[Medication errors in a neonatal unit: One of the main adverse events]. / Los errores de tratamiento en una unidad neonatal, uno de los principales acontecimientos adversos.

INTRODUCTION: Neonatal units are one of the hospital areas most exposed to the committing of treatment errors. A medication error (ME) is defined as the avoidable incident secondary to drug misuse that causes or may cause harm to the patient. The aim of this paper is to present the incidence of ME (including feeding) reported in our neonatal unit and its characteristics and possible causal factors. A list of the strategies implemented for prevention is presented. MATERIAL AND METHODS: An analysis was performed on the ME declared in a neonatal unit. RESULTS: A total of 511 MEs have been reported over a period of seven years in the neonatal unit. The incidence in the critical care unit was 32.2 per 1000 hospital days or 20 per 100 patients, of which 0.22 per 1000 days had serious repercussions. The ME reported were, 39.5% prescribing errors, 68.1% administration errors, 0.6% were adverse drug reactions. Around two-thirds (65.4%) were produced by drugs, with 17% being intercepted. The large majority (89.4%) had no impact on the patient, but 0.6% caused permanent damage or death. Nurses reported 65.4% of MEs. The most commonly implicated causal factor was distraction (59%). Simple corrective action (alerts), and intermediate (protocols, clinical sessions and courses) and complex actions (causal analysis, monograph) were performed. CONCLUSIONS: It is essential to determine the current state of ME, in order to establish preventive measures and, together with teamwork and good practices, promote a climate of safety.

[Towards a safety culture in the neonatal unit: Six years experience]. / Caminando hacia una cultura de seguridad en la unidad neonatal: experiencia de 6 años.

INTRODUCTION: A safety culture is the collective effort of an institution to direct its resources toward the goal of safety. MATERIAL AND METHODS: An analysis is performed on the six years of experience of the Committee on the Safety of Neonatal Patient. A mailbox was created for the declaration of adverse events, and measures for their correction were devised, such as case studies, continuous education, prevention of nosocomial infections, as well as information on the work done and its assessment. RESULTS: A total of 1287 reports of adverse events were received during the six years, of which 600 (50.8%) occurred in the neonatal ICU, with 15 (1.2%) contributing to death, and 1282 (99.6%) considered preventable. Simple corrective measures (notification, security alerts, etc.) were applied in 559 (43.4%), intermediate measures (protocols, monthly newsletter, etc.) in 692 (53.8%), and more complex measures (causal analysis, scripts, continuous education seminars, prospective studies, etc.) in 66 (5.1%). As regards nosocomial infections, the prevention strategies implemented (hand washing, insertion and maintenance of catheters) directly affected their improvement. Two surveys were conducted to determine the level of satisfaction with the Committee on the Safety of Neonatal Patient. A rating 7.5/10 was obtained in the local survey, while using the Spanish version of the Hospital Survey on Patient Safety Culture the rate was 7.26/10. CONCLUSIONS: A path to a culture of safety has been successfully started and carried out. Reporting the adverse events is the key to obtaining information on their nature, etiology and evolution, and to undertake possible prevention strategies.

Trombosis venosa ovárica bilateral idiopática / Idiopathic bilateral ovarian vein thrombosis

La trombosis de la vena ovárica es una afección poco frecuente asociada a estados de hipercoagulabilidad, generalmente en el período puerperal. Presentamos un caso de trombosis bilateral idiopática de la vena ovárica en una mujer con dolor abdominal bajo (AU)

Ovarian vein thrombosis is an uncommon condition associated with hypercoagulatedstatus, generally in the puerperal period. We report a case of idiopathic bilateral ovarian veinthrombosis in a woman with lower abdominal pain (AU)

Second-trimester soft markers: relation to first-trimester nuchal translucency in unaffected pregnancies.

OBJECTIVE: Genetic sonography following first-trimester combined screening appears to increase substantially detection rates for Down syndrome but it relies on the unproved assumption of independence between these tests. In this study we aimed to investigate the relationship between first-trimester nuchal translucency (NT) and a series of second-trimester soft markers and structural defects in unaffected pregnancies. METHODS: NT measurement in the first trimester was followed by second-trimester scan (18 to 23 + 6 weeks) including examination for three categorical markers (intracardiac echogenic foci, hyperechogenic bowel and structural defects) and measurement of nasal bone length, nuchal-fold thickness, femur length, humerus length, renal pelvis diameter and prenasal thickness. All continuous variables were expressed in multiples of the median (MoM) for gestation and correlation coefficients between log-transformed NT and second-trimester variables were calculated. In addition, frequencies of soft markers and structural defects in cases with increased NT were compared to those with normal NT, using MoM cut-offs. RESULTS: In a dataset of 1970 cases, NT was significantly correlated (P < 0.05) with all second-trimester continuous variables, the correlation being strongest for nuchal-fold thickness (r = 0.10). There was a higher frequency of cases with second-trimester nuchal-fold thickness above the 97.5(th) centile (10.7 vs. 2.2%) and hyperechogenic bowel (2.4 vs. 0.1%) in cases with increased NT. CONCLUSIONS: Straightforward reassessment of risk using likelihood ratios derived from the second-trimester genetic sonogram might lead to inaccurate estimates. Multivariate models using continuous second-trimester variables might be preferable in sequential screening strategies.

[Agreement between the self-perception on the body image and the nutritional status in college students from Orense]. / Concordancia entre la autopercepción de la imagen corporal y el estado nutricional en universitarios de Orense.

The aim of this study was to detect the possible changes in dietary behavior among college students from the University Campus of Orense by means of self-perception of their body image. 145 college students participated, 107 women (74% of the study population with a mean age of 25.2 ± 2.9 years) and 38 men (26%, with a mean age of 25.3 ± 3.3 years). This is a descriptive cross-sectional study using questionnaires and assessing the body mass index (BMI), the subjective weight and using two sub-scales of the Eating Disorders Inventory 2: the body dissatisfaction (EDI-IC) sub-scale and the slimness obsession (EDI-OD) sub-scale. The results show that most of the population had normal weight, there exists no obesity among the female population and there were no underweight cases among the male population. More than half of the population (55% of women and 63% of men) that a distorted judgment of their body as compared to the BMI values, with men underestimating their weight and, among women, there are cases underestimating or overestimating their weight. The women more unsatisfied with their body image were those having overweight or low weight, and those more obsessed with losing weight are those in the upper limit of the normal weight. Among men, those having overweight or obesity are the most unsatisfied and most obsessed with losing weight.

Concordancia entre la autopercepción de la imagen corporal y el estado nutricional en universitarios de Orense / Agreement between the self-perception on the body image and the nutritional status in college students from Orense

El objetivo de este trabajo fue detectar posibles alteraciones de la conducta alimentaria en universitarios del Campus de Orense mediante la autopercepción de su imagen corporal. Participaron 145 universitarios, 107 mujeres (74% de la población estudiada con una edad media de 25,2 ± 2,9 años) y 38 hombres (26% con una edad media de 25,3 ± 3,3 años). Se trata de un estudio transversal descriptivo con encuestas en el que se determinó el índice de masa corporal (IMC), el peso subjetivo y se utilizaron dos subescalas del Eating Disorders Inventory 2: la subescala de insatisfacción corporal (EDI-IC) y la de obsesión por la delgadez (EDI-OD). Los resultados muestran que la mayoría de la población es normopeso, no existen casos de obesidad en la población femenina y en la población masculina no se encontraron casos de bajo peso. Más de la mitad de la población (55% de las mujeres y 63% de los hombres) tienen un juicio valorativo distorsionado de su cuerpo respecto a los valores del IMC, observándose que los hombres subestiman su peso y en las mujeres aparecen casos de subestimación y de sobrestimación. Las mujeres más insatisfechas con su figura son las que presentan sobrepeso o bajo peso y las más obsesionadas por adelgazar son las que se encuentran en el límite superior del normopeso. En el grupo de los hombres, los que presentan sobrepeso y obesidad son los más insatisfechos y los más obsesionados por adelgazar (AU)

The aim of this study was to detect the possible changes in dietary behavior among college students from the University Campus of Orense by means of self-perception of their body image. 145 college students participated, 107 women (74% of the study population with a mean age of 25.2 ± 2.9 years) and 38 men (26%, with a mean age of 25.3 ± 3.3 years). This is a descriptive cross-sectional study using questionnaires and assessing the body mass index (BMI), the subjective weight and using two sub-scales of the Eating Disorders Inventory 2: the body dissatisfaction (EDI-IC) sub-scale and the slimness obsession (EDI-OD) sub-scale. The results show that most of the population had normal weight, there exists no obesity among the female population and there were no underweight cases among the male population. More than half of the population (55% of women and 63% of men) that a distorted judgment of their body as compared to the BMI values, with men underestimating their weight and, among women, there are cases underestimating or overestimating their weight. The women more unsatisfied with their body image were those having overweight or low weight, and those more obsessed with losing weight are those in the upper limit of the normal weight. Among men, those having overweight or obesity are the most unsatisfied and most obsessed with losing weight (AU)

Impact of chorioamnionitis on exhaled nitric oxide and endotracheal aspirate levels of nitrites-nitrates and interleukin-8 in mechanically ventilated preterm neonates.

OBJECTIVES: To assess the influence of maternal chorioamnionitis on early exhaled nitric oxide (NO) and levels of nitrites-nitrates and interleukin (IL)-8 in endotracheal aspirate fluid in mechanically ventilated preterm neonates. STUDY DESIGN: Cross-sectional study. PATIENT-SUBJECT SELECTION: Between September 2007 and August 2009, 54 mechanically ventilated preterm neonates were included. Patients were divided into two groups according to the presence or absence of maternal chorioamnionitis, and those without chorioamnionitis (controls) were further stratified into two subgroups by birth weight < or ≥ 2,000 g. METHODOLOGY: The ventilator used was a Babylog 8000. The NO level assessed was the plateau value given by the software of the Sievers NOA apparatus. Collection of endotracheal aspirate fluid samples was performed coinciding with routine aspirations and using the dry technique. RESULTS: The two groups of control neonates showed statistically significant differences in exhaled NO expressed as nl/min and normalized exhaled NO expressed as either nl/min or nl/min/kg, so they are not homogeneous and cannot be used in clinical practice. Serum C-reactive protein and endotracheal aspirate levels of nitrites-nitrates were significantly higher in the chorioamnionitis group than in controls (3.6 vs. 1.07 µmol/L; P = 0.035). Nitrites-nitrates levels were positively correlated with exhaled NO in ppb (ρ = 0.367; P = 0.006). Minute exhaled endogenous NO was significantly higher in the chorioamnionitis group (0.48 vs. 0.27 nl/min/kg; P = 0.021). CONCLUSIONS: In mechanically ventilated preterm infants weighing <2,000 g, maternal chorioamnionitis was associated with an increase of early exhaled NO (nl/min/kg) and serum levels of C-reactive protein and levels of nitrites-nitrates in endotracheal aspirate fluid.

Evaluación del riesgo nutricional mediante el MNA en una población anciana no institucionalizada / Nutritional risk in no-institutionalized older, determined for the mini nutritional assessment (MNA)

En este trabajo se evaluó el estado nutricional de las personas mayores de 65 años de la provincia de Ourense con el fin de detectar posibles riesgos de desnutrición. Participaron 728 ancianos (63,6 por ciento mujeres y 36,4 por ciento hombres) de edad media 80,7±7,4 años. Se midieron parámetros antropométricos (peso, distancia talón-rodilla y circunferencia del antebrazo y de la pantorrilla) y se utilizó el cuestionario Mini Nutritional Assessment (MNA). Se observó que el 70 por ciento de la población no presentaba un estado nutricional adecuado (el 57,5 por ciento está en situación de riesgo de desnutrición y el 12,5 por ciento desnutridos); esta situación empeora entre las personas de 65 a 70 años y los mayores de 81 años y entre la población femenina. Los ítems que se observan con mayor frecuencia en la población estudiada son la pérdida involuntaria de peso, ingerir proteínas sólo en una de las comidas del día, consumir poco líquido, pérdida de apetito, tomar más de tres medicamentos al día y tener una movilidad limitada que no le permite salir de casa.

The objective of this study was to determine the prevalence of the risk of undernutrition by evaluating the nutritional status in a representative sample of older people in Ourense. The total sample was 728 subjects (63,6 percent woman and 36,4 percent men) with a mean age of 80,7±7,4 years old. Anthropometric parameters (weight, distance heel-knee, calf circumference and mid-arm circumference) were determined and the MNA (Mini Nutritional Assessment) was applied and 70 percent of individuals with nutritional problems were identified (57.5 percent with nutritional risk and 12.5 percent malnourished). The subjects aged between 65 and 70 years old, 81 and over, and females presented higher nutritional problems. The items that were observed most frequently in the studied population and therefore responsible for this nutritional situation were the involuntary loss of weight, consumption of at least one serving of protein per day, low daily liquid intakes, loss of appetite, taking more than 3 prescription drugs per day and to have a limited mobility.

Estrategia para mejorar la seguridad del paciente en un servicio de neonatología / Strategies to improve patient safety in a neonatology service

Fundamento. La práctica de la medicina, cada vez más compleja,aumenta el riesgo de acontecimientos adversos. La seguridad delpaciente en la atención sanitaria exige que esté libre de cualquiermal evitable.Objetivo. Analizar los errores detectados en un servicio de neonatología.Método. Se realiza un plan de estudio consistente en:1) Sesión clínica informativa sobre los errores asistenciales. 2) Creaciónde un sistema de notificación de errores anónimo. 3) Períodode reflexión para analizar los errores declarados de manera retrospectiva,con la finalidad de sensibilizar a todo el personal. 4) Creaciónde un grupo de estudio (dos médicos y dos diplomados en enfermería)para analizar de forma prospectiva los errores declaradosy establecer las estrategias necesarias para su prevención.Resultados. Durante el período de reflexión (15 días) se recogen28 errores agrupados en: errores de práctica asistencial (19), secundariosa factores humanos (7) y atribuibles al sistema (2).Durante los tres primeros meses del estudio prospectivo se notifican25 errores: de tratamiento (9), de comunicación (2), en determinacionesanalíticas (1), en la alimentación (2), de asepsia (1), deprocedimientos (7) y de identificación e información (3).Se analizan las causas que pueden producirlos, entre las cualesdestacan la falta de comunicación, la sobrecarga asistencial y lafalta de atención y rutina en el trabajo diario.Conclusiones. Debemos ser conscientes de que evitar el error está ennuestras manos. La notificación anónima del error y su análisis permiteponer en marcha medidas preventivas que repercutirán en unamejor calidad de la asistencia y seguridad de nuestros pacientes(AU)

Background. The increasingly complex practice of medicine augmentsthe risk of adverse events. The principles of patient safety inhealth care demand that the patient be spared of all avoidable harm.Objectives. To analyze the medical errors detected in a neonatologyservice.Methods. The following initiatives were implemented: 1) Trainingseminar on medical errors; 2) Implementation of a system for anonymousreporting of medical errors; 3) Review period to analyze anddiscuss the reported medical errors with the ultimate goal of raisingawareness among the personnel; 4) Establishment of a study team(two physicians and two nurses) to analyze prospectively medicalerrors and to develop the necessary preventive strategies.Results. Twenty-eight medical errors were recorded during the retrospectivereview period (15 days). The errors were grouped intothe following categories: treatment errors (19), errors secondary tohuman factors (7), and factors attributable to the system (2). Duringthe first three months of the prospective evaluation phase, 25 errorswere recorded, which corresponded to treatment (9), communication(2), laboratory errors (1), nutrition (2), antisepsis (1), procedures(7), and identification and information (3). The potential causes forthe errors were analyzed; among them were lack of communication,patient care overload, lack of attention, and daily routines.Conclusions. We must be aware that avoiding medical errors is inour hands. The anonymous reporting and its analysis allow for theimplementation of preventive measures that will lead to an improvementin patient care and patient safety(AU)

[Nutritional risk in no-institutionalized older, determined for the mini nutritional assessment (MNA)]. / Evaluación del riesgo nutricional mediante el MNA en una población anciana no institucionalizada.

The objective of this study was to determine the prevalence of the risk of undernutrition by evaluating the nutritional status in a representative sample of older people in Ourense. The total sample was 728 subjects (63.6% woman and 36.4% men) with a mean age of 80.7 +/- 7.4 years old. Anthropometric parameters (weight, distance heel-knee, calf circumference and mid-arm circumference) were determined and the MNA (Mini Nutritional Assessment) was applied and 70% of individuals with nutritional problems were identified (57.5% with nutritional risk and 12.5% malnourished). The subjects aged between 65 and 70 years old, 81 and over, and females presented higher nutritional problems. The items that were observed most frequently in the studied population and therefore responsible for this nutritional situation were the involuntary loss of weight, consumption of at least one serving of protein per day, low daily liquid intakes, loss of appetite, taking more than 3 prescription drugs per day and to have a limited mobility.

[Arteriographic correlation in 30 patients with renal vascular disease diagnosed with multislice CT]. / Correlación arteriográfica en 30 pacientes con patología vascular renal diagnosticada mediante TC multicorte.

OBJECTIVE: To determine the usefulness of multislice computed tomography (MSCT) in the evaluation of renal vascular disease against a gold standard of digital subtraction angiography (DSA). MATERIAL AND METHODS: We evaluated 30 patients with arterial hypertension and/or kidney failure that underwent MSCT to rule out a vascular cause and DSA to confirm a vascular cause suspected at MSCT. MSCT examinations were performed on a 10-detector scanner with intravenous administration of 80 ml of iodinated contrast (300 mg iodine/ml) at a flow rate of 5 ml/s. A total of 71 renal arteries, 56 main and 15 accessory, were evaluated. Arterial stenoses were classified as: grade 0 (normal artery), grade I (stenosis < 50%), grade II (> or = 50% and < 70%), grade III (> or = 70%), grade IV (occlusion). Stenosis > or = grade II was considered hemodynamically significant. RESULTS: The findings at MSCT and DSA were identical in 56 (78.8%) renal arteries; MSCT overestimated the degree of stenosis in 13 (18.3%) cases. All grade III stenoses were detected at MSCT. In the diagnosis of hemodynamically significant stenosis, MSCT had a sensitivity of 96.5%, specificity 78.5%, accuracy 85.9%, positive predictive value 75.6%, and negative predictive value 97%. CONCLUSIONS: MSCT is a good noninvasive imaging technique for the evaluation of renal vessels; it is useful for screening patients with kidney disease to rule out potentially treatable vascular causes.

Attempt to normalize simulated exhaled nitric oxide according to ventilatory settings.

BACKGROUND: Simulated exhaled nitric oxide (eNO) depends on ventilatory settings used in different experimental conditions. OBJECTIVES: To normalize the simulated minute exhaled nitric oxide according to different ventilatory settings. WORKING HYPOTHESIS: Different ventilatory settings influence the concentrations of exhaled nitric oxide and these results can be normalized. METHODOLOGY AND STUDY DESIGN: We used a rubber lung model (50 ml) with an orifice through which a 3 mm endotracheal tube was introduced. The NO, which simulated that of endogenous production, was delivered through the base of the lung using a unidirectional rotameter and obtaining a concentration of around 25 ppb. The sample of gas was recorded through a 6 F arterial catheter introduced into the endotracheal tube to its tip. The ventilator used was a Babylog 8000. Air delivered was compressed and filtered and had an NO content of under 0.3 ppb. The NO level assessed was the plateau value given by the software of the Sievers NOA apparatus. Each experiment involved sampling during 1 min, three times. Normalization was done using a multiple cubic regression formula. RESULTS: An increase in respiratory frequency or in peak of inspiratory pressure were accompanied by a decrease in eNO (ppb). Minute volume was adjusted for the percentage of leakage given by the ventilator. Normalization was obtained analyzing 518 respirations with different ventilatory settings. The coefficient of variation fell from 15.5% to 0.27%. Validation of the normalization formula was performed in other three groups (320, 372, and 372 respirations) with different simulated NO concentrations (25, 16, and 50 ppb), resulting in reduction of the coefficient of variation from 42.7% to 9.3%, from 42.3% to 10.6% and from 45.2% to 9.6%, respectively. CONCLUSIONS: Normalization of simulated minute eNO according to ventilatory settings is possible using the equipment and experimental set-up reported. Extrapolation to patients is not possible without constraints.

Amioplasia congénita y consumo materno de cocaína / Congenital amyoplasia and maternal cocaine use

Introducción: La artrogriposis múltiple congénita (AMC) es unsíndrome caracterizado por contracturas congénitas no progresivas de dos o más articulaciones. La forma clásica de AMC llamada amioplasia es siempre esporádica. En la artrogriposis neurógena, la forma más frecuente (90%), la afectación inicial se encuentra en las neuronas del asta anterior de la médula, las raíces nerviosas o el nervio periférico. Casos clínicos: Se exponen dos casos de recién nacidos que desarrollaron una clínica similar de amioplasia. El primer niño tenía contracturas articulares, atrofia de los músculos de las extremidades inferiores e incontinencia. El segundo niño presentó paraplejía fláccida con atrofia muscular y atonía muscular abdominal. Las dos madres eran consumidoras de cocaína durante el embarazo. En ambos pacientes los exámenes neurofisiológicos demostraron una denervación a diferentes niveles de la médula espinal. Discusión: Se ha postulado como causa de amioplasia congénita una necrosis de la médula espinal fetal debida a hipotensión sistémica. En adultos se han descrito casos de episodio cerebrovascular relacionados con el consumo de cocaína. Probablemente, los mecanismos están relacionados con la estimulación adrenérgica, la vasoconstricción cerebral y cambios bruscos en la presión arterial. En ambos casos las características clínicas descritas al nacer fueron debidas a denervación de la médula espinal a diferentes niveles. Los defectos encontrados en nuestros pacientes podrían estar asociados a consumo materno de cocaína durante el embarazo, que produciría vasoconstricción del pequeño lecho vascular eisquemia-infarto por alteración vascular en la médula espinal del feto

Introduction: Arthrogryposis multiplex congenita (AMC) is a term used to describe a disorder characterized by multiple, nonprogressive joint contractures at birth. The classic form of peripheral AMC, referred to as amyoplasia, is always sporadic. In neurogenic arthrogryposis, the most frequent form (90%), the initial injury would be in the anterior horm cells of the spinal cord, the nerve roots or the peripheral nerve. Case reports: We report the cases of two newborns who presented similar clinical signs of amyoplasia. One had joint contractures, muscle atrophy and incontinence. The other has flaccid paraplegia with muscle atrophy in lower limbs and abdominal muscle atony. Both mothers consumed cocaine during pregnancy. In both patients, neurophysiological examination demonstrated denervation at different levels of spinal cord. Discussion: Necrosis of the fetal spinal cord caused by systemic hypotension has been postulated as a cause of amyoplasia. The mechanism of cocaine-related cerebrovascular accidents in adults is probably related to adrenergic stimulation, cerebral vasoconstriction adna a sudden surge in blood pressure. In our two cases, the clinical findings reported at birth were due to denervation at different levels of the spinal cord. Therefore, the defects in our patients may be associated with maternal use of cocaine during pregnancy, producing small vessel vasoconstriction and vascular disruption in the fetal spinal cord

Severe hypernatremic dehydration secondary to undetected lactation failure: usefulness of sodium levels in breast milk.

There is a concern that lactation failure and neonatal morbidity might be more common than previously thought. Maybe the early discharge, the lack of timely follow-up, or poor information during pregnancy or after delivery play important roles. A case of severe hypernatremic dehydration secondary to lactation failure is reported and we analyze recent recommendations.

Repercusión fetal y neonatal del shock anafiláctico materno / Impact of maternal anaphylactic shock on the fetus and the newborn

Ante un shock en una embarazada (de causa hemorrágica, séptica, anafiláctica u otra) se debe tener en cuenta que hay dos pacientes vulnerables: la madre y el feto. La mejoría de la madre puede ser conseguida con la administración de inotrópicos, los cuales pueden dañar el feto al disminuir la circulación placentaria. La lesión fetal dependerá de la causa, la intensidad y la duración del shock, así como de la maduración del feto y de los fármacos empleados en su tratamiento. El factor más importante en el tratamiento del shock de la gestante será el rápido restablecimiento de la presión arterial en la madre sin reducir la perfusión placentaria. La lesión fetal puede pasar desapercibida inicialmente, por lo que será imprescindible efectuar un seguimiento clínico y de neuroimagen tanto del feto como del posterior recién nacido

Shock (hemorrhagic, septic, anaphylactic or of some other etiology) during pregnancy involves two vulnerable patients: the mother and the fetus. The recovery of the mother can be achieved with the administration of inotropic agents, but these drugs can harm the fetus by reducing the placental circulation. The extent of the damage depends on the cause, the severity and the duration of the shock, as well as the maturity of the fetus and the drugs employed to treat the mother. The most important factor in the treatment of shock in the pregnant woman is the rapid restoration of her arterial pressure without reducing the placental perfusion. Since the fetal lesion may initially go undetected, prenatal and postnatal clinical follow-up and neuroimaging are indispensable

Plasma endothelin-1 and clinical manifestations of neonatal sepsis.

AIM: To determine whether plasma endothelin-1 (ET-1) relates to clinical manifestations of sepsis in the newborn, especially with systemic hypotension, acidosis, severe hypoxemia (which may represent pulmonary hypertension) and oliguria. METHODS: Prospective study of 35 consecutive newborns with clinical sepsis: 22 with hemoculture-positive (HC+) sepsis and 13 hemoculture-negative (HC-). Plasma ET-1 concentrations were measured within 2 days of the diagnosis of sepsis. SNAP-II severity score was performed at the time of highest clinical severity. RESULTS: Newborns with HC+ sepsis had higher plasma ET-1 concentrations and SNAP-II scores (especially PO 2 /FiO 2 ratio) than HC- septic children. Plasma ET-1 concentrations increased linearly with each item of the SNAP-II score, but only reached significant differences in lowest mean blood pressure (P=0.030), lowest pH (P=0.048), multiple seizures (P=0.010) and lowest urine output (P=0.013). Leukocyte count, immature/total neutrophil ratio and C-reactive protein value were not different. Each item of the SNAP-II score was independently related only to ET-1 level. Oliguria, acidosis and systemic hypotension were more correlated (R 2 >0.5). CONCLUSIONS: Plasma ET-1 levels in neonatal sepsis are related to the severity of clinical manifestations, especially oliguria, acidosis and systemic hypotension.

Efficacy of three treatment schedules in severe meconium aspiration syndrome.

AIM: To compare three different schedules in severe meconium aspiration syndrome (MAS) treatment: standard, bronchoalveolar lavage (BAL) with diluted surfactant, and diluted surfactant BAL plus a single early dexamethasone dose. METHODS: Twenty-four full-term newborns with severe MAS (needing mechanical ventilation and with oxygenation index > or = 15) were divided into three groups: group I (historical control group; n = 6) treated with standard therapy; group II (n = 7) treated in the first hours of life with one BAL using diluted surfactant (beractant 5 mg/mL) in a volume of 15 mL/kg in four aliquots; and group III (n = 11) treated with one diluted surfactant BAL and a previous single dose of intravenous dexamethasone (0.5 mg/kg). RESULTS: At 12 h, groups II and III showed a significant improvement in oxygenation index (OI) compared with group I (14.7% and 27.0% vs -19.6% respectively; p = 0.012). Group III also showed a significantly lower OI than group I at 24 h (63.6% vs -27.9%) and at 48 h (87.1% vs 49.6%). Group III, in comparison to group I, showed a lower FiO2 requirement at 12 h (0.66 vs 1), at 24 h (0.4 vs 0.87) and at 48 h (0.35 vs 0.67), and a decrease in the number of days of inhaled nitric oxide administration, mechanical ventilation, oxygen therapy and hospitalisation period. All patients from groups II and III survived and none developed pneumothorax or respiratory infections. CONCLUSION: Diluted surfactant BAL in the first hours of life combined with an intravenous single dose of dexamethasone may be an effective treatment for severe MAS.

Valor nutricional de los menús servidos en un centro para discapacitados / Evaluation nutritional the menu served in an occupational centre

Se evaluaron los menús de un centro ocupacional anotando y pesando los alimentos del desayuno, comida y cena, transformándose las cantidades en valores de energía y nutrientes mediante el programa Alimentación y Salud. Los valores obtenidos para la energía, proteínas, hidratos de carbono, lípidos (colesterol, AGP, AGM, AGS), vitaminas (A, B1, B2, B6, B12, C, D, E, niacina, ácido fólico) y minerales (Na, K, Ca, P, Mg, Fe, Zn, I), se compararon con las ingestas recomendadas. El menú consta de dos platos acompañados de pan y agua y un postre que varía entre fruta o yogur. Los desayunos consisten en leche con cacao o café y una ración de galletas. Los alimentos que componen el primer plato son pastas y verduras y ocasionalmente legumbres. Como segundo plato se sirve carne con ensalada y dos veces a la semana pescado o huevos. Los alimentos se preparan principalmente fritos en aceite de girasol, siendo el guisado la preparación menos utilizada. El aporte calórico medio de los menús es de 1.780 Kcal, que solo cubre el 59 por ciento de las necesidades energéticas de los varones y el 77 por ciento de las de las mujeres. Existe un desequilibrio en la distribución a lo largo del día con un déficit de calorías aportadas en el desayuno y la cena (19 por ciento y 28,5 por ciento respectivamente) y un exceso en la comida (52,48 por ciento).Los menús aportan elevadas cantidades de proteínas, y de lípidos y un déficit de hidratos de carbono. El índice de calidad de la grasa (AGP+AGM/AGS) es de 1,93, valor ligeramente inferior al adecuado. Existe un riesgo nutricional para las vitaminas D, A y B6 y los minerales I, Zn, y Mg, ya que no se cubre el 75 por ciento de las ingestas recomendadas y por el contrario se observa un exceso de aporte de vitamina E.Nutrición y Salud Pública (AU)

Plasma nitrite/nitrate and endothelin-1 concentrations in neonatal sepsis.

AIM: To determine the changes in plasma nitrite/nitrate (NOx) and endothelin-1 (ET-1) concentrations during neonatal sepsis. METHODS: In a prospective study, 60 consecutive newborns meeting the criteria for sepsis and without receiving exogenous nitric oxide (25 haemoculture-positive [HC+] and 35 haemoculture-negative [HC-]) were compared with 68 healthy newborns (46 full-term and 22 preterm). NOx and ET-1 concentrations were measured in each newborn within 48 h of diagnosis of sepsis and then every third day up to three determinations. SNAP-II and SNAPPE-II severity scores were performed at the moment of highest clinical severity. RESULTS: At the beginning of the sepsis period, controls and septicaemic newborns had similar NOx and ET-1 levels, with the exception of infants with severe HC+ sepsis. Throughout the sepsis period, NOx increased in moderate HC+ sepsis and decreased in HC--sepsis, reaching a significant difference at the end of the study period (59.9 +/- 72.7 vs 33.9 15.3 micromol/L; p = 0.036). Meanwhile, ET-1 in newborns with severe HC+ sepsis remained higher than that in the moderate HC+ sepsis group and HC--group, reaching significant differences in all the periods. The highest ET-1 value was positively correlated with SNAP-II and SNAPPE-II scores. CONCLUSION: NOx concentrations increased throughout the neonatal HC+ sepsis period, reaching significant differences after 7-9 d. The highest ET-1 levels in neonatal HC+ sepsis emerged before the NOx peak, at 3-5 d, and later decreased. Only newborns with severe HC+ sepsis presented a significant increase in ET-1 concentrations from the beginning of the septicaemic process.