção de fisioterapeutas sobre alterações do sistema autônomo e do estado comportamental de recém-nascidos submetidos a procedimentos de estimulação sensório-motora: estudo transversal / Physiotherapists' perception of changes in the autonomic system and behavioral state of newborns undergoing sensory motor stimulation procedures: cross-sectional study

INTRODUÇÃO: A estimulação sensório-motora (ESM) é uma intervenção precoce utilizada em recém-nascidos (RN) para a organização de seus sistemas. O fisioterapeuta que faz uso da ESM deve ter um olhar cuidadoso para os sinais apresentados pelos RN após os procedimentos. OBJETIVO: Analisar a percepção de fisioterapeutas sobre alterações do sistema autônomo e do estado comportamental de RN após procedimentos de ESM. MÉTODOS: Estudo transversal realizado com fisioterapeutas atuantes em unidades neonatais. Os dados foram coletados por questionário eletrônico, processados no programa SPSS (versão 21.0) e apresentados em frequência absoluta (n) e relativa (%). RESULTADOS: Participaram deste estudo 72 fisioterapeutas; 48,6% possuíam título de especialista, 63,9% atuavam em Unidade de Terapia Intensiva Neonatal, 38,8% residiam na região sul e 38,8% na região sudeste do Brasil. A percepção da maioria dos fisioterapeutas após procedimentos de ordem tátil foi estabilidade ou diminuição da frequência cardíaca (FC) e respiratória (FR), e estabilidade da saturação de oxigênio (SpO2 ), e após procedimentos de ordem vestibular foi estabilidade da FC, FR e SpO2 . Houve percepção de sono ativo, sonolência e alerta ativo após todos os procedimentos de ordem tátil e vestibular. O alerta ativo foi percebido após todos os procedimentos e o choro intenso não foi percebido. CONCLUSÃO: Do sistema autônomo, a maioria dos fisioterapeutas perceberam a FC e FR estáveis ou diminuídas e SpO2 estável ou aumentada após os procedimentos de ESM. Do estado comportamental, o alerta ativo foi percebido com maior frequência entre os fisioterapeutas.

INTRODUCTION: Sensory motor stimulation (SMS) is an early intervention used in newborns (NB) to organize their systems. The physiotherapist who uses SMS must pay careful attention to the signs presented by NB after the procedures. OBJECTIVE: To analyze the perception of physiotherapists about changes in the autonomic system and behavioral state of NB after SMS procedures. METHODS: Cross-sectional study carried out with physiotherapists working in neonatal units. Data were collected by electronic questionnaire, processed in the SPSS program (version 21.0) and presented in absolute (n) and relative (%) frequency. RESULTS: 72 physiotherapists participated in this study, 48.6% had a specialist degree, 63.9% worked in Neonatal Intensive Care Unit, 38.8% lived in the southern region and 38.8% in the southeastern region of Brazil. The perception of most physiotherapists after tactile procedures was stability or decrease in heart rate (HR), respiratory rate (RR) and stability of oxygen saturation (SpO2), and after vestibular procedures it was stability of HR, RR and SpO2. There was a perception of active sleep, drowsiness, and active alertness after all tactile and vestibular procedures. Active alertness was noticed after all procedures and intense crying was not noticed. CONCLUSION: Regarding the autonomic system, most physiotherapists noticed stable or decreased HR and RR, and stable or increased SpO2 after SMS procedures. Regarding the behavioral state, active alert was noticed more frequently among physiotherapists.

Community-acquired neonatal SARS-CoV-2 infection: case report / Infecção neonatal por SARS-CoV-2 adquirida na comunidade: relato de caso / Infección neonatal por SARS-CoV-2 adquirida en la comunidad: reporte de caso

Background and Objectives: Data collection on the incidence of COVID-19 is conducted less frequently in newborns (NB) than in adults. In view of the small number of described neonatal SARS-CoV-2 infections, in this study, we report a clinical case of community-acquired COVID-19 infection in a newborn. Methods: Clinical characteristics were collected from the medical records from April 2021 until the final outcome of the newborn in May 2021. Results: This article discusses the case of a full-term male newborn aged 38 weeks. On the 17th day of life, this newborn was admitted to the pediatric unit with fever and zone 4 jaundice, mild lower chest retraction and tachypnea. The mother was diagnosed with COVID-19. Late neonatal sepsis with pulmonary focus was detected. The newborn was hospitalized and the antigen test for COVID-19 came back positive. The condition of the neonate rapidly deteriorated and he was referred to the neonatal intensive care unit (NICU), where he was intubated and placed on pressure-controlled mechanical ventilation. During his second week in the NICU, he developed severe pulmonary hypertension with decreased peripheral oxygen saturation and tachycardia. The newborn required blood transfusion and was put into prone position during part of the treatment. Reductions in mechanical ventilation parameters were not tolerated by the NB's organism and he developed progressive hypoxemia. The newborn died 1 month and 3 days after hospitalization. Conclusion: Our study shows a case of community-acquired COVID-19 that progressed to the severe form of the disease.(AU)

Justificativa e Objetivos: A coleta de dados sobre a ocorrência de covid-19 em recém-nascidos (RN) não é tão frequente quanto em adultos. Portanto, devido ao baixo número de infecções neonatais por SARS-CoV-2 descritas, relatamos, neste estudo, um caso clínico de infecção por covid-19 adquirida na comunidade em um recém-nascido. Métodos: As características clínicas foram coletadas dos prontuários desde abril de 2021 até o último desfecho do RN, em maio de 2021. Resultados: Este artigo abordará um RN do sexo masculino, a termo, com 38 semanas. No 17º dia de vida, o RN deu entrada na unidade pediátrica com quadro de febre e icterícia zona 4, leve retração torácica inferior e taquipneia. A mãe foi diagnosticada com covid-19. Foi detectada sepse neonatal tardia com foco pulmonar. O RN foi internado e o teste de antígeno para covid-19 foi positivo. O quadro do RN regrediu rapidamente, sendo encaminhado à unidade de terapia intensiva neonatal (UTIN), onde foi entubado e adaptado à ventilação mecânica em modo pressão controlada. Na segunda semana de internação na UTIN, desenvolveu hipertensão pulmonar grave com diminuição da saturação periférica de oxigênio e taquicardia. O RN necessitou de transfusão sanguínea e a posição prona foi realizada por períodos. Reduções nos parâmetros do ventilador mecânico não foram toleradas e o RN apresentou hipoxemia progressiva. O RN faleceu um mês e três dias após a internação. Conclusão: Nossos achados apresentam um caso de covid-19 adquirida na comunidade que evoluiu para a forma grave da doença.(AU)

Justificación y Objetivos: La recolección de datos sobre los contagios por covid-19 en recién nacidos (RN) no es tan frecuente como en adultos. En este contexto, y debido al bajo número de infecciones neonatales por SARSCoV-2 descritas, en este estudio se describe un caso clínico de infección posnatal por covid-19 en un recién nacido en la comunidad. Métodos: Se recogieron características médicas de las historias clínicas desde abril de 2021 hasta el último resultado del RN en mayo de 2021. Resultados: Este artículo reporta el caso de un RN del sexo masculino, a término de 38 semanas. Al 17.º día de vida, el RN ingresó a la unidad de pediatría con fiebre e ictericia zona 4, leve retracción torácica inferior y taquipnea. La madre dio positivo para covid-19. En el RN se detectó sepsis neonatal tardía con foco pulmonar. Lo hospitalizaron, y la prueba de antígenos para covid-19 dio como resultado positivo. El estado del RN empeoró rápidamente, lo remitieron a la unidad de cuidados intensivos neonatales (UCIN), donde requirió intubación y ventilación mecánica controlada por presión. En la segunda semana en la UCIN, desarrolló hipertensión pulmonar grave con disminución de la saturación periférica de oxígeno y taquicardia. El RN requirió transfusión sanguínea, y lo pusieron en posición prona por períodos. El paciente no soportó las reducciones en los parámetros del ventilador mecánico y presentó una hipoxemia progresiva. El RN falleció un mes y tres días después de la hospitalización. Conclusión: Los hallazgos muestran un caso del covid-19 adquirido en la comunidad que progresó a la forma grave de la enfermedad.(AU)

Acompañar una doble hospitalización en pandemia: la experiencia de padres con bebés hospitalizados mientras las madres se encuentran hospitalizadas por COVID-19 / Supporting a double hospitalization during the pandemic: The experience of fathers whose infants were hospitalized while their mothers were also hospitalized due to COVID-19

Introducción. La hospitalización de un hijo en la unidad de pacientes críticos neonatal puede ser altamente estresante para padres y madres, lo cual se intensificó en el contexto de la pandemia por COVID-19. A la fecha, no se han encontrado estudios que describan la experiencia de padres que vivieron la doble hospitalización simultánea de su pareja y de su hijo/a al nacer, durante la pandemia por COVID-19. Objetivos. Explorar la vivencia de los padres de tener a sus hijos/as hospitalizados en Neonatología mientras su pareja se encontraba hospitalizada por agravamiento de COVID-19. Población y método. Cuatro entrevistas semiestructuradas fueron realizadas y analizadas mediante un análisis interpretativo fenomenológico. Resultados. Se identificaron cuatro momentos cuando surgieron emociones específicas: a) inicio del contagio, b) hospitalización de la pareja, c) nacimiento del bebé y d) hospitalización del bebé. Culpa, miedo, angustia de muerte, soledad e incertidumbre aparecen muy tempranamente y luego se combinan con emociones como felicidad y empoderamiento, entre otras. La falta de contacto físico con sus parejas e hijos, y las fallas en la comunicación con los equipos de salud se destacan como factores que obstaculizan el ejercicio del rol paternal, mientras que una comunicación fluida con el equipo y una participación activa en los cuidados del bebé son factores protectores. Los padres cumplen una multiplicidad de roles, en la que prima el rol protector. Conclusiones. La comunicación y la atención centrada en la familia, y la participación activa en los cuidados de los bebés tienen el potencial de proteger contra el impacto de esta experiencia compleja de doble hospitalización.

Introduction. The hospitalization of a baby in the neonatal intensive care unit may be highly stressful for both mothers and fathers, and this was even more intense in the context of the COVID-19 pandemic.To date, no studies have been found that describe the experience of fathers who underwent the simultaneous hospitalization of their partner and newborn infant during the COVID-19 pandemic. Objectives. To explore the experience of fathers who had their babies hospitalized in the Neonatal Unit while their partner were hospitalized due to worsening of COVID-19. Population and method. Four semi-structured interviews were conducted and analyzed using an interpretative phenomenological analysis. Results. Four moments were identified when specific emotions arose: a) onset of infection, b) partner hospitalization, c) baby birth, and d) baby hospitalization. Guilt, fear, death anxiety, loneliness, and uncertainty appear very early and are later combined with emotions such as happiness and empowerment, among others. The lack of physical contact with their partners and babies and failures in communication with the health care team stand out as factors that hinder the exercise of the paternal role, while an effective communication with the health care team and active participation in the baby's care are protective factors. Fathers fulfill multiple roles, the most important of which is their role as protectors. Conclusions. Family-centered communication and care and active involvement in baby care may potentially protect against the impact of this complex experience of double hospitalization.

Changes in Neonatal Intensive Care Unit statistics during the COVID-19 pandemic / Cambios en las estadísticas de una Terapia Intensiva Neonatal durante la pandemia COVID-19

Abstract Background: With the identification of COVID-19 disease in China, a pandemic began that affected health-care systems. The Neonatal Intensive Care Unit (NICU) of the Hospital de Ginecobstetricia del Centro Médico Nacional de Occidente experienced an increase in patient flow as part of the COVID-19 strategy of the Instituto Mexicano del Seguro Social (IMSS). This study aimed to analyze the impact of the COVID-19 pandemic on neonatal care and mortality indicators in our unit. Methods: We conducted a retrospective study to compare the number of hospital births, pre-term newborns (PTNB), NICU admissions, and deaths. Changes in frequencies between 2019 and 2021 were analyzed using Poisson distribution. Changes in PTNB births, proportion of admissions, and deaths/NICU discharges were analyzed by z-test for two proportions. Results: Between 2019 and 2021, the number of births increased by more than 2-fold. NICU admissions increased from 770 in 2019 to 1045 in 2021 (p < 0.01). The ratio of deaths/discharge from the service was 16.9% in 2019 and 13.1% in 2021 (p = 0.02). Conclusions: Mortality indicators in the NICU decreased from 2019 to 2021, even with the increase in the number of patients admitted during the COVID-19 pandemic.

Resumen Introducción: Con la identificación de la enfermedad por COVID-19 en China, inició una pandemia que afectó a los sistemas de salud. La Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital de Ginecobstetricia del Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social (IMSS) vio incrementado su flujo de pacientes como parte de la Estrategia COVID-19 del IMSS. El objetivo fue analizar el impacto de la pandemia COVID-19 en los indicadores de atención y mortalidad neonatal en nuestra unidad. Métodos: Se realizó un estudio retrospectivo para comparar el número de nacimientos en el hospital, nacimientos de recién nacidos prematuros (RNPT), ingresos a UCIN y defunciones. Se analizaron los cambios en frecuencias entre los años 2019 a 2021 mediante la distribución de Poisson. Los cambios en nacimientos de RNPT, proporción de ingresos y defunciones/egreso en UCIN se analizaron mediante prueba Z para dos proporciones. Resultados: Entre los años 2019 a 2021, el número de nacimientos incrementó más de 2 veces. Los ingresos a UCIN aumentaron de 770 en 2019, a 1045 en 2021 (p < 0.01). La proporción de defunciones/egreso del servicio fue de 16.9% en 2019, y 13.1% en 2021 (p = 0.02). Conclusiones: Los indicadores de mortalidad en la UCIN disminuyeron de 2019 a 2021, aun con el incremento en el número de pacientes atendidos durante la pandemia COVID-19.

Healthcare-associated infection and pathogen spectrum in neonatal inten-sive care unit:a 5-year single-center study / 中国感染控制杂志

Objective To understand the spectrum and changes of pathogens causing healthcare-associated infec-tion(HAI)in neonatal intensive care unit(NICU).Methods Clinical medical records of neonates with HAI in a hospital from January 2018 to December 2022 were collected,spectrum of pathogens causing HAI were and analyzed retrospectively.Results A total of 7 597 hospitalized neonates were investigated,and 240 of whom had 263 cases of HAI,with an HAI incidence of 3.16％and healthcare-associated case infection incidence of 3.46％.96 cases(36.50％)were bloodstream infection,70(26.62％)were respiratory system infection,and 57(21.67％)were in-fection without clear sites.A total of 170 pathogens were detected from specimens,78(45.88％)of which were Gram-positive bacteria,with Staphylococcus spp.accounting for the highest proportion,78(45.88％)were Gram-negative bacteria,mainly Klebsiella pneumoniae,and 14(8.24％)were fungi.The detection rate of Gram-negative bacteria showed an upward trend from 2018 to 2022(P＜0.01).Conclusion The majority of HAI in NICU is bloodstream infection.In recent years,the detection rate of Gram-negative bacteria has been increasing year by year,and it is necessary to streng-then the prevention and control of HAI in clinical practice.

A Case of Congenital Myotonic Dystrophy with Rehabilitation Intervention in the Neonatal Intensive Care Unit / The Japanese Journal of Rehabilitation Medicine

Congenital myotonic dystrophy is the most severe form of inherited myotonic dystrophy, presenting with generalized muscle weakness, breathing problems, and feeding difficulties. We report a patient with congenital myotonic dystrophy who began rehabilitation early in the neonatal intensive care unit. The mother had myotonic dystrophy and experienced no complications during pregnancy. The patient was born at a gestational age of 38 weeks and 1 day, weighing 2712 g, with an Apgar score of 1/4, and was diagnosed with congenital myotonic dystrophy. Marked generalized hypotonia and respiratory compromise were observed from birth, and the patient was orally intubated and managed with a ventilator. Rehabilitation to promote sensory-motor development was started 13 days after birth. Initially, generalized muscle hypotonia and prominent limitation of joint range of motion were observed. Therefore, joint range of motion exercises, positioning, and rehabilitation of the sensory-motor system were conducted first, while monitoring circulatory and respiratory status. After weaning from the ventilator, feeding evaluation was started on the 123rd day of life. In collaboration with physicians and nurses, feeding volume was increased stepwise to safely introduce oral feeding. The infant gradually became capable of oral intake and was discharged from the hospital on the 160th day of life. In this report, we demonstrated that rehabilitation intervention for infants with congenital myotonic dystrophy from the time of admission to the neonatal intensive care unit contributed to improved motor development, initiation of oral feeding, and smooth discharge.

Infants of diabetic mothers and associated complications in neonatal intensive care unit in Misurata Center

Infants of diabetic mothers (IDM) are at an increased risk of various complications. The aim of this study is to evaluate the prevalence, demographic and clinical characters of IDM admissions to the neonatal intensive care unit, and the factors associated with morbidity and mortality. The study is a 1-year retrospective observational study involving all the cases of IDM admitted to the neonatal intensive care unit at Misurata. The study examined the association of the following ante- peri- and postnatal factors to the morbidity and mortality rate of IDM. A total of 103 IDM were admitted to the NICU with mother age range of 31- 35 years. About 84% of the mothers had multiple pregnancies, 81.5% of the IDM were born through C-section. 72% of the mothers had gestational diabetes. 59% of IDMs were females. Median gestational age was 36 ­ 38 weeks which was associated with higher mortality rate (p = 0.041) ,40% of them were post term. Macrosomia was the most common complication; 41%. About 22% had hypocalcemia and 12% had RDS. Six cases had congenital heart disease (CHD). About 26% of the cases required intravenous fluid (IVF) which had a significantly higher mortality rate (25% vs. 1.3%) (p = 0.008). IDM are at a higher risk of congenital and acquired morbidities and mortality. Delayed birth and the mode of delivery (elective or urgent Csection) are associated with the severity of the gestational diabetes which is significantly associated with higher mortality rate.

Diaphragmatic and excursion thickness in newborns using diaphragmatic kinesiology ultrasound: an observational study / Espessura e excursão diafragmática em recém-nascidos usando ultrassonografia cinesiológica do diafragma: um estudo observacional

Abstract Introduction The study of the diaphragm muscle has aroused the interest of physiotherapists who work with kinesiological ultrasonography, but still little explored; however, its findings can contribute to the clinical practice of hospitalized patients in neonatal intensive care units. Objective To measure the excursion and thickening of the diaphragm and describe measurements among neonates, preterm, and full-term. Methods Diaphragmatic kinesiological ultrasonography was performed on hospitalized newborns, in Neonatal Unit Care Unit, placed in supine position in their own bed, on the sixth day of life. Three repeated measurements of the same respiratory cycle were made, both for excursion and for diaphragmatic thickening. Results 37 newborns participated in the study and 25 were premature. The mean weight at the time of collection was 2,307.0 ± 672.76 grams and the gestational age was 35.7 ± 3.3 weeks. Diaphragmatic excursion increased with increasing gestational age (p = 0.01, df = 0.21) in term infants (p = 0.17, df = 0.35). Conclusion There was a positive correlation between diaphragmatic excursion and gestational age. There was no statistically significant difference in the measurements of excursion and inspiratory diaphragm thickening between preterm and term newborns, although pointing to higher measurements in the latter group.

Resumo Introdução O estudo do músculo diafragma tem des-pertado o interesse dos fisioterapeutas que trabalham com ultrassonografia cinesiológica. Ainda pouco explo-rado, contudo, seus achados podem contribuir para a prática clínica dos pacientes internados em unidades de terapia intensiva neonatal (UTIN). Objetivo Mensurar a excursão e o espessamento diafragmático e descrever as medidas entre recém-nascidos prematuros e a termo. Métodos Realizou-se ultrassonografia cinesiológica diafragmática em recém-nascidos internados em UTIN, posicionados em supino em seu próprio leito, no sexto dia de vida. Foram realizadas três medidas repetidas do mesmo ciclo respiratório, tanto da excursão quanto do espessamento diafragmático. Resultados Participaram do estudo 37 recém-nascidos, dos quais 25 eram pre-maturos. O peso no momento da coleta foi de 2.307,0 ± 672,76 gramas e a idade gestacional foi de 35,7 ± 3,3 semanas. A excursão diafragmática aumentou de acordo com o aumento da idade gestacional (p = 0,01; df = 0,21). A espessura variou entre 0,10 e 0,16 cm durante a inspiração nos prematuros e entre 0,11 e 0,19 cm nos nascidos a termo (p = 0,17; df = 0,35). Conclusão Houve correlação positiva entre a excursão diafragmá-tica e a idade gestacional. Não observou-se diferença estatisticamente significativa das medidas de excursão e de espessamento diafragmático inspiratório entre recém-nascidos prematuros e recém-nascidos a termo, embora apontando para maiores medidas neste último grupo.

Prescription of off-label and unlicensed medication for newborns hospitalized in the Intensive Care Unit / Prescrição de medicamentos off-label e não licenciados para neonatos hospitalizados na Unidade de Terapia Intensiva

ABSTRACT Objective: To analyze the prevalence of off-label and unlicensed prescriptions for a population of neonates admitted to the Neonatal Intensive Care Unit in a hospital in southern Santa Catarina. Methods: Observational study with a cross-sectional design. All neonates admitted to the Intensive Care Unit during the period from March 2020 to March 2021 were included. Data collection was performed through a questionnaire made by the authors and the classification of drugs based on the Electronic Drug Description (Bulário Eletrônico) of the Brazilian Health Regulatory Agency and Drug Dex-Micromedex. Results: Data from 296 neonates were evaluated. The prevalence was 50,7% for prescribing off-label medications and 37,2% for unlicensed medications. The use of drugs was higher in preterm neonates, with low birth weight, 1st minute Apgar between 6-8, 5th minute Apgar between 7-8, and in need of invasive procedures. The most used off-label drugs were ampicillin, gentamicin and fentanyl (92.6, 92.0 and 26.6%, respectively), whereas the most used unlicensed drugs were caffeine, phenobarbital and bromopride (78.1, 16.3 and 10.9%, respectively). Conclusions: This study showed a large percentage of prescriptions made in the off-label (50.7%) and unlicensed (37.2%) form in the Neonatal Intensive Care Unit, corroborating the worrying world scenario. The most exposed neonates were precisely the most vulnerable ones and, among the most commonly prescribed medications, ampicillin and gentamicin stood out in off-label form and caffeine in unlicensed form.

RESUMO Objetivo: Analisar a prevalência de prescrições off-label e não licenciadas uma população de neonatos internados na Unidade de Terapia Intensiva Neonatal em um hospital ao sul de Santa Catarina. Métodos: Estudo observacional com delineamento transversal. Foram incluídos todos os neonatos admitidos na Unidade de Terapia Intensiva durante o período de março de 2020 a março de 2021. A coleta de dados foi realizada a partir de questionário elaborado pelos autores, e a classificação dos medicamentos, com base no Bulário Eletrônico da Agência Nacional de Vigilância Sanitária e no Drug Dex-Micromedex. Resultados: Foram avaliados dados de 296 neonatos. A prevalência foi de 50,7% para prescrição de medicações off-label e 37,2% para medicações não licenciadas. O uso dos fármacos foi maior em neonatos pré-termo, com baixo peso ao nascer, Apgar de 1o minuto entre 6-8, Apgar de 5o minuto entre 7-8, e com necessidade de procedimentos invasivos. Os fármacos off-label mais utilizados foram a ampicilina, gentamicina e fentanil (92,6, 92 e 26,6%, respectivamente), já os fármacos não licenciados mais utilizados foram a cafeína, fenobarbital e bromoprida (78,1, 16,3 e 10,9%, respectivamente). Conclusões: O estudo demonstrou grande porcentagem de prescrições realizadas de forma off-label (50,7%) e não licenciada (37,2%) na Unidade de Terapia Intensiva Neonatal de análise, corroborando o preocupante cenário mundial. Os neonatos mais expostos foram justamente aqueles mais vulneráveis e, entre as medicações mais utilizadas, destacam-se a ampicilina e a gentamicina de modo off-label e a cafeína de modo não licenciado.

Early-onset neonatal sepsis as a risk factor for peri-intraventricular hemorrhage in premature infants / Sepse precoce como fator de risco para hemorragia peri-intraventricular em prematuros

ABSTRACT Objective: To assess early-onset sepsis as a risk factor of peri-intraventricular hemorrhage in premature infants born at less than or equal to 34 weeks' gestation and admitted to a neonatal intensive care unit (NICU). Methods: This retrospective cohort study included premature patients born at less than or equal to 34 weeks' gestation who were admitted to the NICU of a tertiary hospital in southern Brazil, and born from January 2017 to July 2021. Data were collected from patients' medical records. Early-onset sepsis was measured according to the presence or absence of diagnosis within the first 72 hours of life, whereas the outcome, peri-intraventricular hemorrhage, was described as the presence or absence of hemorrhage, regardless of its grade. Results: Hazard ratios were calculated using Cox regression models. A total of 487 patients were included in the study, of which 169 (34.7%) had some degree of peri-intraventricular hemorrhage. Early-onset sepsis was present in 41.6% of the cases of peri-intraventricular hemorrhage, which revealed a significant association between these variables, with increased risk of the outcome in the presence of sepsis. In the final multivariate model, the hazard ratio for early-onset sepsis was 1.52 (95% confidence interval 1.01-2.27). Conclusion: Early-onset sepsis and the use of surfactants showed to increase the occurrence of the outcome in premature children born at less than or equal to 34 weeks' gestation. Meanwhile, factors such as antenatal corticosteroids and gestational age closer to 34 weeks' gestations were found to reduce the risk of peri-intraventricular hemorrhage.

RESUMO Objetivo: O objetivo do presente trabalho foi avaliar a sepse precoce como fator de risco para hemorragia peri-intraventricular (HPIV) em prematuros com 34 semanas ou menos, admitidos em Unidade de Terapia Intensiva (UTI) Neonatal. Métodos: Este estudo de coorte retrospectivo incluiu pacientes prematuros com 34 semanas ou menos, que receberam alta da UTI Neonatal de hospital terciário, no sul do Brasil, nascidos no período de janeiro de 2017 a julho de 2021. Os dados foram coletados por meio dos prontuários desses pacientes. A sepse precoce foi mensurada conforme a presença ou a ausência do diagnóstico nas primeiras 72 horas de vida. Já o desfecho, hemorragia peri-intraventricular, foi descrito conforme a presença ou ausência da hemorragia, independentemente do grau. Resultados: Hazard ratios (HR) foram calculados por meio de modelos de regressão de Cox. Foram incluídos no estudo 487 pacientes. Destes, 169 (34,7%) apresentaram algum grau de hemorragia peri-intraventricular. A sepse precoce esteve presente em 41,6% dos casos de hemorragia peri-intraventricular e apresentou associação significativa, elevando o risco do desfecho quando presente. No modelo multivariável final, o HR para a sepse precoce foi de 1,52 (intervalo de confiança de 95% — IC95% 1,01-2,27). Conclusão: Sepse precoce e uso de surfactante demonstraram aumentar a ocorrência do desfecho em crianças prematuras até 34 semanas, enquanto fatores como corticoide antenatal e idades gestacionais mais próximas a 34 semanas mostraram reduzir o risco de ocorrência hemorragia peri-intraventricular.

Instrument for classifying dependency in neonatal intensive care: analysis of agreement and reliability / Instrumento para classificação de dependência de cuidados neonatais intensivos: análise de concordância e de confiança / Instrumento para clasificación de dependencia de cuidados neonatales intensivos: análisis de concordancia y de confianza

Abstract Objective: to analyze the reliability of the items that compose the instrument for classifying newborns according to the degree of dependence on nursing care in a neonatal intensive care unit. Method: methodological study that analyzed the agreement and reliability of the instrument in a neonatal intensive care unit. Six care nurses and a research nurse assessed 35 newborns and completed the instrument, which was made up of 15 areas of care. The weighted Kappa coefficient and the Intraclass Correlation Coefficient were used for analysis. Results: the areas of: weight (92%), oxygenation (93%) and catheter control (95%) had almost perfect agreement and the area of reaction to stimuli (50%) had poor agreement. The areas of elimination and vital signs showed low reliability, due to the low variability of responses. The Intraclass Correlation Coefficient was 0.94. Conclusion: there are variations in the evaluations of some areas of care due to the imprecise description of items to which scores are assigned, however the instrument is reliable for categorizing the type of care (minimal, intermediate and intensive). Its use can contribute to measuring the quality and safety of newborn care.

Resumo Objetivo: analisar a confiabilidade dos itens que compõem o instrumento para classificação de recém-nascido de acordo com o grau de dependência dos cuidados de enfermagem em uma unidade de terapia intensiva neonatal. Método: estudo metodológico que analisou a concordância e a confiança do instrumento em uma unidade de terapia intensiva neonatal. Seis enfermeiros assistenciais e uma enfermeira pesquisadora avaliaram 35 recém-nascidos e preencheram o instrumento, composto por 15 áreas de cuidado. O coeficiente Kappa ponderado e o Coeficiente de Correlação Intraclasse foram utilizados para análise. Resultados: as áreas peso (92%), oxigenação (93%) e controle de cateteres (95%) obtiveram concordância quase perfeita, e a área reação a estímulos (50%) obteve concordância fraca. As áreas eliminações e sinais vitais apresentaram baixa confiabilidade, devido à pouca variabilidade de respostas. O Coeficiente de Correlação Intraclasse foi de 0,94. Conclusão: há variações nas avaliações de algumas áreas de cuidado devido à descrição imprecisa de itens aos quais são atribuídos escores, entretanto, o instrumento é confiável para categorização do tipo de cuidado (mínimo, intermediário e intensivo). Sua utilização pode contribuir para o dimensionamento de qualidade e para a segurança da assistência ao recém-nascido.

Resumen Objetivo: analizar la confiabilidad de los ítems que componen el instrumento para clasificación de recién nacido de acuerdo con el grado de dependencia de los cuidados de enfermería en una unidad de terapia de cuidados intensivos neonatal. Método: estudio metodológico que analizó la concordancia y la confianza del instrumento en una unidad de terapia de cuidados intensivos neonatal. Seis enfermeros asistenciales y una enfermera investigadora evaluaron 35 recién nacidos y completaron el instrumento, compuesto por 15 áreas de cuidado. El coeficiente Kappa ponderado y el Coeficiente de Correlación Intraclase fueron utilizados para el análisis. Resultados: las áreas peso (92%), oxigenación (93%) y control de catéteres (95%) obtuvieron una concordancia casi perfecta y el área reacción a estímulos (50%) obtuvo una concordancia débil. Las áreas eliminaciones y signos vitales presentaron baja confiabilidad, debido a la poca variabilidad de respuestas. El Coeficiente de Correlación Intraclase fue de 0,94. Conclusión: hay variaciones en las evaluaciones de algunas áreas de cuidado debido a la descripción imprecisa de ítems a los cuales se les atribuyen puntuaciones, sin embargo, el instrumento es confiable para la categorización del tipo de cuidado (mínimo, intermedio e intensivo). Su utilización puede contribuir a la planificación de calidad y a la seguridad de la atención al recién nacido.

Validation of an online course on postural care for preterm newborns / Validación del curso online sobre cuidados posturales del recién nacido prematuro / Validação de curso on-line sobre cuidados posturais ao recém-nascido prematuro

ABSTRACT Objectives: Validation of an online course content on postural care for newborns in the Neonatal Intensive Care Unit and assessment of participant satisfaction. Method: Methodological study of content validation by 13 judges with expertise in neonatology and online education who responded to the educational content validation instrument, and by 175 course participants who evaluated the course through a satisfaction questionnaire. The criterion for validation was agreement above 80.0%, analyzed through the Content Validity Index (CVI), Content Validation Coefficient (CVC), binomial test, and descriptive statistics for analyzing satisfaction variables. Data collection took place from January to June 2022 for the validation stage, and during June 2023 for the evaluation stage conducted by the course participants. Results: All items obtained agreement above 80.0% with a total CVI and CVC of 83.3% and 91.0%, respectively. The course participants positively evaluated the course regarding content organization, coherence between theory and practice, navigability, quality of materials, and applicability in professional practice. Conclusion: The online course was considered valid regarding its objectives, structure/presentation, and relevance. Therefore, it can be offered as an open educational resource in the training of healthcare and nursing professionals to provide postural care to newborns in critical environments, thereby enhancing the performance of developmental care.

RESUMEN Objetivos: Validar el contenido de un curso online sobre cuidados posturales del recién nacido en la Unidad de Cuidados Intensivos Neonatales y verificar la satisfacción de los participantes del curso. Método: Estudio metodológico de validación de contenido realizado por 13 jueces con experiencia en neonatología y educación en línea que respondieron al instrumento de validación de contenido educativo: y por 175 participantes del curso que evaluaron el curso mediante un cuestionario de satisfacción. El criterio de validación fue una concordancia mayor al 80,0%, analizado mediante el Content Validity Index (CVI), Coeficiente de Validación de Contenido (CVC), prueba binomial y estadística descriptiva para analizar las variables de satisfacción. La recolección de datos se realizó de enero a junio de 2022 para la etapa de validación; y en junio de 2023 para la etapa de evaluación realizada por los participantes del curso. Resultados: Todos los ítems lograron una concordancia superior al 80,0% con un CVI y un CVC total de 83,3% y 91,0%, respectivamente. Los participantes del curso coincidieron en una evaluación positiva en términos de organización de contenidos, coherencia entre teoría y práctica, navegabilidad, calidad de los materiales y posibilidad de aplicación en la práctica profesional. Conclusión: El curso en línea se consideró válido en términos de objetivos, estructura/presentación y relevancia. Por lo tanto, puede ofrecerse como un recurso educativo abierto para el perfeccionamiento de los profesionales de la salud y de enfermería con el fin de brindar cuidados posturales a los recién nacidos en ambientes críticos, y elevar la prestación de los cuidados del desarrollo.

RESUMO Objetivos: Validar o conteúdo de um curso on-line sobre cuidados posturais ao recém-nascido na Unidade de Terapia Intensiva Neonatal e verificar a satisfação dos cursistas. Método: Estudo metodológico de validação de conteúdo por 13 juízes com expertise em neonatologia e educação on-line que responderam ao instrumento de validação de conteúdo educacional: e por 175 cursistas que avaliaram o curso mediante um questionário de satisfação. O critério para validação foi concordância superior a 80,0%, analisado por meio do Content Validity Index (CVI), Coeficiente de Validação de Conteúdo (CVC), teste binomial e estatística descritiva para análise das variáveis de satisfação. A coleta de dados ocorreu de janeiro a junho de 2022 para a etapa da validação; e no período de junho de 2023 para a etapa de avaliação realizada pelos cursistas. Resultados: Todos os itens obtiveram concordância superior a 80,0% com CVI e CVC total de 83,3% e 91,0%, respectivamente. Os cursistas avaliaram positivamente o curso quanto à organização do conteúdo, coerência entre teoria e prática, navegabilidade, qualidade dos materiais e possibilidade de aplicação na prática profissional. Conclusão: O curso on-line foi considerado válido no tocante aos objetivos, estrutura/apresentação e relevância. Portanto, pode ser ofertado como recurso educacional aberto no aperfeiçoamento de profissionais de saúde e enfermagem a fim de prestar o cuidado postural aos recém-nascidos em ambiente crítico, elevando o desempenho dos cuidados desenvolvimentais.

Percepção de profissionais de enfermagem sobre o cuidado prestado ao neonato com estomia de eliminação intestinal / Percepción de profesionales de enfermería sobre el cuidado prestado al neonato con ostomía de eliminación intestinal / Nursing professionals' perceptions of the care provided to the neonate with intestinal elimination ostomy

Resumo Objetivos Conhecer a percepção da equipe de enfermagem da unidade neonatal sobre os cuidados prestados ao recém-nascido hospitalizado com estomia intestinal e discutir os fatores que interferem na assistência de enfermagem. Método Estudo exploratório, descritivo, com abordagem qualitativa. Participaram oito enfermeiros e oito técnicos de enfermagem que trabalham em uma Unidade Neonatal do Rio de Janeiro. Os dados foram coletados entre abril e junho de 2022, através de entrevista semiestruturada e análise de conteúdo. Resultados Emergiram duas categorias: "percepções da equipe de enfermagem quanto ao cuidar de recém-nascidos hospitalizados com estomias intestinais e a educação em saúde da família"; e "aspectos facilitadores e dificultadores da assistência de enfermagem ao recém-nascido com estomia intestinal e a importância da educação permanente no cenário da Unidade Neonatal". Conclusão e implicações para prática O manejo de neonatos com estomias intestinais é atual e implica em cuidados de enfermagem com o estoma e pele do recém-nascido, estendendo-se para a prática da educação em saúde dos familiares. É desafiador o manejo de complicações, a indisponibilidade de materiais e o cuidado fragmentado. Tal achado pode subsidiar o desenvolvimento de intervenções de enfermagem sistematizada para os recém-nascidos e seus pais na unidade neonatal.

Resumen Objetivos Conocer la percepción del equipo de enfermería de la unidad neonatal sobre el cuidado prestado al neonato hospitalizado con ostomías intestinales y discutir los factores que interfieren en el cuidado de enfermería. Método Estudio exploratorio, descriptivo, con abordaje cualitativo. Participaron ocho enfermeros y ocho técnicos de enfermería que actúan en una Unidad Neonatal de Rio de Janeiro. Datos colectados entre abril y junio de 2022, por entrevistas semiestructuradas y análisis de contenido. Resultados Emergieron dos categorías: "percepciones del equipo de enfermería sobre el cuidado al recién nacido hospitalizado con ostomías intestinales y la educación en salud de la familia"; y "aspectos que facilitan y dificultan el cuidado de enfermería al recién nacido con ostomía intestinal y la importancia de la educación continua en el ámbito de la Unidad Neonatal". Conclusión e implicaciones para la práctica El manejo de neonatos con ostomías intestinales es actual e implica cuidados de enfermería con el estoma y la piel del recién nacido, extendiéndose a la práctica de educación en salud para familiares. El manejo de complicaciones, la falta de materiales y la atención fragmentada son desafíos. Este hallazgo puede apoyar el desarrollo de intervenciones de enfermería sistematizadas para los recién nacidos y sus padres en la unidad neonatal.

Abstract Objectives To understand the perception of the nursing team of the neonatal unit about the care provided to hospitalized newborns with intestinal ostomy and to discuss the factors that interfere in nursing care. Method Exploratory and descriptive study, with a qualitative approach. Eight nurses and eight nursing technicians who work in a Neonatal Unit in Rio de Janeiro took part. Data were collected between April and June 2022, through semi-structured interviews and content analysis. Results Two categories emerged: "perceptions of the nursing team regarding the care of hospitalized newborns with intestinal ostomies and family health education"; and "facilitating and hindering aspects of nursing care for newborns with intestinal ostomy and the importance of continuing education in the setting of the Neonatal Unit". Conclusion and implications for practice The management of newborns with intestinal ostomies is current and involves nursing care with the stoma and skin of the newborn, extending to the practice of health education for family members. The management of complications, the unavailability of materials and fragmented care are challenging. This finding can support the development of systematized nursing interventions for newborns and their parents in the neonatal unit.

Prevention of complications related to peripherally inserted central catheter insertion techniques in newborns: systematic review and network meta-analysis / Prevención de complicaciones asociadas con las técnicas de inserción de catéter central de inserción periférica en recién nacidos: revisión sistemática y metaanálisis en red / Prevenção de complicações relacionadas a técnicas de inserção do cateter central de inserção periférica em recém-nascidos: revisão sistemática e metanálise em rede

Objective: to analyze the effectiveness of peripherally inserted central catheter insertion techniques in preventing the occurrence of complications related to this device in newborns. Method: a paired and network systematic literature review and meta-analysis, with its search carried out in seven databases and in the Grey Literature, including randomized and non-randomized clinical trials. The risk of bias was assessed using the Cochrane Risk of Bias 2 and Risk of Bias In Non-randomized Studies of Interventions tools. Certainty of the evidence was assessed by means of the Grading of Recommendations Assessment, Development and Evaluation. A meta-analysis was carried out with the aid of the R statistical program. Results: eight studies with 1,126 newborns were included and six insertion techniques were identified: intracavitary electrocardiogram; intracavitary electrocardiogram associated with ultrasound; ultrasound; formula; anatomical landmark; and modified anatomical landmark. Five techniques significantly decreased primary tip malpositioning when compared to the control ( p <0.05). Intracavitary electrocardiogram significantly and more effectively reduced arrhythmias, general complications and phlebitis; the technique that used a formula also reduced general complications. Infection, infiltration, secondary tip malpositioning, catheter rupture, thrombosis, occlusion and catheter-associated skin lesion were not significantly preventable events. Conclusion: intracavitary electrocardiogram and use of the formula were the most effective techniques in reducing complications.

Objetivo: analizar la efectividad de las técnicas de inserción de catéter central de inserción periférica en la prevención de la aparición de complicaciones asociadas con este dispositivo en recién nacidos. Método: revisión sistemática de la literatura y metaanálisis pareado y en red, la búsqueda se realizó en siete bases de datos y en la literatura gris, se incluyeron ensayos clínicos aleatorizados y no aleatorizados. El riesgo de sesgo se evaluó mediante las herramientas Cochrane Risk of Bias 2 y Risk of Bias In Non-randomized Studies of Interventions . La certeza de la evidencia a través de la Grading of Recommendations Assessment, Development and Evaluation . Se realizó un metaanálisis con ayuda del programa estadístico R. Resultados: se incluyeron ocho estudios, con 1126 recién nacidos, y se identificaron seis técnicas de inserción: electrocardiograma intracavitario, electrocardiograma intracavitario asociado a ultrasonido, ultrasonido, fórmula, punto anatómico de referencia y punto anatómico de referencia modificado. Cinco técnicas redujeron significativamente el mal posicionamiento primario de la punta en comparación con el control (p<0,05). El electrocardiograma intracavitario redujo de manera significativa y más efectiva las arritmias, las complicaciones generales y la flebitis; la técnica que utilizó una fórmula también redujo las complicaciones generales. La infección, la infiltración, el mal posicionamiento secundario de la punta, la rotura del catéter, la trombosis, la oclusión y las lesiones de la piel asociadas con el catéter son eventos que no se revinieron significativamente. Conclusión: el electrocardiograma intracavitario y el uso de la fórmula fueron las técnicas más efectivas para reducir las complicaciones.

Objetivo: analisar a efetividade das técnicas de inserção de cateter central de inserção periférica na prevenção da ocorrência de complicações relacionadas a este dispositivo em recém-nascidos. Método: revisão sistemática da literatura e metanálise pareada e em rede, com busca realizada em sete bases de dados e na literatura cinzenta, inclusão de ensaios clínicos aleatorizados e não aleatorizados. O risco de viés foi avaliado pelas ferramentas da Cochrane Risk of Bias 2 e o Risk of Bias In Non-randomised Studies of Interventions. A certeza da evidência pelo Grading of Recommendations Assessment, Development and Evaluation. Realizou-se metanálise com auxílio do programa estatístico R. Resultados: oito estudos, com 1126 recém-nascidos, foram incluídos e seis técnicas de inserção identificadas: eletrocardiograma intracavitário, eletrocardiograma intracavitário associado à ultrassonografia, ultrassonografia, fórmula, marco de referência anatômico e marco de referência anatômico modificado. Cinco técnicas diminuíram significativamente o mau posicionamento primário da ponta quando comparadas com o controle ( p <0,05). O eletrocardiograma intracavitário diminuiu arritmias, complicações gerais e flebite de forma significativa e mais efetiva; a técnica que utilizou uma fórmula também reduziu complicações gerais. Infecção, infiltração, mau posicionamento secundário da ponta, ruptura do cateter, trombose, oclusão e lesão de pele associada ao cateter não foram eventos prevenidos significativamente. Conclusão: eletrocardiograma intracavitário e uso da fórmula foram as técnicas mais efetivas na redução de complicações.

Comparison of obstetric and perinatal complications in intracytoplasmic sperm injection cycles with autologous oocytes and donated oocytes

SUMMARY OBJECTIVE: The aim of this study was to compare the obstetric and perinatal complications in women who became pregnant with autologous oocytes and those who received donated oocytes (DO) in intracytoplasmic sperm injection cycles (ICSI). METHODS: A retrospective cohort study was carried out by collecting data from medical records between 2019 and 2022. Only patients who underwent ICSI in an induced cycle using their own or freshly DO, with male infertility factor and tubal factor, were included. RESULTS: A total of 120 patients were assessed, comprising 51 cases utilizing their own oocytes (control group) and 69 cases employing DO (study group). Patients receiving DO (n=69) exhibited a significantly higher mean age compared to those utilizing their own oocytes (n=51) (41.96±2.16 vs 38.54±1.42 years, p<0.001). There was no significant association between the source of oocytes and gestational age at delivery (p=0.296), birth weight (p=0.836), admission to neonatal intensive care unit (ICU) (p=0.120), or maternal admission to adult ICU (p=0.767). Additionally, the origin of oocytes did not demonstrate any significant association with the risk of pre-eclampsia (p=0.357), gestational diabetes mellitus (p=0.187), premature rupture of membranes (p=0.996), uterine atony (p=0.996), placenta previa (p=0.393), oligohydramnios (p=0.393), or gestational hypertension (p=0.393)." CONCLUSION: An increase in obstetric and perinatal complications was not observed in pregnancies with DO compared to pregnancies with autologous oocytes in women undergoing ICSI without prior comorbidities. Further studies with larger sample sizes are required to validate our findings.

Uso de ceftazidima-avibactam en una recién nacida prematura con infección urinaria bacteriémica por Klebsiella pneumoniae productora de carbapenemasa / Use of ceftazidime-avibactam in a preterm infant with urinary tract infection with bacteremia caused by carbapenemase-producing Klebsiella pneumoniae

Los recién nacidos tienen un alto riesgo de morbimortalidad asociada a infecciones durante su estancia en unidades de cuidado intensivo neonatal, a lo que se asocia un aumento progresivo de infecciones por microorganismos multi-resistentes que requiere el uso de nuevos antimicrobianos. Presentamos el caso de una recién nacida de pretérmino de 36 semanas que cursó con una infección del tracto urinario bacteriémica por Klebsiella pneumoniae productora de carbapenemasa tratada de forma efectiva con 14 días de cefazi- dima-avibactam, sin efectos adversos observados. Según nuestro conocimiento, este es el primer caso reportado en nuestro país del uso de este antimicrobiano en población neonatal. Se necesita más información sobre la eficacia y seguridad de ceftazidima-avibactam en este grupo de pacientes.

Neonates are high risk patients regarding morbimortality secondary to infections during their neonatal intensive care unit stay, which is associated to a progressive increase in the report of multidrug resistant organism infections, that require the use of new antimicrobial. We report the case of a 36-week preterm with an urinary tract infection with bacteriemia caused by carbapenemase- producing Klebsiella pneumoniae treated effectively with 14 day of ceftazidime-avibactam, without observed adverse effects. To our knowledge, this is the first case report in our country of the use of this antibiotic in neonatal population. More information is needed regarding efficacy and safety of ceftazidime-avibactam in this group of patients.

Bioética y toma de decisiones al final de la vida en UCI neonatal

El equipo multidisciplinario especializado, con ayudas diagnósticas avanzadas, brinda, en las unidades de cuidados intensivos neonatales, atención a los recién nacidos en estado crítico de salud. No comprender la muerte como un acontecimiento natural dificulta establecer un equilibrio en el tratamiento proporcionado y exige una juiciosa valoración de los beneficios y cargas basados en una ética responsable. La literatura sugiere que se necesita, en relación con los aspectos bioéticos de la práctica clínica, de capacitación, participación y presencia permanente de los profesionales de la salud en la toma de decisiones en conjunto con las madres, de tal forma que se proporcione consuelo a la familia del neonato.

The specialized multidisciplinary team, with advanced diagnostic aids, provides care for critically ill newborns in the neonatal intensive care units. Not understanding death as a natural event makes it difficult to establish a balance in the treatment provided and requires a judicious assessment of benefits and burdens based on responsible ethics. The literature suggests that there is a need, in relation to the bioethical aspects of clinical practice, for training, participation and permanent presence of health professionals in decision making together with the mothers, in order to provide comfort to the newborn's family.

A equipe multidisciplinar especializada, com recursos avançados de diagnóstico, oferece atendimento a recém-nascidos gravemente enfermos nas unidades de terapia intensiva neonatal. Não entender a morte como um evento natural dificulta o estabelecimento de um equilíbrio no tratamento fornecido e exige uma avaliação criteriosa dos benefícios e ônus com base em uma ética responsável. A literatura sugere que haja uma necessidade, com relação aos aspectos bioéticos da prática clínica, de treinamento, participação e presença permanente dos profissionais de saúde na tomada de decisões junto com as mães, a fim de proporcionar conforto à família do recém-nascido.