ABSTRACT
El presente documento representa un resumen del a organización actual del Servicio de Neonatología (SN). En primer lugar se describe la misión, visión y los valores del mismo, se sigue de una reseña estructural y de la cartera de Servicios. A Continuación se describe la actividad asistencial del paciente ingresado en planta de hospitalización obstétrica y neonatal y su seguimiento ambulatorio en el área de consultas externas. Seguidamente, se expondrá la actividad docente de grado, la formación especializada en Pediatría y la formación continuada. Se comentan las inquietudes en proyectos de investigación y las estrategias de mejora de la calidad del servicio fomentando el plan de humanización del SN centrándose en los cuidados centrados en el desarrollo y la familia. Para finalizar cabe resaltar los objetivos asistenciales, docentes y de investigación actuales de mayor relevancia (AU)
This document represents a summary of the current Neonatology Service (NS) of the University Hospital La Fe de Valencia. In the first place, the mission, vision and values will e described followed by a structural review and all the services that the Hospital provides. Moreover, it will be explained the medical attendance towards patients in obstetric and neonatal hospitalization and its subsequent follow-up out patient clinic. Subsequently, teaching degree, specialized formation in Pediatric and continuing education training will be exposed. Concerns in research projects and strategies to improve the quality of the service in promoting the humanization of NS and focusing on Centered Care and Family Development are described. Finally it is worth emphasizing the attendance, teaching and research objectives (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Child Health Services/organization & administration , Models, Organizational , Delivery of Health Care/statistics & numerical data , Infant, Newborn, Diseases/epidemiology , Health Services ResearchABSTRACT
OBJECTIVE: The objective of this study was to investigate the reliability of end-tidal CO2 (PetCO2) as a non-invasive guide of PaCO2 in the newborn and to analyze the influence of the relationship between ventilation-perfusion in the correlation between both determinations. PATIENTS AND METHODS: End-tidal CO2 (PetCO2) was monitored by capnography in 9 ventilated newborns: 146 arterial blood gas samples were drawn and the results were compared with the PetCO2 values obtained. The gradient or difference between PaCO2 and PetCO2 was calculated to determine the correlation. The ratio a/AO2 was used as an indirect indicator of the ventilation/perfusion relationship (V/Q ratio). RESULTS: The mean gestational age was 30.9 +/- 2.8 weeks and birth weight 1,648 +/- 596 g. The age at the beginning of the study was 2 +/- 1.5 days. The diagnoses corresponded to 5 cases of RDS (56%), 2 cases of wet lung syndrome (22%), 1 case of pneumonia (11%) and 1 pneumothorax (11%). The results of this monitoring were classified in function of the a/AO2 ratio obtained: Group A, a/AO2 < 0.2 and PaCO2-PetCO2 gradient = 13.3 +/- 5; Group B, a/AO2 = 0.2-0.29 and PaCO2-PetCO2 gradient = 8 +/- 2.7; and Group C, a/AO2 > 0.29 and PaCO2-PetCO2 gradient = 2 +/- 1.7. The results show a very good correlation from a a/AO2 ratio > or = 0.3 onwards. The a/AO2 ratio is the major determinant of PaCO2-PetCO2 differences and respiratory frequency has less influence. CONCLUSIONS: 1) Monitoring of end-tidal CO2 does not maintain a good correlation with PaCO2 in serious lung illness. 2) End-tidal CO2 measurement is an effective and accurate technique for the monitoring of newborns when the a/AO2 ratio > or = 0.3 and it can be useful for weaning of mechanical ventilation. 3) PaCO2-PetCO2 differences accurately show the changes in the ventilation-perfusion relationship.
Subject(s)
Capnography/methods , Carbon Dioxide/analysis , Intensive Care, Neonatal , Blood Gas Analysis , Female , Humans , Infant, Newborn , Lung Diseases/diagnosis , MaleSubject(s)
Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Candida/pathogenicity , Endocarditis/drug therapy , Endocarditis/etiology , Gentamicins/therapeutic use , Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Electrocardiography , Endocarditis/diagnostic imaging , Gentamicins/administration & dosage , Humans , Infant, Newborn , Infant, Very Low Birth Weight , Male , UltrasonographyABSTRACT
OBJECTIVE: The objective of this study was to determine the effectivity, results and complications after application of HFOV in a group of newborns with serious respiratory distress. PATIENTS AND METHODS: Between February and October 1995, HFOV was required by 18 newborns in the NICU of the Hospital "La Fe" of Valencia, as ventilatory rescue therapy because of the failure of conventional ventilation in 10 cases (group A) and serious air leaks in 8 cases (group B). We used pure HFOV without superimposed cycles of conventional IMV following a high volume-high pressure strategy. Among the lung pathology, RDS was most frequent (11/18). RESULTS: Twenty-four hours after beginning HFOV, a decrease of the FiO2 was obtained in group A from 0.89 to 0.4 and in group B from 0.7 to 0.4. Oxygenation, ventilation, OI and a/AO2 ration also improved. In the group with conventional ventilation failure, this improvement was significant for all parameters in the first two hours after the start of HFOV (p < 0.01). In the group with air leaks, all parameters improved at two hours, but this change was significant only for oxygenation (p < 0.01). Four newborns died (22%) in the first month. CONCLUSIONS: HFOV is an effective and secure ventilatory method when conventional ventilation fails or serious air leaks occur. Important improvement in oxygenation and ventilation is obtained during the first two hours and it is possible to decrease the oxygen requirements at 24 hours after the start of HFOV.
