Can Intubation Be Improved with Endotracheal Tubes Marked with a Color Scale? Randomized Controlled Study.

OBJECTIVE: This study aimed to assess if a color scale in the endotracheal tube (ETT) can help operators to correctly select the size and depth of placement of the ETT and decrease the time required to complete the procedure and compared with the usual numeric ETT scale in a mannequin model. STUDY DESIGN: The study was conducted in eight centers. Each size of the ETT was identified with a different color. The experimental ETTs had two different colored areas, one for the mouthpiece and another to identify where the ETT should be taped above the lip (an area of 1 cm. The operators were trained as part of the protocol using an instructional video. Four clinical scenarios requiring endotracheal intubation were designed and randomly assigned. Each operator had to select the size and depth of ETT based on the birth weight (BW), and then had to perform four intubations. RESULTS: A total of 108 operators performed 432 intubations. No differences were found in the correct placement and selection of the ETT. Median time (in seconds) required for intubation using numeric versus experimental tube was: for ETT Ø NRP (Neonatal Resuscitation Program) 2.5, 11.5 versus 8 (p < 0.001), ETT Ø 3, 12 versus 10 (p < 0.001), ETT Ø 3.5, 15.5 versus12 (p = 0.003), ETT Ø 4, 12 versus11 (p = 0.019). CONCLUSION: No significant difference was observed in the selection and correct placement of the ETT. However, the intubation time was significantly shorter using the experimental ETT. This device could improve the effectiveness of intubation by reducing the time needed to properly place the ETT at mid trachea. KEY POINTS: · It is an innovative intervention to try to solve a great inconvenience of daily practice.. · The study also raises the difficulty in maintaining the ability of endotracheal intubation.. · It proposes a scale that ensures the correct location with a safe fixation zone..

Maternal-Fetal Immunologic Response to SARS-CoV-2 Infection in a Symptomatic Vulnerable Population: A Prospective Cohort.

BACKGROUND: Coronavirus disease 2019 (COVID-19) disproportionally affects pregnant women and their newborn; however, little is known about variables that modulate maternal-fetal immune response to infection. METHODS: We prospectively studied socioeconomic, biologic, and clinical factors affecting humoral immunity in 87 unvaccinated pregnant women hospitalized in Buenos Aires for symptoms consistent with COVID-19. RESULTS: The number of days between symptom onset and childbirth predicted maternal and newborn virus spike protein receptor binding domain (RBD)-specific immunoglobulin G (IgG). These findings suggest newborns may benefit less when mothers deliver soon after COVID-19 infection. Similarly, a longer time between symptom onset and birth predicted higher in utero transfer of maternal IgG and its concentration in cord blood. Older gestational age at birth was associated with lower maternal to cord blood IgG ratio. Of women with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 87% developed RBD-specific IgA responses in breast milk within 96 hours of childbirth. IgA was not significantly associated with time from infection but correlated with maternal serum IgG and placental transfer. CONCLUSIONS: These results demonstrate the combined role of biologic, clinical, and socioeconomic variables associated with maternal RBD-specific antibodies and supports early vaccination strategies for COVID-19 in socioeconomically vulnerable pregnant women. CLINICAL TRIALS REGISTRATION: NCT04362956.

Edad gestacional, vía de parto y relación con el día y hora de nacimiento en dos instituciones del sector privado de salud / Gestational age, mode of delivery, and relation to the day and time of birth in two private health care facilities

Introducción. A nivel mundial, hay una tendencia ascendente en nacimientos prematuros y cesáreas. El objetivo fue describir edad gestacional (EG), vía de parto, distribución en días y horarios, y relación entre la vía de parto y el momento del nacimiento en dos instituciones privadas.Población y métodos. Estudio prospectivo, transversal, analítico.Resultados. Se incluyeron los 1500 nacidos vivos entre 9-2017 y 8-2018 (1465 embarazadas). El 99,4 % fueron embarazos controlados; el 66,8 % terminaron por cesárea. La causa fue cesárea previa en el 36,4 %, falta de progresión y descenso en el 18,9 % y elección materna en el 9,2 %. El peso promedio al nacer fue de 3232 g ± 561,1 g y la mediana de EG, 39 semanas (rango 38-40) por fecha de última menstruación. El 88,2 % fueron nacidos de término y, de los prematuros, el 76,1 % fueron pretérminos tardíos. Los nacidos de término temprano tuvieron mayor índice de cesáreas (p < 0,001). Los nacimientos por cesárea en días hábiles fueron 849/1201 (el 74,5 %) y, en los días de fin de semana y feriados, 173/299 (el 57,9 %, p < 0,001). Se encontró una relación estadísticamente significativa entre el horario de nacimiento y la realización de cesárea.Conclusiones. La mediana de EG fue 39 semanas. La cesárea fue la vía de nacimiento más frecuente. Los nacimientos se produjeron, predominantemente, de lunes a viernes entre las 8 y las 21 h. El 82,9 % de los nacimientos por cesárea ocurrieron en días de semana laborables

Introduction. There is a worldwide growing trend of preterm births and C-sections. Our objective was to describe gestational age (GA), mode of delivery, day and time distribution, and the relation between the mode of delivery and the time of birth in two private facilities.Population and methods. Prospective, cross-sectional, analytical study.Results. A total of 1500 live newborn infants were included between September 2017 and August 2018 (1465 pregnant women). Of these, 99.4 % had received antenatal care; 66.8 % of pregnancies ended via C-section. The reason was a previous C-section in 36.4 %, lack of progression and descent in 18.9 %, and maternal choice in 9.2 %. The average birth weight was 3232 g ± 561.1 g and the median GA was 39 weeks (range: 38-40) based on the date of the last menstrual period; 88.2 % were term births and, among preterm births, 76.1 % corresponded to late preterm babies. Early term births showed a higher rate of C-sections (p < 0.001). There were 849/1201 (74.5 %) C-sections on weekdays and 173/299 (57.9 %, p < 0.001) on weekends and holidays. A statistically significant relation was observed between the time of birth and the performance of a C-section.Conclusions. The median GA was 39 weeks. C-sections were the most common mode of delivery. Births occurred predominantly Mondays through Fridays between 8 a.m. and 9 p.m.; 82.9 % of C-sections took place on weekdays.

Gestational age, mode of delivery, and relation to the day and time of birth in two private health care facilities. / Edad gestacional, vía de parto y relación con el día y hora de nacimiento en dos instituciones del sector privado de salud.

INTRODUCTION: There is a worldwide growing trend of preterm births and C-sections. Our objective was to describe gestational age (GA), mode of delivery, day and time distribution, and the relation between the mode of delivery and the time of birth in two private facilities. POPULATION AND METHODS: Prospective, crosssectional, analytical study. RESULTS: A total of 1500 live newborn infants were included between September 2017 and August 2018 (1465 pregnant women). Of these, 99.4 % had received antenatal care; 66.8 % of pregnancies ended via C-section. The reason was a previous C-section in 36.4 %, lack of progression and descent in 18.9 %, and maternal choice in 9.2 %. The average birth weight was 3232 g ± 561.1 g and the median GA was 39 weeks (range: 38-40) based on the date of the last menstrual period; 88.2 % were term births and, among preterm births, 76.1 % corresponded to late preterm babies. Early term births showed a higher rate of C-sections (p < 0.001). There were 849/1201 (74.5 %) C-sections on weekdays and 173/299 (57.9 %, p < 0.001) on weekends and holidays. A statistically significant relation was observed between the time of birth and the performance of a C-section. CONCLUSIONS: The median GA was 39 weeks. C-sections were the most common mode of delivery. Births occurred predominantly Mondays through Fridays between 8 a.m. and 9 p.m.; 82.9 % of C-sections took place on weekdays.

Introducción. A nivel mundial, hay una tendencia ascendente en nacimientos prematuros y cesáreas. El objetivo fue describir edad gestacional (EG), vía de parto, distribución en días y horarios, y relación entre la vía de parto y el momento del nacimiento en dos instituciones privadas. Población y métodos. Estudio prospectivo, transversal, analítico. Resultados. Se incluyeron los 1500 nacidos vivos entre 9-2017 y 8-2018 (1465 embarazadas). El 99,4 % fueron embarazos controlados; el 66,8 % terminaron por cesárea. La causa fue cesárea previa en el 36,4 %, falta de progresión y descenso en el 18,9 % y elección materna en el 9,2 %. El peso promedio al nacer fue de 3232 g ± 561,1 g y la mediana de EG, 39 semanas (rango 38-40) por fecha de última menstruación. El 88,2 % fueron nacidos de término y, de los prematuros, el 76,1 % fueron pretérminos tardíos. Los nacidos de término temprano tuvieron mayor índice de cesáreas (p < 0,001). Los nacimientos por cesárea en días hábiles fueron 849/1201 (el 74,5 %) y, en los días de fin de semana y feriados, 173/299 (el 57,9 %, p < 0,001). Se encontró una relación estadísticamente significativa entre el horario de nacimiento y la realización de cesárea. Conclusiones. La mediana de EG fue 39 semanas. La cesárea fue la vía de nacimiento más frecuente. Los nacimientos se produjeron, predominantemente, de lunes a viernes entre las 8 y las 21 h. El 82,9 % de los nacimientos por cesárea ocurrieron en días de semana laborables.