Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas / Sedation and analgesia practices among Spanish neonatal intensive care units

INTRODUCCIÓN: El manejo del dolor y la sedación es una prioridad de los cuidados intensivos neonatales. Se diseñó un estudio con el objetivo de determinar la práctica clínica actual en relación con la sedación y la analgesia en unidades de cuidados intensivos neonatales en España e identificar factores asociados al uso de fármacos sedantes o analgésicos. MÉTODO: Estudio multicéntrico, observacional, longitudinal y prospectivo. RESULTADOS: Participaron 30 unidades neonatales y se reclutó a 468 neonatos. De estos, 198 (42,3%) recibieron medicación sedante o analgésica. En total, se usaron durante el período de estudio 19 fármacos distintos, de los cuales el más utilizado fue el fentanilo. Solo fentanilo, midazolam, morfina y paracetamol se usaron al menos en un 20% de los neonatos que recibieron sedación y/o analgesia. Se usaron 14 pautas distintas de fármacos en perfusión, siendo las más frecuentes la infusión de fentanilo y la combinación de fentanilo y midazolam. Las variables asociadas a recibir sedación y/o analgesia fueron el haber precisado ventilación invasiva (p = < 0,001; OR = 23,79), un score de CRIB>3 (p = 0,023; OR = 2,26), la existencia en la unidad de guías de evaluación del dolor (p < 0,001; OR = 3,82) y de un líder de dolor (p = 0,034; OR = 2,35). CONCLUSIONES: Casi la mitad de los neonatos ingresados en cuidados intensivos recibe medicación sedante y/o analgésica. Existe una importante variabilidad entre las unidades neonatales españolas en relación con las pautas de sedación y analgesia. Nuestros resultados permiten conocer el «estado del arte» y pueden servir de base para la elaboración de guías de práctica clínica a nivel nacional

INTRODUCTION: Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. METHOD: A multicenter, observational, longitudinal and prospective study. RESULTS: Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P<.001; OR=23.79), a CRIB score >3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (P<.001; OR=3.82), and a pain leader(P=.034; OR=2.35). CONCLUSIONS: Almost half of the neonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the 'state of the art', and could serve as the basis of preparing clinical practice guidelines at a national level

[Sedation and analgesia practices among Spanish neonatal intensive care units]. / Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas.

INTRODUCTION: Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. METHOD: A multicenter, observational, longitudinal and prospective study. RESULTS: Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P<.001; OR=23.79), a CRIB score >3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (P<.001; OR=3.82), and a pain leader (P=.034; OR=2.35). CONCLUSIONS: Almost half of the neonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level.

[Impact of hospitalization of an infant during breast-feeding: mother-child investigation]. / Impact de l'hospitalisation d'un nourrisson sur la poursuite de l'allaitement maternel: enquête Mères/Soignants.

A real health priority for governments, breastfeeding has prompted WHO and UNICEF to create the "Baby-Friendly Hospital Initiative" for maternity units respecting the "ten steps to successful breastfeeding". This effort does not include pediatric departments. However, as the properties of breast milk enhance recovery of the infant, it is also important to promote breastfeeding in this branch. Furthermore, few studies have analyzed the constraints of hospitalization on the breastfeeding process. The aim of this study is to identify the constraints imposed by hospitalization on the process of breastfeeding in infants aged 29 days to 6 months suffering from acute disease, during hospitalization and within a week following their return home. This prospective study was conducted between October 1st and December 31st, 2008 in a pediatric department through interviews and questionnaires from breastfeeding mothers and health professionals. 51 mother-infant pairs and 35 caregivers were included in the study. During hospitalization; direct breastfeeding was interrupted for 31 mothers. After hospitalization, 3 mothers had weaned their babies, 12 went from exclusive breastfeeding to mixed feeding and 13 had experienced difficulties. Caregivers partially meet WHO's recommendations. The hospitalization of an infant disrupts the continuation of breastfeeding. To overcome this, actions must be taken in relation with hospitals, departments and professionals. The study's small sample does not prove that the original training of caregivers influence theirs practices.

EELS study of niobium carbo-nitride nano-precipitates in ferrite.

Micro-alloying steels allow higher strength to be achieved, with lower carbon contents, without a loss in toughness, weldability or formability through the generation of a fine ferrite grain size with additional strengthening being provided by the fine scale precipitation of complex carbo-nitride particles. Niobium is reported to be the most efficient micro-alloying element to achieve refinement of the final grain structure. A detailed microscopic investigation is one of the keys for understanding the first stages of the precipitation sequence, thus transmission electron microscopy (TEM) is required. Model Fe-(Nb,C) and Fe-(Nb,C,N) ferritic alloys have been studied after annealing under isothermal conditions. However the nanometre scale dimensions of the particles makes their detection, structural and chemical characterization delicate. Various imaging techniques have then been employed. Conventional TEM (CTEM) and high resolution TEM (HRTEM) were used to characterise the morphology, nature and repartition of precipitates. Volume fractions and a statistical approach to particle size distributions of precipitates have been investigated by energy filtered TEM (EFTEM) and high angle annular dark field (HAADF) imaging. Great attention was paid to the chemical analysis of precipitates; their composition has been quantified by electron energy loss spectroscopy (EELS), on the basis of calibrated 'jump-ratios' of C-K and N-K edges over the Nb-M edge, using standards of well-defined compositions. It is shown that a significant addition of nitrogen in the alloy leads to a complex precipitation sequence, with the co-existence of two populations of particles: pure nitrides and homogeneous carbo-nitrides respectively.

Ethylene spectroscopy using a quasi-room-temperature quantum cascade laser.

Spectroscopic measurements on ethylene were performed using a quasi-room-temperature quantum cascade (QC) laser operated in pulsed mode in the 10.3 microm range. Using transmission spectroscopy, a broadening of the ethylene absorption spectrum was observed with increasing laser pulse duration, due to an increase of the laser linewidth. This linewidth was determined from the measured absorption spectra, showing a value of 0.04 cm(-1) for a 20 ns pulse duration and an enhancement coefficient of 6.5 x 10(-3) cm(-1) per ns in the 20-50 ns pulse length range. Photoacoustic (PA) detection of ethylene was also performed using the QC laser and a resonant PA cell, with a detection limit of 60 ppm.