Capnografía en recién nacidos en ventilación mecánica y su relación con la medición de CO2 en muestras sanguíneas / Capnography in newborns under mechanical ventilation and its relationship with the measurement of CO2 in blood samples

Introducción: Monitorear la presión parcial de CO2 (PCO2) en los recién nacidos que requieren ventilación permitiría evitar hipocapnia e hipercapnia. La medición de CO2 espirada (ETCO2) es una alternativa poco implementada en esta población.Objetivo: Evaluar la relación entre la ETCO2 y la PCO2 en recién nacidos.Métodos: Estudio de corte transversal, comparativo entre dos métodos de medición de PCO2, el convencional mediante análisis de muestras sanguíneas y el estimado mediante ETCO2. Se incluyeron recién nacidos internados que requerían ventilación mecánica convencional. La medición de ETCO2 se realizó mediante un ventilador neonatal Graph Net Neo-TECME®, con capnógrafo incorporado y se obtuvo el gradiente ETCO2-PCO2. Se realizaron análisis de correlación y gráficos de Bland-Altman para estimar la concordancia.Resultados: Se analizaron 277 muestras (ETCO2/PCO2) en 83 recién nacidos. Los valores promedios de ETCO2 y PCO2 fueron de 41,36 mmHg y 42,04 mmHg. Hubo correlación positiva y significativa entre ETCO2 y PCO2 en el análisis global (r = 0,5402; p < 0,001) y en el de cada unidad (p < 0,001). La media de las diferencias fue de 0,68 mmHg (IC 95%- 0,68 a 1,95) y no resultó significativa. Se observó error sistemático positivo (PCO2 > ETCO2) en dos de las unidades, mientras que en la tercera la diferencia fue negativa (PCO2 < ETCO2)Discusión: La correlación entre ETCO y PCO2 es significativa, si bien los valores obtenidos no resultan equivalentes y la diferencia varía entre 0,1 mmHg a 20 mmHg. Asimismo, observamos errores sistemáticos de signo diferente (positivo o negativo) entre las instituciones. (AU)

Introduction: Monitoring the partial pressure of CO2 (PCO2) in newborns who require ventilation would allow avoiding hypocapnia and hypercapnia. The measurement of end-tidal carbon dioxide (ETCO2) is an alternative rarely implemented in this population.Objective: To evaluate the relationship between ETCO2 and PCO2 in newborns.Methods: Cross-sectional study comparing two PCO2 measurement methods, the conventional one by analysis of blood samples and the one estimated by ETCO2. The study included hospitalized newborns that required conventional mechanical ventilation. The ETCO2 was measured with a Tecme GraphNet® neo, a neonatal ventilator with an integrated capnography, and we obtained the ETCO2-PCO2 gradient. We conducted correlation and Bland-Altman plot analyses to estimate the agreement.Results: A total of 277 samples (ETCO2/PCO2) from 83 newborns were analyzed. The mean values of ETCO2 and PCO2 were 41.36 mmHg and 42.04 mmHg. There was a positive and significant correlation between ETCO2 and PCO2 in the overall analysis (r = 0.5402; p < .001) and in the analysis of each unit (p < .001). The mean difference was 0.68 mmHg (95% CI, −0.68 to 1.95) and was not significant. We observed a positive systematic error (PCO2 > ETCO2) in 2 of the units, and a negative difference in the third (PCO2 < ETCO2).Discussion: The correlation between ETCO and PCO2 was significant, although the obtained values were not equivalent, with differences ranging from 0.1 mmHg to 20 mmHg. Likewise, we found systematic errors that differed in sign (positive or negative) between institutions. (AU)

Capnography in newborns under mechanical ventilation and its relationship with the measurement of CO2 in blood samples.

INTRODUCTION: Monitoring the partial pressure of CO2 (PCO2) in newborns who require ventilation would allow avoiding hypocapnia and hypercapnia. The measurement of end-tidal carbon dioxide (ETCO2) is an alternative rarely implemented in this population. OBJECTIVE: To evaluate the relationship between ETCO2 and PCO2 in newborns. METHODS: Cross-sectional study comparing two PCO2 measurement methods, the conventional one by analysis of blood samples and the one estimated by ETCO2. The study included hospitalized newborns that required conventional mechanical ventilation. The ETCO2 was measured with a Tecme GraphNet® neo, a neonatal ventilator with an integrated capnograph, and we obtained the ETCO2-PCO2 gradient. We conducted correlation and Bland-Altman plot analyses to estimate the agreement. RESULTS: A total of 277 samples (ETCO2 / PCO2) from 83 newborns were analyzed. The mean values ​​of ETCO2 and PCO2 were 41.36mmHg and 42.04mmHg. There was a positive and significant correlation between ETCO2 and PCO2 in the overall analysis (r=0.5402; P<.001) and in the analysis of each unit (P<.001). The mean difference was 0.68 mmHg (95% CI, -0.68 to 1.95) and was not significant. We observed a positive systematic error (PCO2 > ETCO2) in 2 of the units, and a negative difference in the third (PCO2 < ETCO2). DISCUSSION: The correlation between ETCO and PCO2 was significant, although the obtained values ​​were not equivalent, with differences ranging from 0.1mmHg and 20mmHg. Likewise, we found systematic errors that differed in sign (positive or negative) between institutions.

Hypoxic Ischemic Encephalopathy in Units Reporting to the Ibero-American Society of Neonatology Network: Prevalence and Mortality.

INTRODUCTION: Hypoxic ischemic encephalopathy is a neurological condition occurring immediately after birth following a perinatal asphytic episode. Therapeutic hypothermia is a safe and effective intervention to reduce mortality and major disability in survivors. In Latin America, perinatal asphyxia is a major problem, but no data are available characterizing its current situation in the region or the impact of hypoxic ischemic encephalopathy on its management. OBJECTIVE: Understand the prevalence, mortality and use of therapeutic hypothermia in newborns at ≥36 weeks gestational age with hypoxic ischemic encephalopathy admitted to neonatal units reporting to the Ibero-American Society of Neonatology Network. METHODS: The Ibero-American Society of Neonatology Network groups various neonatology centers in Latin America that share information and collaborate on research and medical care. We evaluated data on newborns with ≥36 weeks gestational age reported during 2019. Each unit received a guide with definitions and questions based on the Society's 7th Clinical Consensus. Evaluated were encephalopathy frequency and severity, Apgar score, need for resuscitation at birth, use of therapeutic hypothermia and clinical evolution at discharge. Our analysis includes descriptive statistics and comparisons made using the chi-square test. RESULTS: We examined reports of 2876 newborns from 33 units and 6 countries. In 2849 newborns with available data, hypoxic encephalopathy prevalence was 5.1% (146 newborns): 27 (19%) mild, 36 (25%) moderate, 43 (29%) severe, and 40 (27%) of unknown intensity. In those with moderate and severe encephalopathy, frequencies of Apgar scores ≤3 at the first minute (p = 0.001), Apgar scores ≤3 at the fifth minute (p ⟨0.001) and advanced resuscitation (p = 0.007) were higher. Therapeutic hypothermia was performed in only 13% of newborns (19). Neonatal mortality from encephalopathy was 42% (61). CONCLUSIONS: Hypoxic ischemic encephalopathy is a neonatal condition that results in high mortality and severe neurological sequelae. In this study, the overall prevalence was 5.1% with a mortality rate of 42%. Although encephalopathy was moderate or severe in 54% of reported cases, treatment with hypothermia was not performed in 87% of newborns. These data reflect a regional situation that requires urgent action.

CCHD Screening Implementation Efforts in Latin American Countries by the Ibero American Society of Neonatology (SIBEN).

Congenital heart disease (CHD) is among the four most common causes of infant mortality in Latin America. Pulse oximetry screening (POS) is useful for early diagnosis and improved outcomes of critical CHD. Here, we describe POS implementation efforts in Latin American countries guided and/or coordinated by the Ibero American Society of Neonatology (SIBEN), as well as the unique challenges that are faced for universal implementation. SIBEN collaborates to improve the neonatal quality of care and outcomes. A few years ago, a Clinical Consensus on POS was finalized. Since then, we have participated in 12 Latin American countries to educate neonatal nurses and neonatologists on POS and to help with its implementation. The findings reveal that despite wide disparities in care that exist between and within countries, and the difficulties and challenges in implementing POS, significant progress has been made. We conclude that universal POS is not easy to implement in Latin America but, when executed, has not only been of significant value for babies with CHD, but also for many with other hypoxemic conditions. The successful and universal implementation of POS in the future is essential for reducing the mortality associated with CHD and other hypoxemic conditions and will ultimately lead to the survival of many more Latin American babies. POS saves newborns' lives in Latin America.

Uso (y abuso) de antibióticos en la medicina perinatal / Use (and abuse) of antibiotics in perinatal medicine

INTRODUCCIÓN: El uso racional de antibióticos (ATB) implica que los pacientes reciban ATB adecuados a sus necesidades clínicas, en dosis correctas según sus condiciones individuales, durante el tiempo adecuado y al menor costo para ellos y para su comunidad. La mayor tasa de abuso de ATB ocurre durante el período perinatal, a pesar de que existe evidencia de múltiples efectos negativos a corto y a largo plazo. Además, este abuso se asocia con incrementos en los costos de la atención médica. OBJETIVO: Actualizar y reportar la evidencia sobre el uso, abuso y efectos adversos de los ATB en medicina perinatal y las posibles medidas para prevenirlos y, de este modo, mejorar la calidad de los cuidados, los resultados y los costos. Métodos Revisión y análisis: de la literatura relacionada con el uso de ATB en perinatología hasta febrero de 2020. RESULTADOS: El abuso de ATB en perinatología oscila entre el 50 y el 70%, y aún más en algunas unidades neonatales. Los efectos adversos incluyen morbilidades agudas, muerte, aumento de resistencia microbiana, alteraciones del microbioma y disbiosis asociadas a complicaciones graves a lo largo de la vida, como infecciones, alergias, trastornos autoinmunes, enfermedades gastrointestinales, artritis, asma, obesidad y tal vez cáncer. Prevenir y disminuir el uso indebido de ATB conducirá a mejorar la salud y a ahorros significativos en el sector sanitario. En solamente 4unidades de cuidados intensivos neonatales (UCIN), con 1.000 admisiones anuales, el ahorro se estima en 230.000 dólares por año. CONCLUSIÓN: La necesidad de optimizar la utilización de ATB en la medicina perinatal nunca ha sido más urgente

INTRODUCTION: The rational use of antibiotics (ATB) implies that patients receive those adequate for their clinical needs, in correct doses according to their individual conditions, during an adequate period of time, and at the lowest cost for them and their community. The highest rate of ATB abuse occurs during the perinatal period, despite the fact that there is evidence of multiple short- and long-term negative effects. Furthermore, this abuse is associated with increased costs of medical care. OBJECTIVE: To update and report the evidence on the use, abuse, and adverse effects of ATB in perinatal medicine, and possible measures to prevent them, and thus improve health care outcomes and costs. METHODS: A review and analysis was performed from the literature related to the use of ATB in perinatal medicine up to February 2020. RESULTS: ATB abuse in perinatal medicine ranges from 50% to 70%, with even higher rates in some neonatal centres. Adverse effects include death, increased microbial resistance, along with microbiome abnormalities and dysbiosis that lead to serious life-long complications such as infections, allergies, autoimmune disorders, gastrointestinal disorders, arthritis, asthma, obesity, and perhaps cancer. Preventing and reducing the abuse of ATB would lead to better health and to significant savings in the health sector. In only 4neonatal intensive care units, with 1000 admissions per year, savings are estimated at US$230,000 per year. CONCLUSION: The need to optimise the use of ATB in perinatal medicine has never been more urgent

[Perinatal COVID-19 in Latin America]. / COVID-19 perinatal en América Latina.

OBJECTIVE: To evaluate and report the clinical characteristics and outcomes of SARS-CoV-2 infection in pregnant women and newborns in Latin America. METHODS: Descriptive study based on the prospective report of the units of the Ibero-American Society of Neonatology Network. RESULTS: Of 86 pregnant women with COVID-19 confirmed by RT-PCR in seven countries (6 from Latin America, and Equatorial Guinea) 68% (59) were asymptomatic. Of 32% of symptomatic women, 89% (24) had mild symptoms and 3.5% (3) had severe respiratory symptoms. No women died. The cesarean section rate was 38%; gestational age was < 37 weeks in 6% of cases. RT-PCR was performed on all newborns between 16 and 36 hours of age; 6 (7%) were positive. All of them presented mild and transient respiratory distress; none died. Two newborns with negative RT-PCR died from other causes. Breastfeeding was authorized in only 24% of mothers; in 13% milk was expressed and 63% of newborns were fed with formula. In 76% of cases the motherchild pair was separated, and in 95% of cases the mother could not be accompanied at delivery or during the postpartum period. CONCLUSIONS: The lack of maternal accompaniment, the low rate of breastfeeding and the frequent separation of the mother-child dyad are of concern. The health care team must reflect on the need to defend humanized and family-centered care during this pandemic.

[Use (and abuse) of antibiotics in perinatal medicine]. / Uso (y abuso) de antibióticos en la medicina perinatal.

INTRODUCTION: The rational use of antibiotics (ATB) implies that patients receive those adequate for their clinical needs, in correct doses according to their individual conditions, during an adequate period of time, and at the lowest cost for them and their community. The highest rate of ATB abuse occurs during the perinatal period, despite the fact that there is evidence of multiple short- and long-term negative effects. Furthermore, this abuse is associated with increased costs of medical care. OBJECTIVE: To update and report the evidence on the use, abuse, and adverse effects of ATB in perinatal medicine, and possible measures to prevent them, and thus improve health care outcomes and costs. METHODS: A review and analysis was performed from the literature related to the use of ATB in perinatal medicine up to February 2020. RESULTS: ATB abuse in perinatal medicine ranges from 50% to 70%, with even higher rates in some neonatal centres. Adverse effects include death, increased microbial resistance, along with microbiome abnormalities and dysbiosis that lead to serious life-long complications such as infections, allergies, autoimmune disorders, gastrointestinal disorders, arthritis, asthma, obesity, and perhaps cancer. Preventing and reducing the abuse of ATB would lead to better health and to significant savings in the health sector. In only 4neonatal intensive care units, with 1000 admissions per year, savings are estimated at US$230,000 per year. CONCLUSION: The need to optimise the use of ATB in perinatal medicine has never been more urgent.

COVID-19 perinatal en América Latina

[RESUMEN]. Objetivo. Evaluar y reportar las características clínicas y los resultados de la infección por SARS-CoV-2 en mujeres embarazadas y recién nacidos en América Latina. Métodos. Estudio descriptivo basado en el reporte prospectivo de las unidades constituyentes de la Red de la Sociedad Iberoamericana de Neonatología. Resultados. De 86 mujeres embarazadas con COVID-19 confirmadas por RT-PCR en siete países (6 de América Latina y Guinea Ecuatorial) 68% (59) fueron asintomáticas. Del 32% de mujeres sintomáticas, 89% (24) tuvieron síntomas leves y 3,5% (3) presentaron síntomas respiratorios graves. Ninguna mujer falleció. La tasa de cesáreas fue de 38%; la edad gestacional fue < 37 semanas en 6% de los casos. Se realizó RT-PCR a todos los recién nacidos (RN) entre las 16 y 36 horas de vida; en 6 (7%) el resultado del hisopado fue positivo. Todos ellos presentaron dificultad respiratoria leve y transitoria; ninguno falleció. Dos RN con RT-PCR negativa fallecieron por otras causas. Se autorizó el amamantamiento en solo 24% de las madres; en 13% se extrajo leche y en 63% se alimentó al RN con fórmula. En 76% de los casos se separó al binomio madre-hijo, y en 95% de los casos la madre no pudo ser acompañada en el parto ni el puerperio. Conclusiones. Son preocupantes la falta de acompañamiento materno, la baja tasa de lactancia y la frecuente separación de la díada madre-hijo. El equipo de salud debe reflexionar sobre la necesidad de defender el cuidado humanizado y centrado en la familia durante esta pandemia.

[ABSTRACT]. Objective. To evaluate and report the clinical characteristics and outcomes of SARS-CoV-2 infection in pregnant women and newborns in Latin America. Methods. Descriptive study based on the prospective report of the units of the Ibero-American Society of Neonatology Network. Results. Of 86 pregnant women with COVID-19 confirmed by RT-PCR in seven countries (6 from Latin America, and Equatorial Guinea) 68% (59) were asymptomatic. Of 32% of symptomatic women, 89% (24) had mild symptoms and 3.5% (3) had severe respiratory symptoms. No women died. The cesarean section rate was 38%; gestational age was < 37 weeks in 6% of cases. RT-PCR was performed on all newborns between 16 and 36 hours of age; 6 (7%) were positive. All of them presented mild and transient respiratory distress; none died. Two newborns with negative RT-PCR died from other causes. Breastfeeding was authorized in only 24% of mothers; in 13% milk was expressed and 63% of newborns were fed with formula. In 76% of cases the motherchild pair was separated, and in 95% of cases the mother could not be accompanied at delivery or during the postpartum period. Conclusions. The lack of maternal accompaniment, the low rate of breastfeeding and the frequent separation of the mother-child dyad are of concern. The health care team must reflect on the need to defend humanized and family-centered care during this pandemic.

[Folic acid for neural tube defects prevention: consumption and information in fertil-age women in Centro Cuyo Region]. / Acido fólico para prevenir defectos del tubo neural: consumo e información en mujeres en edad fértil de la Región Centro Cuyo.

INTRODUCTION: Neural tube defects are congenital malformations of brain and spinal cord. There is evidence that adequate amounts of folic acid supply to women before and during early pregnancy decreases the risk of having a neural tube defects affected child. Main sources of folic acid are food rich in folic acid, multivitamins with folic acid supplementation, and folic acid fortification of cereal products. OBJECTIVES: To assess folic acid consumption from food and from medication in a group of mothers. To analyze their knowledge about using folic acid to prevent neural tube defects. To evaluate association between inadequate consumption and information, level of education, and concurrence to private or public health sector. To measure the amount of folic acid in bread sold within the region. DESIGN: Observational cross-sectional study. SURVEYS: Mothers of children under 2 months of age that were assisted by 38 pediatricians in five cities in the Region, collected between November 2006 and March 2007. Amount of folic acid in bread: bread samples acquired in the same cities. RESULTS AND CONCLUSIONS: 327 surveys were collected. The average daily intake of folic acid from food was 481 Hg; 43,4% of women consume less than 400 Hg daily. Medical supplementation was suitable in 27,8% of the sample. 52,9% had appropriated knowledge about folic acid and prevention of neural tube defects. Differences were observed between mothers concurring to private or public health sector, and those who had or had not completed secondary school in relation to both supplementation and knowledge of folic acid. The media amount of folic acid in bread samples was 192,34 Hg / 100 g. All samples were manufactured with fortified flour.