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4.
Am J Perinatol ; 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31398730

RESUMO

OBJECTIVE: To assess the applicability of the insertion of small diameter catheters through the femoral vein in extremely low-birth-weight (ELBW) infants. STUDY DESIGN: All femoral small diameter catheters (Silastic or femoral arterial catheter [FAC]) inserted in ELBW infants in a tertiary level neonatal intensive care unit were retrospectively reviewed. Success rate, dwelling time, and percutaneously inserted central venous catheter-related complications were recorded. RESULTS: Thirteen small diameter catheters were inserted in seven ELBW infants. Mean gestational age at birth was 25+3 weeks (standard deviation [SD] ± 2.12) and mean birth weight was 686 g (SD ± 204.9). Mean weight at the first time of insertion was 1,044 g (SD ± 376.3). In two occasions, a FAC was used instead of a Silastic. In most cases (11/13, 84.6%), the patient was intubated prior to the procedure. The mean dwelling time was 16.7 days (SD ± 9.8). Most of the inserted small diameter catheters were removed electively (8/12, 66.7%), except for one episode of clinical sepsis from coagulase-negative Staphylococcus and three cases of accidental line extravasation. No other complications were reported. The success rate was 92.3%. CONCLUSION: Femoral venous catheterization using small diameter catheters in ELBW infants may be promising when other routes have been exhausted. Our results support that it is a feasible technique that can be performed at the bedside with successful results when conducted by experienced personnel.

6.
Neonatology ; 116(1): 76-84, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091527

RESUMO

BACKGROUND AND OBJECTIVES: Therapeutic interventions to improve the efficacy of whole-body cooling for hypoxic-ischemic encephalopathy (HIE) are desirable. Topiramate has been effective in reducing brain damage in experimental studies. However, in the clinical setting information is limited to a small number of feasibility trials. We launched a randomized controlled double-blinded topiramate/placebo multicenter trial with the primary objective being to reduce the antiepileptic activity in cooled neonates with HIE and assess if brain damage would be reduced as a consequence. STUDY DESIGN: Neonates were randomly assigned to topiramate or placebo at the initiation of hypothermia. Topiramate was administered via a nasogastric tube. Brain electric activity was continuously monitored. Topiramate pharmacokinetics, energy-related and Krebs' cycle intermediates, and lipid peroxidation biomarkers were determined using liquid chromatography-mass spectrometry and MRI for assessing brain damage. RESULTS: Out of 180 eligible patients 110 were randomized, 57 (51.8%) to topiramate and 53 (48.2%) to placebo. No differences in the perinatal or postnatal variables were found. The topiramate group exhibited less seizure burden in the first 24 h of hypothermia (topiramate, n = 14 [25.9%] vs. placebo, n = 22 [42%]); needed less additional medication, and had lower mortality (topiramate, n = 5 [9.2%] vs. placebo, n = 10 [19.2%]); however, these results did not achieve statistical significance. Topiramate achieved a therapeutic range in 37.5 and 75.5% of the patients at 24 and 48 h, respectively. A significant association between serum topiramate levels and seizure activity (p < 0.016) was established. No differences for oxidative stress, energy-related metabolites, or MRI were found. CONCLUSIONS: Topiramate reduced seizures in patients achieving therapeutic levels in the first hours after treatment initiation; however, they represented only a part of the study population. Our results warrant further studies with higher loading and maintenance dosing of topiramate.

7.
Fetal Pediatr Pathol ; 38(4): 340-344, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30942125

RESUMO

Background: Fetoscopic laser photocoagulation can directly injure fetal skin and may at birth resemble aplasia cutis congenita (ACC). Case report: A twin monochorionic pregnancy was complicated by twin-to-twin transfusion syndrome requiring in utero laser photocoagulation, resulting in the death of one twin. After birth, the viable baby presented skin lesions in both legs that were congruent with laser-induced burns. Conclusions: Laser-induced burns present as asymmetric superficial non-necrotic or ulcerated lesions, with a geographic outline, which turn into scars with no retraction or contractures and no changes in pain perception or motor limitations over time. ACC lesions are bilateral and symmetric, with a regular outline, an ulcerated or necrotic appearance, a higher degree of skin involvement affecting all skin layers and, over time, they turn into scars with retraction and contractures. These differential features may help clinicians in a challenging approach to the diagnosis of congenital skin defects.


Assuntos
Queimaduras/etiologia , Córion/patologia , Lasers/efeitos adversos , Fotocoagulação/efeitos adversos , Adulto , Anormalidades Congênitas , Diagnóstico Diferencial , Doenças em Gêmeos , Displasia Ectodérmica/terapia , Evolução Fatal , Feminino , Transfusão Feto-Fetal , Fetoscopia/métodos , Humanos , Recém-Nascido , Masculino , Necrose , Gravidez , Gravidez de Gêmeos , Pele/patologia , Dermatopatias/diagnóstico
9.
Sci Rep ; 7(1): 17039, 2017 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-29213095

RESUMO

Therapeutic hypothermia (TH) initiated within 6 h from birth is the most effective therapeutic approach for moderate to severe hypoxic-ischemic encephalopathy (HIE). However, underlying mechanisms and effects on the human metabolism are not yet fully understood. This work aims at studying the evolution of several energy related key metabolites in newborns with HIE undergoing TH employing gas chromatography - mass spectrometry. The method was validated following stringent FDA requirements and applied to 194 samples from a subgroup of newborns with HIE (N = 61) enrolled in a multicenter clinical trial (HYPOTOP) for the determination of lactate, pyruvate, ketone bodies and several Krebs cycle metabolites at different sampling time points. The analysis of plasma samples from newborns with HIE revealed a decrease of lactate, pyruvate and ß-hydroxybutyrate concentrations, whereas rising malate concentrations were observed. In healthy control newborns (N = 19) significantly lower levels of pyruvate and lactate were found in comparison to age-matched newborns with HIE undergoing TH, whereas acetoacetate and ß-hydroxybutyrate levels were clearly increased. Access to a validated analytical method and a controlled cohort of newborns with HIE undergoing hypothermia treatment for the first time allowed the in-depth study of the evolution of key metabolites of metabolic junctions in this special population.


Assuntos
Hipotermia Induzida/métodos , Hipóxia-Isquemia Encefálica/terapia , Ácido 3-Hidroxibutírico/sangue , Acetoacetatos/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Recém-Nascido , Corpos Cetônicos/sangue , Ácido Láctico/sangue , Limite de Detecção , Masculino , Ácido Pirúvico/sangue
10.
An. pediatr. (2003. Ed. impr.) ; 87(4): 236.e1-236.e6, oct. 2017.
Artigo em Espanhol | IBECS | ID: ibc-167304

RESUMO

La alerta de la FDA de diciembre 2016, sobre la seguridad de la anestesia general y las sedaciones en pacientes menores de 3 años y en mujeres embarazadas, ha suscitado numerosas dudas sobre la actitud que deben tomar los profesionales implicados en el tratamiento de estos pacientes. Ante esta situación, las siguientes sociedades científicas médicas: Sociedad Española de Anestesia y Reanimación (SEDAR), Sociedad Española de Cirugía Pediátrica (SECP), Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y Sociedad Española de Neonatología (SENeo), han constituido un grupo de trabajo para analizar y clarificar la seguridad de estas técnicas. En este artículo concluimos que en el momento actual tanto la anestesia general como la sedación profunda deben seguir siendo consideradas como técnicas seguras, porque no existen evidencias de lo contrario en estudios con seres humanos. Esta seguridad no nos permite ignorar el problema, que debe ser seguido con atención, fundamentalmente en pacientes de menos de 3 años, sometidos a procedimientos anestésicos de más de 3 horas o a sedaciones prolongadas en las Unidades de Cuidados Intensivos Neonatales o Pediátricos (AU)


An FDA alert in December 2016 on the safety of general anesthesia and sedations in patients less than 3 years of age and pregnant women has raised doubts in relation to the attitude that professionals implicated in these procedures should adopt in relation to these specific group of patients. Confronted with this situation, the following medical scientific societies: Sociedad Española de Anestesia y Reanimación (SEDAR), Sociedad Española de Cirugía Pediátrica (SECP), Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y Sociedad Española de Neonatología (SENeo), have established a working group to analyze and clarify the safety of these techniques. In the present article we conclude that at present both general anesthesia and profound sedation are considered safe procedures because there is no evidence of the opposite in studies with human beings. However, this ascertained safety should not obviate the problem which still needs to be followed with attention, especially in patients less than 3 years of age undergoing anesthetic procedures for more than 3 hours or prolonged sedation in the Neonatal or Pediatric Intensive Care Units (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Anestesia Geral/normas , Procedimentos Cirúrgicos Operatórios/métodos , Sedação Profunda/normas , Segurança do Paciente/normas , Duração da Cirurgia , Complicações Intraoperatórias/epidemiologia , Terapia Intensiva Neonatal/métodos , Unidades de Terapia Intensiva Pediátrica/normas
11.
An. pediatr. (2003. Ed. impr.) ; 87(3): 148-154, sept. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-166298

RESUMO

Introducción: Las auditorías en tiempo real son una herramienta de seguridad que apenas se ha aplicado anteriormente en el ámbito hospitalario. El objetivo del estudio fue determinar mediante auditorías si la información y el material necesario para la reanimación estaban disponibles para cada paciente de cuidados intensivos y si factores relacionados con el paciente, el momento o su ubicación en la unidad influyen en el cumplimiento de las recomendaciones. Material y métodos: Estudio observacional prospectivo realizado durante el año 2012 en una unidad neonatal nivel III-C. Dentro de un estudio más amplio de auditorías de recursos tecnológicos y procedimientos se incluyó la evaluación de la información escrita sobre el tubo endotraqueal, mascarilla y ambú de cada paciente y los laringoscopios del carro de parada. Dos veces por semana al azar se seleccionaba qué procedimiento o recurso se iba a evaluar. Se definió la variable uso global adecuado cuando todos los ítems evaluados eran correctos en el mismo procedimiento. Resultados: Se realizaron 17 auditorías que incluyeron 296 valoraciones. El coeficiente kappa interobservador fue 0,93. La frecuencia de uso global adecuado de la información y el material de reanimación fue de 62,50% (185/296). La mascarilla y ambú preparado en cada paciente fue la variable mejor cumplimentada (97,3%; p = 0,001). El uso global adecuado fue mejor en días festivos que en laborables (73,97 vs. 58,74%; p = 0,01) y el resto del año frente al verano (66,06 vs. 52%; p = 0,02). Conclusiones: Solo en el 62,5% de los casos toda la información y el material necesario para atender una situación crítica de forma urgente estaba fácilmente disponible. Gracias a las auditorías se identificaron oportunidades de mejora (AU)


Background: Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. Material and methods: Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. Results: A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P=.001). Significant differences were found with improved usage during weekends versus working-day (73.97 vs. 58.74%, P=.01), and the rest of the year versus 3rd quarter (66.06 vs. 52%, P=.02). Conclusions: Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits (AU)


Assuntos
Humanos , Recém-Nascido , Auditoria Clínica/métodos , Gestão da Segurança/normas , Reanimação Cardiopulmonar/instrumentação , Unidades de Terapia Intensiva Neonatal/normas , Segurança do Paciente/normas , Estudos Prospectivos , Equipe de Respostas Rápidas de Hospitais/normas
12.
An Pediatr (Barc) ; 87(4): 236.e1-236.e6, 2017 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-28625557

RESUMO

An FDA alert in December 2016 on the safety of general anesthesia and sedations in patients less than 3 years of age and pregnant women has raised doubts in relation to the attitude that professionals implicated in these procedures should adopt in relation to these specific group of patients. Confronted with this situation, the following medical scientific societies: Sociedad Española de Anestesia y Reanimación (SEDAR), Sociedad Española de Cirugía Pediátrica (SECP), Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y Sociedad Española de Neonatología (SENeo), have established a working group to analyze and clarify the safety of these techniques. In the present article we conclude that at present both general anesthesia and profound sedation are considered safe procedures because there is no evidence of the opposite in studies with human beings. However, this ascertained safety should not obviate the problem which still needs to be followed with attention, especially in patients less than 3 years of age undergoing anesthetic procedures for more than 3 hours or prolonged sedation in the Neonatal or Pediatric Intensive Care Units.


Assuntos
Anestesia/normas , Segurança do Paciente/normas , Procedimentos Cirúrgicos Operatórios , Anestesia/métodos , Humanos , Lactente , Recém-Nascido , Fatores de Tempo
13.
An Pediatr (Barc) ; 87(3): 148-154, 2017 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-27765565

RESUMO

BACKGROUND: Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. MATERIAL AND METHODS: Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. RESULTS: A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P=.001). Significant differences were found with improved usage during weekends versus working-day (73.97 vs. 58.74%, P=.01), and the rest of the year versus 3rd quarter (66.06 vs. 52%, P=.02). CONCLUSIONS: Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits.


Assuntos
Auditoria Clínica , Unidades de Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/normas , Segurança do Paciente/normas , Sistemas Computacionais , Fidelidade a Diretrizes , Humanos , Recém-Nascido , Estudos Prospectivos
15.
Pediatr Neonatol ; 57(2): 97-104, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26205438

RESUMO

BACKGROUND: The impact of health-related continuing education courses on knowledge acquisition and clinical practice is infrequently evaluated, despite higher numbers of people enrolling in them. The majority of health care professionals working in neonatal intensive care units (NICUs) have received no training in developmental care (DC). The purpose of this study was to determine whether participation in a theoretical-practical course on DC had an effect on the degree of knowledge possessed by professionals in general terms and with respect to neonatal intensive care. The relationship between course satisfaction and knowledge acquisition was also studied. METHODS: This was an observational multicenter study conducted in 20 neonatal units in Madrid. A pre- and post-course questionnaire evaluated both knowledge and satisfaction levels regarding the course on DC and the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). We carried out a multivariate linear regression analysis to determine whether there was a correlation between knowledge gained and satisfaction level. RESULTS: A total of 566 professionals participated, with a 99% pre-course and a 90% post-course response rate. The mean rate of correct pre-course answers was 65%, while the mean rate of post-course correct answers was 81% (p < 0.001). Results were similar at all levels of neonatal care (Level I: 64% vs 80%; Level II: 64% vs. 83%; and LEVEL III: 65% vs. 81%). Scores on a scale of satisfaction from 1 to 5 were high (averages of above 4 for all lectures and workshops). Pre-course knowledge scores, but not satisfaction, significantly influenced post-course knowledge (ß 0.499; p < 0.01). CONCLUSION: Previous DC knowledge among Madrid health care professionals was similar, regardless of the level of neonatal care. Course attendance significantly improved the rate of correct answers. Although course satisfaction was high, there did not seem to be a correlation between knowledge gained and satisfaction.


Assuntos
Desenvolvimento Infantil , Capacitação em Serviço , Unidades de Terapia Intensiva Neonatal , Neonatologia/educação , Criança , Humanos , Comportamento do Lactente , Recém-Nascido , Satisfação Pessoal , Espanha , Inquéritos e Questionários
16.
BMC Pediatr ; 15: 206, 2015 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-26654316

RESUMO

BACKGROUND: Random safety audits (RSA) are a safety tool enabling prevention of adverse events, but they have not been widely used in hospitals. The aim of this study was to use RSAs to assess and compare the frequency of appropriate use of infusion pump safety systems in a Neonatal Intensive Care Unit (NICU) before and after quality improvement interventions and to analyse the intravenous medication programming data. METHODS: Prospective, observational study comparing the frequency of appropriate use of Alaris® CC smart pumps through RSAs over two periods, from 1 January to 31 December 2012 and from 1 November 2014 to 31 January 2015. Appropriate use was defined as all evaluated variables being correctly programmed into the same device. Between the two periods they were established interventions to improve the use of pumps. The information recorded at the pumps with the new security system, also extracted for one year. RESULTS: Fifty-two measurements were collected during the first period and 160 measurements during the second period. The frequency of appropriate use was 73.13 % (117/160) in the second period versus 0 % (0/52) in the first period (p < 0.0001). Information was recorded on 44,924 infusions; in 46.03 % (20,680/44,924) of cases the drug name was recorded. In 2.5 % (532/20,680) of cases there was an attempt to exceed the absolute limit. CONCLUSIONS: Random Safety Audits were a very useful tool for detecting inappropriate use of pumps in the NICU. The improvement strategies were effective for improving appropriate use and programming of the intravenous medication infusion pumps in our NICU.


Assuntos
Bombas de Infusão , Unidades de Terapia Intensiva Neonatal/normas , Auditoria Médica , Segurança do Paciente/normas , Humanos , Recém-Nascido , Sistemas de Medicação no Hospital/normas , Estudos Prospectivos , Melhoria de Qualidade , Gestão da Segurança
17.
Biomed Res Int ; 2015: 719497, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26558277

RESUMO

BACKGROUND: Random safety audits (RSAs) are a safety tool but have not been widely used in hospitals. OBJECTIVES: To determine the frequency of proper use of equipment safety mechanisms in relation to monitoring and mechanical ventilation by performing RSAs. The study also determined whether factors related to the patient, time period, or characteristics of the area of admission influenced how the device safety systems were used. METHODS: A prospective observational study was conducted in a level III-C Neonatal Intensive Care Unit (NICU) during 2012. 87 days were randomly selected. Appropriate overall use was defined when all evaluated variables were correctly programmed in the audited device. RESULTS: A total of 383 monitor and ventilator audits were performed. The Kappa coefficient of interobserver agreement was 0.93. The rate of appropriate overall use of the monitors and respiratory support equipment was 33.68%. Significant differences were found with improved usage during weekends, OR 1.85 (1.12-3.06, p = 0.01), and during the late shift (3 pm to 10 pm), OR 1.59 (1.03-2.4, p = 0.03). CONCLUSIONS: Equipment safety systems of monitors and ventilators are not properly used. To improve patient safety, we should identify which alarms are really needed and where the difficulties lie for the correct alarm programming.


Assuntos
Unidades de Terapia Intensiva Neonatal/normas , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Respiração Artificial/instrumentação , Respiração Artificial/normas , Auditoria Clínica , Humanos , Recém-Nascido , Segurança do Paciente , Estudos Prospectivos
18.
J Hum Lact ; 30(3): 283-286, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24847031

RESUMO

The first hour postpartum is critical for long-term, healthy development. At 12 de Octubre Hospital, Madrid, Spain, we developed and implemented a multidisciplinary strategy based on a consensual, participatory protocol for all health care professionals involved in cesarean deliveries. Our aims were 2-fold: the initiation of skin-to-skin (StS) contact with the newborn immediately after birth, regardless of the feeding method chosen, and the recognition of the importance of a companion present for support during the cesarean section (father or other designated by the mother). The objective of this article is to describe a policy developed to ensure timely postcesarean StS contact. Our protocol for neonatal StS contact with the mother is based on reported benefits found in literature, the World Health Organization's international recommendations, and deep respect for a process that is both natural and instinctive. We call it "humanizing the cesarean."

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