SIMUNEO: Control and Monitoring System for Lung Ultrasound Examination and Treatment of Neonatal Pneumothorax and Thoracic Effusion.

Training with real patients is a critical aspect of the learning and growth of doctors in training. However, this essential step in the educational process for clinicians can potentially compromise patient safety, as they may not be adequately prepared to handle real-life situations independently. Clinical simulators help to solve this problem by providing real-world scenarios in which the physicians can train and gain confidence by safely and repeatedly practicing different techniques. In addition, obtaining objective feedback allows subsequent debriefing by analysing the situation experienced and learning from other people's mistakes. This article presents SIMUNEO, a neonatal simulator in which professionals are able to learn by practicing the management of lung ultrasound and the resolution of pneumothorax and thoracic effusions. The article also discusses in detail the hardware and software, the main components that compose the system, and the communication and implementation of these. The system was validated through both usability questionnaires filled out by neonatology residents as well as through follow-up sessions, improvement, and control of the system with specialists of the department. Results suggest that the environment is easy to use and could be used in clinical practice to improve the learning and training of students as well as the safety of patients.

Nasal Intermittent Positive Pressure Ventilation and Bronchopulmonary Dysplasia Among Very Preterm Infants Never Intubated During the First Neonatal Admission: A Multicenter Cohort Study.

Introduction: While non-invasive positive-pressure ventilation (NIPPV) is increasingly used as a mode of respiratory support for preterm infants, it remains unclear whether this technique translates into improved respiratory outcomes. We assessed the association between NIPPV use and bronchopulmonary dysplasia (BPD)-free survival in never intubated very preterm infants. Methods: This multicenter cohort study analyzed data from the Spanish Neonatal Network SEN1500 corresponding to preterm infants born at <32 weeks gestational age and <1,500 g and not intubated during first admission. The exposure of interest was use of NIPPV at any time and the main study outcome was survival without moderate-to-severe BPD. Analyses were performed both by patients and by units. Primary and secondary outcomes were compared using multilevel logistic-regression models. The standardized observed-to-expected (O/E) ratio was calculated to classify units by NIPPV utilization and outcome rates were compared among groups. Results: Of the 6,735 infants included, 1,776 (26.4%) received NIPPV during admission and 6,441 (95.6%) survived without moderate-to-severe BPD. After adjusting for confounding variables, NIPPV was not associated with survival without moderate-to-severe BPD (OR 0.84; 95%CI 0.62-1.14). A higher incidence of moderate-to-severe BPD-free survival was observed in high- vs. very low-utilization units, but no consistent association was observed between O/E ratio and either primary or secondary outcomes. Conclusion: NIPPV use did not appear to decisively influence the incidence of survival without moderate-to-severe BPD in patients managed exclusively with non-invasive ventilation.

Serratia marcescens outbreak in a neonatology unit of a Spanish tertiary hospital: Risk factors and control measures.

BACKGROUND: We describe the investigation undertaken and the measures adopted to control a Serratia marcescens outbreak in the neonatology unit of La Paz University Hospital in Madrid, Spain. METHODS: Weekly rectal and pharyngeal screenings for S marcescens were performed in the neonates starting after detection of the outbreak. Environmental samples and samples from health care workers (HCWs) were obtained for microbiological analysis. An unmatched case-control study was carried out to investigate risk factors for infection/colonization. RESULTS: The outbreak began in June 2016 and ended in March 2017, affecting a total of 59 neonates. Twenty-five (42.37%) neonates sustained an infection, most frequently conjunctivitis and sepsis. Multivariate logistic regression identified the following risk factors: parenteral nutrition (odds ratio [OR], 103.4; 95% confidence interval [CI], 11.9-894.8), history of previous radiography (OR, 15.3; 95% CI, 2.4-95.6), and prematurity (OR, 5.65; 95% CI, 1.5-21.8). Various measures were adopted to control the outbreak, such as strict contact precautions, daily multidisciplinary team meetings, cohorting, allocation of dedicated staff, unit disinfection, and partial closure. Hands of HCWs were the main suspected mechanism of transmission, based on the inconclusive results of the environmental investigation and the high number of HCWs and procedures performed in the unit. CONCLUSIONS: S marcescens spreads easily in neonatology units, mainly in neonatal intensive care units, and is often difficult to control, requiring a multidisciplinary approach. Strict measures, including cohorting and medical attention by exclusive staff, are often needed to get these outbreaks under control.

Recomendaciones para la asistencia respiratoria en el recién nacido (IV). Ventilación de alta frecuencia, ex-utero intrapartum treatment (EXIT), oxigenador de membrana extracorpórea (ECMO) / Recommendations for respiratory support in the newborn (IV). High frequency ventilation, ex-utero intrapartum treatment (EXIT), extracorporeal membrane oxygenation (ECMO)

Las recomendaciones incluidas en este documento forman parte de una revisión actualizada de la asistencia respiratoria en el recién nacido. Están estructuradas en 12 módulos, y en este trabajo se presenta el módulo 8. El contenido de cada módulo es el resultado del consenso de los miembros del Grupo Respiratorio y Surfactante de la Sociedad Española de Neonatología. Representan una síntesis de los trabajos publicados y de la experiencia clínica de cada uno de los miembros del grupo (AU)

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into 12 modules, and in this work module 8 is presented. Each module is the result of a consensus process amongst all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, as well as the clinical experience of each one of the members of the group (AU)

[Recommendations for respiratory support in the newborn (IV). High frequency ventilation, ex-utero intrapartum treatment (EXIT), extracorporeal membrane oxygenation (ECMO)]. / Recomendaciones para la asistencia respiratoria en el recién nacido (IV). Ventilación de alta frecuencia, ex-utero intrapartum treatment (EXIT), oxigenador de membrana extracorpórea (ECMO).

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into 12 modules, and in this work module 8 is presented. Each module is the result of a consensus process amongst all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, as well as the clinical experience of each one of the members of the group.