[Association between heroin consumption in pregnancy and structural abnormalities of the respiratory cilia in newborn infants]. / Asociación entre el consumo de heroína durante la gestación y anomalías estructurales de los cilios respiratorios en el período neonatal.

OBJECTIVE: To describe structural abnormalities of the respiratory cilia in newborn infants whose mothers consumed heroin during pregnancy. PATIENTS AND METHODS: The medical records of 295 newborn infants whose mothers consumed heroin either throughout or at some time during pregnancy and who were cared for in Hospital del Mar in Barcelona (Spain) between January 1982 and December 1997 were reviewed. Seven infants with neonatal respiratory distress after the withdrawal syndrome period were selected. Diagnoses were established by electron microscopy of nasal mucosa samples. RESULTS: All seven newborns with prolonged neonatal respiratory distress had ultrastructural abnormalities of the ciliary axoneme similar to those of primary ciliary dyskinesia or immotile cilia syndrome. The incidence of this alteration in this series was higher than that in the general population. CONCLUSIONS: These data suggest a possible association between ultrastructural abnormalities of the ciliary axoneme and prolonged neonatal respiratory distress in the infants of heroin-consuming mothers.

Asociación entre el consumo de heroína durante la gestación y anomalías estructurales de los cilios respiratorios en el período neonatal / Association between heroin consumption in pregnancy and structural abnormalities of the respiratory cilia in newborn infants

Objetivo: Describir las anomalías estructurales de los cilios respiratorios en los recién nacidos hijos de gestantes consumidoras de heroína durante todo el embarazo o parte de él. Pacientes y métodos: Se revisan retrospectivamente las historias de 295 recién nacidos hijos de madres consumidoras de heroína durante toda la gestación o parte de ella y atendidas en el Hospital del Mar de Barcelona desde enero de 1982 hasta diciembre de 1997. Se seleccionaron 7 recién nacidos que habían presentado distrés respiratorio neonatal prolongado más allá de la duración del síndrome de abstinencia de drogas y estudiados mediante la microscopia electrónica de las muestras obtenidas del raspado de la mucosa nasal. Resultados: Los 7 recién nacidos afectados de distrés respiratorio neonatal prolongado presentaban anomalías ultraestructurales del axonema ciliar compatibles con las del síndrome del cilio inmóvil o discinesia ciliar primaria. La incidencia de estas anomalías en hijos de gestantes consumidoras de heroína durante toda o parte de la gestación en esta serie es superior a la de la población general. Conclusiones: Estos resultados hacen sospechar que el consumo de heroína por la gestante afecta la ultraestructura ciliar de los recién nacidos, manifestándose clínicamente como distrés respiratorio neonatal prolongado (AU)

[Invasive catheters in neonates]. / Catéteres invasivos en el recién nacido.

OBJECTIVE: The care of very sick babies requires the use of invasive catheters in the neonatal intensive care unit. Our objective was to review the invasive catheters placed (umbilical and epicutaneous) between 1994 and 1998 and describe the guidelines used to take care of the intravenous lines. PATIENTS AND METHODS: Two periods were compared (January 1994 until June 1997 and July 1997 until September 1998) and characteristics of the patient and catheter were analyzed. During the first period, sepsis related to the catheter was diagnosed according to clinical and analytical criteria and required a positive blood culture. The same criteria were required in the second period, but coincidence of the organisms in the peripheral and catheter blood culture was also needed. RESULTS: A total of 1,285 central catheters were studied in 958 newborn admissions. Umbilical catheter were used in 6% of the cases and epicutaneous in 23%, most of which were in the upper extremities. The most frequent reason to remove the catheter was the end of the indication. The incidence of catheter related sepsis in the first period was 1% and during the second period 6%. Strict diagnostic criteria used in the second period were more predictive for sepsis. If premature babies were considered alone, the incidence increased to 14%. The most frequent organism isolated was Staphylococcus epidermidis. CONCLUSIONS: To decrease the incidence of sepsis related to catheters, a strict protocol for placement and maintenance must be followed.