Short-course empiric antibiotic therapy for possible early-onset sepsis in the NICU.

OBJECTIVE: On 2/2019, the Neonatal Antimicrobial Stewardship Program at Nationwide Children's Hospital recommended reducing empirical antibiotic therapy for early-onset sepsis (EOS) from 48 to 24 hours with a TIME-OUT. We describe our experience with this guideline and assess its safety. METHODS: Retrospective review of newborns evaluated for possible EOS at 6 NICUs from 12/2018-7/2019. Safety endpoints were re-initiation of antibiotics within 7 days after discontinuation of the initial course, positive bacterial blood or cerebrospinal fluid culture in the 7 days after antibiotic discontinuation, and overall and sepsis-related mortality. RESULT: Among 414 newborns evaluated for EOS, 196 (47%) received a 24 hour rule-out sepsis antibiotic course while 218 (53%) were managed with a 48 hour course. The 24-hour rule-out group were less likely to have antibiotics re-initiated and did not differ in the other predefined safety endpoints. CONCLUSION: Antibiotic therapy for suspected EOS may be discontinued safely within 24 hours.

Antimicrobial defined daily dose in neonatal population.

BACKGROUND: Antimicrobial defined daily dose (DDD), a standardized metric to assess antimicrobial consumption in adult population, has limitations hampering its use in neonatal patients. This study proposes an alternative DDD design applicable for neonates. METHODS: Neonates (<1 month-old) from 6 Spanish hospitals during a 12-months period were included. Weight and weeks gestational age of each neonate were the variables collected. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication selected by the Delphi method. RESULTS: A total of 4820 neonates were included. Mean age was 36.72 weeks of gestational age and Mean weight was 2.687kg. Standardized DDD (intravenous; oral route) for representative antimicrobials were: Amoxicillin (0.08; 0.08), amoxicillin-clavulanic acid (0.27; 0.08), ampicillin (0.27; x), cloxacillin (0.13; 0.13), penicillin G sodium (0.12), cefazolin (0.13), cefuroxime (0.27; x), cefotaxime (0.27), ceftazidime (0.27), ceftriaxone (0.13), cefepime (0.27) piperacillin-tazobactam (0.54), aztreonam (0.24), azithromycin (0.03; 0.03), clindamycin (0.04; 0.04), amikacin (0.04), gentamicin (0.01), metronidazole (0.04; 0.08), ciprofloxacin (0.04; 0.05), levofloxacin (x;x), fluconazole (0.02; 0.02), itraconazole (0.01; 0.01), fosfomycin (0.27). Restricted antimicrobials: meropenem (0.11), teicoplanin (0.02), vancomycin (0.08; 0.11), linezolid (0.08; 0.08), daptomycin (x), amphotericin B liposomal (0.01). CONCLUSIONS: A useful method for antimicrobial DDD measurement in neonatology has been designed to monitor antimicrobial consumption in hospital settings. It should be validated in further studies and thereby included in the design for neonatal antimicrobial stewardship programs in the future.

Antimicrobial defined daily dose in neonatal population / Dosis diaria definida de antimicrobianos en la población neonatal

BackgroundAntimicrobial defined daily dose (DDD), a standardized metric to assess antimicrobial consumption in adult population, has limitations hampering its use in neonatal patients. This study proposes an alternative DDD design applicable for neonates.MethodsNeonates (<1 month-old) from 6 Spanish hospitals during a 12-months period were included. Weight and weeks gestational age of each neonate were the variables collected. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication selected by the Delphi method.ResultsA total of 4820 neonates were included. Mean age was 36.72 weeks of gestational age and Mean weight was 2.687kg. Standardized DDD (intravenous; oral route) for representative antimicrobials were: Amoxicillin (0.08; 0.08), amoxicillin-clavulanic acid (0.27; 0.08), ampicillin (0.27; x), cloxacillin (0.13; 0.13), penicillin G sodium (0.12), cefazolin (0.13), cefuroxime (0.27; x), cefotaxime (0.27), ceftazidime (0.27), ceftriaxone (0.13), cefepime (0.27) piperacillin-tazobactam (0.54), aztreonam (0.24), azithromycin (0.03; 0.03), clindamycin (0.04; 0.04), amikacin (0.04), gentamicin (0.01), metronidazole (0.04; 0.08), ciprofloxacin (0.04; 0.05), levofloxacin (x;x), fluconazole (0.02; 0.02), itraconazole (0.01; 0.01), fosfomycin (0.27). Restricted antimicrobials: meropenem (0.11), teicoplanin (0.02), vancomycin (0.08; 0.11), linezolid (0.08; 0.08), daptomycin (x), amphotericin B liposomal (0.01).

AntecedentesLa dosis diaria definida de antimicrobianos (DDD), un método estandarizado para evaluar el consumo de antimicrobianos en la población adulta, tiene limitaciones que dificultan su uso en la población neonatal. Este estudio propone un diseño alternativo de la DDD aplicable a los recién nacidos.MétodosSe incluyeron neonatos (<1 mes) de 6 hospitales españoles durante un período de 12 meses. El peso y las semanas de edad gestacional de cada recién nacido fueron las variables recogidas. Las DDD (g) de cada antimicrobiano se calcularon multiplicando el peso obtenido por la dosis recomendada (mg/kg) del antimicrobiano para la indicación infecciosa más común seleccionada por el método Delphi.ResultadosSe incluyeron un total de 4.820 recién nacidos. La edad media fue de 36,72 semanas de edad gestacional y el peso medio fue de 2,687kg. La DDD estandarizado (intravenoso; oral) para antimicrobianos seleccionados fueron: amoxicilina (0,08; 0,08), amoxicilina-ácido clavulánico (0,27; 0,08), ampicilina (0,27; x), cloxacilina (0,13; 0,13), penicilina G sódica (0,12), cefazolina (0,13), cefuroxima (0,27; x), cefotaxima (0,27), ceftazidima (0,27), ceftriaxona (0,13), cefepima (0,27) piperacilina-tazobactam (0,54), aztreonam (0,24), azitromicina (0,03; 0,03) clindamicina (0,04; 0,04), amikacina (0,04), gentamicina (0,01), metronidazol (0,04; 0,08), ciprofloxacina (0,04; 0,05), levofloxacina (x; x), fluconazol (0,02; 0,02), itraconazol (0,01; 0,01), fosfomicina (0,27). Antimicrobianos restringidos: meropenem (0,11), teicoplanina (0,02), vancomicina (0,08; 0,11), linezolid (0,08; 0,08), daptomicina (x), anfotericina B liposomal (0, 01).ConclusionesSe ha diseñado un método útil para la medición de las DDD de antimicrobianos en neonatología para controlar el consumo de antimicrobianos en entornos hospitalarios. Debería validarse en estudios posteriores para incluirse en el diseño de los programas de administración de antimicrobianos neonatales en el futuro.

Style of meal service and feeding practices among Mexican American fathers and mothers: An analysis of video-recorded children's evening mealtime at home.

The aim of this study was to examine video-recorded observations of evening family mealtime at home among Mexican American children to help elucidate style of meal service, fathers' and mothers' feeding practices and child's eating behavior. Consistent with guidelines for coding behaviors, we analyzed observational data of evening mealtimes of 71 Mexican American children aged eight to 10 years. Regarding style of meal service, in almost all cases (96%), parents plated the child's food, with more available on the table or counter in 40% of the observations. Mothers almost always served the child (94%). Regarding parental feeding practices, parents used positive involvement in meals (80%), pressure to eat (42%) and restriction of food (9%). Using food as a reward to control behavior was never used by either parent. The majority (75%) of children requested or negotiated to eat less food, or only eat certain items. In Mexican American families, both mothers and fathers play a role in family mealtimes and both use positive involvement in child's meals, and to a lesser extent pressure to eat, with their children aged eight to 10 years. To help reduce the obesity epidemic, intervention strategies are needed, which integrate the family, a plating style of meal and parental feeding practices that promote healthy eating in the home. To reduce obesity among Mexican American children, interventions that focus on parental positive involvement in child's meal and maintenance of home cooked meals could have a positive impact on the entire family.

Antimicrobial defined daily dose in neonatal population.

BACKGROUND: Antimicrobial defined daily dose (DDD), a standardized metric to assess antimicrobial consumption in adult population, has limitations hampering its use in neonatal patients. This study proposes an alternative DDD design applicable for neonates. METHODS: Neonates (<1 month-old) from 6 Spanish hospitals during a 12-months period were included. Weight and weeks gestational age of each neonate were the variables collected. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication selected by the Delphi method. RESULTS: A total of 4820 neonates were included. Mean age was 36.72 weeks of gestational age and Mean weight was 2.687kg. Standardized DDD (intravenous; oral route) for representative antimicrobials were: Amoxicillin (0.08; 0.08), amoxicillin-clavulanic acid (0.27; 0.08), ampicillin (0.27; x), cloxacillin (0.13; 0.13), penicillin G sodium (0.12), cefazolin (0.13), cefuroxime (0.27; x), cefotaxime (0.27), ceftazidime (0.27), ceftriaxone (0.13), cefepime (0.27) piperacillin-tazobactam (0.54), aztreonam (0.24), azithromycin (0.03; 0.03), clindamycin (0.04; 0.04), amikacin (0.04), gentamicin (0.01), metronidazole (0.04; 0.08), ciprofloxacin (0.04; 0.05), levofloxacin (x;x), fluconazole (0.02; 0.02), itraconazole (0.01; 0.01), fosfomycin (0.27). Restricted antimicrobials: meropenem (0.11), teicoplanin (0.02), vancomycin (0.08; 0.11), linezolid (0.08; 0.08), daptomycin (x), amphotericin B liposomal (0.01). CONCLUSIONS: A useful method for antimicrobial DDD measurement in neonatology has been designed to monitor antimicrobial consumption in hospital settings. It should be validated in further studies and thereby included in the design for neonatal antimicrobial stewardship programs in the future.

Epidemiología, manejo y riesgo de transmisión de SARS-CoV-2 en una cohorte de hijos de madres afectas de COVID-19 / Epidemiology, management and risk of SARS-CoV-2 transmission in a cohort of newborns born to mothers diagnosed with COVID-19 infection

INTRODUCCIÓN: La repercusión de la infección materna por SARS-CoV-2 y su riesgo de transmisión vertical es aún poco conocido. Las recomendaciones de las sociedades científicas buscan proporcionar seguridad para el recién nacido sin comprometer los beneficios del contacto precoz. El objetivo del estudio es describir las características y la evolución de recién nacidos de madres infectadas por SARS-CoV-2, así como las medidas implementadas siguiendo las recomendaciones de la Sociedad Española de Neonatología. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo y unicentro de cohortes. Se diseñó un circuito específico para madres con infección por SARS-CoV-2 y sus hijos. Se recogieron datos epidemiológicos y clínicos de las madres y sus recién nacidos. Se realizó PCR al nacer y a los 14 días. RESULTADOS: Se incluyeron 73 madres y 75 neonatos. El 95,9% de infecciones maternas fueron diagnosticadas durante el tercer trimestre, el 43,8% fueron asintomáticas. La mediana de edad gestacional fue de 38 semanas (RIC: 37-40), el 25,9% de los neonatos requirió ingreso. En el 68% se realizó contacto piel con piel en paritorio y el 80% recibieron lactancia materna o donada exclusiva durante su estancia. No se objetivaron resultados positivos de PCR en la primera muestra obtenida nada más nacer, se objetivó un caso de PCR positiva en un neonato asintomático a los 14 días. CONCLUSIONES: El riesgo de transmisión de la infección por SARS-CoV-2 es bajo cumpliendo los protocolos de la Sociedad Española de Neonatología, permitiendo el alojamiento conjunto de madre e hijo, el contacto precoz y el establecimiento eficaz de la lactancia materna

INTRODUCTION: The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. METHODS: Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS: Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study.

BACKGROUND: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. METHODS: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. FINDINGS: On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). INTERPRETATION: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. FUNDING: Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship.

Epidemiology, management and risk of SARS-CoV-2 transmission in a cohort of newborns born to mothers diagnosed with COVID-19 infection.

INTRODUCTION: The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. METHODS: Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS: Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.

INTRODUCCIÓN: La repercusión de la infección materna por SARS-Cov-2 y su riesgo de transmisión vertical es aún poco conocido. Las recomendaciones de las sociedades científicas buscan proporcionar seguridad para el recién nacido sin comprometer los beneficios del contacto precoz. El objetivo del estudio es describir las características y evolución de recién nacidos de madres infectadas por SARS-CoV2, así como las medidas implementadas siguiendo las recomendaciones de la Sociedad Española de Neonatología. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo y unicentro de cohortes. Se diseñó un circuito específico para madres con infección por SARS-CoV2 y sus hijos. Se recogieron datos epidemiológicos y clínicos de las madres y sus recién nacidos. Se realizó PCR al nacer y a los 14 días. RESULTADOS: Se incluyeron 73 madres y 75 neonatos. El 95.9% de infecciones maternas fueron diagnosticadas durante el tercer trimestre, el 43.8% fueron asintomáticas. La mediana de edad gestacional fue 38 semanas (RIC:37­40), el 25.9% de los neonatos requirió ingreso. En el 68% se realizó contacto piel con piel en paritorio y el 80% recibieron lactancia materna o donada exclusiva durante su estancia. No se objetivaron resultados positivos de PCR en la primera muestra obtenida nada más nacer, se objetivó 1 caso de PCR positiva en un neonato asintomático a los 14 días. CONCLUSIONES: El riesgo de transmisión de la infección por SARS-CoV2 es bajo cumpliendo los protocolos de la Sociedad Española de Neonatología, permitiendo el alojamiento conjunto de madre e hijo, el contacto precoz y el establecimiento eficaz de la lactancia materna.

[Epidemiology, management and risk of SARS-CoV-2 transmission in a cohort of newborns born to mothers diagnosed with COVID-19 infection]. / Epidemiología, manejo y riesgo de transmisión de SARS-CoV-2 en una cohorte de hijos de madres afectas de COVID-19.

INTRODUCTION: The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. METHODS: Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS: Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.

Neonates Born to Mothers With COVID-19: Data From the Spanish Society of Neonatology Registry.

OBJECTIVES: To describe neonatal and maternal characteristics of the largest prospective cohort of newborns from mothers with coronavirus disease 2019 (COVID-19), the data of which were prospectively collected from the nationwide registry of the Spanish Society of Neonatology. METHODS: Between March 8, 2020, and May 26, 2020, the data of 503 neonates born to 497 mothers diagnosed with COVID-19 during pregnancy or at the time of delivery were collected by 79 hospitals throughout Spain. RESULTS: Maternal symptoms were similar to that of the general population, with 5% of severe forms. In 45.8% of asymptomatic women at the time of delivery, severe acute respiratory syndrome coronavirus 2 infection was detected because of recommendations established in Spain to perform COVID-19 screening in all women admitted to the hospital for labor. The rate of preterm deliveries was 15.7% and of cesarean deliveries, 33%. The most common diagnostic test was detection of viral RNA by polymerase chain reaction of nasopharyngeal swabs at a median age of 3 hours after delivery (1-12 hours). Almost one-half of neonates were left skin-to-skin after delivery, and delayed clamping of umbilical cords was performed in 43% of neonates. Also, 62.3% of asymptomatic neonates were managed with rooming-in. Maternal milk was received by 76.5% of neonates, 204 of them as exclusive breastfeeding. CONCLUSIONS: The current study indicates that there is no need for separation of mothers from neonates, allowing delayed cord clamping and skin-to-skin contact along with maintenance of breastfeeding in a high percentage of newborns from mothers with COVID-19.

Neonatal Infection Due to SARS-CoV-2: An Epidemiological Study in Spain.

Objective: Coronavirus disease 2019 (COVID-19) cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to increase worldwide. Although some data from pediatric series are available, more evidence is required, especially in neonates, a group with specific characteristics that deserve special attention. This study aimed to describe general and clinical characteristics, management, and treatment of postnatal-acquired (community and nosocomial/hospital-acquired) COVID-19 neonatal cases in Spain. Methods: This was a national prospective epidemiological study that included cases from a National Registry supported by the Spanish Society of Neonatology. Neonates with postnatal SARS-CoV-2 infection were included in this study. General data and infection-related information (mode and source of transmission, age at diagnosis, clinical manifestations, need for hospitalization, admission unit, treatment administered, and complementary studies performed, hospital stay associated with the infection) were collected. Results: A total of 40 cases, 26 community-acquired and 14 nosocomial were registered. Ten were preterm newborns (2 community-acquired and 8 nosocomial COVID-19 cases). Mothers (in both groups) and healthcare workers (in nosocomial cases) were the main source of infection. Hospital admission was required in 22 community-acquired cases [18 admitted to the neonatal intermediate care unit (NIMCU) and 4 to the neonatal intensive care unit (NICU)]. Among nosocomial COVID-19 cases (n = 14), previously admitted for other reasons, 4 were admitted to the NIMCU and 10 to the NICU. Ten asymptomatic patients were registered (5 in each group). In the remaining cases, clinical manifestations were generally mild in both groups, including upper respiratory airways infection, febrile syndrome or acute gastroenteritis with good overall health. In both groups, most severe cases occurred in preterm neonates or neonates with concomitant pathologies. Most of the cases did not require respiratory support. Hydroxychloroquine was administered to 4 patients in the community-acquired group and to 2 patients in the nosocomial group. Follow-up after hospital discharge was performed in most patients. Conclusions: This is the largest series of COVID-19 neonatal cases in Spain published to date. Although clinical manifestations were generally mild, prevention, treatment, and management in this group are essential.

Goal commitment evolution in a Spanish adolescent sample with cannabis use disorder.

INTRODUCTION: The treatment of adolescents with Cannabis Use Disorder (CUD) presents a variety of challenges. The identification of a patient's treatment goal might be an important predictor of cannabis consumption and a key factor when designing the intervention. This paper aims to present the psychometric properties of the Spanish version of the Adolescent Substance Abuse Goal Commitment (ASAGC) questionnaire in adolescent consumers of cannabis and to report the association of goal commitment with the treatment outcome. METHOD: A sample of 115 adolescents between 13 and 18 years old with CUD in outpatient treatment were evaluated. Psychometric properties including exploratory and confirmatory factor analysis, predictive validity, reliability and stability over time were analyzed. RESULTS: ASAGC shows good psychometric properties, with excellent reliability (Cronbach's α of >0.95 for both subscales, Abstinence and Harm Reduction) at baseline and 3 and 6 months (>0.95 for both subscales) and good stability at 3 and 6 months (K = 0.572 and 0.659). Higher scores in Commitment to abstinence at baseline are associated with lower scores of THC in urine at 3 and 6 months (p < .001). CONCLUSION: The ASAGC is a useful tool to study treatment commitment in adolescents that present a CUD. Abstinence commitment is a reliable prognostic factor. However, adolescents committed to HR remain a therapeutic challenge.

Compliance With Biochemical Objectives in Patients on Renal Replacement Therapy Before Kidney Transplantation in Mexico.

OBJECTIVES: The biochemical conditions in which patients arrive before renal transplantation (RT) are rarely evaluated; examples of them are found in the Dialysis Outcomes and Practice Patterns Study (DOPPS). The objective of our study was to ascertain the fulfillment of biochemical goals for patients on renal replacement therapy before RT. MATERIAL AND METHODS: Observational, retrospective study of patients who were on a RT protocol between 2012 and 2017 in 2 RT centers in Mexico. The records of 1188 patients with a history of RT and their lab results before transplantation were analyzed. Anthropometric values including hemoglobin, iron levels, calcium, phosphorus, parathyroid hormone, urea, creatinine, uric acid, and left ventricular ejection fraction were studied. All values were categorized as low, optimal, or high levels. RESULTS: The fulfillment of pretransplant biochemical objectives for elimination of azotemia (urea and creatinine) was achieved in 60% of the patients. Optimal values for calcium were found in 715 (64%) patients and optimal values for albumin were found in 690 (61.8%) patients. In the case of phosphorus, hemoglobin, uric acid, and parathyroid hormone, the optimal values were below 50%. CONCLUSIONS: It is essential to improve compliance with biochemical and clinical objectives for patients on renal replacement therapy (dialysis, hemodialysis) before RT. Only half of the variables were within the optimal range before surgical intervention took place.

Holter heart rhythm disorders in patients with acute kidney injury during hemodialysis / Trastornos del ritmo cardiaco por Holter en pacientes con lesión renal aguda durante hemodiálisis

BACKGROUND: The presence of acute renal injury has been associated with increased cardiovascular morbidity and mortality (sudden death and arrhythmias). OBJECTIVE: To know the frequency of heart rhythm disorders documented by Holter in patients in need of intermittent hemodialysis due to acute renal injury. MATERIAL AND METHODS: A prospective observational study was conducted including patients with a diagnosis of acute renal injury who received intermittent hemodialysis; demographic, clinical and laboratory data were collected from 28 patients. Monitoring was carried out through Holter before, during and after the hemodialysis session. Nonparametric statistics were used, with a significant value of p < 0.05. Risks were established with logistic regression. RESULTS: There was a significant difference in supraventricular extra systoles (82.1% vs. 57.1%), ventricular extra systoles (26.7% vs. 3.6%), and supraventricular tachycardia (6.7% vs. 3.6%). The rest of the rhythm alterations without significance. CONCLUSIONS: Intermittent hemodialysis is a factor associated with the appearance of heart rhythm disorders. The death of patients with acute renal injury and substitution was related to ventricular extra systole detected by transhemodialysis Holter.

INTRODUCCIÓN: La presencia de lesión renal aguda se ha asociado a unas mayores morbilidad y mortalidad de causa cardiovascular (muerte súbita y arritmias). OBJETIVO: Conocer la frecuencia de trastornos del ritmo cardiaco documentado por Holter en pacientes con necesidad de hemodiálisis intermitente por lesión renal aguda. MATERIAL Y MÉTODOS: Se realizó un estudio observacional, prospectivo, en pacientes con diagnóstico de lesión renal aguda que recibieron hemodiálisis intermitente; se recabaron datos demográficos, clínicos y de laboratorio de 28 pacientes. Se realizó monitoreo mediante Holter, previo, durante y posterior a la sesión de hemodiálisis. Se utilizó estadística no paramétrica, con un valor significativo de p < 0.05. Se establecieron riesgos con regresión logística. RESULTADOS: Hubo diferencia significativa en extrasístoles supraventriculares (82.1% frente a 57.1%), extrasístoles ventriculares (26.7% frente a 3.6%) y taquicardia supraventricular (6.7% frente a 3.6%). El resto de las alteraciones del ritmo no mostraron significancia. CONCLUSIONES: La hemodiálisis intermitente es un factor asociado a la aparición de trastornos del ritmo cardiaco. La muerte de los pacientes con lesión renal aguda y sustitución estuvo relacionada con la extrasístole ventricular detectada por Holter transhemodiálisis.

COVID-19 pandemic in Mexico: surveillance protocol in intrahospital hemodialysis units. / Pandemia COVID-19 en México: protocolo de vigilancia en unidades de hemodiálisis intrahospitalarias.

On January 30 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as epidemiological emergency. Globally, various guidelines have been published for the safety of patients with chronic kidney disease (CKD) and health personnel working in hemodialysis centers. In Mexico, the prevalence of CKD is 12.2% and 60,000 patients receive some modality of renal replacement therapy at the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security). This proposal for action is made in the face of suspected and confirmed cases of COVID-19 in intrahospital hemodialysis units.

El 30 de enero de 2020, la Organización Mundial de la Salud (OMS) declaró el brote de COVID-19 como emergencia epidemiológica. A nivel mundial han surgido diversos lineamientos para la seguridad de los pacientes que padecen enfermedad renal crónica (ERC) y el personal de salud que labora en centros de hemodiálisis. En México, la prevalencia de ERC es de 12.2% y 60 000 enfermos reciben alguna modalidad de terapia de reemplazo renal en el Instituto Mexicano del Seguro Social (IMSS). Se realiza esta propuesta de actuación ante casos sospechosos y confirmados de COVID-19 en unidades de hemodiálisis intrahospitalaria.

Programas de intervención en acoso escolar y ciberacoso en educación secundaria con eficacia evaluada: una revisión sistemática / Intervention programs in school bullying and cyberbullying in secondary education with effectively evaluated: A systematic review

Resumen En numerosos países no existen hoy normativas que regulen de forma específica e integral la intervención en situaciones de acoso escolar y ciberacoso, sino que existe una diversidad de protocolos y programas que, además, no han sido habitualmente partícipes de un proceso de evaluación de la eficacia de su implementación. El objetivo del presente trabajo tiene como finalidad hacer una revisión sistemática de las publicaciones existentes en las últimas dos décadas de programas de prevención e intervención en acoso escolar y ciberacoso, desarrollados en España, para el estudiantado de secundaria, implementados en escuelas y que, además, hayan incluido una evaluación de su eficacia. Un total de 10 programas cumplieron los criterios de inclusión. El análisis de los programas permite identificar diseños de intervención con eficacia moderada y alta. Sin la diversidad de enfoques, objetivos específicos y medidas de evaluación, no es posible identificar claves de eficacia generalizables.

Abstract There is currently no regulation in many countries that specifically and comprehensively regulates the intervention in bullying and cyberbullying situations, but rather a variety of protocols and programs that, moreover, have not usually been part of a process to evaluate the effectiveness of their implementation. The objective of the present work was to carry out a systematic review of the existing publications in the last two decades on prevention and intervention programs in school bullying and cyberbullying developed in Spain for secondary school students, implemented in schools, and that have also included an evaluation of its effectiveness A total of 10 programs met the inclusion criteria. The analysis of the programs allows the identification of intervention designs with moderate and high efficiency, although the diversity of approaches, specific objectives and evaluation measures does not make it possible to identify generalizable efficiency keys.

Sleep duration in Mexican American children: Do mothers' and fathers' parenting and family practices play a role?

This study examined parenting styles, parenting practices and family practices that may be associated with weeknight sleep duration among 8- to 10-year-old Mexican American (MA) children. This cross-sectional study of MA children used baseline data from a 2-year cohort study of mother-child pairs (n = 308) with additional data on fathers (n = 166). Children's weeknight sleep duration was accelerometer estimated and averaged for 2 weeknights. Parents reported on their parenting styles and practices regarding food and family food-related practices. Multivariable linear regression analysis was used to examine sleep duration with parenting styles and practices, and family practices, and adjusting for child gender and body mass index. Model 1 included mothers' parenting styles and practices; Model 2 included both mothers' and fathers' parenting styles and practices. Children's average sleep duration was 9.5 (SD = 0.8) hr. Mothers who used pressure to encourage their children to eat and those who used food to control behavior had children with longer sleep duration (ß = 0.21, p < 0.01; ß = 0.15, p = 0.03, respectively). Mothers who reported their children ate dinner with the TV on and those who valued eating dinner as a family had children with shorter sleep duration (ß = -0.16, p = 0.01; ß = -0.18, p = 0.01, respectively). Fathers who restricted the amount of food their children ate had children with shorter sleep duration (ß = -0.27, p = 0.01). Mothers' and fathers' feeding practices, the child's eating dinner with the TV on, and valuing family dinners, played a role in children's weeknight sleep duration among Mexican American families. Parental feeding practices and family mealtime contexts may have an effect on children's weeknight sleep duration.

Obstacles to preventing obesity in children aged 2 to 5 years: Latino mothers' and fathers' experiences and perceptions of their urban environments.

BACKGROUND: The prevalence of obesity among Latino children is alarmingly high, when compared to non-Latino White children. Low-income Latino parents living in urban areas, even if they are well-educated, face obstacles that shape familial health behaviors. This study used qualitative methods to explore parents' experiences in providing meals and opportunities to play to their children aged 2 to 5 years. In contrast to most prior studies, this study examined perceptions of familial behaviors among both mothers and fathers. METHODS: An ecological framework for exploring the associations of parental feeding behaviors and children's weight informed this study. An interview guide was developed to explore parents' experiences and perceptions about children's eating and physical activity and administered to six focus groups in a community-based organization in the Mission District of San Francisco. Transcripts were coded and analyzed. Twenty seven mothers and 22 fathers of Latino children ages 2 to 5 participated. RESULTS: Mothers, fathers, and couples reported that employment, day care, neighborhood environments and community relationships were experienced, and perceived as obstacles to promoting health behavior among their children, including drinking water instead of soda and participating in organized playtime with other preschool-age children. CONCLUSIONS: Results from this study suggest that the parents' demographic, social and community characteristics influence what and how they feed their children, as well as how often and the types of opportunities they provide for physical activity, providing further evidence that an ecological framework is useful for guiding research with both mothers and fathers. Mothers and fathers identified numerous community and society-level constraints in their urban environments. The results point to the importance of standardized work hours, resources for day care providers, clean and safe streets and parks, strong community relationships, and reduced access to sugar-sweetened beverages in preventing the development of obesity in preschool-age Latino children.