Pulse oximetry as a screening test for critical congenital heart disease in term newborns.

BACKGROUND: Pulse oximetry has been suggested as a screening test for congenital heart disease (CHD) in asymptomatic newborns. However, most newborns in Mexico are discharged from the hospital without this evaluation. OBJECTIVE: To evaluate pulse oximetry as a screening test for critical congenital heart disease (CCHD) in term newborns. METHODS: We conducted a cross-sectional study in term newborns between July 2010 and April 2011. Pulse oximetry was determined before hospital discharge; in case of post-ductal oxygen saturation < 95%, a Doppler echocardiogram was performed. RESULTS: From 1,037 newborns screened, two had CCHD, one had pulmonary atresia and ventricular septal defect, and one Ebstein´s anomaly. Minor CHD was present in 10 babies. The overall prevalence of CHD was 11.5 per 1000 live births, and the prevalence of CCHD was 3.9 per 1000 live births. For those with critical disease, pulse oximetry had a sensitivity of 100%, specificity 98.8%, positive predictive value 14.2%, negative predictive value 100%, and positive likelihood ratio of 86.2. In regression analysis, oxygen saturation, respiratory frequency, and postnatal age were related with CCHD. CONCLUSIONS: Pulse oximetry had a good sensitivity and specificity for the identification of critical congenital heart disease in term newborns. Low oxygen saturation, higher respiratory frequency, and early postnatal age were related with congenital heart disease.

Association of oropharyngeal colostrum administration with decreased inflammatory indices in premature newborns weighing less than 1500 g.

BACKGROUND: The administration of colostrum through its absorption at the oropharyngeal level stimulates the mucosa-associated lymphoid tissue, providing a local immunological protection barrier. The study aimed to investigate the association of oropharyngeal colostrum administration with the reduction of inflammatory indices. MATERIALS AND METHODS: This was an observational, ambispective, analytical study of newborns < 32 weeks of gestation at risk of sepsis. Oropharyngeal colostrum was administered at 0.2 mL every 4 h for 5 days. Inflammatory indices were analyzed. Statistical analysis included frequencies, percentages, mean and Standard deviation, contingency coefficient, and Kolmogorov-Smirnov test for the distribution curve of the numerical data. RESULTS: There were 50 patients, 33 (66%) female and 17 (34%) male, with a median gestational age of 30-31 weeks (95% confidence interval [CI]). Nineteen patients had sepsis. A lower positivity rate in C-reactive protein was found, with a median of 0.5-0.6 (95% CI) at 5 days of colostrum administration versus 0.5-1.1 (95% CI) as the initial C-reactive protein. Analysis with χ2 yielded a p = 0.13, and the contingency coefficient showed a p = 0.196, indicating an association. CONCLUSION: Oropharyngeal colostrum administration was associated with a lower C-reactive protein positivity rate and clinical improvement in premature newborns at risk of sepsis.

INTRODUCCIÓN: La administración del calostro a través de su absorción a nivel orofaríngeo estimula el tejido linfoide asociado a mucosas, proporcionando una barrera de protección local e inmunológica. Conocer la asociación de la administración de calostro orofaríngeo con la disminución de los índices inflamatorios. MATERIAL Y MÉTODOS: Observacional, ambispectivo, analítico, recién nacidos < 32 semanas de gestación con riesgo de sepsis, se administró calostro orofaríngeo 0.2 ml cada 4 horas durante 5 días. se analizó índices inflamatorios, evolución clínica. Análisis estadístico: frecuencias, porcentajes, media y DS, coeficiente de contingencia y prueba de Kolmogorov Smirnov para la curva de distribución de los datos numéricos. RESULTADOS: Fueron 50 pacientes, 33 (66%) femenino, 17 (34%) masculino, edad gestacional mediana 30-31 semanas (IC 95%), 19 pacientes cursaron con sepsis encontrando menor índice de positividad en la PCR, mediana de 0.5-0.6 (IC 95%) a los 5 días de administración de calostro vs 0.5-1.1 (IC 95%) como PCR inicial, analizando con Chi cuadrada con valor p = 0.13, mediante coeficiente de contingencia con p = 0.196, traduciendo asociación. CONCLUSIÓN: La calostroterapia se asoció con menor índice de positividad en la PCR; clínicamente hacia la mejoría, en recién nacidos prematuros con riesgo de sepsis.

The use of sildenafil in persistent pulmonary hypertension of the newborn.

We evaluated the effectiveness of sildenafil in the treatment of neonatal pulmonary hypertension. We performed a double-blind randomized clinical trial in 51 full-term infants with persistent pulmonary hypertension confirmed by Doppler echocardiography. Patients were divided in two groups: 20 infants in group A received placebo when the oxygenation index was >20, and 31 infants in group B received 3 mg/kg of oral sildenafil every 6 hours. Arterial blood gases were taken at 1, 4, 7, 13, 19, and 25 hours after treatment was started. Main outcome measures were oxygenation changes, time on mechanical ventilation, and mortality. Both groups were comparable in general variables as well as in illness severity. We observed better oxygenation parameters after 7 hours of sildenafil treatment, but no significant changes were found in the placebo group. Mortality was higher in the placebo group (40%) than in those infants who received sildenafil (6%; P = 0.004), although no difference was found in time on mechanical ventilation between groups. Our results confirm that sildenafil may be a useful adjuvant therapy for term infants with pulmonary hypertension in centers lacking inhaled nitric oxide and extracorporeal membrane oxygenation.

Factores de riesgo asociados al síndrome de abstinencia en recién nacidos con sedoanalgesia / Risk factors associated with abstinence syndrome in newborns with sedoanalgesia

Resumen: Introducción: Opiáceos y benzodiacepinas producen síndrome de abstinencia con mayor frecuencia. Objetivo: Conocer los factores de riesgo asociados al síndrome de abstinencia en pacientes con sedoanalgesia. Material y métodos: Prospectivo, longitudinal, analítico, recién nacidos con sedoanalgesia fentanilo y midazolam más de 24 horas. Analizamos la asociación clínico-demográfica con síndrome de abstinencia mediante la escala de Finnegan. Utilizamos test t-Student, U de Mann-Whitney, χ2 para diferencias de distintas variables, regresión logística para variables independientes que se asociaron al síndrome de abstinencia, alfa < 0.05, programa SPSS v.18. Resultados: Ochenta y cuatro pacientes, 56% hombres, 35 ± 3.8 semanas de gestación, peso 2,350 ± 866 g, cesárea 65.5%. De la escala de Finnegan, 7.1% presentó síndrome de abstinencia; de los cuales, 66.7% fue leve y 33.3% moderado, encontrándose asociación: cesárea, edad materna 30 años, masculino, primera o segunda gesta, 38 semanas de gestación (p ≤ 0.01), peso mayor a 2,700 g, diagnóstico de ingreso postquirúrgico y ventilación mecánica. Conclusión: Existe relación entre variables clínico demográficas en pacientes recién nacidos que reciben sedoanalgesia y la presentación del síndrome de abstinencia; sin embargo, se requieren mayores estudios para establecer y adoptar medidas de prevención.

Abstract: Introduction: Opiates and benzodiazepines are the ones that most frequently produce withdrawal syndrome. Objective: Know the risk factors associated with abstinence syndrome in patients whit sedoanalgesia. Material and methods: Prospective, longitudinal, analytical; newborns received sedoanalgesia with fentanyl and midazolam for more than 24 hours. The clinical-demographic association with abstinence syndrome was analyzed using the Finnegan scale. Test t-Student, Mann-Whitney U and Mann-Whitney, χ2 for differences in different variables, logistic regression the independent variables associated with abstinence syndrome, alpha level < 0.05, SPSS v.23.0 program. Results: 84 patients, 56% male, predominated means: weeks of gestation 35 ± 3.8, weight 2,350 ± 866 g and cesarean 65.5%. To the Finnegan scale 7.1% file abstinence syndrome which 66.7% was mild and 33.3% moderate; the association between the presence of abstinence syndrome is found: cesarean, maternal age of 30 years, male, first or second gestation, 38 weeks gestation (p ≤ 0.01), weighing greater than 2,700 g, diagnosed with post-surgical admission and mechanical ventilation. Conclusion: There is a relationship between clinical demographic variables in newborn patients receiving sedoanalgesia and the presentation of with abstinence syndrome; however further studies are required to establish and adopt preventive measures.

Association of oropharyngeal colostrum administration with decreased inflammatory indices in premature newborns weighing less than 1500 g / Asociación de la administración de calostro orofaríngeo con la disminución de los índices inflamatorios en recién nacidos prematuros menor de 1500 g

Abstract Background: The administration of colostrum through its absorption at the oropharyngeal level stimulates the mucosa-associated lymphoid tissue, providing a local immunological protection barrier. The study aimed to investigate the association of oropharyngeal colostrum administration with the reduction of inflammatory indices. Materials and methods: This was an observational, ambispective, analytical study of newborns < 32 weeks of gestation at risk of sepsis. Oropharyngeal colostrum was administered at 0.2 mL every 4 h for 5 days. Inflammatory indices were analyzed. Statistical analysis included frequencies, percentages, mean and Standard deviation, contingency coefficient, and Kolmogorov–Smirnov test for the distribution curve of the numerical data. Results: There were 50 patients, 33 (66%) female and 17 (34%) male, with a median gestational age of 30-31 weeks (95% confidence interval [CI]). Nineteen patients had sepsis. A lower positivity rate in C-reactive protein was found, with a median of 0.5-0.6 (95% CI) at 5 days of colostrum administration versus 0.5-1.1 (95% CI) as the initial C-reactive protein. Analysis with χ2 yielded a p = 0.13, and the contingency coefficient showed a p = 0.196, indicating an association. Conclusion: Oropharyngeal colostrum administration was associated with a lower C-reactive protein positivity rate and clinical improvement in premature newborns at risk of sepsis.

Resumen Introducción: La administración del calostro a través de su absorción a nivel orofaríngeo estimula el tejido linfoide asociado a mucosas, proporcionando una barrera de protección local e inmunológica. Conocer la asociación de la administración de calostro orofaríngeo con la disminución de los índices inflamatorios. Material y métodos: Observacional, ambispectivo, analítico, recién nacidos < 32 semanas de gestación con riesgo de sepsis, se administró calostro orofaríngeo 0.2 ml cada 4 horas durante 5 días. se analizó índices inflamatorios, evolución clínica. Análisis estadístico: frecuencias, porcentajes, media y DS, coeficiente de contingencia y prueba de Kolmogorov Smirnov para la curva de distribución de los datos numéricos. Resultados: Fueron 50 pacientes, 33 (66%) femenino, 17 (34%) masculino, edad gestacional mediana 30-31 semanas (IC 95%), 19 pacientes cursaron con sepsis encontrando menor índice de positividad en la PCR, mediana de 0.5-0.6 (IC 95%) a los 5 días de administración de calostro vs 0.5-1.1 (IC 95%) como PCR inicial, analizando con Chi cuadrada con valor p = 0.13, mediante coeficiente de contingencia con p = 0.196, traduciendo asociación. Conclusión: La calostroterapia se asoció con menor índice de positividad en la PCR; clínicamente hacia la mejoría, en recién nacidos prematuros con riesgo de sepsis.

Single strain versus multispecies probiotic on necrotizing enterocolitis and faecal IgA levels in very low birth weight preterm neonates: A randomized clinical trial.

BACKGROUND: According to the literature, probiotics are an attractive alternative to prevent necrotizing enterocolitis (NEC). However, due to differences in probiotic composition, randomized controlled trials are necessary to compare different probiotic mixtures. The objective of this study was to compare single strain (Lactobacillus acidophilus boucardii) versus multispecies probiotics on NEC incidence and faecal secretory Immunoglobulin A (sIgA) levels in very low preterm newborns. METHODS: We performed a double-blind randomized trial in 90 newborns. L. acidophilus boucardii strain or multispecies probiotics were randomly assigned to preterm newborns. As the primary outcome, we evaluated NEC incidence on the total length of neonatal intensive care unit (NICU) stay. As the secondary outcome, we measured the change in faecal sIgA levels from baseline to 3 weeks following the use of probiotics. RESULTS: NEC incidence was similar between groups (0% vs. 2.2% for the single strain and multispecies probiotic, respectively). Faecal sIgA levels increased significantly (p < 0.001) within groups (31% for single strain and 47% for multispecies probiotic), but this increase was not different between groups. Neonates with a faecal sIgA level increment >0.45 mg/dl showed higher gestational age, birth weight, and weight at the second and third weeks of follow up than neonates with a faecal sIgA level increment ≤0.45 mg/dl. No adverse effects were found after probiotics use. CONCLUSIONS: No difference between strains of probiotics used was found on NEC incidence or in the increase of faecal sIgA levels. Faecal sIgA levels were positively related to gestational age and body weight in very low preterm infants. ClinicalTrials.gov/NCT02245815.

Diagnóstico prenatal de malformaciones del tracto urinario: evaluación posnatal y resultado clínico / Prenatal diagnosis of urinary tract malformations: postnatal evaluation and clinical outcome

Resumen Antecedentes: Las malformaciones del tracto urinario representan el 15-20% de las anomalías por ecografía prenatal; la prevalencia oscila entre 3 y 6 por cada 1,000 nacimientos. Objetivo: Conocer el desenlace clínico de los recién nacidos diagnosticados prenatalmente con malformación del tracto urinario. Material y métodos: Observacional, analítico, ambispectivo. Recién nacidos con diagnóstico prenatal de malformación urinaria. Evaluación posnatal con pruebas diagnósticas, analizamos días de estancia hospitalaria, intervención quirúrgica y seguimiento. Resultados: 45 pacientes, 55% varones, 65% de término, 77% cesárea. El diagnóstico prenatal más frecuente fue hidronefrosis, 100% se realizó ultrasonido renal posnatal, 27% cistograma miccional, 42% gammagrama renal; 60% requirió estancia hospitalaria prolongada, 27% intervención quirúrgica, 60% seguimiento. 89% de los casos diagnosticados prenatalmente se corroboró algún tipo de malformación del tracto urinario, solo en el 75% de los casos fue el mismo diagnóstico. Conclusión: La evaluación posnatal siempre requiere la realización de un ultrasonido renal y no en todos los casos realización de cistograma miccional o gammagrama renal.

Abstract Background: Urinary tract malformations represent 15-20% of abnormalities in prenatal ultrasound; the prevalence oscillates between 3-6 per 1000 births. Objective: To know the clinical outcome of newborns diagnosed prenatally with some malformation of the urinary tract. Material and methods: Observational, analytical, ambispective. Newborns with prenatal diagnosis of malformation urinary. Postnatal evaluation diagnostic tests performed, we analyzed the days of hospital stay, surgical intervention, follow-up. Results: 45 children, 55% male, 65% term, 77% c-section. Prenatal diagnosis with higher frequency was hydronephrosis. In all cases postnatal renal ultrasound was performed, 27% voiding cystogram, 42% renal gammagram. A 60% of the cases required prolonged hospital stay, 27% required a surgical intervention, 60% were follow-up. 89% of the cases diagnosed prenatally corroborated some type of malformation of the urinary tract, only in 75% of the cases was the same diagnosis. Conclusion: Postnatal evaluation always requires the performance of a renal ultrasound and not in all cases the performance of voiding cystogram or renal gammagram.