The Respiratory Management of the Extreme Preterm in the Delivery Room.

The fetal-to-neonatal transition poses an extraordinary challenge for extremely low birth weight (ELBW) infants, and postnatal stabilization in the delivery room (DR) remains challenging. The initiation of air respiration and the establishment of a functional residual capacity are essential and often require ventilatory support and oxygen supplementation. In recent years, there has been a tendency towards the soft-landing strategy and, subsequently, non-invasive positive pressure ventilation has been generally recommended by international guidelines as the first option for stabilizing ELBW in the delivery room. On the other hand, supplementation with oxygen is another cornerstone of the postnatal stabilization of ELBW infants. To date, the conundrum concerning the optimal initial inspired fraction of oxygen, target saturations in the first golden minutes, and oxygen titration to achieve desired stability saturation and heart rate values has not yet been solved. Moreover, the retardation of cord clamping together with the initiation of ventilation with the patent cord (physiologic-based cord clamping) have added additional complexity to this puzzle. In the present review, we critically address these relevant topics related to fetal-to-neonatal transitional respiratory physiology, ventilatory stabilization, and oxygenation of ELBW infants in the delivery room based on current evidence and the most recent guidelines for newborn stabilization.

Óxido nítrico y ventilación no invasiva en neonatos. Posibilidad terapéutica en pacientes seleccionados / Non-invasive inhaled nitric oxide in term and preterm newborns: A therapeutic option in selected patients

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Desarrollo de un sistema de indicadores para la evaluación de la calidad en transporte interhospitalario: proyecto multicéntrico / Quality indicators in interhospital transport: multicentre project

Introducción: El traslado interhospitalario se realiza por equipos muy diferentes en las distintas regiones de nuestro país, lo que dificulta la comparación de su calidad asistencial. Objetivo: Seleccionar y definir una lista consensuada de indicadores de calidad aplicable a todas las unidades de transporte, especializadas o no, a nivel nacional. Material y métodos: Realización de una propuesta inicial de indicadores por el comité coordinador con representantes del transporte especializado de nuestro país. Valoración del listado por especialistas en transporte de las unidades participantes y los grupos de trabajo de SECIP y SENeo. Selección de los indicadores mediante el método Delphi según su relevancia y factibilidad. Resultados: El listado inicial incluyó 35 posibles indicadores. Fueron valorados por 22 especialistas pertenecientes a siete unidades de transporte. En una primera fase se eligieron por consenso cuatro indicadores, que pasaron directamente al listado definitivo. Se enviaron a los encuestados los resultados del resto de indicadores y las observaciones realizadas por los participantes, y tras ello se realizó una segunda valoración, en la que alcanzaron un consenso aceptable otros 11 indicadores. Tras la elaboración del listado, se estableció de forma consensuada la definición final de cada indicador elegido. Conclusiones: Utilizando un sistema de búsqueda de consenso, definimos una lista de 15 indicadores comunes, que podría ser utilizada por las unidades especializadas de nuestro país y personal asistencial no especializado que realiza traslados pediátricos. Permitirá evaluar el rendimiento individual y comparar las diferentes unidades para encontrar oportunidades de mejora y asegurar la máxima calidad durante el transporte. (AU)

Introduction: Interhospital transport is carried out by variable teams in different regions of our country, and this makes quality evaluation and benchmarking complicated. Project objective: select and define a consensual list of quality measurement that may be used by national transport units, whether specialised or not. Methods: Initial set of quality indicators was proposed by coordinators (members of representative specialised transport units in Spain). Evaluation by selected transport specialists from participating units and SECIP (Society of Paediatric Intensive Care) and SENeo (Spanish Neonatology Society) work teams. Selection of definitive indicators by Delphi method according to relevance and feasibility. Results: A total of 35 quality indicators were included in the initial set. Evaluation was carried out by 22 specialists from seven transport teams. In a first round, four indicators were consensually included in the definitive list. Results for the rest of metrics and comments were sent to all participants, and after a second assessment, 11 other indicators reached enough consensus. After list accomplishment, a consensual final definition for every indicator was established. Conclusions: Using a consensual research method, a list of 15 common indicators was obtained, which may be used by specialised transport teams in our country, and by non-specialised clinics in charge of interhospital paediatric transport. It will allow individual performance to be assessed, as well as benchmarking, in order to find improvement opportunities and ensure the highest quality during interhospital transport. (AU)

Quality indicators in interhospital transport: Multicentre project.

INTRODUCTION: Interhospital transport is carried out by variable teams in different regions of our country, and this makes quality evaluation and benchmarking complicated. Project objective: Select and define a consensual list of quality measurement that may be used by national transport units, whether specialised or not. METHODS: Initial set of quality indicators was proposed by coordinators (members of representative specialised transport units in Spain). Evaluation by selected transport specialists from participating units and SECIP (Society of Paediatric Intensive Care) and SENeo (Spanish Neonatology Society) work teams. Selection of definitive indicators by Delphi method according to relevance and feasibility. RESULTS: A total of 35 quality indicators were included in the initial set. Evaluation was carried out by 22 specialists from 7 transport teams. In a first round, 4 indicators were consensually included in the definitive list. Results for the rest of metrics and comments were sent to all participants, and after a second assessment, 11 other indicators reached enough consensus. After list accomplishment, a consensual final definition for every indicator was established. CONCLUSIONS: Using a consensual research method, a list of 15 common indicators was obtained, which may be used by specialised transport teams in our country, and by non-specialised clinics in charge of interhospital paediatric transport. It will allow individual performance to be assessed, as well as benchmarking, in order to find improvement opportunities and ensure the highest quality during interhospital transport.

Efecto protector del Desmodium molliculum EAM (manayupa) en ratas con toxicidad hepática inducida por naproxeno / Protective effect of Desmodium molliculum EAM (manayupa) in rats with naproxen-induced liver toxicity

Objetivo. Verificar el efecto protector del extracto acuoso de hojas y tallos de Desmodium molliculum EAM (manayupa), en la toxicidad hepática inducida por el naproxeno en ratas Ratus novergicus variedad Wistar albino, hembras. Materiales y métodos. Estudio experimental. Se utilizaron 36 ratas hembras de 250 ± 10 g, divididas en seis grupos de seis: A (control -); B (control + naproxeno); patrón C (silimarina 100 mg / kg) y 3 experimental (EAM): D 80 mg/kg; E 160 mg/kg y F 240 mg/kg). Los grupos B, C, D, E, F recibieron por vía oral naproxeno 27,38 mg, los primeros cinco días y durante 14 días. El efecto protector hepático se determinó mediante el análisis bioquímico: GOT, GPT, GGT, proteínas totales, albúmina sérica, fosfatasa alcalina y creatinina. Resultados. Se encontró que el grupo B perdió peso (180,65 ± 6,5 g), bilirrubina total (0,76 ± 0,4) bilirrubina directa (1.7 ± 0,8), TGO (160 ± 10,4) y TGP (412 ± 20,4) alto, comparado con el grupo A, C, D, E y F. Conclusiones. El EAM tiene efecto protector sobre la toxicidad hepática inducida por naproxeno en ratas, evidenciado por los parámetros bioquímicos.

Objective. To verify the protective effect of the aqueous extract of leaves and stems of Desmodium molliculum EAM (manayupa), on the hepatic toxicity induced by Naproxen in rats Ratus novergicus albino Wistar variety, females. Materials and methods. 36 female rats of 250 ± 10 g were used, divided into six groups of six: A (Control -), B (Control + Naproxen), Pattern C (Silymarin 100 mg / kg) and 3 Experimental (EAM): D 80 mg / kg, E 160 mg / kg and F 240 mg / kg). Groups B, C, D, E, F orally received Naproxen 27.38 mg, the first five days and for 14 days. The hepatic protective effect was determined by the biochemical analysis: GOT, GPT, GGT, total proteins, serum albumin, alkaline phosphatase, creatinine. Results. group B was found to lose weight (180.65 ± 6.5 g), total bilirubin (0.76 ± 0.4) direct bilirubin (1.7 ± 0.8), TGO (160 ± 10.4) and TGP (412 ± 20.4) high, compared to group A, C, D, E and F. Conclusion. EAM has a protective effect on hepatic toxicity induced by naproxen in rats, evidenced by biochemical parameters.