[Neonatal extracorporeal membrane oxygenation: 9 years of experience]. / Oxigenación por membrana extracorpórea neonatal: 9 años de experiencia.

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for reversible respiratory or cardiac diseases. Neonatal pathologies requiring this technique are different from the ones found later in life. OBJECTIVES: To review the main causes requiring ECMO in the neonatal period, to compare the clinical course depending on the initial illness and to identify the sequelae attributable to this technique. MATERIAL AND METHOD: A retrospective review of clinical records of all neonatal patients that received ECMO support in our centre. RESULTS: 45 neonatal ECMO were performed in our unit between January 2001 and June 2009. Forty techniques were due to respiratory failure, 2 secondary to haemodynamic shock and 3 secondary to sepsis. Veno-venous cannulation was used initially in 24 patients (53.3%). The length of technique varied depending on the underlying disease. Patients with congenital diaphragmatic hernia were in ECMO for longer periods. The overall survival to the technique was 86.3% (38/44 patients), also with differences among diseases. Extracorporeal support was withdrawn in 4 children because of a diagnosis of an irreversible pathology and one because of massive brain haemorrhage. No serious adverse outcomes attributable to the technique were found among survivors. CONCLUSIONS: Survival among newborns supported with ECMO in our hospital is similar to that recorded by the ELSO in 2004, although we use veno-venous cannulation in more than a half of the patients. The percentage of moderate to severely impaired neurodevelopmental outcome among survivors after this technique was low.

Factores relacionados con las técnicas de reproducción asistida y su repercusión en el neonato / Factors associated with assisted reproduction technologies and neonatal outcomes

Introducción: Las técnicas de reproducción asistida (TRA) pueden estar asociadas a complicaciones obstétricas y perinatales, incluido un aumento de malformaciones. El objetivo de este estudio fue comparar los resultados obstétricos y neonatales de las gestaciones únicas y múltiples por fertilización in vitro (FIV) e ICSI (intra cytoplasmatic sperm injection`inyección intracitoplásmica de espermatozoides) con las gestaciones espontáneas. Pacientes y métodos: Estudio de casos y controles de los recién nacidos de embarazos obtenidos con las técnicas FIV e ICSI en el Hospital Clínic de Barcelona entre enero de 1999 y diciembre de 2005. Se recogieron 499 casos y 432 controles. Resultados: El grupo estudio (gestaciones por FIV e ICSI) tiene más prematuridad (definida como gestación inferior a 37 semanas), menor peso al nacer (definido como peso inferior al P10 para su edad gestacional y sexo), más embarazos múltiples, madres de mayor edad y más complicaciones obstétricas, como amenaza de aborto y prematuridad, enfermedad placentaria, hipertensión arterial, diabetes gestacional y hemorragias. Los recién nacidos muestran una enfermedad y una mortalidad similar con más ingresos. Al analizar sólo las gestaciones únicas, en el grupo estudio destaca más prematuridad y bajo peso al nacer, más complicaciones obstétricas, más enfermedades neonatales relacionadas con la prematuridad y el aumento de malformaciones (el 9,7 frente al 4,3%, respectivamente; p=0,046). Al analizar sólo las gestaciones múltiples no hay diferencia en prematuridad ni en peso al nacer, ni en número de malformaciones, pero el grupo estudio tiene más complicaciones obstétricas, como amenaza de aborto, diabetes gestacional y toxemia. Aunque la técnica ICSI tiende a asociarse a más malformaciones, no hay diferencia estadística significativa (el 11,0 frente al 5,6%, respectivamente; p=0,099) y el estudio multivariante no muestra una influencia independiente. Conclusiones: Las TRA (FIV e ICSI) se asocian con más prematuridad, bajo peso al nacer y aumento de enfermedad obstétrica. Las gestaciones únicas por FIV e ICSI muestran aumento de malformaciones si bien el riesgo de que éstas aparezcan no depende de las técnicas utilizadas (AU)

Introduction: Assisted reproduction technologies can be associated with poor obstetric and perinatal outcomes and an increase in congenital malformations. The objective of this study was to compare obstetric and perinatal outcome of single and multiple pregnancies conceived by IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection) with spontaneous pregnancies. Patients and methods: A case-control study was conducted on the newborns conceived by IVF and ICSI in Hospital Clínic Barcelona between January 1999 and December 2005. There were 499 cases reported and 432 controls. Results: The case group had an increased risk of preterm birth (<37 weeks) and low birth weight (<10th percentile in relation to gestational age and sex). The case group had more multiple births, higher maternal age, more obstetric complications, such as abortion risk, preterm delivery, placental complications, hypertension, gestational diabetes, maternal haemorrhage. There were no significant differences in perinatal outcome, although newborn conceived by IFV/ICSI were admitted to hospital more. In single pregnancies, the case group showed more preterm deliveries and low birth weight, more obstetric complications and more congenital malformations (9.7% vs. 4.3% P=0.046). In multiple pregnancies there were no significant differences in perinatal outcome and incidence of malformations. The case group had a higher incidence of obstetric complications, such as abortion risk, gestational diabetes and hypertension. Although ICSI was associated to more malformations (11.0% vs. 5.6%), there was no significant statistical difference (P=0.099) and the multivariate analysis did not show an independent influence on risk of malformation. Conclusion: IFV/ICSI techniques have an increased risk of premature delivery, low birth weight, and poorer obstetric outcomes. Single pregnancies tend to have more congenital malformations. The risk of malformations is not associated with a specific technique (AU)

[Factors associated with assisted reproduction technologies and neonatal outcomes]. / Factores relacionados con las técnicas de reproducción asistida y su repercusión en el neonato.

INTRODUCTION: Assisted reproduction technologies can be associated with poor obstetric and perinatal outcomes and an increase in congenital malformations. The objective of this study was to compare obstetric and perinatal outcome of single and multiple pregnancies conceived by IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection) with spontaneous pregnancies. PATIENTS AND METHODS: A case-control study was conducted on the newborns conceived by IVF and ICSI in Hospital Clínic-Barcelona between January 1999 and December 2005. There were 499 cases reported and 432 controls. RESULTS: The case group had an increased risk of preterm birth (<37 weeks) and low birth weight (<10th percentile in relation to gestational age and sex). The case group had more multiple births, higher maternal age, more obstetric complications, such as abortion risk, preterm delivery, placental complications, hypertension, gestational diabetes, maternal haemorrhage. There were no significant differences in perinatal outcome, although newborn conceived by IFV/ICSI were admitted to hospital more. In single pregnancies, the case group showed more preterm deliveries and low birth weight, more obstetric complications and more congenital malformations (9.7% vs. 4.3% P=0.046). In multiple pregnancies there were no significant differences in perinatal outcome and incidence of malformations. The case group had a higher incidence of obstetric complications, such as abortion risk, gestational diabetes and hypertension. Although ICSI was associated to more malformations (11.0% vs. 5.6%), there was no significant statistical difference (P=0.099) and the multivariate analysis did not show an independent influence on risk of malformation. CONCLUSION: IFV/ICSI techniques have an increased risk of premature delivery, low birth weight, and poorer obstetric outcomes. Single pregnancies tend to have more congenital malformations. The risk of malformations is not associated with a specific technique.

Asfixia perinatal: relación entre afectación cardiovascular, neurológica y multisistémica / Perinatal asphyxia: relationship between cardiovascular, neurological and multisystem involvement

Objetivo: Conocer el perfil epidemiológico de los neonatos a término con asfixia perinatal; relacionarlo con la existencia y el grado de encefalopatía hipóxico-isquémica (EHI); valorar la frecuencia de afectación cardiovascular (ACV) y relacionarla con la afectación neurológica y extra neurológica; determinar la relación entre ACV y factores etiopatogénicos de la asfixia. Material y métodos: Estudio retrospectivo de los pacientes que cumplieron criterios de asfixia perinatal entre enero de2000 y diciembre de 2004. Resultados: Se incluyeron 295 pacientes. Un 39% cumplía criterios de EHI: leve 23,1%; moderada 8,8% y grave 7,1%. La afectación pulmonar se dio en un 35,9%, la renal en un 18%,presentaron hipocalcemia un 18,6%, trombopenia un 13,9% y coagulopatía un 21,4%. Un 14,2% de los pacientes presentaron ACV cierta (alteración enzimática y/o ecocardiográfica con shock y/o hipotensión arterial), y un 15,6% ACV probable (sólo hipotensión arterial y/o shock). La existencia de ACV se relaciona con la presencia de EHI y, por consiguiente, con alteraciones en el electroencefalograma y de neuroimagen. Asi mismo,la existencia de ACV aumenta la presencia de afectación extraneurológica. También se constata que los pacientes con ACV presentan más frecuentemente acidosis al ingreso y acidosis metabólica persistente durante su evolución. Conclusiones: La ACV se correlaciona con la existencia y la gravedad de las manifestaciones neurológicas y con la afectación de otros órganos y sistemas, en especial con la acidosis metabólica persistente (AU)

Objective: The aim of this study is to review epidemiological data concerning asphyxia in full-term newborn infants and the relationship between this data and the existence and severity of hypoxic-ischemic encephalopathy (HIE). The authors also evaluate the incidence of cardiovascular involvement (CVI) and the relationship between this condition and neurological and extraneurological involvement. A third objective was to determine the relationship between cardiovascular involvement and the etiological and pathological factors of asphyxia. Materials and methods: A retrospective review of all the asphyxiated term neonates born between January 2000 and December2004. Results: A total of 295 patients were included. Thirty-nine percent were diagnosed as having HIE: mild, 23.1%; moderate8.8%; and severe, 7.1%. Pulmonary involvement was detected in 35.9% of the patients, renal involvement in 18%, hypocalcemia in 18.6% of cases; thrombocytopenia in 13.9% and coagulopathy in 21.4%. Forty-two patients had “proven” CVI (abnormal enzyme levels and/or echocardiographic findings in patients with hypotension and/or shock) and 46 had “possible” CVI (only hypotension and/or shock). CVI is associated with the presence of HIE and, consequently, with abnormal electroencephalographic and neuroimaging findings. Moreover, CVI increases the prevalence of extraneurological involvement. It was also observed that, in patients with CVI, there is a higher incidence of acidosis at admission and persistent metabolic acidosis throughout the course of the disease. Conclusions: CVI correlates with the existence and severity of neurological and extraneurological involvement, and especially with persistent metabolic acidosis (AU)

Rendimiento de los cultivos practicados a pacientes hemato-oncológicos con enfermedades infecciosas graves / Yield of the cultures performed in hemato-oncology patients with serious infectious diseases

Introducción: Los avances en el campo de la oncología pediátrica han aumentado la supervivencia pero las complicaciones infecciosas son frecuentes y la necesidad de los Cuidados Intensivos (UCI-P) se incrementa. El objetivo del trabajo es valorar la rentabilidad de los cultivos practicados a pacientes oncológicos que precisaron ingreso en la UCI.P por una patología infecciosa. Material y Métodos. Estudio descriptivo, retrospectivo, de los pacientes oncológicos ingresados en una UCI-P por patología infecciosa en un hospital de tercer nivel. Resultados: Se incluyeron 22 pacientes que tuvieron 25 episodios de infección. Destacó la presentación en forma de insuficiencia respiratoria aguda en 14 pacientes (56%). Los síntomas infecciosos al diagnóstico previos al ingreso en la UCI-P fueron: sobreinfección respiratoria en 12 caos (48%); sospecha clínico-analítica de sepsis en 8 (16%). En un 43% de los pacientes ingresados en planta, se aisló algún germen en los cultivos realizados previos al ingreso en intensivos. Se aisló el microorganismo patógeno en 17 de los pacientes ingresados en UCI (68%), en un 82% de los casos gracias al hemocultivo. El diagnóstico final más frecuente en la UCI-P fue sepsis en 13, seguida de neumonía en 10 pacientes. Fueron exitus one pacientes (48%). Discusión: El elevado número de cultivos negativos probablemente se deba a que quedaran decapitados por la política antibiótica de amplio espectro. El conocimiento estricto de la epidemiología infecciosa de cada hospital y el estudio etiológico precoz y agresivo permitirían avanzar el tratamiento antibiótico correcto de forma empírica e incrementar la efectividad de la antibioterapia (AU)

Introduction: Recent advances in pediatric oncology have improved survival but infectious complications are frequent and the necessity of pediatric intensive care (PICU) is growing. The objective of this study is to determine the profitability of cultives in oncologic pediatric patients who required PICU admittance because of a infectious pathology. Materials and methods: Retrospective review of oncologic patients medical records, admitted to a reference pediatric intensive care unit (PICU), due to an infectious pathology. Results_ 22 patients who suffered 25 infectious processes were recruited. Acute respiratory insufficiency was the most frequent form of presentation (56%). Infectious symptoms before PICU admittance were: respiratory infection 12 cases (48%); clinical sepsis suspicion or biochemical markers compatible with sepsis in 8 patients (16%). 43% of the cultures recollected before PICU´s admittance were positive. Pathogenic microorganisms were isolated in 17 PICU´s patients (68%); in 82% of the cases, it was isolated in a blood sample. The final diagnoses were; sepsis in 13 cases, pneumonia in 10 cases. 11 patients died (48%). Discussion: The high number of negative cultures could be the result of the empiric broad-spectrum antibiotic therapy that is often used in this group of patients. The know-ledge of every hospital epidemiology and the precocious and aggressive etiologic search could improve the empiric antibiotic treatment and improve antibiotic effectiveness (AU)

Mielomalacia: una causa de insuficiencia respiratoria tardía. A propósito de 2 casos / Myelomalacia: a cause of delayed respiratory failure. Apropos of two cases

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Shock y sintomatología digestiva en un neonato: una forma grave de presentación de la alergia a proteínas de leche de vaca / Shock and digestive symptoms in a neonate: a severe presentation of allergy to cow’s milk proteins

No disponible

Apneas temáticas de estudio en los congresos de la Asociación Española de Pediatría / Apnea and apparent life threatening events. A review of our cases

Objetivos. Revisar epidemiología, factores de riesgo, características de los eventos, exploraciones complementarias realizadas y diagnósticos finales de los pacientes ingresados con sospecha de APNEA/Episodio Aparentemente Letal (EAL). Material y Métodos. Estudio retropectivo de pacientes menores de 1 año ingresados en la Unidad de Estancia Corta (UEC) de nuestro Hospital de los cuales el motivo de consulta fue APNEA/EAL. Resultados. De lso 82 pacientes, el 74% eran menores de dos meses. Los episodios de pausa respiratoria sucedían habitualmente con el paciente despierto (69,5%), sin factor desencadenante (51,2%) y con cambio de coloración (81,1%). En un 94% se hallaron síntomas acompañantes, destacando: síntomas respiratorios en vías altas (41%), cambio de tono muscular (30%), vómitos/Uregurgitación (20,7%) y desviación ocular y/o movimientos anormales (18.35). La exploración física sólo detectó alteraciones en el 28% de los casos, siendo los síntomas cardio-pulmonares los más frecuentes (14,6%). La mayoría de las exploraciones complementarias aportaron escasa información. En un 8% se detectaron apneas reales con la monitorización. Conclusiones. La incidencia de estos eventos es máxima en menores de 2 meses. La primera actuación recomendable en urgencias sería la monitorizaicón. Los exámenes complementarios deben ser dirigidos según sintomatología y exploración física y sólo someter a protocolos completos a aquellos pacientes con apneas reales durante la monitorización (AU)

Objetive. To review the epidemology, risks factors, characteristics of the events, evaluation procedures and final diagnoses of the patients admitted to hospital under suspicion of apparent life-threatening event (ALTE). Material and methods. Retrospective study of infants under 1 year of age admitted to our hospital in short stay medical unit whose reason for attendance was APNEA/ALTE. Results. 82 patients were recruited. 74% younger than 2 months; 56,1% boys. Most respiratory pauses occurred while awake (69,5%), without apparent trigger (51,2%) and with skin colour changes (81,1%). Associated symptoms were observed in 94% of patients: mostly upper respiratory symptoms (41%), change in muscle tne (30%), vomit/regurgitation (20,7%9 and limb or eye abnormal movements (18,3%), Abnormal finding in physical examination were found in 28% of the cases, being cadiopulmonar signs the most frequent (14,6%). Most of the evaluation procedures did not offer useful information in most cases. Real apneas during monitorization were detected in 8% of cases. Conclusions. This type of events are more frequent among under 2 months of age. The first recommended procedure in the emergency department should be patient´s monitoring. Evaluation procedures should be done according to event history and physical examination. A complete apnea protocol should only be offered to infants presenting with real apneas during monitorization (AU)