Terapia con surfactante con técnica mínimamente invasiva: experiencia en un hospital terciario / Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital

INTRODUCCIÓN: La administración de surfactante mediante técnica mínimamente invasiva, conocida como MIST por sus siglas en inglés (Minimal Invasive Surfactant Therapy), es un procedimiento que permite administrar el surfactante estando el paciente conectado a ventilación no invasiva. Cada vez más utilizada en las unidades neonatales, permite reducir el número de intubaciones y la patología asociada a la misma, a la vez que no se priva de la administración de surfactante a los pacientes que lo necesitan. PACIENTES Y MÉTODOS: En los años 2013 y 2014 en el Hospital General Universitario de Elche se administró surfactante mediante técnica mínimamente invasiva en 19 pacientes, 5 de ellos con una edad gestacional igual o menor de 28 semanas al nacimiento. Se realiza comparación con una cohorte histórica de 28 pacientes con distrés respiratorio neonatal que fueron inicialmente tratados con soporte respiratorio no invasivo. RESULTADOS: No se registraron complicaciones que obligaran a detener la técnica. Se observó en todos los casos una disminución de las necesidades de la fracción inspirada de oxígeno. El número de intubaciones fue menor en el grupo MIST respecto al grupo control (42% vs. 54%). DISCUSIÓN: La experiencia recopilada en el presente estudio muestra que la administración de surfactante con técnica MIST es un procedimiento reproducible que permite una buena distribución del surfactante en ventilación no invasiva

INTRODUCTION: Surfactant delivered using a minimally invasive technique, known as MIST (Minimally Invasive Surfactant Therapy) is a method which allows surfactant to be adminstered to a patient connected to non-invasive respiratory support. This is an increasingly used therapy in Neonatal Units that reduces the intubation rate and the pathology associated with intubation and allows the surfactant to be administered to the patients who clinically need it. PATIENTS AND METHODS: In years 2013 and 2014 in the Hospital General Universitario de Elche surfactant was delivered using this method to 19 patients, five of whom were 28 or less weeks of gestation age at birth. A comparison is made with a historical cohort consisting of 28 patients with Respiratory Distress Syndrome treated initially with non-invasive respiratory support. RESULTS: No incidents were recorded that caused the interruption of the administration. A reduction in the fraction of inspired oxygen was observed in all cases after surfactant administration. Fewer intubations in the first 72hours of life were found in the treatment group compared to the control group (42% vs. 54%). DISCUSSION: The experience recorded in the Hospital General Universitario de Elche shows that the administration of surfactant using a MIST technique is a reproducible method of treatment, which allows the surfactant distribution during spontaneous breathing with non invasive respiratory support

[Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital]. / Terapia con surfactante con técnica mínimamente invasiva: experiencia en un hospital terciario.

INTRODUCTION: Surfactant delivered using a minimally invasive technique, known as MIST (Minimally Invasive Surfactant Therapy) is a method which allows surfactant to be administered to a patient connected to non-invasive respiratory support. This is an increasingly used therapy in Neonatal Units that reduces the intubation rate and the pathology associated with intubation and allows the surfactant to be administered to the patients who clinically need it. PATIENTS AND METHODS: In years 2013 and 2014 in the Hospital General Universitario de Elche surfactant was delivered using this method to 19 patients, five of whom were 28 or less weeks of gestation age at birth. A comparison is made with a historical cohort consisting of 28 patients with Respiratory Distress Syndrome treated initially with non-invasive respiratory support. RESULTS: No incidents were recorded that caused the interruption of the administration. A reduction in the fraction of inspired oxygen was observed in all cases after surfactant administration. Fewer intubations in the first 72 hours of life were found in the treatment group compared to the control group (42% vs. 54%). DISCUSSION: The experience recorded in the Hospital General Universitario de Elche shows that the administration of surfactant using a MIST technique is a reproducible method of treatment, which allows the surfactant distribution during spontaneous breathing with non invasive respiratory support.

Ictericia neonatal: evaluación clínica de un bilirrubinómetro transcutáneo / Neonatal jaundi Clinical evaluation of a transcutaneous bilirubinometer

Introducción: Los bilirrubinómetros transcutáneos actuales han demostrado ser útiles como instrumentos de medida de la ictericia neonatal. En este estudio se evalúa si las medidas de la bilirrubina transcutánea (TCB) se correlacionan con las determinaciones de la bilirrubina sérica (TSB), y si la edad gestacional, peso al nacimiento, raza u horas de vida interfieren en esas medidas. Material y métodos: Estudio transversal, observacional y descriptivo sobre una muestra de 65 determinaciones simultáneas de TCB y de TSB. Resultados: Se obtiene un coeficiente de correlación de 0,923 entre ambos métodos. El análisis de covarianza muestra cómo la edad gestacional, raza y peso parecen no ser contribuidores significativos sobre los valores de la TCB. Conclusiones: Aunque el aparato transcutáneo tiende a infraestimar a la TSB, sobre todo con concentraciones elevadas, es una técnica útil para la medición orientativa de la concentración de la bilirrubina en recién nacidos (AU)

Background: Transcutaneous bilirubinometers provide non-invasive data on newborn jaundice. The aim of this study is to evaluate whether the measurement of transcutaneous bilirubin can be correlated with serum bilirubin, and to find out whether gestational age, weight birth, race or hours of life affect those measurements .Method: Descriptive observational cross-sectional study on a sample of 65 simultaneous measurement of transcutaneous (TcB) and serum bilirubin (TSB). Results: The correlation coefficient between both methods was 0.923. Race, gestational age and birth weight tends to not have any effects on the levels of transcutaneous bilirubin. Conclusion: Although bilirubinometer measurements tend to underestimate serum bilirubin, especially in patients with high levels, it is a useful technique as a screening tool in the evaluation of hyperbilirubinaemia (AU)

[Neonatal jaundice: Clinical evaluation of a transcutaneous bilirubinometer]. / Ictericia neonatal: evaluación clínica de un bilirrubinómetro transcutáneo.

BACKGROUND: Transcutaneous bilirubinometers provide non-invasive data on newborn jaundice. The aim of this study is to evaluate whether the measurement of transcutaneous bilirubin can be correlated with serum bilirubin, and to find out whether gestational age, weight birth, race or hours of life affect those measurements. METHOD: Descriptive observational cross-sectional study on a sample of 65 simultaneous measurement of transcutaneous (TcB) and serum bilirubin (TSB). RESULTS: The correlation coefficient between both methods was 0.923. Race, gestational age and birth weight tends to not have any effects on the levels of transcutaneous bilirubin. CONCLUSION: Although bilirubinometer measurements tend to underestimate serum bilirubin, especially in patients with high levels, it is a useful technique as a screening tool in the evaluation of hyperbilirubinaemia.

Rupture of intracranial arterial aneurysms in neonates: case report and review of the literature.

The rupture of cerebral arterial aneurysm is an extremely rare cause of intracranial hemorrhage in infants. Brain magnetic resonance imaging is an excellent technique commonly used to suggest the diagnosis. In this article, we propose color flow Doppler ultrasound as a useful, simple, inexpensive, noninvasive, and accessible option for confirming the lesion.We report one case of cerebral aneurysm in a neonate admitted to our unit. Furthermore, we performed a thorough review of the literature on cerebral aneurysm that led us to the observation that the vast majority of untreated patients suffered a second bleeding that caused death. Thus, we insist on the benefits of a timely treatment.