ABSTRACT
Introducción. En neonatos inmaduros que precisan intubación traqueal para recibir asistencia respiratoria o surfactante exógeno, la extubación puede no ser bien tolerada, siendo preciso reintubar. Objetivo. Evaluar la evidencia científica sobre 1) prevención y tratamiento de la apnea de la prematuridad, 2) prevención del fracaso de la extubación, y 3) registrar y valorar el uso del citrato de cafeína en una UCIN. Métodos. Se realizó una revisión sistemática de la literatura referente al uso del citrato de cafeína en la apnea de la prematuridad. Se realizó un registro de uso de la cafeína y su indicación específica, en la unidad neonatal de nuestro hospital. Resultados. El citrato de cafeína es eficaz y seguro tanto en la profilaxis y tratamiento de la apnea de la prematuridad, como para prevenir el fracaso de la extubación, reduciendo la necesidad de reintubación en un 50%, especialmente con dosis altas (15-20 mg/kg/día). En nuestra unidad, el 85% de los neonatos de menos de 32 sem recibieron tratamiento con cafeína, y en la mitad de casos fue para prevenir el fracaso de la extubación. Conclusiones. En todos los neonatos < 30 sem, y de forma individualizada entre las 30 y 32 sem, se recomienda el uso de citrato de cafeína desde 24 horas antes y durante los 6 días siguientes a la extubación; no siendo preciso determinar de modo sistemático sus niveles sanguíneos. Se recomienda también su uso tras la intubación precoz para administrar surfactante exógeno y extubar. Es aconsejable usar simultáneamente CPAP-n (AU)
Background. Immature neonates requiring tracheal intubation for ventilator support or to receive exogenous surfactant therapy, extubation may not be we1ltolerated been reintubation often required. Methods. A systematic literature review was performed concerning the use of caffeine citrate for prematurity apnea, and more specifically,for the prevention of extubation failure. Moreover, the use of caffeine in infants of less than 32 weeks and its specific indications in our hospital neonatal unit was registered. Results. The use of caffeine is safe and effective in the prophylaxis and treatment of apnea of prematurity, as well as to prevent the extubation failure, (50% reduction), especially if high doses are used (15-20 mg/kg/d). In addition, it is not necessary to routinely measure the blood levels. The simultaneous use of continuous positive airway pressure (CPAP-n) is also recommended. In our unit, 85% of all infants of less than 32 weeks were treated with caffeine citrate, half of them to prevent extubation failure. Conclusions. In all premature infants below 30 week of gestation, and in some between 30 and 32 weeks, the use of caffeine citrate from 24 hours before and for the 6 days following extubation is recommended. The systematic measurement of its blood levels is not required. It is also recommended the simultaneous use of CPAP-n in these infants and in those requiring surfactant to facility their early extubation (AU)
Subject(s)
Female , Humans , Infant, Newborn , Male , Airway Extubation/methods , Caffeine/therapeutic use , Asphyxia Neonatorum/therapy , Apnea/therapy , Infant, Premature/physiology , 1-Methyl-3-isobutylxanthine/therapeutic use , Infant, Premature, Diseases , Evidence-Based Practice , Respiration, Artificial/methodsABSTRACT
Introducción: Este estudio describe la morbilidad y mortalidad de los recién nacidos de muy bajo peso (RNMBP) asistidos en las unidades neonatales del País Vasco y Navarra entre los años 2001-2006, y evalúa los factores que afectan a la mortalidad. Pacientes y métodos: Estudio descriptivo observacional de una cohorte de 1.318 RNMBP asistidos entre el año 2001 y 2006 en cinco hospitales del País Vasco y Navarra. Se recogieron un total de 37 variables incluidas en la base de datos de EuroNeoNet, que se refieren a factores perinatales de riesgo y protectores, características demográficas, días de ingreso, intervenciones, morbilidades y mortalidad. Resultados: Un 94% de las mujeres embarazadas recibieron cuidados prenatales y un 78,7% administración de esteroides prenatales, en ambos casos hubo un aumento significativo durante el periodo estudiado. El 42% de los embarazos fueron múltiples y en un 63% el parto fue por cesárea. La displasia broncopulmonar disminuyó de manera estadísticamente significativa de un 20 a un 15%. La incidencia de hemorragia intraventricular de grado III o IV fue de 7,5% y de leucomalacia periventricular de un 3,1%. Se diagnosticó infección vertical en un 4% de niños y sepsis o meningitis tardía en 25%, enterocolitis necrotizante en 9% y persistencia del conducto arterioso en el 14% de los niños. El tratamiento con indometacina o ibuprofeno disminuyó significativamente durante el estudio. La tasa bruta de mortalidad neonatal total, tardía y precoz se ha mantenido constante en este periodo de tiempo. La mortalidad neonatal inmediata mostró una tendencia descendente y una diferencia significativa por sexo, siendo esta mayor en los varones. Conclusión: Este estudio de base poblacional aporta información valiosa sobre variables resultado en UCIN y puede ayudar en el planteamiento de intervenciones que mejoren la calidad asistencial y disminuyan la morbilidad y mortalidad en estos neonatos de alto riesgo(AU)
Introduction: This study describes very low birth weight (VLBW) infant morbidity and mortality in Basque Country and Navarra neonatal units between the years 2001-2006, and evaluates the factors that affect the mortality. Patients and methods: A descriptive observational study of a cohort of 1,318 VLBW infants in neonatal units in five Basque Country and Navarra hospitals between 2001 and 2006. A total of 37 variables included in EuroNeoNet database were collected as regards, perinatal risk and protective factors, demographic characteristics, length of stay, interventions, morbidity and mortality. Results: A total of 94% of pregnant women received prenatal care and 78.7% antenatal steroids. In both cases there was a significant increase during the period studied. A total of 42% of pregnancies were multiple and in 63% delivery was by Caesarean section. Bronchopulmonary dysplasia statistically significantly decreased from 20% to 15%. The incidence of intraventricular haemorrhage grade III or IV was 7.5% and for periventricular leukomalacia it was 3.1%. Vertical infection was diagnosed in 4% of infants and sepsis or late meningitis in 25%, necrotizing enterocolitis in 9% and patent ductus arteriosus in 14% of the infants. The prophylactic or therapeutic treatment with indometacin or ibuprofen decreased significantly during the study. The overall rate of total, late and first day neonatal mortality was almost constant during this period of time. Nevertheless, the early neonatal mortality showed a decreasing trend and with a significant difference between sexes, being higher in males. Conclusion: This population-based study provides valuable information on clinical outcomes in NICUs, and may help in planning strategies to improve health care quality, and to reduce the morbidity and mortality in these neonates at high risk(AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant Mortality , Infant, Low Birth Weight/physiology , Infant, Very Low Birth Weight/physiology , Indicators of Morbidity and Mortality , Cohort Studies , Mortality/statistics & numerical data , Sepsis/complications , Sepsis/mortalityABSTRACT
INTRODUCTION: This study describes very low birth weight (VLBW) infant morbidity and mortality in Basque Country and Navarra neonatal units between the years 2001-2006, and evaluates the factors that affect the mortality. PATIENTS AND METHODS: A descriptive observational study of a cohort of 1,318 VLBW infants in neonatal units in five Basque Country and Navarra hospitals between 2001 and 2006. A total of 37 variables included in EuroNeoNet database were collected as regards, perinatal risk and protective factors, demographic characteristics, length of stay, interventions, morbidity and mortality. RESULTS: A total of 94% of pregnant women received prenatal care and 78.7% antenatal steroids. In both cases there was a significant increase during the period studied. A total of 42% of pregnancies were multiple and in 63% delivery was by Caesarean section. Bronchopulmonary dysplasia statistically significantly decreased from 20% to 15%. The incidence of intraventricular haemorrhage grade III or IV was 7.5% and for periventricular leukomalacia it was 3.1%. Vertical infection was diagnosed in 4% of infants and sepsis or late meningitis in 25%, necrotizing enterocolitis in 9% and patent ductus arteriosus in 14% of the infants. The prophylactic or therapeutic treatment with indometacin or ibuprofen decreased significantly during the study. The overall rate of total, late and first day neonatal mortality was almost constant during this period of time. Nevertheless, the early neonatal mortality showed a decreasing trend and with a significant difference between sexes, being higher in males. CONCLUSION: This population-based study provides valuable information on clinical outcomes in NICUs, and may help in planning strategies to improve health care quality, and to reduce the morbidity and mortality in these neonates at high risk.
