[Trends of perinatal mortality at the National Institute of Perinatology]. / Tendencias de la mortalidad perinatal en el Instituto Nacional de Perinatología.

The purpose of this study is to address the yearly fetal, neonatal, crude death rates observed at the Instituto Nacional de Perinatología from 1987 through 1997, and the specific death rates for birth weight, gestation age, cause of death, avoidability, and structure and process failures as proxy to quality of medical care. Data come from death certificates following the WHO criteria which includes the maternal medical history, pregnancy follow up, birth attendance, newborn characteristics, autopsy findings, microbiological results, basic cause of death (of both maternal and fetal/neonatal origin), death avoidability, and structure and process issues. The death certificates were analyzed by the Perinatal Mortality Committee and registered into a computerized database. The fetal mortality rate during 1987 was 17.67 per 1000 births, whereas in 1997 it was 21.5 per 1000 births. There was an increasing tendency from 1987 to 1992, with the highest rate being 34.13 during 1992. After 1992 this rate shows a decreasing tendency. The neonatal mortality rate decreased from 42.82 in 1987 to 17.34 per 1000 live births in 1997. The highest rates were observed among the newborns with the lowest birth weights and at the youngest gestational ages. The most frequent cause of death of maternal origin, in both fetal and neonatal deaths, was premature rupture of membranes. As for the most frequent fetal cause of death was antepartum hypoxia, and among neonatal deaths prematurity and immaturity. The percentage of avoidable perinatal deaths has declined dramatically from 27% in 1987 to less than 10% in 1996. Perinatal mortality at the Instituto Nacional de Perinatología has decreased during the period under assessment, due to the reduction of the neonatal mortality rate. Improving the quality of medical care focusing mainly on process issues will help lowering avoidable mortality rates.

Neonatal dermatology: skin care guidelines.

Skin care of the neonate is a very important issue, especially if the infant is either premature or is in critical condition. Guidelines for skin care put special emphasis on the skin barrier properties, transcutaneous absorption, and transepidermal water losses of the skin. The main objective of this article is to give general skin care guidelines for full-term newborn and premature infants, whether in the delivery room, the intensive care unit, or at home. These guidelines are directed to medical staff and nurses with a brief summary for parents.

[The effect of phenobarbital on the severity of intraventricular hemorrhage]. / Efecto del fenobarbital sobre la gravedad de la hemorragia intraventricular.

During an eight-months period, we studied every newborns under 34 gestation weeks who needed mechanical ventilation (MV) from the moment they were born and whom had an ultrasonogram without intraventricular hemorrhage in the first six hours after birth. Patient were separated in two groups: the first, a group of 30 patients received phenobarbital 20 mg/kg IV in the first 6 hours of life and then 2.5 mg/kg, I.V., every 12 hours for the next five days. Blood levels were measured 24 and 96 hours after the initial dose was given. The second group of 30 patients was not treated with phenobarbital. In both groups a brain ultrasonogram was made every 48 hours until 15 days of life. There were no difference in weight, gestational age, Apgar score, way of birth, initial diagnosis, incidence of pneumothorax, mortality and days with MV between the two groups. During the first three days were measured blood glucose, blood pressure, mean airway pressure, PCO2, PO2 and found no significant difference between both groups. The blood pH showed statistically significant difference, with better values at 48-72 hours in the group treated with phenobarbital. The global incidence of intraventricular hemorrhage was 16 (53%) in the group treated and 14 (46%) in the not treated, this difference was not statistically significant. The degree of hemorrhage, found was: I and II degree, eleven (69%) in the treated group and four (28%), in the control group; III and IV degree five (31%), in the treated group and ten (71%), in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Child of insulin-dependent diabetic mother: neonatal impact]. / Hijo de madre diabética insulino-dependiente: repercusiones neonatales.

Pregnancy and diabetes mellitus have been associated to a high incidence of neonatal morbidity and mortality. The purpose of the present study was to determinate the incidence of macrosomia, congenital malformations and their effect in the neonatal period. We review 42 live infants of insulin dependent diabetic mothers (IDDM) in a third level center. The variables analyzed were: severity of maternal diabetes, sex, weight, gestational age, trophism, Apgar score at one minute, mode of delivery, presence of congenital malformations, morbidity and mortality. The population was divided in three groups: 1. Neonates with appropriate for gestational age (AGA), 2. Large for gestational age (LGA), and 3. Small for gestational age (SGA). According to trophism, 27 (64%) were AGA, eleven (26%) were LGA and four (9%) were SGA. About morbidity, hypoglycemia was more frequent in the LGA. The group of SGA had lower Apgar score at one minute compared with the AGA. There were congenital malformations in seven neonates and being more frequent in the SGA group. The proportion of major malformation was of 4.7%. Fetal hyperinsulinemia is responsible for the morbidity of IDDM, being necessary adequate metabolic control of the mothers before pregnancy and the management of diabetes and pregnancy should be done in a center with experience.

[Nosocomial infection in newborn infants on mechanical ventilation]. / Infección nosocomial en recién nacidos con ventilación mecánica.

During a two-year period (1988-1989), were studied newborns treated with intermittent mandatory ventilation (IMV). The goal was to know incidence of infections in these patients and characteristics of these process. Of 187, 40 (21.3%) were infected. For these neonates the mean gestational age was 33 +/- 3 weeks and average for birth weight was 1755 +/- 644 g. In 32 the infecting agent was isolated, being the most common coagulase negative Staphylococcus, it was found in 18 (45%), Klebsiella sp in 7 (17%), Escherichia coli in 1 and Candida albicans in 1. In the remaining 8 (20%) with negative cultures, postmortem confirmation was made in 5 and in 3 by clinical, radiologic or hematologic evidence. Of the 17 positive blood cultures and 3 spinal fluid culture, the same bacteria grew as in the bronchial aspirate. Were found, thrombocytopenia in 22 (55%) and leucocytosis in 19 (47%) as the most common blood changes. Pneumonia was the most common form of infection; it was found in 30 (75%); 22 of 40 died (55%). We concluded that 21.3% of neonates under IMV without infections, may get infected later in the hospital. S. epidermidis is the etiologic agent that predominates through the whole year, except during epidemics caused by others agents.

[The perinatal aspects of surviving low-birth weight neonates]. / Aspectos perinatales de neonatos sobrevivientes de bajo peso.

We analyzed prenatal history of 277 live low birth weight infants (less than 2,500 g). We tried to determine some perinatal factors that may be associated with good prognosis in this group of babies. The variables analyzed were: maternal age, number of prenatal visits, complication of pregnancy, mode of delivery, birth weight, sex, gestational age. Apgar score at 1 minute and the neonatal morbidity. The population was divided in 3 groups: 1. Less than 1,000 g, (3).2. 1,000-1,499 g, (37) and 3. 1,500-2,499 g (237). Each group was also divided in appropriate for gestational age (AGA) and small for gestational age (SGA). We found that morbidity and the risk of death, is less in the SGA compared with AGA, associated with better prenatal care, higher birth weight and gestational age.

[Morbidity and mortality in low birth weight infants]. / Morbilidad y mortalidad en neonatos de bajo peso al nacer.

The results in morbidity and mortality between 415 newborn infants with birth weight under 2,500 g are presented; the patients with great congenital malformations were not included. The population was divided in three categories 1,500-2,499 g, 1,000-1,499 g and less than 1,000 g and each categorie was divided in small for gestational age (SGE) and appropriate for gestational age (AGE). The mortality rate was very high in the extreme low birth weight. 67% of the population were AGE y 33% for SGE. The intrahospitalary morbidity was different between each group, being the SGE with less morbidity and less length of hospitalization, with no relation to birth weight. In our study there was no differences between perinatal asphyxia and birth weight, probably because the SGE babies born in better conditions than the other group.

[Effects of early multimodal stimulation on preterm newborn infants]. / Efectos de la estimulación multimodal temprana en neonatos pretérmino.

During the last trimester of pregnancy, newborns are deprived of both maternal biorhythms, tactile, kinesthetic and auditory stimulation which characterize the intrauterine environment. The purpose of this study is to determine if supplemental multimodal stimulation improves neurobehavioral performance, increases weight gain and shortens hospital stay. Nine neonates with the following characteristics were included in an early multimodal stimulation program: 1) gestational age less than or equal to 34 weeks, 2) feeding through orogastric tubing, 3) hemodynamically stable, with no signs of hemorrhaging, infections, or any suggestion of neurological damage, convulsions or congenital malformations. A control group with the same characteristics was also included in the study. Risk factors for each patient were evaluated and their evolution was closely watched while still in the hospital. Both the postural reflexes and neurobehavioral performance were assessed at the time the child left the hospital and a month afterwards. Statistically significant differences were found in the neurobehavioral performance and postural reflexes of those included in the study group.