Translating Neonatal Resuscitation Guidelines Into Practice in Brazil.

BACKGROUND AND OBJECTIVES: The Brazilian Neonatal Resuscitation Program releases guidelines based on local interpretation of international consensus on science and treatment recommendations. We aimed to analyze whether guidelines for preterm newborns were applied to practice in the 20 Brazilian Network on Neonatal Research centers of this middle-income country. METHODS: Prospectively collected data from 2014 to 2020 were analyzed for 8514 infants born at 230/7 to 316/7 weeks' gestation. The frequency of procedures was evaluated by gestational age (GA) category, including use of a thermal care bundle, positive pressure ventilation (PPV), PPV with a T-piece resuscitator, maximum fraction of inspired oxygen (Fio2) concentration during PPV, tracheal intubation, chest compressions and medications, and use of continuous positive airway pressure in the delivery room. Logistic regression, adjusted by center and year, was used to estimate the probability of receiving recommended treatment. RESULTS: For 3644 infants 23 to 27 weeks' GA and 4870 infants 28 to 31 weeks' GA, respectively, the probability of receiving care consistent with guidelines per year increased, including thermal care (odds ratio [OR], 1.52 [95% confidence interval (CI) 1.44-1.61] and 1.45 [1.38-1.52]) and PPV with a T-piece (OR, 1.45 [95% CI 1.37-1.55] and 1.41 [1.32-1.51]). The probability of receiving PPV with Fio2 1.00 decreased equally in both GA groups (OR, 0.89; 95% CI, 0.86-0.93). CONCLUSIONS: Between 2014 and 2020, the resuscitation guidelines for newborns <32 weeks' GA on thermal care, PPV with a T-piece resuscitator, and decreased use of Fio2 1.00 were translated into clinical practice.

Admission hypothermia, neonatal morbidity, and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center.

This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known: • Admission hypothermia is associated with early neonatal death. • The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New: • Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates. • Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.

Bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns compared with full-term peers in the first six months of life / Densitometria óssea de dupla absorção de raio-X (DXA) em crianças nascidas pré-termo comparada com seus pares a termo nos primeiros 6 meses

OBJECTIVES: To longitudinally assess bone mineral content (BMC), bone mineral density (BMD), and whole-body lean mass obtained through bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns (PTNs) and compare them with full-term newborns (FTNs) from birth to 6 months of corrected postnatal age. METHODS: A total of 28 adequate for gestational age (AGA) newborns were studied: 14 preterm and 14 full-term newborns. DXA was used to determine BMC, BMD, and lean mass in three moments: 40 weeks corrected post-conceptual age, as well as 3 and 6 months of corrected postnatal age. PTNs had gestational age ≤ 32 weeks at birth and were fed their mother's own milk or milk from the human milk bank. RESULTS: All infants had an increase in BMC, BMD, and lean body mass values during the study. PTNs had lower BMC, BMD, and lean mass at 40 weeks of corrected post-conceptual age in relation to FTNs (p < 0.001, p < 0.001, p = 0.047, respectively). However, there was an acceleration in the mineralization process of PTNs, which was sufficient to achieve the normal values of FTNs at 6 months of corrected age. CONCLUSIONS: This study suggests that bone densitometry by dual-energy X-ray absorptiometry is a good method for the assessment of body composition parameters at baseline, and at the follow-up of these PTNs. .

OBJETIVOS: Avaliar longitudinalmente o conteúdo mineral ósseo (CMO), a densidade mineral óssea (DMO) e a massa magra do corpo inteiro obtidos através da densitometria óssea de dupla absorção de Raios-X (DXA) em recém-nascidos pré-termo (RNPT) e comparar com seus pares a termo (RNT) desde o nascimento até 6 meses de idade pós-natal corrigida. MÉTODOS: Foram estudados 28 recém-nascidos adequados para a idade gestacional: 14 recém-nascidos pré-termo e 14 recém-nascidos a termo. Utilizando-se a DXA, foram determinados CMO, DMO e massa magra em três momentos: 40 semanas de idade pós-concepcional corrigida, 3 e 6 meses de idade pós-natal corrigida. Os recém-nascidos pré-termo apresentavam ao nascimento uma idade gestacional igual ou inferior a 32 semanas e receberam leite da própria mãe ou leite humano de banco. RESULTADOS: Todos os recém-nascidos apresentaram um aumento nos valores de CMO, DMO e massa magra durante o estudo. Os recém-nascidos pré-termo apresentaram menor CMO, DMO e massa magra, com 40 semanas de idade pós-concepcional corrigida, em relação aos recém-nascidos a termo (p < 0,001, p < 0,001, e p = 0,047, respectivamente). Entretanto, houve uma aceleração no processo de mineralização nos pré-termos, suficiente para atingirem os valores normais do recém-nascidos a termo aos 6 meses de idade corrigida. CONCLUSÕES: Este estudo sugere que a densitometria óssea de dupla absorção de Raios-X constitui um bom método para a avaliação dos parâmetros de composição corporal no início e no seguimento destes recém-nascidos pré-termo. .

Bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns compared with full-term peers in the first six months of life.

OBJECTIVES: To longitudinally assess bone mineral content (BMC), bone mineral density (BMD), and whole-body lean mass obtained through bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns (PTNs) and compare them with full-term newborns (FTNs) from birth to 6 months of corrected postnatal age. METHODS: A total of 28 adequate for gestational age (AGA) newborns were studied: 14 preterm and 14 full-term newborns. DXA was used to determine BMC, BMD, and lean mass in three moments: 40 weeks corrected post-conceptual age, as well as 3 and 6 months of corrected postnatal age. PTNs had gestational age ≤ 32 weeks at birth and were fed their mother's own milk or milk from the human milk bank. RESULTS: All infants had an increase in BMC, BMD, and lean body mass values during the study. PTNs had lower BMC, BMD, and lean mass at 40 weeks of corrected post-conceptual age in relation to FTNs (p<0.001, p<0.001, p=0.047, respectively). However, there was an acceleration in the mineralization process of PTNs, which was sufficient to achieve the normal values of FTNs at 6 months of corrected age. CONCLUSIONS: This study suggests that bone densitometry by dual-energy X-ray absorptiometry is a good method for the assessment of body composition parameters at baseline, and at the follow-up of these PTNs.

Nosocomial infection in newborns by Pichia anomala in a Brazilian intensive care unit.

Disseminated candidiasis is the most common nosocomial fungal infection, and Candida albicans has been reported to account for 50% to more than 70% of cases of invasive candidiasis. However, recent reports have also suggested the emergence of infections caused by non-albicans species. In addition, less-common pathogenic yeasts (Malassezia, Trichosporon, Rhodotorula, Debaryomyces and Pichia) have recently been reported, with increased frequency, as causes of nosocomial infections with high mortality. This article describes two cases of fungemia caused by Pichia anomala in newborns that occurred in an intensive care unit (ICU), in November 2004 at the Instituto da Criança (Pediatric Institute) of the Hospital das Clínicas of the School of Medicine, São Paulo University, Brazil. The principal factors related to virulence (proteinase and phospholipase) and the susceptibility of the isolated strains to antifungal agents were also evaluated, and the biotype of each strain was determined through the use of an epidemiological marker (killer biotype).

[Interleukins 6 and C-reactive protein for the diagnosis of late onset sepsis in the newborn infant]. / Interleucina 6 e proteína c reativa no diagnóstico de sepse tardia no recém-nascido.

BACKGROUND: Verify the accuracy of interleukin 6 (IL-6) and C-reactive protein (CRP) for diagnosis of late onset sepsis in newborn (NB) infants. METHODS: a prospective cohort study with 43 NB infants hospitalized at the NICU with suspicion of late onset sepsis was carried out. Levels of IL-6 and of CRP were dosed with suspicion diagnoses; day (0) and sequentially on day 1, 3, and 7 of the evolution and the best cut-off values were calculated for the diagnoses. Indices of sensibility (S), specificity (SP), positive predictive value and negative predictive value (PPV, NPV) were calculated for each test as well as for the combination between them. RESULTS: Levels of IL-6 and CRP were above the established cut-off values in the NB infants with sepsis and with presumed sepsis. There was a significant difference between both groups, where the only difference was the positive blood culture for the first group. Diagnosis could be rejected in 6 NB infants. The IL-6 showed better indices on the day of suspicion diagnosis, day 0 (S: 88.9%, Sp: 80.0%, PPV: 76.2%, NPV: 90.9%), followed by the C-reactive protein (S: 94.0%, Sp: 78.3%, PPV: 77.3%, NPV: 94.7%) 24 hours later. The combination of IL-6 / CRP demonstrated to be adequate for early diagnosis of sepsis on day 0 and 24 hours later with S and NPV of 100%. CONCLUSION: for diagnosis of sepsis the combination interleukin 6 / CRP presented accuracy. During the following days their development reflected the clinical evolution of the NB infants.

Interleucina 6 e proteína c reativa no diagnóstico de sepse tardia no recém-nascido / Interleukins 6 and c - reactive protein for the diagnosis of late onset sepsis in the newborn infant

OBJETIVO: Verificar a acurácia da interleucina 6 (IL-6) e da proteína C reativa (PCR) para o diagnóstico de sepse tardia no recém-nascido (RN). MÉTODOS: Trata-se de estudo de coorte prospectivo com 43 RNs internados com suspeita de sepse tardia na UTIN. Foram dosados no dia da suspeita diagnóstica (dia 0) e nos dias 1, 3 e 7 de evolução os níveis séricos da IL-6 e da PCR e calculado o melhor valor de coorte para o diagnóstico de sepse. Também foram calculados os índices de sensibilidade (S), especificidade (E), valor preditivo positivo e negativo (VPP, VPN) para cada um dos testes, assim como para a combinação entre eles. RESULTADOS: Os níveis séricos da IL-6 e da PCR estiveram acima do ponto de coorte nos RN com sepse e com sepse presumível com diferenças significantes entre ambos os grupos, nos quais a única diferença foi hemocultura positiva no primeiro. Foi possível afastar esse diagnóstico em seis RNs. Para o diagnóstico de sepse, a IL-6 obteve os melhores índices no dia da suspeita diagnóstica, dia 0 (S: 88,9 por cento, E: 80 por cento, VPP: 76,2 por cento, VPN: 90,9 por cento), seguida da proteína C reativa (S: 94 por cento, E: 78,3 por cento, VPP: 77,3 por cento, VPN: 94,7 por cento) 24 horas após. A combinação dos dois (IL 6/PCR) mostrou-se mais adequada para o diagnóstico precoce no dia 0 e até 24 horas de evolução com S e VPN de 100 por cento. CONCLUSÃO: A combinação de IL6/PCR apresentou acurácia para o diagnóstico de sepse. A evolução destes testes ao longo dos dias refletiu a evolução clínica dos RN.

Brain abscess by citrobacter diversus in infancy: case report

Citrobacter diversus is closely related to brain abscess in newborn infants. We describe a case of brain abscess by this bacteria in a newborn infant and his clinical and cranial computed tomographic evaluation until the fourth month of life and discuss therapeutic management of this patient

Fatores associados à candidíase sistêmica em recém-nascidos na Unidade de Terapia Intensiva Neonatal / Sistemic candidiasis in the newborn intensive care unity

A candidíase sistêmica em recém-nascidos, especialmente pré-termos, submetidos à terapia intensiva tem aumentado nos últimos anos. Diversos fatores na UTI Neonatal são responsabilizados pelo incremento desta grave infecção. O objetivo deste artigo é analisar a relação entre alguns procedimentos (nutrição parenteral, cateterismo venoso, ventilação mecânica), bem como o uso de antibióticos em recém-nascidos internados em UTI Neonatal e a candidíase sistêmica. Foram estudados, no período de 1991 a 1994, 41 recém-nascidos: 21 com diagnóstico de candidíase sistêmica (Grupo I), e 20 com sepse bacteriana (Grupo II). A análise estatística utilizada foi a univariada de comparação de medianas, por meio do teste do qui-quadrado ou exato de Fisher, adotando-se um nível de significância de 5 por cento (p<0,05). Verificou-se que comparados os dois grupos, naquele com candidíase sistêmica a proporção relativa de cateterismo venoso foi de 9,28 (p=0,0013), de ventilação mecânica 2,98 (p=0,0143), e nutrição parenteral 2,6 (p=0,0238). O número de associação de troca de antibióticos foi maior no mesmo grupo, sendo a associação vancomicina e cefalosporina de terceira geração a que maior correlação teve com a candidíase sistêmica (p=0,0018). Os resultados indicam que os procedimentos invasivos, especialmente o cateterismo venoso, a maior utilização de antibióticos e as associações de largo espectro como vancomicina e cefalosporina de terceira geração correlacionaram-se com a maior incidência de candidíase sistêmica.