A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn.

The use of routine point-of-care ultrasound (POCUS) is increasing in neonatal intensive care units (NICUs), with several centers advocating for 24 h equipment availability. In 2018, the sonographic algorithm for life-threatening emergencies (SAFE) protocol was published, which allows the assessment of neonates with sudden decompensation to identify abnormal contractility, tamponade, pneumothorax, and pleural effusion. In the study unit (with a consulting neonatal hemodynamics and POCUS service), the algorithm was adapted by including consolidated core steps to support at-risk newborns, aiding clinicians in managing cardiac arrest, and adding views to verify correct intubation. This paper presents a protocol that can be applied in the NICU and the delivery room (DR) in relation to three scenarios: cardiac arrest, hemodynamic deterioration, or respiratory decompensation. This protocol can be performed with a state-of-the-art ultrasound machine or an affordable handheld device; the image acquisition protocol is carefully detailed. This method was designed to be learned as a general competence to obtain the timely diagnosis of life-threatening scenarios; the method aims to save time but does not represent a substitute for comprehensive and standardized hemodynamic and radiological analyses by a multidisciplinary team, which might not universally be on call but needs to be involved in the process. From January 2019 to July 2022, in our center, 1,045 hemodynamic consultation/POCUS consults were performed with 25 patients requiring the modified SAFE protocol (2.3%), and a total of 19 procedures were performed. In five cases, trained fellows on call resolved life-threatening situations. Clinical examples are provided that show the importance of including this technique in the care of critical newborns.

COVID-19, implications for the newborn. Literature review. / COVID-19, implicaciones para el recién nacido. Revisión de la literatura.

COVID-19 is an infectious disease caused by the coronavirus called SARS-CoV-2, which was unknown until in December 2019, when the outbreak of viral pneumonia in Wuhan, China, was reported. Since different age groups are susceptible to this infection, including newborns, the objective of this article is to review scientific literature published in English language and available in PubMed database until April 21, 2020, related to epidemiological and clinical aspects in newborns with suspected or confirmed SARS-CoV-2 infection, as well as the recommendations for their management. In general, symptoms in newborns are milder (may even be asymptomatic) and compared to adults, their prognosis is more favorable. However special precautions are required to reduce the potential mother-to-child transmission, and to reduce the possibility of complications in symptomatic neonates.

La COVID-19 es una enfermedad infecciosa causada por el coronavirus SARS-CoV-2, desconocido hasta diciembre de 2019, cuando se reportó el brote de neumonías virales en Wuhan, China. Dado que diferentes grupos de edad son susceptibles a la infección, incluyendo los recién nacidos, el objetivo de este artículo es revisar la literatura científica disponible en la base de datos PubMed en idioma inglés hasta el 21 de abril de 2020, sobre los aspectos epidemiológicos y clínicos en recién nacidos con sospecha o confirmación de infección por SARS-CoV-2, así como las recomendaciones para su manejo. En general, los síntomas en los recién nacidos son más leves (incluso pueden ser asintomáticos) y, en comparación con los adultos, el pronóstico más favorable. Sin embargo, se requieren precauciones especiales para reducir el potencial de transmisión madre-hijo y reducir la posibilidad de complicaciones en los neonatos sintomáticos.