Recomendaciones para la asistencia respiratoria en el recién nacido (III). Surfactante y óxido nítrico / Recommendations for respiratory support in the newborn (III). Surfactant and nitric oxide

Las recomendaciones incluidas en este documento forman parte de una revisión actualizada de la asistencia respiratoria en el recién nacido. Están estructuradas en 12 módulos y en este trabajo se presenta el módulo 7. El contenido de cada módulo es el resultado del consenso de los miembros del Grupo Respiratorio y Surfactante de la Sociedad Española de Neonatología. Representan una síntesis de los trabajos publicados y de la experiencia clínica de cada uno de los miembros del grupo (AU)

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group (AU)

[Recommendations for respiratory support in the newborn (iii). Surfactant and nitric oxide]. / Recomendaciones para la asistencia respiratoria en el recién nacido (iii). Surfactante y óxido nítrico.

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group.

Recomendaciones sobre toma de decisiones y cuidados al final de la vida en neonatología / Recommendations on making decisions and end of life care in neonatology

Los profesionales sanitarios que trabajamos en las unidades de neonatología consideramos que una parte muy importante de nuestro trabajo es el cuidado del recién nacido enfermo y su familia, cuando el neonato presenta una enfermedad incurable o va a morir. El esfuerzo se centra en evitar tratamientos desproporcionados e inútiles, que producen dolor, disconfort y separan al niño de su familia. Estas situaciones suelen ocurrir cuando el neonato tiene una enfermedad incurable, inmadurez extrema con complicaciones o graves malformaciones congénitas. En este documento, el Grupo de Trabajo de Ética de la Sociedad Española de Neonatología realiza una reflexión sobre la toma de decisiones en esta edad de la vida. Se han revisado los aspectos éticos de la limitación de los tratamientos, las bases del proceso de toma de decisiones que deben incluir la información adecuada, la relación de confianza y la deliberación entre padres y profesionales para tomar una decisión correcta. Se destaca la importancia del cuidado de la familia con una situación compleja y de gran sufrimiento, cuando se enfrenta a la recomendación de los profesionales de limitar tratamientos al presentar su hijo una enfermedad de mal pronóstico. La atención al neonato enfermo al final de la vida, y a sus familiares, requiere un considerable esfuerzo, dedicación y formación de todo el personal sanitario. La experiencia cercana de forma reiterada al sufrimiento y a la muerte puede afectar negativamente a los profesionales implicados. Para finalizar, se realiza una reflexión de los aspectos jurídicos de la limitación del tratamiento, la retirada del soporte vital y cómo se deben de realizar y documentar el proceso de decisión, la retirada del soporte vital, la valoración de síntomas y el control del dolor y la sedación(AU)

Healthcare-professionals who work in neonatal units believe that a very important part of their work is the care of sick newborns, and their families if the neonate has an incurable disease or will die. The effort is focused on preventing disproportionate and unnecessary treatments that result in pain and discomfort, and also separate the child from his family. These situations usually occur when the infant has a terminal illness, extreme immaturity with complications, or severe birth defects. The care of the sick neonate care at the end of life, and their families requires a considerable effort, dedication and training of all health personnel. The repeated experience of being close to suffering and death can adversely affect the professionals involved. Finally, there is mention of the legal aspects of limiting treatment, how to perform and document decision process, the withdrawal of life support, assessment of symptoms and pain control and sedation. In this paper, the Ethics Working Group of the Spanish Society of Neonatology reflects on decision making at this time of life. The ethical aspects are reviewed, including, limiting treatment, the basis of decision-making process (that should include adequate information), the relationship of trust, and deliberation between parents and professionals to make the right decision. It highlights the importance of caring for the family in a complex situation and of great suffering, when faced with the recommendation of professionals to limit treatment because their child suffers from a disease with a poor prognosis(AU)

[Recommendations on making decisions and end of life care in neonatology]. / Recomendaciones sobre toma de decisiones y cuidados al final de la vida en neonatología.

Healthcare-professionals who work in neonatal units believe that a very important part of their work is the care of sick newborns, and their families if the neonate has an incurable disease or will die. The effort is focused on preventing disproportionate and unnecessary treatments that result in pain and discomfort, and also separate the child from his family. These situations usually occur when the infant has a terminal illness, extreme immaturity with complications, or severe birth defects. In this paper, the Ethics Working Group of the Spanish Society of Neonatology reflects on decision making at this time of life. The ethical aspects are reviewed, including, limiting treatment, the basis of decision-making process (that should include adequate information), the relationship of trust, and deliberation between parents and professionals to make the right decision. It highlights the importance of caring for the family in a complex situation and of great suffering, when faced with the recommendation of professionals to limit treatment because their child suffers from a disease with a poor prognosis. The care of the sick neonate care at the end of life, and their families requires a considerable effort, dedication and training of all health personnel. The repeated experience of being close to suffering and death can adversely affect the professionals involved. Finally, there is mention of the legal aspects of limiting treatment, how to perform and document decision process, the withdrawal of life support, assessment of symptoms and pain control and sedation.

Reflexiones éticas y recomendaciones para la toma de decisiones clínicas en la atención al recién nacido sano / Ethical reflections and recommendations for making clinical decisions in the care of the healthy newborn

La atención al recién nacido (RN) sano durante su estancia en los centros sanitarios no suele plantear problemas y la relación con la familia transcurre sin que se presenten situaciones de conflicto. Solamente en algunas ocasiones puede haber momentos conflictivos debido a que los padres no aceptan los cuidados o rutinas asistenciales que le proporcionan los profesionales sanitarios. Consideran que el RN no precisa la realización de pruebas o medidas profilácticas, como la administración de vitamina K o punción para la obtención de una muestra de sangre para el cribado neonatal. Esto se debe a que la información que poseen no es la adecuada o porque rechazan algunas medidas, ya que son invasivas y que, a su entender, no se corresponden con el cuidado de un RN sano. Este documento pretende conciliar los valores de la familia y su participación en el cuidado de su hijo, los derechos del RN y los valores de los profesionales sanitarios. Está basado en la información adecuada, la buena relación clínica y la deliberación en caso de discrepancia que puede conducir a modificar algunos procedimientos que no son esenciales en el cuidado del RN(AU)

The care of healthy newborn during their stay in health centres is not usually a problem and there are few conflicts in the relationship with the family. Conflicts may arise because the parents do not accept the care or care routines that health professionals provide. They believe that the newborn does not require testing or prophylactic measures, such as administration of vitamin K, or puncture to obtain a blood sample for newborn screening. This is because the information they have is not adequate, or because they reject some measures as they are invasive and that from their point of view, do not correspond to the care of a healthy newborn. This document seeks to reconcile the values of family and participation in the care of their child, the rights of the newborn, and the values of health professionals. It is based on adequate information, a good clinical relationship, and discussion in case of discrepancies that can lead to changes in some procedures that are not essential in the care of the newborn(AU)

[Ethical reflections and recommendations for making clinical decisions in the care of the healthy newborn]. / Reflexiones éticas y recomendaciones para la toma de decisiones clínicas en la atención al recién nacido sano.

The care of healthy newborn during their stay in health centres is not usually a problem and there are few conflicts in the relationship with the family. Conflicts may arise because the parents do not accept the care or care routines that health professionals provide. They believe that the newborn does not require testing or prophylactic measures, such as administration of vitamin K, or puncture to obtain a blood sample for newborn screening. This is because the information they have is not adequate, or because they reject some measures as they are invasive and that from their point of view, do not correspond to the care of a healthy newborn. This document seeks to reconcile the values of family and participation in the care of their child, the rights of the newborn, and the values of health professionals. It is based on adequate information, a good clinical relationship, and discussion in case of discrepancies that can lead to changes in some procedures that are not essential in the care of the newborn.

[Tetralogy of Fallot with absent pulmonary valve in a newborn and infant. Complete surgical correction]. / Tetralogía de Fallot con agenesia de válvula pulmonar en el recién nacido y lactante. Corrección completa.

We report two patients, a newborn and a 7-month old infant, with tetralogy of Fallot and absent pulmonary valve syndrome. Both had severe obstruction at the level of the ring with aneurysmal pulmonary artery branches, which compressed and displaced the trachea and main bronchial tubes. The neonate required mechanical ventilation from birth. Treatment was aggressive in both patients with interventricular septum defect closure, arterioplasty of the branches and homograft in the infant, and resection of the truncus and pulmonary branches with posterior face suture of both branches associated with a valved conduit in orthotopic position in the neonate. We believe that early treatment avoids airway degeneration and right ventricle volume overload.

Tetralogía de Fallot con agenesia de válvula pulmonar en el recién nacido y lactante. Corrección completa / Tetralogy of Fallot with absent pulmonary valve in a newborn and infant. Complete surgical correction

Se presentan 2 pacientes, un recién nacido y un lactante de 7 meses, con tetralogía de Fallot y agenesia de la válvula pulmonar. Ambos tenían obstrucción grave del anillo con ramas pulmonares aneurismáticas que comprimían y desplazaban la tráquea y los bronquios principales. El paciente recién nacido necesitó ventilación mecánica desde el nacimiento. El tratamiento fue agresivo en ambos, con cierre de la comunicación interventricular, arterioplastia de las ramas y homoinjerto en el lactante y resección del tronco y ramas pulmonares con sutura de la cara posterior de ambas ramas, asociado a un conducto valvulado en posición ortotópica en el neonato. Creemos que el tratamiento precoz evita la degeneración de la vía respiratoria y la sobrecarga de volumen del ventrículo derecho (AU)

[Pulmonary function in the full-term newborn infant without respiratory problems]. / Estudio de la mecánica pulmonar en recién nacidos a término sin problemas respiratorios.

Pulmonary function was measured by computerized pneumotacography in 13 term newborn infants without respiratory problems. Mean (+/- SD) for birth weight, gestation and postnatal age were 3149 +/- 366 g, 39.1 +/- 0.9 weeks, and 4.7 +/- 2.4 days. Esophageal balloon, differential transducer and nasal progs were used. The following parameters were measured in each respiration by the mean squears method: Dynamic compliance (Cdyn), total respiratory resistance (RRt) and work (WRt), respiratory time constant (KTt), rate (RR) and maximal inspiratory and respiratory flows (PIF, PEF). Reproductiveness was found to be good, as the differences between two determinations were not significant (p less than 0.05). The mean differences but for Cdyn (11.9%) were of less than 5%. The mean (+/- SD) and the 3 and 97 percentiles for each parameter studied were: RR 43.8 +/- 7.6 (32.6-61.2) rpm, Tv 6.6 +/- 0.7 (5.8-7.9) ml/kg, Vmin 285 +/- 55.6 (201-405) ml/min, Cdin/kg 1.64 +/- 0.31 (1.13-2.17) ml/cm/kg, RPt 65.2 +/- 21.6 (28.4 +/- 111.4) cm/L/seg, TRt 30.6 +/- 13.7 (15.3-58.8) g/cm/kg, PIF 2.9 +/- 0.6 (1.8 +/- 4.4) L/min y PEF 2.4 +/- 0.7 (1.2-4) L/min.