El peso para la longitud en pretérminos tardíos evaluados con impedancia bioélectrica se asocia a variables antropométricas / Weight for length in late preterm infants assessed with bioelectrical impedance is positively associated with anthropometric variables

Introducción: La masa grasa es mayor en lactantes pretérmino tardíos que en lactantes nacidos a término al mes de vida y esto podría ser un factor de riesgo adicional para el síndrome metabólico en la vida adulta. Objetivos: Para evaluar la composición corporal (CC) en prematuros tardíos utilizamos el análisis de impedancia bioeléctrica y buscamos determinar qué parámetro antropométrico está asociado con la CC. Nuestra hipótesis es que el peso para la longitud está asociado con el índice de masa grasa (IMG) normalizado por longitud al año de vida. Materiales y métodos: Realizamos un estudio de cohortes prospectivo con 2 grupos: prematuros tardíos y nacidos a término. Los datos de CC se midieron mediante análisis de impedancia bioeléctrica. Se calcularon la masa grasa, el IMG, la masa libre de grasa y el índice de MLG normalizado por talla a los 1, 6 y 12 meses de vida. Luego determinamos la asociación del IMG con los parámetros antropométricos mediante un análisis de regresión lineal múltiple. Resultados: Incluimos 97 prematuros tardíos y 47 nacidos a término, aunque la evaluación de CC se realizó en 66 y 33 a los 12 meses de vida. Al mes, el contenido de masa libre de grasa fue mayor en los recién nacidos prematuros tardíos (4013 frente a 3524g); a los 6 meses, tuvieron una mayor velocidad de incremento de peso (5480g versus 4604g) y a los 12 meses de vida, el contenido de masa libre de grasa y el índice de MLG de los recién nacidos prematuros tardíos fue menor que el de los recién nacidos a término (7232 versus 7813g; 12,55 versus 13.26). Según el análisis de regresión multivariable, la puntuación z del peso para la talla a los 12 meses se asoció positivamente con el IMG a los 12 meses en todos los lactantes. (AU)

Introduction: The fat mass is greater in late preterm than full term infants at 1 month post birth, which may be an additional risk factor for metabolic syndrome in adulthood. Objectives: To evaluate body composition (BC) in late preterm infants using bioelectrical impedance analysis to determine which anthropometric parameters are associated with BC. Our hypothesis was that weight-for-length is associated with the length-normalized fat mass index (FMI) at 1 year of life. Materials and methods: We carried out a prospective cohort study in 2 groups: late preterm infants and full term infants. We obtained BC data by bioelectrical impedance analysis. We calculated the fat mass, FMI, fat-free mass (FFM) and length-normalized FFM index at 1, 6 and 12 months of life. After, we assessed the association of the FMI with anthropometric parameters using multiple linear regression analysis. Results: The study included 97 late preterm and 47 full term infants, although at 12 months of life, the BC assessment was performed on 66 and 33 infants, respectively. Late preterm infants, compared to full term infants, had a higher FFM at 1 month (4013g vs. 3524g), a higher weight velocity at 6 months (5480g vs. 4604g) and a lower FFM (7232g vs. 7813g) and FFM index (12.55 vs. 13.26) at 12 months of life. The multivariate regression analysis showed that the weight-for-length z-core at 12 months was positively associated with the FMI at 12 months in all infants. (AU)

The weight for length in late preterm infants assessed with bioelectrical impedance is positively associated with anthropometric variables.

INTRODUCTION: The fat mass (FM) is greater in late preterm than full term infants at 1 month post birth, which may be an additional risk factor for metabolic syndrome in adulthood. OBJETIVES: To evaluate body composition (BC) in late preterm infants using bioelectrical impedance analysis (BIA) to determine which anthropometric parameters are associated with BC. Our hypothesis was that weight-for-length is associated with the length-normalized fat mass index (FMI) at 1 year of life. MATERIALS AND METHODS: We carried out a prospective cohort study in 2 groups: late preterm infants and full term infants. We obtained BC data by BIA. We calculated the fat mass (FM), FMI, fat-free mass (FFM) and length-normalized fat-free mass index (FFMI) at 1, 6 and 12 months of life. After, we assessed the association of the FMI with anthropometric parameters using multiple linear regression analysis. RESULTS: The study included 97 late preterm and 47 full term infants, although at 12 months of life, the BC assessment was performed on 66 and 33 infants, respectively. Late preterm infants, compared to full term infants, had a higher FFM at 1 month (4013 vs 3524 g), a higher weight velocity at 6 months (5480 g versus 4604 g) and a lower FFM (7232 vs 7813 g) and FFMI (12.55 vs 13.26) at 12 months of life. The multivariate regression analysis showed that the weight-for-length z-core at 12 months was positively associated with the FMI at 12 months in all infants. CONCLUSION: The weight-for-length z-score at 12 months is strongly associated with the FMI at 1 year of life. Further studies are needed to investigate whether an increment in this anthropometric parameter may modulate the risk of chronic diseases.

Implementation of a neonatal donation protocol in the neonatal intensive care unit: A single-center experience.

BACKGROUND: Lack of specific protocols for neonatal donation contributes to the rarity of neonatal donors. In this study, we evaluate the impact of the implementation of a neonatal donation protocol in our NICU. METHODS: In this single-center study, we conducted a retrospective chart review of neonatal deaths in our NICU from January 2013 to January 2022. The study was divided into two periods: before and after the implementation of a neonatal donation protocol. The referral rates of potential neonatal donors to the OPO in the two periods were compared using the chi-square test. A p value < .05 was considered statistically significant. RESULTS: Sixty-four infants were reviewed. Seven (10.9%) met the inclusion criteria for potential neonatal donors after DCC. The referral rate of potential neonatal donors increased from 2.5% to 16.7% after the implementation of this protocol (p = .041), and one infant (4.1%) became an effective heart-valve donor. CONCLUSION: The implementation of a local neonatal donation protocol could have contributed to increase the referral rate of potential neonatal donors in our NICU. Following the implementation of a local neonatal donation protocol, we were able to perform a heart-valve donation for the first time in our unit.

Signatia congénita / Congenital syngnathia

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Anemia fetal grave y encefalopatía epiléptica neonatal causada por una nueva mutación en el gen PNPO / Severe fetal anemia and neonatal epileptic encephalopathy caused by a novel PNPO mutation

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Central-peripheral Temperature Monitoring as a Marker for Diagnosing Late-onset Neonatal Sepsis.

BACKGROUND: The prognosis for late-onset sepsis depends largely on a timely diagnosis. We assess central-peripheral temperature difference monitoring as a marker for late-onset neonatal sepsis diagnosis. METHODS: We performed a prospective, observational study focusing on a cohort of 129 very low-birth-weight infants. Thermal gradient alteration was defined as a difference of > 2°C maintained during 4 hours. We then determined its association with the late-onset sepsis variable through logistic regression. RESULTS: We enrolled 129 preterm babies in 52 months. Thermal gradient alterations showed an adjusted odds ratio for late-onset sepsis of 23.60 (95% confidence interval [CI], 6.80-81.88), with a sensitivity of 83% and negative predictive value of 94%. In 71% of cases, thermal gradient alteration was the first clinical sign of sepsis, while C-reactive protein was < 1.5 mg/dL in 64% of cases and procalcitonin < 2 ng/mL in 36%. These figures indicate potential for early diagnosis. CONCLUSIONS: Sustained increases of central-peripheral temperature differences are an early sign of evolving late-onset sepsis.

Cinco pasos para la disminución de las infecciones relacionadas con la asistencia sanitaria en prematuros grandes inmaduros. Estudio cuasiexperimental / Five steps to decreasing nosocomial infections in large immature premature infants: A quasi-experimental study

Objetivos: El objetivo de este estudio fue evaluar el impacto de un conjunto de 5 intervenciones sobre la incidencia de infecciones relacionadas con la asistencia sanitaria en una unidad de Neonatología de nivel iii. Material y métodos: Estudio cuasiexperimental pre-postintervención. Se incluyó a aquellos prematuros con peso al nacimiento <1.500 g o edad gestacional <32 semanas que ingresaron en los 12 meses previos y posteriores a la implantación de las medidas (enero del 2014). Las intervenciones consistieron en optimizar la higiene de manos, protocolizar la inserción y la manipulación de catéteres intravenosos centrales, fomentar la alimentación con leche materna, implantar una política de uso racional de antibióticos y establecer un sistema de vigilancia epidemiológica de gérmenes multirresistentes. Como variable principal se analizó la densidad de incidencia de infecciones relacionadas con la asistencia sanitaria antes y después de implementar las medidas. Resultados: Fueron incluidos 33 pacientes en cada período, homogéneos en edad gestacional, peso y otras variables demográficas. Se constató una densidad de incidencia de 8,7 y 2,7 infecciones/1.000 días de estancia en los períodos pre y postintervención respectivamente (p <0,05). También se halló una disminución estadísticamente significativa en el porcentaje de días en ventilación mecánica, así como de pacientes que recibieron hemoderivados y fármacos vasoactivos. Conclusiones: Esta estrategia, basada en la puesta en marcha de 5 medidas concretas, fue efectiva en la disminución de infecciones relacionadas con la asistencia sanitaria en una unidad con tasas elevadas de dichas infecciones. Esta reducción pudo contribuir a una menor tasa de empleo de ventilación mecánica, hemoderivados y fármacos vasoactivos en el período postintervención (AU)

Objectives: An evaluation is made of the impact of a series of five interventions on the incidence of hospital-related infections in a level iii neonatal unit. Material and methods: Quasi-experimental, pre-post intervention study, which included preterm infants weighing 1,500g at birth or delivered at <32 weeks gestation, admitted in the 12 months before and after the measures were implemented (January 2014). The measures consisted of: optimising hand washing, following a protocol for insertion and handling of central intravenous catheters, encouraging breastfeeding; applying a protocol for rational antibiotic use, and establishing a surveillance system for multi-resistant bacteria. The primary endpoint was to assess the incidence of hospital-acquired infections before and after implementing the interventions. Results: Thirty-three matched patients were included in each period. There was an incidence of 8.7 and 2.7 hospital-related infections/1,000 hospital stay days in the pre- and post-intervention periods, respectively (P<.05). Additionally, patients in the treatment group showed a statistically-significant decrease in days on mechanical ventilation, use of blood products, and vasoactive drugs. Conclusions: The strategy, based on implementing five specific measures in a unit with a high rate of hospital-related infections, proved effective in reducing their incidence. This reduction could contribute to lowering the use of mechanical ventilation, blood products, and vasoactive drugs (AU)

[Five steps to decreasing nosocomial infections in large immature premature infants: A quasi-experimental study]. / Cinco pasos para la disminución de las infecciones relacionadas con la asistencia sanitaria en prematuros grandes inmaduros. Estudio cuasiexperimental.

OBJECTIVES: An evaluation is made of the impact of a series of five interventions on the incidence of hospital-related infections in a level iii neonatal unit. MATERIAL AND METHODS: Quasi-experimental, pre-post intervention study, which included preterm infants weighing 1,500g at birth or delivered at <32 weeks gestation, admitted in the 12 months before and after the measures were implemented (January 2014). The measures consisted of: optimising hand washing, following a protocol for insertion and handling of central intravenous catheters, encouraging breastfeeding; applying a protocol for rational antibiotic use, and establishing a surveillance system for multi-resistant bacteria. The primary endpoint was to assess the incidence of hospital-acquired infections before and after implementing the interventions. RESULTS: Thirty-three matched patients were included in each period. There was an incidence of 8.7 and 2.7 hospital-related infections/1,000 hospital stay days in the pre- and post-intervention periods, respectively (P<.05). Additionally, patients in the treatment group showed a statistically-significant decrease in days on mechanical ventilation, use of blood products, and vasoactive drugs. CONCLUSIONS: The strategy, based on implementing five specific measures in a unit with a high rate of hospital-related infections, proved effective in reducing their incidence. This reduction could contribute to lowering the use of mechanical ventilation, blood products, and vasoactive drugs.

The value of lipopolysaccharide binding protein for diagnosis of late-onset neonatal sepsis in very low birth weight infants.

OBJECTIVE: To assess the accuracy of lipopolysaccharide binding protein (LBP) for diagnosing late-onset neonatal sepsis (LONS) in very low birth weight (VLBW) infants. STUDY DESIGN: Observational, prospective study. We assessed the diagnostic performance of LBP in 26 suspected LONS episodes among 54 patients. Proven and probable LONS episodes were recorded according to established criteria. Receiver operating characteristic curve analysis was performed to evaluate LBP's ability to predict LONS. RESULTS: LONS was diagnosed in 17 of 26 episodes. LBP levels were significantly higher in confirmed LONS episodes (P<0.001). The area under the curve of LBP was 0.89. A cut-off of 17.5 µg/mL had a sensitivity of 94.1%, a specificity of 77.8%, a positive predictive value of 88.9% and a negative predictive value of 87.5%. CONCLUSIONS: Serum LBP measurement may be useful as an additional tool in the evaluation of suspected LONS in VLBW infants.

Central-peripheral temperature gradient: an early diagnostic sign of late-onset neonatal sepsis in very low birth weight infants.

AIMS: We assessed central-peripheral temperature gradient alteration for the diagnosis of late-onset neonatal sepsis and compared earliness detection of this sign with altered blood cell count and C-reactive protein. METHOD: Thirty-one preterm babies (<1500 g or <32 weeks) participated in an observational prospective study. Axillary (central) and sole (peripheral) temperatures were continuously monitored with a thermal probe (ThermoTracer; Dräger Medical AGF & Co. KgaA, Lübeck, Germany) adjusting incubator air temperature for a thermal gradient <1.5°C. Central-peripheral temperature alteration was defined as a thermal gradient >2°C that could not be corrected with protocolized air temperature modifications. Proven (positive blood culture) sepsis and probable late-onset sepsis were recorded. RESULTS: Late-onset sepsis was diagnosed in 11 neonates (proven, 9; probable, 2). Thermal gradient alteration was present in 12 cases, in association with the onset of sepsis in 10 and concomitantly with a ductus arteriosus and stage 1 necrotizing enterocolitis in 2. Thermal gradient alteration had a sensitivity of 90.9% [95% confidence interval (CI), 62.3-98.4] and specificity of 90% (95% CI, 69.9-97.2%), and in 80% of cases, it occurred before abnormal laboratory findings. CONCLUSIONS: Central-peripheral temperature gradient monitoring is a feasible, non-invasive, and simple tool easily applicable in daily practice. An increase of >2°C showed a high-sensitivity and specificity for the diagnosis of late-onset sepsis.