Vitamin D deficiency in Mexican mothers and their newborns. / Deficiencia de vitamina D en madres y neonatos mexicanos.

Objective: The purpose of this study is to establish the prevalence of vitamin D deficiency and their newborns and analyze the risk factors related to this deficiency. Methods: This is an observational, transversal, and prospective study. It included 191 puerperal women and their full-term newborns. Serum 25 hydroxyvitamin D values were analyzes by enzyme immunoassay. Results: 61% of the puerperal presented deficiency and 26% insufficiency of vitamin D. In the newborn group 98% showed deficiency and 66% of them presented severe deficiency. There is a positive correlation between the values of vitamin D in mothers and their newborns (r2 = 0.173 ng/ml; p = 0.017). The lowest levels were in autumn. (15.75 ng/mL mothers, 6 ng/mL newborns). There was no correlation between vitamin D levels in mothers and their dietary intake, maternal skin type, sun time exposure and prenatal body mass index. Conclusions: This is the first study that shows the existence of a high deficiency of vitamin D in Mexican mothers and their newborns.

Congenital lateral abdominal wall hernia.

Congenital abdominal wall defects that are located outside of the anterior wall are extremely rare and difficult to classify because there are no well accepted guidelines. There are two regions outside of the anterior wall: the flank or lateral wall; and the lumbar region. We report the case of a patient with an oval 3 cm-diameter hernia defect located above the anterior axillary line, which affects all layers of the muscular wall. An anorectal malformation consisting of a recto-vestibular fistula was also identified, and chest X-ray showed dextrocardia. The suggested treatment is repair of the defect before 1 year of age. Given that the anomalies described may accompany lateral abdominal wall hernia, it is important to diagnose and treat the associated defects.

Leptin, IL-6 and TNF-α levels in umbilical cord blood of healthy term newborns in relation to mode of delivery.

In the development of the foetal immune system, cytokines play an important role in its function. Therefore, we sought to determine whether the mode of delivery affects the expression of leptin, IL-6 and TNF-α in umbilical cord blood in healthy term newborns. We collected 125 samples of umbilical cord blood to analyse leptin, IL-6 y TNF-α levels with multiplex immunoassay (MIA). The samples were classified according to mode of delivery: vaginal delivery (VD) and caesarean section (CS). Leptin and IL-6 had higher concentrations in umbilical cord blood in VD than in CS: 42.55 ng/ml (11.92-104.28) versus 35.20 ng/ml (3.26-9326.76), p = 0.039; 9.32 pg/ml (1.13-2020.31) versus 3.81 pg/ml (0.52-834.69) p < 0.001, respectively. Also, a weak correlation between TNF-α and IL-6 was found (r = 0.238, p = 0.007). The most important finding in our study was the differential concentrations of leptin and IL-6 according to mode of delivery.

[Evaluation of strategies aimed at reducing the level of noise in different areas of neonatal care in a tertiary hospital]. / Evaluación de las estrategias enfocadas a disminuir el nivel de ruido en las diferentes áreas de atención neonatal en un hospital de tercer nivel.

OBJECTIVE: To determine the noise levels of different areas responsible for newborn care, develop intervention strategies to decrease the noise, and evaluate its effectiveness. METHODS: Prospective, observational and longitudinal study carried out using a sonometer, measuring sound levels for three weeks in the neonatal intensive care unit (NICU), neonatal intermediate care unit (UCIREN), delivery (TOCO QX) and nursery (CUNERO) units. We implemented an intervention program and subsequent measurements were performed under the same initial conditions. RESULTS: When comparing the decibel levels in different areas during the three weeks, pre- and post-intervention, we found at the neonatal intensive care unit 59.9±4.8 vs. 56.4±4.7 dB (p<0.001), neonatal intermediate care unit 55.3±3.9 vs. 51.3±4.4 dB (p<0.001), delivery unit 57.3±4.6 vs. 57.3±5.5 dB (NS), and nursery unit 57.6±5.8 vs. 53.9±5.8 dB (p<0.001). CONCLUSIONS: There was a significant reduction in noise levels of 3.5 dB at the NICU, 4 dB at UCIREN and 3.7 dB at TOCO QX, so the intervention program was effective in these areas; however, the decibel levels registered continue above those recommended by international standards.

A new positive-pressure device for nasal foreign body removal.

OBJECTIVES: Nasal foreign bodies (FBs) are common causes of pediatric emergency consultations. The different methods for removing nasal FBs have varying levels of efficacy. The aim of this study was to evaluate the safety and efficacy of a new device for nasal FB removal in children. METHODS: A nasal occlusion device that uses modulated positive pressure to remove FBs was evaluated in a series of 18 patients ranging in age from 1 to 8 years diagnosed with a nasal FB during a period of 7 months. RESULTS: The device successfully removed FBs in 17 (94.4%) of the 18 patients. In 12 of the cases (66.7%), the FB was removed during the first attempt. None of the patients had complications or sequelae at the time of removal or at the follow-up visit. CONCLUSIONS: The nasal occlusion device used in this study was found to be a promising, safe, effective, and easy to use tool for FB removal in a pediatric emergency room setting.

Gut microbiota in preterm infants receiving breast milk or mixed feeding.

BACKGROUND: Preterm birth is the leading cause of mortality in newborns, with very-low-birth-weight infants usually experiencing several complications. Breast milk is considered the gold standard of nutrition, especially for preterm infants with delayed gut colonization, because it contains beneficial microorganisms, such as Lactobacilli and Bifidobacteria. AIM: To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less. METHODS: An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less, born at the University Hospital Dr. José Eleuterio González at Monterrey, Mexico. A total of 40 preterm neonates were classified into breast milk feeding (BM) and mixed feeding (MF) groups (21 in the BM group and 19 in the MF group), from October 2017 to June 2019. Fecal samples were collected before they were introduced to any feeding type. After full enteral feeding was achieved, the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing. Numerical variables were compared using Student's t-test or using the Mann-Whitney U test for nonparametric variables. Dominance, evenness, equitability, Margalef's index, Fisher's alpha, Chao-1 index, and Shannon's diversity index were also calculated. RESULTS: No significant differences were observed at the genus level between the groups. Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group (P < 0.011). In addition, higher counts of Gammaproteobacteria were detected in the final than in the initial sample (P = 0.040). According to the Margalef index, Fisher's alpha, and Chao-1 index, a decrease in species richness from the initial to the final sample, regardless of the feeding type, was observed (P < 0.050). The four predominant phyla were Bacteroidetes, Actinobacteria, Firmicutes, and Proteobacteria, with Proteobacteria being the most abundant. However, no significant differences were observed between the initial and final samples at the phylum level. CONCLUSION: Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria, contributing to the literature of the gut microbiota structure of very low-birth-weight, preterm.

[Risk factors associated with intrauterine growth restriction in newborns attended in a university hospital]. / Crecimiento intrauterino. (corrected) Factores para su restricción.

BACKGROUND: intrauterine growth restriction (IUGR) is related with neonatal morbidity and mortality. The detection and prenatal monitoring are necessary for an early intervention. The objective was to establish the prevalence and risk factors associated with intrauterine growth restriction in the university hospital Dr. José Eleuterio González. METHODS: we performed an observational, cross-sectional study, during the period from May 2009 to April 2010. The sample was divided into two groups, asymmetrical and symmetrical IUGR. RESULTS: the global prevalence of IUGR was 13.5 %. We included 464 patients, 324 (70 %) with asymmetric IUGR and 140 (30 %) with symmetric IUGR. The maternal variables were not statistically significant (p = ns) between groups. We found a mean weight at birth higher (2548 ± 437.33) in the symmetric IUGR group (p < 0.01), as well as a higher vaginal delivery rate (p < 0.05) as compared with the asymmetrical IUGR group. The overall mortality rate was higher in the asymmetric IUGR group (p < 0.01). CONCLUSIONS: prevalence of IUGR in our population is higher than that reported in the literature; there were more preterm infants and higher mortality in the asymmetric group.

[Incidence and risk factors associated with in-hospital neonatal sepsis]. / Sepsis neonatal intrahospitalaria. Incidencia y factores de riesgo.

BACKGROUND: inhospital neonatal sepsis (IHNS) is a clinical syndrome characterized by an inflammatory reaction with local or systemic signs of infection, accompanied by the causal agent in the first month of life. The objective was to know the incidence and risk factors associated with IHNS. METHODS: during 2006 and 2007 a total of 49 patients in the case group and 50 patients in the control group were included in the study. A serie of qualitative variables comparing the two groups to determine their association were analyzed. RESULTS: We found an incidence of IHNS in our hospital of 3.7 %. The most frequently observed risk factors were: birth weight between 1501-2500 g, in the hypotrophic group, the use of central vascular access, ranitidine, steroids, parenteral nutrition, endotracheal intubation, orogastric catheter, vesical catheter, and also the presence of cardiopathy or hyaline membrane disease (HDM). The mortality rate was 24.4 %. CONCLUSIONS: the incidence of IHNS was less than reported in the literature. The number of deaths associated with IHNS was low.

Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates.

BACKGROUND: Poor positioning of a central venous catheter (CVC) can cause severe complications. The objective is to create a formula that predicts the optimal insertion depth of a real time ultrasound-guided CVC in the right internal jugular vein (RIJV) in newborns. METHODS: Between 2015 and 2017, 91 newborns that required a CVC were included in a prospective observational study. Variables such as gestational age, gender, weight, height, and neck length were studied. On the chest x-ray, the distance between the insertion site on the skin and the catheter tip was measured. RESULTS: Of the patients included, 50 (54.9%) were males and 40 (44.4%) females; 64 (70.3%) were preterm. Mean gestational age was 33.44 (25 to 41) weeks, weight 2020 (580 to 3980) g, and height 43.04 (26 to 53) cm. Variables were correlated with catheter length and an algorithm was modeled for the introduction method, in which the highest corrected determination coefficient was obtained for weight (R2 = 0.723). CONCLUSION: This study demonstrated that the weight of the newborn was the most significant individual predictor of optimal insertion depth of a CVC in the RIJV. The formula Y = 2.6 + 0.7 (weight in kg) that we suggest is practical and reproducible. LEVEL OF EVIDENCE: Level IV.

Differences in omentin-1 levels in term newborns according to birth weight.

BACKGROUND: Adipokines are produced by adipose tissue and are involved in metabolic processes. Omentin-1 is an adipokine that has been shown in vitro to possibly be involved in insulin sensitivity modulation. The prenatal stage is a crucial period for development of metabolic diseases in the long term, therefore, small (SGA) and large (LGA) for gestational age newborns have an increased risk of type 2 diabetes and metabolic syndrome later in life. AIMS: To evaluate the differences in omentin-1 concentrations in umbilical cord blood from healthy term newborns according to birth weight and explore the association between omentin-1 and anthropometry, glucose, insulin and insulin sensitivity. STUDY DESIGN: This was a secondary analysis of stored umbilical cord blood of term newborns. SUBJECTS: Newborns classified according to birth weight as SGA (n = 30), adequate for gestational age (AGA) (n = 12) and LGA (n = 34). OUTCOME MEASURES: An analysis of omentin-1, glucose and insulin were performed. RESULTS: Differences were found in serum omentin-1 levels (ng/mL) between SGA 328.17 ±â€¯108.04, AGA 253.05 ±â€¯98.25 and LGA 250.91 ±â€¯100.48 (p = 0.009). In the linear regression analysis, the independent variables HOMA-IR, QUICK-I and FGIR were predictors of serum omentin-1 levels (r = 0.175, p = 0.003). CONCLUSIONS: Omentin-1 cord blood levels have a differentiated behavior according to weight for gestational age with LGA newborns having lower levels and SGA newborns higher levels. HOMA-IR, QUICK-I and FGIR weakly predicted omentin-1 in cord blood, suggesting that omentin-1 possibly has an implication in insulin sensitivity since birth.

Efficacy and safety of ultrasound-guided internal jugular vein catheterization in low birth weight newborn.

BACKGROUND: Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. METHODS: We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV). The study population was low birth weight (LBW) newborns <2500g, very low birth weight (VLBW) newborns <1500g and extremely low birth weight (ELBW) newborns <1000g. RESULTS: There were 53% female patients, mean gestational age was 31weeks, mean weight 1352g and the CVC was placed at a mean of 12days of extrauterine life. Birth weight distribution was 39% LBW; 33% VLBW and 28% ELBW. A mean of two (1-8) attempts were necessary with a procedure duration of 16.8 (10-40) minutes. Success of RIJV catheterization was 94%. One attempt was necessary in 50% and up to 5 attempts in 95.7%. Success by weight was VLBW, 97.2%; ELBW, 92.9%; LBW, 91.7%. A venous hematoma occurred in 5% of cases. CONCLUSIONS: Ultrasound-guided RIJV cannulation with real-time visualization to gain access to the central venous circulation in low birth weight newborns is effective and safe.

Adding Multiple Adipokines into the Model do not Improve Weight Gain Prediction by Leptin Levels in Newborns.

OBJECTIVE: Most adipose tissue programming is realized in early life. Also, the postnatal three months, rather than the later phases of infancy, may be more relevant in the development of an adverse cardiometabolic risk profile. The adipokines phenotype, as a predictor of early-life weight gain, has been recently explored in cord blood. To determine whether in addition to leptin levels in cord samples, adiponectin, interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), resistin, plasminogen activator inhibitor-1 (PAI-1), and tumor necrosis factor alpha (TNF-α) levels improve weight gain prediction during the first three months of life. METHODS: Adiponectin, IL-6, MCP-1, leptin, resistin, PAI-1, and TNF-α were measured by multiplex immunoassay in a subsample of 86 healthy term newborns. RESULTS: Leptin levels significantly predicted weight gain at 3 months of follow-up (r2=0.09, p=0.006). In the multivariate analysis, including additional adipokines in the model, stepwise or all at once, did not increase the prediction of weight gain after the first three months of life. CONCLUSION: Adding adiponectin, IL-6, MCP-1, resistin, PAI-1, and TNF-α to the prediction model of weight gain in healthy newborns did not prove to be useful. It is probable that their relative contribution to weight gain is not important. Only leptin was relevant as a predictor of weight gain at the 3-month endpoint.

Vascular assessment of the right internal jugular vein in low birth weight newborns.

OBJECTIVE: To determine the dimensions and depth of the right internal jugular vein (RIJV) in low birth weight newborns by ultrasound and assess the differences in weight and determine the relationship of the vein with the carotid artery. METHOD: We performed a vascular assessment of the RIJV in 100 low birth weight newborns. The subjects were divided into three groups, low birth weight (LBW) newborns, <2500 g; very low birth weight (VLBW) newborns, <1500 g; and extremely low birth weight (ELBW) newborns <1000 g. RESULTS: Of the newborns, 39% had LBW, 33% had VLBW, and 28% had ELBW. The medians were gestational age 31 weeks, weight 1300 g, anteroposterior diameter of the RIJV 2.2 mm, and the distance from the skin-RIJV 3.6 mm. In LBW newborns, the median anteroposterior diameter of RIJV was 2.7 mm; in LBW newborns 2.2; in ELBW newborns 1.9 (p < 0.001); the median distance from skin to RIJV for LBW newborns was 4.1 mm; for VLBW newborns, 3.6 and for ELBW newborns 2.9 (p < 0.01); differences that were statistically significant. CONCLUSIONS: In low birth weight newborns, the diameter and depth of the RIJV is directly proportional to the weight of the subjects studied.

Utilidad de la estreptoquinasa en un neonato de 990 g con trombosis arterial aguda de femoral izquierda secundaria a colocación de catéter umbilical / Streptokinase use in a neonate of 990 g, with acute thrombosis in left lower extremity secondary to umbilical artery catheter

El uso del catéter arterial umbilical continúa siendo de amplia utilización en los recién nacidos críticamente enfermos, con riesgo de complicaciones como sangrado, arritmias cardiacas, onfalitis, trombosis, sepsis, enterocolitis, hemorragia intraventricular, etc. Presentamos el caso de un neonato prematuro de 990g con enfermedad de membrana hialina grave que presentó, trombosis arterial aguda que involucró el miembro inferior izquierdo, Se manejó con estreptoquinasa (trombolítico) y finalmente la lesión se limitó con pérdida de la articulación tarso-metatarsiana y del calcáneo. El diagnóstico de trombosis en la actualidad se realiza por ultrasonido-doppler, el manejo puede ser heparina, trombolíticos y/o quirúrgico. Existe escasa experiencia con el uso de trombolíticos en la etapa neonatal

Utilización del surfactante exógeno en la enfermedad de membrana hialina / Use of exogenous surfactant in hialine membrane disease

El surfactante pulmonar es una substancia natural cuya función es la de disminuir la tensión superficial de los alveolos para evitar colapso durante la respiración; su ausencia produce una entidad conocida como enfermedad de membrana hialina (EMH), más frecuente en prematuros ocasionando dificultad respiratoria de leve a severa con alta morbi-mortalidad. En la actualidad contamos con surfactante exógeno de cuatro tipos: natural, natural modificado, sintético y sintético naturalizado. Cuando se administra inmediatamente después del nacimiento se llama profiláctico; si es después de la identificación de la EMH se llama de rescate. El uso de surfactante exógeno ha combinado la evolución de la EMH con disminución en: mortalidad, fuga de aire, displasia broncopulmonar, hemorragia intraventricular-periventricular, enterocolitis necrosante, persistencia del conducto arterioso, retinopatía del prematuro, etc. La terapia de reemplazo con surfactante está asociada con pocas complicaciones clínicas significativas como: apneas, brandicardia, hemorragia pulmonar, obstrucción del tubo endotraqueal. Se recomiendan múltiples dosis de tres o cuatro dependiendo del tipo utilizado. En la actualidad de terapia con surfactante esta reservada para niños en quienes el problema principal es la deficiencia del surfactante

Experiencia clínica con la ventilación de alta frecuencia de flujo interrumpido en un hospital privado / The clinical expriencie with the high frequency ventilation of interrupted flow

Objetivo: Se documenta la experiencia clínica obtenida con la ventilación de alta frecuencia de flujo interrumpido, en una unidad de cuidados intensivos neonatales. Material y métodos: Se incluyeron para estudio a 19 niños que ameritaron cambio de ventilación mandatoria intermitente a ventilación de alta frecuencia de flujo interrumpido a criterios clínicos y gasométricos, así como la frecuencia de complicaciones observadas en los niños. Resultados: Los neonatos tenían problemas pulmonares. El diagnóstico principal para decidir el cambio a la VAFFI fue la hipertensión pulmonar persistente. Hubo una diferencia significativa entre la predicción de muerte y la que ocurrió (P < 0.05). Los neonatos mostraron mejoría significativa (P < 0.05) en la PaO2 y la PaCO2. Conclusiones: La VAFFI es útil en pacientes hipoxémicos, particularmente eliminando CO2. Disminuye el riesgo de muerte y complicaciones entre los pacientes que la reciben, de acuerdo a los criterios clínicos que se adoptaron en ese estudio

Neumoperitoneo neonatal secundario a la ventilación mecánica intermitente / Secundary neonatal pneumoperitoneum at the intermittent mechanical ventilation

La causa más frecuente de neumoperitoneo en los neonatos es la perforación del tracto gastrointestinal; algunos casos son debidos al síndrome de fuga de aire pulmonar, es por ello que tal causa forma parte del diagnóstico diferencial, cuando se manifiesta relacionada con el tratamiento del niño con ventilación mecánica intermitente, con presión inspiratoria máxima elevada. Este trabajo presenta el caso de un recién nacido de 2 300 g, con enfermedad de membrana hialina, que desarrolló hipertensión pulmonar persistente a las 48 hosas de vida. Se trató con ventilación mecánica intermitente, con presión inspiratoria máxima de 30; se produjo enfisema intersticial, neumomediastino y neumotórax. Al tercer día de vida aquejó distensión abdominal y neumoperitoneo. Al analizar su causa se infirió que era consecutiva a barotrauma; su evolución fue satisfactoria con tratamiento conservador. Se concluyó que si se considera la posibilidad del origen respiratorio del neumoperitoneo en un neonato se evitan, en caso de confirmarlo, procedimientos quirúrgicos innecesarios.

Morbilidad de neonatos con enfermedad de membrana hialina, con y sin aplicación de surfactante exógeno / The hialine membrane disease and morbility in neonates

Se presentan los resultados de un estudio realizado con el propósito de conocer la morbilidad y mortalidad de 18 recién nacidos (RN) prematuros con enfermedad de membrana hialina (EMH) a los cuales se les aplicó surfactante exógeno (grupo A) comparados con un grupo histórico de 20 niños sin surfactante (grupo B). Al confrontar las diversas variables en estudio no se encontró una diferencia estadística en cuanto a edad de gestación (29.0 ñ 2.5 ñ 3.2 semanas) y peso (1,210 ñ 350 vs 1,120 + 330g); tampoco hubo diferencias en cuanto a la vía de nacimiento, Apgar, sexo y trofismo. En relación a la morbilidad y letalidad, se encontró una mayor frecuencia de niños con persistencia del conducto arterioso en el grupo A (p<0.01) al igual que para neumonía (p<0.01). Hubo mayor letalidad en el grupo B (p<0.01) y mayor incidencia de displasia broncopulmonar. Se concluye que el uso de surfactante exógeno es imperativo para modificar el curso de la EMH en neonatos con deficiencia de surfactante; con su uso disminuye la letalidad y la displasia broncopulmonar

Empleo del sulfato de magnesio en la hipertensión pulmonar persistente del recién nacido / Use of magnesium suplhate in the persistent pulmonary hypertension in neonates

El objetivo del presente estudio fue evaluar el uso del sulfato de magnesio como terapéutica de rescate en la hipertensión pulmonar persistente (HPP) del recién nacido. La muestra estuvo constituida por 13 neonatos; las variables analizadas fueron: peso, edad de gestación, vía de nacimiento, Apgar y administración de sulfato de magnesio. Se analizaron los cambios en las variables gasométricas, en las pruebas de la función hepática y renal, en las pruebas de coagulación, en los electrólitos séricos y en la tensión arterial. Los resultados mostraron una mejoría significativa en todas las constantes gasométricas: (pH, PaO2, PaCO2, HCO3) en la saturación de Hb y en el exceso de base. Hubo una disminución significativamente en la concentración del calcio e incremento en la concentración de magnesio. Se concluye en que el sulfato de magnesio, a infusión continua, es una buena alternativa de rescate en neonatos con HPP, en hospitales que no cuentan con ventiladores de alta frecuencia o aparatos de oxigenación por membrana extracorpórea