Sección de Perinatología. Servicio de Pediatría del Hospital Universitario Cruces / Perinatology section: pediatrics department of the Hospital Universitario Cruces

En este artículo se presenta la organización, la actividad asistencial, docente y de investigación y los índices de calidad de la Sección de Perinarología del Hospital Universitario Cruces (HU Cruces). Se trata de un proceso multidisciplinar que tiene como principal objetívo contribuir a mantener y, si es posible, mejorar la calidad de la atención sanitaria del recién nacido (RN) y su madre, contando con la implicación y participación de todo e! personal sanitario de la Sección y en coordinación con otras áreas asistenciales (Unidad de Medicina Perinatal, Unidad de Medicina Fetal y Unidad Neonatal) y especialistas. Se describirá nuestra actual Cartera de Servicios y las estrategias de mejora para favorecer la información prenatal, la asistencia especializada a partos de riesgo y e! control posnatal, tanto de los RN aparentemente sanos, como de los que requieran una adaptación especial o un control multidisciplinar postnatal, promocionando y favoreciendo la inseparabilidad de la madre y su hijo de manera segura y la lactancia materna (LM) (AU)

This paper presents the Organization, the Quality Indexes and the Health Care, Teaching and Research activities of the Perinatology Section at Cruces University Hospital. The paper holds a multidisciplinary perspective and its main objective is to help to maintain and, if possible, improve newborns and mothers' health care quality, relying on the participation of all the health care workers in the Section and on the coordination with other care areas (Unit of Perinatal Medicine, Fetal Medicine Unit and Neonatal Unit) and specialists. Our current service portfolio will be presented together with suggestions of improvement strategies leading to the following objectives: prenatal information improvement, specialized care for risk births, postnatal control, related both to apparently healthy newborns and to those requiring special adaptation or a multidisciplinary postnatal control, and the encouragement of safe mother-child inseparability and breastfeeding (AU)

Perforación esofágica con neumomediastino en un recién nacido de extremado bajo peso / Esophageal perforation with pneumomediastinum in a very-low-birthweight infant

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[Extracorporeal membrane oxygenation (ECMO). I. Is it really needed in Spain?]. / Oxigenación por membrana extracorpórea (ECMO) neonatal. I. Es realmente necesaria en nuestro país?

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a cardiorespiratory support technique used to treat newborns with severe respiratory insufficiency. ECMO has not been used yet in newborns in Spain, with its necessity being question. The aim of this study was to evaluate the need for ECMO for respiratory or cardiac cases in our neonatal population, as well as to study the predictive capacity of several respiratory indices. PATIENTS AND METHODS: A retrospective observational study was carried out. Data from 2,133 newborns admitted during a 48 month period was reviewed. Babies were considered ECMO candidates if they died of respiratory failure or after surgery for a cardiac defect and if they had no ECMO exclusion criteria. The capacity of several respiratory indices to predict mortality was analyzed. RESULTS: We considered 16 babies who died to be ECMO candidates, 6 with respiratory failure (1/3,028 live births) and 10 with cardiac defects 3 of them inborn (1/6,057). The total ECMO need was 1/2019 live births. None of the oxygenation indices studied accurately predicted the 80% mortality rate. CONCLUSIONS: In Spain, it is necessary to start several neonatal ECMO programs since some 200 newborn infants with severe respiratory failure or cardiac defects could benefit from such a program annually.

[Treatment of preterm neonates with severe respiratory distress syndrome using exogenous natural surfactants of porcine origin]. / Tratamiento con surfactante natural exógeno de origen porcino de recién nacidos pretérmino con síndrome del distrés respiratorio grave.

From September 1989 to September 1990, a total of 25 newborn infants with severe RDS (on mechanical ventilation and with a FiO2 above 0.6) were treated with porcine surfactant (Curosurf), since its efficacy has been demonstrated in a prior clinical trial (Pediatrics 1988; 82: 683-91). The mean birth weight and gestational age were 1,327 +/- 566 g and 29.5 +/- 3.8 weeks, respectively. Twenty-four percent of the babies had an arterial pH below 7.1. At a mean postnatal age of 9.1 +/- 10.7 hours, a dose of 200 mg/Kg of Curosurf was given by the tracheal route. Mean paO2 rose from 47 +/- 14 mm Hg to 166 +/- 64 mm Hg (p less than 0.001). The paO2 increased in 24 of the 25 cases and in 20 (80%) the post-treatment paO2 was a least two times higher than the pre-treatment value. An hour after surfactant treatment, the paCO2 decreased from 58 +/- 21 mm Hg to 45 +/- 16 mm Hg (p less than 0.01) and the pH increased from 7.19 +/- 0.15 to 7.28 less than 0.11 (p less than 0.001). The following complications were observed: pulmonary interstitial emphysema (16%), pneumothorax (8%), patent ductus arteriosus (36%), intraventricular hemorrhage (28%) and bronchopulmonary dysplasia (24%). The neonatal survival rate and the survival rate after discharge from the hospital were 76% and 64%, respectively. The combined survival and absence of DBP was 32%. Nonsurvivors had lower birth weights and gestation ages, as well as lower paO2 5 min after treatment and higher FiO2 24 hours after surfactant treatment than did the survivors.