Incidencia de parálisis braquial obstétrica tras programa de entrenamiento en distocia de hombros / Incidence of obstetric brachial plexus palsy after a training program in shoulder dystocia

Introducción: La distocia de hombros es una emergencia obstétrica no prevenible que causa graves complicaciones, como la parálisis braquial obstétrica. El objetivo del estudio fue determinar la incidencia de parálisis braquial obstétrica y de otras complicaciones neonatales asociadas a la distocia de hombros en los partos atendidos en un Hospital Universitario tras la implantación de un curso basado en simulación, de carácter voluntario y destinado a todos los profesionales en paritorio. Material y métodos: Estudio observacional retrospectivo; registro de los casos de distocia de hombros y de las complicaciones asociadas (principalmente parálisis braquial obstétrica) que tuvieron lugar entre enero del 2017 y diciembre del 2020, tras la implantación del curso. De forma paralela, se rescataron los casos de parálisis braquial obstétrica que tuvieron lugar en el hospital antes del entrenamiento (2008-2016). Resultados: En el período 2017-2020, de entre 125 distocias de hombros (lo que representa el 1,38% de los partos vaginales), hubo 14 casos de parálisis braquial obstétrica (el 11,2% de las distocias de hombros), siete fracturas de clavícula y una fractura de húmero; ninguna de las parálisis braquiales obstétricas fue permanente ni requirió tratamiento o rehabilitación más allá de los seis meses. En los años anteriores al entrenamiento, hubo siete casos de parálisis braquial obstétrica, dos permanentes y cinco transitorias (tres de las cuales necesitaron rehabilitación). Conclusión: Estos resultados reflejan la importancia de conocer la morbilidad presente en el paritorio y el posible beneficio de la formación basada en simulación para la resolución de estas complicaciones obstétricas. (AU)

Introduction: Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis. Material and methods: Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008–2016). Results: In 2017–2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation). Conclusion: These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications. (AU)

Incidence of obstetric brachial plexus palsy after a training program in shoulder dystocia.

INTRODUCTION: Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis. MATERIAL AND METHODS: Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008-2016). RESULTS: In the 2017-2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation). CONCLUSION: These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications.

Negative Transmission of SARS-CoV-2 to Hand-Expressed Colostrum from SARS-CoV-2-Positive Mothers.

Aim: The objective of our study was to determine whether the SARS-CoV-2-positive mothers transmit the virus to their hand-expressed colostrum. Methods: This is an observational prospective study that included pregnant women who tested positive for SARS-CoV-2 by PCR test on a nasopharyngeal swab at the moment of childbirth and who wanted to breastfeed their newborns. A colostrum sample was obtained from the mothers by manual self-extraction. To collect the samples, the mothers wore surgical masks, washed their hands with an 85% alcohol-based gel, and washed their breast with gauze that was saturated with soap and water. Results: We obtained seven colostrum samples from different mothers in the first hours postdelivery. SARS-CoV-2 was not detected in any of the colostrum samples obtained in our study. Conclusion: In our study, breast milk was not a source of SARS-CoV-2 transmission. Hand expression (assuring that a mask is used and that appropriate hygienic measures are used for the hands and the breast), when direct breastfeeding is not possible, appears to be a safe way of feeding newborns of mothers with COVID-19.

Tos, hipoxemia y dificultad respiratoria en el periodo neonatal. No siempre es lo que parece / Cough, respiratory distress and hypoxemia in neonatal period. It is not always what it seems

La dificultad respiratoria en el periodo neonatal tardío constituye un reto pediátrico no solo diagnóstico, sino de tratamiento, ya que a las múltiples causas del cuadro se deben sumar los factores inherentes a la propia vulnerabilidad del niño. En la práctica habitual, la principal causa de estos cuadros son las infecciones (fundamentalmente víricas), aunque se deben tener en cuenta otras etiologías como cardiológicas, digestivas, metabólicas o anatómicas. Presentamos un caso clínico de tos, dificultad respiratoria e hipoxemia en un neonato de 17 días de vida en el que los datos de la anamnesis, la exploración y el cuadro clínico condujeron a la realización de pruebas complementarias específicas que llevaron al diagnóstico de neumonía por Chlamydia. Realizaremos asimismo una revisión sobre el estado actual de la cuestión basándonos en el cuadro clínico que presentaba el recién nacido

Respiratory distress in the late neonatal period is a challenge for the pediatrician, not only in diagnosis but also in treatment, as the inherent factors of the child's vulnerability must be added to the multiple possible etiologies. In practice, viral infections are responsible for a high percentage of these conditions. However, other etiologies such as cardiologic, digestive, metabolic or anatomical causes must be taken into account. We introduce a case report of a 17-day-old neonate with cough, respiratory distress and hypoxemia. The anamnesis, physical examination and clinical findings led to specific complementary tests. All these conduced to the diagnosis of pneumonia caused by Chlamydia. We also perform a review of the current state of the knowledge, based on the clinical condition presented on the neonate

Lactancia materna y tratamiento con litio: Caso clínico / Lithium while breastfeeding: Case report

El tratamiento con litio forma parte de la terapia habitual en las personas que sufren el trastorno bipolar. Habitualmente, aquellas madres que desean dar el pecho a sus hijos son sometidas a la disyuntiva entre modificar el tratamiento o bien administrar lactancia artificial. La administración de litio durante la lactancia materna se ha asociado con diversos efectos adversos en el lactante, tales como alteraciones tiroideas, hipotermia o hipotonía, entre otros. Son pocas las publicaciones en las que no se observan dichas anomalías en los lactantes. A continuación, se presenta el caso de un lactante amamantado por su madre en tratamiento con litio que no presentó alteraciones renales ni tiroideas.

Lithium therapy is currently a cornerstone of treatment for mothers who suffer bipolar disorders. Those who wish to breastfeed their children are often told they have to decide whether modifying the treatment for their disorder or even avoiding lactation. Lithium administration during breastfeeding has been described to produce certain side effects such as thyroid disorders, hypothermia and hypotonia. To our knowledge, there are few publications where infants have no laboratory abnormalities. Here we present the case of an infant without renal or thyroid alteration while he was breastfed.

[Lithium while breastfeeding: Case report]. / Lactancia materna y tratamiento con litio: Caso clínico.

Lithium therapy is currently a cornerstone of treatment for mothers who suffer bipolar disorders. Those who wish to breastfeed their children are often told they have to decide whether modifying the treatment for their disorder or even avoiding lactation. Lithium administration during breastfeeding has been described to produce certain side effects such as thyroid disorders, hypothermia and hypotonia. To our knowledge, there are few publications where infants have no laboratory abnormalities. Here we present the case of an infant without renal or thyroid alteration while he was breastfed.

El tratamiento con litio forma parte de la terapia habitual en las personas que sufren el trastorno bipolar. Habitualmente, aquellas madres que desean dar el pecho a sus hijos son sometidas a la disyuntiva entre modificar el tratamiento o bien administrar lactancia artificial. La administración de litio durante la lactancia materna se ha asociado con diversos efectos adversos en el lactante, tales como alteraciones tiroideas, hipotermia o hipotonía, entre otros. Son pocas las publicaciones en las que no se observan dichas anomalías en los lactantes. A continuación, se presenta el caso de un lactante amamantado por su madre en tratamiento con litio que no presentó alteraciones renales ni tiroideas.

The Relationship of the Administration of Intrapartum Synthetic Oxytocin and Breastfeeding Initiation and Duration Rates.

AIM: The consequences that intrapartum administration of hormones can have on breastfeeding are unclear. The aim of the study is to determine if synthetic intrapartum oxytocin, used routinely for induction/stimulation, has a relationship to initiation/duration of breastfeeding. PATIENTS AND METHODS: We conducted a cohort study that was carried out in a tertiary university hospital distinguished by WHO-UNICEF as a BFHI (Baby-Friendly Hospital Initiative). A group of 53 mother and newborn dyads who had been exposed to intrapartum synthetic oxytocin were compared with 45 nonexposed dyads. A breastfeeding questionnaire was administered by a midwife blind to patient group through phone calls 3 and 6 months after delivery. RESULTS: No statistically significant differences were observed between the two groups in the rates of mothers exclusively breastfeeding (EBF) or nonexclusively breastfeeding. The percentage of those who were EBF when discharged was 97.3% in the oxytocin-nonexposed group and 87.1% in the oxytocin-exposed group (p = 0.14). At 3 months, the group rates of exclusive breastfeeding were 72.5% in the nonoxytocin-exposed group versus 65.9% in the oxytocin-exposed group (p = 0.71). At 6 months, rates of breastfeeding were 31.4% versus 27.9% (p = 0.53) in the oxytocin-nonexposed and oxytocin-exposed groups, respectively. CONCLUSIONS: In this study, no statistically significant effect of intrapartum synthetic oxytocin administration was observed pertaining to the initiation or duration of breastfeeding.

Intrapartum synthetic oxytocin reduce the expression of primitive reflexes associated with breastfeeding.

AIM: Several synthetic peptide manipulations during the time surrounding birth can alter the specific neurohormonal status in the newborn brain. This study is aimed at assessing whether intrapartum oxytocin administration has any effect on primitive neonatal reflexes and determining whether such an effect is dose-dependent. MATERIALS AND METHODS: A cohort prospective study was conducted at a tertiary hospital. Mother-infant dyads who received intrapartum oxytocin (n=53) were compared with mother-infant dyads who did not receive intrapartum oxytocin (n=45). Primitive neonatal reflexes (endogenous, antigravity, motor, and rhythmic reflexes) were quantified by analyzing videotaped breastfeeding sessions in a biological nurturing position. Two observers blind to the group assignment and the oxytocin dose analyzed the videotapes and assesed the newborn's state of consciousness according to the Brazelton scale. RESULTS: The release of all rhythmic reflexes (p=0.01), the antigravity reflex (p=0.04), and total primitive neonatal reflexes (p=0.02) in the group exposed to oxytocin was lower than in the group not exposed to oxytocin. No correlations were observed between the dose of oxytocin administered and the percentage of primitive neonatal reflexes released (r=0.03; p=0.82). CONCLUSIONS: Intrapartum oxytocin administration might inhibit the expression of several primitive neonatal reflexes associated with breastfeeding. This correlation does not seem to be dose-dependent.

Mode of delivery may influence neonatal responsiveness to maternal separation.

INTRODUCTION: Maternal-infant separation (MIS) is a highly stressful situation for the neonate. MATERIALS AND METHODS: A study was conducted to observe and describe the reactions of term neonates to brief maternal separation and restoration of skin contact within the first 48 h of life, and to assess whether the mode of delivery influences neonatal responsiveness. A brief maternal-infant separation situation was videotaped to observe the reactions of the newborns within the first 12-48 h of life. Characteristics observed in the newborns were: the Moro reflex, spreading out arms and feet, looking at the mother, presence/lack of crying, and some dichotomous variables (present or lacking); in mothers: adult speech, "motherese" speech, speaking to another adult present in the room, singing, clicking, tapping on the diaper, rocking, kissing the baby, touching toes, touching hands, changing position, making loving comments, calling the newborn by his/her name and touching his/her back. Crying on restoration of contact was measured. RESULTS: Ten neonates born by planned C-section and 21 neonates born by oxytocin-induced vaginal delivery were included. No behavioral differences were observed according to the mode of delivery. Neonates born by vaginal delivery took longer (64.8±8.6 s) to calm down than those born by C-section (0.9±1.4 s) (p=0.004). A correlation was observed between cortisol concentrations at birth and the time required to calm the baby down (r=0.41; p=0.02). CONCLUSION: Neonates born by a planned C-section cried much less on maternal separation, which might indicate an altered attachment behavior and altered response to stress. Further studies are needed to determine the potential long-term implications of variations in mother-infant attachment during the first days of life.

Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study.

AIM: To investigate the effect intrapartum oxytocin administration can have on Primitive Neonatal Reflexes. The secondary objective was to observe the influence of intrapartum oxytocin may have on breastfeeding. METHODS: Twenty healthy primiparae with a single gestation at term were included. To assess Primitive Neonatal Reflexes, video film was taken during an experimental situation designed to elicit Primitive Neonatal Reflexes. Three independent observers blinded to the oxytocin dose that had been administered coded the Primitive Neonatal Reflexes. Data regarding breastfeeding were collected by telephone at 3 months. RESULTS: Medium oxytocin dose was 1931.9 ± 1754.4 mUI. A Kappa index >0.75 was obtained for four Primitive Neonatal Reflexes: swallow, jaw jerk, suck and gazing. A negative association was found between oxytocin dose and sucking (p = 0.03). At 3 months of life, women exclusively breastfeeding (63.1%) had received a significantly lower average dose of oxytocin than those not exclusively breastfeeding (36.8%) (p = 0.04). CONCLUSION: In this pilot study, intrapartum exogenous oxytocin seems to disturb sucking and breastfeeding duration. Further studies are required to confirm these results and to ascertain whether there could be other effects of intrapartum oxytocin on newborn behaviour.

Oxytocin and autism: a hypothesis to research. Can perinatal oxitocinergic manipulation facilitate autism?

The study of the neurohormonal and behavioral processes and neural mechanisms involved in the development of attachment between the infant and the mother has received increased attention over the last years. Oxytocin has been shown to play a central role in the regulation of affiliate social behavior, including sexual behavior, mother infant bonding and social memory and recognition. Following normal physiological vaginal birth highest levels plasmatic endogenous oxytocin are achieved, which has been related to the presence of a sensitive period which seems to facilitate bonding and initial mother and newborn attachment. Perinatal manipulation of peptidic hormones like oxytocin can have life long lasting effects on social and sexual behaviors in animal models. Disregulation of oxytocinergic system has been observed in individuals with autistic disorders. A review of the possible effects of oxytocinergic perinatal manipulation in human newborns is discussed in the present review article. The hypothesis of the possible effect of perinatal oxytocin manipulation on the ethiology of autism is discussed.