Parasympathetic evaluation for procedural pain assessment in neonatology.

INTRODUCTION: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. MATERIAL AND METHODS: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15 min after the procedure. RESULTS: The study included 86 records for 49 patients. In the first 4 min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79 min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. CONCLUSIONS: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4 min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales.

[Antenatal corticosteroids and incidence of neonatal respiratory distress after elective caesarean section in late preterm and term neonates]. / Corticoides antenatales e incidencia de distrés respiratorio del recién nacido en las cesáreas programadas del pretérmino tardío y término precoz.

INTRODUCTION: Birth by elective caesarean section in late preterm and early term newborn increases the risk of respiratory distress. Administration of antenatal corticosteroids in these cases could reduce the respiratory distress and its severity. OBJECTIVES: To determine the influence of antenatal corticosteroids use in elective caesarean sections in the respiratory distress of the newborn from 35+0 to 38+6 weeks of gestational age. PATIENTS AND METHODS: Retrospective analytical study of caesarean sections from 35+0 to 38+6 gestational age was conducted in a tertiary hospital from January 2013 to April 2017. Data were collected from medical records of pregnant women and newborns after an implementation of new protocol of betamethasone administration to these elective caesarean sections. Analysis was performed on 2newborn subgroups: preterm newborn (PTN) 35-36 gestational age and term (TN) 37-38 weeks. RESULTS: A total of 208 elective caesarean sections were performed in the study period. Corticosteroids were administered in 97 (46.6%) of cases. The percentage of respiratory distress was higher in the group of preterm newborn compared to term newborn (29% vs. 8.8%, P<.001) and in term newborn higher at a lower gestational age. Between treated with corticosteroids or not, no significant differences were found in the treated and non-treated in the development of respiratory distress (PTN 30 vs. 30%, TN 9.1 vs. 6.9%, P=.6). CONCLUSIONS: No statistically significant differences were found in this study in favour of the administration of an antenatal dose of betamethasone in the reduction of respiratory distress in the elective caesarean sections from 35+0 to 38+6 gestational age. The delay in the indication of elective caesarean sections, whenever possible, could help reduce the incidence of newborn respiratory distress.

[Late neonatal sepsis caused by Streptococcus pyogenes]. / Sepsis neonatal tardía por Streptococcus pyogenes.

Currently, the group A Streptococcus is a unusual cause of infection in the neonatal period. The description of cases of severe infection in the newborn is sporadic. We present a 12-days-old newborn attended at the emergency room for fever without focus, which developed neurological and systemic involvement during admission. Clinical presentation, evolution and treatment are described. Blood culture isolation of group A Streptococcus confirmed late sepsis by this bacteria, probably with associated meningitis.

Sepsis neonatal tardía por Streptococcus pyogenes / Late neonatal sepsis caused by Streptococcus pyogenes

Actualmente, Streptococcus grupo A es una causa infrecuente de infección en el período neonatal. La descripción de casos de infección grave en el recién nacido es esporádica. Presentamos un recién nacido de 12 días de vida que acudió al servicio de urgencias por síndrome febril sin foco, que durante su ingreso desarrolló afectación neurológica y sistémica. Describimos la presentación clínica, la evolución y el tratamiento. El aislamiento de Streptococcus grupo A en el hemocultivo confrma la sepsis tardía por este germen con probable meningitis asociada.

Currently, the group A Streptococcus is a unusual cause of infection in the neonatal period. The description of cases of severe infection in the newborn is sporadic. We present a 12-days-old newborn attended at the emergency room for fever without focus, which developed neurological and systemic involvement during admission. Clinical presentation, evolution and treatment are described. Blood culture isolation of group A Streptococcus confrmed late sepsis by this bacteria, probably with associated meningitis.