Presencia de COVID-19 en mujeres gestantes y pacientes neonatos / Presence of COVID-19 in pregnant women and neonatal patients

Objetivo: Analizar la presencia de covid-19 en mujeres gestantes y pacientes neonatos. Método: Se basó en una revisión sistemática. Resultados: Se seleccionaron 15 articulos que evidenciaban información directa con el objetivo planteado. Conclusión: Se determinó que el contagio desde una madre positiva COVID-19, es poco probable que se transmita desde la fecundación hasta los 3 meses de gestación, y en el caso de que posteriormente a este lapso llegase a contagiarse la madre no provocará amenazas de perdida gestacional, sin embargo, se han presentado una minoría de casos en los cuales aumenta el riego de una labor de parto prematura. Las pacientes gestantes y sus hijos que sean diagnosticados con coronavirus serán atendidos de la misma manera que pacientes comunes ya que el virus no es más fuerte ni menos invasivo.

Objective: To analyze the presence of covid-19 in pregnant women and neonatal patients. Method: It was based on a systematic review. Results: 15 articles were selected which showed direct information with the proposed objective. Conclusion: It was determined that infection from a COVID-19 positive mother is unlikely to be transmitted from fertilization to 3 months of gestation, and in the event that the mother becomes infected after this period it will not cause threats of gestational loss, however, there have been a minority of cases in which the risk of premature labor increases. Pregnant patients and their children who are diagnosed with coronavirus will be cared for in the same way as ordinary patients since the virus is not stronger or less invasive.

Characterization of oxidative stress in animal model of neonatal hypoxia.

PURPOSE: To evaluate the oxidative stress in swine neonates submitted to hypoxia. METHODS: Ten large white piglets, healthy newborns, of both sexes, were divided into two groups and submitted to an experimental hypoxia protocol with reduced inspired oxygen fraction. The hypoxia group, composed of six animals, was submitted to oxygen reduction for 180 min. The animals in the control group, n = 4, were handled and evaluated simultaneously, but without oxygen reduction. RESULTS: 180 min after the start of the hypoxic insult, a significant difference was observed in the oximetry, and heart rate of the hypoxia group was compared to the control group (p<0.05). There was no significant difference in the oxidative stress analyses. Reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), lipid peroxidation (TBARS), protein carbonyl (PC), and myeloperoxidase (MPO) in the piglets' brain tissue were analyzed. CONCLUSIONS: Hypoxia causes adverse effects in swine neonates, although there is a natural physiological resistance of swine neonates to respond to this insult. Analyses of GSH, SOD, CAT, TBARS, MPO, and PC were tabulated and are presented as parameters for further studies to be carried out on an animal model of swine hypoxia.

Characterization of oxidative stress in animal model of neonatal hypoxia

Purpose To evaluate the oxidative stress in swine neonates submitted to hypoxia. Methods Ten large white piglets, healthy newborns, of both sexes, were divided into two groups and submitted to an experimental hypoxia protocol with reduced inspired oxygen fraction. The hypoxia group, composed of six animals, was submitted to oxygen reduction for 180 min. The animals in the control group, n = 4, were handled and evaluated simultaneously, but without oxygen reduction. Results 180 min after the start of the hypoxic insult, a significant difference was observed in the oximetry, and heart rate of the hypoxia group was compared to the control group (p<0.05). There was no significant difference in the oxidative stress analyses. Reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), lipid peroxidation (TBARS), protein carbonyl (PC), and myeloperoxidase (MPO) in the piglets’ brain tissue were analyzed. Conclusions Hypoxia causes adverse effects in swine neonates, although there is a natural physiological resistance of swine neonates to respond to this insult. Analyses of GSH, SOD, CAT, TBARS, MPO, and PC were tabulated and are presented as parameters for further studies to be carried out on an animal model of swine hypoxia.

Prevalence of urinary cotinine levels in children under 5 years of age during consultations for acute respiratory disease at the emergency department of the Universidad de La Sabana clinic.

BACKGROUND: Several environmental factors favour the occurrence of acute respiratory disease, which is the main reason for paediatric consultations in our country (Colombia). Tobacco smoke is considered a significant environmental pollutant with a great impact on health. The objective of this study is to estimate the prevalence of cotinine levels measured in urine, in children between 1 to 60 months of age who attended an emergency department with acute respiratory disease. METHODS: A cross-sectional study was conducted that included children between 1 and 60 months of age with acute respiratory disease who were admitted to the emergency department of the Universidad de La Sabana Clinic between April and July 2016. RESULTS: We included 268 patients and 36% were female. Of the total population examined, 33.96% showed positive results for urinary cotinine, of whom 97.8% had values between 10 and 100 ng/ml, which is considered positive for exposure to second-hand smoke. The principal pathology was recurrent wheezing in 43.96% of these cases. Regarding the presence of smokers at home, it is important to mention that in 54.95% of the children with positive urinary cotinine test was no related with smokers at home. And in 45.05% of positive urinary cotinine was evidence of smokers at home, being associated with the positive result P <  0.001 and smoking within the house P = 0.018; smoking when children were present did not have significant P = 0.105. The activities performed after smoking such as hand washing, change of clothes, eating, brushing teeth, did not influence the test result P = 0.627. CONCLUSIONS: A high prevalence of urinary cotinine was observed, which is associated with the presence of a smoker at home, and this relationship was independent of the activities performed by the smoker after smoking. In addition, a positive test for urinary cotinine was presented in some children without documented exposure to cigarette smoke inside the home, which may be explained by the presence of environmental cotinine. Therefore, it is necessary to perform educational interventions aimed at parents and caregivers who smoke.

Educational strategy for the development of skills in exchange transfusion: a randomized clinical trial protocol.

BACKGROUND: Exchange transfusion is a highly complex procedure that requires high levels of expertise. Trainee paediatricians do not have adequate training in exchange transfusion because opportunities to perform this procedure in practice are scarce. This protocol seeks to compare two educational interventions for exchange transfusion that allow students to develop competencies to perform the technique in an appropriate and safe way. METHODS/DESIGN: This is a randomized parallel single-blind clinical trial with allocation by simple randomization to the educational intervention (simulation or a digital didactic environment). Students from the paediatric specialization who volunteer to participate will be included. A practical evaluation of the procedure will be performed through a simulated scenario using a standardized clinical case. The main outcome is defined as the result of evaluation using the Objective Structured Clinical Examination; superior performance will be defined when the percentage is greater than or equal to 85%, and non-superior performance will be defined when the result is less than 84%. The chi-square independence test or the Fisher exact test will be used to evaluate the effect of the interventions. Multivariate analysis will be performed using a non-conditional logistic regression model. Stata 15® software will be used. DISCUSSION: Exchange transfusion is a procedure that requires expertise to achieve adequate outcomes. The inclusion of new educational strategies, such as simulation and digital didactic environments, is seen as a training option that can improve performance in clinical skills, reduce adverse events and increase the level of trust. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04070066. Registered on 28 August 2019. https://clinicaltrials.gov.

Effect of skin-to-skin contact at birth on early neonatal hospitalization.

BACKGROUND: Skin-to-skin contact (SCC) at birth has a positive impact on breastfeeding indicators and physiological stabilization at birth. On the other hand, globally and in Colombia, morbidity and mortality have increased in intermediate- and low-risk infants. The aim of the study was to assess the effect of immediate skin-to-skin contact, compared to separation at birth, on the risk of hospitalization of intermediate- and low-risk infants prior to discharge from the maternity ward. METHODOLOGY: A retrospective cohort study of newborn who underwent a SCC compared to habitual management was conducted. Intermediate- and low-risk neonates with spontaneous neonatal adaptation and cardiorespiratory stability at birth were included. Main outcome measure was hospital admission prior to the discharge from the maternity ward. RESULT: A total of 816 infants were included, 672 (82.3%) in the skin-to-skin contact group and 144 (17.6%) in the habitual management group. The main causes of hospital admission were jaundice and feeding/sucking related issues. Significantly lower admission to the neonatal unit was found for infants in the contact group compared to infants who did not receive skin-to-skin contact (13.8% vs. 26.4%; OR 0.46, 95% CI 0.29-0.71, p = 0.001). CONCLUSION: Skin-to-skin contact in newborns of intermediate and low risk has protective effects on the risk of hospital admission within the first few hours of life. SSC is proposed as a prevention strategy in second-level care scenarios.

Evaluation of two strategies for debriefing simulation in the development of skills for neonatal resuscitation: a randomized clinical trial.

OBJECTIVE: To evaluate two debriefing strategies for the development of neonatal resuscitation skills in health professionals responsible for the critical newborn care in a high-complexity university Hospital. RESULTS: A simple blind randomized clinical trial was conducted. Twenty-four professionals (pediatricians, nurses, and respiratory therapists) were randomly assigned for two interventions; one group received oral debriefing and the other oral debriefing assisted by video. Three standardized clinical scenarios that were recorded on video were executed. A checklist was applied for the evaluation, administered by a reviewer blinded to the assignment of the type of debriefing. The two debriefing strategies increased the technical and behavioral neonatal resuscitation skills of the participants, without one being superior to the other. The coefficient of the difference in the compliance percentage between the two types of debriefing was - 3.6% (95% CI - 13.77% to 6.47%). When comparing the development of technical and behavioral skills among the professionals evaluated, no significant differences were found between the types of debriefing. The two debriefing strategies increase compliance percentages, reaching or approaching 100%. Trial Registration ClinicalTrials.gov NCT03606278. July 30, 2018. Retrospectively registered.

APENDICITIS NEONATAL: REPORTE DE DOS CASOS / Neonatal appendicitis: Two case reports

La apendicitis neonatal es una patología infrecuente, de difícil diagnóstico y con una mortalidad elevada. Se han estudiado diversas teorías sobre su etiología que consideran que la apendicitis en el periodo neonatal podría corresponder a una manifestación de inmadurez inmunitaria. El cuadro clínico de apendicitis en este grupo etáreo no tiene las características clásicas, incluyendo signos y síntomas inespecíficos, que pueden corresponder a patologías más frecuentes como la enterocolitis necrotizante. La perforación intestinal constituye la complicación más frecuente y el diagnóstico se realiza usualmente de forma intraoperatoria. En el presente artículo, se describen dos neonatos con diagnóstico intraoperatorio de apendicitis, nacidos en la Clínica Universidad de La Sabana en el año 2016. En ellos, se destaca el cuadro clínico de presentación y manejo quirúrgico, los cuales permitieron identificar esta patología.

Neonatal appendicitis is a rare condition, difficult to diagnose, and with a high mortality. Several hypotheses on its etiology have been postulated, since appendicitis in the neonatal period may correspond to a manifestation of immune immaturity. The clinical condition of appendicitis in this age group does not have the classic features, which include signs and nonspecific symptoms that may correspond to most frequent pathologies, such as necrotizing enterocolitis. Intestinal perforation is the most frequent complication and the diagnosis is usually intraoperative. The cases described in here correspond to two newborns with intraoperative diagnosis of appendicitis, delivered in the Universidad de La Sabana Clinic in 2016. Highlights on the aforementioned clinical condition are included. Surgical management, which allowed us to identify this pathology, was described.

Efecto de un sistema de enseñanza personalizado en la evaluación de competencias en el manejo del neonato / Effects of the personalized teaching system in the evaluation of competencies in handling of neonate

Introducción: las intervenciones y procedimientos correctamente aplicados durante el periodo neonatal disminuyen el riesgo, las complicaciones y las secuelas en el recién nacido. Es importante la adquisición de competencias durante la formación en el pregrado, con un impacto favorable en la reducción de la morbimortalidad neonatal. Objetivo: en el presente estudio se evaluó un sistema de enseñanza personalizado en el desarrollo de competencias en el manejo inmediato del recién nacido en estudiantes de Medicina, a través de un Examen Clínico Objetivo Estandarizado (ECOE). Métodos: se realizó un estudio antes y después, aplicando un sistema de enseñanza personalizado con devolución constructiva inmediata y recapacitación a los 8 días, a una población de estudiantes de medicina de la Universidad de La Sabana. Para realizar el contraste de hipótesis a las variables con distribución normal se aplicó la prueba T pareada y para las variables con distribución no normal la prueba de Wilcoxon. La información se procesó en el programa Stata 11. Se consideró un p valor < ,0,05 como estadísticamente significativo. Resultados: se observó una mejoría en las competencias con la intervención. En el resultado global (teórico mas práctico) mejoró del 60,3 por ciento al 83,14 por ciento posterior a la intervención educativa, con una diferencia de 22,82 por ciento a favor de la intervención (p < 0,001). Conclusiones: se evidencia una mejoría en las habilidades prácticas y conocimientos teóricos en las competencias del manejo inmediato del recién nacido posterior a la intervención educativa personalizada(AU)

Introduction: interventions and procedures that have been properly executed during the neonatal stage decreases risk, damage, and sequela during neonatal stage. The acquisition of clinical skills during premedical training is of the upmost importance and has a favourable impact in the decrease of neonatal morbimortality. Objective: in this study, a personalized teaching system for the development of the skills in the immediate handling of newborns by medicine students was evaluated, using an Objective Standardized Clinical Exam (OSCE). Methods: a study was done using a before and after design, where a personalized teaching system with immediate constructive feedback and retraining with a Master class after 8 days was used with medicine students of the Universidad de La Sabana. For hypothesis testing of the variable with normal distribution a paired T test was used, and for variables with abnormal distribution the Wilcoxon signed-rank test was used. The information processed using the program Stata. A p value of less than 0.05 was considered as statistically significant. Results: improvement was observed in the acquisition of competence after intervention. The overall result (theoretical and practical) improved from 60.3 percent to 83.14 percent after the intervention education, with a difference of 22.82 percent in favor of the intervention (p <0.001). Conclusions: there is evidence of improvement in the practical skills and theoretical knowledge for the immediate handling of newborns during birth after the personalized educational intervention(AU)

1031-1034delTAAC (Leu125Stop): a novel familial UBE3A mutation causing Angelman syndrome in two siblings showing distinct phenotypes.

BACKGROUND: More than 50 mutations in the UBE3A gene (E6-AP ubiquitin protein ligase gene) have been found in Angelman syndrome patients with no deletion, no uniparental disomy, and no imprinting defect. CASE PRESENTATION: We here describe a novel UBE3A frameshift mutation in two siblings who have inherited it from their asymptomatic mother. Despite carrying the same UBE3A mutation, the proband shows a more severe phenotype whereas his sister shows a milder phenotype presenting the typical AS features. CONCLUSIONS: We hypothesized that the mutation Leu125Stop causes both severe and milder phenotypes. Potential mechanisms include: i) maybe the proband has an additional problem (genetic or environmental) besides the UBE3A mutation; ii) since the two siblings have different fathers, the UBE3A mutation is interacting with a different genetic variant in the proband that, by itself, does not cause problems but in combination with the UBE3A mutation causes the severe phenotype; iii) this UBE3A mutation alone can cause either typical AS or the severe clinical picture seen in the proband.