Evaluating the quality of the processes of care and clinical outcomes of premature newborns admitted to neonatal intensive care units in Mexico.

OBJECTIVES: To develop quality of care (QoC) indicators, evaluate the quality of the processes of care (QPC) and clinical outcomes, and analyze the association between the QPC and severe clinical outcomes of preterm newborns admitted to neonatal intensive care units (NICUs). DESIGN: Mixed methods approach: (1) development of QoC indicators via modified RAND/UCLA method; (2) cross-sectional study of QoC evaluation and (3) multiple logistic regression analysis to ascertain the association between the QPC and severe clinical outcomes. SETTING: Two NICUs belonged to the Mexican Institute of Social Security in Mexico City. PARTICIPANTS: About 489 preterm neonates (<37 weeks of gestation) without severe congenital anomalies. MAIN OUTCOME MEASURE(S): The QoC indicators; ≥60% of recommended QPC and severe clinical outcomes. RESULTS: The QoC included 10 QPC indicators across four domains: respiratory, nutrition and metabolism, infectious diseases, and screening, and five outcome indicators. The lower QPC indicators were for the nutrition and metabolism domain (17.8% started enteral feeding with human milk, and 20.7% received sodium bicarbonate appropriately). The higher QPC indicator was for the screening domain (97.6% of neonates <30 weeks gestation underwent early (≤14 days) transfontanelar ultrasound). The mean recommended QPC that neonates received was 47.5%. Only 26.6% of neonates received ≥60% of recommended QPC. About 60.7% of neonates developed severe clinical outcomes including mortality and healthcare-related major morbidity. Receiving ≥60% of recommended QPC was associated with a decrease of nearly half of odds of severe clinical outcomes. CONCLUSION: The evaluation of the QoC in NICUs is essential to address modifiable gaps in quality.

Cambios en la hemodinamia cerebral y sistémica en recién nacidos bajo sedación y analgesia con fentanilo / Changes in cerebral and systemic hemodynamics in newborns under sedation and analgesi with fentanyl

Introducción. Objetivo: determinar las variaciones del flujo sanguíneo cerebral con la aplicación de fentanilo en neonatos críticamente enfermos. Material y métodos. Diseño: estudio longitudinal, prospectivo, descriptivo y observacional. Si Neonatología del Hospital de Pediatría, Centro Médico Nacional. Se incluyeron 18 pacientes tratados con fentanilo en bolo (5 µg / kg) e infusión contimua (3 µg/kg/hora). Se hicieron mediciones basales, a la hora y a las 24 horas de la aplicación del fármaco de la tensión arterial (TA) sistólica, diastólica y media y por ultrasonido (Modo M y B) se midieron las fracciones de eyección y acortamiento del ventrículo izquierdo. Por medio de Doppler pulsado se midieron la velocidad de flujo sanguíneo y el índice de pulsatilidad de la arteria cerebral anterior en los mismos momentos establecidos. Resultados. Se encontraron diferencias significativas en: la TA diastólica, la telediástole de la arteria cerebral y la fracción de acortamiento entre las mediciones basales y a las 24 horas (P< 0.05) para cada una de ellas. No hubo efecto adverso con el tratamiento en ninguna de las mediciones hemodinámicas, sistémicas o cerebrales. Conclusiones. Las diferencias encontradas entre los valores basales y los subsecuentes probablemente se atribuyan a la administración de fentanilo