Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up.

BACKGROUND: Neonatal sepsis is a worldwide public health issue in which, depending on the studied population, marked variations concerning its risk and prognostic factors have been reported. The aim of this study was to assess risk and prognostic factors for neonatal sepsis prevailing at a medical unit in southeastern Mexico. Thus, we used a historic cohort design to assess the association between a series of neonates and their mothers, in addition to hospital evolution features and the risk and prognosis of neonatal sepsis (defined by Pediatric Sepsis Consensus [PSC] criteria) in 11,790 newborns consecutively admitted to a Neonatology Service in Mérida, Mexico, between 2004 and 2007. RESULTS: Sepsis was found in 514 of 11,790 (4.3 %) newborns; 387 of these cases were categorized as early-onset (<72 h) (75.3 %) and 127, as late-onset (>72 h) (24.7 %). After logistic regression, risk factors for sepsis included the following: low birth weight; prematurity; abnormal amniotic fluid; premature membrane rupture (PMR) at >24 h; respiratory complications, and the requirement of assisted ventilation, O(2) Inspiration fraction (IF) >60 %, or a surgical procedure. Some of these factors were differentially associated with early- or late-onset neonatal sepsis. The overall mortality rate of sepsis was 9.5 %. A marked difference in the mortality rate was found between early- and late-onset sepsis (p >0.0001). After Cox analysis, factors associated with mortality in newborns with sepsis comprised the following: prematurity; low birth weight; low Apgar score; perinatal asphyxia, and the requirement of any invasive medical or surgical procedure. CONCLUSIONS: The incidence of neonatal sepsis in southeastern Mexico was 4.3 %. A different risk and prognostic profile between early- and late-onset neonatal sepsis was found.

[Confounding effect of prematurity in the neonatal death associated with obstetric maternal morbidity]. / Efecto confusor de la prematuridad en la muerte neonatal asociada con morbilidad obstétrica materna.

BACKGROUND: Prematurity is considered the main factor of neonatal mortality in developed countries (60 to 80% of cases). OBJECTIVE: To determine if obstetric morbidity and/or prematurity are associated with neonatal death. PATIENTS AND METHODS: A cohort of 25,365 live newborns since January 1st 2000 to December 31st 2004 was studied. Neonatal mortality was compared according to the number of prenatal visits, single or multifetal pregnancy, the presence or not of preeclampsia/eclampsia, cesarean section or vaginal delivery, and duration of rupture of membranes, stratifying by weeks of gestational age or by preterm and term gestation, as it was convenient. Chi-square test and Odds Ratio (OR) with 95% Confidence Intervals were calculated (CI). RESULTS: There was not significant statistical difference in neonatal mortality at less number of prenatal visits, between single and twin pregnancies, in the presence of preeclampsia/eclampsia and pregnancies without complications, when they were stratified by group of gestational age. When it was controlled gestational age, malformations and maternal-fetal and obstetrical morbidity, there was not difference in mortality of neonates born vaginally or by cesarean section. It was observed an increased risk or neonatal mortality in preterm neonates with 48 hours or more of rupture of membranes (OR 3.05 CI 95% 1.64-5.66) CONCLUSIONS: Performing and stratified analysis, prematurity was the factor associated with neonatal mortality, and not the number of prenatal visits, multifetal pregnancy, preeclampsia/eclampsia, or cesarean section. The duration of rupture of membranes is an independent factor of prematurity for neonatal mortality.

[Impact of maternal antecedents on neonatal mortality in a regional perinatal hospital]. / Repercusión de los antecedentes maternos en la mortalidad neonatal de un hospital perinatal.

OBJECTIVE: Determine the prevalence of maternal risk factors and evaluate their impact on neonatal mortality in a regional perinatal center. MATERIALS AND METHODS: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal antecedents were registered in a data base: sociodemographic; medical history; obstetric antecedents of previous pregnancies; as well as evolution of current pregnancy and birth. Newborn birth weight, gestational age and condition at discharge were registered too. Neonates who died were considered cases and controls those discharged alive. Mortality was compared to the presence or absence of risk factors in maternal medical history. Prevalence, odds ratio (OR) with 95% confidence interval, and attributable fraction in the exposed and the population were calculated with the SPSS 8.0 and Epi Info 6.4 programs. RESULTS: The most notable maternal factors associated with newborn mortality were maternal age > or = 30 years OR 1.5 (1.37-2.0), less than 7 prenatal exams OR 2.17 (1.52-3.09) (53.5% attributable fraction in the exposed and 23.3% in population), eclampsia OR 4.66 (2.82-7.64), type-II diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to human immunodeficiency virus OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and abruptio placentae OR 42.18 (21.06-83.1). CONCLUSIONS: Transpartum risk factors had a larger impact on mortality than pregnancy or pregestational factors.

Association of complementary or alternative medicine use with quality of life, functional status or cumulated damage in chronic rheumatic diseases.

Quality of life, functional status, or cumulated damage were compared between users and non-users of complementary and alternative medicine (CAM) in 445 rheumatic patients (rheumatoid arthritis [RA]: 64; systemic lupus erythematosus [SLE]: 192; fibromyalgia [FM]: 34; and knee osteoarthritis [KOA]: 155). CAM use was reported by 249 subjects (55.9%; 95%CI; 51.4-60.6). After a general linear model was applied, CAM use was associated with lower scores in the physical function (p = 0.02) and bodily pain (p = 0.03) domains of the SF-36 survey. In FM, RA and KOA, functional status was not different between users and non-users. CAM use was associated with higher cumulated damage (p = 0.04) in SLE. In patients with chronic rheumatic diseases, CAM use was not associated with better quality of life. Additionally, in SLE patients, CAM use was associated with higher cumulated damage. More research on CAM use in chronic rheumatic diseases is needed to better delineate its risk/benefit profile.

[Maternal history impact in neonatal mortality]. / Influencia de los antecedentes maternos en la mortalidad neonatal.

BACKGROUND: Perinatal clinical picture allows identifying psychosocial features in pregnant women, them medical, obstetrical, and pregnancy history, present delivery, and neonatal mortality risk factors. OBJECTIVE: To know prevalence of maternal risk factors and evaluates them impact on neonatal mortality. MATERIALS AND METHODS: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal sociodemographic and obstetrical history was registered in a database; as well as weight, gestational age, and neonate discharge condition. Dead neonates were considered cases and controls those discharged alive. Mortality was compared with maternal history. Prevalence, odds ratio (OR) with 95% confidence interval, and exposed and population attributable fraction were calculated with the SPSS 8.0 and Epi Info 6.4 applications. RESULTS: Maternal factors associated with newborn mortality were: maternal age > or = 30 years OR 1.5 (1.37-2.0), less than seven prenatal consultations OR 2.17 (1.52-3.09), 53.5% of attributable fraction in exposed and 23.3% in population, eclampsia OR 4.66 (2.82-7.64), type 2 diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to HIV OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and premature separation of the placenta OR 42.18 (21.06-83.1). CONCLUSIONS: Risk factors history during delivery has a larger impact on mortality than pregnancy or pregestational factors.

[Neonatal mortality in a regional perinatal hospital in Merida, Yucatan, 1995-2004. II. Analysis of causes and risk factors]. / Mortalidad neonatal en un hospital perinatal regional de Mérida, Yucatán, de 1995 al 2004. II. Anlisis de causas y factores de riesgo.

OBJECTIVE: To analyze the causes of neonatal mortality, its distribution, the moment of appearance and risk factors. PATIENTS AND METHOD: We studied a cohort of 46,297 live newborns born at the mentioned hospital, weighing 500 g or more. In a database we registered: birth weight, gestational age, days of hospital stay, discharged condition, one and five Apgar minute score, morbidity, death causes, moment of death, reducible death/reducible difficult death rate presented in less than 24 hours, 1 to 6 days, and 7 to 27 postnatal days. We compared morbidity, mortality, and risk factors in a three-year period to facilitate the analysis. RESULTS: Mortality increased with the lesser one minute Apgar score: 0.2, 9.7 and 42.9% when score was 7-10, 4-6, or 0-3, respectively, and 0.6, 41.9 and 62.9% at five minute Apgar score. Malformations were the first cause of death, which increased from 28.6 to 40.3%. Respiratory distress syndrome mortality decreased 34% and that of meconium aspiration syndrome 53%. Reducible death/hardly reducible death rate occurred from 1 to 6 days decreased 67%, from 5.2 to 1.7 (reference value 1). CONCLUSIONS: Preventable causes of death decreased significantly, particularly those related to perinatal causes, although they are still high compared with developed countries.

[Prevalence of positive skin tests to indoor allergens in preschooler children with respiratory allergy in Merida, Yucatan, Mexico]. / Prevalencia de pruebas cutáneas positivas a alergenos intradomiciliarios en preescolares con alergia respiratoria de Mérida, Yucatán, México.

BACKGROUND: Infantile asthma and rhinitis are commonly thought to be caused by indoor allergens but preschooler children are not commonly skin tested. OBJECTIVE: To know the frequency of skin test reactivity to indoor allergens in allergic preschooler children. MATERIAL AND METHODS: We evaluated 176 children (103 females/73 males) between 2 and 5 years old with respiratory allergy. All of the children tested had at least one positive skin test (house dust mite, cockroach, dog, feathers, and cat). RESULTS: Seventy seven children had allergic rhinitis (44%), 68 had asthma and rhinitis (39%), and 31 had only asthma (18%). One hundred thirty two (75%) of the children were skin test positive to house dust mite, 91 (52%) to cockroach, 31 (18%) to dog, 25 (14%) to feathers, and 24 (14%) to cat. Furthermore, the frequency of sensitization to house dust mite has an increase associated with the age of the patients with a significant difference at 5 years old (odds ratio=11.63, I.C. 95%=3.83-37.10; p <0.001). CONCLUSIONS: The most frequent indoor allergen was house dust mite, with a trend directly proportional to age of the patients.

[Peak expiratory flow in 6-12 year-old children from Merida, Yucatan, Mexico]. / Flujo espiratorio máximo en niños de 6 a 12 años de edad de la ciudad de Mérida, Yucatán, México.

BACKGROUND: Assessment of pulmonary function may be done by several procedures, such as spirometric and flow metric ones. OBJECTIVE: To obtain a peak expiratory flow rate (PEFR) percentilar curve in healthy schoolchildren of both sexes of Merida, Yucatan, Mexico. MATERIAL AND METHODS: We carried out a transversal and observational study in schoolchildren between 6 and 12 years old of both sexes. They were evaluated by a demographic questionnaire that included age, weight, height and health status, and then the PEFR was assessed using a mini-Wright Peak Flow Meter recording the highest of the three numbers achieved. RESULTS: We included 621 healthy schoolchildren between 6 and 12 years old of both sexes, 321 girls and 300 boys, of two schools that were selected by random sampling. The media age was 9 +/- 2 years old, height 128 +/- 10 cm, weight 30.34 +/- 9.75 kg, corporal surface 1.049 +/- 0.22 m2, and PEFR 293.72 +/- 66 L/min. When we compared the PEFR with age, height and weight, we saw that height was a more reliable predictor than age or weight, since higher values of R were obtained. There was not a significant difference of PEFR between boys and girls. CONCLUSIONS: Our results show that the pulmonary function values increase proportionally to height, which showed the higher correlation to FEM.

[Survival at 5 years of adult patients with acute lymphoblastic leukemia]. / Supervivencia a cinco años de pacientes adultos con leucemia linfoblástica aguda.

OBJECTIVE: To estimate and to compare against other series, the overall survival time (OST) in patients with diagnosis of acute lymphoblastic leukemia (ALL), cared for and followed-up at a tertiary-care hospital in Merida, Yucatan, Mexico, between January 1995 to December 1999. MATERIAL AND METHODS: Clinical records of 110 patients aged 14 years or older, were identified and reviewed. Age, sex, ALL subtypes, follow-up time, OST and mortality rates were the analyzed variables. Inferential statistics, including parametric and nonparametric tests and its 95% confidence intervals (95% CI), were used when appropriate. Six months periods, the median survival time (MST), and the five-years OST using Kaplan-Meier methods (K-M) for ALL as a group and for its subtypes, were calculated. RESULTS: The median age of ALL patients was 19 years. Male gender was more affected (68%) than female gender. One to 55 months was the followed-up time, being the followed-up mean time 16.9 +/- 12.1 months, although 12 months, 55 months and sixty months OST was 70%, 11% and zero percent, respectively, being during all the followed-up time always unfavourable to male gender. Mortality rate was 53%, and male was again the most affected one. L2-ALL was the most frequent subtype, having the least mortality rate (38%) between subtypes (p = 0.012) because its OST was better than for L1 and L3 subtypes. CONCLUSIONS: In ALL adult patients, mortality rate was higher having 0% OST, at 60 months.

[Graphic representation of the neonatal mortality risk at a regional perinatal center in Mérida, Yucatán, México]. / Representación gráfica del riesgo de mortalidad neonatal en un centro perinatal regional en Mérida, Yucatán, México.

OBJECTIVE: To determine the neonatal mortality risk according to gestational age and birth weight. MATERIAL AND METHODS: The cohort consisted of 19,668 newborns of Centro Médico Nacional (National Medical Center) Ignacio García Téllez, a tertiary level healthcare institution of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS) of the Yucatan Peninsula. All newborns discharged from the hospital between January 1st, 1995 and October 31st, 1999 were included in the study. Birth weight, gestational age, and conditions upon discharge were recorded. Absolute risk (AR) of mortality was calculated for each week-of-gestation- and birth group. RESULTS: Observed AR in newborns 34 to 44 weeks of gestational age and weighing at least 2,250 g was 0.4, while that for those 26 to 32 weeks of gestational age and weighing between 1000 g was 15%. CONCLUSIONS: AR of neonatal mortality increased inversely proportional to gestational age and birth weight. These data can be used as reference values for our hospital and for comparison with other hospitals. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Representacián gráfica del riesgo de mortalidad neonatal en un centro perinatal regional en Mérida, Yucatán, México / Graphic representation of the neonatal mortality risk at a regional perinatal center in Mérida, Yucatán, México

OBJECTIVE: To determine the neonatal mortality risk according to gestational age and birth weight. MATERIAL AND METHODS: The cohort consisted of 19,668 newborns of Centro MÚdico Nacional (National Medical Center) Ignacio GarcÝa TÚllez, a tertiary level healthcare institution of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS) of the Yucatan Peninsula. All newborns discharged from the hospital between January 1st, 1995 and October 31st, 1999 were included in the study. Birth weight, gestational age, and conditions upon discharge were recorded. Absolute risk (AR) of mortality was calculated for each week-of-gestation- and birth group. RESULTS: Observed AR in newborns 34 to 44 weeks of gestational age and weighing at least 2,250 g was 0.4, while that for those 26 to 32 weeks of gestational age and weighing between 1000 g was 15. CONCLUSIONS: AR of neonatal mortality increased inversely proportional to gestational age and birth weight. These data can be used as reference values for our hospital and for comparison with other hospitals.

Efecto del levamisol en la actividad microbicida y quimiotaxis en células polimorfonucleares / The effect of levamisol on the functions of chemotaxis and bacterial activity

Antecedentes: la septicemia neonatal puede tener una mortalidad del 20 por ciento en recién nacidos pequeños para su edad gestacional. Esta predisposición a las infecciones se ha explicado por alteraciones inmunológicas. El propósito de este trabajo es conocer el efecto del levamisol en las funciones de quimiotaxis y actividad bactericida de las células polimorfonucleares en recién nacidos pequeños para su edad gestacional. Material y método: se estudiaron 20 recién nacidos de término. Diez eran pequeños para su edad gestacional y los otros 10 tenían peso adecuado. Se midió la actividad microbicida y la quimiotaxis; se hicieron comparaciones entre los grupos con pruebas estadísticas no paraméticas. Resultados: en el grupo de neonatos pequeños para su edad gestacional la actividad microbicida fue semejante a la del grupo testigo, pero la actividad quimiotáctica estuvo disminuida (p < 0.05)

Prevalencia de mastopatía fibroquística en pacientes con endometriosis / Fibrocystic breast disease prevalence in patients with endometriosis

Se estudió la prevención de mastopatía fibroquística en una población de pacientes con endometriosis. Estudio realizado en la clínica de Biología de la Reproducción de referencia en un centro de atención médica de tercer nivel. Se incluyeron 43 pacientes con el diagnóstico laparoscópico de endometriosis en quienes se efectuó la búsqueda intencionada de datos clínicos y ultrasonográficos de mastopatía fibroquística en su período de control. La edad promedio de las pacientes fue 28 años, con un rango de 18 a 36 años. De las 43 pacientes con endometriosis, en 37.2 por ciento se efectuó el diagnóstico de mastopatía fibroquística. De estas pacientes por grupo de edad fue de 37.5 por ciento entre las de 30-34 años, y de 31.2 por ciento entre los 20-24 años. El 43.7 por ciento de las pacientes que tenían ambas patologías tenían el antecedente de un embarazo y 25 por ciento tenían alteraciones menstruales. La prevalencia de mastopatía fibroquística en pacientes con endometriosis fue de 37 por ciento se observó fuerte evidencia de asociación entre ambas patologías

Manejo del catéter transuretral posoperatorio con dos técnicas del drenaje vesical en cirugía por relajación del piso pélvico / Management of postoperative transurethral catheter with two techniques for bladder drainage in surgery for pelvic floor relaxation

Se realizó un estudio de cohortes concurrentes aleatorio entre dos métodos de drenaje vesical transuretral posoperatorio: con la técnica cerrada y la abierta con el objetivo de determinar cuál de los dos métodos es más eficiente. Se incluyeron 50 pacientes posoperadas por relajación del piso pélvico o incontinencia urinaria de esfuerzo, que fueron asignadas en forma aleatoria a dos grupos de 25 pacientes cada uno. En el grupo con técnicas cerrada se estableció más tempranamente la función vesical normal en comparación con las de la técnica abierta (P< 0.05), así como la reducción significativa de la incidencia de infección del tracto urinario (P< 0.05). Se concluye que el denaje vesical transuretral con la técnica cerrada es más eficiente que la técnica abierta, después de cirugía por relajación del piso pélvico o incontinencia urinaria de esfuerzo

Concentración de IgE en sangre de cordón umbilical en recién nacidos sanos / Concentration of IgE in blood of the umbilical cord in newborn

Las concentraciones séricas de IgE se modifican por factores como edad, raza, condiciones ambientales y estado de salud. Se estudiaron 113 niños recién nacidos de 38 a 42 semanas de gestación, clínicamente sanos, a los que se les extrajo sangre del cordón umbilical y se les midió la concentración de IgE por el método de ELISA. Se obtuvieron los siguientes resultados: 85 por ciento de los niños recién nacidos tenían concentraciones de IgE de 0.5 UI/ml a 4.0 UI/ml. No se observaron diferencias estadísticamente significativas respecto a la edad gestacional o el sexo. Las concentraciones séricas de IgE observadas en estos pacientes fueron un poco mayores que las informadas en otros grupos estudiados. Esos resultados pueden considerarse para el diagnóstico de enfermedades alérgicas en recién nacidos e identificación de factores de riesgo

Utilidad de la aspiración e intubación traqueal en la prevención del síndrome de aspiración meconial / Utility of tracheal aspiration and endotracheal intubation in the prevention of meconium aspiration syndrome

Objetivo. Determinar la utilidad de la intubación endotraqueal y aspiración directa a tráquea para disminuir la incidencia de síndrome de aspiración meconial en recién nacidos sanos y vigorosos nacidos con líquido amniótico meconial y conocer las complicaciones del procedimiento. Diseño. Estudio de cohortes concurrentes sin asignación aleatoria. Unidades de estudio. Ciento cincuenta y uno recién nacidos con peso igual o mayor de 2,500 g, nacidos con líquido amniótico meconial de cualquier densidad, con Apgar igual o mayor de 7 al minuto de vida y clínicamente sanos. Mediciones y resultados. Se dividieron a los pacientes en dos grupos. A todos los pacientes se les realizó aspiración nasofaríngea al momento de nacer la cabeza y antes del nacimiento completo. Al grupo 1 (n=88) no se realizó ningún procedimiento y al grupo 2 (n=63) se realizó laringoscopia para la visualización y aspiración directa a tráquea posterior al nacimiento. No se presentó ningún caso de SAM. ningún paciente del grupo 1 presentó complicaciones y dos pacientes del grupo dos presentaron complicaciones pulmonares. Conclusiones. Las maniobras de laringoscopia y aspiración traqueal no están indicadas como procedimiento de rutina en pacientes sanos y vigorosos con líquido amniótico meconial, ya que existe mayor riesgo de complicación

Transferencia in vitro de inmunidad a PPD con extracto dializable de leucocitos de calostro humano / In vitro immunity transference of PPD with human dialysable colostral leukocyte extract

Se pretende demostrar la transferencia de hipersensibilidad a PPD en un modelo in vitro con extracto dializable de leucocitos de calostro de madres PPD- y PPD+ (EDLC PPD- Y PPD-), a través de la medición de la actividad del factor inhibidor de la migración de leucocitos (LIF) de sangre de cordón de recién nacidos de madre PPD+. En los resultados se observa que el EDLC PPD+ incubado con leucocitos de recién nacidos de madres PPD- tuvieron inhibición de la migración de los leucocitos, comprados con la migración de los leucocitos incubados con EDLC PPD-; lo que sugiere que en el modelo in vitro se transfiere hipersensibilidad a PPD con el EDLC.

Cuantificación del número y la función de las células mononucleares: RFc gamma de niños con desnutrición protéico-calórica (DPC) / Quantitative of number and the function of the mononuclear cells: Rfcy of malnutrition protein-caloric children (MPC)

Se han reconocido varios tipos de receptores de membrana en los linfocitos T, entre ellos se encuentran los receptores para las cadenas pesadas de inmunoglobulinas m* y gama, ellos participan en el reconocimiento de antígenos, además de ser marcadores de superficie para las subpoblaciones de linfocitos T. En la desnutrición proteico-calórica (DPC) se han observado alteraciones inmunológicas tanto en la inmunidad celular como en la inmunidad humoral, un ejemplo de ello es el incremento en las cifras de inmunoglobulinas o la disminución en la respuesta inmune celular a ciertos antígenos. Es posible que ésta alteración en la respuesta inmune esté asociada con una disfunción de las subpoblaciones de linfocitos T; por lo que nos propusimos investigar si existen diferencias entre el núnero, porcentaje y función de las subpoblaciones de linfocitos T entre lactantes sanos y con DPC. Observamos un aumento en el número y porciento de linfocitos T gama en niños con DPC, en relación con las células T de lactantes sanos (p<0.05). Sin embargo, hubo una mala respuesta de linfocitos T totales y subpoblación gama al estímulo con fitohemaglutinina en pacientes con DPC. Nuestros hallazgos, además de ser concordantes con lo reportado en el literatura, también sugieren que hay una disfunción en la subpoblación de células T gama.