Comparison between selective head cooling and whole-body cooling in neonatal therapeutic hypothermia / Comparação entre resfriamento seletivo da cabeça e resfriamento de corpo inteiro na hipotermia terapêutica neonatal

INTRODUCTION: Experimental evidence, as well as improved clinical studies of the reduction of brain injury and, improves the neurological outcome, in newborns with hypoxic-ischemic encephalopathy (HIE) occurring in therapeutic hypothermia (TH). OBJECTIVE: To verify the potential of hypothermic hypoxic-ischemic encephalopathy (HIE) therapy in neonatal asphyxia, based on literature data, comparing the benefits between selective head cooling (SHC) and whole-body cooling (WBC), see that the use of TH as a standard treatment in newborns with moderate or severe HIE has been adopted. METHODS: A search was performed in the PubMed and SciELO databases of human studies, using the keywords "Therapeutic Hypothermia", "Induced Hypothermia", and "Hypoxic-Ischemic Encephalopathy", "Selective cooling of the head", "Total body cooling" and its variables. RESULTS: Eleven articles were selected to compose the review, after detailed reading. There is a consensus, that the reduction of the risk of death or disability at 18 months of life in neonates with moderate to severe HIE, occurs to TH through the techniques of WBC or SHC. It was found in the studies that there is no difference in terms of adverse effects between the two methods. As for radiological changes, such as hypoxic-ischemic injuries and the incidence of seizures after cooling, they are more frequent with SHC. CONCLUSION: Both WBC and SHC demonstrated neuroprotective properties, although WBC provides a broader area of brain protection. However, no significant differences were found between the methods in terms of adverse effects and beneficial short or long-term results.

INTRODUÇÃO: Evidências experimentais, assim como estudos clínicos, sugerem a redução da lesão cerebral e melhora do desfecho neurológico, em recém-nascidos com encefalopatia isquêmica hipóxica (EHI) submetidos à hipotermia terapêutica (HT). OBJETIVO: Verificar a potencialidade da terapia hipotérmica de encefalopatia hipóxico-isquêmica (EHI) na asfixia neonatal, com base em dados da literatura, comparando os benefícios entre o resfriamento seletivo da cabeça (RSC) e o resfriamento de corpo inteiro (RCI), visto que o uso de hipotermia terapêutica (HT) como tratamento padrão em recém-nascidos com EHI moderada ou grave tem sido amplamente adotada. MÉTODOS: Foi realizada uma busca nas bases de dados PubMed e SciELO de estudos em humanos, utilizando-se as palavras-chave "Therapeutic Hypothermia", "Induced Hypothermia", "Hypoxic-Ischemic Encephalopathy", "selective head cooling", "whole body cooling" e suas respectivas variáveis. RESULTADOS: Foram selecionados 11 artigos para compor a revisão, após leitura detalhada. É consenso, a redução do risco de morte ou incapacidade aos 18 meses de vida nos neonatos com EHI moderado a grave, submetidos à HT através das técnicas de RCI ou RSC. Constatou-se diante dos estudos que não há diferença em termos de efeitos adversos entre os dois métodos. Quanto às alterações radiológicas, as lesões hipóxico-isquêmicas e incidência de convulsões após o resfriamento são mais frequentes com o RSC. CONCLUSÃO: Tanto RCI quanto o RSC demonstraram propriedades neuroprotetoras, embora o RCI proporcione uma área de proteção cerebral mais ampla. No entanto, não foram constatadas diferenças significativas entre os métodos quanto a efeitos adversos e a resultados benéficos em curto e longo prazo.

Risk factors for neonatal asphyxia and establishment of a nomogram model for predicting neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia.@*METHODS@#A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively.@*RESULTS@#Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia.@*CONCLUSIONS@#The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.

Perfil epidemiológico dos recém-nascidos com Apgar baixo no quinto minuto / Epidemiological profile of newborns with a low fifth minute Apgar

O escore de Apgar avalia rapidamente o estado clínico de neonatos. A asfixia perinatal é uma das causas do baixo índice de Apgar e contribui significativamente com a morbimortalidade. Objetivo: Avaliar a prevalência do Apgar baixo no quinto minuto de vida e determinar o perfil epidemiológico desses pacientes. Método: É estudo retrospectivo transversal epidemiológico. Foram coletados os dados dos recém-nascidos vivos com Apgar 5' <7 de 2 anos. Excluiu-se pacientes com anomalias congênitas e 118 pacientes foram analisados. Resultados: A prevalência do Apgar 5' <7 foi de 21,47/1000. Sexo masculino, nascimento a termo e por cesárea, apresentação cefálica, bolsa rota no ato, gestações simples, mães entre 20 e 34 anos com hipotireoidismo e diabetes, em uso de medicação, e mais de 6 consultas de pré-natal foram a maioria dentre os fatores analisados. Do total, 33,9% eram pré-termo; 30,5% tinham baixo peso; 24% apresentaram líquido amniótico meconial; 16% distócia; e 13% circular de cordão. Conclusão: A prevalência do Apgar 5' <7 foi de 21,47/1000. O perfil epidemiológico dentre os fatores analisados foi sexo masculino, nascimento a termo e por cesárea, apresentação cefálica, bolsa rota no ato, gestações simples, mães entre 20-34 anos com hipotireoidismo e diabete, em uso de medicação, e mais de 6 consultas de pré-natal

The Apgar score quickly assesses the clinical status of neonates. Perinatal asphyxia is one of the causes of low Apgar scores and contributes significantly to neonatal morbidity and mortality. Objective: To evaluate the prevalence of low Apgar in the fifth minute of life and to determine the epidemiological profile of these patients. Method: It is a retrospective cross-sectional epidemiological study. Data were collected from live newborns with Apgar5' <7 over 2 years. Patients with congenital anomalies were excluded, and 118 patients were analyzed. Results: The prevalence of Apgar 5' <7 was 21.47/1000. Male, full-term and cesarean delivery, cephalic presentation, water breaking during labor, singlet pregnancies, mothers between 20 and 34 years old with hypothyroidism and diabetes, using medication, and more than 6 prenatal consultations were the majority among the analyzed factors; 33.9% were preterm; 30.5% underweight; 24% had meconium-stained amniotic fluid; 16% dystocia and 13% nuchal cord. Conclusion: The prevalence of Apgar 5' <7 was 21.47/1000. The epidemiological profile among the analyzed factors was male gender, full-term birth and by cesarean section, cephalic presentation, ruptured water at the moment, simple pregnancies, mothers between 20-34 years old with hypothyroidism and diabetes, using medication, and more than 6 consultations of prenatal care

Impacto de uma intervenção educativa no manejo da hipotermia terapêutica neonatal: estudo quase experimental / Impact of an educational intervention in the management of neonatal therapeutic hypothermia: a quasi-experimental study

Introdução: A hipotermia terapêutica é o tratamento indicado para encefalopatia moderada a grave em recém-nascidos. A terapia requer uma equipe de enfermagem capacitada e integrada, visando um cuidado qualificado, efetivo e seguro. Modelos teóricos têm sido desenvolvidos para auxiliar a incorporação de evidências científicas à prática dos enfermeiros, representando um desafio na área da saúde. A implementação de uma intervenção educativa, guiada pela estrutura i-PARIHS (Estrutura Integrada de Promoção da Ação na Implementação de Pesquisa em Serviços de Saúde), poderá preencher a lacuna entre a teoria e a prática, beneficiando a assistência e tornando os sujeitos ativos no manejo do recém-nascido em hipotermia terapêutica. Objetivo geral: avaliar o impacto de uma intervenção educativa, guiada pelo referencial teórico i-PARIHS, sobre o manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica na unidade intensiva neonatal no conhecimento, atitudes e práticas de enfermeiros. Objetivos específicos: analisar o conhecimento, atitude e prática dos enfermeiros sobre o manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica pré e pós-intervenção educativa; identificar as barreiras e facilitadores percebidos pelos enfermeiros sobre o manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica na unidade intensiva neonatal; implementar uma intervenção educativa, guiada pelo referencial i-PARIHS, para melhorar o conhecimento, a atitude e a prática dos enfermeiros sobre o manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica na unidade intensiva neonatal; comparar o conhecimento, atitude e prática dos enfermeiros após a intervenção educativa e os indicadores quanto ao manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica. Método: trata-se de um estudo de intervenção, do tipo quase-experimental, realizado com 29 enfermeiros de uma unidade intensiva neonatal, referência no Rio de Janeiro. O desfecho principal: conhecimento, atitudes e práticas dos enfermeiros no manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica na unidade intensiva neonatal A intervenção compreendeu três fases: pré-intervenção - intervenção educativa- pós-intervenção. A intervenção educativa contou com cinco encontros: "Asfixia Perinatal x Hipotermia Terapêutica", "Controle da temperatura", "Cuidados de enfermagem na HT: avaliação de dor", "Monitoramento neurológico" e "Cuidado Centrado na Família". Para a análise estatística utilizou-se de análise descritiva e aplicação dos testes Wilcoxon-Mann-Whitney e Mc Nemar, sendo o nível de significância adotado de 0,05. Resultados: a análise dos resultados do pré e pós-teste demonstrou um incremento no escore de acertos das questões sobre conhecimento, atitude e prática dos enfermeiros no manejo do recém-nascido submetido à hipotermia terapêutica na unidade intensiva neonatal, apresentando significância estatística para a maioria dos itens. Para a inovação foram construídos lembretes, fluxo de admissão para recém-nascido da instituição e uma cartilha para os pais como produto da intervenção com os enfermeiros. Conclusão: O resultado das auditorias realizadas, após a implementação das evidências, constatou uma transformação positiva da prática dos enfermeiros. A utilização da estrutura i-PARIHS evidenciou a necessidade e o valor de investir no engajamento das partes interessadas, na avaliação colaborativa do contexto e na cocriação de inovação usando facilitação qualificada. A intervenção educativa, guiada pela estrutura i-PARIHS, mostrou ter impacto no manejo do recém-nascido submetido à hipotermia terapêutica por enfermeiros.

Introduction: Therapeutic hypothermia is the currently indicated treatment for moderate to severe encephalopathy in newborns. Therapy requires a trained and integrated nursing team, aiming at qualified, effective and safe care. Theoretical models have been developed to help the incorporation of scientific evidence into nurses' practice, representing a challenge in the health area. The implementation of an educational intervention, guided by the i-PARIHS (Integrated Promoting Action on Research Implementation in Health Services Framework) framework, can fill the gap between theory and professional practice, benefiting care and making subjects active in the management of newborns with therapeutic hypothermia. General objective: to evaluate the impact of an educational intervention guided by the theoretical framework i-PARIHS, on the management of newborns with perinatal asphyxia in therapeutic hypothermia in the neonatal intensive care unit on the knowledge, attitudes and practices of nurses. Specific objectives: to analyze the knowledge, attitude and practice of nurses on the management of newborns with perinatal asphyxia in pre- and post-educational therapeutic hypothermia; to identify barriers and facilitators perceived by nurses on the management of newborns with perinatal asphyxia in therapeutic hypothermia in the neonatal intensive care unit; implement an educational intervention, guided by the i-PARIHS framework, to improve nurses' knowledge, attitude and practice on the management of newborns with perinatal asphyxia in therapeutic hypothermia in the neonatal intensive care unit and compare the knowledge, attitude and practice of nurses after the participatory educational intervention program and indicators regarding the management of newborns with perinatal asphyxia in therapeutic hypothermia. Method: this is a quasi-experimental intervention study carried out with 29 nurses from a neonatal intensive care unit, a reference in Rio de Janeiro. The main outcome: knowledge, attitudes and practices of nurses in the management of newborns with perinatal asphyxia in therapeutic hypothermia in the neonatal intensive unit The intervention comprised three phases: pre-intervention - educational intervention - post-intervention. The educational intervention had five meetings: "Perinatal Asphyxia x Therapeutic Hypothermia", "Temperature control", "Nursing care in HT: pain assessment", "Neurological monitoring" and "Family-Centered Care". For the statistical analysis, descriptive analysis and application of the Wilcoxon-Mann-Whitney and Mc Nemar tests were used, with the adopted significance level of 0.05. Results: the analysis of pre- and post-test results showed an increase in the correct score of questions about nurses' knowledge and practices in the management of newborns submitted to therapeutic hypothermia in the neonatal intensive care unit, showing statistical significance for most items. For innovation, reminders, admission flow for newborns at the institution and a booklet for parents were created as a product of the intervention with nurses. Conclusion: The result of the audits carried out, after the implementation of the evidence, found a positive transformation of the nurses' practice. Using the i-PARIHS framework highlighted the need and value of investing in stakeholder engagement, collaborative context assessment, and co-creation of innovation using qualified facilitation. The educational intervention guided by the i-PARIHS framework was shown to have an impact on the management of newborns with perinatal asphyxia in therapeutic hypothermia by nurses.

Maternal and neonatal complications of childbirth among adolescents at the Sylvanus Olympio University Hospital Centre (CHU-SO), Lomé

Objective: To determine maternal and neonatal complications occurring at childbirth among adolescents.Materials and methods: This is a retrospective, descriptive study conducted from 1st July to 31st December 2019 at the maternity ward of the Sylvanus Olympio University Hospital Centre (CHU- SO), Lomé, Togo. The socio- demographic parameters of the mothers, details of prenatal and perinatal events and the clinical profile of the newborns at birth were studied. Results: The records of 332 adolescent mothers were studied. The average age of the mothers was 17.4 ± 1.5 years, with a range of 13-19 years. The pregnancies in two-thirds (66.3%) were supervised in centres without surgical facilities and by midwives in 83.1% of cases. A little over half of the mothers (53.3%) attended at least four antenatal clinic sessions, while 3.6% attended none. The modes of delivery were spontaneous vaginal (62.3%) and Caesarean section (35.2%). Complications of pregnancy were recorded in 12.9% of the mothers. There were statistically significant associations between the referred status of the mothers and haemorrhages, retained placenta and sepsis (p = 0.001, 0.038 and 0.011, respectively). There were no maternal deaths. The newborn babies required resuscitation in 6.3% of cases, while 7.0% were stillborn.There was a statistically significant relationship between the referred status of mothers and the occurrence of perinatal deaths (p =0.0001). Conclusion: Adolescent mothers are at risk of complications during childbirth, and these risks are increased by poor antenatal care and attempted deliveries in centres without surgical facilities.

Valoración de no inferioridad del Score de "reanimación y adaptación neonatal" frente al puntaje de Apgar / Noninferiority assessment of the "neonatal resuscitation and adaptation score" versus the Apgar score

Introducción: La evaluación de la transición desde el medio intrauterino en los recién naci-dos se realiza con el puntaje de Apgar (1953), proporciona una evaluación rápida del estado clínico, sin embargo, contiene variables subjetivas en su calificación. El nuevo puntaje de Reanimación y Adaptación Neonatal incorpora intervenciones de la reanimación neonatal. El objetivo fue demostrar la no inferioridad del nuevo puntaje frente al de Apgar. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal que empleó simultáneamente las dos puntuaciones. Con una muestra de 396 neonatos. El análisis uni-varial usó frecuencias absolutas y relativas y el bivarial usó Curvas ROC para la exactitud diagnóstica y pruebas significancia estadística. Resultados: La necesidad de reanimación fue del 35,6%, de ventilación mecánica del 19,6% y el diagnóstico de asfixia del 22%. La Curva ROC que examinó la variable asfixia mostró un índice de Youden a favor del nuevo puntaje, en el primer y quinto minuto, con similares resultados en las variables ventilación mecánica y reanimación neonatal. Conclusión: el puntaje de Reanimación y Adaptación Neonatal no es inferior al de Apgar en la valoración de asfixia. Al igual que su predecesor reconoce la necesidad de reanimación así como la necesidad de ventilación mecánica en los neonatos con puntuaciones bajas. Es una nueva herramienta de fácil aplicación y comprensión para la determinación del estado de transición en los recién nacidos.

Introduction: Evaluation of the transition from the intrauterine environment in newborns is carried out with the Apgar score (1953), which provides a quick estimation of the clinical state; however, it contains subjec-tive variables in its qualification. The new Neonatal Resuscitation and Adaptation score incorporates neo-natal resuscitation interventions. The objective was to demonstrate the noninferiority of the new score compared to the Apgar score. Methods: An observational, descriptive, cross-sectional study was carried out that used the two scores sim-ultaneously. With a sample of 396 neonates. The univariate analysis used absolute and relative frequen-cies, and the bivarial analysis used ROC curves for diagnostic accuracy and statistical significance tests. Results: The need for resuscitation was 35.6%, mechanical ventilation was 19.6%, and the diagnosis of as-phyxia was 22%. The ROC curve that examined the variable asphyxia showed a Youden index in favor of the new score in the first and fifth minutes, with similar results in the variables mechanical ventilation and neo-natal resuscitation. Conclusion: The neonatal resuscitation and adaptation scores were not lower than the Apgar score in the assessment of asphyxia. Like its predecessor, it recognizes the need for resuscitation as well as the need for mechanical ventilation in neonates with low scores. It is a new tool with easy application and understand-ing for the determination of the transition state in newborns

Resultado perinatal y obstétrico en embarazadas mayores a 35 años y menores a 15 años: (Estudio descriptivo retrospectivo. realizado en el Departamento de Ginecoobstetricia del hospital General San Juan de Dios) / Perinatal and obstetric outcome in pregnant women older than 35 years and younger than 15 years: (Retrospective descriptive study. Performed in the Department of Gynecology and Obstetrics of the Hospital General San Juan de Dios)

En Guatemala, el embarazo en la adolescencia es un problema social, que repercute seriamente en el desarrollo de los adolescentes. El fenómeno se vincula, directamente, con los factores económicos y, sobre todo, con el acceso a la educación y la información, aspectos que de ser accesibles ayudarían a promover un cambio favorable entre las personas con menos recursos. La edad avanzada en el embarazo representa un factor de riesgo de morbimortalidad materna, perinatal e infantil. Se realizo un Estudio descriptivo retrospectivo, se revisaron las papeletas médicas de todas las pacientes embarazadas que cumplieron con los criterios de inclusión. Dentro del estudio se incluyeron 289 pacientes, se observó mayor prevalencia de pacientes >35 años, respecto a los antecedentes prenatales, la edad gestacional más prevalente fue 37 a 41 semanas, el promedio de número de citas de control prenatal fue de 2.98, las complicaciones más frecuentes fueron infección y trabajo de parto pretérmino. En cuanto a los antecedentes natales, la Cesárea trans peritoneal fue la vía de resolución más prevalente y la asfixia perinatal fue la complicación más frecuente. Se observó asociación estadísticamente significativa entre complicaciones pre, natales y post natales edad materna mayor a 35 años. El hallazgo de sobrepeso y obesidad en pacientes mayores a 35 años se puede asociar con la prevalencia de complicaciones y el bajo promedio del número de controles prenatal. La falta de asociación entre edad materna menor a 15 años y complicaciones puede ser atribuida a que estas pacientes llevan un mejor control prenatal, debido al seguimiento especializado que se cuenta por parte del MSPAS. (AU)

In Guatemala, teenage pregnancy is a social problem, which seriously affects the development of adolescents. The phenomenon is directly linked to economic factors and, above all, to access to education and information, aspects that if accessible would help promote a favorable change among people with fewer resources. Advanced age in pregnancy represents a risk factor for maternal, perinatal and infant morbidity and mortality. A retrospective descriptive study was carried out, the medical records of all pregnant patients who met the inclusion criteria were reviewed. The study included 289 patients, a higher prevalence of patients> 35 years of age was observed, with respect to prenatal history, the most prevalent gestational age was 37 to 41 weeks, the average number of prenatal control appointments was 2.98, complications the most frequent were infection and preterm labor. Regarding the natal history, trans peritoneal caesarean section was the most prevalent means of resolution and perinatal asphyxia was the most frequent complication. A statistically significant association was observed between prenatal and postnatal complications, maternal age greater than 35 years. The finding of overweight and obesity in patients older than 35 years can be associated with the prevalence of complications and the low average number of prenatal check-ups. The lack of association be-tween maternal age less than 15 years and complications can be attributed to the fact that these patients have better prenatal control, due to the specialized follow-up provided by the MSPAS. (AU)

Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia: a multicenter study in Hubei Province, China / 中国当代儿科杂志

OBJECTIVES@#To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia.@*METHODS@#A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December, 2018 and had blood glucose data within 12 hours after birth. Their blood glucose data at 1, 2, 6, and 12 hours after birth (with an allowable time error of 0.5 hour) were recorded. According to the presence or absence of brain injury and/or death during hospitalization, the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates. The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short-term prognosis.@*RESULTS@#Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals (48.5% vs 42.6%, @*CONCLUSIONS@#Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis, and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.

Incidência de crises epiléticas eletrográficas em recém nascidos internados na uti neonatal com o diagnóstico de asfixia moderada e grave: relato de série de casos / Incidence of electrographic epileptic seizures in newborns admitted to the neonatal intensive care unit with a diagnosis of moderate and severe asphyxia: case series report

Introdução: A asfixia perinatal ocorre em cerca de 8-10% de todos os partos no Brasil e exige atenção na prevenção e na abordagem assistencial. Nas formas leves, a recuperação é total. As formas moderada e grave causam déficits neurológicos permanentes e alterações no desenvolvimento neurológico (48%) ou morte (27%).3 Convulsões também estão frequentemente presentes e o seu diagnóstico adequado é fundamental, tendo em vista que o quadro convulsivo por si só pode agravar a lesão cerebral. Embora a eletroencefalografia convencional (EEG) ainda represente o padrão ouro de diagnóstico, o monitoramento contínuo usando o aEEG pode ser crucial para o reconhecimento e intervenção precoces.7,8 . Objetivo: Descrever a incidência de convulsões eletrográficas captadas pelo vídeo aEEG (eletroencefalograma de amplitude integrada) em uma coorte de recém-nascidos internados na UTI neonatal com diagnóstico de asfixia moderada e grave ao nascer. Método: Trata-se de um estudo retrospectivo, descritivo, do tipo séries de caso. Critérios de inclusão: Recém nascidos que experimentaram um evento hipóxico isquêmico ao nascer, no período de julho de 2017 à julho de 2020, com IG ≥ 35 semanas e com o APGAR ≤ 7 no 5º minuto de vida. A amostra foi classificada em dois grupos, imediatamente ao nascimento: graves e moderados. A monitorização pelo aEEG foi aplicada integralmente em ambos os grupos, assim como a avaliação quanto à presença ou ausência de convulsões clínicas e eletrográficas. Critérios de exclusão: Recém-nascidos com anomalias congênitas, anomalias cromossômicas e recém nascidos que tenham sido transferidos após 6h de vida. O estudo ocorreu em 3 unidades de terapia intensiva neonatal, localizadas no Estado do Rio de Janeiro. Resultados: Neste período de 3 anos, foram internados 5484 recém nascidos nas unidades neonatais, sendo que 97 (1,76%) sofreram algum tipo de insulto hipóxico isquêmico no período perinatal ou neonatal imediato. Destes 97, 65 preencheram os critérios de inclusão do estudo. Excluímos do estudo 4 recém nascidos (1 por alteração genética e 3 por transferência hospitalar após 6h de vida). Foram classificados como grupo grave (N= 26 (42,6%)). Todos os outros RN foram classificados como grupo moderado (N= 35 (57,4%)). Observamos no grupo grave 1 RN (3,84%) com convulsões clínicas, 10 RN (38,46%) com convulsões eletrográficas e 1 RN (3,84%) com ambas as formas de convulsão e no grupo moderado 2 RN (5,71%) com convulsões clínicas, 8 RN (22,85%) com convulsões eletrográficas e 2 RN (5,71%) com ambas as formas de convulsão. Conclusão: Observamos grande quantidade de convulsões eletrográficas, não traduzidas clinicamente, indicando que a utilização do aEEG é fundamental para o diagnóstico rápido e preciso de convulsões em recém nascidos de alto risco.

Introduction: Perinatal asphyxia occurs in about 8-10% of all births in Brazil and requires attention in prevention and care approach. In light forms, recovery is complete. The moderate and severe forms cause permanent neurological deficits and changes in neurological development (48%) or death (27%).3 Seizures are also frequently present and its proper diagnosis is essential, considering that the convulsive condition by itself can aggravate the brain damage. Although conventional electroencephalography (EEG) still represents the gold standard for diagnosis, continuous monitoring using aEEG can be crucial for early recognition and intervention.7,8 Objective: To describe the incidence of electrographic seizures captured by aEEG video (integrated amplitude electroencephalogram) in a cohort of newborns admitted to the NICU with a diagnosis of moderate and severe asphyxia at birth. Method: This is a retrospective, descriptive, case series study. Inclusion criteria: Newborns who experienced a hypoxic ischemic event at birth, from July 2017 to July 2020, with GA ≥ 35 weeks and with APGAR ≤ 7 in the 5th minute of life. The sample was classified into two groups, immediately at birth: severe and moderate. Monitoring by aEEG was fully applied to both groups, as well as the evaluation of the presence or absence of clinical and electrographic seizures. Exclusion criteria: Newborns with congenital anomalies, chromosomal anomalies and newborns who were transferred after 6h of life. The study took place in 3 neonatal intensive care units located in the State of Rio de Janeiro. Results: In this 3-year period, 5484 newborns were hospitalized in neonatal units, and 97 (1.76%) suffered some type of hypoxic-ischemic insult in the perinatal or immediate neonatal period. Of these 97, 65 met the study's inclusion criteria. We excluded 4 newborns from the study (1 due to genetic alteration and 3 due to hospital transfer after 6h of life). They were classified as a severe group (N=26 (42.6%)). All other NB were classified as a moderate group (N=35 (57.4%)). We observed in the severe group 1 NB (3.84%) with clinical seizures, 10 NB (38.46%) with electrographic seizures and 1 NB (3.84%) with both forms of seizure and in the moderate group 2 NB (5 .71%) with clinical seizures, 8 NB (22.85%) with electrographic seizures and 2 NB (5.71%) with both forms of seizure.Conclusion: We observed a large number of clinically untranslated electrographic seizures, indicating that the use of aEEG is essential for the rapid and accurate diagnosis of seizures in high-risk newborns.

Hipotermia terapêutica na encefalopatia hipóxico-isquêmica neonatal: revisão integrativa / Therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: integrative review / Hipotermia terapéutica em la encefalopatía hipóxico-isquémica neonatal: revisión integrativa

Objetivo: identificar evidências acerca do uso seguro da hipotermia terapêutica em recém-nascidos. Método: revisão integrativa realizada entre junho e julho de 2018, em fontes eletrônicas da Biblioteca Virtual de Saúde e PubMed, por meio da pergunta:"Que evidências podem subsidiar o cuidado de enfermagem voltado para a redução de sequelas em recém-nascidos submetidos à hipotermia terapêutica?".Foram eleitos nove artigos para análise, sendo oito internacionais e um nacional. Resultados:o resfriamento deve acontecer por 72 horas, com hipotermia leve. As indicações para inclusão no protocolo foram: primeiras seis horas de vida, idade gestacional maior que 35 semanas e acidose na primeira hora de vida.São cuidados essenciais: monitoração hemodinâmica, observação da pele, controle térmico retal, vigilância do Eletroencefalograma de Amplitude Integrada. Conclusão: a terapêutica apresenta benefícios, porém sua aplicação depende de protocolo institucional e treinamento das equipes com foco nas potenciais complicações.

Objective: to identify the evidence on safe use of therapeutic hypothermia in newborns. Method: integrative review of the literature, conducted between June and July of 2018, in electronic sources from the Virtual Health Library and PubMed, through the question: "What evidence can support nursing care aimed at reducing sequelae in newborns undergoing therapeutic hypothermia?". Analysis was conducted for nine selected article, being eight from international literature and one from Brazilian national literature. Results: cooling should occur for 72 hours with mild hypothermia. Indications for inclusion in the protocol were: first six hours of life, gestational age greater than 35 weeks and acidosis in the first hour of life. Essential care includes hemodynamic monitoring, skin observation, rectal thermal control, Integrated Amplitude Electroencephalogram surveillance. Conclusion: the therapy has benefits, but its application depends on institutional protocol and team training focusing on potential complications.

Objetivo: identificar la evidencia sobre el uso seguro de la hipotermia terapéutica en recién nacidos. Método: revisión integradora de la literatura, realizada entre junio y julio de 2018, en fuentes electrónicas de la Biblioteca Virtual de Salud y PubMed, a través de la pregunta: "¿Qué evidencia puede apoyar la atención de enfermería dirigida a reducir las secuelas en los recién nacidos que sufren hipotermia terapéutica?". Se realizaron análisis para nueve artículos seleccionados, ocho de literatura internacional y uno de literatura nacional brasileña. Resultados: el enfriamiento debe ocurrir durante 72 horas con hipotermia leve. Las indicaciones para la inclusión en el protocolo fueron: primeras seis horas de vida, edad gestacional mayor de 35 semanas y acidosis en la primera hora de vida. El cuidado esencial incluye monitoreo hemodinámico, observación de la piel, control térmico rectal, vigilancia integrada de electroencefalograma de amplitud. Conclusión: la terapia tiene beneficios, pero su aplicación depende del protocolo institucional y del entrenamiento del equipo, enfocándose en posibles complicaciones.

Factores de riesgo que inciden en la mortalidad neonatal en el Hospital Dr. León Becerra Camacho Del Cantón Milagro 2014-2017 / Risk factors that affect neonatal mortality in the Dr. León Becerra Hospital Camacho Del Cantón Milagro 2014-2017

Según la OMS, la mortalidad neonatal está asociada a factores que son de necesaria identificación para reducir la incidencia. El objetivo del trabajo es identificar los factores de riesgo que inciden en el evento. Se utilizó un diseño transversal, retrospectivo, descriptivo, cuantitativo, con una población de 74 neonatos que fallecieron en los servicios de neonatología del Hospital Dr. León Becerra Camacho 2014-2017. Los resultados arrojan que de los neonatos fallecidos, el mayor porcentaje es el sexo masculino, de madres con edades entre 21 y 35 años, donde la mayoría pertenecen a zonas urbanas con instrucción secundaria incompleta y dedicada a las labores del hogar. Como características maternas encontramos que la mayoría, fueron secundigestas, el 60.81% con controles mínimos, el 56,7% con parto vaginal. Las características Obstétricos encontradas revelan que el 67.5% tuvieron menos de 1-2 años de periodo intergenésico, el 100% presentaron Infecciones de vías Urinarias, 44.5% tuvieron Ruptura Prematura de Membrana, y desproporción cefálica con traumas obstétricas en un 33,7%. Como factores neonatales y fetales tenemos que el 51.3% fueron neonatos a Término con peso adecuado para edad gestacional, y el 51.3% tuvieron depresión severa y 44,5% con sufrimiento fetal, siendo la patología más frecuente la Asfixia en un 51,3% seguido del 33,7% de Membrana Hialina, y las comorbilidades más comunes son la acidosis metabólica en un 87.8%, seguidos de 48.6% con prematurez. Se propone fortalecer los protocolos para el manejo de la embarazada, que permitan mejorar la calidad de la atención, favoreciendo al binomio madre hijo(AU)

According to OMS, neonatal mortality is associated with factors that are necessary to identify the incidence. The objective of the work is to identify the risk factors that affect the event. It is a cross-sectional, retrospective, descriptive, quantitative design, with a population of 74 neonates who have fallen into the neonatology services of the Hospital Dr. León Becerra Camacho 2014-2017. The majority of people in urban areas with incomplete secondary education and dedicated to household chores. The maternal characteristics of the majority were secundigestas, 60.81% with minimal controls, 56.7% with vaginal delivery. The Obstetric characteristics revealed in 67.5% occurred during 1-2 years of the intergenesic period, 100% were published in Urinary Tract Infections, 44.5% were performed Premature Membrane Rupture, and the cephalic disproportion with obstetric traumas in 33.7%. As neonatal and fetal factors we have that 51.3% were Term neonates with adequate weight for gestational age, and 51.3% had a severe severity and 44.5% with fetal, the most frequent pathology being Asphyxia in 51.3% Following 33.7% of the Hyaline Membrane, and the most common Comorbidities in metabolic acidosis in 87.8%, followed by 48.6% with prematurity. It was proposed to strengthen protocols for the management of the pregnant woman, to improve the quality of care, favoring the child(AU)

Caracterización de recién nacidos con asfixia neonatal, ingresados a sala de neonatología en el Hospital Básico Gabriela Alvarado, Danlí, El Paraíso, Honduras, 2018 / Characterization of newborns with neonatal asphyxiation, admitted to neonatology room at the Gabriela Alvarado Basic Hospital, Danlí, El Paraíso, Honduras, 2018

Objetivo: Caracterizar a los recién nacidos con asfixia neonatal, ingresados en la sala de neonatología, Hospital Básico Gabriela Alvarado, Danlí El Paraíso Honduras, 2018 Es un estudio de tipo descriptivo de corte transversal. Metodología: Se tomó una muestra de 36 expedientes de los recién nacidos que fueronndiagnosticados con asfixia neonatal. Se utilizó el programa Epi Info 7 y Microsoft Excel para presentar una distribución de frecuencia expresada en cifras absolutas y porcentajes. Resultados: de los 36 expedientes de niños con Asfixia neonatal, el mayor grupo de edad de las madres de estos niños se encontró el 58.33% entre las edades 13-17 años, siendo el 67% del área de Danlí y 30.56%, cursaron primaria incompleta, y el 38.89% sien do madres solteras. Conclusión: De los niños que presentaron asfixia neonatal las características más representativas fue la edad de la madre, seguidamente el nivel educativo de las mismas y ser solteras. La mayoría de los recién nacidos pertenecen al género masculino, con un peso dentro de lo normal. La estadía hospitalaria oscila entre 5 a 10 días, todos ellos recibiendo terapias a diario. Del total de las complicaciones que se identifican, resulta predominante la del Síndrome de Distrés Respiratorio (SDR)

Conocimientos y actitudes sobre encefalopatía hipóxico-isquémica e hipotermia terapéutica: Resultados de una intervención educativa / Knowledge and attitudes on hypoxic-ischemic encephalopathy and therapeutic hypothermia: Results of an educational intervention

Antecedentes: La asixia perinatal, producida al feto/neonato por hipoxia y/o hipoperfusión tisular, puede llevar a ence-falopatía hipóxico-isquémica (EHI). La hipotermia terapéutica (HT) es eicaz para tratar EHI moderada/severa. Objetivo: Determinar conocimientos y actitudes sobre EHI e HT del personal sanitario y estudiantes antes y después de una intervención educativa, Departamento de Pediatría, Hospital Escuela (HE), Tegucigalpa, 2019. Métodos: Estudio cuasi experimental. Médicos, enfermeras, estudiantes de grado y posgrado fueron invitados a participar mediante consentimiento informado. El ensayo consistió en evaluación pre-intervención (Fase 1), seguida de intervención educativa, video y documento enviados por aplicación WhatsApp, y evaluación post-intervención (Fase 2). Se registraron características sociodemográicas. Se evaluó conocimientos (Excelente, Muy bueno, Bue-no, Deiciente) y actitudes (Buena, Regular, Mala, Muy mala). Se midió el cambio (Delta Porcentaje) entre proporción de participantes de acuerdo a conocimientos y actitudes pre y post-intervención. Resultados: De 181 potenciales participantes, en Fase 1 participaron 147 (81.2%) y en Fase 2, 127 (70.2%). Inicialmente, 93.2% (137) demostró un conocimiento deiciente y actitud buena 38.0% (56), regular 28.0% (41), mala 32.0% (47). El conocimiento bueno aumentó en 561.2% (3.1% versus 20.5%), conocimiento muy bueno aumentó en 185.1% (4.7% versus 13.4%), conocimiento deiciente disminuyó en 35.9% (92.2% versus 59.1%). La actitud regular au-mentó en 37.0% (27.0% versus 37.0%), actitud mala disminuyó 30.4% (32.8% versus 22.8%). Discusión: La intervención educativa mejoró conocimiento y actitud en relación a HT y EHI. La HT disponible en HE puede mejorar el desenlace de EHI. Se recomienda fortalecer las medidas educativas institucionales sobre el protocolo de HT...(AU)

Selective head cooling and whole body cooling as neuroprotective agents in severe perinatal asphyxia

SUMMARY INTRODUCTION The possibility that hypothermia has a therapeutic role during or after resuscitation from severe perinatal asphyxia has been a longstanding focus of research. Studies designed around this fact have shown that moderate cerebral hypothermia, initiated as early as possible, has been associated with potent, long-lasting neuroprotection in perinatal patients. OBJECTIVES To review the benefits of hypothermia in improving cellular function, based on the cellular characteristics of hypoxic-ischemic cerebral injury and compare the results of two different methods of cooling the brain parenchyma. METHODS Medline, Lilacs, Scielo, and PubMed were searched for articles registered between 1990 and 2019 in Portuguese and English, focused on trials comparing the safety and effectiveness of total body cooling with selective head cooling with HIE. RESULTS We found that full-body cooling provides homogenous cooling to all brain structures, including the peripheral and central regions of the brain. Selective head cooling provides a more extensive cooling to the cortical region of the brain than to the central structures. CONCLUSIONS Both methods demonstrated to have neuroprotective properties, although full-body cooling provides a broader area of protection. Recently, head cooling combined with some body cooling has been applied, which is the most promising approach. The challenge for the future is to find ways of improving the effectiveness of the treatment.

RESUMO INTRODUÇÃO A possibilidade de a hipotermia ter um papel terapêutico durante ou após a reanimação da asfixia perinatal grave tem sido um foco de pesquisa de longa data. Estudos desenhados em torno desse fato mostraram que a hipotermia cerebral moderada, iniciada o mais cedo possível, tem sido associada à neuroproteção potente e duradoura em espécies perinatais. OBJETIVOS Resumidamente, analisar os benefícios da hipotermia na melhoria da função celular, com base nas características celulares da lesão cerebral hipóxico-isquêmica e comparar os resultados de dois métodos diferentes de resfriamento do parênquima cerebral. MATERIAL E MÉTODOS Medline, Lilacs, SciELO e PubMed foram pesquisados para artigos registrados entre 1990 e 2019 nos idiomas português e inglês, com foco em estudos comparando segurança e eficácia do resfriamento corporal total com o resfriamento seletivo da cabeça com EHI. RESULTADOS Descobrimos que o resfriamento de corpo inteiro fornece resfriamento homogêneo para todas as estruturas cerebrais, incluindo as regiões periférica e central do cérebro. O resfriamento seletivo da cabeça fornece um resfriamento mais amplo para a região cortical do cérebro do que para as estruturas centrais. CONCLUSÕES Ambos os métodos demonstraram ter propriedades neuroprotetoras, embora o resfriamento de corpo inteiro forneça uma área mais ampla de proteção. Recentemente, o resfriamento da cabeça combinado com algum resfriamento corporal foi aplicado e essa é a maneira mais promissora. O desafio para o futuro é encontrar formas de melhorar a eficácia do tratamento.

Factores asociados con bajo puntaje de Apgar en la maternidad del Centro Hospitalario Pereira Rossell / Factors associated with low Apgar score in the maternity of Pereira Rossell Hospital / Fatores associados com baixa pontuação de Apgar na maternidade do Centro Hospitalar Pereira Rossell

Introducción: La depresión neonatal es una de las causas más frecuentes de ingreso de recién nacidos a unidades especializadas de atención neonatal. La asfixia perinatal es una de las causas de bajo puntaje de Apgar, siendo uno de los criterios clínicos para su diagnóstico. Los principales factores de riesgo vinculados con bajos puntajes de Apgar pueden ser maternos (edad, patologías obstétricas, nivel socioeconómico, adicciones, etc.), del trabajo de parto y parto o, alteraciones fetales. Objetivos: Determinar los factores perinatales asociados a la baja puntuación de Apgar a los 5 minutos. Diseño: Estudio retrospectivo de casos y controles en los años 2015 y 2016. Institución: Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. Participantes: Se incluyeron todos los recién nacidos término con Apgar a los 5 minutos menor o igual a 5. Resultados: Hubo un total de 12.528 nacimientos de recién nacidos vivos de término en el HM. 34 casos de recién nacidos con Apgar a los 5 minutos menor o igual a 5. Esto corresponde al 0,27% de la población. No se identificaron diferencias estadísticamente significativas en cuanto a los principales factores asociados a asfixia perinatal. Conclusiones: En el análisis de esta población, la mayoría de los factores analizados no se asocia con los casos de Apgar a los 5 minutos menor o igual a 5 (depresión neonatal moderada-severa), por lo que la mayoría de estos casos pueden no ser evitables.

Introduction: Neonatal depression is one of the most frequent causes of admission of newborns to specialized units of neonatal care. Perinatal asphyxia is one of the causes of low Apgar score, and it is one of the clinical criteria for its diagnosis. Main risk factors associated with low Apgar scores can be maternal (age, obstetric pathologies, socioeconomic level, addictions, etc.), of labor and delivery or, fetal alterations. Objective: To determine the perinatal factors associated with the low Apgar score at 5 minutes. Design: Retrospective study of cases and controls in 2015 and 2016. Institution: Maternity, Women Hospital, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. Patients: We included all term newborns with Apgar at 5 minutes less than or equal to 5. Results: There was a total of 12,528 births of term full-term newborns in the HM. 34 cases of newborns with Apgar at 5 minutes less than or equal to 5. This corresponds to 0.27% of the population. No statistically significant differences were identified regarding the main factors associated with perinatal asphyxia. Conclusions: In the analysis of this population, most of the analyzed factors are not associated with cases of Apgar at 5 minutes less than or equal to 5 (moderate-severe neonatal depression), so that most of these cases may not be avoidable.

Introdução: A depressão neonatal é uma das causas mais freqüentes de internação de recém-nascidos em unidades especializadas de atenção neonatal. A asfixia perinatal é uma das causas do baixo índice de Apgar, sendo um dos critérios clínicos para o seu diagnóstico. Os principais fatores de risco associados aos baixos escores de Apgar podem ser maternos (idade, patologias obstétricas, nível socioeconômico, dependências, etc.), de trabalho de parto e parto, ou alterações fetais. Objetivos: Determine os fatores perinatais asociados ao baixo índice de Apgar aos 5 minutos. Design: Estudo retrospectivo de casos e controles nos anos de 2015 e 2016. Instituição: Hospital da Mulher, Centro Hospitalar Pereira Rossell, Montevidéu, Uruguai. Participantes: Todos os recém-nascidos a termo com Apgar a 5 minutos menor ou igual a 5 foram incluídos. Houve um total de 12.528 nascidos vivos a termo no MB. 34 casos de recém-nascidos com Apgar a 5 minutos menor ou igual a 5. Isso corresponde a 0,27% da população. Não foram identificadas diferenças estatisticamente significantes quanto aos principais fatores associados à asfixia perinatal. Conclusões: Na análise dessa população, a maioria dos fatores analisados não está associada aos casos de Apgar em 5 minutos menor ou igual a 5 (depressão neonatal moderada a grave), de modo que a maioria desses casos pode não ser evitável.

Indicadores de calidad de la atención a neonatos con patologías seleccionadas: estudio piloto / Quality care indicators for neonates with selected pathologies: pilot study

Resumen: Objetivo: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). Material y métodos: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. Resultados: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. Conclusiones: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.

Abstract Objective: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). Materials and methods: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. Results: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. Conclusions: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.

Perfil clínico ­ epidemiológico de la asfixia perinatal en recién nacidos de la Unidad de Neonatología del Hospital Nacional de Niños Benjamín Bloom de enero de 2013 a diciembre de 2016 / Clinical-epidemiological profile of perinatal asphyxia in newborns of the Neonatology Unit of the Benjamin Bloom National Children's Hospital from January 2013 to December 2016

La asfixia perinatal es un factor importante que contribuye a la mortalidad infantil que es un indicador de los estándares sociales, educativos y económicos de un país. Uno de los objetivos del desarrollo sostenible es para 2030 poner fin a las muertes evitables de recién nacidos y de niños menores de 5 años, logrando que todos los países intenten reducir la mortalidad neonatal al menos hasta 12 por cada 1.000 nacidos vivos. A pesar de la reducción en la morbimortalidad neonatal en los últimos años, la asfixia perinatal sigue siendo una causa importante de muerte y discapacidad motora y cognitiva a nivel mundial. Se ha estimado que la incidencia de asfixia perinatal es de 1/1,000 nacidos vivos en países desarrollados, llegando a 5-10/1,000 nacidos vivos en países en vías de desarrollo. En el Hospital Nacional de Niños Benjamín Bloom la asfixia perinatal es una causa importante de referencia y de admisión en la Unidad de Neonatología. Se realizó un estudio descriptivo de corte transversal, retrospectivo. Según los datos obtenidos por medio del Sistema de Morbimortalidad en la Web (SIMMOW) del Ministerio de Salud entre el período comprendido 2013 ­ 2016 se registraron 180 casos de los cuales 114 fueron incluidos en nuestro estudio. La asfixia perinatal es un problema de salud relevante, en la Unidad de Neonatología del Hospital Nacional de Niños Benjamín Bloom es predominante en el sexo masculino, hijos de madres jóvenes entre 19 ­ 25 años sanas, primigestas que provienen del área rural del país, los manifestaciones clínicas más importantes son hipotensión que requiere uso de aminas vasoactivas y la falla renal aguda evidenciada por el aumento de creatinina en el 43% y 39% de casos respectivamente. La complicación más frecuente es la hipertensión pulmonar persistente se presentó en el 20% de casos, la mortalidad en nuestro estudio fue del 25%. Es necesario continuar con medidas de prevención orientadas a mejorar la atención en el primer y segundo nivel de salud con el fin de impactar en factores de riesgo y disminuir los casos de asfixia perinatal. La principal complicación de la asfixia perinatal es la hipertensión pulmonar persistente por lo tanto se debe mejorar el manejo de esta. Se deben realizar otras investigaciones que completen el perfil clínico de la asfixia perinatal pero enfocada a la búsqueda de secuelas a largo plazo y el impacto de estas en la calidad de vida de los pacientes

Incidence of neonatal asphyxia and contributing factors for the develpment of severe asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study / 中国当代儿科杂志

OBJECTIVE@#To investigate the incidence of neonatal asphyxia and possible contributing factors for the development of severe asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture, China.@*METHODS@#A total of 16 hospitals in Hubei Enshi Tujia and Miao Autonomous Prefecture were selected as research centers. A retrospective analysis was performed for the clinical data of 22 294 live births in these 16 hospitals from January to December, 2016 to investigate the incidence rate of neonatal asphyxia and possible contributing factors for the development of severe asphyxia.@*RESULTS@#Of the 22 294 neonates born alive, 733 (3.29%) were diagnosed with neonatal asphyxia, among whom 627 had mild asphyxia and 106 had severe asphyxia. The neonates with low maternal education level, maternal anemia during pregnancy, chorioamnionitis, abnormal amniotic fluid, abnormal umbilical cord, placenta previa, placental abruption, Tujia Minority, preterm birth, and low birth weight had a higher incidence of severe asphyxia (P<0.05).@*CONCLUSIONS@#The incidence rate of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture is higher. Low maternal education level, maternal anemia during pregnancy, chorioamnionitis, abnormal amniotic fluid, abnormal umbilical cord, placenta previa, placental abruption, Tujia Minority, preterm birth, and low birth weight may be related to the development of severe neonatal asphyxia.