Programa multicéntrico para la atención integral del recién nacido con agresión hipóxico-isquémica perinatal (ARAHIP) / Multicenter program for the integrated care of newborns with perinatal hypoxic-ischemic insult (ARAHIP)

INTRODUCCIÓN: El recién nacido con indicadores de potencial evento hipóxico-isquémico perinatal precisa de una atención integral que detecte precozmente si necesita tratamiento con hipotermia y el control de los factores agravantes del da˜no cerebral en las primeras 6 h de vida. PACIENTES Y MÉTODOS: Aplicación de un programa prospectivo de ámbito poblacional que ordena y sistematiza la atención durante las primeras 6 h de vida en los ≥ 35 semanas nacidos con indicadores de agresión hipóxico-isquémica perinatal. El programa involucra 12 hospitales (91.217 m2), 7 de nivel asistencial i-ii y 5 de nivel III. Se establecen 4 protocolos: a) detección del recién nacido con potencial agresión hipóxico-isquémica; b) vigilancia de la repercusión neurológica y en otros órganos; c) control y tratamiento de complicaciones, y d) vigilancia y acciones durante el transporte. RESULTADOS: Entre junio del 2011 y junio del 2013, de 32.325 recién nacidos ≥ 35 semanas, 213 cumplieron criterios de potencial agresión hipóxico-isquémica perinatal (7,4 por 1.000). El 92% siguió la monitorización establecida en el programa; 33 recién nacidos tuvieron encefalopatía hipóxico-isquémica moderada-grave (1 por 1.000) y 31/33 (94%) recibieron tratamiento con hipotermia. CONCLUSIONES: El programa Atención integral al Recién nacido con Agresión Hipóxico-Isquémica Perinatal ha permitido ofrecer atención integral al recién nacido con indicadores de agresión hipóxico-isquémica perinatal. Se han controlado factores comórbidos agravantes de la lesión cerebral y se han detectado aquellos con encefalopatía hipóxico-isquémica moderadagrave, permitiendo iniciar la hipotermia dentro de las primeras 6 h de vida. Programas de ámbito poblacional son cruciales para disminuir la morbimortalidad asociada a la encefalopatía hipóxico-isquémica

INTRODUCTION: Newborns with perinatal indicators of a potential hypoxic-ischemic event require an integrated care in order to control the aggravating factors of brain damage, and the early identification of candidates for hypothermia treatment. PATIENTS AND METHODS: The application of a prospective, populational program that organizes and systematizes medical care during the first 6 hours of life to all newborns over 35 weeks gestational age born with indicators of a perinatal hypoxic-ischemic insult. The program includes 12 hospitals (91,217 m2); two level I centers, five level II centers, and five level III hospitals. The program establishes four protocols: a) detection of the newborn with a potential hypoxic-ischemic insult, b) surveillance of the neurological repercussions and other organ involvement, c) control and treatment of complications, d) procedures and monitoring during transport. RESULTS: From June 2011 to June 2013, 213 of 32325 newborns above 35 weeks gestational age met the criteria of a potential hypoxic-ischemic insult (7.4/1000), with 92% of them being cared for following the program specifications. Moderate-severe hypoxic-ischemic encephalopathy was diagnosed in 33 cases (1/1,000), and 31 out of the 33 received treatment with hypothermia (94%). CONCLUSIONS: The program for the Integrated Care of Newborns with Perinatal Hypoxic-Ischemic Insult has led to providing a comprehensive care to the newborns with a suspected perinatal hypoxic-ischemic insult. Aggravators of brain damage have been controlled, and cases of moderate-severe hypoxic-ischemic encephalopathy have been detected, allowing the start of hypothermia treatment within the first six hours of life. Populational programs are fundamental to reducing the mortality and morbidity of hypoxic-ischemic encephalopathy

[Multicenter program for the integrated care of newborns with perinatal hypoxic-ischemic insult (ARAHIP)]. / Programa multicéntrico para la atención integral del recién nacido con agresión hipóxico-isquémica perinatal (ARAHIP).

INTRODUCTION: Newborns with perinatal indicators of a potential hypoxic-ischemic event require an integrated care in order to control the aggravating factors of brain damage, and the early identification of candidates for hypothermia treatment. PATIENTS AND METHODS: The application of a prospective, populational program that organizes and systematizes medical care during the first 6 hours of life to all newborns over 35 weeks gestational age born with indicators of a perinatal hypoxic-ischemic insult. The program includes 12 hospitals (91,217 m(2)); two level i centers, five level ii centers, and five level iii hospitals. The program establishes four protocols: a) detection of the newborn with a potential hypoxic-ischemic insult, b) surveillance of the neurological repercussions and other organ involvement, c) control and treatment of complications, d) procedures and monitoring during transport. RESULTS: From June 2011 to June 2013, 213 of 32325 newborns above 35 weeks gestational age met the criteria of a potential hypoxic-ischemic insult (7.4/1000), with 92% of them being cared for following the program specifications. Moderate-severe hypoxic-ischemic encephalopathy was diagnosed in 33 cases (1/1,000), and 31 out of the 33 received treatment with hypothermia (94%). CONCLUSIONS: The program for the Integrated Care of Newborns with Perinatal Hypoxic-Ischemic Insult has led to providing a comprehensive care to the newborns with a suspected perinatal hypoxic-ischemic insult. Aggravators of brain damage have been controlled, and cases of moderate-severe hypoxic-ischemic encephalopathy have been detected, allowing the start of hypothermia treatment within the first six hours of life. Populational programs are fundamental to reducing the mortality and morbidity of hypoxic-ischemic encephalopathy.

Perforación uterina por mioma necrosado en el puerperio / Perforation of the uterus due to myoma infarction in the puerperium

Se presenta el caso de una puérpera que acudió a urgencias 13 días después del parto por dolor abdominal y vómitos. Ante la presencia de un abdomen agudo se realizó una laparotomía y se evidenciaron 2 miomas necrosados, uno de los cuales había perforado el útero (AU)

Partial aortic ligature induces selective long-term c-fos like immunoreactivity in the organum vasculosum of the lamina terminalis, medial preoptic area and choroid plexus in the rat.

Partial aortic ligature causes an increase in water and sodium intake. Circumventricular brain regions are known to be involved in the regulation of these processes. In this work we use c-fos-like immunoreactivity to detect active areas involved in the long-term control of increased water and sodium intake due to partial aortic ligature. A significant increase in water intake was found on the first day after the induction, while natriophilia was observed on the fourth day. c-fos-like immunoreactivity was found selectively in the subfornical organ, the organum vasculosum of the lamina terminalis, the medial preoptic area, and the choroid plexus of the third ventricle. Present results provide further evidence for the involvement of circumventricular organs and the preoptic area in the regulation of hydromineral balance. Moreover, they suggest a maintained and long-term regulation of sodium intake by these same brain areas.