Implementation of a neonatal donation protocol in the neonatal intensive care unit: A single-center experience.

BACKGROUND: Lack of specific protocols for neonatal donation contributes to the rarity of neonatal donors. In this study, we evaluate the impact of the implementation of a neonatal donation protocol in our NICU. METHODS: In this single-center study, we conducted a retrospective chart review of neonatal deaths in our NICU from January 2013 to January 2022. The study was divided into two periods: before and after the implementation of a neonatal donation protocol. The referral rates of potential neonatal donors to the OPO in the two periods were compared using the chi-square test. A p value < .05 was considered statistically significant. RESULTS: Sixty-four infants were reviewed. Seven (10.9%) met the inclusion criteria for potential neonatal donors after DCC. The referral rate of potential neonatal donors increased from 2.5% to 16.7% after the implementation of this protocol (p = .041), and one infant (4.1%) became an effective heart-valve donor. CONCLUSION: The implementation of a local neonatal donation protocol could have contributed to increase the referral rate of potential neonatal donors in our NICU. Following the implementation of a local neonatal donation protocol, we were able to perform a heart-valve donation for the first time in our unit.

Religion, Spirituality and Folk Medicine/Superstition in a Neonatal Unit.

Beliefs and practices surrounding religion and spirituality (RS) feature in neonatal units, although healthcare professionals and families hold different views on their role in neonatal care. Descriptive study performed at the Neonatology Unit of Santa Lucía University Hospital, Cartagena. Separate forms concerning spirituality, religion and folk medicine were administered to professionals ascribed to the unit (n = 70) and parents (n = 93). 70% of professionals and 60.2% of parents perceive RS as playing a relevant role in neonatal care; however, 45% of professionals prefer that parents do not express their RS beliefs. Actual use of prayer by parents while in the unit was 55.9%, compared to the staff's estimation of 20.8% (p < 0.001); parents believe that RS affects outcomes indirectly, mediating through caregivers, contrary to the staff perception that parents turn to RS for a direct effect on outcomes (p < 0.001); professionals, unlike parents, found RS to be of little benefit to children (p < 0.001) or in reducing parental anxiety (p < 0.001). Amulets were found alongside 26.6% of children. Up to 40% of parents believe in magic concepts such as evil eye. Many families express RS while a member is hospitalized and, while staff recognize its importance, they often fail to respond correctly. The use of amulets and ritual objects is still common and can express the need for emotional and psychological support. Caregivers need to be aware of the medical, psychological and emotional implications of these practices.

[Need for resuscitation in preterm neonates less than 32 weeks treated with antenatal magnesium sulphate for neuroprotection]. / Necesidad de reanimación en prematuros menores de 32 semanas expuestos a sulfato de magnesio para neuroprotección fetal.

INTRODUCTION: Magnesium sulphate administration is recommended for foetal neuroprotection in pregnant women at imminent risk of early preterm birth. OBJECTIVE: To evaluate the relationship between intrapartum magnesium sulphate for foetal neuroprotection and delivery room resuscitation of preterm infants less 32 weeks. PATIENTS AND METHOD: A prospective observational study was conducted on preterm infants less 32 weeks exposed to magnesium sulphate for neuroprotection, and a comparison made with another historic group immediately before starting this treatment. Cases in both groups that had not reached lung maturity with corticosteroids were rejected. The rates of resuscitation, morbidity and mortality for each of the groups were analysed and compared. RESULTS: There was a total of 107 preterm, with 56 exposed to magnesium sulphate. Rate of advanced resuscitation were similar between the two groups. There were no other differences in mortality, invasive mechanical ventilation, time to first stool, and other comorbidities. CONCLUSIONS: Intrapartum magnesium sulphate for foetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation and other morbidities in these cohorts of less than 32 weeks preterm infants.

Silver Russell syndrome in a preterm girl with 8q12.1 deletion encompassing PLAG1.

Silver Russell syndrome (SRS) is a congenital disorder characterized by intrauterine growth retardation (IUGR), feeding difficulties and postnatal growth retardation. In a small number of cases, PLAG1 variants have been described (OMIM #618907). PLAG1 haploinsufficiency decreases Insulin-like growth factor 2 expression and produces a Silver Russell syndrome-like phenotype. Here, we describe the phenotype and molecular features of a 26 months girl with clinical features of SRS, and a de novo 2.1 Mb deletion encompassing PLAG1 is reported in association with clinical features suggestive of SRS.

[Five steps to decreasing nosocomial infections in large immature premature infants: A quasi-experimental study]. / Cinco pasos para la disminución de las infecciones relacionadas con la asistencia sanitaria en prematuros grandes inmaduros. Estudio cuasiexperimental.

OBJECTIVES: An evaluation is made of the impact of a series of five interventions on the incidence of hospital-related infections in a level iii neonatal unit. MATERIAL AND METHODS: Quasi-experimental, pre-post intervention study, which included preterm infants weighing 1,500g at birth or delivered at <32 weeks gestation, admitted in the 12 months before and after the measures were implemented (January 2014). The measures consisted of: optimising hand washing, following a protocol for insertion and handling of central intravenous catheters, encouraging breastfeeding; applying a protocol for rational antibiotic use, and establishing a surveillance system for multi-resistant bacteria. The primary endpoint was to assess the incidence of hospital-acquired infections before and after implementing the interventions. RESULTS: Thirty-three matched patients were included in each period. There was an incidence of 8.7 and 2.7 hospital-related infections/1,000 hospital stay days in the pre- and post-intervention periods, respectively (P<.05). Additionally, patients in the treatment group showed a statistically-significant decrease in days on mechanical ventilation, use of blood products, and vasoactive drugs. CONCLUSIONS: The strategy, based on implementing five specific measures in a unit with a high rate of hospital-related infections, proved effective in reducing their incidence. This reduction could contribute to lowering the use of mechanical ventilation, blood products, and vasoactive drugs.

[Catheter tip position and risk of mechanical complications in a neonatal unit]. / Complicaciones mecánicas asociadas a la localización de la punta de catéteres centrales en una unidad neonatal.

INTRODUCTION: The use of central catheters (CC) is associated with mechanical complications (MC). OBJECTIVE: Our objetive was to determine the relationship between CC positions and associated MC in neonates. MATERIAL: A descriptive analytical study was performed over a six year period in the NICU of the University Hospital Santa Lucía de Cartagena. Details were collected on the CC used, indication, reason for withdrawal, position in the imaging, MC, and treatment arising from them, as well as epidemiological data. RESULTS: Of the total of 604 CC studied, the majority (347) were via the umbilical vein, followed by epicutaneous (193), and femoral vein (34). There were MC in 14.2% of catheters. Incorrect position of the tip was associated with greater MC (21.1 vs 8.2%; P<.001), including withdrawal due to MC (8.4 vs 3.1%; P<.01), extravasation (4.9 vs 1.9%; P<.05), pleural and pericardial effusions (1.4 vs 0.0%; P<.05), liver haematomas (4.6 vs 0.6%; P<.01), and ascites (2.8 vs 0.0%; P<.01). The midclavicular epicutaneous position of the tip was associated with greater MC (18.5 vs 6.8%; P<.05) than the brachiocephalic (0 vs 6.8%;NS). The low and ductal position of the umbilical vein catheter was also associated with higher rates of MC (24.5 vs 6%; P<.001 and 27 vs 6%; P<.001) due to the position of the tip. The most common complication was accidentally dislodged catheter. CONCLUSIONS: The incorrect location of the tip was associated with more MC. The midclavicular epicutaneous had more risk than centrally or brachiocephalic locations. The low and ductal positions of the umbilical vein catheter were associated with higher rates of MC.

Perinatal outcome of macrosomic infants born to diabetic versus non-diabetic mothers. / Resultados perinatales entre macrosomas hijos de madre diabética y macrosomas hijos de madre no diabética.

OBJECTIVE: To assess the incidence and perinatal complications of macrosomic infants born to diabetic and non-diabetic mothers. PATIENTS AND METHODS: A six-year retrospective study of newborns at our hospital. A total of 996 macrosomic newborns were found. Maternal characteristics, mode of delivery, and perinatal outcomes were studied. RESULTS: Of 18005 newborns, 996 were macrosomic infants (5.53%). Of these, 103 (10.3%) were born to diabetic mothers. Diabetic mothers had higher parity (1.89 vs. 1.35; P<0.000), cesarean section rate (52.4 vs. 31.1%; P<0.05), and resuscitation rate (5.8 vs. 1.8%; P<0.006; RR: 2.9; 95% CI: 1.42-5.9), and greater need for hospitalization (19.4 vs. 9.6%; p<0.002; RR: 2; 95% CI: 1.3-3.2) and intensive care (5.8 vs. 0.7%; P<0.000; RR: 5.3; 95% CI: 2.8-10) mostly for hypoglycemia (7.8 vs. 1%; P<0.000; RR: 5; 95% CI: 2.8-8.3), jaundice (8.7 vs. 2.1%; P<0.000; RR: 3.1; 95% CI: 1.9-5.9), respiratory distress (4.9 vs. 1.3%; P<0.009; RR: 2.9; 95% CI: 1.4-6.7), and asphyxia (2.9 vs. 0.4%; P<0.005; RR: 4.3; 95% CI: 1.8-11.1). No differences were found in birth trauma. CONCLUSIONS: Macrosomic infants born to diabetic mothers have an increased risk of hospital admission in the neonatal period for hypoglycemia, jaundice, respiratory distress, and asphyxia, and a greater need of intensive care. Obstetric trauma rates were similar in both groups.

Necesidad de reanimación en prematuros menores de 32 semanas expuestos a sulfato de magnesio para neuroprotección fetal / Need for resuscitation in preterm neonates less than 32 weeks treated with antenatal magnesium sulphate for neuroprotection

Introducción: El empleo de sulfato de magnesio para neuroprotección fetal es un tratamiento cada vez más frecuente. Objetivo: Estudiar la asociación entre sulfato de magnesio administrado a la gestante y la necesidad de reanimación neonatal. Pacientes y método: Estudio prospectivo de un grupo de prematuros menores de 32 semanas expuestos al sulfato de magnesio como neuroprotector y otro grupo retrospectivo inmediatamente anterior al inicio de este tratamiento. En ambos grupos se descartaron los casos que no habían recibido maduración pulmonar con corticoides. Se analizaron y compararon el porcentaje de reanimación y diferentes comorbilidades. Resultados: Se incluyó a 107 prematuros, 56 expuestos al sulfato de magnesio. El porcentaje de reanimación avanzada fue similar en ambos grupos. No se encontraron diferencias en mortalidad, ventilación mecánica invasiva, tiempo de la primera deposición y otras comorbilidades. Conclusiones: El sulfato de magnesio para neuroprotección no aumenta de forma significativa la necesidad de reanimación de los prematuros menores de 32 semanas.

Introduction: Magnesium sulphate administration is recommended for foetal neuroprotection in pregnant women at imminent risk of early preterm birth. Objective: To evaluate the relationship between intrapartum magnesium sulphate for foetal neuroprotection and delivery room resuscitation of preterm infants less 32 weeks. Patients and method: A prospective observational study was conducted on preterm infants less 32 weeks exposed to magnesium sulphate for neuroprotection, and a comparison made with another historic group immediately before starting this treatment. Cases in both groups that had not reached lung maturity with corticosteroids were rejected. The rates of resuscitation, morbidity and mortality for each of the groups were analysed and compared. Results: There was a total of 107 preterm, with 56 exposed to magnesium sulphate. Rate of advanced resuscitation were similar between the two groups. There were no other differences in mortality, invasive mechanical ventilation, time to first stool, and other comorbidities. Conclusions: Intrapartum magnesium sulphate for foetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation and other morbidities in these cohorts of less than 32 weeks preterm infants.