Necesidades de cuidados en recién nacidos con encefalopatía hipóxico-isquémica tratados con hipotermia terapéutica / Care needs in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia

Objetivo: describir las necesidades de cuidados de Enfermería derivadas de las principales secuelas en recién nacidos (RN) diagnosticados de encefalopatía hipóxico-isquémica (EHI) y tratados con hipotermia terapéutica en el Hospital Universitario Miguel Servet de Zaragoza (España).Método: estudio descriptivo transversal con datos retrospectivos sobre 32 pacientes, mediante revisión de historias clínicas. Variables de estudio: variables sociodemográficas, clínicas (para establecer la gravedad de la EHI se utilizó la escala de García-Alix) y necesidades de cuidados enfermeros.Resultados: se estudiaron 32 pacientes. El 68,8% fue diagnosticado de EHI moderada y el 31,2% de EHI severa, con resultado de fallecimiento tras el tratamiento del 21,9%. El 31,3% sufrió aspiración de líquido meconial en el momento del parto. Un 32% tuvo alteraciones visuales, un 20% alteraciones en la integridad de la piel, un 16% problemas de eliminación y crisis epilépticas, y un 12% microcefalia. El 100% estaba escolarizado, el 12% tenía apoyo en el colegio y solamente el 4% necesitó acudir a un centro de educación especial. El 68% de las familias recibió apoyo tras el alta hospitalaria. El 56% fue incluido en un programa de atención temprana.Conclusión: la población infantil con EHI tratados con hipotermia presentan secuelas a medio-largo plazo, siendo las más relevantes las alteraciones visuales, las de la integridad de la piel, problemas de eliminación, crisis epilépticas y microcefalia. Se han de potenciar los programas de seguimiento y apoyo tras el alta para poder detectar de forma precoz los signos de alarma, así como para el acompañamiento de sus familias. (AU)

Objective: to describe the Nursing care needs derived of the main consequences in newborns (NBs) diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia at the Hospital Universitario Miguel Servet in Zaragoza (Spain).Method: a descriptive cross-sectional study with retrospective data about 32 patients, through clinical record review. The study variables were sociodemographic, clinical (the scale by García-Alix was used to determine the severity of GIE), and Nursing care needs.Results: thirty-two (32) patients were studied; 68.8% were diagnosed with moderate HIE and 31.2% with severe HIE, with 21.9% of death outcomes after treatment. Out of these patients, 31.3% suffered meconium fluid aspiration at the time of delivery; 32% had visual alterations, 20% had alterations in their skin integrity, 16% had elimination problems and epileptic seizures, and 12% presented microcephalia. 100% of them were enrolled in school, 12% had support at school, and only 4% needed to attend a special education centre. Regarding their families, 68% received support after discharge from hospital, and 56% were included in an early care program.Conclusion: the paediatric population with HIE treated with hypothermia presented sequels at medium-long term; the most relevant were visual and skin integrity alterations, elimination problems, epileptic seizures and microcephalia. Programs for follow-up and support after discharge from hospital must be promoted, for an early detection of warning signs, as well as for accompanying their families. (AU)

Desarrollo del dolor fetal y neonatal / Development of fetal and neonatal pain

Resumen: El dolor es el principal síntoma reportado a nivel mundial, es la principal causa de sufrimiento humano. Se considera que para que un individuo sienta dolor deben estar presentes: nociceptores, neurotransmisores del dolor, vías que llevan el estímulo al cerebro, el tálamo y conexión con la corteza. Por un tiempo se consideró que en esta etapa no se contaba con la madurez suficiente del sistema nervioso para sentir dolor; sin embargo, en la actualidad hay evidencia de que el feto presenta dolor; y su presencia altera el desarrollo del sistema nervioso. La presente revisión proporciona una visión actualizada de la ontogenia del dolor fetal y neonatal.

Abstract: Pain is the main symptom reported worldwide, it is the main cause of human suffering. It is considered that for an individual to feel pain, the following must be present: nociceptors, pain neurotransmitters, pathways that carry the stimulus to the brain, the thalamus and connection with the cortex. For a time it was considered that at this stage the nervous system was not mature enough to feel pain, however, there is currently evidence that the fetus has pain; and its presence alters the development of the nervous system. This review provides an updated view of the ontogeny of fetal and neonatal pain.

Lineamientos técnicos para la implementación de unidades de puertas abiertas en la atención de neonatos y población pediátrica / Technical guidelines for the implementation of open-door units in neonatal and paediatric care

Para salvaguardar la vida de cada niña y niño es imprescindible la participación de madres, padres, familiares y cuidadores en las unidades de atención neonatal y pediátricas, enfatizando el enfoque de derecho que facilita la transmisión de conocimientos, fomentando una cultura de corresponsabilidad entre el personal de salud y los / as usuarios /as, además promoviendo el empoderamiento de los familiares y cuidadores en el cuidado de niñas o niños durante el periodo de internación. Razón por la cual se han elaborado los presentes lineamientos, que promueven la transformación de las unidades de atención neonatales y pediátricas, a un modelo de puertas abiertas, con calidad, y con calidez, dando un mayor protagonismo y participación activa de las personas que son parte importante de la vida y desarrollo de la niña o niño, asegurando un enfoque práctico que facilite su implementación como parte de los derechos de la niñez, promoviendo la vinculación y participación activa de madres, padres, familiares y cuidadores las 24 horas del día en conjunto con el equipo de salud.

In order to safeguard the lives of each child, the participation of mothers, fathers, relatives and caregivers in neonatal and paediatric care units is essential, emphasizing the legal approach that facilitates the transmission of knowledge, fostering a culture of co-responsibility between health personnel and users//s, and promoting the empowerment of family members and caregivers in the care of children during the period of hospitalization.This is why these guidelines, which promote the transformation of neonatal and pediatric care units, have been developed into an open-door model with quality and warmth, giving greater prominence and active participation to persons who are an important part of the life and development of the child, ensuring a practical approach that facilitates its implementation as part of the rights of the child, promoting the involvement and active participation of mothers, fathers, relatives and caregivers 24 hours a day in conjunction with the health team.

Lineamientos técnicos para realizar tamizaje metabólico neonatal (Crecer juntos) / Technical Guidelines for Performing Neonatal Metabolic Screening (Growing Together)

El Ministerio de Salud, en el contexto de la Política Nacional de Apoyo al Desarrollo Infantil Temprano "Crecer Juntos" y en consonancia con la reciente Ley Nacer con Cariño para un Parto Respetado y un Cuidado Cariñoso y Sensible para el Recién Nacido, emanada desde el Despacho de La primera dama, decide implementar estrategias para disminuir la morbimortalidad, incluyendo el abordaje de aquellas situaciones o condiciones que afecten el neurodesarrollo en los niños y niñas. En este sentido, se ha tomado a bien, ampliar el tamizaje metabólico neonatal para incluir la detección de los errores congénitos del metabolismo más frecuentes como son: hipotiroidismo congénito, fibrosis quística, fenilcetonuria, tirosinemia neonatal transitoria, enfermedad de jarabe de arce e hiperplasia suprarrenal congénita. Por lo anterior, los presentes lineamientos técnicos de tamizaje metabólico neonatal, describen las disposiciones para realizar la toma de muestra para la detección, confirmación diagnóstica, tratamiento oportuno, seguimiento, monitoreo y evaluación en los establecimientos del Sistema Nacional Integrado de Salud (SNIS)

The Ministry of Health, in the context of the National Early Childhood Development Support Policy "Growing Together" and in line with the recent Birth with Affection Act for Respected Childbirth and Caring and Sensitive Care for the Newborn, from the Office of the First Lady, decides to implement strategies to reduce morbidity and mortality, including addressing those situations or conditions that affect neurodevelopment in children. In this sense, we have taken good care to expand the neonatal metabolic screening to include the detection of the most frequent congenital errors of metabolism such as: congenital hypothyroidism, cystic fibrosis, phenylketonuria, transient neonatal tyrosinemia, maple syrup disease and congenital adrenal hyperplasia. Therefore, the present technical guidelines for neonatal metabolic screening describe the arrangements for sampling for detection, diagnostic confirmation, timely treatment, monitoring, monitoring and evaluation in the National Integrated Health System

Factores de riesgo asociados a estancia hospitalaria prolongada en cuidados intensivos neonatales: Un estudio de casos y controles

Objetivo: Identificar las patologías o condiciones neonatales que influyen en la prolongación de la estancia hospitalaria en una Unidad de Cuidados Intensivos Neonatales (UCIN). Materiales y métodos: Se realizó un estudio observacional, retrospectivo, de casos y controles; en neonatos hospitalizados de la UCIN, durante el periodo 2015 - 2019, considerando sus diagnósticos perinatales y posnatales como factores a evaluar, así como la estancia hospitalaria. Se dividieron dos grupos: casos (estancia prolongada) y controles (estancia no prolongada). Los datos recolectados fueron procesados en el programa SPSS v.23 obteniendo el OR y la Regresión Logística Binaria. Resultados: Se incluyeron 361 neonatos (91 casos y 270 controles), encontrándose significancia en factores perinatales (p<0.05): Peso al nacer (1000g a <1500g, ORa 8.2: IC3.1 - 21.2) y edad gestacional (28 a 31 sem., ORa 18.6: IC4.8-71.4; 32-33 sem, ORa 8.1: IC3.5 - 18.4); y factores posnatales (p<0.05): Síndrome de distrés respiratorio (ORa 10.3:IC 4.8-22.2), Hipertensión pulmonar persistente (OR 32.2:IC 1.8-559.0), sepsis (ORa 7.1: IC 3.1-16.0), Malnutrición neonatal (ORa 10.2:IC 4.7-22.1) y anemia del prematuro (ORa 8.3:IC 2.4-28.1). No alcanzaron significancia: asfixia, taquipnea transitoria del recién nacido, neumonía, neumotórax, displasia broncopulmonar, síndrome de aspiración meconial, conducto arterioso persistente, cardiopatía congénita, hiperbilirrubinemia, hipoglicemia, enterocolitis necrotizante y apnea del prematuro. Conclusiones: El peso al nacer, edad gestacional, Síndrome de distrés respiratorio, Hipertensión pulmonar persistente, sepsis, malnutrición neonatal y anemia del prematuro son factores de riesgo para estancia hospitalaria prolongada.

Objective: Identify neonatal pathologies or conditions that influence the prolongation of hospital stay in a Neonatal Intensive Care Unit (NICU). Materials and methods: An observational, retrospective, case-control study was carried out; in neonates hospitalized in the NICU, during the period 2015-2019, considering their perinatal and postnatal diagnoses as factors to be evaluated, as well as hospital stay. Two groups were divided: cases (prolonged stay) and controls (non-prolonged stay). The collected data were processed in the SPSS v.23 program, obtaining the OR and the Binary Logistic Regression. Results: 361 neonates (91 cases and 270 controls) were included, finding significance in perinatal factors (p<0.05): Birth weight (1000g to <1500g, ORa 8.2: CI3.1 - 21.2) and gestational age (28 to 31 weeks , ORa 18.6: CI4.8-71.4; 32-33 weeks, ORa 8.1: CI3.5 - 18.4); and postnatal factors (p<0.05): RDS (ORa 10.3: CI 4.8-22.2), PHT (OR 32.2: CI 1.8-559.0), sepsis (ORa 7.1: CI 3.1-16.0), Neonatal malnutrition (ORa 10.2: CI 4.7 -22.1) and anemia of prematurity (aOR 8.3: CI 2.4-28.1). The following did not reach significance: asphyxia, transient tachypnea of ​​the newborn, pneumonia, pneumothorax, bronchopulmonary dysplasia, meconium aspiration syndrome, patent ductus arteriosus, congenital heart disease, hyperbilirubinemia, hypoglycemia, necrotizing enterocolitis, and apnea of ​​prematurity. Conclusions: Birth weight, gestational age, RDS, PHPT, sepsis, neonatal malnutrition and anemia of prematurity are risk factors for prolonged hospital stay.

Nosocomial outbreak caused by Serratia marcescens in a neonatology intensive care unit in a regional hospital. Analysis and improvement proposals.

OBJECTIVES: Serratia marcescens (SM) may cause nosocomial outbreaks in Neonatal Intensive Care Units (NICU). We describe an outbreak of SM in a NICU and propose additional prevention and control recommendations. METHODS: Between March 2019 and January 2020, samples were taken from patients in the NICU (rectal, pharyngeal, axillary and other locations) and from 15 taps and their sinks. Control measures were implemented including thorough cleaning of incubators, health education to staff and neonates'relatives, and use of single-dose containers. PFGE was performed in 19 isolates from patients and in 5 environmental samples. RESULTS: From the first case in March 2019 to the detection of the outbreak, a month elapsed. Finally, 20 patients were infected and 5 colonized. 80% of infected neonates had conjunctivitis, 25% bacteremia, 15% pneumonia, 5% wound infection, and 5% urinary tract infection. Six neonates had two foci of infection. Among the 19 isolates studied, 18 presented the same pulsotype and only one of the isolates from the sinkhole showed a clonal relationship with those of the outbreak. Initial measures established were ineffective to control de outbreak and were implemented with exhaustive cleaning, use of individual eye drops, environmental sampling and changing sinks. CONCLUSION: This outbreak presented a high number of neonates affected due to its late detection and torpid evolution. The microorganisms isolated from the neonates were related to an environmental isolate. Additional prevention and control measures are proposed, including routine weekly microbiological sampling.

Outbreaks by Klebsiella oxytoca in neonatal intensive care units: Analysis of an outbreak in a tertiary hospital and systematic review.

OBJECTIVE: Klebsiella oxytoca can cause nosocomial infections, affecting vulnerable newborns. There are few studies describing nosocomial outbreaks in the neonatal intensive care units (NICU). In this study, a systematic review of the literature was carried out to know the main characteristics of these outbreaks and the evolution of one is described. METHODS: We conducted a systematic review in the Medline database up to July 2022, and present a descriptive study of an outbreak with 21 episodes in the NICU of a tertiary hospital, between September 2021 and January 2022. RESULTS: 9 articles met the inclusion criteria. The duration of outbreaks was found to be variable, of which 4 (44.4%) lasted for a year or more. Colonization (69%) was more frequent than infections (31%) and the mortality rate was 22.4%. In studies describing sources, the most frequent was the environmental origin (57.1%). In our outbreak there were 15 colonizations and 6 infections. The infections were mild conjunctivitis without sequelae. Molecular typing analysis made it possible to detect 4 different clusters. CONCLUSIONS: There is an important variability in the evolution and results of the published outbreaks, highlighting a greater number of colonized, use of PFGE (pulsed-field gel electrophoresis) techniques for molecular typing and implementation of control measures. Finally, we describe an outbreak in which 21 neonates were affected with mild infections, resolved without sequelae and whose control measures were effective.

Albúmina sérica predictor de resultados intrahospitalarios en pacientes admitidos a la UCIN del Hospital de la Mujer / Serum albumin predicator of intrahospital outcomes in patients admitted to the NICU of the women's hospital

INTRODUCCIÓN: En el estrés metabólico existe una sobreproducción proteica de reactantes positivos de la fase aguda y en el hígado, se frena la síntesis de otras proteínas, incluyendo la albúmina, denominadas Reactantes Negativos de la Fase Aguda. Los rangos de referencia precisos para la hipoalbuminemia patológica han resultado difíciles de determinar en los recién nacidos. MATERIAL Y MÉTODOS: Descriptivo de corte transversal en 494 recién nacidos. Se realizó un análisis exploratorio de los datos con estadística descriptiva mediante el paquete estadístico SPSS v.20. RESULTADOS: 494 neonatos fueron seleccionados, 39% fueron prematuros tardíos, 27% reportó hipoalbuminemia en sus diferentes grados que se correlacionaron con los días de internación en UCIN (p=0,0001), necesidad y tiempo en ventilador mecánico (p=0,001), con la mortalidad (p=0,001) y patología infecciosa (p=0,001). DISCUSIÓN: La incidencia acumulada de sepsis no confirmada por hemocultivo fue de 54%, La hipoalbuminemia tiene asociaciones importantes con la evolución y pronóstico en pacientes pediátricos. La PCR no tiene correlación en el estudio (p=0,232) y solo fue reactiva en 4 pacientes (0,8%). CONCLUSIONES: El nivel de albúmina sérica reportada en las primeras 24 horas de ingreso a la UCIN es un predictor para los resultados intrahospitalarios (tiempo y requerimiento de ventilación mecánica), mortalidad neonatal, sepsis neonatal y enfermedad de membrana hialina. Su determinación sérica debe ser incluida en la lista de exámenes de laboratorio solicitados a su admisión y la PCR al ingreso debe ser excluida por su pobre sensibilidad como sugiere la SIBEN.

INTRODUCTION: In metabolic stress, there is a protein overproduction of positive acute phase reactants and in the liver, the synthesis of other proteins, including albumin, called negative acute phase reactants is slowed down. Precise reference ranges for pathologic hypoalbuminemia have proven difficult to determine in neonates. MATERIAL AND METHODS: Descriptive cross section in 494 newborns. An exploratory analysis of the data with descriptive statistics was carried out using the statistical package SPSS v.20. RESULTS: 494 neonates were selected, 39% were late preterm, 27% reported hypoalbuminemia in its different degrees that correlated with the days of hospitalization in the NICU (p=0.0001), need and time on a mechanical ventilator (p=0.001), with mortality (p=0.001) and infectious pathology (p=0.001). DISCUSSION: The cumulative incidence of sepsis not confirmed by blood culture was 54%. Hypoalbuminemia has important associations with outcome and prognosis in pediatric patients. CRP does not correlate the study (p=0.232) and was only reactive in 4 patients (0.8%). CONCLUSIONS: Serum albumin level reported in the first 24 hours of NICU admission is a predictor for in-hospital outcomes (time and requirement of mechanical ventilation), neonatal mortality, neonatal sepsis, and hyaline membrane disease. Its serum determination should be included in the list of laboratory tests requested upon admission and the PCR upon admission should be excluded due to its poor sensitivity, as suggested by SIBEN.

Sistematización de experiencia de pulpos para neonatos Instituto Roosevelt Bogotá Colombia / Sistematização da experiência do polvo para neonatos Instituto Roosevelt BogotáColômbia / Systematization octopus experience for neonates Instituto Roosevelt Bogotá Colombia

The initiative octopuses for newborns began with the Noupops NGO "thread for life"which emerged in 2012 in Denmark and in 2017 in Spain, which the Roosevelt Institute in Colombiahas been implementing since 2018. This qualitative research was based on the systematization ofexperiences, finding that the weavers and its possibility to heal through weaving is related to theancestral knowledge of how to do it and the mastery that is combined when they make the octopus.The project leaders refer to the importance of volunteering and donations for weaving the octopus,the therapeutic role in the mother-child relationship that these elements provides and refines, andits potential in the humanization of health services. The mother-child binomial in the voices of themothers capitalizes the experience of being present with the baby, which implies reducing the feeling of anxiety and abandonment. Health personnel highlight the difficulty of the initiative within amedicalized scheme by assuming the octopus as an object of risk, which is controlled with sterilization. The evidenced value in the bond of the mother-child binomial, however, make the health personnel to reevaluate the lack of objective evidence that allows them to "guarantee" sterilization overthe benefit.(AU)

La iniciativa pulpos para neonatos comienza en 2012 en Dinamarca y en 2017 en Españasurge la Noupops ONG "hilo para la vida", a partir de la cual el Instituto Roosevelt en Colombia laimplementa desde 2018. Esta investigación cualitativa se basó en la sistematización de experiencias,encontrando que, en las tejedoras, es una posibilidad para sanar y sanarse a través del tejido y serelaciona con el conocimiento ancestral de cómo hacerlo y la maestría que se conjuga al realizar elpulpo. Las lideresas del proyecto, refieren la importancia del voluntariado y donaciones, el papelterapéutico en el binomio madre hijo y su potencial en la humanización de los servicios de salud. Elbinomio madre hijo en las voces de las madres, capitaliza la experiencia de estar presente con elbebé, lo que implica disminuir la sensación de zozobra y abandono. El personal de salud resalta ladificultad de la iniciativa dentro de un esquema medicalizado al asumirse como un objeto deriesgo, lo cual se controla con esterilización. Valoran el poder en el vínculo del binomio madre hijo,sin embargo, manifiestan que carecen de pruebas objetivas que les permitan “avalar” su beneficio.(AU)

A iniciativa polvos para recém-nascidos, a qual vem se implementando no Instituto Roosvelt na Colombia desde 2018, começou em 2012 na Dinamarca e em 2017 na Espanha surgiu a ONGNoupops "thread for life". A pesquisa qualitativa, que foi baseada na sistematização de experiências,constatou que nas mulheres tecelãs existe uma possibilidade de curar e se curar através da tecelagemque está relacionada ao saber ancestral conjugado com a destreza na confecção do polvo. As líderesdo projeto referem a importância do voluntariado e as doações, o papel terapêutico na relação mãefilho e seu potencial na humanização dos serviços de saúde. O binômio mãe-filho nas vozes dasmães capitaliza a experiência de estar presente com o bebê, o que implica diminuir o sentimento deansiedade e abandono. Os profissionais da saúde destacam a dificuldade da iniciativa dentro de umesquema medicalizado ao se assumirem como objeto de risco, que é controlado com esterilização.Valorizam o poder no vínculo do binômio mãe-filho, porém, afirmam que carecem de evidênciasobjetivas que permitam "garantir" seu benefício.(AU)

Avaliação audiológica em bebês nascidos de mães que tiveram covid-19 no período gestacional / Audiological assessment in babies born to mothers who had covid-19 during gestation / Evaluación audiológica en bebés nacidos de madres que tenían covid-19 durante la gestación

Introdução: No final de dezembro de 2019, um grupo de casos inexplicáveis de pneumonia foi relatado em Wuhan, China. Alguns dias depois, o agente causador dessa misteriosa doença foi identificado como um novo coronavírus que se disseminou de forma rápida. As infecções maternas, contraídas antes ou durante a gravidez, podem ser transmitidas ao feto, durante a gestação (infecção congênita), durante o parto (infecção perinatal) e pela amamentação (infecção pós-natal) e podem causar danos ao feto ou ao recém-nascido. Objetivo: descrever a avaliação audiológica realizada em uma série de crianças cujas mães tiveram COVID-19, em sua forma leve, no período gestacional. Metodologia: Para a avaliação audiológica foram realizadas a anamnese e os exames de emissões otoacústicas por produto de distorção, nas frequências de 1,5 a 12KHz e pontencial auditivo de tronco encefálico por click. Resultados: A amostra foi composta por 47 recém-nascidos recém-nascidos. Os resultados dos testes das emissões otoacústicas evocadas por produto de distorção indicaram funcionalidade das estruturas avaliadas apontando normalidade da função coclear com nível de resposta adequado para a média de resultados obtidos até a frequência de 11kHz para a amplitude de resposta e para a relação sinal-ruído. Foi possível encontrar em toda a amostra a presença das ondas I, III e V na intensidade de 80dBHL e presença da onda V nas intensidades de 50 e 35dBHL bilateralmente. Conclusão: Não foi estabelecida uma correlação direta da infecção materna pelo vírus da covid-19 com os achados audiológicos nos recém- nascidos. Cabe mencionar que esse foi um estudo preliminar e que essas crianças precisam continuar em acompanhamento para investigação de futuros desfechos tardios no aparelho auditivo.

Introduction: In late December 2019, a cluster of unexplained pneumonia cases was reported in Wuhan, China. A few days later, the causative agent of this mysterious disease was identified as a new coronavirus that spread rapidly. Maternal infections, contracted before or during pregnancy, can be transmitted to the fetus during pregnancy (congenital infection), during childbirth (perinatal infection) and through breastfeeding (postnatal infection) and can cause harm to the fetus or newborn. -born. Objective: to describe the audiological evaluation carried out in a series of children whose mothers had COVID-19, in its mild form, during the gestational period. Methodology: For the audiological evaluation, anamnesis and distortion product otoacoustic emissions tests were carried out, at frequencies from 1.5 to 12KHz and brainstem auditory potential by click. Results: The sample consisted of 47 newborns. The results of the distortion product evoked otoacoustic emissions tests indicated functionality of the evaluated structures, pointing to normal cochlear function with an adequate response level for the average of results obtained up to a frequency of 11kHz for the response amplitude and the signal-to-noise ratio. . It was possible to find in the entire sample the presence of waves I, III and V at an intensity of 80dBHL and the presence of wave V at intensities of 50 and 35dBHL bilaterally. Conclusion: A direct correlation between maternal infection by the Covid-19 virus and audiological findings in newborns was not established. It is worth mentioning that this was a preliminary study and that these children need to continue being monitored to investigate future late outcomes with the hearing aid.

Introducción: A finales de diciembre de 2019, se informó un grupo de casos de neumonía inexplicable en Wuhan, China. Unos días después, el agente causante de esta misteriosa enfermedad fue identificado como un nuevo coronavirus que se propagó rápidamente. Las infecciones maternas, contraídas antes o durante el embarazo, pueden transmitirse al feto durante el embarazo (infección congénita), durante el parto (infección perinatal) y a través de la lactancia (infección posnatal) y pueden causar daños al feto o al recién nacido. Objetivo: describir la evaluación audiológica realizada a una serie de niños cuyas madres tuvieron COVID-19, en su forma leve, durante el período gestacional. Metodología: Para la evaluación audiológica se realizaron pruebas de anamnesis y otoemisiones acústicas de productos de distorsión, en frecuencias de 1,5 a 12KHz y potencial auditivo de tronco encefálico mediante click. Resultados: La muestra estuvo compuesta por 47 recién nacidos. Los resultados de las pruebas de distorsión producto de emisiones otoacústicas evocadas indicaron funcionalidad de las estructuras evaluadas, apuntando a una función coclear normal con un nivel de respuesta adecuado para los resultados promedio obtenidos hasta una frecuencia de 11kHz para la amplitud de respuesta y la relación señal-ruido. . Se pudo encontrar en toda la muestra la presencia de ondas I, III y V con una intensidad de 80dBHL y la presencia de la onda V con intensidades de 50 y 35dBHL de forma bilateral. Conclusión: No se estableció una correlación directa entre la infección materna por el virus Covid-19 y los hallazgos audiológicos en los recién nacidos. Cabe mencionar que este fue un estudio preliminar y que estos niños necesitan seguir siendo monitoreados para investigar futuros resultados tardíos con el audífono.

Diagnóstico audiológico de lactentes após falha na triagem auditiva neonatal universal / Hearing assessment after referral in universal newborn hearing screening

RESUMO Objetivo Estudar o processo de diagnóstico audiológico de lactentes que falharam na Triagem Auditiva Neonatal Universal (TANU). Métodos Análise dos prontuários de 51 lactentes que falharam na TANU nas maternidades do munícipio e que foram encaminhados a um centro de referência em saúde auditiva para diagnóstico audiológico, entre janeiro e junho de 2021. Foram identificados os lactentes que finalizaram o diagnóstico, aqueles que não compareceram ao agendamento para exames ou evadiram durante o processo. Tentativas de contato foram realizadas com os responsáveis pelos lactentes que evadiram, para identificar o motivo da evasão. Resultados O comparecimento ao diagnóstico ficou em 75%, com evasões entre o encaminhamento da maternidade para o centro de referência, bem como durante o processo de diagnóstico. Cinquenta por cento dos sujeitos concluíram as avaliações audiológicas até os 3 meses de vida. A tentativa de contato foi bem-sucedida com os responsáveis pelos lactentes que evadiram, sendo os motivos mais frequentes: adoecimento do lactente, distância entre a moradia e o centro de referência, horário de trabalho dos pais. Conclusão Na etapa de diagnóstico, o índice de comparecimento e o tempo de conclusão até o terceiro mês de vida da criança ficaram abaixo dos índices recomendados, diminuindo a efetividade do Programa de Triagem Auditiva Neonatal Universal (PTANU). A busca ativa por contato telefônico e uso de aplicativo de mensagem telefônico foi importante para reduzir a evasão em 76%. Outras ferramentas que aprimorem o processo para um diagnóstico não prolongado, evitando evasões, necessitam ser estudadas.

ABSTRACT Purpose To study the process of hearing assessment in infants who were referred by professionals responsible for Universal Newborn Hearing Screening (UNHS). Methods Analysis of the medical records of 51 infants referred by maternity hospitals where UNHS was performed and were referred to a Hearing Health Center, between January and June 2021. Infants who completed hearing assessment, who never attended the appointments, or were lost during the diagnostic process were identified. Attempts were made to contact infants' guardians in order to understand the reason for missing the appointments. Results The attendance to the diagnosis was 75%. Fifty percent of the infants completed hearing assessment as recommended, up to 3 months of life. The attempt to contact parents who missed the appointments was successful, and the most frequent reasons are: the infant was ill on the day of scheduled appointment, distance from home to the hearing health center, parents' working hours. Conclusion For the diagnostic stage, the attendance rate and the age for completing hearing assessment were below the recommended. The active search for telephone contact and use of phone messaging application was important to reduce evasion by seventy-six percent. Tools that optimize the diagnostic process with less infants missing still must be studied.

Métodos para la detección de cardiopatías congénitas en neonatos

Las cardiopatías congénitas conforman el grupo de las malformaciones innatas más comunes, siendo vital su detección temprana. Este estudio tuvo por objetivo caracterizar las publicaciones acerca de los métodos para la detección de cardiopatías congénitas en neonatos a partir de tres categorías: las características generales de las investigaciones, la información de los investigadores y la definición y características de las metodologías practicadas. Para tal efecto, y con ayuda de tablas dinámicas de MS Excel 16.52 y el software VOSviewer 1.6.17, se llevó a cabo una revisión sistematizada que permitió recopilar 63 artículos publicados entre 2010 y 2021 en Scopus, Web of Science y PubMed. Los hallazgos evidencian que la producción académica ha ido incrementándose desde el 2018, teniendo a Estados Unidos a la vanguardia de esta y siendo la ecocardiografía y la oximetría los procedimientos más estudiados. La comparación entre las metodologías advierte que la detección por oximetría es la más destacable, en cuanto a los factores evaluados. Esta investigación abre nuevas líneas de indagación en la materia con la finalidad de desarrollar y aplicar nuevas metodologías o perfeccionar las ya existentes para que se ajusten a las necesidades de la población.

Congenital heart disease is one of the most common innate malformations, and early detection is vital. The aim of this study was to characterize the publications on methods for the detection of congenital heart disease in neonates based on three categories: the general characteristics of the investigations, the information provided by the researchers, and the definition and characteristics of the methodologies used. For this purpose, and with the help of MS Excel 16.52 pivot tables and VOSviewer 1.6.17 software, a systematized review was carried out that allowed us to compile 63 articles published between 2010 and 2021 in Scopus, Web of Science and PubMed. The findings evidence that academic production has been increasing since 2018, with the United States being at the forefront of this and echocardiography and oximetry being the most studied procedures. The comparison between the methodologies warns that detection by oximetry is the most outstanding in terms of the factors evaluated. This research opens up new lines of investigation in the field with the aim of developing and applying new methodologies or improving existing ones to meet the needs of the population.

Presencia de dientes natales o neonatales en pacientes pediátricos con y sin labio y paladar hendido / Presence of natal or neonatal teeth in pediatric patients with and without cleft lip and palate

Objetivo: determinar la presencia de dientes natales y neonatales en pacientes pediátricos con/sin labio y paladar hendido, que han sido atendidos en un hospital de tercer nivel de 2019-2020, mediante la revisión de expedientes clínicos. Métodos: estudio retrospectivo, observacional descriptivo y revisión de expedientes de pacientes atendidos de 2019-2020. Resultados: en el hospital de tercer nivel se reportan 15 nacimientos por día, 5475 al año. De estos, se identificaron 110 bebés con dientes natales revisados en cuneros, 84 pacientes con labio y paladar hendido en consulta, con una relación de 1:50, mayor prevalencia en dientes inferiores centrales. Su manejo fue resuelto con extracciones en todos los casos, debido a la movilidad dental y el riesgo potencial en la alimentación por bronco aspiración del paciente. Conclusiones: los dientes neonatales y natales se encontraron con mayor frecuencia en pacientes de unidades de tercer nivel consultadas, posiblemente por ser centros de referencia. Se identificó confusión en el personal de salud respecto a la nomenclatura de los dientes que presentan los pacientes al nacer (dientes neonatales), además, se encontró una alta frecuencia de dientes natales en los pacientes estudiados en este caso. La relevancia se encuentra en que no hay estudios que definan la razón del porqué los pacientes nacen con dientes. La respuesta puede estar relacionada con un factor hormonal de la madre, aunque no se ha encontrado evidencia sobre esto. Mientras que los dientes neonatales

Objective: To determine the presence of natal and neonatal teeth in pediatric patients with/without cleft lip and palate who have been seen in a tertiary hospital from 2019-2020, by reviewing clinical records. Methods: Retrospective, descriptive observational study and review of patient records from 2019-2020. Results: In the third level hospital 15 births are reported per day, 5475 per year. Of these, 110 babies with natal teeth were identified in the nursery, 84 patients with cleft lip and palate were identified in consultation, with a ratio of 1:50, with a higher prevalence in lower central teeth. Their management was solved with extractions in all cases, due to tooth mobility and the potential risk in feeding by bronchial aspiration of the patient. Conclusions: Neonatal and natal teeth were found more frequently in patients in the tertiary level units consulted, possibly because they were referral centers. Confusion was identified among health personnel regarding the nomenclature of the teeth that patients present at birth (neonatal teeth), and a high frequency of natal teeth was found in the patients studied in this case. The relevance lies in the fact that there are no studies that define the reason why patients are born with teeth. The answer may be related to a hormonal factor of the mother, although no evidence on this has been found. While neonatal teeth occurred less frequently, there are no conclusive studies either.

Neonatos en las emergencias pediátricas. Estudio comparativo de las Bronquiolitis con otras patologías neonatales que requirieron hospitalización

Introducción: La bronquiolitis en una infección viral de las vías respiratoria y la causa más frecuente de hospitalización de los lactantes menores El objetivo del estudio fue comparar las características clínicas, socioeconómicas y la evolución de neonatos ingresados por bronquiolitis (BR), con aquellos que ingresaron por otras patologías. (0P) Material y método : estudio observacional descriptivo. Fueron incluidos neonatos con diagnóstico de BR y aquellos que ingresaron por OP Variables: edad postnatal, antecedentes sexo, motivo de ingreso, comorbilidades, ingreso a la unidad de cuidados intensivos pediátricos (UCIP) , días de hospitalización, estrato socioeconómico, presencia de atopia familiar y exposición ambiental al humo. Los datos fueron analizados en SPSS Resultados: ingresaron al estudio 75 neonatos con BR y 86 ingresados OP .El 45% de los neonatos con BR ingresaron por riesgo social, y el 38,4% de los neonatos con OP por sospecha de sepsis neonatal tardía.Los neonatos con BR tenían mayor edad postnatal; 21 días, vs 8,5 p=0,001, procedían de zonas urbanas en el 98,6% vs 79% p=0,001 y las madres tenían menor edad 23 años vs 25 años respectivamente p=0,01. Además, presentaron mayor frecuencia de exposición al humo ambiental. (p=0,01) y menor frecuencia de comorbilidades (p=0,03) Ningún paciente con BR ingreso a la UCIP vs 3,5% en el grupo de neonatos con OP. Conclusiones: Los neonatos con BR, tenían mayor edad, procedían de zonas urbanas, menor comorbilidades, sus madres eran más jóvenes y tenían mayor exposición al humo ambiental. La mayoría fueron cuadros leves de BR

Introduction : Bronchiolitis in a viral infection of the respiratory tract and the most frequent cause of hospitalization of young infants The objective of the study was to compare the clinical, socioeconomic characteristics and the evolution of neonates admitted for bronchiolitis (BR), with those admitted for other pathologies. (0P) Material and method : descriptive observational study. Neonates diagnosed with BR and those admitted for OP were included: Variables: postnatal age, sex, reason for admission, comorbidities, admission to the pediatric intensive care unit (PICU), days of hospitalization, socioeconomic stratum, presence of familial atopy and environmental exposure to smoke. Data were analyzed in SPSS. Results: 75 infants with BR and 86 admitted OP entered the study. 45% of infants with BR were admitted for social risk, and 38.4% of infants with OP due to suspected late neonatal sepsis. Neonates with BR had higher postnatal age; 21 days, vs 8.5 p=0.001, came from urban areas in 98.6% vs. 79% p=0.001 and mothers were younger, 23 years vs. 25 years respectively p=0.01. In addition, they presented a higher frequency of exposure to environmental smoke. (p=0.01) and lower frequency of comorbidities (p=0.03) No patient with BR admission to the PICU vs 3.5% in the group of neonates with OP. Conclusions: Neonates with BR were older, came from urban areas, had fewer comorbidities, their mothers were younger, and they had greater exposure to environmental smoke. Most cases were mild BR.

Association between maternal-infant bonding and depressive symptoms in Neonatal Intensive Care Unit mothers: A case-control study.

OBJECTIVES: Maternal perinatal depression has been associated with impaired mother-infant bonding. The adverse effect of this impaired bonding has been reported. This study aimed to investigate and compare the posnatal depressive symptoms and the mother-infant bonding in a Neonatal Intensive Care Unit (NICU) and of mothers with healthy newborns respectively. Secondly, was to explore the association between depressive symptomatology and bonding in both groups. METHODS: In this case study, mothers in the early pospartum period who gave birth in the same perinatal center of Greece were recruited to participate. The cases consisted of 88 mothers of neonates who were hospitalized in the NICU and controls were 100 mothers of full-term healthy neonates. For the collection of the data questionnaires including demographics and perinatal variables were used. For the bonding and posnatal assessment, the Mother to Infant Bonding Scale, the Postpartum Bonding Questionnaire, and the Hospital Anxiety and Depression Scale were used. RESULTS: There was a significant difference between the mean of bonding scores of NICU mothers and the control group (t = -2.696, P = 0.008). NICU mothers presented lower scores in bonding with the newborn compared to the control group and presented higher depression scores compared to those of controls (χ2 = 28.588, P = 0.000). The depression scores were correlated with bonding scores in both groups. DISCUSSION: A NICU admission has an impact on bonding and in some way interacts with maternal pospartum mental health, therefore more research is needed. CONCLUSIONS: NICU mothers have been presented as more vulnerable than mothers of healthy infants since they expressed a lower mother-infant bonding and higher depression scores. The support of these vulnerable mothers and the facilitation of mother-infant bonding by the NICU staff is of utmost importance.

Brain MRI without anesthesia in children less than 3 months old.

INTRODUCTION: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. PATIENTS AND METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p = 0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6 min (range, 6-30 min). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. CONCLUSION: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

Capnografía en recién nacidos en ventilación mecánica y su relación con la medición de CO2 en muestras sanguíneas / Capnography in newborns under mechanical ventilation and its relationship with the measurement of CO2 in blood samples

Introducción: Monitorear la presión parcial de CO2 (PCO2) en los recién nacidos que requieren ventilación permitiría evitar hipocapnia e hipercapnia. La medición de CO2 espirada (ETCO2) es una alternativa poco implementada en esta población.Objetivo: Evaluar la relación entre la ETCO2 y la PCO2 en recién nacidos.Métodos: Estudio de corte transversal, comparativo entre dos métodos de medición de PCO2, el convencional mediante análisis de muestras sanguíneas y el estimado mediante ETCO2. Se incluyeron recién nacidos internados que requerían ventilación mecánica convencional. La medición de ETCO2 se realizó mediante un ventilador neonatal Graph Net Neo-TECME®, con capnógrafo incorporado y se obtuvo el gradiente ETCO2-PCO2. Se realizaron análisis de correlación y gráficos de Bland-Altman para estimar la concordancia.Resultados: Se analizaron 277 muestras (ETCO2/PCO2) en 83 recién nacidos. Los valores promedios de ETCO2 y PCO2 fueron de 41,36 mmHg y 42,04 mmHg. Hubo correlación positiva y significativa entre ETCO2 y PCO2 en el análisis global (r = 0,5402; p < 0,001) y en el de cada unidad (p < 0,001). La media de las diferencias fue de 0,68 mmHg (IC 95%- 0,68 a 1,95) y no resultó significativa. Se observó error sistemático positivo (PCO2 > ETCO2) en dos de las unidades, mientras que en la tercera la diferencia fue negativa (PCO2 < ETCO2)Discusión: La correlación entre ETCO y PCO2 es significativa, si bien los valores obtenidos no resultan equivalentes y la diferencia varía entre 0,1 mmHg a 20 mmHg. Asimismo, observamos errores sistemáticos de signo diferente (positivo o negativo) entre las instituciones. (AU)

Introduction: Monitoring the partial pressure of CO2 (PCO2) in newborns who require ventilation would allow avoiding hypocapnia and hypercapnia. The measurement of end-tidal carbon dioxide (ETCO2) is an alternative rarely implemented in this population.Objective: To evaluate the relationship between ETCO2 and PCO2 in newborns.Methods: Cross-sectional study comparing two PCO2 measurement methods, the conventional one by analysis of blood samples and the one estimated by ETCO2. The study included hospitalized newborns that required conventional mechanical ventilation. The ETCO2 was measured with a Tecme GraphNet® neo, a neonatal ventilator with an integrated capnography, and we obtained the ETCO2-PCO2 gradient. We conducted correlation and Bland-Altman plot analyses to estimate the agreement.Results: A total of 277 samples (ETCO2/PCO2) from 83 newborns were analyzed. The mean values of ETCO2 and PCO2 were 41.36 mmHg and 42.04 mmHg. There was a positive and significant correlation between ETCO2 and PCO2 in the overall analysis (r = 0.5402; p < .001) and in the analysis of each unit (p < .001). The mean difference was 0.68 mmHg (95% CI, −0.68 to 1.95) and was not significant. We observed a positive systematic error (PCO2 > ETCO2) in 2 of the units, and a negative difference in the third (PCO2 < ETCO2).Discussion: The correlation between ETCO and PCO2 was significant, although the obtained values were not equivalent, with differences ranging from 0.1 mmHg to 20 mmHg. Likewise, we found systematic errors that differed in sign (positive or negative) between institutions. (AU)

Asociación entre el vínculo madre-hijo y los síntomas depresivos en madres de la Unidad de Cuidados Intensivos Neonatales: estudio caso-control / Association between maternal-infant bonding and depressive symptoms in Neonatal Intensive Care Unit mothers: A case-control study

Objetivos: Se ha asociado la depresión perinatal de la madre a un vínculo madre-hijo deficiente. Se ha reportado el efecto adverso de la deficiencia de dicho vínculo. El objetivo de este estudio fue investigar y comparar los síntomas depresivos posnatales y el vínculo madre-hijo en una Unidad de Cuidados Intensivos Neonatales (UCIN), y las madres con neonatos sanos, respectivamente. Y, en segundo lugar, explorar la asociación entre la sintomatología depresiva y los vínculos en ambos grupos. Métodos: En este estudio de casos se seleccionó a madres que se encontraban en el periodo posparto temprano, que habían dado a luz en el mismo centro perinatal de Grecia. Los casos consistieron en 88 madres de neonatos que fueron hospitalizados en la UCIN y 100 controles, consistentes en madres de neonatos sanos a término. Para la recopilación de los datos se utilizaron cuestionarios que incluían datos demográficos y variables perinatales. Para la evaluación del vínculo y la situación posnatal, se utilizaron la Mother to Infant Bonding Scale, el Postpartum Bonding Questionnaire y la Hospital Anxiety and Depression Scale. Resultados: Existió una diferencia significativa entre las puntuaciones sobre el vínculo de las madres de la UCIN y el grupo control (t=–2,696, p=0,008). Las madres de la UCIN presentaron menores puntuaciones en términos de vínculo con los neonatos, en comparación con el grupo control, y presentaron puntuaciones más altas de depresión en comparación con los controles (χ2=28,588, p=0,000). Las puntuaciones sobre depresión guardaron relación con las puntuaciones sobre vínculos en ambos grupos. Discusión: El ingreso en la UCIN tiene un impacto sobre el vínculo e interactúa de alguna manera con la salud mental posparto de la madre. Por ello se hace necesaria más investigación.(AU)

Objectives: Maternal perinatal depression has been associated with impaired mother-infant bonding. The adverse effect of this impaired bonding has been reported. This study aimed to investigate and compare the posnatal depressive symptoms and the mother-infant bonding in a Neonatal Intensive Care Unit (NICU) and of mothers with healthy newborns respectively. Secondly, was to explore the association between depressive symptomatology and bonding in both groups. Methods: In this case study, mothers in the early pospartum period who gave birth in the same perinatal center of Greece were recruited to participate. The cases consisted of 88 mothers of neonates who were hospitalized in the NICU and controls were 100 mothers of full-term healthy neonates. For the collection of the data questionnaires including demographics and perinatal variables were used. For the bonding and posnatal assessment, the Mother to Infant Bonding Scale, the Postpartum Bonding Questionnaire, and the Hospital Anxiety and Depression Scale were used. Results: There was a significant difference between the mean of bonding scores of NICU mothers and the control group (t=-2.696, P=.008). NICU mothers presented lower scores in bonding with the newborn compared to the control group and presented higher depression scores compared to those of controls (χ2=28.588, P=.000). The depression scores were correlated with bonding scores in both groups. Discussion: A NICU admission has an impact on bonding and in some way interacts with maternal pospartum mental health, therefore more research is needed. Conclusions: NICU mothers have been presented as more vulnerable than mothers of healthy infants since they expressed a lower mother-infant bonding and higher depression scores. The support of these vulnerable mothers and the facilitation of mother-infant bonding by the NICU staff is of utmost importance.(AU)

Capnography in newborns under mechanical ventilation and its relationship with the measurement of CO2 in blood samples.

INTRODUCTION: Monitoring the partial pressure of CO2 (PCO2) in newborns who require ventilation would allow avoiding hypocapnia and hypercapnia. The measurement of end-tidal carbon dioxide (ETCO2) is an alternative rarely implemented in this population. OBJECTIVE: To evaluate the relationship between ETCO2 and PCO2 in newborns. METHODS: Cross-sectional study comparing two PCO2 measurement methods, the conventional one by analysis of blood samples and the one estimated by ETCO2. The study included hospitalized newborns that required conventional mechanical ventilation. The ETCO2 was measured with a Tecme GraphNet® neo, a neonatal ventilator with an integrated capnograph, and we obtained the ETCO2-PCO2 gradient. We conducted correlation and Bland-Altman plot analyses to estimate the agreement. RESULTS: A total of 277 samples (ETCO2 / PCO2) from 83 newborns were analyzed. The mean values ​​of ETCO2 and PCO2 were 41.36mmHg and 42.04mmHg. There was a positive and significant correlation between ETCO2 and PCO2 in the overall analysis (r=0.5402; P<.001) and in the analysis of each unit (P<.001). The mean difference was 0.68 mmHg (95% CI, -0.68 to 1.95) and was not significant. We observed a positive systematic error (PCO2 > ETCO2) in 2 of the units, and a negative difference in the third (PCO2 < ETCO2). DISCUSSION: The correlation between ETCO and PCO2 was significant, although the obtained values ​​were not equivalent, with differences ranging from 0.1mmHg and 20mmHg. Likewise, we found systematic errors that differed in sign (positive or negative) between institutions.

Resonancia magnética cerebral sin anestesia en niños menores de 3 meses / Brain MRI without anesthesia in children less than 3 months old

Introducción: El uso de anestesia general en niños pequeños conlleva riesgos, a corto y largo plazo. El objetivo de este estudio fue evaluar la eficacia de la técnica de resonancia magnética (RM) cerebral sin anestesia mediante fijación con colchón en niños menores de 3 meses. Pacientes y métodos: Estudio prospectivo de casos y controles realizado en el año 2019. Los casos fueron pacientes menores de 3 meses con indicación de RM craneal, estables y sin soporte ventilatorio; las resonancias se realizaron usando la técnica de dar de comer y dormir y un colchón inmovilizador. Los controles fueron pacientes de la misma edad y sexo, inestables clínicamente, derivados para realizar RM craneal con anestesia general. Tres radiólogos pediátricos evaluaron el éxito de la RM (si respondía a la pregunta clínica), si era necesario repetirla y calificaron la presencia de artefactos de movimiento en una escala del 1 al 4. Resultados: 47 casos fueron incluidos en este estudio (28 niños, 19 niñas; media: 31 días de vida), de los cuales (89%) 42 RM fueron llevadas a cabo de manera exitosa. Los estudios realizados de manera ambulatoria se asociaron a mayor posibilidad de fallo de la técnica que los realizados a ingresados (valor de p 0,02). El 60% de las RM de los casos realizados tuvieron calidad óptima y el 30%, subóptima (artefacto de movimiento en una o dos secuencias). No se detectaron problemas de seguridad con esta técnica. La media de duración de los estudios fue de 16,6 minutos (rango 6-30 minutos). El 100% de las RM de los controles bajo anestesia general se llevaron a cabo con éxito, con una calidad óptima en el 89% y subóptima en el 11% restante. En el primer año de experiencia con esta técnica, de 47 RM realizadas, se evitó el uso de anestesia general a 42 recién nacidos. Conclusión: La técnica de dar de comer y dormir y fijación con colchón neumático para realizar RM sin anestesia puede realizarse de forma eficaz y segura en niños menores de 3 meses.(AU)

Introduction: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. Patients and methods: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. Results: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p=0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6minutes (range, 6-30minutes). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. Conclusion: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.(AU)