Incubadora neonatal con ventilación mecánica embebida / Mechanical Ventilation embedded in Neonatal Incubator

RESUMEN Se presenta un equipo de soporte de vida neonatal (ESVIN) que emplea la terapia térmica y terapia ventilatoria (neumática) en un solo equipo para proveer ventilación pulmonar con aire caliente, humedecido y enriquecido con oxígeno, en un ambiente caliente, humidificado y estéril. El equipo es capaz de simultáneamente dar ventilación pulmonar e incubar, siendo una de sus características principales la minimización de la condensación del agua en el corrugado y ofrece la característica adicional de evitar la movilización y/o desconexión del neonato para realizar ciertos procedimientos tales como: cirugías e intubaciones, entre otras. Los principales resultados son el tiempo de acceso al neonato menor a 2 s y minimización de la condensación de agua. Asimismo, los resultados del control térmico son de tiempo de estabilización en el habitáculo de 75 minutos para la temperatura de 36 °C y tiempo de estabilización de la temperatura de la piel del neonato de 58 minutos.

ABSTRACT A neonatal life support equipment (ESVIN) employing simultaneously thermal therapy and ventilatory (pneumatic) therapy is presented in a single kit to provide pulmonary ventilation with warm, moistened and oxygen enriched air in a warm, humidified and sterile environment. The invention behind ESVIN provided simultaneously pulmonary ventilation and incubation having optimized the minimization of water condensation in the corrugated pipe and offered the additional feature of avoiding the mobilization and / or disconnection of the neonate to perform certain procedures such as: surgeries and intubations, among others. ESVIN has an access to newborns of less than 2 s and non-visible water condensation. The main results in thermal control were a stabilization time in the newborn compartment of 75 minutes for the temperature of 36 °C and a stabilization of the temperature of the skin of the neonate of 58 minutes.

Morbidity in extreme low birth weight newborns hospitalized in a high risk public maternity / Morbidade em recém- nascidos prematuros de extremo baixo peso em unidade de terapia intensiva neonatal

Abstract Objectives: to determine the prevalence of the most common morbidities in extremely low birth weight (ELBW) infants hospitalized in a newborn intensive care unit (NICU) and to evaluate the influence of these morbidities through the length of in-hospital stay. Methods: observational, longitudinal, prospective and analytical study in a high risk reference maternity NICU from Sergipe, realized with 158 ELBW infants admitted between March 2014 and April 2015. The analysis of the hospitalization time was realized through the Kaplan-Meier method. Results: the average weight of premature was 785,2g ± 138,2g. The gestational age vary from 22 to 35 weeks and the average was 26,8 weeks. Of those admitted at NICU, sixty three (39,9%) were discharged and 95 (60,1%) died. The time of hospitalization was influenced for morbidities as: patent ductus arteriosus (PDA), intraventricular hemorrhage and sepsis. Acute respiratory distress syndrome was the most common complication (157 - 99,4%). The incidence of persistent arterial duct, intraventricular hemorrhage, sepsis, hypothermia, hypoglycemia and retinopathy of prematurity was 39,2%, 17,1%, 32,3%,50,3%, 52,3% e 16,6% respectively. Conclusions: the morbidities from respiratory tract, cardiac, neurological and infectious were the most prevalent, whilst PDA, intraventricular hemorrhage and sepsis were the morbidities that significantly influenced the time of hospitalization.

Resumo Objetivos: determinar a prevalência das morbidades mais comuns em recém-nascidos de extremo baixo peso (RNEBP) internados em uma unidade de terapia intensiva neonatal (UTIN) e avaliar a influência dessas morbidades no tempo de internamento. Métodos: estudo observacional, longitudinal, prospectivo e analítico, na UTIN de uma maternidade publica referência em alto risco do estado de Sergipe, realizado com 158 RNEBP admitidos no período de março de 2014 a abril de 2015. A análise do tempo de internamento foi realizada através do método Kaplan- Meier. Resultados: os RNEBP apresentaram médio de 785,2g ± 138,2g. A idade gestacional variou entre 22 e 35 semanas e média de 26,8 semanas. Dos admitidos na UTIN, 63 (39,9%) receberam alta e 95 (60,1%) tiveram óbito como desfecho. O tempo de internamento foi influenciado por morbidades como: persistência do canal arterial (PCA), hemorragia intracraniana e sepse. Síndrome do desconforto respiratório foi a morbidade mais comum 157 (99,4%). A incidência de persistência do canal arterial, hemorragia intraventricular, sepse, hipotermia , hipoglicemia e retinopatia da prematuridade foi de 39,2%, 17,1%, 32,3%,50,3%, 52,3% e 16,6%respectivamente. Conclusões: as morbidades do aparelho respiratório, cardíacas, neurológicas e infecciosas foram as mais prevalentes, enquanto a PCA, hemorragia intracraniana e sepse foram as morbidades que influenciaram significativamente o tempo de internação.

Absence of neonatal intensive care units in secondary medical care zones is an independent risk factor of high perinatal mortality in Japan.

AIM: National medical projects are carried out according to medical care plans directed by the Medical Care Act of Japan. In order to improve Japanese perinatal medical care, it is necessary to determine the factors that might influence perinatal outcome. METHODS: Statistical data of births and perinatal deaths were obtained for all municipalities in Japan from 2008 to 2012 from the Portal Site of Official Statistics of Japan (e-Stat). The perinatal mortality of all 349 Japanese secondary medical care zones was calculated. The number of neonatal intensive care units (NICUs), maternal-fetal intensive care units (MFICUs), pediatricians and obstetricians in 2011 were also obtained from e-Stat. Nine secondary medical care zones in two prefectures, Fukushima (7) and Miyagi (2) were excluded to eliminate the influence of the 2011 Great East Japan Earthquake. RESULTS: The 340 secondary medical care zones were divided into three groups according to population size and density: metropolis, provincial city, and depopulation. The number of secondary medical care zones in each group were 52, 168, and 120, respectively. The secondary medical care zones in the depopulation group had fewer pediatricians and significantly fewer NICUs and MFICUs than the metropolis group, but there was no significant difference in perinatal mortality. The only independent risk factor for high perinatal mortality, determined by multivariable analysis, was the absence of an NICU (P = 0.011). CONCLUSIONS: To consider directions in perinatal medical care, planned arrangement and appropriate access to NICUs is indispensable.

Estudio observacional de procedimientos médicos dolorosos realizados a infantes nacidos prematuros internados en unidad de cuidados intensivos neonatales (UCIN) / Observational study of painful medical procedures performed on preterm infants Admitted to the neonatal intensive care unit (NICU)

El dolor impacta en el infante, sobre todo en el nacido prematuro, dejando huellas más profundas de las que podría vivenciar un adulto. Este sufrimiento empaña a todo el ser, obligando a los profesionales de la salud a realizar una mirada abarcadora de esta temática, comprendiendo las esferas bio-psico-socio-axioculturales de la persona. Los autores que se han encargado de estudiar el dolor aseguran que el niño nacido prematuro no solo siente dolor sino que, producto de su inmadurez, se le presentaría con mayor intensidad y de manera difusa. Con motivo de analizar indicadores que correspondan a sensaciones de dolor en estos niños, se ha realizado un estudio observacional en la Unidad de Cuidados Intensivos Neonatales (UCIN) de un hospital privado de niños de la Ciudad Autónoma de Buenos Aires (CABA) - Argentina. La muestra fue de 14 niños pre-término, de los cuales 7 fueron prematuros muy extremos, 3 prematuros extremos y otros 4 prematuros moderados, correspondiendo esta clasificación a la sugerida por UNICEF (2010). Los indicadores tanto fisiológicos como conductuales observados fueron frecuencia cardiaca (FC), saturación de oxígeno (SO), tiempos de recuperación (TR) y comportamiento. Hallamos como resultados que los indicadores varían según edad gestacional. En prematuros muy extremos, la frecuencia cardiaca (FC) tiende a disminuir y no se presentan signos conductuales ante el procedimiento doloroso. A medida que aumenta la edad gestacional, estos valores van modificando su comportamiento, asemejándose cada vez más a las respuestas manifestadas por los bebés recién nacidos a término. La saturación de oxígeno en prácticamente la totalidad de la muestra presentó disminución de sus valores y los tiempos de recuperación fueron variables. Por lo tanto, siguiendo los indicadores presentados por las escalas de dolor, los bebés prematuros reaccionan de manera diferente ante el dolor que los niños recién nacidos de término...

Pain impacts in the infant, especially in the newborn, leaving deeper footprints that in the adult. This suffering tarnishes the whole being, forcing health professionals to perform a comprehensive view of this subject, comprising the bio-psycho-socio-cultural and axiological spheres of the individual. Authors who have been commissioned to study the pain ensure that the child who born premature not only feels pain, but like a product of his immaturity this would present more intensely and diffusely. Due to analyze indicators corresponding to sensations of pain in these children, was performed an observational study in Neonatal Intensive Care Unit (NICU) of a private children’s hospital of Buenos Aires (CABA) - Argentina. The sample included 14 preterm children of which 7 were premature very extreme, 3 premature extreme and 4 premature moderate, corresponding to the classification suggested by UNICEF (2010). Both physiological and behavioral indicators observed were heart rate (HR), oxygen saturation (OS), recovery time (RT) and behavior. We find as results that the indicators vary by gestational age. In very extreme premature heart rate (HR) tends to decrease and no behavioral signs are present in the painful procedure. As gestational age increases these values are changing their behavior, increasingly resembling the responses expressed by in term newborn. Oxygen saturation in most of the sample had decreased its values and recovery times were variable. Therefore, following signs presented by pain scales, premature babies react to pain different way that term newborns...