Management of abdominal distension in the preterm infant with noninvasive ventilation: Comparison of cenit versus 2x1 technique for the utilization of feeding tube.

BACKGROUND: Preterm infants are fed by orogastric / nasogastric tube until they reach maturation and coordination of sucking, swallowing and respiration at approximately 32-34 weeks of corrected age. While being on non-invasive ventilation (NIV), they frequently present abdominal distension. Currently at our institution two techniques are used for the management of abdominal distension in preterm infants fed by bolus via orogastric tube: cenit and 2 x 1.The aim of this study was to compare the proportion of preterm infants presenting NIV-associated abdominal distension with each of these techniques. STUDY DESIGN: We conducted a randomized clinical trial including infants of <  36.6 weeks of gestation and <  1500 g of birth weight who were admitted to our NICU during the period of April 1, 2016 to April 1, 2018 and received NIV. The presence of abdominal distension >  2 cm was the primary outcome. Secondary outcomes were presence of reflux, regurgitation, oxygen saturation during feeding and days to reach full feedings. Feeding tube drainage, stool characteristics and the use of prokinetics were confounding variables. RESULTS: A total of 97 patients were included. Forty-six in the cenit group and 51 in the 2 x 1 group. There was no difference in the proportion of infants with abdominal distension >  2 cm between groups. Oxygen saturation during feeding at volume of 150 ml/kg/day was higher in the cenit group with statistical significance. CONCLUSION: The use of cenit or 2 x 1 technique in preterm infants with NIV did not improve abdominal distension or other indicators of feeding tolerance.

[Neurologic development of children at age two who had been treated at a neonatal intensive care unit]. / El neurodesarrollo a los dos años de vida de neonatos tratados en una unidad de cuidados intensivos neonatales.

The principal objective of this study was to evaluate, at 2 years of age, the neurological development of a group of children who had been treated in the neonatal intensive care unit (NICU) of the National Institute of Perinatology of Mexico. All the children born between 1 January 1992 and 31 December 1993 who had entered the NICU and stayed for 3 or more days were studied from the neurological, psychological, auditory, linguistic, motor, and neuromuscular standpoint. This group included 134 patients, who had had an average gestational age of 32 weeks and an average birth-weight of 1,677 g. They had stayed in the hospital an average of 51 days, and 75% of them had undergone artificial respiration. In the examination done at age 2, 66.5% of the children were normal and 8.2% had serious impairments. There were statistically significant associations between their neurological condition and the days of artificial respiration (P < 0.0001), the days spent in the NICU (P < 0.000004), and the gestational age in weeks (P < 0.03). There was no association between the children's sex and the results of the assessments. The study results showed a decrease in neural abnormalities in comparison with the results obtained in similar studies 10 years earlier.

[Auditory provoked potentials in children with neonatal risk for hypoacusia]. / Potenciales provocados auditivos en niños con riesgo neonatal de hipoacusia.

Auditory evoked potentials of the brain stem (AEPBS) provide a simple noninvasive method of evaluating hearing function and have been widely used for early detection of hypoacusis in children. Between April 1992 and May 1994, a study was done of 400 Mexican children who presented at least one neonatal risk factor for hearing impairment. The average age of the children studied was 6.6 months and their average gestational age at birth was 35.1 weeks. Just over half of them (51%) had been treated with amikacin. The study found 1427 risk factors (3.5 per child), the most common ones being exposure to ototoxic substances, hyperbilirubinemia, and birthweight of less that 1500 g. In 27% of the children, peripheral auditory changes were found, and 13% did not respond to auditory stimuli. Low birthweight and young gestational age at birth, high serum concentration of bilirubin, sepsis, subependymal or intraventricular hemorrhage, mechanical ventilation, and exposure to ototoxic substances were significantly associated with the presence of severe or profound hypoacusis.

[Risk factors for hypoacusis and audiometric findings in preschool children who had been admitted to neonatal intensive care units]. / Factores de riesgo para hipoacusia y hallazgos audiométricos en una población preescolar egresada de cuidados intensivos neonatales.

Thirty preschool children who survived from a neonatal intensive care unit were studied with pure tone audiometry between 125 to 8000 Hertz. Examinations were performed in a cross-sectional study at 36 to 72 postnatal months of age. Hypoacusis was found in three patients. Risk factors most frequently found in hypoacusic children were hyperbilirubinemia, hypoxia neonatorum and ototoxic exposure. All hypoacusic children had a history of preterm birth, one suffered hypoxia neonatorum, and two hyperbilirubinemia. The patients' group had an average of 2.26 risk factors. These data suggest that perinatal auditory damage occurs in the presence of additional hearing damage risk factors leading to hypoacusis.

[Maxillofacial anthropometry tables in healthy newborns]. / Tablas de antropometría maxilofacial en recién nacidos sanos.

With the purpose of having parameters which can be useful to evaluate the maxillofacial anthropometric characteristics at birth, we present the results of maxillofacial anthropometric measurements of 22 items in 373 healthy eutrophic newborns of both sexes delivered at the National Institute of Perinatology in Mexico City. Minor alterations of facial structures may indicate the presence of a dysmorphological syndrome such as: wide nasal bridge and wide intercantal distance. This study did not show big increments in the different anthropometric measurements from one week of gestation to the next, except for the bizygomatic and intercommissural measurements.

[Subependymal/intraventricular hemorrhage in preterm newborn infants. Neurodevelopmental course during the first year of life]. / Hemorragia subependimaria/intraventricular en neonatos pretérmino. Evolución del neurodesarrollo durante el primer año de vida.

Subependymal/intraventricular hemorrhage (SE/IVH) is the most frequently encountered type of hemorrhage in the neonatal period. Premature infants often develop SE/IVH which remains is one of most serious neonatal events. We studied a group of 96 premature newborn infants: half of which were diagnosed with SE/IVH. We evaluated the babies at six and 12 months of age which++ a battery of neurobehavioral exams, including neurological, psychological, motor an audiological test. In 52 of infants with SE/IVH showed some type of neurobehavioral abnormality, compared with 13% of non-SE/IVH infants. In 56% of SE/IVH infants had neurological abnormalities at 12 months (P < 0.0001) difference with non-SE/IVH), predominantly in areas of muscle tone and reflex. Motor abnormalities were encountered in 42% of SE/IVH children, and in 4% of non-SE/IVH children at 12 months. Psychometric abnormalities at 12 months were noted in 53% of the SE/IVH group. Hypocusis were noted in 38% of the SE/IVH group and in 15% of the non-SE/IVH group.

[Nosocomial infection in the neonatal period at a third level care center]. / Infección nosocomial en la etapa neonatal en un centro de tercer nivel de atención.

Results are presented on epidemiologic surveillance of nosocomial infection of all neonates attended at the Instituto Nacional de Perinatologia throughout 1988-1990, reporting rates of 2.1, 2.9 and 5.5 per 100 discharge for each of the years studied. Data are presented in full by service, showing rates of 4.7, 9.5 and 23.0 per 100 discharge in Neonatal Intensive Care Unit (NICU) and 1.5, 3.2 and 6.7 per 100 discharge for Neonatal Intermediate Care (NIC) for the same three years. With respect to type of infection, septicemia, pneumonia and conjunctivitis come as the most frequent causes of infection and Staphylococcus sp coagulase negative (30%), Staphylococcus aureus (27%) and Escherichia coli (7%) as the prevailing microorganisms in nosocomial infection.

[Nosocomial infection during puerperium]. / Infección nosocomial durante el puerperio.

Material and methods used to assess the epidemiology of puerperal infection (PI) in the National Institute of Perinatology (Mexico) between 1984 and 1990, are described. We observed that the general rate of PI ranged between 1.6 and 3.1; post-cesarean section posed a higher risk of infection than vaginal partum. Endometritis, associated with cesarean section, was the most frequent form of PI and gram positive flora was the most frequently found etiological agent. In general terms, we found that the rate of PI remained constant through the years of study, even when there was a significant increase in the practice of cesarean operations. Finally, we emphasize the need for the standardization of clinical norms used to assess the epidemiology of infection events. Standard norms will allow health-service institutions to compare results, observe tendencies, predict changes and take preventive actions.

[Alterations in neuro-development in the 1st year of life in newborn infants weighing 2000 grams or less at birth]. / Alteraciones del neurodesarrollo en el primer año de vida en neonatos que pesaron 2.000 gramos o menos al nacer.

The infants with low weight at birth have great chance of exhibiting early death or neurodevelopmental sequelae. We prospectively evaluated the neurological and psychological development during the first year of life in 118 infants who weighted less than 2,000 g at birth. All patients were examined with the Amiel Tison and Grenier test (neurologic evaluation), Gesell test (psychological) and Brunette-Lezine test (Psychomotor scale). Mean gestational age was 33 weeks (SD = 3.1) and birth mean weight was 1495 g (SD = 291). Seventy per cent were delivered by cesarean section. Neurological abnormalities were found in 20 infants (alteration of muscular tone in all and motor deficit in 50%). Twenty five per cent had abnormal Gesell test and 17% psychomotor retardation (13% mild and 4% severe).

[Growth curves for premature infants during the 1st year of life]. / Curvas de crecimiento del neonato pretérmino durante el primer año de vida.

A 107 newborn premature children were anthropometrically evaluated during the first 12 months of their lives at the Growth Clinic of the National Institute of Perinatology in Mexico City. The study was longitudinal and included variables such as weight, height, cephalic, thoracic, abdominal and bronchial perimeters. The data are show in percentiles of 10, 50 and 90 for each variable. A symmetrical logarithmic behavior throughout the entire curve was seen with each of the six indicators evaluated, whose greatest percentage increase within the growth rate was generally seen during the first semester, decreasing during the second. It was seen that once the child reaches one, the premature infant reaches the full-term child (50 percentile) in weight, height and cephalic perimeter. In addition, the average speed of growth was four times greater for weight, two times greater for height and similar for the cephalic perimeter of the premature child with respect to the full-term infant. We conclude that it is useful to count on specific growth curves for premature children since their speed and rhythm of growth are different than for the full-term child during the first year of life.

[A follow-up during the first year of life of newborn infants with very low weight at birth]. / Seguimiento durante el primer año de vida, de neonatos con muy bajo peso al nacer.

Groups of low-weight neonates, especially those under 1,500 g, discharged from the Intensive Care Unit, have a greater frequency of having psychoneurologic, audiologic, language and ophthalmologic scars in comparison with those neonates who suffered no complications. These frequencies vary considerably depending on different authors, the type of sequela and the duration of the follow-up. It is difficult to identify early on, which of these children will be affected in his later development. The currently used prognostic indexes have shown the importance of combining the child's psychoneurologic and biologic evolution as well as his surrounding environmental factors. Thirty-eight newborns were studied. Each weighted 1,500 g or less and were discharged from the Neonatal Intensive Care Unit. All of the patients were subsequently evaluated by specialists in Neurology, Psychology, Social Communication, Neuromotor Rehabilitation and Ophthalmology at 3, 6, 9 and 12 months of age (37 weeks) and included in a study conducted by the Program for Pediatric Follow-up at the National Institute of Perinatology. In general, the number of abnormalities found in each of the specialties during the first months of life was notorious, which later decreased as the child got older. For example, Neurology found abnormalities at 3 months in a proportion of 0.61 and at 12 months, it decreased to 0.19 (P less than 0.001). During neuromotor stimulation something similar was seen at three months a proportion of 0.39 abnormalities were recorded while at 12 months this decreased to 0.18. The human communication tests showed a proportion of 0.32 at 3 months and 0.10 at 12 months (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[The neurological and psychomotor evolution at 2 years of age of newborn infants who underwent assisted ventilation]. / Evolución neurológica y psicomotora a los dos años de vida de recién nacidos que fueron sometidos a ventilación asistida.

It is important to evaluate the development of neonates submitted to assisted ventilation since it is one of the most commonly used procedures in patients with respiratory failure. A group of 50 neonates who had been submitted to assisted ventilation were studied and compared to another group of 50 children with the same inclusion criteria, except for the fact that they had not needed ventilation. They were each evaluated since birth and thereafter every two months during their first year of life and every three months in the second year. The Amiel Tison Neurological Assessment was used to evaluate the children during the first year while the Mayo Clinic General Neurological Exploration adapted for nursing children was applied during the following year. In assessing psychomotor development, the Brunette Lezine Scale, standardized for Mexican children, was used. For practical purposes, a sample of the results obtained during the second year are presented while some pertinent variables are commented on. For those included in the ventilated group, results show a higher frequency of hyaline membrane disease (27 cases), intraventricular hemorrhage (19), pneumonia (18), and arterious duct persistence (13). The control group showed the following frequencies, respectively: 0, 4, 5, and 4 cases. The ventilation group was found to have a statistically significant higher relative risk rate (P less than 0.05) and a higher risk for neurologic sequelae (P less than 0.001) when compared to the control group. Asphyxia and hemorrhaging were factors associated and present in the ventilated group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hearing and language sequelae in survivors of a neonatal intensive care unit]. / Secuelas de audición y lenguaje en sobrevivientes de una Unidad de Cuidados Intensivos Neonatales.

INTRODUCTION: The purpose of this study is to record the hearing and language sequelae in a sample of children from the Intensive Care Unit between the ages of two and three. MATERIALS AND METHODS: Forty-one children were studied after being submitted to neuropsychological, hearing and language tests. Both normal and abnormal parameters for each test allowed the categorization of the children. RESULTS: In the general sample there were 24 full-term children versus 17 preterm children. The neurological testing showed a tendency towards normality. The same was seen in language testing since the proportion of normality corresponded to those children born after a full term. There were practically no differences in those suspected from both groups and a greater percentage of abnormal children were found among the pre-term infants. From an audiological standpoint there was a predominance of normal children; there was only one patient with severe bilateral hypoacusis who needed an electric auxiliary hearing device and two other patients with peripheral ear dysfunction classified as serous middle ear otitis. CONCLUSIONS: The incidence of hypoacusis in this sampling type is similar to that reported in the literature. Those patients with a history of assisted mechanical ventilation have been later found to have, as a sequelae, serous middle ear otitis, which corresponds to that reported by Paradise. The development of language stages were altered more so in preterm children. In some patients, the lack of stimulation associated with a low socioeconomic back group favors the delay in the development of language skills.

[Effects of early multimodal stimulation on preterm newborn infants]. / Efectos de la estimulación multimodal temprana en neonatos pretérmino.

During the last trimester of pregnancy, newborns are deprived of both maternal biorhythms, tactile, kinesthetic and auditory stimulation which characterize the intrauterine environment. The purpose of this study is to determine if supplemental multimodal stimulation improves neurobehavioral performance, increases weight gain and shortens hospital stay. Nine neonates with the following characteristics were included in an early multimodal stimulation program: 1) gestational age less than or equal to 34 weeks, 2) feeding through orogastric tubing, 3) hemodynamically stable, with no signs of hemorrhaging, infections, or any suggestion of neurological damage, convulsions or congenital malformations. A control group with the same characteristics was also included in the study. Risk factors for each patient were evaluated and their evolution was closely watched while still in the hospital. Both the postural reflexes and neurobehavioral performance were assessed at the time the child left the hospital and a month afterwards. Statistically significant differences were found in the neurobehavioral performance and postural reflexes of those included in the study group.

[The prone position as an indicator of deviated motor development during the first year of life]. / La posición prona como indicador de un desarrollo motor desviado en el primer año de la vida.

The adequate control and alignment of a baby in the prone position during the first year of life is a basic necessary milestone for a normal, neuromotor development. In this study the prone position was registered in 246 babies with a previous pediatric evaluation, three options could be made: normal retarded or altered. The Milani Comparetti neuromotor evaluation was also realized for each baby at the same time with the same classification options. Both results were compared. A sensitivity and specificity = 1.0 were found for the prone position registered. This test is fast and simple, so it is recommended at a first attention level in high risk population for neuromotor disability.

[The Apgar score as a predictor of neurologic sequellae]. / El puntaje de Apgar como predictor de secuelas neurológicas.

65 newborns with Apgar score less than 7 were studied. Initially 2 groups were formed. Group 1 with severe asphyxia Apgar 0-3 and group 2 with moderate asphyxia Apgar 4-7. Each group was divided according to Apgar score at 5 minutes; with good recuperation Apgar greater than or equal to 6 and bad recuperation Apgar less than 6. So four subgroups were formed. All patients were evaluated with Amiel Tison neurological examination at 12 months old. Of the 65 newborns, 52 (80%) had a normal neurologic examination, and only 12 (20%) were not normal. There were not significant statistic differences neither between the moderate and severely asphyxiated groups nor between the four subgroups at 5 minutes and their neurological examination. We conclude that the Apgar score at 5 minutes is not a good predictive of neurological sequelae, because there is a myriad of factors difficult to investigate in relation to the etiology of neurologic sequelae. We stress the importance of reviewing the original idea about the Apgar score as a useful method (instrument) to evaluate the hemodynamic and homeostatic conditions of the newborns.

[Clinical characterization of a sample of newborns at risk of presenting with an altered neurologic evaluation]. / Caracterización clínica de una muestra de recién nacidos en riesgo de presentar una evaluación neurológica alterada.

Being the Prachtl's Neurological Sieve a systematic condense analysis of neurologic screening which allows to establish a normal or suspicious neurologic condition at a sensibility of 0.85, and specificity of 0.77 with a predictive value of 0.78 (in our experience), we take it as an axis variable capable to discriminate among the population with and without risk of neurologic injury or sequela. Thirty-five newborn infants with an Apgar score at birth equal or below 6, were taken into study for the purpose of featuring the group of neonates on risk to show an altered neurologic evaluation. The study was held under the hypothesis that: low Apgar score, and morbidity and mortality risk index, need to be complemented with hospital outcome (Casaer) and the estimation of factors affecting physical and mental development (Eggermont), in order to be able to feature those neonates in risk for developing a neurologic injury or sequela. Findings showed that Prechtl's Neurological Sieve is directly influenced by the magnitude of recovery from the one to five minutes Apgar Score, by the Casaer's first or initial score and by the Eggermont's assessment items. It is also related in an indirect way to the birth weight, the gestational age, the morbidity and mortality risk index, the 1 and 5 minutes Apgar score and the final or discharge Casaer evaluation.

[Neurologic follow-up of polycythemic newborn infants]. / Seguimiento neurológico de neonatos policitémicos.

Seventy five newborn infants with neonatal polycythemia diagnosis (venous hematocrit levels greater than 65% were studied). They were born in the Instituto Nacional de Perinatologia and follow through their first year of life searching for neurologic findings. The more frequent signs related to polycythemia in this group were: presence of plethora, respiratory distress, cyanosis and tremors; the associated findings were hypoglycemia, hyperbilirubinemia, necrotizing enterocolitis and meconium aspiratum. Sixty eight of the seventy five neonates developed symptomatology and seven didn't. The eight neonates who developed neurologic transient impairments belonged to the symptomatic group in a 0.11 proportion. We concluded that the number of babies with neurologic findings in our sample was small in comparison with other reference studies; we also found that the exchange transfusion is not a preventive measure for neurologic sequel, but it is useful to diminish the symptomatology caused by polycythemia; besides we don't recommend this procedure in asymptomatic babies because the complication risks as the enterocolitis. We propose a simple treatment scheme.