Impact on cerebral hemodynamics of the use of volume guarantee combined with high frequency oscillatory ventilation in a neonatal animal respiratory distress model.

High-frequency oscillatory ventilation (HFOV) is an alternative to conventional mechanical ventilation (CMV). Recently, the use of volume guarantee (VG) combined with HFOV has been suggested as a safe strategy capable of reducing the damage induced by ventilation in immature lungs. However, the possible impact of this new ventilation technique on cerebral hemodynamics is unknown. To evaluate the cerebral hemodynamics effect of HFOV combined with VG in an experimental animal model of neonatal respiratory distress syndrome (RDS) due to surfactant deficiency compared with HFOV and CMV+VG (control group). Eighteen newborn piglets were randomized, before and after the induction of RDS by bronchoalveolar lavage, into 3 mechanical ventilation groups: CMV, HFOV and HFOV with VG. Changes in cerebral oxygen transport and consumption and cerebral blood flow were analyzed by non-invasive regional cerebral oxygen saturation (CrSO2), jugular venous saturation (SjO2), the calculated cerebral oxygen extraction fraction (COEF), the calculated cerebral fractional tissue oxygen extraction (cFTOE) and direct measurement of carotid artery flow. To analyze the temporal evolution of these variables, a mixed-effects linear regression model was constructed. After randomization, the following statistically significant results were found in every group: a drop in carotid artery flow: at a rate of -1.7 mL/kg/min (95% CI: -2.5 to -0.81; p < 0.001), CrSO2: at a rate of -6.2% (95% CI: -7.9 to -4.4; p < 0.001) and SjO2: at a rate of -20% (95% CI: -26 to -15; p < 0.001), accompanied by an increase in COEF: at a rate of 20% (95% CI: 15 to 26; p < 0.001) and cFTOE: at a rate of 0.07 (95% CI: 0.05 to 0.08; p < 0.001) in all groups. No statistically significant differences were found between the HFOV groups. CONCLUSION: No differences were observed at cerebral hemodynamic between respiratory assistance in HFOV with and without VG, being the latter ventilatory strategy equally safe. WHAT IS KNOWN: • Preterm have a situation of fragility of cerebral perfusion wich means that any mechanical ventilation strategy can have a significant influence. High-frequency oscillatory ventilation (HFOV) is an alternative to conventional mechanical ventilation (CMV). Recently, the use of volume guarantee (VG) combined with HFOV has been suggested as a safe strategy capable of reducing the damage induced by ventilation in immature lungs. Several studies have compared CMV and HFOV and their effects at hemodynamic level. It is known that the use of high mean airway pressure in HFOV can cause an increase in pulmonary vascular resistance with a decrease in thoracic venous return. WHAT IS NEW: • The possible impact of VAFO + VG on cerebral hemodynamics is unknown. Due the lack of studies and the existing controversy, we have carried out this research project in an experimental animal model with the aim of evaluating the cerebral hemodynamic repercussion of the use of VG in HFOV compared to the classic strategy without VG.

Serologic evolution and follow-up to IgG antibodies of infants born to mothers with gestational COVID.

BACKGROUND: It is known that SARS-CoV-2 antibodies from pregnant women with SARS-CoV-2 infection during pregnancy cross the placenta but the duration and the protective effect of these antibodies in infants is scarce. METHODS: This prospective study included mothers with SARS-COV-2 infection during pregnancy and their infants from April 2020 to March 2021. IgG antibodies to SARS-CoV-2 spike protein were performed on women and infants at birth and at two and six months during follow-up. Anthropometrical measures and physical and neurological examinations and a clinical history of symptoms and COVID-19 diagnosis were collected. Simple linear regression was performed to compare categorical and continuous variables. To compare the mother's and infant's antibody titers evolution, a mixed linear regression model was used. A predictive model of newborn antibody titers at birth has been established by means of simple stepwise linear regression. RESULTS: 51 mother-infant couples were included. 45 (90%) of the mothers and 44 (86.3%) of the newborns had a positive serology al birth. These antibodies were progressively decreasing and were positive in 34 (66.7%) and 7 (13.7%) of infants at 2 and 6 months, respectively. IgG titers of newborns at birth were related to mothers' titers, with a positive moderate correlation (Pearson's correlation coefficient: 0.82, p < 0,001). Fetal/maternal antibodies placental transference rate was 1.3 (IQR: 0.7-2.2). The maternal IgG titers at delivery and the type of maternal infection (acute, recent, or past infection) was significantly related with infants' antibody titers at birth. No other epidemiological or clinical factors were related to antibodies titers. Neurodevelopment, psychomotor development, and growth were normal in 94.2% of infants in the third follow-up visit. No infants had a COVID-19 diagnosis during the follow-up period. CONCLUSIONS: Transplacental transfer of maternal antibodies is high in newborns from mothers with recent or past infection at delivery, but these antibodies decrease after the first months of life. Infant's IgG titers were related to maternal IgG titers at delivery. Further studies are needed to learn about the protective role of maternal antibodies in infants.

Microwave-assisted autohydrolysis of avocado seed for the recovery of antioxidant phenolics and glucose.

This study describes the valorization of avocado seed (AS) within a green biorefinery concept using microwave-assisted autohydrolysis. After the treatment at temperatures of 150-230 °C for 5 min, the resulting solid and liquor were characterized. The temperature of 220 °C led to the simultaneous optimal values of antioxidant phenolics/flavonoids (42.15 mg GAE/g AS, 31.89 RE/g AS, respectively) and glucose + glucooligosaccharides (38.82 g/L) in the liquor. Extraction with ethyl acetate allowed the recovery of the bioactive compounds while maintaining the polysaccharides in the liquor. The extract was rich in vanillin (99.02 mg/g AS) and contained several phenolic acids and flavonoids. The solid phase and the phenolic-free liquor were subjected to enzymatic hydrolysis to produce glucose, reaching values of 9.93 and 105 g glucose/L, respectively. This work demonstrates that microwave-assisted autohydrolysis is a promising technology to obtain fermentable sugars and antioxidant phenolic compounds from avocado seeds following a biorefinery scheme.

Chylothorax in newborns after cardiac surgery: a rare complication?

The aim of this study was to analyze patients diagnosed with chylothorax after congenital heart disease surgery among a cohort of neonatal patients, comparing the evolution, complications, and prognosis after surgery of patients who were and were not diagnosed with chylothorax, and to analyze possible risk factors that may predict the appearance of chylothorax in this population. Retrospective and observational study included all neonates (less than 30 days since birth) who underwent congenital heart disease surgery in a level III neonatal intensive care department. We included infants born between January 2014 and December 2019. We excluded those infants who were born before 34 weeks of gestational age or whose birth weight was less than 1800 g. We also excluded catheter lab procedures and patent ductus arteriosus closure surgeries. Included patients were divided into two groups depending on whether they were diagnosed with chylothorax or not after surgery, and both groups were compared in terms of perinatal-obstetrical information, surgical data, and NICU course after surgery. We included 149 neonates with congenital heart disease surgery. Thirty-one patients (20.8%) developed chylothorax, and in ten patients (32.3%), it was considered large volume chylothorax. Regarding the evolution of these patients, 22 infants responded to general dietetic measures, a catheter procedure was performed in 9, and 5 of them finally required pleurodesis. Cardiopulmonary bypass, median sternotomy, and delayed sternal closure were the surgical variables associated with higher risks of chylothorax. Patients with chylothorax had a longer duration of inotropic support and mechanical ventilation and took longer to reach full enteral feeds. As complications, they had higher rates of cholestasis, catheter-related sepsis, and venous thrombosis. Although there were no differences in neonatal mortality, patients with chylothorax had a higher rate of mortality after the neonatal period. In a multiple linear regression model, thrombosis and cardiopulmonary bypass multiplied by 10.0 and 5.1, respectively, the risk of chylothorax and have an umbilical vein catheter decreases risk. CONCLUSION: We have found a high incidence of chylothorax after neonatal cardiac surgery, which prolongs the average stay and causes significant morbidity and mortality. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during the neonatal period. WHAT IS KNOWN: • Acquired chylothorax in the neonatal period usually appears as a complication of congenital heart disease surgery, being the incidence quite variable among the different patient series (2.5-16.8%). The appearance of chylothorax as a complication of a cardiac surgery increases both mortality and morbidity in these patients, which makes it a quality improvement target in the postsurgical management of this population. WHAT IS NEW: •Most of the published studies include pediatric patients of all ages, from newborns to teenagers, and there is a lack of studies focusing on neonatal populations. The main strength of our study is that it reports, to the best of our knowledge, one of the largest series of neonatal patients receiving surgery for congenital heart disease in the first 30 days after birth. We have found a high incidence of chylothorax after cardiac surgery during the neonatal period compared to other studies. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during this period of life.

Microwave-assisted extraction of hemicellulosic oligosaccharides and phenolics from Robinia pseudoacacia wood.

Microwave-assisted autohydrolysis is an environmentally friendly intensification technology that permits the selective solubilization of hemicelluloses in form of oligosaccharides in a short time and with low energy consumption. The purpose of this work was to evaluate the suitability of microwave-assisted autohydrolysis to produce oligosaccharides and phenolics with potential prebiotic and antioxidant activities from Robinia pseudoacacia wood. The influence of treatment time (0-30 min) and temperature (200-230 °C) on oligosaccharide production was studied and conditions of 230 °C and 0.25 min resulted in maximum content of xylooligosaccharides (7.69 g XO/L) and more efficient energy consumption. Furthermore, under those conditions, liquors showed high contents of phenols (80.28 mg GAE/g of RW) and flavonoids (44.51 RE/g) with significant antioxidant activities (112.07 and 102.30 mg TE/g, measured by ABTS and FRAP tests, respectively). Additionally, the solubilized hemicelluloses were structurally characterized by HPAEC-PAD, MALDI-TOF-MS, FTIR and TGA/DSC, and HPLC-ESI-MS analysis allowed the tentative identification of 17 phytochemicals.

Lung Ultrasound Scores Progress Differently in Extreme and Very Preterm Infants after Birth: A Multicentre Prospective Study.

INTRODUCTION: The lung ultrasound score (LUS) has been suggested to predict moderate-severe bronchopulmonary dysplasia (msBPD) in preterm infants. We aimed to assess LUS evolution after birth in preterm infants and the effect of gestational age. METHODS: This multicentre prospective observational study was performed with newborns born before 33 weeks of gestation. We created two groups: group 1 (23-27 weeks) and group 2 (28-32 weeks). We compared LUSs between the groups from birth until 36 weeks of postmenstrual age, and we estimated the LUS evolution in each group with a linear multilevel mixed-effects regression model. The effects of the need for surfactant or an msBPD diagnosis were also studied. RESULTS: We included 339 patients: 122 (36%) in group 1 and 217 (64%) in group 2. The infants in group 1 showed a steady progression in the LUS from birth until 4 weeks of age and a subsequent decrease; the infants in group 2 showed a progressive decrease in the LUS throughout the study. This progression varied significantly in the first weeks of life in infants who required surfactant at birth and after the first week of life in the patients diagnosed with msBPD. DISCUSSION/CONCLUSIONS: Extremely preterm infants showed persistently high LUSs during the first weeks of life, regardless of the progression to msBPD. In this group, the infants who did not require surfactant at birth exhibited an increase in their LUSs after the first week until their values were equal to the remaining infants in their group.

Impact of Gestational COVID-19 on Neonatal Outcomes: Is Vertical Infection Possible?

BACKGROUND: The vertical transmission of severe acute respiratory coronavirus-2 (SARS-CoV-2) remains highly debated. Here, we evaluated SARS-CoV-2-transmission in newborns with intrauterine conditions. METHODS: This was a prospective, observational and multicentric study involving 13 Spanish hospitals included in the GEStational and NEOnatal-COVID cohort. Pregnant women with microbiologically confirmed SARS-CoV-2 infection during any trimester of pregnancy or delivery and their newborns were included from March to November 2020. Demographic, clinical and microbiological data were also obtained. Viral loads were analyzed in different maternal and newborn biological samples (placenta, breast milk and maternal blood; urine, meconium and newborn blood). RESULTS: A total of 177 newborns exposed to SARS-CoV-2 were included. Newborns were tested by reverse transcriptase-polymerase chain reaction using nasopharyngeal swabs within the first 24-48 hours of life and at 14 days of life. In total 5.1% were considered to have SARS-CoV-2 infection in the neonatal period, with 1.7% considered intrauterine and 3.4% intrapartum or early postnatal transmission cases. There were no differences in the demographic and clinical characteristics of the pregnant women and their newborns' susceptibility to infections in their perinatal history or background. CONCLUSIONS: Intrauterine transmission of SARS-CoV-2 is possible, although rare, with early postnatal transmission occurring more frequently. Most infected newborns remained asymptomatic or had mild symptoms that evolved well during follow-up. We did not find any maternal characteristics predisposing infants to neonatal infection. All infected newborn mothers had acute infection at delivery.Although there was no presence of SARS-CoV2 in cord blood or breast milk samples, SARS-CoV-2 viral load was detected in urine and meconium samples from infected newborns.

Diastematomielia: ¿disrafismo «oculto»? / Diastematomyelia: «Hidden» spinal dysraphism?

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Neonatal pneumothoraces with atypical location: the role of lung ultrasound.

Neonatal pneumothorax (NP) is a potentially life-threatening condition. Lung ultrasound (LUS) has shown higher sensitivity and specificity in diagnosis compared to x-rays, but evidence regarding its usefulness in complex NP is lacking. We report four neonates suffering from cardiac or esophageal malformations who developed lateral and/or posterior pneumothoraces, in which LUS helped, making NP diagnosis and management easier and faster. CONCLUSION: LUS is an easy-to-use, fast, simple, and accurate tool when evaluating newborns with NP, also in atypical positions such as in surgical patients. WHAT IS KNOWN: • Lung ultrasound (LUS) has higher sensitivity and specificity than x-rays in the diagnosis of pneumothorax in neonatal patients. WHAT IS NEW: • This is the first report about neonatal pneumothorax in non-conventional areas (lateral/posterior) diagnosed by lung ultrasound and how obtaining this information is critical in order to optimize management.

Microwave hydrothermal processing of the invasive macroalgae Sargassum muticum within a green biorefinery scheme.

This study deals with the multiproduct valorization of the invasive macroalgae Sargassum muticum within a green biorefinery concept using microwave hydrothermal treatment. Temperatures of 160 and 180 °C for 0-60 min (severities 1.62-3.54) were evaluated, allowing a recovery of a liquid phase rich in fucoidan-derived compounds (up to 4.81 g/L), oligomers and phenolics with antioxidant capacity (up to 2.85 g TE/L by ABTS assay), and a high-enzymatically susceptible solid (glucan to glucose conversion 76-100% in 9 h) suitable for bioethanol production (20.5 g/L in 18 h, corresponding to 96% ethanol yield). Moreover, energy consumption of the pretreatments' temperature-time binomial was evaluated showing significant differences, demonstrating the advantages of microwave as alternative heating pretreatment.

Lung ultrasound in preterm infants with respiratory distress: experience in a neonatal intensive care unit.

Lung ultrasound (LUS) has been described as a useful tool in early prognosis of several respiratory diseases of the newborn, especially preterm infant newborns (PTNB) with respiratory distress syndrome (RDS), but still, it is not a standard of care in many neonatal units. We have conducted a descriptive, prospective study in a tertiary neonatal unit during 1 year. PTNB less than 35 weeks with respiratory distress at birth on non-invasive ventilation were recruited. A LUS was performed in the first 12 h of life and scored from 6 to 18 points (6 areas, 1 to 3 points each). They were followed until discharge. Main outcomes: need for surfactant treatment. Sixty-four preterm infants, median gestational age 29 weeks. Median LUS score in surfactant group was significantly higher than in no surfactant group (p < 0.0001). LUS ROC curve for surfactant treatment shows AUC 0.97 (IC 95% 0.92-1). LUS Odds ratio for surfactant treatment 3.17 (IC 95% 1.36-7.35).Conclusion: Early high LUS score correlates with surfactant necessity in preterm infants with respiratory distress at birth.What is Known:• Lung ultrasound (LUS) is a useful tool in determining prognosis of preterm infants with respiratory distress at birth.What is New:• This study adds evidence about LUS and preterm infants with respiratory distress, early predicting surfactant need and mechanical ventilation.

Neonato con tumoraciones cervicales / Neonate with cervical tumours

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Detección precoz de la incontinencia urinaria femenina ¿En qué fallamos? / Early detection of female urinary incontinence: what are we doing wrong?

Objetivo. Identificar factores relaciona-dos con el fallo en la detección de pérdidas de orina en la mujer adulta como preámbulo a la incontinencia urinaria. Sujetos/material. Estudio transversal descriptivo en mujeres mayores de 20 años seleccionadas al azar en varios centros de salud de Tenerife, a las que se administra un formulario para identificar las posibles causas de la no identificación de pérdidas de orina por los profesionales sanitarios. Los resultados se ofrecen con el valor puntual de la muestra y en intervalos de confianza al 95%. Resultados. Se estudiaron 409 mujeres de cuatro centros de salud. Con una edad de 43 años (12), el 65% (60%-70%) refirió padecer pérdidas de orina. El problema afecta al 55% (40%-60%) de las mujeres en edad fértil. Un 68%, (62%-74%) de las mujeres afectadas no consultó con ningún profesional mientras que el 74% (69%-79%) indicó que ningún profesional sanitario les había preguntado sobre esta cuestión. El 55% (49%-61%) de las mujeres con pérdida de orina que no consulta alega no hacerlo porque no le da importancia, el 27% (22%-32%), porque no afecta a su vida diaria, el 15% (11%-19%), porque no lo considera un problema de salud el 9% (5%-13%), porque lo considera inevitable por su edad, el 7% (4%-10%), por no tener tiempo para ello, y el 6% (3%-9%), por causarles vergüenza con frecuencias menores al 3% (1%-5%), por otros motivos. Conclusiones. La prevalencia de pérdidas de orina en mujeres es elevada y no se consulta a los profesionales sanitarios por considerar este problema normal y aceptable, sin haber una búsqueda activa de casos por parte de los profesionales sanitarios

Objective. To identify possible risk factors related with failure detecting urine loss in adult women before suffering from urinary incontinence. Subjects/material. Descriptive cross-sectional study in randomly selected women older than 20 years in several health centers in Tenerife who are given a test to identify possible causes of not detecting urine loss by health professionals. The results are offered with the punctual value of the sample and in 95% confidence intervals. Results. 409 women from four health centers were studied; 65% (60%-70%) of wo-men aged 43 years old (12) reported suffering urine loss. This problem affects 55% (40%-60%) childbearing age women. 68% (62%-74%) of affected women didn’t consult any health professional and 74% (69%-79%) indicated that no health professional had asked them about this issue. 55% (49%-61%) of women suffering from urine loss who doesn’t consult claims not doing it cause they judge it irrelevant, 27% (22%-32%) because it doesn’t affect their daily life, 15% (11%-19%) because the don't think that's a health problem, 9% because they think that's inevitable for their age, 7% (4%-10%) because they didn’t have any time to ask, and 6% (3%-9%) because they felt ashamed for it, and less than 3% (1%-5%) for other reasons. conclusions. Prevalence of urine loss in women is high and women don’t ask health professionals because they think that this is a normal and acceptable problem, as well as there isn’t an active case search by health professionals

New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring.

OBJECTIVE: To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA). STUDY DESIGN: Infants <32 weeks' GA (n = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible (n = 54) or masked (n = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28-29+6, or ≥30 weeks). RESULTS: Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2O; p < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age. CONCLUSION: Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.

Utilización de escalas en el laboratorio de evaluación integral sicomotriz del Centro Internacional de Restauración Neurológica a pacientes que padecen de esclerosis múltiple / Utilization of scales laboratory psychomotor comprehensive assessment of the International Center for Neurological Restoration patients suffering from Multiple Sclerosis

La evaluación y diagnóstico de las funciones motrices se erige en un aspecto importante y vital para los especialistas y oacientes que acuden a nuestra nstitución a fin de valorar sus posibilidades neurorrestaurativas para cumplimentar un plan de rehabilitación, encaminado a recuperar parcial o totalmente estas funciones, teniendo en cuenta sus potencialidades; de ahí que la evaluación antes y después del tratamiento neurorrestaurativo cobre vital importancia en pacientes con patologías neurológicas como la Esclerosis Múltiple; por ello el objetivo de nuestro trabajo fue valorar la sensilibidad de los test que se aplican para dicha patología en el Laboratorio de Evaluación Integral Sicomotriz (LEIS), del Centro Internacional de Restauración Neurológica (CIREN), a través de la compacación de los resultados obtenidos en las evaluaciones (inicial y final al tratamiento neurorrestaurativo) para el conocimiento del estado real de los pacientes. La muestra estuvo conformada por 25 pacientes atendidos en la Clínica de Lesiones Raquimedulares y Enfermedades Neuromusculares, a los que se les aplicaron los test evaluativos antes y después del tratamiento neurorrestaurativo, comparándose ambos resultados, para ello también se utilizó la prueba de Significación Estadística: Wilcoxon matched pairs test, evidenciándose que los test aplicados en el LEIS permitieron definir los puntos de partida para el tratamiento de rehabilitación física y se cuantificaron de manera objetiva los cambios en la capacidad física ocurridos en los pacientes en el desarrollo de su rehabilitación.