Sistema de intervención psicológica en unidad de cuidados intensivos neonatales: intervención psicológica en padres de niños prematuros / Psychological intervention system in neonatal intensive care unit: psychological intervention in preterm neonate’s parents

Objetivos: Evaluar el grado de estrés, estado emocional y preocupaciones que dificultan la relación paterno-filial, cuando un niño prematuro de muy bajo peso al nacer (inferior a 1.500 gramos), ingresa en la Unidad de Cuidados Intensivos Neonatales (UCIN), para diseñar una intervención psicológica apropiada que promueva el vínculo de los padres hacia su hijo. Material y métodos: Los sujetos en estudio fueron los padres de los recién nacidos de muy bajo peso ingresados en UCIN durante el periodo de estudio. El método utilizado fue la aplicación de un cuestionario de estrés (PSS:NICU) y otro de reacciones emocionales (Cuestionario de Neonatología), en los primeros 10 días de ingreso, y realización de Grupos de Padres, durante la hospitalización. Con los datos de los cuestionarios se realizó un análisis descriptivo, a través del programa SPSS 10 para Windows. Resultados: El 89% de las familias aceptaron el apoyo psicológico ofrecido. El 45,5%de madres y 38% de padres evalúan como extremadamente estresante la situación de hospitalizaciónde su hijo, aunque predominando los sentimientos positivos que se experimentan hacia su hijo y el personal sanitario que lo cuida, respecto a los negativos. Conclusiones: La Escala PSS:NICU y el Cuestionario de Neonatología son instrumentos adecuados de valoración en UCIN. Los Grupos de Padres representan un elemento terapéutico de primer orden como intervención psico-educativa que facilita un estilo de afrontamiento más activo, promoviendo el vínculo paterno-filial. Convendría impulsar la atención temprana padres-hijo desde la hospitalización, y mantener un seguimiento tras el alta hospitalaria de estas familias. Para ello, se hace necesario incluir profesionales psicólogos que realicen esta labor desde el nacimiento hasta edades escolares

Objective: To evaluate the stress degree, emotional state and worries preterm’s parents that make difficult the bonding, when a very low weight preterm neonate (below 1.500 grams) is admitted in the Neonatal Intensive Care Unit (NICU), and design an appropriate psychological intervention to promote attachment between parents and baby. Design and methods: The subjects were very low weight preterm neonate’s parents, admitted in the NICU, during the study period. The parents were evaluated by the PSS:NICU and Neonatology Questionnaire in the first ten days in the NICU, and assistanceto the Parents Group, during newborn’s hospitalization. It was made a descriptive analysis of the PSS:NICU and Neonatology Questionnaire dates. Results: 89% of the families accepted psychological support offered. 45,5% of mothersand 38% of fathers rated as extremely stressful the experience of having their baby hospitalized in the NICU, although positive feelings to their baby and to the staff who careof the baby, are more experienced than negative. Conclusions: PSS:NICU Scale and Neonatology Questionnaire are assessment instruments appropriated for NICU. Parents Group is the most therapeutic element as psycho-educational intervention, promoting attachment parents-baby. It will be good foment the early attention parents-baby, since hospitalization, and continue tracking after discharge in these families. For this, it is necessary include psychologist professionals that make this functions since birth until scholar ages

[Medication errors in a neonatal unit]. / Errores en las prescripciones médicas en una unidad neonatal.

INTRODUCTION: Medication errors occur as a result of human mistakes or system flaws and could be prevented by studying and modifying the conditions that predispose to errors. In recent years, interest in medical errors has increased because of their health and economic implications. OBJECTIVES: To evaluate the frequency and types of prescribing errors in the Neonatology Unit of the Hospital 12 Octubre before and after an intervention to raise awareness of errors among the medical staff by comparing the frequency of error before and after the intervention. PATIENTS AND METHODS: We conducted a prospective pilot study in two phases. In the first phase, we studied prescribing errors by reviewing 100 prescriptions for newborns admitted to the Intensive or Intermediate Care Units. When the prescriptions were written, the neonatologists were unaware that the study would be performed. Legibility, dose, units used to express medications, route of administration, use of abbreviations, specification of dosage per kilogram of body weight and use of brand names were evaluated. The information was analyzed and an information-training intervention was performed in which the results were made known in a clinical session and recommendations for improving prescriptions were made. In the second phase, another 100 prescriptions were reviewed. The results were compared with those obtained before the intervention using the chi-squared test. RESULTS: In the first phase, 22 % of prescriptions were illegible or doubtful, 4 % contained dose errors and 28 % did not specify the route of administration. After the intervention, 8 % (p 0.005) of prescriptions were illegible, 4 % contained dose errors and 5 % (p 0.0001) did not specify the route of administration. Regarding other quality markers, the percentage of prescriptions specifying dosage per kilogram of body weight increased from 46 % to 78 %. Brand names were used in 21 %. Units were always expressed in abbreviations. All errors were severity index 0 or 1. CONCLUSIONS: The first step in prevention is recognition of mistakes. Increasing awareness among the medical staff of the consequences of errors improved the quality of prescriptions in our department. Awareness of the frequency and type of errors is the first step towards implementing strategies to reduce iatrogeny.

Errores en las prescripciones médicas en una unidad neonatal / Medication errors in a neonatal unit

Introducción: Los errores de medicación son debidos a fallos humanos o del sistema de utilización de fármacos, y se pueden prevenir estudiando y modificando las situaciones que predisponen al error. En los últimos años el interés por este tema es creciente por su trascendencia sanitaria y económica. Objetivos: Estimar la frecuencia y las características de los errores de prescripción en el Servicio de Neonatología del Hospital 12 Octubre antes y después de una intervención para concienciar al personal sobre el error médico, comparando la frecuencia del error preintervención y postintervención. Pacientes y métodos: Se trata de un estudio piloto con diseño prospectivo en dos fases. En la primera se realizó un estudio de los errores de prescripción, revisando 100 prescripciones de recién nacidos ingresados en cuidados intensivos e intermedios. Cuando se realizaron las prescripciones, los neonatólogos desconocían que se iba a realizar el estudio. Se valoró: legibilidad, dosificación, unidades en que se expresaba la medicación, vía de administración, uso de abreviaturas, especificación de la dosis por kilo de peso y uso de marcas comerciales. Tras analizar los datos, se realizó una intervención de información-formación que consistió en exposición de los datos en sesión clínica y recomendaciones para mejorar las prescripciones. En la segunda fase se realizó nueva revisión de las prescripciones y comparación de los errores preintervención y postintervención utilizando la prueba estadística de chi-cuadrado (2).Resultados: En el primer estudio se encontraron 22% de prescripciones ilegibles o dudosas, 4% con errores de dosificación y 28% en las que no constaba la vía de administración. Tras la intervención formativa se redujeron a 8% (p 0,005) prescripciones ilegibles, 4% con errores de dosificación y 5% sin especificación de la vía de administración. Respecto a otros marcadores de calidad de prescripción, la especificación de dosis por kilogramo de peso mejoró (de 46 a 78%). Se usaron nombres comerciales en el 21%. Las unidades siempre se expresan abreviadas. Todos los errores encontrados fueron de nivel de gravedad 0 ó 1. Conclusiones: El reconocimiento de un error es el primer paso para prevenirlo, y la concienciación de los médicos de las consecuencias de los errores han mejorado la calidad de las prescripciones en nuestro servicio. El ser conscientes de la frecuencia y de los tipos de errores que se comenten es el primer paso para poder establecer estrategias que permitan la disminución de la iatrogenia (AU)

[Outcome at 3 years of age in a low birth weight cohort]. / Evolución a los 3 años de edad de una cohorte de recién nacidos de muy bajo peso.

OBJECTIVE: The objective of this study was to establish the outcome at 3 years of age for very low birth weight newborns admitted to the Hospital 12 de Octubre from January 1991 to December 1993. PATIENTS AND METHODS: A follow-up study was performed. The pediatric assessment included a neurological, psychological, visual and audiological evaluation. At the end of the follow-up, children were blindly assessed to determine the rate of neurosensory disability. The severity of the neurosensory disability was graded as severe, moderate or mild by a functional classification. The rates of cerebral palsy, blindness and deafness were reported. RESULTS: Two hundred fifty-three infants between 500 and 1,499 g were admitted to the Hospital 12 de Octubre of which 182 survived. Of these, 137 (75% of the survivors) were assessed at 3 years of age. The children who dropped out during the follow-up period had similar characteristics to those with a complete follow-up program except that the drop-out child was more likely to belong to a disadvantaged family. The rate of neurosensory disability was 28.5% (39/137), 16% were mild, 5% moderate and 7% severe. The rate of cerebral palsy was 13% (18/137), blindness 1.4% and deafness 0.7%. CONCLUSIONS: Children from more disadvantaged families are less likely to continue in follow-up programs and this supposes a bias in the follow-up program. At 3 years, neurosensory disability was diagnosed in 1 out of every 4 children and cerebral palsy in 1 out of 8 children.

[High frequency ventilation in the newborn. Study of 27 cases]. / Ventilación de alta frecuencia en el recién nacido. Estudio de 27 casos.

The clinical histories of 27 neonates ventilated with high frequency respirators (Volumetric Diffusive Respirator VDR-2) have been analyzed in order to evaluate the efficiency of this type of ventilation in neonatal pathology. The average gestational age of these patients was 32 +/- 4 weeks. Most of them (70%) presented respiratory distress due to hyaline membrane disease. Of the remaining cases, three (11%) presented with congenital diaphragmatic hernia, two with pulmonary hypertension, two with meconium aspiration syndrome, one with Group B Streptococal sepsis/shock and one with case diaphragmatic agenesia. Between two and six hours after initiation of high frequency ventilation (HFV), pH, paCO2 and pO2 improved significantly in relationship to former values (p < 0.05- p < 0.001), reaching values in the normal range at 6.5 +/- 14 hours regarding pH, 30 +/- 50 hours regarding paCO2 and 6.5 +/- 10 hours regarding paO2. No hemodynamic modification could be attributed to this procedure. The principal complications were ectopic air (62%) and necrotizing tracheobronchitis (TBN) (25%). Bronchopulmonary dysplasia (BDP) was diagnosed in 20% of the cases, ductus (DAP) in 33% of the cases and intracraneal hemorrhage in 25% of the cases. Mortality was 70%. High frequency ventilation is an alternative procedure to conventional ventilation in this group of neonates. It produces an important number of favorable responses, but has complications that can not be overlooked.

PIP: Clinical records of 27 newborns treated with high frequency ventilation in a hospital neonatal service in Madrid were retrospectively studied. High frequency ventilation is a technique with specific indications that has recently been applied in some neonatal pathologies as an alternative to conventional ventilation. The respirators, model 2 Volumetric Diffusive Respirators, were used in 24 of the 27 cases because of failure of conventional ventilation. The 27 newborns weighed an average of 1850 +or- 944 g and ranged from 900 to 4000 g. Their average gestational age was 32 +or- 4 weeks, and the range was 26-42 weeks. 19 had respiratory difficulties stemming from hyaline membrane disease, 3 had congenital diaphragmatic hernias, 2 had pulmonary hypertension, and one each had meconium aspiration syndrome, septic shock from group B streptococcus, and diaphragmatic agenesia. 66% were delivered by cesarean. The pH, paCO2, and paO2 improved significantly between 2 and 6 hours after initiation of HFV treatment. Values in the normal range were reached at 6.5 +or- 14 hours for pH, 30 +or- 50 hours for paCO2, and 6.5 +or- 10 hours for paO2. No hemodynamic modifications were attributed to HFV. The most significant complications were ectopic air (62%) and necrotizing tracheobronchitis (25%). Broncopulmonary dysphasia was diagnosed in 20%, ductus in 33%, and intracraneal hemorrhage in 25%. The case fatality rate was 70%. Ten newborns improved definitively with HFV and proceeded to conventional ventilation. Two later succumbed to other causes. The study showed that HFV can lead to serious complications and should be applied with great prudence despite it great potential benefit.

[Asphyxiating thoracic dysplasia in 2 dizygotic twins]. / Displasia torácica asfixiante en dos gemelas dicigóticas.

Two cases of asphyxiating thoracic dysplasia in a pair of dizygous twin females are described. Both were diagnosed at birth and presented characteristic clinical, radiological and pathological features of this rare entity.

[Follow-up of children born to parents affected by the toxic oil syndrome]. / Seguimiento de hijos nacidos de padres afectados por el síndrome tóxico.

Conditions at birth and evolution during the first year of life of a group of infants whose parents were affected by the Spanish Toxic Syndrome are presented. They are distributed in three groups: first those infants of high risk whose father or mother (or both) have consumed toxic oil; second children whose parents had consumed non-brandname oil not demonstrated to have been toxic and without signs of disease; and a third control group of normal newborns without previous medical history. From the present study, authors cannot affirm whether ingestion of toxic oil by pregnant women had influenced intrauterine growth or first year growth. Nonetheless, new studies are needed which clarify evolutionary aspects of these children.