Apnea or cyanosis as COVID-19 initial presentation in newborns.

INTRODUCTION: The clinical manifestation of coronavirus disease 2019 (COVID-19) infection in newborns varies from asymptomatic infection to severe illness. Apnea or cyanosis as the earliest symptoms is rarely mentioned. The aim of this study is to describe the characteristics of newborns with COVID-19 infection admitted to the neonatal intensive care unit considering cyanosis or apnea as a form of presentation. METHODOLOGY: This is a descriptive observational study with retrospectively collected data. All neonates under 30 days old and preterm infants with corrected gestational age of 44 weeks who had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with a positive antigen or reverse transcriptase polymerase chain reaction (RT-PCR) test and who were attended to between March 2020 and March 2022 were included. RESULTS: During the two years of the study, 410 patients were admitted to the neonatal unit. Twenty-six patients (6.3%) presented with confirmed SARS-CoV-2 infection. The main clinical characteristic at admission was apnea in 55% and cyanosis in 45%. Of the 11 patients admitted with this presentation, eight were diagnosed with COVID-19 acute upper respiratory disease, and three met the definition of COVID-19 bronchiolitis. A large proportion of the patients had a mild infection (65%, n = 17), 31% (n = 8) had a severe infection and only one patient had a critical infection, accounting for 4%. CONCLUSIONS: Apnea and cyanosis can be a manifestation of SARS-CoV-2 infection in newborns, which suggests the need to include it in the diagnostic workup as other viral respiratory infections.

Miedo a la muerte y a su proceso en personal de Pediatría durante la pandemia por COVID-19

Introducción: La evidencia obtenida en estudios previos señala que existe mayor ansiedad por el proceso de morir que, por la muerte misma, aunque falta mayor investigación. Objetivo: Analizar el miedo a la muerte y al proceso de morir propio y de otros en el servicio de Pediatría del Hospital Pablo Tobón Uribe. Metodología: Se realizó un estudio analítico transversal con la Escala de Miedo a la Muerte de Collett-Lester en 143 personas: 25,2 % pediatras generales y subespecialistas, 70,6 % profesionales de Enfermería y auxiliares, y 4,2 % terapeutas respiratorios. El análisis incluyó estadística descriptiva, pruebas de Chi2, U de Mann-Whitney, Fisher, T de Student, ANOVA y el Alfa de Cronbach. Resultados: los hallazgos del estudio sugieren que es menor el miedo a la propia muerte que el miedo a la muerte de otros, y no hay diferencia entre el miedo al proceso de morir propio y de otros. Es mayor el miedo a la muerte en enfermeras profesionales y menor en pediatras subespecialistas. Existe mayor miedo a la muerte en el servicio de UCI-UCE (media: 3,53 DS: 0,88) comparado con Urgencias (media: 2,66 DS: 0,59). Hay asociación entre el miedo a la muerte con: el sexo femenino (p = 0,000), tener una creencia religiosa (p = 0,048), y el cargo (p = 0,007). La escala tuvo muy alta fiabilidad (Alfa de Cronbach: 0,95). Discusión: es de aclarar que este estudio fue realizado durante el segundo año de la pandemia del COVID-19, cuando había menor temor, mayor conocimiento y vacunas, cuyos resultados se corresponden con otros estudios. Conclusión: en el presente estudio el mayor miedo a la muerte se asoció con ser mujer, tener creencia religiosa y laborar en UCI-UCE comparado con Urgencias.

Introduction: The evidence obtained from previous research suggests that there is more anxiety related to dying compared with death. Nevertheless, more research is needed. Objective: To analyze the fear of death and dying, oneself and others, in the pediatric service personnel at Pablo Tobón Uribe Hospital in Medellín. Methodology: This was a transversal analytic study to apply the Collett-Lester Fear of Death Scale on 143 people: 25,2 % were general pediatricians and subspecialists, 70,6 % were professional nurses and medical assistants, and 4,2 % were respiratory therapists. The analysis included descriptive statistics, Chi2 test, Mann-Whitney U test, Fisher, StudentsT, ANOVA and Cronbach's Alpha. Results: Here we report the mean of one's fear of death is lower than the fear of others' death. There is no difference when comparing the fear of one's process of dying mean, rather than when it's others. Fear of death is higher in professional nurses and lower in pediatric subspecialists. The study shows higher fear of death in the ICU-IMC services (mean: 3,53 SD: 0,88) compared with the emergency room (mean:2,66 SD: 0,59). There is a statistical association between fear of death and being a woman (p=0,000), having a religious belief (p=0,048) and job position (p=0,007). The scale has a high internal consistency (Cronbach's Alpha: 0,95). Discussion: It is important to mention that this research was conducted during the second year of the COVID-19 pandemic, when the fear had decreased, and with more knowledge and the vaccines were ready, the results are coherent with other papers. Conclusion: In this study the higher fear of death was associated with being a woman, having a religious belief and working in ICU-IMC compared to the emergency room.

Atención centrada en el paciente y la familia en la Unidad de Cuidado Intensivo Pediátrico del hospital Pablo Tobón Uribe, sistematización de la experiencia / Patient and Family-Focused Care in the Pediatric Intensive Care Unit of the Pablo Tobon Uribe Hospital. Systematization of the Experience / Atendimento focado no paciente e a família na Unidade de Terapia Intensiva Pediátrica do hospital Pablo Tobón Uribe, sistematizado da experiencia

Resumen Ante las frías relaciones que se suelen establecer en las unidades de cuidado intensivo pediátricas (UCIP), entre el personal de salud y las familias de los menores internados, algunos médicos del hospital Pablo Tobón Uribe, al buscar mejorar la comunicación, desarrollaron una estrategia que propició el diálogo y la escucha asertiva, luego de poner en práctica el modelo de "Atención Centrada en el Paciente y la Familia". La metodología de sistematización de experiencias permitió un análisis reflexivo de los testimonios recogidos en los múltiples encuentros entre personal de salud y 820 familiares. Los resultados, en términos de aprendizajes, permitieron evidenciar una atención integral que involucró a la familia como sujeto de cuidado, concienció sobre la repercusión psicológica que implica la experiencia de permanencia en la UCIP y estimuló una reflexión crítica del equipo de salud en la atención ofrecida a las familias de los pacientes en la práctica clínica diaria.

Abstract Faced with the usual cold relationships established in the pediatric intensive care units (PICU) between the health personnel and the families of hospitalized children, some physicians of the Pablo Tobon Uribe hospital, aiming for an improvement in the communication, developed a strategy that promoted assertive dialogue and listening, after implementing a "Patient and Family-Focused Care" model. The experience systematization methodology allowed for a reflective analysis of the testimonials collected during the multiple encounters between the health personnel and 820 relatives. Results, in terms of learning, evidence an integral attention involving the family as the subject of care, raising awareness on the psychological repercussions implied by the experience of staying in the PICU, and encouraged a critical reflection from the health personnel regarding the attention offered to the families of the patients during the daily clinical practice.

Resumo Perante os frios relacionamentos geralmente estabelecidos nas unidades de terapia intensiva pediátrica (UTIP), entre profissionais de saúde e as famílias das crianças intemas, alguns médicos do hospital Pablo Tobón Uribe, em procura de melhorar a comunicação, desenvolveram uma estratégia que propiciou o diálogo e escuta assertiva, uma vez eles puseram em prática o modelo de "Atendimento Focado no Paciente e a Família". A metodologia de sistematização de experiências permitiu uma análise reflexiva dos depoimentos coletados nos múltiplos encontros entre profissionais de saúde e 820 familiares. Os resultados, em termos de aprendizagem, permitiram evidenciar um atendimento integral que envolveu a família como sujeito de cuidado, conscientizou sobre a repercussão psicológica que a experiência de permanência na UCIP traz e estimulou uma reflexão crítica da equipe de saúde no atendimento oferecido às famílias dos pacientes na prática clínica diária.