Efficacy and Safety of Intravenous Magnesium Sulfate in Spinal Surgery: A Systematic Review and Meta-Analysis.

Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of magnesium sulfate is partial and controversial, necessitating a comprehensive meta-analysis to evaluate its efficacy and safety. The aim of this study was to conduct a comprehensive meta-analysis to evaluate the efficacy and safety of magnesium sulfate in spinal surgery compared to other available options. This meta-analysis adhered to the PRISMA guidelines. Patients undergoing spinal surgery were included, with the intervention group receiving intravenous magnesium sulfate (MS) at various doses or combinations, whereas the comparison group received other alternatives or a placebo. The efficacy and safety outcomes were assessed. Data were collected from multiple databases and analyzed using Review Manager version 5.4. Heterogeneity was assessed and fixed- or random-effects models were applied. The meta-analysis included eight studies (n = 541). Magnesium sulfate demonstrated significant reductions in pain at 24 h (MD -0.20, 95% CI: -0.39 to -0.02) and opioid consumption (SMD -0.66, 95% CI: -0.95 to -0.38) compared to placebo. Additionally, a decrease in the use of muscle relaxants (SMD -0.91, 95% CI: -1.65 to -0.17) and remifentanil (SMD -1.52, 95% CI: -1.98 to -1.05) was observed. In contrast, an increase in extubation time (MD 2.42, 95% CI: 1.14 to 3.71) and verbal response (MD 1.85, 95% CI: 1.13 to 2.58) was observed compared to dexmedetomidine. In conclusion, magnesium sulfate administration in spinal surgery reduced pain and opioid consumption, and prolonged orientation and verbal response. No significant differences in blood pressure or heart rate were observed between the groups.

Incidence of cardiac anomalies in congenital vertebral deformity: systematic review and meta-analysis of 2910 patients.

PURPOSE: This study aimed to analyze the overall incidence of cardiac abnormalities in patients with congenital scoliosis and the possible influencing factors. METHODS: PubMed, Embase, and Cochrane Library were searched for relevant studies. The quality of the studies was assessed independently by two authors using the methodological index for nonrandomized studies (MINORS) criteria. The following data were extracted from the included studies: bibliometric data, number of patients, number of patients with cardiac anomalies, gender, types of deformity, diagnostic method, type of cardiac anomaly, location, and other associated anomalies. The Review Manager 5.4 software was used to group and analyze all the extracted data. RESULTS: This meta-analysis included nine studies and identified that 487 of 2,910 patients with congenital vertebral deformity had cardiac anomalies diagnosed by ultrasound (21.05%, 95% CI of 16.85-25.25%). The mitral valve prolapse was the most frequent cardiac anomaly (48.45%) followed by an unspecified valvular anomaly (39.81) and an atrial septal defect (29.98). A diagnosis of cardiac anomalies was highest in Europe (28.93%), followed by USA (27.21%) and China (15.33%). Females and formation defects were factors significantly associated with increased incidence of cardiac anomalies: 57.37%, 95% CI of 50.48-64.27% and 40.76%, 95% CI of 28.63-52.89%, respectively. Finally, 27.11% presented associated intramedullary anomalies. CONCLUSIONS: This meta-analysis revealed that the overall incidence of cardiac abnormalities detected in patients with congenital vertebral deformity was 22.56%. The incidence rate of cardiac anomalies was higher in females and those with formation defects. The study offers guidance for ultrasound practitioners to accurately identify and diagnose the most common cardiac anomalies.

Efficacy of perioperative gabapentin use in patients with idiopathic scoliosis undergoing fusion surgery: a systematic review and meta-analysis.

PURPOSE: This study aimed to assess whether the perioperative use of gabapentin was associated with decreased opioid use. METHODS: A meta-analysis was performed using PubMed, Embase, Scopus, and Cochrane Library. The randomized clinical trials included were focused on patients with adolescent idiopathic scoliosis who underwent posterior fusion surgery and were treated with gabapentin versus placebo medicine. The primary outcomes were opioid consumption at 24, 48, 72, and 96 h; time to introduction of oral medication, length of hospital stay, and period of urinary catheterization were also recorded. Data were combined using the Review Manager 5.4 software. RESULTS: Four randomized clinical trials with a pool of 196 adolescent patients (mean age: 14.8 ± 2.0 years) were included. At 24 and 48 h after surgery, opioid consumption was significantly lower in the gabapentin group: (standardized mean difference [SMD]: -0.50; 95% confidence interval [CI] - 0.79 to - 0.22) and (SMD: - 0.59; 95% CI - 0.88 to - 0.30), respectively. At 72 and 96 h, there were no significant differences between studies: (SMD: - 0.19; 95% CI - 0.52 to 0.13) and (SMD: 0.12; 95% CI - 0.25 to 0.50), respectively. Regarding the administration type, there were significant differences in favor of the 15 mg/kg subgroup with 600 mg at 48 h (SMD: - 0.69; 95% CI - 1.08 to - 0.30). There were no significant differences concerning the time to introduction of oral medication (MD: - 0.08; 95% CI - 0.39 to 0.23), hospitalization time (MD: - 0.12; 95% CI - 0.40 to 0.16), or period of urinary catheterization (SMD: - 0.27; 95% CI - 0.58 to 0.05). CONCLUSIONS: Gabapentin decreased opioid consumption during the first 48 h. Doses of 15 mg/kg showed superiority in reducing opioid consumption in the first 48 h. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Meta-analysis on the efficacy and safety of anterior vertebral body tethering in adolescent idiopathic scoliosis.

PURPOSE: In this meta-analysis, we analyzed the efficacy and safety of anterior vertebral body tethering in patients with adolescent idiopathic scoliosis. METHODS: We performed a literature search and analyzed the following data: baseline characteristics, efficacy measures (corrections of the main thoracic curve, proximal thoracic curve, and thoracolumbar curve, thoracic kyphosis, lumbosacral lordosis, rib hump, lumbar prominence and SRS-22 scores, and complications. Analyses were performed with Cochrane's Review Manager version 5.4. RESULTS: Twelve studies met the inclusion criteria. Significant corrections of the main thoracic (MD 22.51, 95% CI 12.93 to 32.09) proximal thoracic (MD 10.14°, 95% CI 7.25° to 13.02°), and thoracolumbar curve (MD 12.16, 95% CI 9.14 to 15.18) were found. No statistically significant corrections were observed on the sagittal plane assessed by thoracic kyphosis (MD - 0.60°, 95% CI - 2.45 to 1.26; participants = 622; studies = 4; I2 = 36%) and lumbosacral lordosis (MD 0.19°, 95% CI - 2.16° to 2.54°). Significant corrections were identified for rib hump (MD 5.26°, 95% CI 4.19° to 6.32°) and lumbar prominence (MD 1.20°, 95% CI 0.27° to 2.13°) at final follow-up. Significant improvements of total SRS-22 score (MD - 0.96, 95% CI - 1.10 to - 0.83) were achieved at final follow-up. The most common complication was overcorrection (8.0%) and tether breakage (5.9%), with a reoperation rate of 10.1%. CONCLUSIONS: Anterior vertebral body tethering is effective to reduce the curve in the coronal plane and clinical deformity. Maximum correction is achieved at one year. The method should, however, be optimized to reduce the rate of complications.

Meta-analysis of the efficacy of ketamine in postoperative pain control in adolescent idiopathic scoliosis patients undergoing spinal fusion.

PURPOSE: In this meta-analysis, we aim to compare ketamine use versus a control group (saline solution) during induction of anesthesia in adolescent idiopathic scoliosis patients undergoing fusion surgery in terms of postoperative opioid consumption, pain control, and side effects. METHODS: A PubMed search of studies published over the last 20 years using the descriptor/terms "ketamine AND scoliosis" was performed. Baseline characteristics of each article were obtained and efficacy measures analyzed (morphine equivalent treatment at 24, 48, and 72 h postoperatively, complications (vomiting/nausea and pruritus), length of hospital stay (days); and pain score (VAS)) (Review Manager 5.4 software package). RESULTS: Five randomized clinical trials were included. Morphine administration showed statistically significant differences at 24 and 48 h (MD - 0.15, 95% CI - 0.18 to - 0.12) and (MD - 0.26, 95% CI - 0.31 to - 0.21) between the ketamine and control (saline solution), respectively. No intergroup differences were found regarding nausea/vomiting and pruritus (OR 0.77, 95% CI 0.35 to 1.67) and (OR 0.71, 95% CI 0.31 to 1.62), respectively, same as for the pain score (MD - 0.75, 95% CI - 1.71 to 0.20). CONCLUSIONS: The use intraoperative and postoperative continuous low doses of ketamine significantly reduces opioid use throughout the first 48 h in patients with AIS who undergo posterior spinal fusion.

Socioeconomic inequalities in low birth weight risk before and during the COVID-19 pandemic in Argentina: A cross-sectional study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have exacerbated existing socioeconomic inequalities in health. In Argentina, public hospitals serve the poorest uninsured segment of the population, while private hospitals serve patients with health insurance. This study aimed to assess whether socioeconomic inequalities in low birth weight (LBW) risk changed during the first wave of the COVID-19 pandemic. METHODS: This multicenter cross-sectional study included 15929 infants. A difference-in-difference (DID) analysis of socioeconomic inequalities between public and private hospitals in LBW risk in a pandemic cohort (March 20 to July 19, 2020) was compared with a prepandemic cohort (March 20 to July 19, 2019) by using medical records obtained from ten hospitals. Infants were categorized by weight as LBW < 2500 g, very low birth weight (VLBW) < 1500 g and extremely low birth weight (ELBW) < 1000 g. Log binomial regression was performed to estimate risk differences with an interaction term representing the DID estimator. Covariate-adjusted models included potential perinatal confounders. FINDINGS: Of the 8437 infants in the prepandemic cohort, 4887 (57•9%) were born in public hospitals. The pandemic cohort comprised 7492 infants, 4402 (58•7%) of whom were born in public hospitals. The DID estimators indicated no differences between public versus private hospitals for LBW risk (-1•8% [95% CI -3•6, 0•0]) and for ELBW risk (-0•1% [95% CI -0•6, 0•3]). Significant differences were found between public versus private hospitals in the DID estimators (-1•2% [95% CI, -2•1, -0•3]) for VLBW risk. The results were comparable in covariate-adjusted models. INTERPRETATION: In this study, we found evidence of decreased disparities between public and private hospitals in VLBW risk. Our findings suggest that measures that prioritize social spending to protect the most vulnerable pregnant women during the pandemic contributed to better birth outcomes. FUNDING: No funding was secured for this study.

Avoiding Above-the-Knee Amputation with a Free Tibiofibular-Talocalcaneal Fillet Flap and Free Latissimus Dorsi Flap.

Despite the advances achieved in reconstructive surgery, amputation is still the only option after some severe traumas. Preservation of the knee joint is considered a significant functional advantage. We present the case of a 39-year-old man with a comminuted Gustilo type IIIC open tibia fracture with massive bone loss. To achieve a well-fashioned amputation stump and preserve the knee joint, a free osteocutaneous fillet flap was performed, including the distal tibia and fibula, talus, and calcaneus bones. As a result, a sensate and long amputation stump covered with thick skin from the sole of the foot provided a stable coverage with an excellent functional result and adjustment to prosthesis.

Spiral ganglion cells and macrophages initiate neuro-inflammation and scarring following cochlear implantation.

Conservation of a patient's residual hearing and prevention of fibrous tissue/new bone formation around an electrode array are some of the major challenges in cochlear implant (CI) surgery. Although it is well-known that fibrotic tissue formation around the electrode array can interfere with hearing performance in implanted patients, and that associated intracochlear inflammation can initiate loss of residual hearing, little is known about the molecular and cellular mechanisms that promote this response in the cochlea. In vitro studies in neonatal rats and in vivo studies in adult mice were performed to gain insight into the pro-inflammatory, proliferative, and remodeling phases of pathological wound healing that occur in the cochlea following an electrode analog insertion. Resident Schwann cells (SC), macrophages, and fibroblasts had a prominent role in the inflammatory process in the cochlea. Leukocytes were recruited to the cochlea following insertion of a nylon filament in adult mice, where contributed to the inflammatory response. The reparative stages in wound healing are characterized by persistent neuro-inflammation of spiral ganglion neurons (SGN) and expression of regenerative monocytes/macrophages in the cochlea. Accordingly, genes involved in extracellular matrix (ECM) deposition and remodeling were up-regulated in implanted cochleae. Maturation of scar tissue occurs in the remodeling phase of wound healing in the cochlea. Similar to other damaged peripheral nerves, M2 macrophages and de-differentiated SC were observed in damaged cochleae and may play a role in cell survival and axonal regeneration. In conclusion, the insertion of an electrode analog into the cochlea is associated with robust early and chronic inflammatory responses characterized by recruitment of leukocytes and expression of pro-inflammatory cytokines that promote intracochlear fibrosis and loss of the auditory hair cells (HC) and SGN important for hearing after CI surgery.

Chronic infections of the spine.

Chronic infections following posterior fusion are relatively uncommon. They develop in a previous asymptomatic patient at a distant time from the surgery. Chronic infections arise from direct inoculation or hematogenous seeding. To eradicate a chronic infection, the pathogens, biofilm, non-viable tissues, adherence on surfaces, and instrumentation must be removed. The appropriate antibiotherapy is used in a short (4 weeks) or long protocol (9 weeks). Some patients may need repeated surgeries (leaving the instrumentation in situ) to avoid progressive deformity or symptomatic pseudoarthrosis in cases of implant removal.

Pain and disability following fusion for idiopathic adolescent scoliosis: prevalence and associated factors.

STUDY DESIGN: Retrospective prognostic study. OBJECTIVES: To describe the prevalence of pain following fusion for adolescent idiopathic scoliosis and to identify factors associated with pain and disability. METHODS: From 126 consecutive patients surgically treated for scoliosis between 1997 and 2007, 104 (82.5%) completed SRS-22 and ODI questionnaires at a last follow-up (mean, 4.8 years; range 1-11.2 years). Prevalence of pain and disability were determined from SRS questions 1 and 9 respectively, with "any" pain or decrease in activity considered clinically significant. SRS Pain Domain Scores (PDS) were also evaluated. RESULTS: Most participants reported "no pain" (38.5%) or "mild pain" (30.8%) and 72.1% of participants reported a current work/school activity level of 100% normal. An association between instrument type and the presence of any pain in the previous 6 months was noted (P = .022). Instrument type was the only factor that was significantly associated with the PDS (P = .0052). CONCLUSIONS: The high percentage of patients reporting no pain or mild pain may suggest overall success of the procedures. Although an association between instrument type and pain was seen, unmeasured factors that contributed to the decision of what instrument to use may confound the relationship. From these data a causal inference cannot be made.Final class of evidence-prognosisSTUDY DESIGNProspective CohortRetrospective Cohort•Case controlCase seriesMETHODSPatients at similar point in course of treatment•F/U ≥ 85%Similarity of treatment protocols for patient groupsPatients followed up long enough for outcomes to occur•Control for extraneous risk factors•*Overall class of evidenceIIIThe definiton of the different classes of evidence is available on page 55.*Potentially confounding factors were systematically explored and considered for stratified analysis as appropriate.

Beneficial effects of aerobic training in adolescent patients with moderate idiopathic scoliosis.

AIM AND METHODS: The major aim of this study was to determine whether after 6 weeks of aerobic training adolescent idiopathic scoliosis (AIS) girls who suffer from mild scoliotic curvatures (n = 6) behaved in a similar way than healthy controls (n = 6) in different biochemical, anthropometric, and cardio respiratory parameters. RESULTS: The maximal power output and the power output achieved at the anaerobic threshold (AT), during the maximal exercise test, were significantly increased in both experimental groups, when compared with resting conditions. The training program caused significant changes in body composition (i.e., a decrease in body fat %) only in the scoliotic group. Regarding the cardio respiratory measurements, VO(2max) was increased by 17% in AIS group and 10% in the healthy group. CONCLUSIONS: Our results suggest that physical activity should be encouraged in scoliotic girls with mild curvatures.

[Efficacy and securyty of therapeutic hypothermia for hypoxic ischemic encephalopathy: a meta-analysis]. / Meta análisis sobre la eficacia y seguriada de la hipotermia en el tratamiento de la encefalopatía isquémica.

BACKGROUND: Animal and human experimental models suggest that therapeutic hypothermia could reduce neurological disabilities in asphyxiated newborn without adverse events. The objective of this study was review the effectiveness and safety of hypothermia as treatment for hypoxic ischemic encephalophaty. METHODS: MEDLINE, COCHRANE LIBRARY, Academic Google and LILACS databases were searched. Randomized controlled trials with main outcomes of death, neurodevelopmental disability and adverse events were eligible for inclusion in the meta-analysis. RESULTS: Tree studies were included with 751 patients. Combined results of death reduction was not significant (RR 0.83 CI95% 0.67 to 1.04). Severe to moderate neurodevelopmental disability (RR 0.70 CI95% 0.55 to 0.89) and cerebral palsy (RR 0.66 CI95% 0.50 to 0.89) were reduced significantly in newborns receiving hypothermia compared with controls. Cardiac arrhythmias (RR 3.51 CI95% 1.29 to 9.54) and coagulation disorders (RR 1,23 CI95% 1.03 a 1.48) were more common adverse events with hypothermia. CONCLUSIONS: Hypothermia is effective in reducing neurological disability and cerebral palsy. Cardiac arrhythmias and coagulation disorders were more common with hypothermia, however they were clinically benign.

Sex differences in intraventricular hemorrhage rates among very low birth weight newborns.

BACKGROUND: The influence of male or female sex on newborn outcomes has been recognized for >30 years. Several studies have observed higher mortality and morbidity in males than in females. It is not clear how this sex difference is sustained in postnatal complications such as intraventricular hemorrhage (IVH), especially in very low birth weight (VLBW) newborns. OBJECTIVE: This study examined possible sex-related differences in IVH rates among VLBW neonates. METHODS: In a retrospective observational study conducted in Hospital Privado, Córdoba, Argentina, data from 332 consecutive VLBW newborns in a 12-year period were reviewed. Maternal factors, labor and delivery characteristics, and neonatal parameters, including the results of cranial ultrasound examination to detect IVH, were compared for males and females. Bivariate and multivariate logistic regression analyses were performed. RESULTS: A total of 322 VLBW newborns were included, 168 males and 154 females. Compared with female neonates, male neonates had a higher risk of overall IVH (26.8% vs 9.7%; odds ratio [OR] = 3.4 [95% CI, 1.8-6.4]; P < 0.001) and for grades III or IV on the Papile scale (16.1% vs 1.9%; OR = 9.6 [95% CI, 2.9-32.5]; P < 0.001). In the multivariate logistic regression model, male sex sustained the association with a greater risk of IVH (OR = 6.8 [95% CI, 3.8-12.0]). CONCLUSIONS: IVH was significantly associated with male sex in these VLBW newborns. Because other factors affect these differences, further research is required.

Comparación de la morbimortalidad entre recién nacidos prematuros pequeños y adecuados para la edad gestacional de acuerdo a estándares de crecimiento neonatales y fraccionales / Comparison of the morbimortality between small premature newborns and adequate for gestational age in agreement to standards of neonatal and fractional growth

Objetivo: Evaluar eventos neonatales adversos en recién nacidos prematuros ≤ 34 semanas pequeños y adecuados para su edad gestacional de acuerdo a estándares de crecimiento neonatales y fraccionales. Material y métodos: Estudio de una cohorte hospitalaria de recién nacidos prematuros con una edad gestacional ≤ 34 semanas, admitidos a la unidad de cuidados intensivos neonatales, desde el 1/1/98 hasta el 31/12/08. Las variables estudiadas fueron: mortalidad, enfermedad de membrana hialina, displasia broncopulmonar, hemorragia intraventricular (todos los grados), enterocolitis necrotizante y retinopatía del prematuro (todos los estadios). Las mismas se analizaron en un modelo de riesgo estimado mediante el cálculo del OR con IC95 por ciento. Resultados: La prevalencia de recién nacidos pequeños para la edad gestacional de acuerdo a los estándares de crecimiento neonatales fue de 56/218 (25,7 por ciento IC95 por ciento 19,6 a 31,7), mientras que de acuerdo a los estándares fraccionales fue de 78/218 (35,8 por ciento IC95 por ciento 29,2 - 42,4, p = 0,029). Cuando los recién nacidos prematuros pequeños para la edad gestacional fueron comparados a los adecuados para la edad gestacional de acuerdo a los estándares fraccionales presentaron un riesgo significativamente aumentado para mortalidad (OR 3 IC95 por ciento 1,2-7,7); enfermedad de membrana hialina (OR 2,7 IC95 por ciento 1,1-6,9), displasia broncopulmonar (OR 1,9 IC95 por ciento 1,1-3,7) y hemorragia intraventricular (OR 3,8 IC95 por ciento 2-6,9), mientras que el cotejo con estándares neonatales no arrojó diferencias. Conclusión: Las curvas fraccionales identificaron un aumento significativo en el riesgo de eventos adversos en prematuros pequeños para la edad gestacional, en comparación con las curvas neonatales.

Objective: To evaluate neonatal and fractional growth standards in determining charges of mortality and morbidity between premature small for gestational age infants. Material and methods: Hospital-based cohort study of singleton newborns of ≤ 34 weeks gestational age admitted to neonatal intensive care unit between January 1, 1998 and December 31, 2008. Outcome variables include: mortality, hyaline membrane disease, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and retinopathy of prematurity. For each variable bivariate analysis were performed (OR CI95 per cent). Results: The prevalence of small for gestational age according to neonatal growth standards was 56/218 (25.7 per cent, CI95 per cent 19.6-31.7) and according to fractional standards was 78/218 (35.8 per cent CI95 per cent 29.2-42.4, p= 0.029). According to fractional growth standards, when small for gestational age was compared with adequate for gestational age, it was associated with an increased risk of mortality (OR 3 CI95 per cent 1.2-7.7), hyaline membrane disease (OR 2, 7, CI95 per cent 1.1-6.9), bronchopulmonary dysplasia (OR 1.9 CI 95 per cent 1.1-3.7) and intraventricular hemorrhage (OR 3.8 CI95 per cent 2-6.9). Neonatal growth standard was not associated with an increased risk of mortality or morbidity. Conclusions: Fractional growth standards identifying an increased risk of adverse neonatal outcomes between preterm SGA infants, than neonatal standards.

Valor de la troponina T como marcador de daño miocárdico en recién nacidos de madres con hipertensión inducida por la gestación / Value of the troponina T like scoreboard of hurt damage miocárdico in newborn children of mothers with hypertension induced by the gestation

La hipertensión inducida por la gestación (HIG) puede reducir el flujo sanguíneo útero-placentario, provocar hipoxia, desnutrición fetal y restricción del crecimiento intrauterino (RCIU). La HIG puede generar un medio intrauterino adverso en su función de proveer oxígeno y nutrientes al feto, el cual inicia respuestas de adaptación para sobrevivir. Estos mecanismos de defensa privilegian el aporte de oxígeno hacia el cerebro en detrimento de otros órganos, incluyendo el miocardio. El medio intrauterino hostil, expresado en el bajo peso al nacer, se ha relacionado a la aparición de enfermedades crónicas en la edad adulta, tales como hipertensión arterial, diabetes tipo 2 y enfermedad coronaria (EC). La troponina T, proteína que integra la unidad contráctil actina-miosina del miocardio, es el mejor marcador de isquemia cardiaca en adultos con enfermedad coronaria (EC). Niveles elevados de troponina T en sangre de cordón (TTSC) en recién nacidos de madres con HIG pueden estar asociados a isquemia cardiaca fetal. Nos propusimos evaluar la presencia de isquemia cardiaca fetal en embarazos complicados con HIG a través de la medición de TTSC. Estudio prospectivo de corte, reclutando neonatos de embarazos normales y recién nacidos de madres con HIG. El valor promedio TTSC del grupo control fue 0,021 µg/L ± 0,011. El valor promedio TTSC en neonatos de madres con HIG fue 0,035 ± 0,021 µg/L. Los valores de TTSC se hallaron más altos en neonatos de madres con HIG (p=0,001). El 23,5% presento RCIU y un 11,76% Sindrome de Dificultad Respiratoria (SDR) y requerimiento oxigeno. Podemos concluir que los recién nacidos de madres con HIG tienen valores más elevados de TTSC. Esto sugiere que la HIG podría estar asociada a isquemia cardiaca en el feto.

Valor de la troponina T como marcador de daño miocárdico en recién nacidos de madres con hipertensión inducida por la gestación / Value of the troponina T like scoreboard of hurt damage miocárdico in newborn children of mothers with hypertension induced by the gestation

La hipertensión inducida por la gestación (HIG) puede reducir el flujo sanguíneo útero-placentario, provocar hipoxia, desnutrición fetal y restricción del crecimiento intrauterino (RCIU). La HIG puede generar un medio intrauterino adverso en su función de proveer oxígeno y nutrientes al feto, el cual inicia respuestas de adaptación para sobrevivir. Estos mecanismos de defensa privilegian el aporte de oxígeno hacia el cerebro en detrimento de otros órganos, incluyendo el miocardio. El medio intrauterino hostil, expresado en el bajo peso al nacer, se ha relacionado a la aparición de enfermedades crónicas en la edad adulta, tales como hipertensión arterial, diabetes tipo 2 y enfermedad coronaria (EC). La troponina T, proteína que integra la unidad contráctil actina-miosina del miocardio, es el mejor marcador de isquemia cardiaca en adultos con enfermedad coronaria (EC). Niveles elevados de troponina T en sangre de cordón (TTSC) en recién nacidos de madres con HIG pueden estar asociados a isquemia cardiaca fetal. Nos propusimos evaluar la presencia de isquemia cardiaca fetal en embarazos complicados con HIG a través de la medición de TTSC. Estudio prospectivo de corte, reclutando neonatos de embarazos normales y recién nacidos de madres con HIG. El valor promedio TTSC del grupo control fue 0,021 Ag/L ± 0,011. El valor promedio TTSC en neonatos de madres con HIG fue 0,035 ± 0,021 Ag/L. Los valores de TTSC se hallaron más altos en neonatos de madres con HIG (p=0,001). El 23,5% presento RCIU y un 11,76% Sindrome de Dificultad Respiratoria (SDR) y requerimiento oxigeno. Podemos concluir que los recién nacidos de madres con HIG tienen valores más elevados de TTSC. Esto sugiere que la HIG podría estar asociada a isquemia cardiaca en el feto.(AU)

Comparación de la morbimortalidad entre recién nacidos prematuros pequeños y adecuados para la edad gestacional de acuerdo a estándares de crecimiento neonatales y fraccionales / Comparison of the morbimortality between small premature newborns and adequate for gestational age in agreement to standards of neonatal and fractional growth

Objetivo: Evaluar eventos neonatales adversos en recién nacidos prematuros ≤ 34 semanas pequeños y adecuados para su edad gestacional de acuerdo a estándares de crecimiento neonatales y fraccionales. Material y métodos: Estudio de una cohorte hospitalaria de recién nacidos prematuros con una edad gestacional ≤ 34 semanas, admitidos a la unidad de cuidados intensivos neonatales, desde el 1/1/98 hasta el 31/12/08. Las variables estudiadas fueron: mortalidad, enfermedad de membrana hialina, displasia broncopulmonar, hemorragia intraventricular (todos los grados), enterocolitis necrotizante y retinopatía del prematuro (todos los estadios). Las mismas se analizaron en un modelo de riesgo estimado mediante el cálculo del OR con IC95 por ciento. Resultados: La prevalencia de recién nacidos pequeños para la edad gestacional de acuerdo a los estándares de crecimiento neonatales fue de 56/218 (25,7 por ciento IC95 por ciento 19,6 a 31,7), mientras que de acuerdo a los estándares fraccionales fue de 78/218 (35,8 por ciento IC95 por ciento 29,2 - 42,4, p = 0,029). Cuando los recién nacidos prematuros pequeños para la edad gestacional fueron comparados a los adecuados para la edad gestacional de acuerdo a los estándares fraccionales presentaron un riesgo significativamente aumentado para mortalidad (OR 3 IC95 por ciento 1,2-7,7); enfermedad de membrana hialina (OR 2,7 IC95 por ciento 1,1-6,9), displasia broncopulmonar (OR 1,9 IC95 por ciento 1,1-3,7) y hemorragia intraventricular (OR 3,8 IC95 por ciento 2-6,9), mientras que el cotejo con estándares neonatales no arrojó diferencias. Conclusión: Las curvas fraccionales identificaron un aumento significativo en el riesgo de eventos adversos en prematuros pequeños para la edad gestacional, en comparación con las curvas neonatales.(AU)

Objective: To evaluate neonatal and fractional growth standards in determining charges of mortality and morbidity between premature small for gestational age infants. Material and methods: Hospital-based cohort study of singleton newborns of ≤ 34 weeks gestational age admitted to neonatal intensive care unit between January 1, 1998 and December 31, 2008. Outcome variables include: mortality, hyaline membrane disease, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and retinopathy of prematurity. For each variable bivariate analysis were performed (OR CI95 per cent). Results: The prevalence of small for gestational age according to neonatal growth standards was 56/218 (25.7 per cent, CI95 per cent 19.6-31.7) and according to fractional standards was 78/218 (35.8 per cent CI95 per cent 29.2-42.4, p= 0.029). According to fractional growth standards, when small for gestational age was compared with adequate for gestational age, it was associated with an increased risk of mortality (OR 3 CI95 per cent 1.2-7.7), hyaline membrane disease (OR 2, 7, CI95 per cent 1.1-6.9), bronchopulmonary dysplasia (OR 1.9 CI 95 per cent 1.1-3.7) and intraventricular hemorrhage (OR 3.8 CI95 per cent 2-6.9). Neonatal growth standard was not associated with an increased risk of mortality or morbidity. Conclusions: Fractional growth standards identifying an increased risk of adverse neonatal outcomes between preterm SGA infants, than neonatal standards.(AU)

[An amphibian model for the study of evolutionary respiratory control]. / Un modelo anfibio para el estudio evolutivo del control respiratorio.

Recent perinal advances have made possible that premature newborns survive increasingtly in earlier developmental stages. This babies requires sophisticated and costly critical intensive care to address the problems associated with inmadurity of the respiratory system. In addition respiratory instability and apnea reflecting inmaturity of the respiratory control system are major causes of morbidity and prolonged hospitalization in this highly vulnerable group of patients. These concerns have contributed to the development of research in respiratoy evolutionary neurobiology. While the majority of researchers working in this field use rodents as an animal model, recent research using in vitro brainstem preparations from bullfrog (Rana catesbeiana) have reveled the technical advantages of this model to study the basic principles underlying respiratory control and its ontogeny between vertebrates. The present article review the recent advances in the area of research with special interest on episodic breathing and the role of serotoninergic and GABAergic modulation of respiratory control during development.

Un modelo anfibio para el estudio evolutivo del control respiratorio / Anphibian model study for evolutionary respiratory control

Los enormes progresos de la medicina perinatal han permitido la sobrevivencia de recién nacidos prematuros en estadios de desarrollo cada vez más precoces. Estos pequeños pacientes requieren de medios muy sofisticados y costosos para paliar su inmadurez respiratoria. Además de las complicaciones asociadas al desarrollo pulmonar, la inestabilidad respiratoria y las apneas asociadas a la inmadurez de los circuitos nerviosos productores del control respiratorio, contribuyendo éstos últimas, como factor principal de morbilidad, a las prolongadas hospitalizaciones que presenta esta tan vulnerable población. Éstos imperativos médicos combinados a la curiosidad fisiológica han contribuido al desenvolvimiento de novedosas investigaciones en neurobiología respiratoria. Si bien la mayoría de los trabajos realizados en éste campo utilizan a los múridos como modelos experimentales, las investigaciones recientes efectuadas a partir del tronco cerebral aislado de anfibios (Rana catesbeiana) han revelado las ventajas técnicas de este modelo animal, para mostrar los principales fenómenos que rigen el funcionamiento y el desarrollo del sistema de control respiratorio entre los vertebrados. El presente artículo se propone repasar los avances más recientes realizados en la investigación de la neurobiología evolutiva del control respiratorio, prestando una atención particular a la respiración episódica, así como al rol que desempeñan la modulación serotoninérgica y Gabaérgica de la actividad respiratoria en el curso del desarrollo.

Recent perinal advances have made possible that premature newborns survive increasingtly in earlier developmental stages. This babies requires sophisticated and costly critical intensive care to address the problems associated with inmadurity of the respiratory system. In addition respiratory instability and apnea reflecting inmaturity of the respiratory control system are major causes of morbidity and prolonged hospitalization in this highly vulnerable group of patients. These concerns have contributed to the development of research in respiratoy evolutionary neurobiology. While the majority of researchers working in this field use rodents as an animal model, recent research using in vitro brainstem preparations from bullfrog (Rana catesbeiana) have reveled the technical advantages of this model to study the basic principles underlying respiratory control and its ontogeny between vertebrates. The present article review the recent advances in the area of research with special interest on episodic breathing and the role of serotoninergic and GABAergic modulation of respiratory control during development.