Establishment of a nomogram model for predicting necrotizing enterocolitis in very preterm infants / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors for necrotizing enterocolitis (NEC) in very preterm infants and establish a nomogram model for predicting the risk of NEC.@*METHODS@#A total of 752 very preterm infants who were hospitalized from January 2015 to December 2021 were enrolled as subjects, among whom 654 were born in 2015-2020 (development set) and 98 were born in 2021 (validation set). According to the presence or absence of NEC, the development set was divided into two groups: NEC (n=77) and non-NEC (n=577). A multivariate logistic regression analysis was used to investigate the independent risk factors for NEC in very preterm infants. R software was used to plot the nomogram model. The nomogram model was then validated by the data of the validation set. The receiver operating characteristic (ROC) curve, the Hosmer-Lemeshow goodness-of-fit test, and the calibration curve were used to evaluate the performance of the nomogram model, and the clinical decision curve was used to assess the clinical practicability of the model.@*RESULTS@#The multivariate logistic regression analysis showed that neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding were independent risk factors for NEC in very preterm infants (P<0.05). The ROC curve of the development set had an area under the curve (AUC) of 0.833 (95%CI: 0.715-0.952), and the ROC curve of the validation set had an AUC of 0.826 (95%CI: 0.797-0.862), suggesting that the nomogram model had a good discriminatory ability. The calibration curve analysis and the Hosmer-Lemeshow goodness-of-fit test showed good accuracy and consistency between the predicted value of the model and the actual value.@*CONCLUSIONS@#Neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding are independent risk factors for NEC in very preterm infant. The nomogram model based on the multivariate logistic regression analysis provides a quantitative, simple, and intuitive tool for early assessment of the development of NEC in very preterm infants in clinical practice.

Effects of terlipressin and naloxone compared with epinephrine in a rat model of asphyxia-induced cardiac arrest

OBJECTIVE: To evaluate the hemodynamic and metabolic effects of terlipressin and naloxone in cardiac arrest. METHODS: Cardiac arrest in rats was induced by asphyxia and maintained for 3.5 minutes. Animals were then resuscitated and randomized into one of six groups: placebo (n = 7), epinephrine (0.02 mg/kg; n = 7), naloxone (1 mg/kg; n = 7) or terlipressin, of which three different doses were tested: 50 µg/kg (TP50; n = 7), 100 µg/kg (TP100; n = 7) and 150 µg/kg (TP150; n = 7). Hemodynamic variables were measured at baseline and at 10 (T10), 20 (T20), 30 (T30), 45 (T45) and 60 (T60) minutes after cardiac arrest. Arterial blood samples were collected at T10, T30 and T60. RESULTS: The mean arterial pressure values in the TP50 group were higher than those in the epinephrine group at T10 (165 vs. 112 mmHg), T20 (160 vs. 82 mmHg), T30 (143 vs. 66 mmHg), T45 (119 vs. 67 mmHg) and T60 (96 vs. 66.8 mmHg). The blood lactate level was lower in the naloxone group than in the epinephrine group at T10 (5.15 vs. 10.5 mmol/L), T30 (2.57 vs. 5.24 mmol/L) and T60 (2.1 vs. 4.1 mmol/L). CONCLUSIONS: In this rat model of asphyxia-induced cardiac arrest, terlipressin and naloxone were effective vasopressors in cardiopulmonary resuscitation and presented better metabolic profiles than epinephrine. Terlipressin provided better hemodynamic stability than epinephrine. .

El juego de la asfixia en la adolescencia: entre la experimentación y el riesgo / The choking game in adolescence, between experimentation and risk

En el último año ha tenido lugar una serie de muertes de adolescentes en Salta que podrían estar relacionadas con un peligrosojuego llamado “juego de la asfixia”. Se lo practica desde hace muchos años en varios países del mundo y consiste en provocar hipoxia cerebral por algunos segundos, mediante diferentes técnicas, para obtener un instante de éxtasis y placer.Consideramos relevante que el equipo de salud conozca esta práctica y pueda identificar, a través de signos y íntomas, cuando un adolescente pueda estar jugando al juego de la asfixia.

Risk factors and outcomes for retinopathy of prematurity in neonatal infants with a birth weight of 1,501-2,000 g in a Chinese Neonatal Unit

To determine the risk factors and outcomes of retinopathy of prematurity [rop] in infants with a birth weight of 1,501-2,000 g. Materials and methods: clinical characteristics and risk factors were compared and nonconditional logistic regression analysis was performed to determine independent predictors for rop. There were 54 [9.8%] cases of rop in 553 patients with a birth weight of 1,501-2,000 g. The most common classification of rop was in stage 1 [50/54, 92.6%; stages 2 and 3 rop: 2 infants each]. By logistic regression analysis, the following factors independently predicted rop: gestational age at birth

Bilateral Retrobulbar Hemorrhage and Visual Loss Following Traumatic Asphyxia

Retrobulbar hemorrhage and permanent visual loss are rare presentations following traumatic asphyxia. In this case, bilateral permanent visual disturbance developed in a woman after chest-crushing trauma without direct trauma to the orbits. A computed tomography scan confirmed bilateral retrobulbar hemorrhages. An ophthalmologic exam revealed bilateral subconjunctival hemorrhages and severe lid edema. Despite high-dose steroid therapy, visual recovery was limited, and optic nerve atrophy developed. Ischemia of the optic nerve associated with retrobulbar hemorrhage may be postulated as one of the causes of permanent visual impairment following traumatic asphyxia.

Associação entre dois diferentes tipos de estrangulamento com a variação da pressão intraocular em atletas de jiu-jitsu / Association between two different types of strangling and intraocular pressure variation in jiu-jitsu athletes

OBJETIVO: Verificar a associação entre dois diferentes tipos de estrangulamento com a variação da pressão intraocular em atletas de jiu-jitsu. MÉTODO: Estudo observacional em grupo de 9 atletas de jiu-jitsu, com mínimo 6 meses de treinamento, sexo masculino, idades entre 20 e 30 anos, sem presença de lesões físicas e do bulbo ocular. Buscou-se associação entre a variação da pressão intraocular e os estrangulamentos Frontal da Guarda (E1) e Frontal da Montada (E2). A pressão intraocular foi determinada com o tonômetro de Perkins, inicialmente sem que o atleta tivesse realizado atividade física nas 24 horas antecedentes e após cada golpe. Realizou-se medidas da pressão intraocular por 12 minutos, uma a cada 3 minutos de recuperação (R1; R2; R3; R4), com o indivíduo deitado. Como procedimento estatístico foi empregado o teste ANOVA e o pós-teste de Bonferroni. RESULTADOS: Ocorreu redução significativa da pressão intraocular em ambos os olhos durante a situação E2 comparada a E1 em todos os momentos da aferição de recuperação: R1 (OD: 8,22 ± 1,39 vs.11,33 ± 2,00 / OE: 8,55 ± 1,23 vs. 11,88 ± 1,90), R2 (OD: 8,44 ± 1,87 vs.10,22 ± 2,53 / OE: 9,00 ± 1,80 vs. 10,44 ± 2,35), R3 (OD: 8,44 ± 1,74 vs.9,78 ± 2,54 / OE: 8,55 + 1,42 vs. 10,33 ± 1,93) todos com p<0,01 e R4 (OD: 8,88 ± 2,08 vs.9,55 ± 2,87 / OE: 9,11 ± 1,53 vs. 10,44 ± 2,18) com p<0,05. A redução da PIO foi significativamente maior (p < 0,05) no E2 no momento R1 (OD: 10,77 ± 1,92 vs.8,22 ± 1,39 / OE: 11,44 ± 1,94 vs. 8,55 ± 1,23). CONCLUSÃO: Houve associação entre a pressão intraocular e o estrangulamento no jiu-jitsu, com redução desta.

PURPOSE: To verify the association between two different types of strangling with intraocular pressure variation in jiu-jitsu athletes. METHODS: An observational study was performed on 9 athletes of jiu-jitsu, with at least 6 month of training, male, aged 20 to 30 years, without any physical and eyeball lesions. Associations between intraocular pressure and Cross Choke from the guard strangling (E1), and E2 - Cross Choke from mount strangling were gotten. Intraocular pressure was determined by using Perkins tonometer, at first in the absence of physical exercise over the last 24 hours and after each strangling. Then it was carried out the intraocular pressure measure at each 3 minutes, during 12 minutes of exercise recovery (R1, R2, R3, and R4) keeping the athletes lied down. Statistical analysis was done using ANOVA test and Bonferroni post-test. RESULTS: Meaningful reduction of both eyes intraocular pressure occurred at the E2 situation comparing to the E1 situation at all exercise recovery measures: R1 (OD: 8.22 ± 1.39 vs.11.33 ± 2.00 / OE: 8.55 ± 1.23 vs. 11.88 ± 1.90), R2 (OD: 8.44 ± 1.87 vs.10.22 ± 2.53 / OE: 9.00 ± 1.80 vs. 10.44 ± 2.35), R3 (OD: 8.44 ± 1.74 vs.9.78 ± 2.54 / OE: 8.55 ± 1.42 vs. 10.33 ± 1.93) all with p<0,01 e R4 (OD: 8.88 ± 2.08 vs.9.55 ± 2.87 / OE: 9.11 ± 1.53 vs. 10.44 ± 2.18) with p<0.05. Meaningful IOP reduction (p<0.05) was observed at the R1 moment of E2 strangling (OD: 10.77 ± 1.92 vs.8.22 ± 1.39 / OE: 11.44 ± 1.94 vs. 8.55 ± 1.23). CONCLUSION: There is association between intraocular pressure and jiu-jitsu strangling exercises, with intraocular pressure reduction.

Ahogamiento incompleto, valoración de la injuria cerebral al ingreso: terapia intensiva pediátrica / Nearly drowning, valuation of the cerebral injury when entering the hospital: intensive pediatric therapy

Se realizó una investigación descriptiva retrospectiva que incluyó a todos los pacientes que fueron ingresados en el Servicio de Terapia Intensiva del Hospital Eliseo Noel Caamaño, en el período comprendido desde junio de 1982 hasta junio de 2004, con el diagnóstico de Ahogamiento Incompleto, con el propósito de determinar el estado neurológico y su relación con diferentes variables que pueden haber influido en la intensidad del daño, así como la sobrevivencia final de los mismos. Los resultados obtenidos nos permitieron conocer el manejo del paciente pediátrico que ha sufrido este tipo de accidentes, así como su estado a la llegada al Servicio. El 68 por ciento de los pacientes tuvieron una afección de moderada a severa según las escalas de Conn y Glasgow, además existió una correlación de hasta un 97 por ciento entre dichos métodos de evaluación. Dentro de las variables que influenciaron en el estado de los niños al ingreso se destacó un tiempo de inmersión mayor de 5 minutos para los clasificados como severos, 70 por ciento de la muestra, fallecieron el 7 por ciento de todos los pacientes estudiados, todos ellos clasificados como severos.

We carried out a descriptive retrospective study including all the patients that were entered in the Service of Intensive Therapy of the hospital Eliseo Noel Caamaño, in the period from June 1982 to June 2004, with the diagnosis of nearly drowning, with the purpose of determining the neurological state and its relation with different variables that might have influence in the intensity of the damage, as well as in the final surviving of the patients. The obtained results allowed us knowing the managing of the paediatrics patient that have suffered this kind of accidents, as well as their state at the arrival to the service; 68 percent of the patients had a moderated to severe affection according to the Conn and Glasgow scales; moreover, there was a correlation of up to 97 percent between these evaluation methods. Among the variables that influenced in the state of the children at the entering, there was an immersion time of more than 5 minutes for those classified as severe, 70 percent of the sample; 7 percent of all the studied patients died, all of them classified as severe.

Post obstructive pulmonary edema in a child who attempted suicidal hanging.

Postobstructive pulmonary edema occurs rarely in children. We describe here a child who attempted suicide by hanging and developed postobstructive pulmonary edema and was successfully managed. There was a rapid response to management with morphine and supportive care, enabling extubation by 30 hours of ventilatory support. The case highlights an unusual cause of postobstructive pulmonary edema.

Compensatory rebound of body movements during sleep, after asphyxia in neonatal rats / Resposta compensatória dos movimentos corporais do sono após a asfixia em ratos recém-nascidos

PURPOSE: The usefulness of body movements that occur during sleep when assessing perinatal asphyxia and predicting its long-term consequences is contradictory. This study investigated whether neonatal rats manifest these movements in compensatory rebound after asphyxia, and if these alterations play an important role in its pathogenesis. METHODS: Eight neonatal rats (aged 6-48h) were implanted with small EMG and EKG electrodes and sleep movements were recorded over a 30-minute control period. Recordings were continued during asphyxia caused by the enclosure of the animal in a polyvinyl sheet for 60 minutes, followed by a 30-minute recovery period. RESULTS: Heart rate was lowered to bradycardic level during asphyxia causing behavioral agitation and increased waking time during the initial phase (30 minutes). Sleep-related movements were also significantly reduced from 12.5 ± 0.5 (median ± SE/2min) to 9.0 ± 0.44 in the final half of the period (Anova, p<0.05). Movement frequency increased in the recovery period to 15.0 ± 0.49 (Anova, p<0.05). CONCLUSION: These data show that newborn rats present compensatory rebound of body movements during sleep which may help in the diagnosis of asphyxia and other problems related to sleep parameters.

OBJETIVO: A utilidade dos movimentos corporais (MC) que ocorrem durante o sono para diagnosticar e predizer as conseqüências, em longo prazo, da asfixia perinatal é contraditório. Este estudo investigou se ratos recém-nascidos (RN) manifestam MC em resposta compensatória à asfixia, e se estas alterações podem ter alguma importância na sua patogênese. MÉTODOS: Oito ratos RN (6-48h de vida) foram submetidos à implantação de pequenos eletrodos para registros da eletromiografia e eletrocardiografia. Os MC e a freqüência cardíaca (FC) foram registrados durante períodos de 30 min: fase controle (F1), fases de asfixia (F2; F3) e fase de recuperação pós-asfixia (F4). A asfixia foi promovida pelo envolvimento completo do animal com uma lâmina de polivinil. RESULTADOS: A FC diminuiu progressivamente durante F2 e F3 até a bradicardia. Em F2 houve grande agitação dos animais e aumento dos períodos de vigília. Em F3 houve redução significante dos MC de 12,5 ± 0,5 (Md ± SE/2min) para 9,0 ± 0,44 (P<0,05). A freqüência dos MC aumentou em F4 para 15,0 ± 0,49. CONCLUSÃO: Estes dados mostram que ratos RN com asfixia apresentam MC compensatórios durante o sono que podem ajudar no diagnóstico desta afecção e de outros problemas relacionados aos parâmetros do sono.

Causas de óbitos entre asmáticos graves admitidos no Programa de Controle da Asma e da Rinite Alérgica na Bahia / Causes of death in asthma patients enrolled in the Bahia State Program for the Control of Asthma and Allergic Rhinitis

OBJETIVO: Descrever características demográficas e clínicas de asmáticos que apresentaram como desfecho a morte e relatar as condições que concorreram para o óbito entre admitidos no Programa de Controle da Asma e da Rinite Alérgica na Bahia (ProAR). MÉTODOS: Estudo observacional retrospectivo e descritivo. Foram coletadas informações de atestados de óbitos e prontuários médicos de 16 dos 930 portadores de asma grave acompanhados no ambulatório Central de Referência do ProAR entre dezembro de 2003 e junho de 2006. RESULTADOS: Foram identificadas 16 (1,72 por cento) mortes em asmáticos do ProAR. Destes, 10 pacientes eram do sexo masculino; as idades variaram de 39 a 74 anos (mediana, 55 anos), sendo 12 (75 por cento) pacientes do grupo racial negróide. A duração da doença diagnosticada pelo médico foi de 1 a 68 anos (mediana, 30 anos). História pessoal e familiar de atopia foi observada em 43,8 e 53,8 por cento destes casos, respectivamente. História familiar de atopia não foi relatada em 3 casos. Tabagismo (<10 maços/ano) no passado foi identificado em 37,5 por cento dos casos. As causas registradas em atestados de óbito foram: asma ou crise de asma em 8 (50 por cento); insuficiência respiratória em 3 (18,75 por cento); infarto agudo do miocárdio em 2 (12,5 por cento); hepatite em 1 (6,25 por cento); choque hipovolêmico em 1 (6,25 por cento); e parada cardiorrespiratória em 1 (6,25 por cento). Dos 16 óbitos, 13 (81,25 por cento) ocorreram dentro de uma unidade hospitalar. CONCLUSÃO: A maioria dos óbitos dos asmáticos graves foi atribuída a asfixia e doenças cardiovasculares, em ambiente hospitalar; sexo masculino, idade avançada, tempo prolongado de doença e obstrução fixa aos fluxos aéreos foram características comuns nos pacientes estudados.

OBJECTIVE: To report demographic and clinical characteristics of patients with asthma who evolved to death, as well as to describe the conditions related to this outcome in a subgroup of patients admitted to the Program for the Control of Asthma and Rhinitis in Bahia (ProAR). METHODS: A descriptive, retrospective, observational study. Data from clinical charts and death certificates of 16 patients of 930 subjects with severe asthma monitored at the ProAR Central Reference Center from December 2003 to June 2006 were reviewed. RESULTS: Of the 930 patients participating in the program, 16 (1.72 percent) died. Of these, there were 10 males and 6 females, ranging in age from 39 to 74 years (median, 55 years); 12 (75 percent) of the patients were black. Time since diagnosis ranged from 1 to 68 years (median, 30 years). In 43.8 and 53.8 percent, respectively, there was a personal or family history of atopy. Ex-smokers (<10 pack-years) accounted for 37.5 percent of the cases. Causes of death listed on the death certificates were as follows: asthma or asthma exacerbations in 8 (50 percent); respiratory failure in 3 (18.75 percent); acute heart infarction in 2 (12.5 percent); hepatitis in 1 (6.25 percent); hypovolemic shock in 1 (6.25 percent); and cardiorespiratory arrest in 1 (6.25 percent). Of the 16 deaths, 13 (81.25 percent) occurred inside hospitals. CONCLUSION: Asphyxia and cardiovascular diseases were the most common atributed causes of mortality in this subgroup of patients with severe asthma. Hospital-based mortality, male gender, advanced age, long-term disease and fixed airflow obstruction were the aspects most frequently observed in the cases studied.

Displasia torácica asfixiante: síndrome de Jeune / Asphyxiating thoracic dysplasia: Jeune syndrome

Se describe el caso de un recién nacido con síndrome de Jeune, un trastorno genético cuya principal característica es la insuficiencia respiratoria por hipoplasia pulmonar secundaria a tórax estrecho.

Delayed death in a case of attempted strangulation mechanism of cerebral thrombosis and infarction -A case report.

Throttling is usually a homicidal act and generally the assailant continues the compression until the victim is dead. Pressure applied on the neck for about 3 -4 minutes consistently or more, is considered to be sufficient to cause death; the survival time depending upon the degree and duration of compression of the neck. The death may either be instantaneous or may be delayed for a few hours to a few days but in rare circumstances, the victim may survive, if rescue measures and treatment are promptly instituted. One such case of a male aged about 60 years, who was hospitalized after attempted manual strangulation for about 19 days and died thereafter, is being discussed. Medico legal autopsy findings of such a case are being evaluated in the light of existing literature.

Traumatic asphyxia in children

Introducción. la asfixia traumática se caracteriza por cianosis cervical y facial, hemorragia subconjuntival, ingurgitación vascular grave y equimosis de cara y cuello. Estos signos se cree son complicaciones asociadas a este síndrome son neurológicas, consistentes en agitación y desorientación inicial; y pulmonares, que pueden ser desde edema pulmonar leve hasta hemorragia parenquimatosa extensa. El pronóstico es bueno y la mortalidad y morbilidad pueden ser resultante de lesiones asociadas. Casos Clínicos. Se presentan 5 niños con asfixia traumática. Todos los pacientes fueron consecutivos a trauma compresivo en el tórax. Uno de ellos tenía síndrome de SCIWORA. La contusión pulmonar fue una lesión comúnmente asociada. Todos sobrevivieron. Conclusiones. La asfixia traumática es un evento raro y su diagnóstico es relativamente fácil. Frecuentemente, requiere sólo de medidas sintomáticas y el pronóstico es bueno

Neonatal necrotizing enterocolitis an epidemiological study.

Necrotizing enterocolitis (NEC) was diagnosed in 77 infants among 2200 admissions to the NICU during the period January 1986 to September 1990. The incidence was 0.5% of all live births and 3.5% of NICU admissions. Majority (57.1%) had Stage I of the disease while 23.4% had Stage II and 19.5% had Stage III of the disease. The average birth weight of the babies was 1650 +/- 577 g and gestational age 33.3 +/- 2.6 weeks. Majority (53.2%) were very low birth weight (VLBW) babies. Incidence was significantly more (5.7% vs 0.25%, p < 0.001) in VLBW infants and in preterm infants of gestational age less than 32 weeks (5.2% vs 0.09%, p < 0.001). Multiple risk factors were present in these babies while 8 babies did not have any risk factor. Risk of developing NEC was significantly more if infants had any of these risk factor (p < 0.001). Incidence of severe birth asphyxia was more in Stage I cases (35.7% vs 10.3%, p < 0.05). The age at presentation was 4.9 +/- 4.8 days and majority (96%) presented during the first 14 days. The overall survival was 61% and was 70.5, 77.8 and 13.3% in Stages I, II and III, respectively. VLBW and preterm infants had a higher mortality.

Asfixia por inmersión / Immersion by asphyxia

Se analizan 19 pacientes ingresados con el diagnóstico de asfixia por inmersión entre el 31 de diciembre de 1983 y el 31 de diciembre de 1987 con una edad promedio de 2 años 3 meses. Al momento del rescate todos los niños tenían cianosis y 16 apnea, pero sólo 11 recibieron algún tipo de reanimación, siendo ésta adecuada sólo en 4. Siete pacientes ingresaron en etapa A de Coon, 2 en etapa B y 10 en etapa C. En 6 casos se efectuó monitoría de la presión intracraneana, demostrándose hipertensión en dos, que fallecieron. Cinco pacientes desarrollaron edema pulmonar no cardiogénico y 4 presentaron hipotensión arterial acentuada en las primeras 24 horas, requiriendo fluidoterapia, coloides y medicamentos inotrópicos. Cuatro pacientes fallecieron, todos estaban en etapa C al ingreso. Sólo un paciente quedó con secuelas neurológicas definitivas. En las primeras horas siguientes a la reanimación, las principales complicaciones fueron la inestabilidad hemodinámica, los trastornos respiratorios y los derivados de la encefalopatía hipóxica. El aumento de la PIC no fue un problema precoz, cuando se presentó lo hizo en forma tardía, 24 a 48 horas después de la inmersión. Se subraya la necesidad de fomentar la prevención, mejorar los programas de transporte y educación de técnicas de reanimación básica

Factores de riesgo perinatal que generan demandas de atención neonatal intensiva / Perinatal risk factors that produce demands on intensive neonatal care

Se analizan los factore que determinan el ingreso de los recién nacidos a la Unidad de Terapia Intensiva. Entre éstos, la prematuridad, la asfixia, la hipotermia en recién nacidos por cesárea, así como los embarazos múltiples y la ausencia de trabajo de parto previo a la cesárea, incrementan el riesgo de ingresar a cuidados intensivos. Se insiste en la necesidad de normalizar la asistencia del neonato, de poner en marcha acciones dirigidas a la prevención del parto prematuro y de reconsiderar las indicaciones de la operación cesárea