Risk factors for healthcare-associated infections in newborns after surgery in a neonatal intensive care unit.

BACKGROUND: Health care-associated infections (HAIs) are a common cause of morbidity and mortality. There is little information on the risk factors associated with HAI in surgical newborns. OBJECTIVE: To identify the risk factors associated with healthcare-associated infections in surgical newborns. METHODS: Nested case-control study carried out during 2016-2017. Cases were newborns with healthcare-associated infections and controls were newborns without infection. Perinatal characteristics, use of antimicrobial prophylaxis, use of central venous catheter (CVC), mechanical ventilation, parenteral nutrition, age, and weight at the time of surgery, type of surgery, surgical wound classification, duration of surgery, number of surgical procedures, postsurgical HAIs and type of infection were registered. Univariate and multivariate analyses were performed. RESULTS: Seventy-one cases and 142 controls were included. The most frequent HAI was bloodstream infection (36.6%); the main microorganisms isolated in blood cultures were gram-positive cocci. Independent risk factors associated with HAIs in the multivariate analysis were CVC duration > 8 days (aOR = 17.2, 95% CI = 3.8-49.1), ≥ 2 surgeries (aOR = 16.5, 95% CI 5.8 -42.1) and abdominal surgery (aOR = 2.6, 95% CI = 1.2-6.6). CONCLUSION: Newborns undergoing surgery, mainly those with risk factors, require close monitoring during the postoperative period. CVC should be withdrawn as soon as possible.

ANTECEDENTES: Las infecciones asociadas a la atención de la salud (IAAS) son causa frecuente de morbilidad y mortalidad. OBJETIVO: Identificar los factores de riesgo para el desarrollo de IAAS en recién nacidos (RN) sometidos a cirugía. MATERIAL Y MÉTODOS: Estudio de casos y controles anidado en una cohorte. Los casos fueron RN sometidos a cirugía, con IAAS y los controles, RN sometidos a cirugía sin IAAS. Se registraron datos perinatales, uso de profilaxis antimicrobiana, de catéter venoso central (CVC), ventilación mecánica, nutrición parenteral y sondas; edad y peso al momento de la cirugía, tipo de cirugía, clasificación de la herida quirúrgica, duración de la cirugía, número de procedimientos quirúrgicos y tipo de infección. Se realizó análisis univariado y multivariado. RESULTADOS: Se incluyeron 71 casos y 142 controles. Las IAAS más frecuentes fueron las infecciones sanguíneas (36.6 %); los principales microorganismos aislados en hemocultivos fueron cocos grampositivos. Los factores de riesgo asociados a IAAS en el análisis multivariado fueron duración del CVC > 8 días (RMa = 17.2), ≥ 2 intervenciones quirúrgicas (RMa = 16.5) y cirugía abdominal (RMa = 2.6). CONCLUSIONES: Los RN sometidos a cirugía, principalmente aquellos con factores de riesgo, requieren vigilancia estrecha durante el posoperatorio. El CVC debe ser retirado tan pronto sea posible.

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

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

Evaluating the quality of the processes of care and clinical outcomes of premature newborns admitted to neonatal intensive care units in Mexico.

OBJECTIVES: To develop quality of care (QoC) indicators, evaluate the quality of the processes of care (QPC) and clinical outcomes, and analyze the association between the QPC and severe clinical outcomes of preterm newborns admitted to neonatal intensive care units (NICUs). DESIGN: Mixed methods approach: (1) development of QoC indicators via modified RAND/UCLA method; (2) cross-sectional study of QoC evaluation and (3) multiple logistic regression analysis to ascertain the association between the QPC and severe clinical outcomes. SETTING: Two NICUs belonged to the Mexican Institute of Social Security in Mexico City. PARTICIPANTS: About 489 preterm neonates (<37 weeks of gestation) without severe congenital anomalies. MAIN OUTCOME MEASURE(S): The QoC indicators; ≥60% of recommended QPC and severe clinical outcomes. RESULTS: The QoC included 10 QPC indicators across four domains: respiratory, nutrition and metabolism, infectious diseases, and screening, and five outcome indicators. The lower QPC indicators were for the nutrition and metabolism domain (17.8% started enteral feeding with human milk, and 20.7% received sodium bicarbonate appropriately). The higher QPC indicator was for the screening domain (97.6% of neonates <30 weeks gestation underwent early (≤14 days) transfontanelar ultrasound). The mean recommended QPC that neonates received was 47.5%. Only 26.6% of neonates received ≥60% of recommended QPC. About 60.7% of neonates developed severe clinical outcomes including mortality and healthcare-related major morbidity. Receiving ≥60% of recommended QPC was associated with a decrease of nearly half of odds of severe clinical outcomes. CONCLUSION: The evaluation of the QoC in NICUs is essential to address modifiable gaps in quality.

[Frecuencia y gravedad de la retinopatía del prematuro en una unidad de cuidados intensivos neonatales].

INTRODUCTION: Retinopathy of prematurity (ROP) is a disease where retinal blood vessels do not develop normally and may cause visual damage and blindness. OBJECTIVE: To determine the frequency and severity of ROP in preterm newborns. METHOD: A descriptive, comparative study was carried out within the 2009-2013 period. Patients' general characteristics were recorded, including gestational age and postmenstrual age at the moment of ophthalmologic examination, as well as ROP severity and type of treatment. RESULTS: A total of 326 preterm newborns were included: 47.8 % (n = 156) had ROP; in 21.1 % it was severe (stage ≥ 3). Median gestational age was 28 weeks in preterm newborns with ROP, median birth weight was 1000 g, and median postmenstrual age at ophthalmological examination was 36 weeks. Of the infants with ROP, 71.1 % received treatment: 63.4 % of those who had mild ROP and 100 % of those with severe ROP. CONCLUSIONS: ROP frequency was high, higher than that reported in developed countries and similar to that in developing countries. The frequency of severe ROP was also higher. It is necessary for effective programs for the detection and opportune treatment of ROP to be established.

INTRODUCCIÓN: La retinopatía del prematuro (ROP) es una enfermedad en la que los vasos sanguíneos de la retina no se desarrollan normalmente, lo que puede ocasionar daño visual y ceguera. OBJETIVO: Identificar la frecuencia y gravedad de la ROP en recién nacidos prematuros. MÉTODO: Estudio descriptivo comparativo realizado en el periodo 2009-2013. Se registraron características generales de los pacientes, edad posnatal y edad posconcepcional al momento de la exploración oftalmológica, así como gravedad y tratamiento de la ROP. RESULTADOS: Se incluyeron 326 recién nacidos prematuros: 47.8 % (n = 156) tuvo ROP, en 21.1 % fue grave (estadio ≥ 3). La mediana de la edad gestacional fue de 28 semanas en los recién nacidos prematuros con ROP, el peso al nacer fue de 1000 g y la edad posconcepcional a la exploración oftalmológica fue de 36 semanas. De los niños con ROP, 71.1 % recibió tratamiento, 63.4 % de aquellos que tuvieron ROP leve y 100 % de aquellos con ROP grave. CONCLUSIONES: La frecuencia de ROP fue alta, mayor a la reportada en los países desarrollados y similar a la de otros países en desarrollo. La frecuencia de ROP grave también fue mayor. Es necesario establecer programas efectivos de detección y tratamiento oportuno de ROP.

[Risk factors for nosocomial infection in a level III Neonatal Intensive Care Unit]. / Factores de riesgo asociados a infección nosocomial (IN) en una Unidad de Cuidados Intensivos Neonatales (UCIN) de tercer nivel.

INTRODUCTION: Nosocomial infections are a major and a frequent problem in neonatal intensive care units and increase morbidity, mortality, and costs. The objective of this study was to identify the risk factors associated with nosocomial infections in a neonatal intensive care unit. METHODS: Nested case control study. Records from patients were registered: gestational age, sex, birth weight, central venous catheter and other devices, congenital malformations, surgeries, mechanical ventilation, steroid use, H2 blockers, length of stay in neonatal intensive care unit, type of infection, and etiological agent. RESULTS: We studied 188 cases with nosocomial infections and 192 controls without nosocomial infections. The most frequent infection was sepsis (34.8%) and coagulase negative Staphylococcus was the principal etiological agent (37.2%). The risk factors associated with nosocomial infection were central venous catheter (OR: 7.3; 95% CI: 2.3-22.8), duration of neonatal intensive care unit stay>14 days (OR: 3.4; 95% CI: 1.7-6.7), H2 blockers (OR: 2.3; 95% CI: 1.2-4.2), number of surgeries≥2 (OR: 3; 95% CI: 1.1-7.9) and mechanical ventilation>7 days (OR: 2.1; 95% CI: 1.1-4.2). CONCLUSIONS: Some risk factors associated to nosocomial infections in this study are similar to those found previously, with the exception of the number of surgeries that was not reported in previous studies.

Global Prevalence and Severity of Retinopathy of Prematurity over the Last Four Decades (1985-2021): A Systematic Review and Meta-Analysis.

BACKGROUND: Retinopathy of prematurity (ROP) is a vasoproliferative disease of the retina that occurs in premature infants. The prevalence of ROP reported so far is inconsistent. AIM: To conduct a systematic review to describe the trend of ROP prevalence between 1985 and 2021, and to determine the influence of countries' economic conditions on ROP prevalence. METHODS: We searched PubMed, Embase, and Google Scholar for studies published between January 1985 and December 2021 using the following MeSH terms: "retinopathy of prematurity", "ROP", "incidence", and "prevalence". Two independent reviewers examined the articles to select studies that met the selection criteria and performed data extraction and study quality assessment. For the meta-analysis, the pooled prevalence was calculated using a random-effects model and R software. RESULTS: Of 5,250 titles and abstracts, 139 original studies met the inclusion criteria; a total of 121,618 premature infants were included in these studies. The pooled prevalence of ROP was 31.9% (95% confidence interval [CI] 29.0-34.8) and that of severe ROP was 7.5% (6.5-8.7). In general, no significant differences in prevalence were found over the four decades; however, we found a higher prevalence in premature infants ≤28 weeks of gestational age. In addition, the highest ROP prevalence was found in lower-middle-income countries with high mortality rates. In contrast, the highest severe ROP prevalence was found in high-income countries. CONCLUSION: ROP remains a common cause of morbidity in premature infants worldwide. Therefore, it seems necessary to maintain early identification strategies for patients at higher risk, particularly in low- and middle-income countries.

Factors associated with vitamin D deficiency in health care workers exposed to SARS-CoV-2: a cross-sectional study.

Introduction: Globally, up to 76.6% of the population may be affected by vitamin D (VD) deficiency, which has been linked to increased morbidity and mortality from COVID-19. This underscores the importance of further research into VD supplementation, particularly for health care workers, who are at higher risk due to indoor work environments and dietary challenges associated with shift schedules. Objective: This study aimed to identify factors associated with VD deficiency in Mexican health care workers exposed to SARS-CoV-2. Materials and methods: We conducted a cross-sectional study from June 2020 to January 2021 among frontline health care workers treating hospitalized COVID-19 patients. Blood samples were collected to measure 25-hydroxy VD levels via radioimmunoassay. We also assessed previous COVID-19 infection and comorbidities that could influence VD levels. Results: The study included 468 health care workers. The median serum VD concentration was 16.6 ng/mL. VD deficiency was found in 69.4% (n = 325) of participants, while only 5.1% (n = 24) had normal levels. Those with type 2 diabetes (13.3 ng/mL vs. 17.1 ng/mL) or obesity (15.7 ng/mL vs. 17.1 ng/mL) had significantly lower VD levels than their counterparts (p < 0.001 and p = 0.049, respectively). No significant differences were found among participants with high blood pressure. Multivariate analysis revealed that type 2 diabetes was independently associated with VD deficiency. Conclusion: There is a high prevalence of VD deficiency among health care workers, which is potentially linked to both personal health factors and occupational conditions.

[Aswer to "Comment on article "Bibliometric analysis of scientific publications on COVID-19 elaborated by staff of the Instituto Mexicano del Seguro Social""]. / Respuesta a "Comentario al artículo "Análisis bibliométrico de las publicaciones científicas sobre COVID-19 realizadas por personal IMSS"".

We thank the group headed by Jorge Valencia Alonso for taking the time to review in detail and prepare the letter about our article entitled: " Bibliometric analysis of scientific publications on COVID-19 elaborated by staff of the Instituto Mexicano del Seguro Social", which has recently been published in the Medical Journal of the Mexican Social Security Institute. Based on your observations and comments, we allow ourselves to make the following clarifications following the same sequence of your letter to the Editor.

Agradecemos al grupo encabezado por Jorge Valencia Alonso por tomarse el tiempo para revisar con detalle y elaborar la carta sobre nuestro artículo titulado: "Análisis bibliométrico de las publicaciones científicas sobre COVID-19 por personal del IMSS", que recientemente se ha publicado en la Revista Médica del Instituto Mexicano del Seguro Social. De acuerdo con sus observaciones y comentarios, nos permitimos realizar las siguientes aclaraciones siguiendo la misma secuencia de su carta al Editor.

[Survival and morbidity of infants with necrotizing enterocolitis treated with surgery]. / Cirugía en enterocolitis necrotizante en niños. Supervivencia y morbilidad.

OBJECTIVES: to determine the survival rate and type of morbidity during the first year of life of infants with necrotizing enterocolitis (NED) who underwent to surgical treatment. METHODS: a comparative and descriptive study was performed. Thirty two children with NEC (19 deaths and 13 survivals) who underwent to surgery during neonatal period were studied. Perinatal conditions, surgical procedures and findings, morbidity and survival rate during the first year of life were registered. RESULTS: all patients underwent to laparotomy, except three patients who died and were managed with peritoneal drainage only. During the first year of life, cholestasis and intestinal obstruction were the main causes of morbidity in survivals and deaths. Survival rate during neonatal period was 78 %, and 40.6% in the first year of life. CONCLUSIONS: morbidities during the first year of life were related to surgery. In this series, there was a high survival rate in neonatal period, which diminished in the first year of life.

COVID-19 in Neonates with Positive RT-PCR Test. Systematic Review.

BACKGROUND: COVID-19 is an infectious disease of variable severity caused by a new coronavirus. Clinical presentation ranges from asymptomatic cases to severe illness. Most cases in newborns appear to be asymptomatic or mild. OBJECTIVE: To conduct a systematic review of the literature on published studies of COVID-19 in newborns with a positive RT-PCR test. METHODS: The PubMed and EMBASE databases were searched for infection data in newborns from 1 December 2019-21 May 2021. The mesh terms included "SARS-CoV-2", "COVID-19", "novel coronavirus", "newborns" and "neonates". The selection criteria were as follows: original studies reporting clinical, radiological, laboratory, and outcome data in newborns with a positive RT-PCR test for SARS-CoV-2. Two independent investigators reviewed the studies. RESULTS: Seventy-two studies that involved 236 newborns were included. The main clinical manifestations were fever (43.2%), respiratory (46.6%), and gastrointestinal (35.2%) symptoms; 60.1% had mild/moderate disease. A total of 52.5% had a chest X-ray; 43.5% were normal, and 24.1% reported consolidation/infiltration images. The most frequent laboratory abnormalities were elevated C reactive protein and elevated procalcitonin and lymphopenia. Mortality was 1.7%. CONCLUSION: Symptoms of SARS-CoV-2 infection were mild to moderate in most of the newborns. The prognosis was good, and mortality was mainly associated with other comorbidities.

[Bibliometric analysis of scientific publications on COVID-19 elaborated by staff of the Instituto Mexicano del Seguro Social]. / Análisis bibliométrico de las publicaciones científicas sobre COVID-19 realizadas por personal IMSS.

Background: Since the beginning of the pandemic, new knowledge about COVID-19 obtained by research has been disseminated in medical and scientific journals, but the large number of publications that have been generated in such a short time has been impressive. Objective: To perform a bibliometric analysis of the published articles in medical-scientific journals carried-out by the Mexican Social Security Institute (IMSS) personnel on COVID-19. Material and methods: Systematic review of the literature, identifying the publications included in the PubMed and EMBASE databases, up to September 2022. Articles on COVID-19 were included, in which at least one author had IMSS affiliation; there was no restriction on the type of publication, so original articles, review articles, clinical case reports, etc. were included. The analysis was descriptive. Results: 588 abstracts were obtained, of which 533 full length articles met the selection criteria. Most were research articles (48%), followed by review articles. Mainly clinical or epidemiological aspects were addressed. They were published in 232 different journals, with a predominance of foreign journals (91.8%). Around half of the publications were carried out by IMSS personnel together with authors from other institutions, national or foreign. Conclusions: The scientific contributions prepared by IMSS personnel have contributed to understanding clinical, epidemiological and basic aspects of COVID-19, which has had an impact on improving the quality of care for its beneficiaries.

Introducción: desde el inicio de la pandemia los nuevos conocimientos sobre COVID-19 han sido difundidos en revistas médico-científicas, y ha sido impresionante la gran cantidad de publicaciones que se ha generado en tan poco tiempo. Objetivo: realizar un análisis bibliométrico de los artículos publicados en revistas médico-científicas elaborados por personal del Instituto Mexicano del Seguro Social (IMSS) sobre COVID-19. Material y métodos: revisión sistemática de la literatura, identificando las publicaciones incluidas en las bases de datos PubMed y EMBASE, hasta septiembre de 2022. Se incluyeron los artículos sobre COVID-19 en los que al menos un autor tuviera adscripción IMSS, sin restricción del tipo de publicación, por lo que se incluyeron artículos originales, de revisión, reportes de casos clínicos, etc. El análisis fue de tipo descriptivo. Resultados: se obtuvieron 588 resúmenes, de los cuales 533 artículos cumplieron con los criterios de selección. La mayoría correspondió a artículos de investigación y revisión. Principalmente se abordaron aspectos clínicos o epidemiológicos. Se publicaron en 232 revistas diferentes, predominando revistas extranjeras (91.8%). Alrededor de la mitad de las publicaciones fueron realizadas por personal del IMSS en conjunto con autores de otras instituciones, nacionales o extranjeras. Conclusiones: las aportaciones científicas elaboradas por personal del IMSS han contribuido a conocer aspectos clínicos, epidemiológicos y básicos sobre COVID-19, lo cual ha impactado en la mejora de la calidad de atención de sus derechohabientes.

[Risk, association, and impact measures in clinical research studies. How to interpret them for their application in medical care]. / Medidas de riesgo, asociación e impacto en los estudios de investigación clínica. Cómo interpretarlas para su aplicación en la atención médica.

The practice of evidence-based medicine includes the critical analysis of clinical research studies, and, within it, the interpretation of the results reported. In addition, to statistical data, there are estimators that can help clinicians transfer research findings to routine clinical practice. These estimators are measures of risk, association, and impact. Risk measures report current uncertainty or probability (prevalence of a disease, sensitivity, specificity) or for future events (cumulative incidence, incidence density). Measures of association are related to the identification of the risk in order to determine whether certain factors increase or decrease the probability of development of a disease (relative risk, odds ratio, hazard ratio). While measures of impact allow, among other things, to estimate the effect of a treatment (relative risk reduction, absolute risk reduction, number needed to treat). In this review, each of these estimators is described, defined, and presented with examples.

Parte del ejercicio de la medicina basada en evidencia incluye el análisis crítico de los estudios de investigación clínica y dentro de este, la interpretación de los resultados presentados. Además de los datos estadísticos, existen estimadores que pueden ayudar a los clínicos a trasladar los hallazgos de las investigaciones a la práctica clínica habitual. Estos estimadores son las medidas de riesgo, asociación e impacto. Las medidas de riesgo informan sobre la incertidumbre o probabilidad en el presente (prevalencia de una enfermedad, sensibilidad, especificidad) o para eventos futuros (incidencia acumulada, densidad de incidencia). Las medidas de asociación se relacionan con la identificación del riesgo para determinar si ciertos factores aumentan o disminuyen la probabilidad del desarrollo de una enfermedad (riesgo relativo, razón de momios, cociente de riesgo). Mientras que las medidas de impacto permiten, entre otros, estimar el efecto de un tratamiento (reducción del riesgo relativo, reducción del riesgo absoluto, número necesario por tratar). En esta revisión se describen, definen y presentan ejemplos de cada uno de estos estimadores.

Systematic review and meta-analysis as a support tools for research and clinical practice.

Systematic reviews are secondary investigations that compile published results that have been obtained from studies involving human subjects. Meta-analysis is the term used to describe the carrying out of statistical analysis of the combination of the results of two or more original studies, which had to be selected from a systematic review. In this way, a meta-analysis cannot exist without a systematic review. Systematic reviews arise due to the exponential increase in the information; to provide all health personnel with a study that critically analyzes the results and discriminates those that may be useful in clinical practice. Systematic reviews are one of the fundamental tools in evidence-based medicine, in which two of the main steps refer to both the search and the critical analysis of the studies, which shall support medical decisions on aspects that are mainly related to diagnosis, treatment, or prognosis. On the other hand, systematic reviews have been essential for some time now when developing evidence-based clinical practice guidelines and they can be used to make decisions on health policies. The methodology for performing and interpreting systematic reviews and meta-analysis is described in this article.

Las revisiones sistemáticas son investigaciones secundarias que compilan los resultados publicados obtenidos a partir de estudios en seres humanos. El término metaanálisis es utilizado para describir el análisis estadístico de la combinación de los resultados de dos o más estudios originales, los cuales debieron ser seleccionados a partir de una revisión sistemática. De esta forma, no puede haber metaanálisis sin una revisión sistemática. Las revisiones sistemáticas surgen debido al incremento exponencial de la información, para facilitar un estudio que analice críticamente los resultados y discrimine los que puedan ser útiles en la práctica clínica. Las revisiones sistemáticas son una de las herramientas fundamentales en la medicina basada en evidencia, en la cual dos de los pasos principales se refieren a la búsqueda y lectura crítica de los estudios, que apoyarán las decisiones médicas sobre aspectos relacionados principalmente con el diagnóstico, tratamiento o pronóstico. Por otro lado, desde hace tiempo, las revisiones sistemáticas son imprescindibles al elaborar guías de práctica clínica basadas en evidencia y pueden ser utilizadas para tomar decisiones en políticas de salud. En este artículo se describe la metodología para la realización e interpretación de revisiones sistemáticas y metaanálisis.

[B-type brain natriuretic peptide as marker of hemodynamic overload of the patent ductus arteriosus in the preterm infant]. / Péptido natriurético cerebral tipo B como marcador de sobrecarga hemodinámica del conducto arterioso permeable en el recién nacido prematuro.

Introducción: El ecocardiograma es el método de referencia para el diagnóstico del conducto arterioso permeable (CAP) hemodinámicamente significativo (CAP-hs) del recién nacido prematuro (RNP). El péptido natriurético tipo B (BNP) puede ser útil en el diagnóstico y el manejo del CAP-hs. Objetivo: Evaluar la utilidad del BNP como marcador de sobrecarga hemodinámica del conducto arterioso permeable en el RNP con edad gestacional < 32 semanas o peso < 1500 gramos, e identificar el mejor punto de corte para los valores de BNP que mejor prediga un CAP con repercusión hemodinámica que requiera tratamiento farmacológico o quirúrgico. Método: Estudio retrospectivo, observacional y descriptivo de RNP < 32 semanas de gestación o peso < 1500 gramos en los que se realizó ecocardiograma y determinación del BNP. Análisis de muestra global y por subgrupos, en función del CAP-hs. Resultados: Se analizaron 29 pacientes. Se encontró una correlación significativa entre la relación CAP/peso y los valores del BNP (prueba de Spearman: 0.71; intervalo de confianza del 95%: 0.45-0.87; p < 0.001). El mejor punto de corte del BNP para predecir CAP-hs fue 486.5 pg/ml, con una sensibilidad del 81% y una especificidad del 92% (p < 0.001). Conclusión: El punto de corte del BNP identificado en el presente estudio se correlacionó con la presencia de CAP-hs.

Risk Factors for Central Line-Associated Bloodstream Infection in Critically Ill Neonates.

OBJECTIVE: To identify independent risk factors to develop a central line- associated bloodstream infection (CLABSI) in critically ill neonates with major underlying diseases. METHODS: A nested case-control study was conducted in a neonatal intensive care unit (NICU). Patients with a central venous catheter (CVC) were included. Cases were neonates who developed a CLABSI and controls were patients without CLABSI. Variables included: perinatal history, characteristics of the catheter, installation and catheter use, surgical interventions, and hospital stay. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. X2, Fisher exact, and Mann-Whitney U tests were used when appropriate. Variables with a p value ≤0.10 in the univariate analysis were introduced in a non-conditional logistic regression model. RESULTS: Seventy four cases and 105 controls were analyzed. Univariate risk factors were: any surgery, abdominal surgery, length of hospitalization (≥14 d), double-lumen CVC, surgical cut-down technique, complications, CVC placement in internal jugular vein, dressing type, blood transfusions, parenteral nutrition, and number of CVC manipulations (>200). In the logistic regression analysis, independent risk factors with a p value <0.05 were: double-lumen catheter (OR 5.8, 95% CI 1.2-30), length of hospitalization ≥14 d (OR 4.6, 95% CI 1.8-11.4), abdominal surgery (OR 2.7, 95% CI 1.2-6.2) and blood transfusions (OR 2.5, 95% CI 1.2-5.3). CONCLUSIONS: One risk factor was related to the catheter itself. Management of underlying diseases in specialized NICU contributes to a greater extent to the development of a central line-associated bloodstream infection.

[Neonatal and maternal morbidity among adolescent and adult women. A comparative study]. / Morbilidad neonatal y materna en mujeres adolescentes y mujeres adultas. Estudio comparativo.

OBJECTIVE: To identify neonatal and maternal morbidity among adolescent and adult women. MATERIAL AND METHODS: We used a cross sectional study design. Recorded data from newborn infants: gestational age, birth weight, sex, route of delivery, Apgar score, Silverman score and morbidity; and mothers' data reviewed: age, marital status, scholarship, occupation, monthly income, drug abuse history, number of pregnancies, abortion, deliveries, cesarean section, prenatal follow up and complications during the pregnancy. RESULTS: One hundred newborn infants were studied in each group. Complications during pregnancy were present among 26% of adult women and 10% of adolescents (p = 0.04). Gestational age and birth-weight were similar in both groups. Birth by cesarean section was more frequent among the offspring of adult women (65% vs. 48%, p = 0.015). Perinatal asphyxia and birth trauma were observed more often in children from adolescent mothers (p < 0.05). Mortality rate was 5% and 1% among the offspring of adolescent and adult women, respectively. CONCLUSIONS: The morbidity in pregnancy was more frequent in adult women. The offspring of adolescent women had a higher incidence of perinatal complications like asphyxia and birth trauma. Mortality rate was higher in children from adolescent mothers.

Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease.

BACKGROUND: Congenital heart diseases are among the most common congenital malformations. Approximately 50% of the patients with congenital heart disease undergo cardiac surgery. Nosocomial infections (NIs) are the main complications and an important cause of increased morbidity and mortality associated with congenital heart diseases. This study's objective was to identify the risk factors associated with the development of NIs after cardiac surgery in newborns with congenital heart disease. METHODS: This was a nested case-control study that included 112 newborns, including 56 cases (with NI) and 56 controls (without NI). Variables analyzed included perinatal history, associated congenital malformations, Risk-Adjusted Congenital Heart Surgery (RACHS-1) score, perioperative and postoperative factors, transfusions, length of central venous catheter, nutritional support, and mechanical ventilation. STATISTICAL ANALYSIS: Differences were calculated with the Mann-Whitney-U test, Pearson X2, or Fisher's exact test. A multivariate logistic regression was used to determine the independent risk factors. RESULTS: Sepsis was the most common NI (37.5%), and the main causative microorganisms were gram-positive cocci. The independent risk factors associated with NI were non-cardiac congenital malformations (OR 6.1, CI 95% 1.3-29.4), central venous catheter indwelling time > 14 days (OR 3.7, CI 95% 1.3-11.0), duration of mechanical ventilation > 7 days (OR 6.6, CI 95% 2.1-20.1), and ≥5 transfusions of blood products (OR 3.1, CI 95% 1.3-8.5). Mortality attributed to NI was 17.8%. CONCLUSION: Newborns with non-cardiac congenital malformations and with >7 days of mechanical ventilation were at higher risk for a postoperative NI. Efforts must focus on preventable infections, especially in bloodstream catheter-related infections, which account for 20.5% of all NIs.

Factores de riesgo para infecciones asociadas al cuidado de la salud en recién nacidos sometidos a cirugía en una unidad de cuidados intensivos neonatales / Risk factors for healthcare-associated infections in newborns after surgery in a neonatal intensive care unit

Resumen Antecedentes: Las infecciones asociadas a la atención de la salud (IAAS) son causa frecuente de morbilidad y mortalidad. Objetivo: Identificar los factores de riesgo para el desarrollo de IAAS en recién nacidos (RN) sometidos a cirugía. Material y métodos: Estudio de casos y controles anidado en una cohorte. Los casos fueron RN sometidos a cirugía, con IAAS y los controles, RN sometidos a cirugía sin IAAS. Se registraron datos perinatales, uso de profilaxis antimicrobiana, de catéter venoso central (CVC), ventilación mecánica, nutrición parenteral y sondas; edad y peso al momento de la cirugía, tipo de cirugía, clasificación de la herida quirúrgica, duración de la cirugía, número de procedimientos quirúrgicos y tipo de infección. Se realizó análisis univariado y multivariado. Resultados: Se incluyeron 71 casos y 142 controles. Las IAAS más frecuentes fueron las infecciones sanguíneas (36.6 %); los principales microorganismos aislados en hemocultivos fueron cocos grampositivos. Los factores de riesgo asociados a IAAS en el análisis multivariado fueron duración del CVC > 8 días (RMa = 17.2), ≥ 2 intervenciones quirúrgicas (RMa = 16.5) y cirugía abdominal (RMa = 2.6). Conclusiones: Los RN sometidos a cirugía, principalmente aquellos con factores de riesgo, requieren vigilancia estrecha durante el posoperatorio. El CVC debe ser retirado tan pronto sea posible.

Abstract Background: Healthcare-associated infections (HAIs) are a common cause of morbidity and mortality. Objective: To identify the risk factors for the development of HAIs in newborns (NBs) undergoing surgery. Material and methods: Nested case-control study. Cases were NBs undergoing surgery with HAIs, while controls were NBs undergoing surgery with no HAIs. Perinatal data, use of antimicrobial prophylaxis, use of central venous catheter (CVC), mechanical ventilation, parenteral nutrition, and other medical devices were recorded, as well as age and weight at the time of surgery, type of surgery, surgical wound classification, duration of surgery, number of surgical procedures, and type of infection. Univariate and multivariate analyses were performed. Results: Seventy-one cases and 142 controls were included. The most frequent HAI was bloodstream infection (36.6%); the main microorganisms isolated in blood cultures were gram-positive cocci. The risk factors associated with HAIs in the multivariate analysis were CVC duration > 8 days (aOR = 17.2), ≥ 2 surgical interventions (aOR = 16.5) and abdominal surgery (aOR = 2.6). Conclusions: NBs undergoing surgery, mainly those with risk factors, require close monitoring during the postoperative period. CVC should be withdrawn as soon as possible.

[Balloon angioplasty for native aortic coarctation in children younger than 12 months: immediate and medium-term results]. / Angioplastía con balón de la coartación aórtica nativa en niños menores de 12 meses: resultado inicial y a mediano plazo.

INTRODUCTION AND OBJECTIVES: The use of the balloon angioplasty (BA) in the treatment of patients with native aortic coarctation during childhood, particularly during the first 12 months of age, is controversial. The aim of this study was to report our experience with the use of this therapeutic technique and review the immediate and middle-term results in patients until 12 months age with native aortic coarctation and to identify those factors related with the outcome. MATERIAL AND METHOD: We review retrospectively the clinical records of 35 patients less than 12 months of age with diagnosis of native aortic coarctation who underwent balloon angioplasty as first choice treatment during an eight year span (1998-2005). Total population was divided in two groups: group A patients < or = 3 months of age (n = 19) and group B patients between 4-12 months of age (n = 16). RESULTS: Mean age at the time of balloon angioplasty was 4.3 +/- 3.3 months (range 0.7-12 months) and the mean body weight was 5.5 +/- 1.7 kg (range 2.6-10 kg). Initial result after BA was successful in 30 of 35 patients (85.8%) with a peak residual pressure gradient < or = 20 mm Hg. Successful result were obtained in 15 of 19 patients in group A (78.9%) and in 15 of 16 patients in group B (93.8%). The mean peak residual pressure gradient change from 46.9 +/- 20.3 mm Hg to 11.6 +/- 8.1 mmHg (p < 0.001) and the maximal coarctation diameter increase from 3.0 +/- 1.6 mm to 6.0 +/- 1.8 mm after BA in the group total. We did not observe deaths related to the procedure. On the follow-up recoarctation was observed in 17/35 patients (48.6%) 13 of them in group A (68.4%) and 4 in group B (25%). Ten patients with recoarctation underwent immediate surgical correction (9 in group A) while the other 7 underwent a second BA procedure (4 in group A). At the end of the study period AB was effective in 23 of 35 patients (65.7%), 9 of them in group A (47.3%) and 14 in group B (87.5%). The incidence of complications following BA was higher in group A (21%) than for group B (12.5%). Incidence of aneurysms was 15.8% for group A and 18.8% for group B (3 patients in each group). CONCLUSIONS: Balloon angioplasty is a safe and effective alternative treatment for native aortic coarctation, even during the neonatal period. Due to the high incidence of aneurysm formation in children less than 1 year of age, a better selection of patients, the use of low-profile balloons and optimal postoperative care is mandatory to improve the final outcome and decrease the incidence of complications. A second balloon angioplasty procedure might improve the final outcome.

[Risk factors for birth injuries]. / Factores de riesgo asociados a traumatismo al nacimiento.

OBJECTIVE: To identify risk factors associated with birth trauma. SETTING: Servicio de Neonatología, Hospital General "Dr. Manuel Gea González", Secretaría de Salud. DESIGN: Case-control, prolective study. PATIENTS: There were 129 cases and 134 controls. MEASURES: We recorded the following variables: a) maternal and delivery: age, weight, height, prenatal care, pre-existing disease or gestational disease, mode of delivery, anesthetic management during labor, use of external maneuvers or forceps; b) newborn: birth weight, gestational age, academic degree of attendant physician at delivery, and type of birth injury. RESULTS: The independent risk factors associated to birth injury were: for ecchymoses; general anesthesia (OR 13.7, 95% CI = 3 - 62.6), breech presentation (OR 6.4, 95% IC 95% = 1.4 - 27.9) and gestational age < or = 32 weeks (OR 6.4, 95% CI = 1.3 - 31.1); for lacerations, vaginal dystocic delivery or cesarean section (OR 19, 95% CI = 4.4 - 81.1) and use of external maneuvers (OR 5.6, 95% CI = 1.5 - 21.6); for cephalhematoma maternal height < or = 1.54 m (OR 7.4, 95% CI = 2.3 - 23.7) and external maneuvers (OR 7.2, 95% CI = 2.3 - 23.7); for caput succedaneum, external maneuvers (OR 3.4, 95% CI = 1.5-7.7) and maternal age < or = 19 or > or = 36 years (OR 3.0, 95% CI = 1.4 - 6.4). CONCLUSIONS: Risk factors associated with birth injuries identified in this study involved maternal conditions, neonatal conditions and mechanism of delivery.