Steps to improve umbilical vein catheterization in neonatal care.

INTRODUCTION: In neonatal units, umbilical vessel catheterization is the preferred method to gain vascular access in the initial management of the newborn because it is quick and easy. The failure rate ranges from to 50%, as the catheter can be found in the portal system in up to 40% of cases, leading to complications. This failure rate warrants the investigation of different methods to reduce the frequency of catheter malposition. We describe different techniques to improve the success rate in umbilical vein catheterization, such as the double catheter technique, positioning the newborn in right lateral decubitus for insertion, liver compression, and ultrasound-guided catheter insertion. The primary objective of the study was to assess the impact of new techniques on the success rate of central umbilical venous catheterization. MATERIAL AND METHODS: Pre- and post-intervention quasi-experimental study in a level B NICU conducted in January-June 2022 (pre-intervention) and July-December 2022 (post-intervention). RESULTS: Prior to the introduction of these new catheterization techniques, the failure rate of blind umbilical catheter insertion was 52%. Since the introduction of these measures, the overall failure rate has decreased to 27%. CONCLUSIONS: After the introduction of the new catheterization and recanalization methods, our success rate in umbilical vein catheterization has increased, and we believe it is necessary to implement them in units with similar failure rates to ours.

Pasos para la mejora en la canalización umbilical en neonatología / Steps to improve umbilical vein catheterization in neonatal care

Introducción: En las unidades neonatales se utiliza el catéter venoso umbilical como acceso vascular de elección en la atención inicial del recién nacido debido a su rápido y fácil acceso. Presenta una tasa de fracaso del 25% al 50%, ya que hasta en un 40% de los casos puede encontrarse en el sistema portal conllevando complicaciones. Esto justifica la búsqueda de métodos para disminuir la tasa de catéteres mal posicionados. Se describen diferentes técnicas para mejorar la tasa de éxito a la hora de canalizar la vena umbilical, como son la técnica del doble catéter, la posición del recién nacido para canalizar en decúbito lateral derecho, la compresión hepática y la canalización de forma ecoguiada. El objetivo principal de este estudio es evaluar el impacto de las nuevas técnicas en la tasa de éxito de canalización venosa umbilical central. Material y métodos: Estudio cuasiexperimental pre- y postintervención en una UCIN nivel B durante enero-junio de 2022 (preintervención) y julio-diciembre de 2022 (postintervención). Resultados: Previo a la introducción de estas nuevas técnicas de canalización nuestra tasa de fracaso en la canalización, siempre llevada a cabo a ciegas, era de un 52% y con la introducción de estas medidas ha disminuido la tasa de fracaso a un 27% de forma global. Conclusiones: Tras la introducción de los nuevos métodos de canalización y recanalización, nuestra tasa de éxito en la canalización de la vena umbilical ha aumentado, y creemos necesario implantarlo en unidades con tasas de fracaso similares a la nuestra. (AU)

Introduction: In neonatal units, umbilical vessel catheterization is the preferred method to gain vascular access in the initial management of the newborn because it is quick and easy. The failure rate ranges from 25% to 50%, as the catheter can be found in the portal system in up to 40% of cases, leading to complications. This failure rate warrants the investigation of different methods to reduce the frequency of catheter malposition. We describe different techniques to improve the success rate in umbilical vein catheterization, such as the double catheter technique, positioning the newborn in right lateral decubitus for insertion, liver compression, and ultrasound-guided catheter insertion. The primary objective of the study was to assess the impact of new techniques on the success rate of central umbilical venous catheterization. Material and methods: Pre- and post-intervention quasi-experimental study in a level B NICU conducted in January to June 2022 (pre-intervention) and July to December 2022 (post-intervention). Results: Prior to the introduction of these new catheterization techniques, the failure rate of blind umbilical catheter insertion was 52%. Since the introduction of these measures, the overall failure rate has decreased to 27%. Conclusions: After the introduction of the new catheterization and recanalization methods, our success rate in umbilical vein catheterization has increased, and we believe it is necessary to implement them in units with similar failure rates to ours. (AU)

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.

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.