ABSTRACT
INTRODUCCIÓN: Estudio retrospectivo en la unidad de cuidados intensivos neonatales de un hospital de tercer nivel sobre la incidencia de hiponatremia precoz (primeras 48 horas de vida) en prematuros. Buscamos factores de riesgo y de protección para esa alteración, como punto de partida para un cambio en la actuación médica al prescribir fluidos intravenosos. MATERIAL Y MÉTODOS: Muestra de 256 prematuros (edad gestacional: 235-366) ingresados en la unidad de cuidados intensivos neonatales de nuestro hospital, entre enero de 2016 y junio de 2018. Se determinó qué pacientes recibieron aportes intravenosos de sodio en distintos intervalos de las primeras 48 horas de vida y cuántos padecieron hiponatremia de cualquier tipo (< 135 mmol/l) y moderada-grave (< 130 mmol/l). Se estudió la relación entre hiponatremia precoz y peso/edad gestacional, administración de corticoides prenatales, enfermedad respiratoria, sepsis precoz y asfixia perinatal. RESULTADOS: Padecieron hiponatremia 81 pacientes, 31,64% del total (hasta un 50% en < 30 semanas de edad gestacional), siendo moderada-grave (< 130 mmol/l) en un 17,3% de los casos. El periodo de tiempo con más casos de hiponatremia fue el de las primeras 12 horas de vida (22,64%). Demostraron ser factores de riesgo el peso (p = 0,034), la edad gestacional (p < 0,001) y el padecimiento de enfermedad respiratoria (p < 0,001) y, en el análisis multivariable, este último se mostró relacionado de forma independiente con la hiponatremia precoz (p < 0,01; OR = 5,24; IC 95%: 2,79-9,84). La administración de betametasona prenatal no demostró proteger. CONCLUSIÓN: Según nuestros resultados creemos conveniente aportar sodio en los fluidos intravenosos prescritos los primeros días de vida, particularmente en prematuros de menos edad gestacional y en afectos de enfermedad respiratoria
INTRODUCTION: A retrospective study was conducted in the Neonatal Intensive Care Unit of a tertiary hospital to determine the incidence of early hyponatraemia (first 48hours of life) in preterm infants. Risk and protection factors in this condition were also examined as a starting point for a change in the medical action when prescribing intravenous fluids. MATERIAL AND METHODS: The study included a sample of 256 premature babies (gestational age: 235-366) admitted to the Neonatal Intensive Care Unit of a tertiary hospital between January 2016 and June 2018. The number of patients receiving intravenous sodium in different intervals during the first 48hours of life was determined, as well as the number of those with hyponatraemia of any type (< 135 mmol/l), and moderate-severe (< 130 mmol / l). An analysis was made of the relationship between early hyponatraemia and weight / gestational age, antenatal steroids exposure, respiratory pathology, early sepsis, and perinatal asphyxia. RESULTS: Hyponatraemia occurred in 81 patients, 31.64% of the total (up to 50% in < 30 weeks of gestational age), and was moderate-severe (< 130 mmol / l) in 17.3% of the cases. The period of time with the most cases of hyponatraemia was in the first 12hours of life (22.64%). Weight (P=.034), gestational age (P < .001) and respiratory disease (P < .001) were found to be risk factors and, in a multivariate analysis, the latter was independently related to early hyponatremia (P < .01, OR = 5.24, 95% CI: 2.79-9.84). Antenatal betamethasone exposure did not show to be a protection factor. CONCLUSION: According to the results of this study, it is considered an advantage to provide sodium in the intravenous fluids prescribed during the first days of life, particularly in preterm infants of lower gestational age and with respiratory disease involvement
Subject(s)
Humans , Male , Female , Infant, Newborn , Fluid Therapy/methods , Hyponatremia/etiology , Hyponatremia/prevention & control , Infant, Premature, Diseases/etiology , Infant, Premature, Diseases/prevention & control , Intensive Care, Neonatal/methods , Sodium/therapeutic use , Hyponatremia/diagnosis , Infant, Premature , Infant, Premature, Diseases/diagnosis , Infusions, Intravenous , Protective Factors , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCCIÓN: La succión nutritiva es un hito importante para la correcta alimentación del neonato. Los prematuros no tienen desarrollada esta habilidad, por lo que se han diseñado diferentes maneras de estimular su aparición. OBJETIVO: Comprobar si la estimulación de los reflejos orales innatos, a través de reacciones neuromotrices, disminuye el tiempo para adquirir la destreza de succión nutritiva. MATERIAL Y MÉTODOS: Se estudiaron neonatos nacidos antes de la semana 34 de gestación y alimentados mediante sonda por succión ineficaz. El grupo control estuvo constituido por los recién nacidos con las mismas características nacidos durante el año 2016. El grupo experimental fue estimulado mediante reacciones neuromotrices hasta el retiro de la sonda. Las variables observadas fueron el tiempo de transición a la alimentación oral completa, el peso, la talla y el perímetro craneal al alta, la saturación periférica de oxígeno y la frecuencia cardiaca antes y después de la intervención, así como la calidad de la succión mediante la escala ECLES. RESULTADOS: Completaron el estudio 23 niños en el grupo de intervención y 25 en el grupo de control histórico. Los niños del grupo intervenido mostraron transición acelerada a la alimentación oral independiente y valores más elevados de altura (p = 0.01), peso (p < 0.001) y perímetro craneal (p = 0.04) en el momento del alta hospitalaria. La edad gestacional al alta y la duración total de la hospitalización no mostraron diferencias entre grupos (p > 0.05). CONCLUSIONES: La estimulación mediante reacciones neuromotrices disminuye el tiempo necesario para alcanzar la succión nutritiva en los neonatos pretérmino. BACKGROUND: Nutritive suction is an important milestone for correct newborn feeding. Premature infants do not develop this ability therefore, several proposals for their appearance have being designed. OBJECTIVE: Assess whether the stimulation of the innate oral reflexes using neuromotor reactions reduces the time to acquire sucking behavior. MATERIAL AND METHODS: Newborns before 34 weeks of gestation, fed by tube feeding due to an ineffective suction, were studied. Control group consisted of newborns with the same characteristics born during 2016. Experimental group was stimulated by neuromotor reactions until the tube feeding was retired. Observed variables included transition time to complete oral feeding, weight, height and cranial perimeter at discharge, peripheral oxygen saturation and heart rate before and after intervention, as well as quality of suction behavior using ECLES scale. RESULTS: A total of 23 babies from intervention group completed the study, and 25 from historical control group. Children of intervention group showed an accelerated transition to independent oral feeding and higher values of height (p = 0.01), weight (p < 0.001) and cranial perimeter (p = 0.04), at the time of hospital discharge. Gestational age at discharge and total duration of hospitalization did not show differences between groups (p > 0.05). CONCLUSION: Oral stimuli intervention by means of neuromotor reactions reduced the time necessary to reach suction behavior in preterm babies.
ABSTRACT
INTRODUCTION: A retrospective study was conducted in the Neonatal Intensive Care Unit of a tertiary hospital to determine the incidence of early hyponatraemia (first 48hours of life) in preterm infants. Risk and protection factors in this condition were also examined as a starting point for a change in the medical action when prescribing intravenous fluids. MATERIAL AND METHODS: The study included a sample of 256 premature babies (gestational age: 235-366) admitted to the Neonatal Intensive Care Unit of a tertiary hospital between January 2016 and June 2018. The number of patients receiving intravenous sodium in different intervals during the first 48hours of life was determined, as well as the number of those with hyponatraemia of any type (<135mmol / l), and moderate-severe (<130mmol / l). An analysis was made of the relationship between early hyponatraemia and weight / gestational age, antenatal steroids exposure, respiratory pathology, early sepsis, and perinatal asphyxia. RESULTS: Hyponatraemia occurred in 81 patients, 31.64% of the total (up to 50% in<30 weeks of gestational age), and was moderate-severe (<130mmol / l) in 17.3% of the cases. The period of time with the most cases of hyponatraemia was in the first 12hours of life (22.64%). Weight (P=.034), gestational age (P<.001) and respiratory disease (P<.001) were found to be risk factors and, in a multivariate analysis, the latter was independently related to early hyponatremia (P<.01, OR=5.24, 95% CI: 2.79-9.84). Antenatal betamethasone exposure did not show to be a protection factor. CONCLUSION: According to the results of this study, it is considered an advantage to provide sodium in the intravenous fluids prescribed during the first days of life, particularly in preterm infants of lower gestational age and with respiratory disease involvement.
