[Clinical course of children of mothers with addictions into a neonatal intensive care unit in western Mexico]. / Evolución clínica de hijos de madres con adicciones internados en una unidad de terapia intensiva neonatal del Occidente de México.

BACKGROUND: Pregnancy in women addicted represents, in itself, a major risk of destruction of physical and mental health of the unborn child; urgent prevention is the same as essential to providing quality care to the mother and child knowledge. OBJECTIVE: Describe the physical and sociodemographic characteristics of neonates in intensive care units, born of mothers with addictions. MATERIALS AND METHOD: Cross-sectional, descriptive study of neonates with addict mothers, analyzing age, gender, clinical symptoms and complications. Findings for frequency-percentages with regard to qualitative variables, and medians and ranges for quantitative variables. SPSS-20.0-Windows Statistics software package. RESULTS: 618 patients admitted to the NICU, 180(29%) showing withdrawal symptoms; irritability in 117 (63%), intensive crying in 93 (51%), spontaneous Moro reflex 74 (42%), diarrhea 61 (30%), fever 61 (30%). Birth defects 124 (20%), from greater to lesser occurrence: disorders in central nervous system, digestive tract and abdominal wall, extremities, kidneys, and others. 309 (50%) weight lower than 2600g. The most frequent metabolic disorders were hypoglycemia, Metabolic Acidosis and jaundice, among others. CONCLUSIONS: Every day, we see more children born of substance-dependent mothers in the Mexico. Our study reveals high mortality rate and many complications for this group; thus, it becomes necessary to institute preventive measures among Mexican women of childbearing age in order to prevent illegal drug use and to increase treatment among pregnant addicts. Gynecologists, pediatricians and neonatologists must have extensive knowledge regarding the entire clinical-social spectrum of symptoms that may be observed in children of mothers suffering addictions.

[Tuberculosis in perinatal stage. A challenge to the binomial care mother-son. Report of two cases]. / Tuberculosis en la etapa perinatal. Un reto en la atención de la madre y su hijo. Reporte de dos casos clínicos.

Case report of 18-year old female patient with clinical signs of pulmonary tuberculosis during pregnancy at beginning of fourth month into term, with airway impairment, as evidenced by dry cough, fever and night sweats, as well as a 6 kg. weightloss. Twenty-two days after giving birth, the patient was hospitalized with high fever and deteriorated health conditions, requiring treatment in the intensive care unit due to complications such as severe malnutrition, septic shock, pulmonary abscess, pachypleuritis, empyema and bronchopleural fistula. The tuberculosis diagnosis was established through ABF identification with Ziehl-Neelsen stain of the pleural fluid. The patient was hospitalized for 42 days, including eleven days on a mechanical ventilator, before being discharged. Her newborn daughter was admitted to the Pediatric Intensive Care Unit on the 19th day of life due to coughing, fever, difficulty in breathing, liquid stool and rejecting food. The newborn was hospitalized in the newborn intensive care unit for twenty-two days, developing major sepsis and multiple organ failure, which complications led to her death. An autopsy was conducted, revealing granulomatous lesions consistent with tuberculosis in lungs, liver, small intestine, large intestine and peritoneum; additionally the PCR of bronchial aspirate was positive to Mycobacterium tuberculosis DNA.

Transporte neonatal seguro en la población abierta del estado de Jalisco: impacto del programa S.T.A.B.L.E. en la morbilidad y mortalidad / Safe neonatal transport in Jalisco state: impact of S.T.A.B.L.E. program on morbidity and mortality

Introducción. El transporte neonatal desde las unidades médicas hasta las unidades de tercer nivel en muchos casos es desorganizado y arriesgado, situación que compromete aún más el estado de salud del neonato enfermo. El objetivo del estudio fue analizar el impacto del programa S.T.A.B.L.E. (de las siglas en inglés: Sugar and Safe care, Temperature, Airway, Blood, Lab work, Emotional support) en la morbimortalidad de los neonatos trasladados del interior del estado de Jalisco y de la zona metropolitana de Guadalajara, a la Unidad de Cuidados Intensivos Neonatales Externos (UCIN-EX) del Hospital Civil de Guadalajara. Métodos. Se diseñó un estudio prospectivo de 2005 a 2009. El proceso de intervención se basó en la aplicación del programa S.T.A.B.L.E. a todo neonato que requirió ser trasladado. Esto se logró con la intervención de los médicos reguladores del Sistema de Atención Médica de Urgencias (SAMU) del estado de Jalisco. Se implementó un curso de capacitación para el personal médico y paramédico de los centros de atención que refieren pacientes a nuestra unidad, con el fin darles a conocer el programa S.T.A.B.L.E. y su forma de aplicación. Resultados. Un total de 3,277 neonatos fueron incluidos en el estudio, 384 antes de implementar el programa y 2,893 con la aplicación del programa S.T.A.B.L.E. En el grupo con intervención se observó una frecuencia mayor de pacientes con temperatura corporal normal a su ingreso a la unidad receptora [516 (87%) vs. 227 (59%) p < 0.01 ], así como cifras de glicemia en rangos normales [690 (93%) vs. 173 (45%) p < 0.001]. La mortalidad durante el periodo de hospitalización en la unidad receptora fue menor en el grupo con intervención [405 (14%) vs. 84 (22%) p < 0.05]. Después del proceso de intervención, más pacientes fueron trasladados en incubadora [2,806 (97%) vs. 200 (52%) p < 0.001]; de igual forma, en más pacientes se aplicaron métodos de monitoreo de oximetría de pulso [2,575 (89%) vs. 235 (61 %) p < 0.01 ]. En cuanto al número de transportes neonatales regulados y autorizados por el sistema SAMU, se observó un incremento a favor del grupo con intervención [2,806 (97%) vs. 234(61%) p < 0.001]. La frecuencia de defunciones durante el transporte neonatal no presentó diferencias [30 (1 %) vs. 10 (2.6%) p = NS]. Conclusiones. El traslado de neonatos enfermos al tercer nivel de atención médica en el estado de Jalisco se realizó de forma segura, con una mejoría importante en la morbilidad. El programa S.T.A.B.L.E. fue altamente eficiente y de fácil aplicación. La disminución de la mortalidad de los pacientes con intervención del programa durante el periodo de hospitalización requiere estudios especialmente diseñados para establecer posibles asociaciones.

Background. Transporting newborn infants to third-level units is often disorganized, thus entailing several risks that may further compromise the health of newborn patients. Methods. A prospective study was designed in orderto assess the impact ofthe S.T.A.B.L.E. program (Sugarand Safe Care, Temperature, Airway, Blood, Lab work, Emotional support) from 2005 to 2009 in regard to morbidity and mortality rates of newborn patients who had to be transferred from other regions within Jalisco state or within Guadalajara's metropolitan area to the Neonatal Intensive Care Unit ofthe Civil Hospital in Guadalajara. The intervention process was based on applying the S.T.A.B.L.E. program to all newborns who needed to be transferred and was achieved with the intervention ofthe physicians regulating the Emergency Medical Assistance System (SAMU) of the state of Jalisco. A training course, as well as an educational brochure, was given to medical and paramedical staff from the medical assistance centers referring patients to our unit in orderto provide them with information on the S.T.A.B.L.E. program and its implementation. Results. A total of 3,277 newborn infants were included in the study, 384 before the intervention program and 2,893 once the S.T.A.B.L.E. program was implemented. Within the group transferred after the program's implementation, we observed a greater incidence of patients with normal body temperature upon admission to the receiving unit [516 (87%) vs. 227 (59%); p < 0.01 ] as well as with blood glucose figures within the normal range [690 (93%) vs. 173 (45%); p < 0.001]. Mortality during the hospitalization period in the receiving unit was lower in the group treated after the program's implementation [405 (14%) vs. 84 (22%); p < 0.05]. After the intervention process, more patients were transported in incubators [2,806 (97%) vs. 200 (52%); p < 0.001] and equally, pulse oximetry monitoring methods were applied in a greater number of patients [2,575 (89%) vs. 235 (61 %); p < 0.01 ]. With regard to the number of transfers of newborns that were regulated and authorized by the SAMU system, we also observed an increase in such numbers for the group treated after the intervention program [2,806 (97%) vs. 234 (61 %); p < 0.001]. There was no difference in the incidence of death during the newborns' transport [30 (1%) vs. 10 (2.6%); p = NS]. Conclusions. Transfer of ill newborns to third-level medical care units in the state of Jalisco was safely undertaken with a significant improvement in morbidity rates. The S.T.A.B.L.E. program was highly effective and easy to implement. The decrease in mortality during the hospitalization period of patients treated after the intervention program merits further studies especially designed to establish possible associations.

[Out-of-hospital delivery. Experience of ten years in Jalisco, Mexico]. / Parto fortuito. Experiencia de diez años en Jalisco, México.

BACKGROUND: Birth without medical assistance, or outs hospitals is defined as one that occurs without the optimal medical and health care conditions for mother and son pairing. Frequency of this phenomenon is not known in Mexico. OBJECTIVE: To observe clinical outcomes, morbidity, mortality, epidemiological and geographical patterns. MATERIAL AND METHOD: A retrospective study including newborns of mothers who have had deliveries without medical assistance in accidental conditions, admitted to Unidad de Cuidados Intensivos Neonatales Externos, Hospital Civil de Guadalajara Fray Antonio Alcalde (Mexico). From January 2000 to December 2009. RESULTS: In 4,762 (100%) neonatal records evaluated, 582 (12%) were newborns birth for deliveries out of hospital. 314 (54%) female and 268 (46%) male, first mother's gravidity 195 (33%) and second o more gravidity 387 (68%) were registered. The Hospital stay average was 3-day. Discharge diagnoses: healthy 463 (79%), neonatal sepsis 16 (4%), respiratory distress 35 (6%), jaundice 33 (6%), pneumonia 12 (2%), metabolic disorders 13 (3%), other diagnoses 10 (2%). Place of births: 366 Guadalajara metropolitan area (63%), state of Jalisco, 180 (31%) other states of the Mexican Republic 36 (6%). Lambed at home 117 (20%), 52 bath home (9%), toilet bowl 29 (5%), car 128 (22%), road 58 (10%), hospital admission 104 (18%), Ambulance 42 (7%) Other 52 (9%). CONCLUSION: In our study we observed that 79% of the newborns were healthy. They are the third leading cause of admission to Neonatal Intensive Care Unit External. The most common neonatal complications were solved without consequence. No neonatal mortality cases were founded.

Hijos de madres adictas con síndrome de abstinencia en Terapia Intensiva Neonatal / Neonatal abstinence syndrome in a Neonatal Intensive Care Unit

Introducción. En años recientes, se ha incrementado el consumo de drogas en mujeres mexicanas durante la gestación, surgiendo como entidad el síndrome del feto adicto y el síndrome de abstinencia en el neonato (SAN). Objetivo: caracterizar una muestra de neonatos, hijos de madres adictas a drogas ilícitas y que desarrollaron síndrome de abstinencia, así como conocer la respuesta terapéutica del fenobarbital en estos pacientes. Métodos. Se aplicó en forma prospectiva un cuestionario estructurado sobre la madre y el producto de todos los hijos de madres consumidoras de drogas ilegales que ingresaron a la Unidad de Cuidados Intensivos Neonatales Externos del Antiguo Hospital Civil de Guadalajara "Fray Antonio Alcalde" entre el 1 de enero de 2003 y el 20 de diciembre de 2007, por presentar SAN. Resultados. Noventa y dos neonatos desarrollaron SAN durante el período evaluado. La media de la edad materna fue de 22 años, con un bajo nivel educacional. La droga más utilizada por las madres fue la cocaína, y 10 de ellas resultaron VIH-positivas. La edad gestacional promedio fue de 37 semanas. El peso al nacer, la talla corporal y el conteo de Apgar promedios fueron de 2 600 g, 47 cm y 9 puntos, respectivamente. El síntoma más frecuente fue la irritabilidad (77% de la muestra), y en todos los casos el tratamiento con fenobarbital resultó adecuado para el control clínico de los síntomas y signos. Conclusiones. El SAN constituyó 3.5% del total de ingresos en nuestra institución durante un período de 4 años. En general, los neonatos mostraron cortejo sintomático similar al reportado previamente en la literatura. Se observó una alta incidencia de infecciones concurrentes -en particular, VIH- y un predominio de la cocaína y la marihuana como las drogas más consumidas por las madres. El tratamiento con fenobarbital resultó exitoso para el control de síntomas y signos en todos los casos. Dada su incidencia e importancia clínica, el uso de drogas durante el embarazo y sus consecuencias sobre el producto merecen un estudio más consistente e intensivo en México.

Introduction. To our knowledge, in spite of the increasing drug-abuse statistics in Mexican pregnant women, there are no published clinical researches approaching this issue in our country. We describe the characteristics of neonatal abstinent infants admitted in the Neonatal Intensive Care Unit (NICU) located at the Hospital Civil of Guadalajara. Objective: To describe the characteristics of a sample of neonatal abstinent children as well as the efficacy of phenobarbital as a pharmacological alternative. Methods. Children from drug dependent mothers who were admitted to NICU from January 1st 2003 to December 20th 2007 and developed the neonatal abstinence syndrome (NAS) were prospectively evaluated with a structured feedback form including parental data. Results. Ninety two NAS cases (3.5% of the total) were recruited in the assessed period. Mother's mean age was about 22 years with a low educational profile. The most common drug consumed by the mothers was cocaine (35%). Ten mothers had HIV-positive results, while the neonatal averaged gestational age was 37 weeks. Birth weight, corporal size and Apgar score mean values were 2 600 g, 47 cm and 9 points, respectively. The most common symptom was irritability in 77% of the patients. All the cases were treated with phenobarbital reaching a successful clinical remission of the symptoms. Conclusions. NAS represented the 3.5% of all the neonate patients admitted in NICU throughout 4 years. Our observations correspond to those previously reported in the literature. High incidence of concomitant infectious conditions was observed -especially HIV- and the predominant used drugs were cocaine and marijuana. Due to its high incidence and clinical relevance, drug-abuse during pregnancy ought to have further study in our country.