Validation of a prognostic index in the critically ill newborn.

OBJECTIVE: Elaborate and assess the degree of validity of a prognostic model for evaluating patients admitted to the Neonatal Intensive Care Unit (NICU). DESIGN: Cases and controls nested in a cohort. SETTING: NICU of two tertiary hospitals and another second level hospital. PATIENTS: The study was carried out in two phases. During the first phase (elaboration of a model), 336 newborns were studied; 112 belonged to the case group (dead patients) and 224 to the control group (live patients discharged). For the second phase (model validation), 300 patients were included that did not participate in the first phase, 100 cases and 200 controls. MEASUREMENTS: For each patient admitted to the study, clinical, paraclinical, perinatal and comorbidity factors were determined within the first 12 hours. Variables of statistical significance in the bivariate analysis were included in a logistic regression model with the objective of identifying a prognostic model. RESULTS: The variables that constituted the prognostic index were gestational age x birth weight, the paO2/FiO2 ratio x O2 saturation, arrest cardiac, major congenital malformations, septicemia and base excess. The model showed to have a sensitivity of 70% and a specificity of 91% during the elaboration cohort. In the validation cohort, sensitivity was 68% and specificity was 92%, a positive predictive value of 80%, negative predictive value of 85% and a correct classification rate was 84%. CONCLUSIONS: The Neonatal Mortality Prognostic Index (NMPI) developed in this study showed to be useful for the evaluation of hospital mortality for severely ill newborns admitted to NICU.

[Treatment of acute poisoning caused by carbamazepine, digoxin, and acetylsalicylic acid, with repeated doses of activated charcoal]. / El tratamiento de las intoxicaciones agudas causadas por carbamazepina, digoxina y ácido acetilsalicílico, mediante la administración de dosis repetidas de carbón activado.

Twelve pediatric patients with acute poisonings caused by carbamazepine, digoxin and acetylsalicylic acid were treated with multiple doses of activated charcoal combined with a saline cathartic (adsorption surface of activated charcoal nearly 950 m2/g). This procedure was effective to shorten the plasmatic levels of the drugs, besides the clinical improvement of the poisoned patients. The average initial and final levels of the drugs were: carbamazepine 21.64 and 0.9 micrograms/ml (lowering 95.81%, p < 0.05), digoxin 5.14 and 1.1 ng/ml (lowering 78.6%, P < 0.05) and acetylsalicylic acid 418.5 and 57.5 micrograms/ml, respectively, (lowering 86.3%, p < 0.05). These results suggest the usefulness of activated charcoal in the clearance of the four overdosed drugs.

[Liaison psychiatry at a neonatal intensive care unit. Interphase between psychiatry of the infant and neonatology]. / Psiquiatría de enlace en una unidad de cuidados intensivos neonatales. Interfase entre la psiquiatría del lactante y la neonatología.

A description is made of the situation of neonates and their families during hospitalization in the Neonatal Intensive Care Unit (NICU). Emphasis is made on the stressful situations faced by the infants, the families and the caregivers as well as on potential interventions to ameliorate their negative impact and to promote a favorable outcome. With the infants, the situation is one of overwhelming aversive stimulation, noncontingent responses and painful procedures, coupled with deprivation of normative experiences, propiciated by their illness and the structure of the unit. With the families, their feelings of impotence, guilt, and separation from their infant are highlighted, and interventions are described that may help them in this situation of crisis. With the staff the intervention consists on education and sensitization to the infant's needs. The liaison psychiatrist is the infant's voices with the families and the staff. The literature is reviewed in terms of the potential effects of favorable stimulation and of the negative experiences of neonates while at the NICU.

[The transfusion of blood and its derivatives in the neonate]. / Transfusiones de sangre y sus derivados en el neonato.

Blood and its products are valuable therapeutic resources for the pediatrician who care for newborns with severe illnesses. The use of blood and its products requires for the hospital personnel working at neonatal care units to be precise and up to date on the indications and complications of total blood, the globular package, albumin, plasma, the concentration of granulocytes, platelets and immunoglobulins for intravenous use. This review gathers, on the one hand, accumulated experiences by the members of the Commission of Blood and its Products from the Pediatric Hospital of the National Medical Center and on the other hand, a selection of the more important concepts which have been judged so by the authors and expressed in the current medical literature.