Balloon Atrial Septostomy in a Premature Infant.

Balloon atrial septostomy (BAS) in premature and very low weight infants has not been described. We present a successful BAS in a 1.4-kg, 13-day-old ex-31 6/7-week infant with dextro-transposition of the great arteries and a restrictive atrial septum. (Level of Difficulty: Advanced.).

Stenting of critical aortic coarctation in neonates between 600 and 1,350 g. Using a transfemoral artery approach. A single center experience.

Background: Stenting of aortic coarctation (CoA) in newborns with a very low bodyweight remains rare and challenging. In this study we aim to highlight on two points: first the feasibility of CoA stenting in such babies and second the importance of using echocardiogram for guiding the intervention without the need for contrast agent. Methods: Between 2020 and 2022 three preterm babies with very low (VLWB) and extremely low weight (ELWB) underwent CoA-stenting in our center. The weight of the patients at time of intervention was 1,350, 1,200, and 600 g, respectively. The femoral artery was chosen in all patients as vascular access. Transthoracic echocardiography, sonography of the femoral arteries and head ultrasound were applied for follow up. Results: All three interventions were successfully done, with no complications. Coronary stents were implanted. In one Patient (1,350 g) the stent was inserted without sheath. In two patients with renal failure, the stenting was performed under echocardiography-guidance without contrast agent. The follow up showed a preserved function of the left ventricle in all patients. No relevant gradient was reported and no stent re-intervention was required. Sonographic follow up showed a patent femoral artery in all patients. Two patients were operated 73 and 110 days after stenting, and the stents were successfully removed. In the third patient the intervention was performed 130 days ago and he is waiting for the operation. Conclusion: CoA-stenting in VLWB and ELWB is feasible and can bridge them to the next surgery without complications. Echocardiography-guided CoA-stenting in VLWB is a considerate option especially in patients with renal failure. Accessing the femoral artery by experienced doctors, using local anesthesia before the puncture and before removing the sheath might help to protect the vessel from stenosis or occlusion.

Adenosine Blood Level: A Biomarker of White Matter Damage in Very Low Birth Weight Infants.

BACKGROUND: Very low birth weight infants are at risk of developing periventricular white matter lesions. We previously reported high blood adenosine levels in premature infants and infants with low birth weight. We asked whether blood adenosine levels could be related to the vulnerability of the maturing white matter to develop lesions. The present study aims at finding a biomarker for the early detection of brain white matter lesions that can profoundly influence the neurodevelopmental outcome, whose pathophysiology is still unclear. METHODS: Dried blood spots were prospectively collected for the newborn screening program and adenosine concentration measurements. Fifty-six newborns who tested four times for blood adenosine concentration (at days 3, 15, 30, and 40 post-birth) were included in the program. All infants underwent brain MRI at term equivalent age. Neurodevelopmental outcomes were studied with Griffiths Mental Development Scales (GMDS) at 12 ± 2 months corrected age. RESULTS: Blood adenosine concentration increased over time from a median of 0.75 µM at Day 3 to 1.46 µM at Day 40. Adenosine blood concentration >1.58 µM at Day 15 was significantly associated with brain white matter lesions at MRI (OR (95 % CI) of 50.0 (3.6-688.3), p-value < 0.001). A moderate negative correlation between adenosine at 15 days of life and GMDS at 12 ± 2 months corrected age was found. CONCLUSION: These findings suggest a potential role for blood adenosine concentration as a biomarker of creberal white matter lesions in very low birth weight infants.

Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus.

BACKGROUND: Patent ductus arteriosus (PDA) is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights. When PDA persists, interstitial lung water content increases, which could lead to abnormal circulation hemodynamics and pulmonary edema. It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA. AIM: To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA. METHODS: From January 2018 to March 2020, 69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group. At the same time, 89 very low-weight preterm neonates without PDA were randomly selected as the control group. All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth. The clinical characteristics and main ultrasonography results were compared between the two groups. Pearson's analysis was used to analyze the correlation between lung ultrasonography score (LUS) and other related clinical and ultrasonography results in all neonates. In the PDA group, PDA diameters were recorded, and the correlation with LUS and left atrium to aortic (LA/AO) dimension ratio were also analyzed. LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA. When the ratio is ≥ 1.5, it suggests the possibility of hemodynamic changes in persistent PDA. A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa. RESULTS: A total of 158 neonates were enrolled in this study, including 69 in the PDA group and 89 in the control group. There were no statistical differences in sex, gestational age, birth weight, ventilator dependence, hospitalization length and left ventricular ejection fraction between the two groups (P > 0.05). The LUS and LA/AO ratio in the PDA group were higher than those in the control group (P < 0.05), but there was no difference of LUS in neonates with or without use of the ventilator (t = 0.58, P = 0.16). In all cases, LUS was negatively correlated with gestational age (r = -0.28, P < 0.01) and birth weight (r = -0.36, P < 0.01), while positively correlated with the LA/AO ratio (r = 0.27, P < 0.01). In the PDA group, PDA diameter was positively correlated with the LA/AO ratio (r = 0.39, P < 0.01) and LUS (r = 0.31, P < 0.01). Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA (area under the curve = 0.741; sensitivity = 93.75%; specificity = 50.94%). CONCLUSION: Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.

Efectividad de un protocolo para la atención del dolor en neonatos menores de 1 500 gramos / Effectiveness of a protocol for pain management in newborns with less than 1 500 grams

Introducción: La atención al dolor resulta prioritaria en las unidades de cuidados intensivos neonatales. No se recogen antecedentes en Cuba de implementación de algún protocolo para el abordaje del dolor en neonatos, que no se limite solamente al tratamiento farmacológico durante la asistencia respiratoria o cirugía neonatal. Objetivo: Determinar la efectividad de un protocolo para la prevención y alivio del dolor en recién nacidos menor de 500 gramos, basado principalmente en las recomendaciones de la Sociedad Iberoamericana de Neonatología. Métodos: Estudio basado en las recomendaciones de la Sociedad Iberoamericana de Neonatología, de tipo analítico prospectivo de ANTES y DESPUÉS en 55 neonatos menor de 1500 gramos, nacidos en el Hospital Ginecoobstétrico Docente Provincial de Matanzas en el período marzo/2016 a marzo/2018, en el cual se comparó la intensidad del dolor según la escala COMFORTneo aplicada durante la realización de tres procederes: inserción del catéter venoso umbilical, inserción de catéter percutáneo y punción del talón, en dos grupos de pacientes: un grupo antes (n=29) y un grupo después de aplicar el protocolo de dolor (n=26). Para el análisis de variables se empleó el coeficiente de Spearman. Se consideró significativo todo valor p menor de 0,05. Resultados: El peso promedio de los neonatos estudiados fue 1 180 gramos. Luego de la implementación del protocolo se observó una disminución significativa en la intensidad del dolor durante la realización de los procederes seleccionados. Las medidas no farmacológicas fueron las más empleadas. Conclusiones: El protocolo implementado es efectivo para lograr disminuir la intensidad del dolor en neonatos menor de 1 500 gramos(AU)

Introduction: Pain management is a priority in Neonatal Intensive Care Units. There are not antecedents in Cuba of any protocol carried out for management of neonatal pain, apart from the pharmacological treatment during neonatal respiratory assistance or surgery. Objective: To determine effectiveness of a protocol for prevention and pain relief in infants with less than 1500 grams, mainly based on recommendations of the Ibero-American Society of Neonatology. Methods: A prospective analytical study of before and after was made in 55 infants with less than 1500 grams, who were born in the Teaching Gynecological and Obstetric Provincial Hospital of Matanzas, Cuba, in the period from March,2016 to March, 2018. For the study, the intensity of pain was compared by means of the COMFORTneo scale, which was carried out during the performance of three procedures: umbilical vein catheterization, percutaneous venous catheterization and heel lance; in two patients groups: one before (n=29) and the other after the implementation of the pain protocol (n=26). Spearman coefficient was used for statistical analysis of ordinal qualitative variables. All less than; 0.05 values were considered significant. Results: The average weight of the studied newborns was 1 180 grams. After implementing the protocol, a significant decrease in pain intensity was observed during the performance of the selected procedures. Non-pharmacological measures were the most used. Conclusion: The implemented protocol is effective for decrease pain intensity in newborns with less than 1 500 grams(AU)

Morbilidad y mortalidad del recién nacido pretérmino menor de 1 500 gramos / Morbility and mortality of the preterm newborn weighing under 1 500 g

Introducción: uno de los desafíos más importantes en el campo de la neonatología ha sido el tratamiento integral al recién nacido muy pequeño, así como el lograr disminuir las elevadas tasas de morbilidad y mortalidad en estos con edad gestacional extremadamente baja. Métodos: se realizó un estudio descriptivo observacional de corte transversal, en el que se incluyeron 139 neonatos con peso al nacer menor de 1 500 g y menos de 37 semanas de edad gestacional, en el período de 2003-2007, en el Hospital Ginecoobstétrico Dr. Eusebio Hernández. Las variables de estudio fueron: edad gestacional, peso al nacer, sexo, modo de nacimiento, puntaje de Apgar, evaluación nutricional, morbilidad y causa de muerte. Se presentaron los resultados mediante tasas y porcentajes principalmente. Resultados: la incidencia hallada fue del 0,66 por ciento en el período de estudio. Más de la mitad de los pacientes nacieron mediante cesárea (57,6 por ciento) y el 73,3 por ciento obtuvo una puntuación de Apgar normal. La incidencia de recién nacidos con peso inferior a los 1 000 g fue de 11,5 por ciento. Más de ¾ del universo se clasificó con crecimiento intrauterino restringido. La primera causa de morbilidad fue la sepsis de comienzo tardío, seguido por la enfermedad de la membrana hialina. El 100 por ciento de los pacientes inmaduros no sobrevivió (menos de 28 semanas), mientras que el 37,5 por ciento de los extremadamente pequeños al nacer (menos de 1 000 g) fueron egresados vivos. La entidad que más muertes causó fue la sepsis (34,2 por ciento), principalmente, la sepsis de comienzo tardío, con un índice de letalidad 1,5 mayor que la sepsis congénita. Conclusiones: la incidencia de los neonatos de muy bajo peso fue inferior a lo referido en reportes internacionales. La sepsis y la enfermedad de la membrana hialina constituyeron las principales causas de morbilidad y mortalidad. Los neonatos minúsculos y los inmaduros conformaron el grupo de mayor aporte a la mortalidad(AU)

Introduction: one of the more significant challenges in the field of the neonatology has been the integral treatment to a very small newborn as well as to achieve decrease the high rates of morbility and mortality in newborns with a very low gestational age. Methods: an observational and descriptive and cross-sectional study was conducted in 139 neonates weighing under 1 500 g and with less than 37 weeks of gestational age, over 2003-2007 in the "Dr. Eusebio Hernandez" Gynecology and Obstetric Hospital. The study variables were: gestational age, birth weight, sex, birth route, Apgar score, nutritional assessment, morbility and cause of death. Authors showed the results mainly by means of rates and percentages. Results: the incidence found was of the 0, 66 percent during study period. More than a half of patients born by cesarean section (57.6 percent) and the 73.3 percent had a normal Apgar score. The newborn incidence weighing under 1 000 g was of 11.5 percent. More than the three quarter of universe was diagnosed with a restricted intrauterine growth. The first cause of morbility was the late onset sepsis, followed by the hyaline membrane disease. The 100 percent of immature patients dyed (less than 28 weeks), whereas the 37.5 percent of the very small at birth (less than 1 000 g) were alive at discharge. The entity that more deaths provoked was the sepsis (34.2 percent), mainly, the late onset sepsis, with a lethality rate 1,5 higher than the congenital sepsis. Conclusions: the incidence of neonates with very low weight was lower than mentioned in the international reports. Sepsis and hyaline membrane disease were the major causes of morbility and mortality. The very little neonates and those immature were included the group with more cases of mortality(AU)

Morbilidad y mortalidad del recién nacido pretérmino menor de 1 500 gramos / Morbility and mortality of the preterm newborn weighing under 1 500 g

Introducción: uno de los desafíos más importantes en el campo de la neonatología ha sido el tratamiento integral al recién nacido muy pequeño, así como el lograr disminuir las elevadas tasas de morbilidad y mortalidad en estos con edad gestacional extremadamente baja. Métodos: se realizó un estudio descriptivo observacional de corte transversal, en el que se incluyeron 139 neonatos con peso al nacer menor de 1 500 g y menos de 37 semanas de edad gestacional, en el período de 2003-2007, en el Hospital Ginecoobstétrico "Dr. Eusebio Hernández". Las variables de estudio fueron: edad gestacional, peso al nacer, sexo, modo de nacimiento, puntaje de Apgar, evaluación nutricional, morbilidad y causa de muerte. Se presentaron los resultados mediante tasas y porcentajes principalmente. Resultados: la incidencia hallada fue del 0,66 % en el período de estudio. Más de la mitad de los pacientes nacieron mediante cesárea (57,6 %) y el 73,3 % obtuvo una puntuación de Apgar normal. La incidencia de recién nacidos con peso inferior a los 1 000 g fue de 11,5 %. Más de ¾ del universo se clasificó con crecimiento intrauterino restringido. La primera causa de morbilidad fue la sepsis de comienzo tardío, seguido por la enfermedad de la membrana hialina. El 100 % de los pacientes inmaduros no sobrevivió (menos de 28 semanas), mientras que el 37,5 % de los extremadamente pequeños al nacer (menos de 1 000 g) fueron egresados vivos. La entidad que más muertes causó fue la sepsis (34,2 %), principalmente, la sepsis de comienzo tardío, con un índice de letalidad 1,5 mayor que la sepsis congénita. Conclusiones: la incidencia de los neonatos de muy bajo peso fue inferior a lo referido en reportes internacionales. La sepsis y la enfermedad de la membrana hialina constituyeron las principales causas de morbilidad y mortalidad. Los neonatos minúsculos y los inmaduros conformaron el grupo de mayor aporte a la mortalidad.

Introduction: one of the more significant challenges in the field of the neonatology has been the integral treatment to a very small newborn as well as to achieve decrease the high rates of morbility and mortality in newborns with a very low gestational age. Methods: an observational and descriptive and cross-sectional study was conducted in 139 neonates weighing under 1 500 g and with less than 37 weeks of gestational age, over 2003-2007 in the "Dr. Eusebio Hernandez" Gynecology and Obstetric Hospital. The study variables were: gestational age, birth weight, sex, birth route, Apgar score, nutritional assessment, morbility and cause of death. Authors showed the results mainly by means of rates and percentages. Results: the incidence found was of the 0, 66 % during study period. More than a half of patients born by cesarean section (57.6 %) and the 73.3 % had a normal Apgar score. The newborn incidence weighing under 1 000 g was of 11.5 %. More than the three quarter of universe was diagnosed with a restricted intrauterine growth. The first cause of morbility was the late onset sepsis, followed by the hyaline membrane disease. The 100% of immature patients dyed (less than 28 weeks), whereas the 37.5 % of the very small at birth (less than 1 000 g) were alive at discharge. The entity that more deaths provoked was the sepsis (34.2 %), mainly, the late onset sepsis, with a lethality rate 1,5 higher than the congenital sepsis. Conclusions: the incidence of neonates with very low weight was lower than mentioned in the international reports. Sepsis and hyaline membrane disease were the major causes of morbility and mortality. The very little neonates and those immature were included the group with more cases of mortality.

Seguimiento de recién nacidos de muy bajo peso al nacer: disponibilidad, características estructurales y de funcionamiento en maternidades públicas / Follow up of very low birth weight newborns: availability, structure and funcioning in public maternity hospitals

INTRODUCCION: Los recién nacidos de muy bajo peso al nacer presentan necesidades especiales de vigilancia y tratamiento después del alta de la unidad de cuidados intensivos neonatales. El ingreso de estos niños a Programas de Seguimiento Ambulatorio de Recién Nacidos de Alto Riesgo (PSAR) constituye una necesidad imperativa, ya que en Argentina estos casos representan un tercio de la mortalidad infantil. Estos programas integran la asistencia de alta complejidad a la atención ambulatoria primaria, estableciendo estrategias de prevención activas.OBJETIVO: Establecer un diagnóstico situacional respecto a la disponibilidad, características estructurales y de funcionamiento de los PSAR en maternidades públicas de la provincia de Buenos Aires con más de 3.000 partos anuales.METODOS: Se realizó un estudio transversal prospectivo de diagnóstico en terreno para evaluar los servicios de salud. La población accesible fueron 21 maternidades; en las que se efectuaron dos encuestas personalizadas en los lugares de trabajo a los jefes de servicio y a los responsables del PSAR, que incluyeron preguntas sobre estructura física, recursos humanos, organización, funcionamiento y registros.RESULTADOS: Cuatro centros no poseen PSAR por carencias de recursos humanos, edilicias y de interconsultores pediátricos. Los restantes 17 centros cuentan con PSAR, aunque con dificultades en recursos humanos (enfermería y equipos interdisciplinarios pediátricos), un escaso registro de datos y deserción, y métodos de diagnóstico y tratamiento no sostenidos en el tiempo.CONCLUSIONES: Son pocos los centros que cumplen con el mínimo estándar de los PSAR, es decir, que proporcionan funciones de asistencia, auditoría, docencia e investigación. Es necesario implementar políticas sanitarias de prevención, detección precoz y tratamiento de trastornos asociados con prematurez, además de optimizar recursos zonales mediante la creación de redes de atención.

INTRODUCTION: Infants with very low weight birth have special needs for monitoring and treatment after discharge from the neonatal intensive care unit. These children must be included in newborn high risk follow-up programs (NHRFPs) in Argentina, because they represent one third of infant mortality. The programs integrate highlt ocmplex assistance to primary patient care, establishing active prevention strategies.OBJECTIVE: To establish a situational analysis regarding availability, structural and operational characteristics of NHRFPs belonging to public maternity hospitals in the province of Buenos Aires with over 3.000 deliveries per year.METHODS: A cross-sectional, prospective, diagnostic study was conducted to evaluate health services. The accessible population consisted of 21 maternity units; two surveys for department and program heads were performed, including questions about physical infrastructure, human resources, organization, operation and records.RESULTS: Four centers do not have NHRFPs due to lack of human resources, facilities or pediatric consultants. The remaining 17 centers have NHRFPs, but also difficulties in human resources (pediatric nursing and interdisciplinary teams), poor record of data and dropout, and the methods of diagnosis and treatment are not sustained over times.CONCLUSIONS: There are few centers that meet the minumum standard of a NHRFP, that is, that provide support, auditing, teaching and research. It is necessary to implement health policies for prevention, early detection and treatment of disorders associated with prematurity, as well as local resource optimization by creating networks of care.

Seguimiento de recién nacidos de muy bajo peso al nacer: disponibilidad, características estructurales y de funcionamiento en maternidades públicas / Follow up of very low birth weight newborns: availability, structure and funcioning in public maternity hospitals

INTRODUCCION: Los recién nacidos de muy bajo peso al nacer presentan necesidades especiales de vigilancia y tratamiento después del alta de la unidad de cuidados intensivos neonatales. El ingreso de estos niños a Programas de Seguimiento Ambulatorio de Recién Nacidos de Alto Riesgo (PSAR) constituye una necesidad imperativa, ya que en Argentina estos casos representan un tercio de la mortalidad infantil. Estos programas integran la asistencia de alta complejidad a la atención ambulatoria primaria, estableciendo estrategias de prevención activas.OBJETIVO: Establecer un diagnóstico situacional respecto a la disponibilidad, características estructurales y de funcionamiento de los PSAR en maternidades públicas de la provincia de Buenos Aires con más de 3.000 partos anuales.METODOS: Se realizó un estudio transversal prospectivo de diagnóstico en terreno para evaluar los servicios de salud. La población accesible fueron 21 maternidades; en las que se efectuaron dos encuestas personalizadas en los lugares de trabajo a los jefes de servicio y a los responsables del PSAR, que incluyeron preguntas sobre estructura física, recursos humanos, organización, funcionamiento y registros.RESULTADOS: Cuatro centros no poseen PSAR por carencias de recursos humanos, edilicias y de interconsultores pediátricos. Los restantes 17 centros cuentan con PSAR, aunque con dificultades en recursos humanos (enfermería y equipos interdisciplinarios pediátricos), un escaso registro de datos y deserción, y métodos de diagnóstico y tratamiento no sostenidos en el tiempo.CONCLUSIONES: Son pocos los centros que cumplen con el mínimo estándar de los PSAR, es decir, que proporcionan funciones de asistencia, auditoría, docencia e investigación. Es necesario implementar políticas sanitarias de prevención, detección precoz y tratamiento de trastornos asociados con prematurez, además de optimizar recursos zonales mediante la creación de redes de atención.

INTRODUCTION: Infants with very low weight birth have special needs for monitoring and treatment after discharge from the neonatal intensive care unit. These children must be included in newborn high risk follow-up programs (NHRFPs) in Argentina, because they represent one third of infant mortality. The programs integrate highlt ocmplex assistance to primary patient care, establishing active prevention strategies.OBJECTIVE: To establish a situational analysis regarding availability, structural and operational characteristics of NHRFPs belonging to public maternity hospitals in the province of Buenos Aires with over 3.000 deliveries per year.METHODS: A cross-sectional, prospective, diagnostic study was conducted to evaluate health services. The accessible population consisted of 21 maternity units; two surveys for department and program heads were performed, including questions about physical infrastructure, human resources, organization, operation and records.RESULTS: Four centers do not have NHRFPs due to lack of human resources, facilities or pediatric consultants. The remaining 17 centers have NHRFPs, but also difficulties in human resources (pediatric nursing and interdisciplinary teams), poor record of data and dropout, and the methods of diagnosis and treatment are not sustained over times.CONCLUSIONS: There are few centers that meet the minumum standard of a NHRFP, that is, that provide support, auditing, teaching and research. It is necessary to implement health policies for prevention, early detection and treatment of disorders associated with prematurity, as well as local resource optimization by creating networks of care.

Recién nacido de peso extremo / The extreme weight newborn

El nacimiento y atención de los recién nacidos de extremo bajo peso constituyen hoy día un reto para los perinatólogos. Se realizó un estudio descriptivo retrospectivo de todos los neonatos con peso inferior a 1 000 g al nacer y que fueron atendidos en el Servicio de Cuidados Neonatales del Hospital Ginecoobstétrico Provincial Docente Mariana Grajales de Villa Clara durante los años 2000 a 2008, con el objetivo de describir su comportamiento desde el punto de vista perinatológico. Asimismo identificar y relacionar variables maternas y neonatales en este grupo de peso así como describir incidencia de la morbilidad y mortalidad en los neonatos con peso inferior a 1 000 g. Para ello se realizó observación documental y se confeccionó instrumento aplicado a los 24 neonatos de este grupo nacidos en dicho período. Se incluyeron variables relacionadas con antecedentes perinatales, morbilidad y mortalidad que dieron salida a los objetivos planteados, se confeccionaron tablas para expresar los resultados. La incidencia del recién nacido de extremo bajo peso fue baja (0,07 por ciento del total de nacidos vivos), la mayoría nacieron antes de las 30 semanas de edad gestacional (78 por ciento) y el peso frecuente entre 900 y 999 g (67 por ciento). Estos pacientes presentaron como morbilidad frecuente: la enfermedad de membrana hialina y apnea, infecciones generalizadas, íctero fisiológico agravado, trastornos metabólicos (hipoglicemia, acidosis metabólica), apgar bajo al nacer y anemia. Necesitaron ventiloterapia el 50 por ciento de los niños, motivada por la enfermedad de membrana hialina y las infecciones, entre otras; la supervivencia fue del 70,8 por ciento (17 pacientes) y las causas de mortalidad fueron diversas

Birth and very low-weight newborn care are nowadays a challenge for perinatology specialists. A retrospective and descriptive study was conducted in all neonates weighing less than 1 000 g at birth seen in Neonatal Care Service of Mariana Grajales Teaching Provincial Gynecology and Obstetrics Hospital of Villa aClara province from 2000 to 2008 to describe its behavior from the perinatology point of view, as well as to identify and to relate the maternal and neonatal variables in this weight group and to describe the morbidity and mortality incidence in neonates weighing less than 1 000 g. Thus, we made a documentary observation designing an instrument applied to 24 neonates born during such period. Included are the variable related to perinatal backgrounds, morbidity and mortality yielded the proposed objectives; results are expressed in tables. The very low weight newborn incidence was low (0.,07 percent of all the live birth) most of them born before 30 weeks of gestational age (78 percent) and a frequent weight between 900 and 999 g (67 percent). These patients had a frequent morbidity: hyaline membrane disease and apnea, systemic infections, severe physiologic icterus, metabolic disorders (hypoglycemia, metabolic acidosis) a low Apgar score at birth and anemia. The 50 percent of children needed ventilation therapy due to hyaline membrane disease and infections among others; survival was of 70,8 percent (17 patients) and mortality causes were diverse

Perfil nosológico de recém-nascidos de muito baixo peso: revisão em Maternidade Universitária / Nosologic profile in very low weight neonates: a University Maternity review

Objetivo: A Organização Mundial da Saúde (OMS) define como recém-nascido de muito baixo peso (RNMBP) os recém-nascidos (RN) < 1.500 g. Com o avanço da tecnologia médica, interrupções prematuras da gestação objetivando melhor sobrevida dos conceptos e/ou das mães ocorrem com maior frequência. O objetivo desta pesquisa é descrever os fatores maternos, pré-natais, do parto e neonatais definidores do prognóstico para os RNMBP durante sua permanência na UTI neonatal do HUAP. Método: Estudo descritivo transversal retrospectivo. Prontuários de RNMBP no período de nov 2002-dez 2003 foram estudados. Dados da gestação, parto e período neonatal foram registrados em protocolo e avaliados através de frequência simples e percentual. Resultados: No período observado houve o nascimento de 301 RN, sendo que 44 eram RNMBP (14,6%). Os principais fatores maternos foram hipertensão arterial, multiparidade, ausência de união conjugal estável e pré-natal inadequado. Fatores perinatais incluíram prematuridade (idade gestacional < 33 semanas, < 1.100 g), parto cesáreo, asfixia periparto, necessitando suporte avançado de vida. A doença da membrana hialina, sepse e icterícia se associaram. As terapêuticas mais utilizadas foram surfactante, oxigenioterapia (16 dias em média), antibioticoterapia e fototerapia, com tempo médio de internação de 48 dias. Os óbitos, em seis casos (13,6%), ocorreram por sepse, prematuridade extrema e asfixia. Conclusão: A hipertensão arterial materna guarda relação com a prematuridade. O peso ao nascimento <1000 g, infecção e asfixia perinatal constituíram critérios de maior gravidade na amostra. A partir de intervenções perinatais oportunas e cuidados neonatais invasivos os bebês asfíxicos puderam ter um melhor prognóstico.

Retinopatía de la prematuridad en el neonato con peso menor de 1 500 g / Retinopathy of prematurity in neonate weighing less than 1 500 g

INTRODUCCIÓN. La retinopatía del prematuro (ROP) es una retinopatía neovascular que se desarrolla hasta en el 84 por ciento de los niños prematuros. Es inversamente proporcional al peso y a la edad gestacional y muy frecuente en el menor de 1500 g. El objetivo de esta investigación fue conocer la incidencia de retinopatía de la prematuridad en los neonatos de menos de 1500 g de peso, así como algunos factores asociados. MÉTODOS. Se realizó un estudio prospectivo longitudinal en el cual se incluyeron 31 neonatos con peso menor de 1500 g, ingresados en la unidad de cuidados intensivos neonatales del Hospital Iván Portuondo entre enero del 2004 y diciembre del 2008. No se incluyeron los fallecidos en ese período. En todos los casos se realizaron pesquisas de ROP. Se tomó en cuenta el sexo y la edad gestacional menor de 36 semanas. Se valoraron algunos factores de riesgo para ROP. RESULTADOS. Se encontró ROP en el 25,8 por ciento de los 31 neonatos: el 6,5 por ciento con ROP I Y ROP II, el 9,7 por ciento con ROP III y el 3,2 por ciento con ROP IV. Se encontró retina inmadura en el 74,2 por ciento de los pacientes. El 9,7 por ciento de los casos y el paciente con grado IV recibieron tratamiento quirúrgico con rayos láser. Se encontró mayor incidencia en el sexo masculino y factores asociados como la dificultad respiratoria y la ventilación, en el 75 por ciento de los casos. CONCLUSIÓN. La incidencia de ROP fue baja en comparación con los resultados de otros estudios

INTRODUCTION: Retinopathy of prematurity (RP) is a neovascular retinopathy developing in the 84 percent of premature infants. It is proportional in inverse order to weight and to gestational age and its frequent in an infant weighing less than 1500 g. The aim of present research was to know the prematurity retinopathy incidence in neonates weighing less than 1500 g, s well as some related factors. METHODS: A longitudinal and prospective study was conducted including 31 neonates weighing less than 1500 g, admitted in neonatal intensive care unit of the Ivan Portuondo Hospital from January, 2004 to December, 2008. Those deceased weren't included. In all the cases authors carried out screening of RP, taking into account the sex and a gestational age lower than 36 weeks. Some risk factors for RP were assessed. RESULTS: RP was present in the 25,8 percent of the 31 neonates: the 6,5 percent with RP I and RP II, the 9,7 percent with RP III and the 3,2 percent with RP IV. We found immature retina in the 74,2 percent of patients. The 9,7 of cases and the patients with IV degree underwent surgical treatment using Laser rays. There was a greater incidence in male sex and related factors (respiratory failure and ventilation in the 75 percent of cases. CONCLUSION: RP incidence was low compared with the results from other studies

Estudo longitudinal do desenvolvimento de crianças nascidas pré-termo no primeiro ano pós-natal / Longitudinal study of the development of children born preterm in the first year of post-natal age

O objetivo do estudo foi avaliar indicadores de desenvolvimento de crianças nascidas pré-termo e comparar o desempenho nas faixas de 5 a 7 e 10 a 14 meses de idade corrigida. Foram relacionados indicadores do desenvolvimento com variáveis neonatais e do ambiente familiar e sexo. Trinta crianças foram avaliadas pelo Denver-II. As cuidadoras responderam à entrevista e o prontuário médico foi analisado. Na faixa de 5 a 7 meses, 20 por cento das crianças apresentaram risco para problemas de desenvolvimento e 27 por cento de 10 a 14 meses. Houve diferença significativa entre as fases com mais risco na linguagem na faixa de 10 a 14 meses. As crianças nascidas com menor peso e idade gestacional, que permaneceram mais tempo hospitalizadas e com situações familiares adversas apresentaram mais problemas de desenvolvimento.

The aim of the study was to assess the development of children born preterm and to compare the performance in the ranges of 5-7 and 10-14 months of corrected age. The children's development indicators and the variables of neonatal period and familial environment were correlated. Thirty children were assessed by Denver-II. The caregivers were interviewed and the medical chart was examined. Twenty per cent of children presented risk for developmental problems at 5-7 months, and 27 percent at 10-14 months. There was statistical significant difference between ages in language, with high risk at 10-14. The children with lower birthweight, lower gestational age, longer time stay in the hospital, and with adverse family situations showed higher risk for developmental problems.

Sepse neonatal como fator de risco para leucomalácia periventricular em pré-termos de muito baixo peso / Periventricular leukomalacia in very low birth weight preterm neonates with high risk for neonatal sepsis

OBJETIVO: Verificar a associação de leucomalácia periventricular (LPV) e sepse neonatal em recém-nascidos de muito baixo peso (RNMBP). MÉTODOS: Foram incluídos RNMBP com suspeita clínica de infecção nascidos na instituição de 01/08/2005 a 31/07/2007. Foram excluídos óbitos antes dos 14 dias, malformações do sistema nervoso central e infecções congênitas. Foi realizado ultra-som cerebral no terceiro dia e semanalmente até a sexta semana de vida ou alta. LPV foi diagnosticada por hiperecogenicidade difusa periventricular persistente por mais de 7 dias, ou por cistos periventriculares. RNMBP foram divididos em grupos com e sem LPV. Sepse foi definida por manifestação clínica com cultura positiva. Os testes t, Mann-Whitney, qui-quadrado e regressão logística foram usados. RESULTADOS: Foram incluídos 88 RNMBP, sendo que 62 (70,5 por cento) sobreviveram e 51 (57,8 por cento) tiveram LPV. Os grupos foram semelhantes no peso de nascimento, idade gestacional, escore de Apgar, tipo de parto, SNAPPE-II, presenças de enterocolite necrosante, persistência de canal arterial e óbitos. Sepse e ventilação mecânica foram mais freqüentes no grupo com LPV (23,5 e 2,7 por cento, p = 0,005; 86 e 59 por cento, p = 0,004, respectivamente). Na regressão logística, ambos foram fatores de risco independentes para LPV (p = 0,027 e 0,015, respectivamente). CONCLUSÃO: Corioamnionite é fator de risco definido para LPV. Demonstramos que sepse neonatal também é fator de risco importante. Acreditamos que a resposta inflamatória sistêmica seja o principal fator envolvido na etiopatogenia da LPV em RNMBP.

OBJECTIVE: To investigate the association between periventricular leukomalacia (PVL) and neonatal sepsis in very low birth weight infants (VLBWI). METHODS: We studied VLBWI with a clinical suspicion of infection who had been born at our institution between the 1st of August, 2005 and the 31st of July, 2007. Children were excluded if they died before reaching 14 days, had malformations of the central nervous system or congenital infections. Ultrasound brain scans were carried out on the third day and weekly up until the sixth week of life or discharge. Periventricular leukomalacia was diagnosed by persistent diffuse periventricular hyperechogenecity for more than 7 days, or by periventricular cysts. The VLBWI were separated into two groups on the basis of the presence or absence of PVL. Sepsis was defined as clinical manifestation plus a positive culture. The Mann-Whitney, chi-square and t tests were applied followed by logistic regression. RESULTS: A total of 88 VLBWI were studied. Of these, 62 (70.5 percent) survived and 51 (57.8 percent) had PVL. Both groups were similar in terms of birth weight, gestational age, Apgar score, type of delivery, SNAPPE-II score, presence of necrotizing enterocolitis, persistent ductus arteriosus and deaths. Sepsis and mechanical ventilation were more common in the group with PVL (23.5 and 2.7 percent, p = 0.005; 86 and 59 percent, p = 0.004, respectively). Both of these were identified as, independent risk factors for PVL by logistic regression (p = 0.027 and 0.015, respectively). CONCLUSIONS: Chorioamnionitis has been defined as a risk factor for PVL. We have demonstrated that neonatal sepsis is also an important risk factor. We believe that the systemic inflammatory response is the principal factor involved in the etiopathogenesis of PVL among VLBWI.