Validation of a prognostic index in the critically ill newborn.

OBJECTIVE: Elaborate and assess the degree of validity of a prognostic model for evaluating patients admitted to the Neonatal Intensive Care Unit (NICU). DESIGN: Cases and controls nested in a cohort. SETTING: NICU of two tertiary hospitals and another second level hospital. PATIENTS: The study was carried out in two phases. During the first phase (elaboration of a model), 336 newborns were studied; 112 belonged to the case group (dead patients) and 224 to the control group (live patients discharged). For the second phase (model validation), 300 patients were included that did not participate in the first phase, 100 cases and 200 controls. MEASUREMENTS: For each patient admitted to the study, clinical, paraclinical, perinatal and comorbidity factors were determined within the first 12 hours. Variables of statistical significance in the bivariate analysis were included in a logistic regression model with the objective of identifying a prognostic model. RESULTS: The variables that constituted the prognostic index were gestational age x birth weight, the paO2/FiO2 ratio x O2 saturation, arrest cardiac, major congenital malformations, septicemia and base excess. The model showed to have a sensitivity of 70% and a specificity of 91% during the elaboration cohort. In the validation cohort, sensitivity was 68% and specificity was 92%, a positive predictive value of 80%, negative predictive value of 85% and a correct classification rate was 84%. CONCLUSIONS: The Neonatal Mortality Prognostic Index (NMPI) developed in this study showed to be useful for the evaluation of hospital mortality for severely ill newborns admitted to NICU.

[Case-control study of an outbreak of S. marcescens in a neonatal intensive care unit]. / Estudio de casos y controles en un brote de S. marcescens en una unidad neonatal de cuidados intensivos.

OBJECTIVE: To analyze an outbreak of Serratia marcescens in a neonatal intensive care unit and identify the risk factors associated to the development of infection. MATERIAL AND METHODS: It was a case-control study from March to July 1995. Factors included were age, sex, intravascular devices, nebulizers, mechanical ventilation, use of total parenteral nutrition (TPN), underlying diseases, surgical interventions, tubes, previous antimicrobial treatment and days of exposure. The associations were explored using the odds ratio. RESULTS: 24 cases and 30 controls were included. In the univariate analysis the significant risk factors (OR,IC) were use of central venous catheter (4.57, 1.01-23.5), days of use of TPN (4.38, 1.03-16.5), days of previous antimicrobial treatment (4.87, 1.60-22) and days of exposure (2.7, 2.65-27.6). In the multivariate analysis the significant risk factors were previous antimicrobial treatment (3.98, 2.36-18.2), days of previous antimicrobial treatment (6.76, 3.02-24.6) and days of use of TPN (4.87, 1.67-15.6). CONCLUSIONS: The significant risk factors in our study were previous antimicrobial treatment, days of antimicrobial and days of use of TPN.

[Evaluation of diagnostic tests for hypocalcemia in critically ill newborns]. / Evaluación de pruebas diagnósticas de hipocalcemia en neonatos gravemente enfermos.

OBJECTIVE: To determine sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV, NPV) of total and calculated calcium and of QTc and QoTc intervals for the diagnosis of hypocalcemia in critically ill newborns. SETTING: A neonatal intensive care unit. METHODS: We included all newborn less than 28 days of age; we excluded those with calcium treatment, hypomagnesemia or congenital heart disease. Serum levels of total calcium, albumin and ionic calcium were measured as well as the QTc and QoTc intervals. Values for Sn, Sp, PPV and NPV were calculated according to cutoff points of the literature and with those of our receptor operating curves (ROC). Ionic calcium was considered the gold standard (hypocalcemia < 1.10 mmol/L). RESULTS: We included 53 newborns; 21/53 (40%) had hypocalcemia. Clinical features were similar among patients with or without hypocalcemia. For total calcium the Sn was 47%; Sp = 87%; PPV = 71% and NPV = 72%. For calculated calcium there values were: 55, 75, 57 and 73; for QoTc: 47, 81, 61 and 70%; and for QTc: 19, 87, 50 and 62% respectively. With the ROC values the Sn for total calcium and QTc was improved. CONCLUSIONS: Among critical ill newborns, total and calculated calcium were better in identifying patients with hypocalcemia whereas QTc and QoTc were better in those without hypocalcemia.

[Experience in the use of central venous catheterization via subclavian puncture in a pediatric hospital]. / Experiencia en el uso de la cateterización venosa central por punción subclavia en un hospital pediátrico.

OBJECTIVE: To assess the frequency and type of complications during central venous catheter installation by subclavian puncture, and during its use in children admitted to an ICU. PATIENTS AND METHODS: Patients from one month to 15 years of age, admitted to the Intensive Care Unit of the Hospital de Pediatría Centro Médico Nacional, Siglo XXI, who underwent a percutaneous infraclavicular subclavian puncture for central venous catheter complications were included. Clinical features, diagnosis, complications and indications for the procedure were registered. RESULTS: 92 patients and 102 subclavian punctures were included for analysis. Effectively index was 88.3%. Main diagnosis was infectious diseases in 29.4% and neoplasia in 22.5%. Hemodynamic monitoring was the more frequent indication for the procedure (44%). Of the catheter 45% were successfully installed at first intent. The complication in the installation appear in 11.7%. Was arterial subclavian puncture (6.8%), hematoma (2.9%), without hemodynamic deterioration no any case. The mean time of permanence was 8.8 days. The late complications was present in average 7.3 days, in 18.6% of the cases. Predominance infection in entrance place of catheter. CONCLUSIONS: Installation of venous central catheter by subclavian puncture prove a great utility in our patients, with a few complications and a high effectively. For experimental personal the central venous catheterization by subclavian puncture in pediatric patients to be importance in the first place in critical ill children.

[Frequency of poisoning in a general hospital in Mexico City]. / Frecuencia de intoxicaciones en un hospital general de la ciudad de México.

We analyzed 56 cases of children with diagnosis of poisoning, which were attendant at the pediatric emergency room at "Dr. Manuel Gea Gonzalez" General Hospital, during a period between October 1st 1987 and September 31st, 1988. A greater incidence among infants below 5 years of age was observed, 16.07% of these were newborn infants. Male infants were the most affected. The most frequent causes were iatrogenic and accidental incidents. Only 4 cases of suicide attempt was reported. Medically prescribed drugs were the most frequent cause of poisoning. Of these, anticholinergic agents were the number one cause. Among other types of agents, a relatively high incidence of mushroom poisoning was observed. General death rate was 10.71%. Through a survey answered by 400 physicians, we studied their knowledge of basic concepts of toxicology, commercial names, doses and side effects of certain drugs; 24% of these were pediatricians, and the rest were general physicians. This survey reveals adequate knowledge of commercial names of drugs, but poor knowledge of basic toxicology, doses and side effects of these drugs.

Citomegalovirus como agente causal de lesiones ulcerativas en tubo digestivo. / Cytomegalovirus as etiological agent of ulcerative lesions in digestive tract

Las numerosas comunicaciones sobre cuadros diarreicos, sangrados y perforaciones en tubo digestivo ocasionados probablemente por citomegalovirus en pacientes adultos homosexuales, plantean la posibilidad de la infeccion directa de la mucosa intestinal por el virus citomegalico contenido en el liquido seminal. En la edad pediatrica se encontraron trece casos con cuadros de diarrea prolongada, en ocasiones con sangre en las evacuaciones provocados por ulceraciones muy similares a las descritas en el adulto; el proceso de vasculitis que acompano a las lesiones mostro las celulas caracteristicas de la infeccion por citomegalovirus. Se establecio asi la posibilidad de infeccion directa de las celulas del tracto gastrointestinal por las particulas virales contenidas en la leche materna con posible diseminacion posteriormente a otros organos

[Enteritis and its complications. Etiology and most frequent anatomoclinical picture]. / Enteritis y sus complicaciones. Etiopatogenia y cuadros anatomoclínicos más frecuentes.

A study is made of the environmental, etiologic, pathogenic, clinical and anatomical characteristics of the bacterial or parasitic enteral processes which most frequently cause death to the patients. Considerations on the pathogenesis of the complications found at the postmortem studies in children with diarrhea are likewise offered.

[Toxoplasmosis. Anatomo clinical characteristics and morphological indentification of the parasite using the silver-impregnation technic]. / Toxoplasmosis. Características anatomoclínicas e identificación morfológica del parásito mediante técnicas de impregnación argéntica

The clinical and anatomicopathological characteristics of acute and chronic toxoplasmosis are described as they affect different structures and systems. The lesion to adrenal glands is compared to that seen in disseminated herpes simplex; however, the question remains as to why in both congenital infections, necrosis of adrenal glands appears without inflammatory reaction. The investigation of special techniques for localization and identification of Toxoplasma gondii "groups" or cysts, leads to the conclusion that Grocott's silver impregnation technique used for the identification of Entamoeba histolytica is also useful to discover Toxoplasma in tissues.

[Congenital toxoplasmosis]. / Toxoplasmosis congénita

Judged by the cases studied at the Hospital de Pediatría, congenital toxoplasmosis may be transmitted to several descendants and the infection capacity of the mother persists for a long time. The possibility of toxoplasma infection should be investigated in cases of hydrocephalus, convulsions, microcephalia, ocular lesions or pictures of neonatal hepatitis. To explain invasion to the central nervous system by Toxoplasma gondii, a pathogenic hypothesis is offered.