Experience of Minimally Invasive Surgery in Neonates with Congenital Malformations in a Tertiary Care Pediatric Hospital.

AIM: The aim of this study is to report the experience with minimally invasive surgery (MIS) in neonates with congenital malformations in a tertiary care pediatric hospital. MATERIALS AND METHODS: Design: descriptive study. All neonates undergoing MIS from 2013 to 2018 were included in the study. Perinatal data, characteristics of surgery, type and duration of analgesia, postoperative mechanical ventilation duration, postoperative hospitalization, and postoperative morbidity and mortality surgery-related rates were recorded. RESULTS: Seventy-one neonates were included. Gestational age and weight at surgery ranged from 24 to 41 weeks and from 1350 g to 4830 g, respectively. Procedures performed were esophageal atresia/tracheoesophageal fistula repair, congenital diaphragmatic hernia repair, diaphragmatic plication, fundoplication/gastrostomy, intestinal atresia repair, and pancreatectomy. The median follow-up period was 14 months. Five neonates (7%) were converted to open, for surgical difficulties. Nine (12.6%) neonates had intraoperative complications, with decreased oxygen saturation as the most common complication. The median duration of analgesia and postoperative mechanical ventilation was 3 days in most procedures. The morbidity and mortality rates were 36.6% and 2.8%, respectively. CONCLUSIONS: In this first experience with MIS in neonates, the duration of analgesia and hospitalization was shorter for some procedures. However, intraoperative and postoperative complications were still high, which was possibly attributed to the learning curve. Thus, it is expected that the frequency of the complications presented in this study will be reduced in future.

Revisión sistemática y meta-análisis sobre la efectividad del surfactante bovino como tratamiento de prematuros con síndrome de dificultad respiratoria / Systematic review and meta-analysis of bovine surfactant effectiveness for the treatment of respiratory distress syndrome in premature newborns

Introducción. Con el propósito de determinar la efectividad del surfactante bovino (SB) para el tratamiento del síndrome de dificultad respiratoria (SDR) en recién nacidos prematuros (RNP), se realizó una revisión sistemática y meta-análisis. Métodos. Se incluyeron ensayos clínicos aleatorizados (ECA) donde se comparó SB con placebo. Las variables de desenlace fueron: mortalidad, morbilidad, días de ventilación mecánica (VM) y de estancia hospitalaria. Los ECA publicados hasta el 2010 se identificaron en Medline, EMBASE y la Colaboración Cochrane. La selección de los ECA fue por pares. En el meta-análisis se calculó riesgo relativo (RR) y diferencia de medias ponderada (DMP), con intervalos de confianza al 95% (IC95%). Resultados. De 865 títulos y resúmenes, se revisaron 89 artículos en extenso y se seleccionaron 12 ECA. El SB se mostró efectivo en cuatro variables: mortalidad (RR 0.73, IC95% 0.60-0.88, P =0.001), neumotórax (RR 0.41; IC95% 0.33-0.51, P <0.0001), enfisema intersticial pulmonar (RR 0.45; IC95% 0.36-0.56, P <0.0001) y días de VM (DMP -9.57; IC95% -16.58, -2.56, P =0.007). Para otras, como displasia broncopulmonar, enterocolitis necrosante, hemorragia intraventricular o alteración del desarrollo neurológico, no se determinó ventaja con SB. Conclusiones. En RNP, el uso de SB es efectivo al disminuir la mortalidad, la frecuencia de neumotórax y enfisema intersticial pulmonar, así como el tiempo de VM y, posiblemente, el de estancia hospitalaria.

Background. In order to evaluate the effectiveness of the bovine surfactant (BS) for the treatment of newborns with respiratory distress syndrome (RDS), we performed a systematic review and meta-analysis. Methods. Randomized-controlled trials (RCT) assessing the BS in comparison with placebo for the treatment of prematures with RDS were included. Outcome measures evaluated were: mortality, morbidity, days on mechanical ventilation (MV) and length of hospitalization. RCT published until 2010 were obtained from Medline, EMBASE and Cochrane Collaboration. Selection of included studies was based on a peer-review process. For the meta-analyses, relative risk (RR) and weighted mean differences (WMD) were calculated, with 95% confidence intervals (95%CI). Results. From 865 titles and abstracts obtained, 89 papers were reviewed and 12 RCT were selected. Among the outcome measures assessed, BS was shown to be effective in only in four: mortality (RR 0.73, 95% CI 0.60-0.88, p =0.001), pneumothorax (RR 0.41; 95% CI 0.33-0.51, p <0.0001), pulmonary interstitial emphysema (RR 0.45; 95% CI 0.36-0.56, p <0.0001) and on days of MV (WMD -9.57; 95% CI -16.58 to -2.56, p =0.007). However, we did not find any positive effect on bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage or abnormal neurological development. Conclusions. In newborns with RDS, bovine surfactant is effective regarding mortality, pneumothorax, and pulmonary interstitial emphysema, as well as on decrease in the length of MV and possibly on length of hospitalization.

[Risk factors for surgical site infections in newborns in a neonatal intensive care unit]. / Factores de riesgo asociados a infección del sitio quirúrgico en recién nacidos en una unidad de cuidados intensivos neonatales.

OBJECTIVE: To identify risk factors associated to surgical site infection (SSI) in newborns. DESIGN: Case-control study. Site. Neonatal intensive care unit (NICU), Hospital de Pediatría, Centro Medico Nacional SXXI, IMSS. PATIENTS: 279 patients were included (125 cases and 154 controls). DATA: Gestational age, birth weight, previous infection, hospital stay, type of surgery, surgical drains, length of surgical procedure, bleeding during surgery, surgical site classification, serum albumin, classification of infection and surgeon performing the procedure. RESULTS: Five independent factors associated to SSI were identified: surgical reinterventions (OR = 13.6, CI 95% = 4.3-42.7); length of surgery > 60 minutes (OR = 3.0, CI 95% = 1.4-6.3); preoperative stay > 5 days (OR = 2.8, CI 95% = 1.3-5.6); consultant surgeon (OR = 2.7, CI 95% = 1.3-5.3), and previous systemic infection (OR = 2.1, CI 95% = 1.1-4.3). Lethality was 8.2% (n = 23), 74% in the group of cases (n = 17). CONCLUSIONS: Factors associated to SSI are mainly related to the characteristics of surgery and those of the patient. Lethality was low, but most of deaths were in the group of cases.

Factores de riesgo asociados a infección del sitio quirúrgico en recién nacidos en una unidad de cuidados intensivos neonatales / Risk factors for surgical site infections in newborns in a neonatal intensive care unit

Objective. To identify risk factors associated to surgical site infection (SSI) in newborns. Design. Case-control study. Site. Neonatal intensive care unit (NICU), Hospital de Pediatría, Centro Médico Nacional SXXI, IMSS. Patients. 279 patients were included (125 cases and 154 controls). Data. Gestational age, birth weight, previous infection, hospital stay, type of surgery, surgical drains, length of surgical procedure, bleeding during surgery, surgical site classification, serum albumin, classification of infection and surgeon performing the procedure. Results. Five independent factors associated to SSI were identified: surgical reinterventions (OR = 13.6, CI 95% = 4.3-42.7); length of surgery > 60 minutes (OR = 3.0, CI 95% = 1.4-6.3); preoperative stay > 5 days (OR = 2.8, CI 95% = 1.3-5.6); consultant surgeon (OR = 2.7, CI 95% = 1.3-5.3), and previous systemic infection (OR = 2.1, CI 95% = 1.1-4.3). Lethality was 8.2% (n = 23), 74% in the group of cases (n = 17). Conclusions. Factors associated to SSI are mainly related to the characteristics of surgery and those of the patient. Lethality was low, but most of deaths were in the group of cases.

Objetivo. Identificar los factores de riesgo asociados a infección del sitio quirúrgico (ISQ) en recién nacidos. Diseño. Casos y controles. Lugar. Unidad de cuidados intensivos neonatales, Hospital de Pediatría, Centro Médico Nacional SXXI, IMSS. Pacientes. Se estudiaron 279 pacientes (125 casos y 154 controles). Mediciones. Las variables estudiadas fueron edad gestacional, peso al nacer, infección previa, estancia hospitalaria, cirugía realizada, colocación de canalizaciones, tiempo quirúrgico, sangrado transquirúrgico, tipo de herida, reintervenciones, albúmina sérica, tipo de infección, y cirujano que realizó la cirugía. Resultados. Se identificaron cinco factores independientes asociados a infección del sitio quirúrgico: reintervenciones quirúrgicas (RM = 13.6, IC 95% = 4.3-42.7); duración de la cirugía > 60 minutos (RM = 3.0, IC 95% = 1.4-6.3); estancia prequirúrgica > 5 días (RM = 2.8, IC 95% = 1.3-5.6); cirujano interconsultante (RM = 2.7, IC 95% =1.3-5.3), e infección sistémica previa (RM = 2.1, IC 95% = 1.1-4.3). La letalidad fue de 8.2% (n =23), 74% fueron del grupo de casos (n = 17). Conclusiones. Los factores asociados a ISQ encontrados se relacionan con factores inherentes al paciente y a la cirugía. La letalidad fue baja; sin embargo, la mayoría de los fallecimientos fueron en el grupo de casos.