Valoración de la satisfacción de los padres en una unidad neonatal / Assessment of parental satisfaction in a neonatal unit

Introducción: La satisfacción de los padres en una unidad neonatal (UN) debe ser evaluada como elemento de calidad asistencial. Objetivos: 1/Determinar cómo influye el nivel de gravedad sobre la satisfacción de los padres. 2/Comparar los resultados antes y después de un traslado de centro. Material y métodos: Se aplicó una encuesta de satisfacción a los padres de los neonatos (RN) ingresados en la UN. Se recogieron datos de 87 de los RN ingresados durante 10 meses, distribuidos en 2 categorías según gravedad. Se valoró la satisfacción de los padres sobre aspectos humanos y físicos en la UN, estudiando si esta se afectó por la gravedad del RN. Se valoró el impacto del traslado sobre la satisfacción. Se realizaron análisis estadísticos descriptivos y modelos multivariantes. Resultados: Se observó una polarización entre los aspectos humanos y los relacionados con el medio. Fueron estadísticamente significativos la valoración del horario de acceso de los padres y la crítica sobre mobiliario, luz y espacio físico. Los padres de los RN más graves valoraron mejor el horario pero peor el entorno. La percepción de dolor en los procedimientos es mayor en niños más graves y un 66% de los padres preferiría estar presente en los mismos. Comparando entre la UN antigua y la nueva, el único parámetro significativo fue la percepción sobre la información suministrada, peor valorada en el nuevo hospital. La lactancia materna mejoró significativamente. La satisfacción general fue elevada. Conclusiones: Los padres de niños graves valoran la accesibilidad y son críticos con la comodidad. El horario de entrada de los padres y la ausencia de luz y ruido son predictores significativos de satisfacción en niños con estancias prolongadas. La percepción del acceso a la información empeoró con el traslado, probablemente por falta de adaptación al medio(AU)

Introduction: Parental satisfaction in a neonatal unit needs to be checked as a quality element in health care. Objectives: 1/To measure how the severity of the newborn condition influences parental satisfaction. 2/To compare the results before and after moving to a new building. Methods: Parental satisfaction in 87 of the newborns admitted to our neonatal unit over a 10 month period was documented using a questionnaire survey. The newborns were divided into 2 categories, depending on the severity of their condition. Parental satisfaction as regards human and environmental issues was checked as to whether it was affected by the severity of the illness. The impact of the move to a new building on satisfaction was also analysed. Statistical descriptive studies and multivariate models were used. Results: A polarised tendency was seen between human and environmental aspects. The following issues were statistically significant: visiting hours for parents, and criticisms about furniture, light and physical space. Parents of seriously ill children appreciated the visiting hours but judged the environment negatively. Pain perception in procedures was higher in serious illnesses, and 66% of parents would rather be present during those procedures. When comparing both hospitals, the only significant value regarding the new centre, was the lower perception of information given by the staff. Breastfeeding improved significantly. General satisfaction was high. Conclusions: Parents of seriously ill newborns are mainly concerned about access hours and comfort. Parent visiting hours and lack of noise and light are significant parameters predicting satisfaction in children with long stays. Perception of access to information got worse in the new hospital, probably due to lack of staff adaptation(AU)

[Assessment of parental satisfaction in a neonatal unit]. / Valoración de la satisfacción de los padres en una unidad neonatal.

INTRODUCTION: Parental satisfaction in a neonatal unit needs to be checked as a quality element in health care. OBJECTIVES: 1/To measure how the severity of the newborn condition influences parental satisfaction. 2/To compare the results before and after moving to a new building. METHODS: Parental satisfaction in 87 of the newborns admitted to our neonatal unit over a 10 month period was documented using a questionnaire survey. The newborns were divided into 2 categories, depending on the severity of their condition. Parental satisfaction as regards human and environmental issues was checked as to whether it was affected by the severity of the illness. The impact of the move to a new building on satisfaction was also analysed. Statistical descriptive studies and multivariate models were used. RESULTS: A polarised tendency was seen between human and environmental aspects. The following issues were statistically significant: visiting hours for parents, and criticisms about furniture, light and physical space. Parents of seriously ill children appreciated the visiting hours but judged the environment negatively. Pain perception in procedures was higher in serious illnesses, and 66% of parents would rather be present during those procedures. When comparing both hospitals, the only significant value regarding the new centre, was the lower perception of information given by the staff. Breastfeeding improved significantly. General satisfaction was high. CONCLUSIONS: Parents of seriously ill newborns are mainly concerned about access hours and comfort. Parent visiting hours and lack of noise and light are significant parameters predicting satisfaction in children with long stays. Perception of access to information got worse in the new hospital, probably due to lack of staff adaptation.

Seguimiento del neurodesarrollo de niños nacidos por técnicas de reproducción asistida / Monitoring neurodevelopment in children born as a result of using assisted reproduction techniques

Introducción. En los últimos años algunas publicaciones han demostrado una mayor incidencia de defectos congénitoso anomalías cromosómicas vinculadas a la fecundación in vitro (FIV) convencional, y otras publicaciones sugieren unaposible influencia negativa de la microinyección espermática (ICSI) sobre el neurodesarrollo. Objetivo. Determinar si habíadiferencias en el desarrollo médico y en el neurodesarrollo entre niños concebidos por técnicas de FIV convencional y niñosconcebidos por técnicas de ICSI. Sujetos y métodos. La muestra se compone de 17 infantes nacidos por FIV (nueve niños yocho niñas) y de 40 infantes nacidos por ICSI (23 niños y 17 niñas). Todos ellos procedían de embarazos de FIV y de ICSI obtenidosen el servicio de reproducción asistida de nuestro hospital y controlados por el mismo equipo de obstetricia y perinatología.A todos los pacientes se les realizó una exploración pediátrica a los 24 meses de edad cronológica y una exploraciónneuropsicológica. La exploración se realizó en una única sesión. Se evaluó específicamente el neurodesarrollo mediante lasescalas de Bayley de desarrollo infantil. Resultados y conclusiones. Los infantes de FIV convencional y e ICSI de nuestro estudiomostraron una salud y un neurodesarrollo similares a los de la población general a la edad de 2 años. La ICSI, comparadacon la FIV convencional, se muestra tan segura como ésta en relación con la evolución médica y cognitiva de los niños (AU)

Introduction. In recent years a number of publications have reported a higher incidence of congenital defects or chromosome abnormalities linked to conventional in vitro fertilisation (IVF), and some other publications have suggested that intracytoplasmic sperm injection (ICSI) may have a negative influence on neurodevelopment. Aim. To determine whether there were any differences in the medical development and the neurodevelopment of children conceived using conventionalIVF techniques and those conceived using ICSI techniques. Subjects and methods. Our sample consisted of 17 babies born after IVF (nine males and eight females) and 40 infants born after ICSI (23 males and 17 females). All of them were the resultof pregnancies induced by IVF and ICSI achieved in the assisted reproduction service at our hospital and followed up by the same team of obstetricians and specialists in maternal-foetal medicine. At the chronological age of 24 months all the patients were submitted to a paediatric examination and a neuropsychological examination. The examination was performed in onesingle session. Neurodevelopment was evaluated specifically by means of the Bayley scales of infant development. Results and conclusions. The health and neurodevelopment of infants from conventional IVF and from ICSI in our study were similar to those of the general population at the age of two years. ICSI proved to be as safe as conventional IVF as regards the children’s medical and cognitive progression (AU)

[Monitoring neurodevelopment in children born as a result of using assisted reproduction techniques]. / Seguimiento del neurodesarrollo de niños nacidos por tecnicas de reproducción asistida.

INTRODUCTION: In recent years a number of publications have reported a higher incidence of congenital defects or chromosome abnormalities linked to conventional in vitro fertilisation (IVF), and some other publications have suggested that intracytoplasmic sperm injection (ICSI) may have a negative influence on neurodevelopment. AIM. To determine whether there were any differences in the medical development and the neurodevelopment of children conceived using conventional IVF techniques and those conceived using ICSI techniques. SUBJECTS AND METHODS: Our sample consisted of 17 babies born after IVF (nine males and eight females) and 40 infants born after ICSI (23 males and 17 females). All of them were the result of pregnancies induced by IVF and ICSI achieved in the assisted reproduction service at our hospital and followed up by the same team of obstetricians and specialists in maternal-foetal medicine. At the chronological age of 24 months all the patients were submitted to a paediatric examination and a neuropsychological examination. The examination was performed in one single session. Neurodevelopment was evaluated specifically by means of the Bayley scales of infant development. RESULTS AND CONCLUSIONS: The health and neurodevelopment of infants from conventional IVF and from ICSI in our study were similar to those of the general population at the age of two years. ICSI proved to be as safe as conventional IVF as regards the children's medical and cognitive progression.

Síndrome de Aicardi-Goutières / Aicardi-Goutières syndrome

No disponible

[Bacterial tracheitis due to Haemophilus influenzae]. / Traqueítits bacteriana por Haemophilus influenzae.

We present a case of bacterial tracheitis in a 6.5 year old girl. Clinical signs and symptoms consisted of severe croup with high grade fever, which were preceded by upper respiratory tract prodrome. Initial treatment with steroids and nebulized epinephrine was unsuccessful. The patient was intubated a few hours after admission. Thick purulent secretions emerging from the trachea and the normal appearance of the epiglottis suggested the diagnosis of bacterial tracheitis, which was confirmed by isolation of Haemophilus influenzae in the culture of the tracheal secretions. The patient was administered a 14 day course of endovenous ceftriaxone and was kept on mechanical ventilation for 7 days. Fever and purulent tracheal secretions continued for the next 5 days. After 48 hours without these signs, laryngotracheobronchoscopy ruled out residual obstruction. Extubation was successfully performed. Fourteen days later physical examination showed no abnormalities and the patient was discharged. No complications were found during followup. The clinical, diagnostic and therapeutic aspects of this potentially life threatening entity that should taken into account in the differential diagnosis of severe croup are discussed.

Traqueítits bacteriana por Haemophilus influenzae / Bacterial tracheitis due to haemophilus influenzae

Se presenta un caso de traqueítis bacteriana en una niña de 6 años y medio. La forma clínica de presentación fue la de un crup intenso con fiebre alta y pródromos catarrales en los días previos, que no respondió al tratamiento inicial con adrenalina inhalada y corticoides y precisó intubación orotraqueal a las pocas horas del ingreso. La visualización de secreciones purulentas fluyendo de la tráquea en el momento de la intubación, con epiglotis de aspecto normal, orientó el diagnóstico de traqueítis bacteriana, que fue confirmado por el crecimiento de Haemophilus influenzae en el cultivo de dichas secreciones. Se administró tratamiento con ceftriaxona por vía intravenosa durante 14 días y ventilación mecánica durante 7 días. La fiebre alta y las secreciones traqueales purulentas persistieron durante los 5 primeros días de tratamiento. A los 2 días de desaparición de dichos signos, y previa laringotraqueobroncoscopia normal, se extubó con éxito. Tras 2 semanas de ingreso fue dada de alta con exploración física normal, y no se han observado complicaciones posteriores. Se revisan aspectos clínicos, diagnósticos y terapéuticos de una enfermedad que puede conllevar un compromiso vital y que debe considerarse en el diagnóstico diferencial de todo crup grave (AU)

Seguimiento posnatal del feto conpielectasia: un problema no resuelto / Postnatal followup of fetal pyelectasis: an unresolved problem

El control posnatal del feto con pielectasia ha sido objeto de controversia en la bibliografía reciente. La definición de pielectasia, la necesidad de estudiar o no a todos estos recién nacidos con el objetivo teórico de prevenir la nefropatía por reflujo y las infecciones urinarias, qué exploraciones hacerles y cuándo (ecografía posnatal, cistografía sistemática, estudios isotópicos), y si es necesario someterlos o no a profilaxis antibiótica, son aspectos que no están suficientemente aclarados. Tampoco la relación entre pielectasia prenatal, reflujo vesicorrenal e infección parece lineal. Este artículo intenta ordenar las controversias actualmente existentes al respecto, comentando finalmente el papel de las alteraciones genéticas en el desarrollo de los distintos tipos de nefropatía y malformaciones renales (AU)

[Postnatal followup of fetal pyelectasis: an unresolved problem]. / Seguimiento posnatal del feto conpielectasia: un problema no resuelto.

Postnatal followup of fetal pyelectasis is a controversial topic in recent literature. Questions such as the definition of pyelectasis, whether these neonates should be selected for postnatal study in an attempt to prevent reflux nephropathy and urinary tract infections, which complementary investigations (postnatal ultrasonography, cystourethrography, isotopic studies) should be performed and when, and whether these neonates should be administered antibiotic prophylaxis are unresolved issues. In addition, the relationship between prenatal pyelectasis, vesicoureteral reflux and infections is not at present clear. In this article, we try to review and order the present controversies, and briefly introduce the role of genetic aspects in the origin of different forms of nephropathy and renal malformations.

[Renovascular hypertension due to unilateral renal artery stenosis with hypokalemic alkalosis, the salt-losing syndrome and reversible hyperechogenicity of the contralateral kidney. A study of 2 infants]. / Hipertensión renovascular por estenosis unilateral de la arteria renal con alcalosis hipocaliémica, síndrome de pérdida salina e hiperecogenicidad reversible del riñón contralateral. Estudio de dos lactantes.

This report describes two infants with severe arterial hypertension secondary to unilateral renal artery stenosis which was manifested by polyuria, polydipsia, hypokalemic alkalosis, hyponatremia, increased natriuresis and increased plasma values of rennin and aldosterone. On sonographic examination, the contralateral non-stenotic kidney of both patients appeared enlarged and hyperechogenic mimicking parenchymal lesion. When the patients became normotensive, their sodium and potassium balance became normal and their contralateral non-stenotic kidney also became normal in size and echogenicity. The increase of the filtration and the natriuresis observed in the contralateral non-stenotic kidney of the patients with renovascular hypertension due to renal artery stenosis might be responsible for the hyperechogenicity. When the patients became normotensive, the filtration and excretion of sodium of the contralateral kidney also became normal and the increase of echogenicity also disappeared. The reversibility of the sonographic findings suggest a functional origin.