ABSTRACT
BACKGROUND: Early onset neonatal sepsis (EOS) is a public health problem; antibiotic treatment is often unnecessary and can increase morbimortality. EOS risk calculator are available that allows limiting the use of antibiotics. OBJECTIVE: To compare the patterns of antibiotic use and hospitalization time in infant newborns (NB) ≥ 34 weeks of gestational age (GA) in a historical cohort attended from November 2017 to April 2018 vs. a prospective cohort from November 2018 to April 2019, before and after implementing the use of an EOS risk calculator, respectively. MATERIAL AND METHODS: Ambispective, observational, longitudinal, analytical study in infants NB ≥ 34 GA attended before and after implementing the use of an EOS risk calculator. The patterns of antibiotic´s use were compared. Simple frequencies and proportions, means and standard deviations or medians with ranges, Mann-Whitney U Test and Chi square test with SPSS V. 20.0 statistical package were used; considering significant values of p < 0.05. RESULTS: Thirty patients were included, 15 NB for each period, the gestational age average was 36.8 ± 2.3 GA. there was no statistically significant difference in the frequency of diagnosis of EOS with blood culture or days of hospital stay. Antibiotics were beginning in all the infants attended before the implementation of the EOS risk calculator, unlike 46.7% of the infants after its implementation (p = 0.001). CONCLUSIONS: The EOS risk calculator is an easy tool to use, and demonstrated to be useful in decreasing unnecessary use of antibiotics.
INTRODUCCIÓN: la sepsis neonatal temprana (SNT) es un problema de salud pública. El tratamiento con antibióticos frecuentemente es innecesario y no inocuo. El uso de calculadoras de riesgo de SNT permite disminuir el uso injustificado de antibióticos. OBJETIVO: comparar el uso de antibióticos y tiempo de hospitalización en recién nacidos (RN) ≥ 34 semanas de gestación (SDG) en una cohorte histórica atendida de noviembre de 2017 a abril de 2018 frente a una cohorte prospectiva de noviembre de 2018 a abril del 2019, antes y después de la implementación del uso de una calculadora de riesgo de SNT. MATERIAL Y MÉTODOS: estudio ambispectivo, observacional, analítico en RN ≥ 34 SDG atendidos antes y después de implementar una calculadora de riesgo de SNT. Se comparó el uso de antibióticos así como el tiempo de hospitalización. Se usaron frecuencias, proporciones, medidas de tendencia central y dispersión, U de Mann-Whitney y Chi cuadrada, con el paquete estadístico SPSS V. 20.0; siendo significativos los valores de p < 0.05. RESULTADOS: se incluyeron 30 pacientes, 15 para cada grupo, de 36.8 ± 2.3 SDG. No hubo diferencia significativa en la frecuencia de diagnóstico de SNT con hemocultivo ni en los días de estancia intrahospitalaria. Se usó antibióticos en el 100% de los RN antes frente al 46.7% después del uso de la calculadora (p = 0.001). CONCLUSIONES: la calculadora de riesgo de SNT es una herramienta de uso sencillo y que demostró ser útil para disminuir el uso innecesario de antibióticos.
Subject(s)
Neonatal Sepsis , Sepsis , Anti-Bacterial Agents/therapeutic use , Humans , Infant , Infant, Newborn , Infant, Premature , Neonatal Sepsis/diagnosis , Neonatal Sepsis/drug therapy , Prospective Studies , Retrospective Studies , Risk Assessment , Risk Factors , Sepsis/diagnosis , Sepsis/drug therapyABSTRACT
BACKGROUND: SARS-CoV-2 infection has become a global problem with significant infectiousness and mortality, affecting all age groups. One of the groups of greater risk are the pregnant women and their newborns. We present a report the first neonate born to a mother with COVID-19 who was treated at the Hospital de Gineco Obstetricia No. 3, in La Raza National Medical Center. CLINICAL CASE: Male newborn of 34 weeks of gestation, son of a mother diagnosed with COVID-19, "not vigorous," who required ventilatory support with intermittent positive pressure and mechanical ventilation due to respiratory depression secondary to the sedative and anesthetic type medications that the mother had received. During hospital stay of the child, he presented an adequate evolution and the two tests from nasopharyngeal swab at days 1 and 8 of extra-uterine life were negative for SARS-CoV-2 infection. CONCLUSIONS: The different clinical manifestations of newborns with COVID-19 have been described in other studies, while the vertical transmission in the newborn up to this moment is uncertain.
INTRODUCCIÓN: la infección por SARS-CoV-2 se ha convertido en un problema mundial con importante infectocontagiosidad y mortalidad, afectando a todos los grupos de edad. Uno de los grupos de mayor riesgo son las mujeres embarazadas y con ello la afección a sus recién nacidos. A continuación, se reporta el caso del primer neonato hijo de madre con COVID-19 atendido en el Hospital de Gineco Obstetricia No. 3 del Centro Médico Nacional La Raza. CASO CLÍNICO: recién nacido masculino de 34 semanas de gestación, hijo de madre con diagnóstico de COVID-19, "no vigoroso", que requirió apoyo ventilatorio con presión positiva intermitente y ventilación mecánica debido a depresión respiratoria secundaria a los medicamentos de tipo sedante y anestésicos que había recibido la madre. Durante su estancia tuvo una evolución adecuada y las dos pruebas de hisopado nasofaríngeo a los días uno y ocho de vida extrauterina fueron negativas para la infección por SARS-CoV-2. CONCLUSIONES: las distintas manifestaciones clínicas de recién nacidos con COVID-19 han sido descritas en otros estudios, mientras que la transmisión vertical en el recién nacido hasta este momento es incierta.
ABSTRACT
BACKGROUND: Central venous catheter (CVC) installation is essential for the treatment of critically ill neonates; however, it is associated with the development of neonatal intracardiac thrombosis, which is a complication that is associated with a poor prognosis. We aimed to identify specific risk factors for the development of intracardiac thrombosis in the right atrium (RA) and superior vena cava (SVC) related to the use of CVC in critically ill neonates. METHODS: A case-control study was conducted at the tertiary referral neonatal intensive care unit of the Pediatric Hospital Siglo XXI in Mexico City, Mexico from 2008 to 2013. The included cases (n = 43) were de novo patients with intracardiac thrombosis in the RA and SVC diagnosed by echocardiography. The controls (n = 43) were neonates without intracardiac thrombosis or thrombosis at other sites. A logistic regression analysis was conducted, and odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: The independent risk factors for intracardiac thrombosis in the RA and SVC were the surgical cut-down insertion technique (OR = 2.98; 95% CI: 1.18-9.10), a maternal history of gestational diabetes/diabetes mellitus (OR = 10.64; 95% CI: 1.13-121.41), Staphylococcus epidermidis infection (OR = 7.09; 95% CI: 1.09-45.92), and CVC placement in the SVC (OR = 5.77; 95% CI: 1.10-30.18). CONCLUSION: This study allowed us to identify several contributing factors to the development of intracardiac thrombosis in the RA and SVC related to the installation of a CVC in a subgroup of critically ill neonates. Multicenter and well-designed studies with a larger number of patients could help validate our findings and/or identify other risk factors that were not identified in the present study.
