Neonatal hypotension survey: a South African perspective

Background. Neonatal hypotension remains one of the most controversial topics in neonatology. Various definitions are used but lack an evidence base. Owing to the variation in defining a low blood pressure (BP), significant differences in pharmacological manipulation of BP are evident. Objectives. The aim of the present research was to determine (1) the diagnostic criteria for neonatal hypotension and (2) management strategies for neonatal hypotension in South Africa. Methods. A 29-point questionnaire was designed to determine the criteria used by South African neonatologists and paediatricians to diagnose and manage neonatal hypotension. The survey was conducted at two different time points in 2017. Results. The combination of the two surveys resulted in a 9.3% (47/507) response rate. A BP below the gestational age (in weeks) was the most common definition used for neonatal hypotension (75%). Most clinicians (86%) administered fluid prior to initiating inotrope therapy. Dopamine, dobutamine and adrenaline were the most common first-, second- and third-line anti-hypotensive drugs used. Most clinicians (77%) did not use a hypotension management guideline. Conclusion. Neonatal hypotension definition and management in South Africa are similar to international patterns, despite a lack of evidence to support the diagnosis and management strategies

Rol de la scintigrafía renal 99m TC-DMSA en el diagnóstico de localización y evolución de la infección urinaria en niños / Renal scintigraphy TC99M-DMSA diagnosis of localization and evaluate urinary infection in children

Cincuenta y un niños en quienes presentando los criterios clásicos clínicos y biológicos fueron diagnosticados un primer episodio de Infección Urinaria Complicada (Pielonefritis aguda). Se realizaron una ecografia renal y una scintigrafia renal 99m TC-DMSA dentro de las 24 horas seguidas a su admisión. Una uretrocistografía miccional y un control de la 99m TC-DMSA fueron realizadas después del episodio agudo. Defectos corticales renales en 47 exámenes (92,2 por ciento) fueron detectados con 99m TC-DMSA y en 28 (55 por ciento) a la ecografía. La scintigrafía renal 99m TC-DMSA es entre todas las técnicas de imagenería para evaluar el tracto urinario superior; la que más ayuda en la localización de la infección urinaria y en la identificación de niños susceptibles de desarrollar cicatrices renales.