Experiences of water immersion during childbirth: a qualitative thematic synthesis.

BACKGROUND: The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence-based care aimed at promoting women's participation in informed decision-making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women's autonomy and well-being during childbirth. Currently, water immersion is used as a non-pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women's and midwives' experiences, values, and preferences regarding water immersion during childbirth. METHODS: A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non-qualitative studies, mixed-methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. RESULTS: Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. CONCLUSIONS: The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rigorous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results.

Artritis séptica de hombro por E. coli en un prematuro / Septic arthritis of the shoulder caused by E. coli infection in a premature infant

Presentamos el caso de un prematuro de 33 semanas y 1600 g, con antecedente de traslado en las primeras 12 horas de vida a la Unidad de Cuidados Intensivos Neonatales de un hospital terciario por hipertensión pulmonar grave y afectación multiorgánica, que a su regreso a nuestro centro a las 37 semanas corregidas comienza con decaimiento y pausas de apnea. Tras un inicio de cuadro subagudo e inespecífico, con alteraciones analíticas discretas, presenta progresivamente tumefacción, dolor e impotencia funcional del hombro derecho. Se realiza el diagnóstico de artritis séptica del mismo tras evidenciar derrame articular por ecografía y obtener líquido articular purulento en la punción-aspiración. Recibe precozmente antibioterapia empírica, que se ajusta al antibiograma una vez que se conoce que crece un E. coli sin resistencias en el líquido articular. La mejoría es inicialmente lenta pero, tras tres semanas de antibioterapia intravenosa sin necesidad de cirugía abierta, la recuperación es franca aunque no total. Completa otras tres semanas de antibioterapia oral con cefuroxima-axetilo en dosis altas. La evolución en su seguimiento es adecuada, con normalización y desaparición del derrame articular a los cinco meses de edad (AU)

We present the case of a premature infant 33 weeks of gestational age and 1600 g, that had required intensive care at a tertiary hospital due to refractory pulmonary hipertensión and multiorganic illness, at his return to our center, at 37 weeks of corrected gestational age, with a peripheral line in his right axilla, presents with frequent apneas and feeding intolerance. The initial presentation is subacute and unspecific, with discrete alterations in his blood tests, but progressively starts with inflammatory signs, pain and shoulder movement limitations. Septic arthritis is diagnosed after revealing joint effusion by ultrasonography and obtaining synovial fluid with purulent characteristics by needle aspiration. He was started on empiric intravenous antibiotics that were later adjusted according to the antibiogram once the results for the synovial fluid culture turned positive for E. coli. Clinical recovery was slow at first, but clearly improved throughout a three week intravenous antibiotic course, and the infant did not need open surgery. At discharge, there was an almost full recovery in terms of movement range of the shoulder and he was pain free. The infant completed another three weeks of oral antibiotics with cefuroxime-axetile. Ongoing follow-up yielded excellent results (AU)

Sistemas de ventilación no invasiva de alto flujo en neonatología: revisión y aproximación a su utilización en hospitales de la Comunidad de Madrid / High flow non-invasive ventilation systems: review and approximation to its use in hospitals throughout Madrid

El uso de sistemas de ventilación de alto flujo ha ido creciendo en el ámbito de la neonatología en los últimos años. Estos dispositivos difieren de los sistemas de ventilación de presión continua (CPAP), por ejemplo, en la necesidad de que exista una fuga pericánula variable, y no deben emplearse como sustitutos de la CPAP. Es fundamental garantizar un adecuado calentamiento y humidificación del flujo para su correcta utilización. Sin embargo, a pesar de los numerosos estudios que intentan demostrar su eficacia y seguridad, y de la impresión subjetiva de ser un buen método de oxigenoterapia no invasiva, tanto en niños nacidos a término como en prematuros, aún desconocemos la presión espiratoria final exacta que generan en la orofaringe, y en qué patologías deben emplearse; por tanto, de momento no se pueden establecer protocolos de uso estandarizados (AU)

There is an increasing use of heated and humidified high flow ventilation systems in neonatology. There are some clear differences with continued airway pressure ventilation systems, such as the need for a variable nose leak. Heated and humidified airflow is imperative for its correct use. Despite a wide number of studies attempting to demonstrate its safety and effectiveness, and the general impression that it is a valid mode of oxygen therapy, both in preterm and term babies, we still do not know precisely what end expiratory pressure is being generated or in what scenarios to use it, therefore no standardized protocols for its use have currently been established (AU)

Cianosis central secundaria a hiperproducción de leche materna en un neonato / Central cyanosis in a newborn secondary to over production of milk in the mother

Presentamos el caso de un neonato que comienza con episodios de cianosis a las 48 horas de vida. Se realiza un diagnóstico diferencial completo y las pruebas complementarias indicadas, descartando patología cardiaca, neurológica, infecciosa o metabólica como causante. A partir de su ingreso, se evidencia clínicamente una hiperproducción de leche materna con cuadros de desaturación en clara relación con las tomas. Se implementan medidas de control de la producción de leche y del flujo de eyección de la misma con excelentes resultados. Evolutivamente, la niña pasa a tolerar bien las tomas, y la producción de leche se va regulando acorde a sus necesidades (AU)

A two day old neonate presenting with central cianosis episodes, undergoes a full differential diagnosis and the necessary laboratory and ultrasound tests. No cardiac, neurologic, infectious or metabolic cause is found for these episodes. Upon being admitted to the neonatal unit, the mother presents with clear signs of milk overproduction and the baby is seen to have desaturation falls during breastfeeding. Complete clinical improvement occurs after implementing milk production and ejection flow control strategies. The baby is found to tolerate breastfeeding perfectly thereafter and the mother's milk production gradually descends according to the baby's needs (AU)

El prematuro tardío: el gran olvidado / Late preterm infant: the forgotten patient

Los recién nacidos prematuros tardíos son aquellos nacidos a una edad gestacional entre la semana 34+0 y 36+6. Estos niños tienen tasas de morbilidad más altas que los recién nacidos a término por su relativa inmadurez fisiológica y metabólica, lo que conlleva una estancia hospitalaria prolongada y un aumento del coste económico. Además, la tasa de reingreso y la mortalidad son también mayores que en los nacidos a término. El objetivo de esta revisión es definir el concepto de "prematuro tardío", describir las complicaciones médicas y riesgos que se encuentran comúnmente en este grupo de niños, presentar las características que les predisponen a una morbimortalidad más alta y sugerir guías para la valoración y manejo de estos pacientes tras el nacimiento(AU)

Late preterm infants are born at a gestational age between 34 and 36 weeks and 6 days. These children have higher morbidity than term infants due to their relative physiologic and metabolic immaturity, leading to a longer average birth hospital stay with a higher cost of care. Moreover, the rate of readmission and mortality are also higher than in term infants. The purpose of this review is to define "late-preterm", describe medical complications and risks that are commonly found in this group of children, present the characteristics of late-preterm infants that predispose them to higher morbidity and mortality and suggest guidelines for assessment and management of these patients after birth(AU)

Continuidad asistencial del niño prematuro / No disponible

No disponible

Panayiotopoulos syndrome: probable genetic origin, but not in SCN1A.

Panayiotopoulos syndrome is encompassed in the classification of the ILAE in idiopathic focal epilepsies. Mutations in the SCN1A gene have been associated with the development of this syndrome. We present two cases of Panayiotopoulos syndrome in two monozygotic twins, who underwent a molecular analysis of SCN1A, but no alteration was found. These cases suggest a genetic origin, and SCN1A appears to be associated with the outcome but not with the development of this syndrome.

Cefalohematoma calcificado persistente: a propósito de un caso / Persistent calcified cephalhematoma: a case report

Los cefalohematomas son lesiones relacionadas con traumatismos obstétricos que afectan al 1,5-2,5% de los recién nacidos. Suelen desaparecer espontáneamente en pocas semanas. En el presente artículo se expone un caso de cefalohematoma calcificado persistente en un lactante de 5 meses, que no precisó tratamiento y que se resolvió cuando el paciente cumplió un año(AU)

Cephallhematomas are birth trauma-related injuries affect in 1.5% to 2.5% of newborns infants. They usually disappear spontaneously within a few weeks. In this article, we report a case of persistent calcified cephallhematoma in a 5-month-old infant, which did not require treatment and resolved when the patient was one year old(AU)