Needs assessment to improve neonatal intensive care in Mexico.

BACKGROUND: At the time of the research, Dr Weiss was a clinical fellow in neonatal-perinatal medicine at Baylor College of Medicine, Texas Children's Hospital. Dr Profit was on faculty at Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Section of Neonatology. He held a secondary appointment in the Department of Medicine, Section of Health Services Research and conducted his research at the VA Health Services Research and Development Center of Excellence where he collaborated with Dr Kowalkowski.: Improving the quality of neonatal intensive care is an important health policy priority in Mexico. A formal assessment of barriers and priorities for quality improvement has not been undertaken. AIM: To provide guidance to providers and policy makers with regard to addressing opportunities for better care delivery in Mexican neonatal intensive care units. OBJECTIVE: To conduct a needs assessment regarding improvement of quality of neonatal intensive care delivery in Mexico. METHODS: Spanish-language survey administered to a volunteer sample of Mexican neonatal care providers attending a large paediatric conference in Mexico in June 2011. Survey domains included institutional context of quality improvement, barriers, priorities, safety culture, and respondents' characteristics. Results were analysed using descriptive analyses of frequencies, proportions and percentage positive response (PPR) rates. RESULTS: Of 91 respondents, the majority identified neonatology as their primary specialty (n = 48, 65%) and were physicians (n = 55, 73%). Generally, providers expressed a desire to improve quality of care (PPR 69%) but reported notable deterrents. Respondents (n, %) identified family inability to pay (38, 48%), overcrowded work areas (38, 44%), insufficient financial reimbursement (25, 36%), lack of availability of nurses (26, 30%), ancillary staff (25, 29%), and subspecialists (22, 25%) as the principal barriers. Respiratory care (27, 39%)--reduction of mechanical ventilation and initiation of nasal continuous positive airway pressure--and reduction in frequency of late-onset infections (19, 28%) were selected as top clinical priorities. There were substantial opportunities for improving safety (PPR 48%) and teamwork climate (PPR 58%). CONCLUSION: These findings may guide efforts to improving quality of care delivery in Mexican neonatal intensive care units.

[Renin activity in the plasma of premature newborns not ill]. / Actividad de renina en plasma en recién nacidos prematuros no enfermos.

In a prospective manner, sequential plasma renin activity (PRA) was measured in a group of sixteen non-sick premature infants on day 1, 3, 10, 17 and 24 of life. These infants had the following criteria in order to enter the study: breastfeeding, Apgar score greater than 7 at 5 minutes and no medical problems. PRA reached the maximum level by day 10,139 ng/mL/h declining slowly over the next two weeks, but remaining higher than on day one of life. Serum sodium levels were also measured since day one of life; these levels were found low during the entire time of study. We can speculate that our higher PRA values could be related to the physiologic hyponatremia found more accentuated between the third and fourth weeks of life.

Blood components in neonatal medicine.

During a six-month period, 552 infants were admitted to a level III Neonatal Intensive Care Unit (NICU) and four level II units. Of the 953 cross matches of blood components requested from the blood bank, 83% were administered. Forty-four percent of the infants received multiple blood transfusions from multiple blood donors (mean 3.9 donors, range two to 11). Thirty-one percent received multiple transfusions from only one donor. The mean total volume of blood given was 22.5 ml (range 3 to 120 ml), exclusive of blood used for exchange transfusions. Seventy percent of the blood components were given to infants weighing less than 2,500 gm, and 44% were given to infants weighing less than 1,500 gm. Hospitals having only level II units must have the same blood banking facilities as hospitals with level III units, since 21% of the infants given transfusion received the blood component while receiving level II care.