[Transcatheter closure of patent ductus arteriosus using the Amplatzer duct occluder in children: initial and one-year results]. / Cierre percutáneo del conducto arterioso persistente con dispositivo Amplatzer en niños: resultados inmediatos y a un año.

OBJECTIVE: Percutaneous closure of patent ductus arteriosus (PDA) is a well established technique. Our objective was to determine the safety and efficacy of the Amplatzer occluder for the treatment of PDA in children. METHODS: From November 2005 to June 2007 we reviewed the clinical records of 39 patients (23 girls and 16 boys), with a mean age of 19.8 +/- 13.7 months and weight 9.2 +/- 3.2 Kg, who underwent percutaneous closure of a PDA with an Amplatzer device. The forty one percent of the patients (16/39) were < or = 1 year of age, and 71.8 % (28/39) weighed < or = 10 Kg. The age of children with body weight < or = 10 Kg was 13.1 +/- 6.1 months (range 5-33 months). The morphology of the PDA was determined by a lateral aortogram and classified according to Krichenko. All the patients were followed-up with radiologic and echocardiographic control at 24 hours, 1, 3, 6 and 12 months postinsertion (median 20 months). RESULTS: The PDA diameter ranged between 2.0 mm to 12 mm (3.6 mm +/- 2.0 mm) in the 39 patients included. PDA types according to Krichenko were: type A = 25 (64.1%), type B = 1 (2.6%), type C = 5 (12.8%), type D = 2 (5.1%) and type E = 3 (7.7%). Three patients had a residual PDA post-surgical closure attempt. Qp/Qs ratio was 2.4 +/- 1.5 (range 1.0-6.7) and the relation PSP/PSS was 0.49 +/- 0.18 (range: 0.21-0.87). Pulmonary hypertension was present in 16 patients (41%). The Amplatzer occluder was implanted successfully in 36/39 patients (92.3%). The procedure failed in three cases: 1) difficulty to place the device due to wrong assessment of the ductus size; 2) difficulty to advance the device due to angulation (kinking) of the releasing system; 3) migration of the device to descending aorta. The mean time of fluoroscopy and for the entire procedure was 13.2 +/- 6.3 minutes and 65.3 +/- 21.9 minutes, respectively. There were no deaths with the procedure. Minor and mayor complications occurred in eight patients, all of them but one, in children with body weight < or = 10 Kg. In the 36 successful insertions an aortogram showed complete occlusion in 26 (66.7%), trivial leak through the occluder in 6 (15.45), mild leak in 4 (10.3%), and moderate leak in 2 (5.1%). A control echocardiogram 24 h after the insertion showed a successful rate of 82.1% (32/36). Complete occlusion of the PDA was obtained in 35/36 patients (97.2%) at 3 months follow-up study. In 4 patients the percutaneous occlusion technique did not result in PDA closure, and 3 of them underwent a surgical closure. On follow-up, 3 patients developed mild stenosis of the left pulmonary artery and two a mild pressure gradient in the descending aorta. CONCLUSIONS: Percutaneous closure of PDA with an Amplatzer is a safe and effective technique. In children with ductus arteriosus diameter > or = 2 mm the Amplatzer device should be recommended over surgical closure. The incidence of complications after the procedure is higher in patients under 10 kg of body weight.

Transcatheter closure of patent ductus arteriosus using the amplatzer duct occluder in infants under 1 year of age.

INTRODUCTION AND OBJECTIVES: Percutaneous closure of patent ductus arteriosus (PDA) is a well-established technique. We evaluated the usefulness of the Amplatzer duct occluder for the percutaneous closure of patent ductus arteriosus in 29 children under 1 year of age. METHODS: The patients' mean age was 8.9+/-2.8 months and their mean weight was 6.4+/-1.5 kg. In addition, 24.1% of patients were aged 6 months or less and 17.2% weighed 5 kg or less. All completed follow-up (0.5-36 months). RESULTS: The minimum PDA diameter was 3.16+/-1.24 mm. The device was implanted successfully in 26 patients (89.6%). Failures were due to either the device migrating to the descending aorta, persistent moderate leakage, or to difficulty in the advancement of the device. No deaths were associated with the procedure. Three major complications occurred in two patients (10.3%). Aortography showed initial total occlusion in 65.5% of patients. At 3-month follow-up, total occlusion was observed in 96.1% of patients. Ultimately, closure was achieved successfully in 25 of the 29 patients (86.2%). During follow-up, four patients exhibited mild left pulmonary artery stenosis and one exhibited mild stenosis of the descending aorta. CONCLUSIONS: In children under 1 year of age, percutaneous closure of patent ductus arteriosus using an Amplatzer occluder was a safe and effective procedure. It is possible that improvements in the design of the occluder could decrease the complication rate.

Cierre transcatéter del conducto arterioso persistente con dispositivo de Amplatzer en niños menores de un año / Transcatheter closure of patent ductus arteriosus using the amplatzer duct occluder in infants under one year of age

Introducción y objetivos. El cierre percutáneo del conducto arterioso persistente (CAP) es una técnica bien establecida. Evaluamos la utilidad del oclusor de Amplatzer (ADO), en el cierre percutáneo del CAP en 29 niños menores de 1 año. Métodos. La edad de los pacientes fue de 8,9 ± 2,8 meses y el peso, 6,4 ± 1,5 kg. El 24,1% de los pacientes con edad ≤ 6 meses y el 17,2%, con peso ≤ 5 kg. Se realizó seguimiento en todos (0,5-36 meses). Resultados. El diámetro mínimo del conducto fue 3,16 ± 1,24 mm. El dispositivo se implantó con éxito en 26 (89,6%) pacientes. Las causas del fracaso se debieron a migración del dispositivo a la aorta descendente, persistencia de la fuga en forma moderada y dificultad en progresar el dispositivo. La mortalidad fue nula con el procedimiento. Ocurrieron 3 complicaciones mayores en 2 (10,3%) pacientes. Un aortograma mostró oclusión completa inicial en el 65,5% de los pacientes. La oclusión completa del conducto se demostró en el 96,1% de los pacientes al tercer mes de seguimiento. El éxito final del cierre del CAP se logró en 25/29 (86,2%) pacientes. En el seguimiento, 4 pacientes mostraron estenosis leve en la rama pulmonar izquierda, y 1, estenosis leve en la aorta descendente. Conclusiones. En niños menores de 1 año, el cierre percutáneo del CAP con el oclusor de Amplatzer es un procedimiento efectivo y seguro. Las mejoras en el diseño del oclusor posiblemente disminuirán la frecuencia de complicaciones (AU)

Introduction and objectives. Percutaneous closure of patent ductus arteriosus (PDA) is a well-established technique. We evaluated the usefulness of the Amplatzer duct occluder for the percutaneous closure of patent ductus arteriosus in 29 children under 1 year of age. Methods. The patients’ mean age was 8.9 [2.8] months and their mean weight was 6.4 [1.5] kg. In addition, 24.1% of patients were aged 6 months or less and 17.2% weighed 5 kg or less. All completed follow-up (0.5-36 months). Results. The minimum PDA diameter was 3.16[1.24] mm. The device was implanted successfully in 26 patients (89.6%). Failures were due to either the device migrating to the descending aorta, persistent moderate leakage, or to difficulty in the advancement of the device. No deaths were associated with the procedure. Three major complications occurred in two patients (10.3%). Aortography showed initial total occlusion in 65.5% of patients. At 3-month follow-up, total occlusion was observed in 96.1% of patients. Ultimately, closure was achieved successfully in 25 of the 29 patients (86.2%). During follow-up, 4 patients exhibited mild left pulmonary artery stenosis and 1 exhibited mild stenosis of the descending aorta. Conclusions. In children under 1 year of age, percutaneous closure of patent ductus arteriosus using an Amplatzer occluder was a safe and effective procedure. It is possible that improvements in the design of the occluder could decrease the complication rate (AU)

Cierre percutáneo del conducto arterioso persistente con dispositivo Amplatzer en niños: resultados inmediatos y a un año / Transcatheter closure of patent ductus arteriosus using the Amplatzer duct occluder in children: initial and one-year results

OBJECTIVE: Percutaneous closure of patent ductus arteriosus (PDA) is a well established technique. Our objective was to determine the safety and efficacy of the Amplatzer occluder for the treatment of PDA in children. METHODS: From November 2005 to June 2007 we reviewed the clinical records of 39 patients (23 girls and 16 boys), with a mean age of 19.8 +/- 13.7 months and weight 9.2 +/- 3.2 Kg, who underwent percutaneous closure of a PDA with an Amplatzer device. The forty one percent of the patients (16/39) were < or = 1 year of age, and 71.8 % (28/39) weighed < or = 10 Kg. The age of children with body weight < or = 10 Kg was 13.1 +/- 6.1 months (range 5-33 months). The morphology of the PDA was determined by a lateral aortogram and classified according to Krichenko. All the patients were followed-up with radiologic and echocardiographic control at 24 hours, 1, 3, 6 and 12 months postinsertion (median 20 months). RESULTS: The PDA diameter ranged between 2.0 mm to 12 mm (3.6 mm +/- 2.0 mm) in the 39 patients included. PDA types according to Krichenko were: type A = 25 (64.1%), type B = 1 (2.6%), type C = 5 (12.8%), type D = 2 (5.1%) and type E = 3 (7.7%). Three patients had a residual PDA post-surgical closure attempt. Qp/Qs ratio was 2.4 +/- 1.5 (range 1.0-6.7) and the relation PSP/PSS was 0.49 +/- 0.18 (range: 0.21-0.87). Pulmonary hypertension was present in 16 patients (41%). The Amplatzer occluder was implanted successfully in 36/39 patients (92.3%). The procedure failed in three cases: 1) difficulty to place the device due to wrong assessment of the ductus size; 2) difficulty to advance the device due to angulation (kinking) of the releasing system; 3) migration of the device to descending aorta. The mean time of fluoroscopy and for the entire procedure was 13.2 +/- 6.3 minutes and 65.3 +/- 21.9 minutes, respectively. There were no deaths with the procedure. Minor and mayor complications occurred in eight patients, all of them but one, in children with body weight < or = 10 Kg. In the 36 successful insertions an aortogram showed complete occlusion in 26 (66.7%), trivial leak through the occluder in 6 (15.45), mild leak in 4 (10.3%), and moderate leak in 2 (5.1%). A control echocardiogram 24 h after the insertion showed a successful rate of 82.1% (32/36). Complete occlusion of the PDA was obtained in 35/36 patients (97.2%) at 3 months follow-up study. In 4 patients the percutaneous occlusion technique did not result in PDA closure, and 3 of them...

Correlación entre el gasto y el aporte de energía en neonatos hospitalizados en una unidad de cuidados intensivos / Correlation between energy consumption and intake in infants hospitalized in an intensive care unit

Introducción. Una alimentación adecuada es esencial en el manejo del niño en estado crítico. Este estudio analiza la correlación entre el aporte total de energía (ATE) y el gasto energético total (GET) de pacientes hospitalizados en una Unidad de Cuidados Intensivos Neonatales (UCIN), considerando si nació pretérmino (PT), recibió alimentación parenteral (AP), o tratamiento quirúrgico (TQ). Métodos. Estudio transversal con 29 pacientes evaluados después de alcanzar estabilidad hemodinámica y ventilatoria. El GET se estimó mediante calorimetría indirecta, y el ATE sumando la energía administrada por vía enteral y parenteral. El análisis estadístico incluyó correlación de Spearman, U Mann-Whitney, prueba exacta de Fisher y regresión múltiple. Resultados. Catorce pacientes nacieron PT, y 21 recibieron TQ. Al momento del estudio, 14 recibían AP y 63% estaban desnutridos. El ATE fue mayor para los PT (P =0.022), los de AP (P =0.038) y los de TQ (P =0.046); el GET fue mayor en los PT (P =0.003). La correlación entre GET y ATE fue significativa sólo para alimentación enteral (r =0.518, P =0.046). El ATE fue inadecuado en 85.1% de los pacientes. Conclusiones. El ATE para niños atendidos en la UCIN parece ser inadecuado cuando se calcula por ecuaciones; se sugiere utilizar la determinación del gasto energético por calorimetría indirecta por lo menos en pacientes bajo el régimen de AP total.

Introduction. An adequate feeding is essential in the management of critically ill infants. This study analyzes the association between total energy intake (TEI) and total energy consumption (TEC) of patients hospitalized in a neonatal intensive care unit (NICU) taking into account whether were born preterm (PT), received parenteral nutrition (PN), or underwent surgical treatment (ST). Methods. A cross-sectional design including 29 patients hospitalized in a NICU after hemodynamic and ventilatory stability was conducted. TEC was determined by indirect calorimetry and TEI by the summation of the energy administered by enteral and parenteral pathways. The statistical analysis included, Spearman correlation, U Mann-Whitney test, exact Fisher test, and multiple regression. Results. Fourteen patients were born PT, 21 underwent ST; 14 were under PN regime at the moment of the study and 63% were undernourished. TEI was higher in PT (P =0.022), PN (P =0.038), and ST (P =0.046) patients; TEC was greater only in PT infants (P =0.003). TEC correlated with TEI only in patients receiving enteral nutrition (r=0.518, P =046). TEI was inadequate in 85.1% of the patients. Conclusion. The amount of energy administered to patients hospitalized in the NICU is inadequate when it is estimated by standardized equations. We suggest determining TEC by indirect calorimetry at least in patients under total PN.

Transcatheter closure of patent ductus arteriosus using the amplatzer duct occluder in infants under one year of age.

INTRODUCTION AND OBJECTIVES: Percutaneous closure of patent ductus arteriosus (PDA) is a well-established technique. We evaluated the usefulness of the Amplatzer duct occluder for the percutaneous closure of patent ductus arteriosus in 29 children under 1 year of age. METHODS: The patients' mean age was 8.9±2.8 months and their mean weight was 6.4±1.5kg. In addition, 24.1% of patients were aged 6 months or less and 17.2% weighed 5kg or less. All completed follow-up (0.5-36 months). RESULTS: The minimum PDA diameter was 3.16±1.24 mm. The device was implanted successfully in 26 patients (89.6%). Failures were due to either the device migrating to the descending aorta, persistent moderate leakage, or to difficulty in the advancement of the device. No deaths were associated with the procedure. Three major complications occurred in two patients (10.3%). Aortography showed initial total occlusion in 65.5% of patients. At 3-month follow-up, total occlusion was observed in 96.1% of patients. Ultimately, closure was achieved successfully in 25 of the 29 patients (86.2%). During follow-up, four patients exhibited mild left pulmonary artery stenosis and one exhibited mild stenosis of the descending aorta. CONCLUSIONS: In children under 1 year of age, percutaneous closure of patent ductus arteriosus using an Amplatzer occluder was a safe and effective procedure. It is possible that improvements in the design of the occluder could decrease the complication rate.

[Balloon angioplasty for native aortic coarctation in children younger than 12 months: immediate and medium-term results]. / Angioplastía con balón de la coartación aórtica nativa en niños menores de 12 meses: resultado inicial y a mediano plazo.

INTRODUCTION AND OBJECTIVES: The use of the balloon angioplasty (BA) in the treatment of patients with native aortic coarctation during childhood, particularly during the first 12 months of age, is controversial. The aim of this study was to report our experience with the use of this therapeutic technique and review the immediate and middle-term results in patients until 12 months age with native aortic coarctation and to identify those factors related with the outcome. MATERIAL AND METHOD: We review retrospectively the clinical records of 35 patients less than 12 months of age with diagnosis of native aortic coarctation who underwent balloon angioplasty as first choice treatment during an eight year span (1998-2005). Total population was divided in two groups: group A patients < or = 3 months of age (n = 19) and group B patients between 4-12 months of age (n = 16). RESULTS: Mean age at the time of balloon angioplasty was 4.3 +/- 3.3 months (range 0.7-12 months) and the mean body weight was 5.5 +/- 1.7 kg (range 2.6-10 kg). Initial result after BA was successful in 30 of 35 patients (85.8%) with a peak residual pressure gradient < or = 20 mm Hg. Successful result were obtained in 15 of 19 patients in group A (78.9%) and in 15 of 16 patients in group B (93.8%). The mean peak residual pressure gradient change from 46.9 +/- 20.3 mm Hg to 11.6 +/- 8.1 mmHg (p < 0.001) and the maximal coarctation diameter increase from 3.0 +/- 1.6 mm to 6.0 +/- 1.8 mm after BA in the group total. We did not observe deaths related to the procedure. On the follow-up recoarctation was observed in 17/35 patients (48.6%) 13 of them in group A (68.4%) and 4 in group B (25%). Ten patients with recoarctation underwent immediate surgical correction (9 in group A) while the other 7 underwent a second BA procedure (4 in group A). At the end of the study period AB was effective in 23 of 35 patients (65.7%), 9 of them in group A (47.3%) and 14 in group B (87.5%). The incidence of complications following BA was higher in group A (21%) than for group B (12.5%). Incidence of aneurysms was 15.8% for group A and 18.8% for group B (3 patients in each group). CONCLUSIONS: Balloon angioplasty is a safe and effective alternative treatment for native aortic coarctation, even during the neonatal period. Due to the high incidence of aneurysm formation in children less than 1 year of age, a better selection of patients, the use of low-profile balloons and optimal postoperative care is mandatory to improve the final outcome and decrease the incidence of complications. A second balloon angioplasty procedure might improve the final outcome.

Angioplastía con balón de la coartación aórtica nativa en niños menores de 12 meses: resultado inicial y a mediano plazo / Balloon angioplasty for native aortic coarctation in children younger than 12 months: immediate and medium-term results

INTRODUCTION AND OBJECTIVES: The use of the balloon angioplasty (BA) in the treatment of patients with native aortic coarctation during childhood, particularly during the first 12 months of age, is controversial. The aim of this study was to report our experience with the use of this therapeutic technique and review the immediate and middle-term results in patients until 12 months age with native aortic coarctation and to identify those factors related with the outcome. MATERIAL AND METHOD: We review retrospectively the clinical records of 35 patients less than 12 months of age with diagnosis of native aortic coarctation who underwent balloon angioplasty as first choice treatment during an eight year span (1998-2005). Total population was divided in two groups: group A patients < or = 3 months of age (n = 19) and group B patients between 4-12 months of age (n = 16). RESULTS: Mean age at the time of balloon angioplasty was 4.3 +/- 3.3 months (range 0.7-12 months) and the mean body weight was 5.5 +/- 1.7 kg (range 2.6-10 kg). Initial result after BA was successful in 30 of 35 patients (85.8%) with a peak residual pressure gradient < or = 20 mm Hg. Successful result were obtained in 15 of 19 patients in group A (78.9%) and in 15 of 16 patients in group B (93.8%). The mean peak residual pressure gradient change from 46.9 +/- 20.3 mm Hg to 11.6 +/- 8.1 mmHg (p < 0.001) and the maximal coarctation diameter increase from 3.0 +/- 1.6 mm to 6.0 +/- 1.8 mm after BA in the group total. We did not observe deaths related to the procedure. On the follow-up recoarctation was observed in 17/35 patients (48.6%) 13 of them in group A (68.4%) and 4 in group B (25%). Ten patients with recoarctation underwent immediate surgical correction (9 in group A) while the other 7 underwent a second BA procedure (4 in group A). At the end of the study period AB was effective in 23 of 35 patients (65.7%), 9 of them in group A (47.3%) and 14 in group B (87.5%). The incidence of complications following BA was higher in group A (21%) than for group B (12.5%). Incidence of aneurysms was 15.8% for group A and 18.8% for group B (3 patients in each group). Conclusions: Balloon angioplasty is a safe and effective alternative treatment for native aortic coarctation, even during the neonatal period. Due to the high incidence of aneurysm formation in children less than 1 year of age, a better selection of patients, the use of low-profile balloons and optimal postoperative care is mandatory to...

Hormonas gastrointestinales en la estimulación enteral mínima en neonatos prematuros enfermos / Gastrointestinal hormone and minimal enteral feeding in sick premature infants

Objetivo. Medir la respuesta hormonal con estimulación enteral mínima (EEM) en prematuros enfermos. Metología. Fueron 41 pacientes, con peso al nacimiento <1800 g, distribuidos en: grupo I (temprano) con inicio del estímulo en menos de cinco días de edad (n=26), y grupo II (tardío) entre 10 y 14 días (n=15). Se hicieron mediciones basales de cuatro hormonas gastrointestinales (gastrina, PIG, motilina y neurotensina y se inició la estimulación con fórmula para prematuros diluida, comenzando un un mL cada dos horas e incrementando un mL diario hasta alcanzar aproximadamente 120 mL como volumen total, y se registraron las mediciones de las hormonas. Resultados. No hubo diferencia intergrupos en peso, edad gestacional, trofismo y estancia hospitalaria. Hubo diferencias intragrupos entre las mediciones basal y final en todas las hormonas en ambos grupos. Los resultados por subgrupos de edad gestacional (menores y mayores de 32 semanas) y eutróficos e hipotróficos mostraron diferencial basal-final. En relación con peso al nacer y volumen de leche de la EEM, los resultados fueron variables. No hubo complicaciones con el uso del EEM. Conclusiones. El EEM favorece la secreción hormonal gastrointestinal en prematuros enfermos aun administrado tardíamente. El EEM no incrementó las complicaciones abdominales. El peso, la edad gestacional, y el grado trofismo no se asocian a la magnitud de la secreción hormonal

Letalidad y morbilidad en neonatos con peso menor de 1,000 gramos / Lethality and morbidity in neonates with weight under 1,000 gm

Con la finalidad de conocer la morbilidad y letalidad de los recién nacidos con peso al nacer extremadamente bajo (< 1,000 g) que ingresan a una Unidad de Cuidados Intensivos Neonatales (UCIN), se estudiaron 49 neonatos atendidos en un lapso de dos años. Setenta y cinco por ciento tuvieron un peso bajo para su edad de gestación y el 24 por ciento fueron de peso adecuado. La morbilidad predominante estuvo relacionada con el aparato respiratorio tanto de origen pulmonar como extrapulmonar, seguida de las producidas por alteraciones metabólicas y hemorragia intraventricular. La tasa de letalidad fue de 71.7 por ciento, siendo más elevada a menor peso y mayor necesidad de asistencia ventilatoria convencional. Se observaron secuelas en 80 por ciento de los 14 sobrevivientes, sin que estuviesen asociadas a la edad de gestación, peso corporal, y trofismo. La sobrevida se asoció a un menor requerimiento de apoyo ventilatorio, por lo que probablemente la menor letalida en los niños que sobrevivieron se debió a que tuvieron menor morbilidad respiratoria

La citología del aspirado bronquial en el diagnóstico temprano de displasia broncopulmonar / Bronchial aspirate cytology in diagnosis of bronchopulmonary dysplasia

Se realizó un estudio prospectivo para evaluar la utilidad de la citología del aspirado bronquial en el diagnóstico temprano de displasia broncopulmonar. Los pacientes con displasia broncopulmonar fueron de menor peso y edad gestacional, recibieron ventilación y oxígeno por tiempo más prolongado y con mayores parámetros de ventilación. La citología del aspirado bronquial permitió el diagnóstico de la displasia broncopulmonar desde la segunda semana y es capaz de predecir el riesgo relativo se desarrollaría a partir de la segunda semana, sobre todo con clases II y III en la citología. La citología del aspirado bronquial es útil en el diagnóstico temprano de la displasia broncopulmonar y podría permitir la inclusión de los pacientes en protocolos dirigidos a una intervención más temprana en el tratamiento de esta patología pulmonar cronica

Utilidad del ambroxol en el neonato con síndrome de dificultad respiratoria / The use of ambroxol in the treatment of neonatal respiratory distress sydrome

Se valora la utilidad del ambroxol en el tratamiento del recién nacido con síndrome de dificultad respiratoria (SDR). El grupo I (n=26) recibió ambroxol y el grupo II (n=22), fue el grupo control. Ambos grupos se sometieron a intubaciones y asistencia ventilatoria mecánica convencional. No hubo diferencia significativa en edad gestacional, peso y apgar al nacimiento. La edad de ingreso fue menor en forma significativa en el grupo I. Al evaluar el efecto sobre PaO2, se observó aumento significativo en los días 1 y 2 de tratamiento en el grupo I, así como también en el índice de oxigenación en el primer día. La extubación fue más precoz en el grupo I aunque no significativa. Hubo también niños con atelectasia pulmonar postextubación (APE). El ambroxol mejora la PaO2 y el índice de oxigenación en los primeros días de tratamiento, por lo que constituye una alternativa en el tratamiento integral de neonatos con síndrome de dificultad respiratoria