Multiple red blood cell transfusions and iron overload in very low birthweight infants.

BACKGROUND AND OBJECTIVES: To estimate the risk of iron overload in very low birthweight (VLBW) infants who receive more than two red blood cell (RBC) transfusions, in comparison with those who receive two or less during their hospital stay. MATERIALS AND METHODS: Prospective open cohort study in VLBW infants with >2 (exposed) and ≤2 (non-exposed) RBC transfusions. Ferritin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at birth and after each RBC transfusion. The incidence of iron overload was determined. Risk factors were analysed using a logistic regression model. RBC transfusion volume correlations with ferritin, ALT and AST were calculated with Spearman's rank correlation coefficient, as well as correlations between ferritin and aminotransferases. RESULTS: A total of 63 patients were enrolled, 18 of which were exposed and 45 non-exposed. Twelve patients developed severe iron overload, eight exposed (44·5%) vs. four (8·8%) non-exposed (RR: 5, 95% CI: 1·7-14·6). Multivariate analysis showed that the number of transfusions increased the risk of iron overload (OR: 2·07, 95% CI: 1·36-2·14) while a higher one-minute Apgar score was associated with a lower risk (OR: 0·56, 95% CI: 0·32-0·99). Severe iron overload mainly occurred with a transfusion volume higher than 120 ml/kg. There was a positive correlation between ferritin and transfusion (r = 0·53; P < 0·001). CONCLUSION: There was a higher risk of iron overload in exposed infants in comparison with non-exposed infants. Severe iron overload in VLBW infants may occur with a total transfusion volume >120 ml/kg.

¿Dónde queda reflejada la actividad enfermera desarrollada en los hospitales? / Where the nursing activity is reflected

Antecedentes y Objetivos: El Conjunto Mínimo Básico de Datos recoge información sobre la actividad hospitalaria. A través de la codificación se traduce la información del episodio clínico a un lenguaje numérico que clasifica cada paciente en un Grupo Relacionado por el Diagnóstico o GRD. En la codificación se emplea el Manual de la Clasificación Internacional de Enfermedades que recoge entre sus procedimientos algunas actividades propias del trabajo independiente que realiza enfermería. Nos propusimos describir el impacto del trabajo de enfermería en el Informe de Alta Médico, a través de los GRDs de episodios codificados, averiguar qué servicios registran mejor la actividad que realizan los profesionales de enfermería y analizar cómo influyen sobre el registro de actividades de enfermería variables como la entidad de afiliación y el motivo del alta. Material y Métodos: Procedimos a la extracción de las actividades de enfermería incluidas en el Manual de Codificación de la Clasificación Internacional de Enfermedades, encontrando 192 actividades propias de enfermería. Se empleó la Base de Datos de la actividad hospitalaria del año 2006 que se remite a la Consejería de Sanidad de la Comunidad Autónoma de Madrid, con 13.544 episodios codificados. Mediante el programa «Estación Clínica» de 3M®, se incluyeron las actividades de enfermería obtenidas, para conocer los GRDs en los que aparecía al menos una de las actividades de enfermería. Resultados y Discusión: Se analizaron y relacionaron los informes que describían al menos una actividad de enfermería con el total de episodios codificados. Se comparó la descripción de actividades de enfermería entre informes de servicios médicos y quirúrgicos. Se analizó la información en función de la entidad de afiliación y del motivo de alta. Se exponen las limitaciones del trabajo y se discuten los resultados obtenidos. Conclusiones: El Informe de Alta Médico es un documento que apenas refleja el trabajo del personal de enfermería en los hospitales. Los Servicios Médicos reflejan en mayor medida que los Servicios Quirúrgicos la actividad que realizan los profesionales de enfermería. La Clasificación Internacional de Enfermedades describe vagamente las actividades propias de enfermería, siendo necesarios estudios de contabilidad analítica que ponderen el peso que aportan las intervenciones de enfermería a los Grupos Relacionados por el Diagnóstico (AU)

Antecedents and Objectives: The Minimum Basic Data Set compiles information on hospital activity. Through its codification the clinical information is translated into a numerical language that classifies each patient into a Diagnosis-Related Group (DRG). This codification is based on the Manual of the International Classification of Diseases (ICD) that includes among its procedures some activities from the independent work carried out by nurses. Our purpose was to describe the impact of the nursing work on the medical discharge report through the DRG,s of codified clinical episodes, find out what departments have a better control of the work performed by the nursing professionals and analyze how variablessuch as health insurance entity and discharge reason influence the logging of nursing activities. Material and Methods: we proceeded to extract the nursing activities included in the Manual of the International Classification of Diseases, finding 192 nursing activities. The database of the hospital activity of 2006 that is sent to the Health Regional Ministry of the Autonomous Community of Madrid, including 13.544 codified episodes, was utilized. The nursing activities so obtained were included in the 3M“ software “Estación Clínica” in order to determine the DRG,s in which at least one nursing activity was identified. Results and Discussion: the reports that described at least one nursing activity were analyzed and correlated to the total of codified reports. The description of nursing activities in medical reports was compared in medical and surgical departments. The information was analyzed in accordance with the health insurance entity and the discharge reason. The limitations of this article are presented and the results discussed. Conclusions: the Medical Discharge Report is a document that hardly reflects the nursing personnel work in the hospitals. The medical departments tend to reflect to a greater extent than the surgical departments the activity of the nursing personnel. The International Classification of Diseases barely describes the nursing activities making necessary analytical accountancy methods in order to have a measure of the share of the nursing activities in the DRG,s (AU)