ABSTRACT
Las recomendaciones incluidas en este documento forman parte de una revisión actualizada de la asistencia respiratoria en el recién nacido. Están estructuradas en 12 módulos y en este trabajo se presenta el módulo 7. El contenido de cada módulo es el resultado del consenso de los miembros del Grupo Respiratorio y Surfactante de la Sociedad Española de Neonatología. Representan una síntesis de los trabajos publicados y de la experiencia clínica de cada uno de los miembros del grupo (AU)
The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group (AU)
Subject(s)
Female , Humans , Infant, Newborn , Male , Respiration/genetics , Surface-Active Agents/administration & dosage , Surface-Active Agents/pharmacology , Nitric Oxide/deficiency , Nitric Oxide , Pulmonary Atelectasis/enzymology , Pulmonary Atelectasis/metabolism , Hyaline Membrane Disease/metabolism , Hyaline Membrane Disease/pathology , Respiration/immunology , Surface-Active Agents , Surface-Active Agents/metabolism , Nitric Oxide/standards , Nitric Oxide/therapeutic use , Pulmonary Atelectasis/complications , Pulmonary Atelectasis/diagnosis , Hyaline Membrane Disease/complications , Hyaline Membrane Disease/diagnosisABSTRACT
The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group.
Subject(s)
Neonatology , Nitric Oxide/administration & dosage , Respiration, Artificial/methods , Surface-Active Agents/administration & dosage , Consensus , Humans , Infant, NewbornABSTRACT
AIM: To learn the characteristic of the neonatal intensive care units (NICUs) that offer neonatal respiratory assistance in Spain. MATERIAL AND METHOD: A structured survey was developed and sent to all Spanish neonatal units to learn about the respiratory care offered in 2005. RESULTS: A total of 96 Units answered the survey, with an estimated representatively of 63%, with a range from 3 to 92%, depending on the geographical area. Level IIIc Units were in the upper range. Answer the survey 26 units type IIb (27%), 16 IIIa (17%), 40 IIIb (42%) and 14 IIIc (14%). The total number of level III NICU beds was 541 (1.2 beds per 1000 livebirths; range, 0.7-1.7). The mean number of beds per NICU was 4.1 in level IIIa Units, 2.8 in those IIIb and 14.6 in type IIIc NICUs. In level III NICUs, the bed per physician ratio was 2.4 and that of beds per registered nurse was 2.8 (2.2 in level IIIc NICUs). There were a total 13,219 admissions, 54% of those needed mechanical ventilation (36% in IIIa and 65% in level IIIc NICUs). Oxygen blenders for resuscitation at birth were available in 42% of level IIIb and IIIc NICUs. NICUs had one neonatal ventilator per bed, and 63% of units had high frequency ventilation available. All units had nasal-CPAP systems, 25% of level IIIa Units, 58% IIIb and 64% of those type IIIc had systems for nasal ventilation. All level IIIc and 93% of level IIIb NICUs were able to provide inhaled nitric oxygen therapy. Four NICUS offered ECMO. CONCLUSIONS: The mean number of NICU beds per 1000 livebirths is within the lower limits of those been recommended, and there were wide variations among different geographical areas. A 54% of those babies admitted to NICUs required mechanical ventilation. The mean number of NICU beds per registered nurse was 2.8. There was an adequate number of neonatal ventilators (one per bed) and 63% were able to provide HFV. All NICUs hand n-CPAP systems.
Subject(s)
Intensive Care Units, Neonatal , Respiration, Artificial/statistics & numerical data , Humans , Infant, NewbornABSTRACT
Objetivo: conocer el tipo de unidades de cuidados intensivos neonatales (UCIN) que proporcionan asistencia respiratoria neonatal en España y sus características. Material y método: encuesta multicéntrica estructurada para conocer la actividad asistencial respiratoria prestada por las UCIN en 2005. Resultados: contestaron 96 unidades neonatales con una representatividad estimada en un 63%, con un intervalo entre el 3 y el 92%, según las áreas geográficas; las unidades IIIc se encuentran en el rango superior. Contestaron la encuesta 26 unidades tipo IIb (27%), 16 IIIa (17%), 40 IIIb (42%) y 14 IIIc (14%). Las camas totales de intensivos de nivel III fue de 541 (1,2 camas cada 1.000 recién nacidos vivos; intervalo, 0,7-1,7). La media de camas por unidad fue de 4,1 para las IIIa, 2,8 para las IIIb y 14,6 para las IIIc. En las unidades de nivel III, la relación camas/médicos fue de 2,4 camas/medico y la de camas/enfermeras 2,8 camas/enfermera (2,2 en nivel IIIc). Hubo un total de 13.219 ingresos, de los que el 54% precisó ventilación (el 36% en las IIIa y el 65% en las IIIc). La posibilidad de reanimación en el paritorio con mezcla de gases (aire y oxígeno) sólo la tiene el 42% de las IIIb y IIIc. La relación respirador/cama fue de 1/1; el 63% puede proporcionar ventilación de alta frecuencia (VAF). Todas disponen de sistemas de presión positiva continua nasal (CPAP-n). Sistemas para aplicar ventilación nasal intermitente están disponibles en el 25% de las IIIa, el 58% de las IIIb y el 64% de las IIIc. Todas las IIIc y el 93% de las IIIb pueden proporcionar oxido nítrico inhalado. Cuatro unidades disponían de ECMO. Conclusiones: la media de camas de UCIN de nivel III cada mil nacidos está en el límite bajo de lo recomendable, con notables diferencias regionales. La necesidad de ventilación mecánica fue del 54%. La relación de camas por enfermera fue de 2,8. Existe una buena dotación de respiradores (1 por cama) con alta disponibilidad de VAF (63%). Todas las unidades disponen de CPAP-n (AU)
Aim: To learn the characteristic of the neonatal intensive care units (NICUs) that offer neonatal respiratory assistance in Spain. Material and method: A structured survey was developed and sent to all Spanish neonatal units to learn about the respiratory care offered in 2005. Results: A total of 96 Units answered the survey, with an estimated representatively of 63%, with a range from 3 to 92%, depending on the geographical area. Level IIIc Units were in the upper range. Answer the survey 26 units type IIb (27%), 16 IIIa (17%), 40 IIIb (42%) and 14 IIIc (14%). The total number of level III NICU beds was 541 (1.2 beds per 1000 livebirths; range, 0.71.7). The mean number of beds per NICU was 4.1 in level IIIa Units, 2.8 in those IIIb and 14.6 in type IIIc NICUs. In level III NICUs, the bed per physician ratio was 2.4 and that of beds per registered nurse was 2.8 (2.2 in level IIIc NICUs). There were a total 13,219 admissions, 54% of those needed mechanical ventilation (36% in IIIa and 65% in level IIIc NICUs). Oxygen blenders for resuscitation at birth were available in 42% of level IIIb and IIIc NICUs. NICUs had one neonatal ventilator per bed, and 63% of units had high frequency ventilation available. All units had nasal-CPAP systems, 25% of level IIIa Units, 58% IIIb and 64% of those type IIIc had systems for nasal ventilation. All level IIIc and 93% of level IIIb NICUs were able to provide inhaled nitric oxygen therapy. Four NICUS offered ECMO. Conclusions: The mean number of NICU beds per 1000 livebirths is within the lower limits of those been recommended, and there were wide variations among different geographical areas. A 54% of those babies admitted to NICUs required mechanical ventilation. The mean number of NICU beds per registered nurse was 2.8. There was an adequate number of neonatal ventilators (one per bed) and 63% were able to provide HFV. All NICUs hand n-CPAP systems (AU)
Subject(s)
Humans , Infant, Newborn , Intensive Care Units, Neonatal/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Health Services Research , SpainABSTRACT
Las recomendaciones incluidas en este documento señalan las indicaciones actuales del tratamiento con óxido nítrico inhalado (ONi) en el recién nacido, diferenciando claramente las apoyadas en evidencia científica de las que todavía no lo están, como su uso en prematuros. Tras comentar la metodología, dosificación y efectos secundarios, se insiste en las causas de falta de respuesta al ONi
The recommendations in this document describe the current indications for inhaled nitric oxide (iNO) treatment in the newborn and clearly distinguish between those supported by scientific evidence and those for which evidence is still lacking, such as its use in preterm infants. The methodology for iNO administration, its dosage and the main secondary effects are discussed, and the reasons for lack of response to this treatment are analyzed
Subject(s)
Infant, Newborn , Humans , Infant, Newborn, Diseases/therapy , Nitric Oxide/administration & dosage , Administration, Inhalation , Endothelium-Dependent Relaxing Factors/administration & dosage , Heart Defects, Congenital , Hernia, Diaphragmatic/congenital , Infant, Premature , Persistent Fetal Circulation Syndrome , Respiratory Distress Syndrome, NewbornABSTRACT
The recommendations in this document describe the current indications for inhaled nitric oxide (iNO) treatment in the newborn and clearly distinguish between those supported by scientific evidence and those for which evidence is still lacking, such as its use in preterm infants. The methodology for iNO administration, its dosage and the main secondary effects are discussed, and the reasons for lack of response to this treatment are analyzed.
Subject(s)
Infant, Newborn, Diseases/therapy , Nitric Oxide/administration & dosage , Administration, Inhalation , Endothelium-Dependent Relaxing Factors/administration & dosage , Heart Defects, Congenital , Hernias, Diaphragmatic, Congenital , Humans , Infant, Newborn , Infant, Premature , Persistent Fetal Circulation Syndrome , Respiratory Distress Syndrome, NewbornABSTRACT
From a cohort of 162 children born to 161 mothers belonging to risk groups for human immunodeficiency virus (HIV) infection, we have studied 32 asymptomatic HIV seropositive and 19 HIV seronegative mothers and their offspring seropositive mothers when compared with the seronegative group had lower counts of leukocytes, lymphocytes, CD4+ cells and CD4+/CD8+ ratio as well as higher IgG and IgM serum levels. The offspring from HIV seropositive mothers differed from children born to HIV seronegative mothers in having higher lymphocyte counts, serum IgG level and spontaneous in vitro IgG production. The number of lymphocytes and the IgG serum level correlated in the child HIV seropositive mother pairs. Two children born to HIV seropositive mothers had a CD4+/CD8+ ratio below 0.8. The significance of these abnormalities and its possible relationship with active HIV infection in children is at present unknown.