Nursing care in therapeutic hypothermia in neonates with hypoxic-ischaemic encephalopathy. Review of the literature.

INTRODUCTION: Hypoxic-ischaemic encephalopathy is one of the main causes of neurological damage in the new-born. Therapeutic hypothermia is the current treatment to reduce mortality and disability in new-borns with this condition. OBJECTIVE: To identify nursing care in new-borns with severe to moderate EHI, treated with active therapeutic hypothermia. MATERIALS AND METHODS: A review of the scientific literature was carried out in different databases (PubMed, Lilacs, IBECS, Cinhal, OvidSP, Cuiden, Embase and Cochrane Plus) over the last five years. The documentary assessment was carried out by peers and the quality was evaluated using the CEBM and GRADE scales. RESULTS: Of the 22 articles selected and reviewed, it is evident that therapeutic hypothermia is effective in reducing the mobility and mortality of neo-nates with hypoxic-ischaemic encephalopathy. Nursing care during hypothermia treatment focuses on four basic pillars: general care for stabilisation of the new-born, preparation of the material, administration of medical treatment in all its phases and emotional support of the family. CONCLUSIONS: Therapeutic hypothermia is effective in reducing the sequelae and mortality of neonates with hypoxic-ischaemic encephalopathy. Nursing care is essential throughout the treatment, in the early detection of complications in the infant and psychological support for parents. It is essential for nurses to receive training in this care.

Cuidados enfermeros a neonatos con encefalopatía hipóxico-isquémica en hipotermia terapéutica. Revisión bibliográfica / Nursing care in therapeutic hypothermia in neonates with hypoxic-ischaemic encephalopathy. Review of the literature

Introducción La encefalopatía hipóxico-isquémica es una de las principales causas de daño neurológico en el neonato. Actualmente, la hipotermia terapéutica es el tratamiento de elección para reducir la mortalidad y la discapacidad en los niños que presentan esta patología. Objetivo Identificar los cuidados enfermeros en recién nacidos con encefalopatía hipóxico-isquémica moderada a severa tratados con hipotermia terapéutica activa. Materiales y métodos Se realizó una revisión de la literatura científica en diferentes bases de datos (PubMed, Lilacs, IBECS, Cinhal, OvidSP, Cuiden, Embase y Cochrane Plus) durante los últimos 5 años. La valoración documental se realizó por pares y la calidad se evaluó mediante las escalas CEBM y GRADE. Resultados De los 22 artículos seleccionados y revisados se evidencia que la hipotermia terapéutica es efectiva al reducir la morbimortalidad de los neonatos con encefalopatía hipóxico-isquémica. Los cuidados enfermeros durante el tratamiento de hipotermia se centran en 4 pilares básicos: los cuidados generales para la estabilización del recién nacido, la preparación del material, la administración del tratamiento médico en todas sus fases y el soporte emocional de la familia. Conclusiones La hipotermia terapéutica es efectiva al reducir las secuelas y la mortalidad de los neonatos con encefalopatía hipóxico-isquémica. Los cuidados enfermeros son esenciales y están presentes durante todo el tratamiento, detectan precozmente complicaciones en los niños y ofrecen apoyo psicológico a los padres. La formación del personal de enfermería en estos cuidados es fundamental. (AU)

Introduction Hypoxic-ischaemic encephalopathy is one of the main causes of neurological damage in the new-born. Therapeutic hypothermia is the current treatment to reduce mortality and disability in new-borns with this condition. ObjectiveTo identify nursing care in new-borns with severe to moderate hypoxic-ischaemic encephalopathy, treated with active therapeutic hypothermia. Materials and methods A review of the scientific literature was carried out in different databases (PubMed, Lilacs, IBECS, Cinhal, OvidSP, Cuiden, Embase and Cochrane Plus) over the last five years. The documentary assessment was carried out by peers and the quality was evaluated using the CEBM and GRADE scales. Results Of the 22 articles selected and reviewed, it is evident that therapeutic hypothermia is effective in reducing the mobility and mortality of neo-nates with hypoxic-ischaemic encephalopathy. Nursing care during hypothermia treatment focuses on four basic pillars: general care for stabilisation of the new-born, preparation of the material, administration of medical treatment in all its phases and emotional support of the family. Conclusions Therapeutic hypothermia is effective in reducing the sequelae and mortality of neonates with hypoxic-ischaemic encephalopathy. Nursing care is essential throughout the treatment, in the early detection of complications in the infant and psychological support for parents. It is essential for nurses to receive training in this care. (AU)

Nursing care in therapeutic hypothermia in neonates with hypoxic-ischaemic encephalopathy. Review of the literature. / Cuidados enfermeros a neonatos con encefalopatía hipóxico-isquémica en hipotermia terapéutica. Revisión bibliográfica.

INTRODUCTION: Hypoxic-ischaemic encephalopathy is one of the main causes of neurological damage in the new-born. Therapeutic hypothermia is the current treatment to reduce mortality and disability in new-borns with this condition. OBJECTIVE: To identify nursing care in new-borns with severe to moderate hypoxic-ischaemic encephalopathy, treated with active therapeutic hypothermia. MATERIALS AND METHODS: A review of the scientific literature was carried out in different databases (PubMed, Lilacs, IBECS, Cinhal, OvidSP, Cuiden, Embase and Cochrane Plus) over the last five years. The documentary assessment was carried out by peers and the quality was evaluated using the CEBM and GRADE scales. RESULTS: Of the 22 articles selected and reviewed, it is evident that therapeutic hypothermia is effective in reducing the mobility and mortality of neo-nates with hypoxic-ischaemic encephalopathy. Nursing care during hypothermia treatment focuses on four basic pillars: general care for stabilisation of the new-born, preparation of the material, administration of medical treatment in all its phases and emotional support of the family. CONCLUSIONS: Therapeutic hypothermia is effective in reducing the sequelae and mortality of neonates with hypoxic-ischaemic encephalopathy. Nursing care is essential throughout the treatment, in the early detection of complications in the infant and psychological support for parents. It is essential for nurses to receive training in this care.

Los neonatos también tienen gripe / Neonates also have flu

INTRODUCCIÓN: Los niños son la población de mayor incidencia de gripe y la principal fuente de transmisión de la enfermedad. Sin embargo, hay pocos casos reportados y poca información sobre el manejo en la edad neonatal, población especialmente vulnerable. El objetivo de este estudio es describir los casos de gripe en neonatos ingresados en un hospital terciario, comparando el manejo con otros centros descritos en la literatura. MATERIAL Y MÉTODOS: Presentamos un estudio descriptivo, longitudinal y retrospectivo de casos de gripe neonatal entre 2009 y 2019 en una unidad nivel III en neonatología. Se han estudiado variables epidemiológicas, clínicas, diagnósticas, pronósticas y terapéuticas de interés. RESULTADOS: Se estudiaron un total de 13 casos. Se encontró ambiente epidémico familiar en el 61,5% de los pacientes. La infección respiratoria superior y las desaturaciones fueron los síntomas más prevalentes (69,2%). El virus más frecuentemente aislado fue el de la Gripe A tipo H1N1 (69,2%). El 61,5% se trataron con antibioterapia y dos (15,4%) recibieron tratamiento con oseltamivir. El 46,1% de los casos precisó ingreso en Unidad de Cuidados Intensivos Neonatales y soporte ventilatorio, pero no se registró ningún éxitus. CONCLUSIONES: La población neonatal es especialmente vulnerable a la gripe y sus complicaciones, requiriendo con frecuencia ingreso en las unidades de cuidados intensivos. Evitar el ambiente epidémico es un arma importante en la prevención. Dado que es una patología infrecuente en este grupo de edad, existe escasa evidencia sobre su adecuado manejo, por lo que consideramos necesarios más estudios para optimizar su tratamiento y soporte

INTRODUCTION: Children are the population with the biggest flu incidence and the main source of transmission of this illness. However, there are few cases reported and few information regarding it management in neonates, a very vulnerable population. The aim of this study is describing flu neonatal cases admitted in a tertiary care hospital and comparing it management with other centres described in the literature. MATERIAL AND METHODS: We present a descriptive, longitudinal and retrospective study of flu neonatal cases between 2009 and 2019 in the Unit of Neonatology in a tertiary care hospital. Epidemiological, clinical, diagnostic, prognostic and therapeutic variables of interest have been studied. RESULTS: 13 cases were studied. Family epidemic environment was found in 61.5% of patients. Upper respiratory infection and desaturations were the most prevalent symptoms (69.2%). The most frequently isolated virus was Influenza A type H1N1 (69.2%). 61.5% were treated with antibiotherapy and two cases (15.4%) with oseltamivir. 46.1% of cases required admission to the Neonatal Intensive Care Unit and ventilatory support, but no exitus was recorded. CONCLUSIONS: Neonatal population is especially vulnerable to flu and its complications, often requiring admission to Intensive Care Units. Avoiding the epidemic environment is an important prevention weapon. Given that it is an infrequent pathology in this age group, there is little evidence about its proper management, so we consider that more studies are necessary for its treatment and support

On-line in-tube solid phase microextraction coupled to capillary liquid chromatography-diode array detection for the analysis of caffeine and its metabolites in small amounts of biological samples.

In-tube solid phase microextraction (IT-SPME) coupled on-line to capillary liquid chromatography with diode array detection provides a simple and fast analytical methodology for the simultaneous quantitation of caffeine and its three primary metabolites (theobromine, paraxanthine and theophylline) in micro samples of serum, saliva and urine matrices. The sample amount required for one analysis was only 2.5 µL of saliva, 6.25 µL of serum or 40 µL of urine, a requirement for its implementation in a hospital laboratory for preterm newborns, where sample availability is a major problem. In standard conditions, 25 µL of diluted saliva or serum (or 100 µL of urine) were processed by IT-SPME in 30 cm of commercially available capillary GC column coated with ZB-FFAP (100% nitroterephthalic modified polyethylene glycol). The retained compounds were desorbed from the IT-SPME capillary by the mobile phase (a gradient mixture of water and methanol) and the separation was carried out in a C18 column (150 mm × 0.5 mm i.d., 5 µm particle size). Analytes eluted before 14 min, at a flow rate of 15 µL min-1, and were detected by absorbance at 275 nm. The calibration graphs presented good linearity (R2 > 0.99), without the presence of matrix effect, and recoveries between 84 and 112% were obtained. Limits of detection (S/N = 3) were 0.1 µg·mL-1 in serum and 0.5 µg·mL-1 in saliva and urine samples, for all compounds, and the intra- and inter-day variation coefficients (n = 3) were between 3 and 17%. Analytical figures of merit were similar to those proposed by other methodologies, but using lower sample volume and a faster and simpler sample treatment and analysis. Paired samples of serum and saliva from preterm newborns treated with caffeine at the pediatric intensive care unit were analyzed by the method, with statistically equivalent results for caffeine concentrations.

Hemorragia intracraneal intraútero por trombopenia neonatal aloinmune: a propósito de dos casos y revisión de la literatura / In utero intracranial hemorrhage caused by neonatal alloimmune thrombocytopenia (NAIT). Report of two cases and literature update

Introducción: La trombopenia neonatal aloinmune (TNAI) es la causa más frecuente de trombopenia grave, aislada y precoz en el recién nacido sano. Es el resultado de la aloinmunización materna frente a antígenos plaquetarios humanos (HPA) del feto. El mecanismo fisiopatológico todavía es poco conocido. El paso de anticuerpos se produce en etapas tempranas de la gestación con consecuencias graves, como la hemorragia intracraneal. Casos clínicos: Se presentan dos casos de hemorragia intracraneal intraútero secundarios a TNAI. El primero de ellos seinicia con una gran hemorragia intraparenquimatosa, y requiere una única transfusión de donante aleatorio para remontar la cifra de plaquetas. El segundo se presenta con una hemorragia intraventricular y se trata con transfusiones seriadas de plaquetasHPA-1a negativas e inmunoglobulina intravenosa. Discusión y conclusiones: La TNAI se presenta generalmente como una trombopenia aislada y grave en el recién nacido. Eldiagnóstico es de exclusión y se confirma mediante la detección de anticuerpos antiplaquetarios en la madre. Dada la gravedad de las consecuencias, ante la sospecha de TNAI, deben realizarse de inmediato transfusiones de plaquetas, preferentemente de las compatibles, para evitar hemorragias. El riesgo de recurrencia en futuras gestaciones es muy elevado, por lo que se debe establecer un protocolo de manejo de éstas. El reto de futuro es el establecimiento de un cribado antenatal, como ya se hace con la isoinmunización Rh (AU)

Introduction: The neonatal alloimmune thrombocytopenia (NAIT) is the commonest cause of early isolated severe thrombocytopenia in the healthy newborn. It’s the result of maternal alloimmunization against fetal platelet antigens. However, the pathophysiologic mechanism is not well known yet. Alloantibodies cross the placenta in early stages of pregnancy provoking serious complications in the newborn such as intracranial hemorrhage. Case report: We present two cases of in utero intracranial hemorrhage caused by TNAI. In one of them a large intraparenchymal hemorrhage (IPH) was the first clinical symptom, how everhe recovered platelet count with just one transfusion of an aleatory donor, not needing further treatment. The second one exhibited at first an intraventricular hemorrhage (IVH) and was treated with serial transfusions of HPA-1a negative platelets and intravenous immunoglobulin (IVIG).Discussion and conclusions: The NAIT appears commonly as an isolated and severe thrombocytopenia in the newborn period. The diagnosis is made after excluding other causes of neonatal thrombocytopenia, and is confirmed proving the presence of maternal antiplatelet alloantibodies. Due to the severity of its consequences, when confronted with the suspicion of TNAI, a platelet transfusion should to be performed immediately preferably with negative antigen platelets to avoid bleeding. Since there is a high risk of recurrence in following gestations the availability of an established protocol is recommended. The future challenge is the establishment of antenatal screening programs similar to that performed in Rh isoimmunization (AU)

Valoración del dolor en el recién nacido. Medidas no farmacológicas para el tratamiento / Pain evaluation in newborn. Non-pharmacological measurements for treatment

Durante mucho tiempo se ha postulado que el reciénnacido no era capaz de percibir dolor. Sin embargohoy existen evidencias anatómicas y fisiológicasque demuestran que el recién nacido, inclusopretérmino, es capaz de percibir dolor.Dado que el dolor es una experiencia emocionalpersonal, debe ser evaluado por el propio paciente.En los neonatos esto no es posible, por lo que existenmétodos objetivos para la valoración del dolor.Estos se basan en la observación principalmente,de parámetros conductuales y fisiológicos. Dichosparámetros se integran en diversas escalas. Lasmás utilizadas son la PIPP (Premature Infant PainProfile) y la CRIES; ambas son sencillas, rápidasde realizar y bien aceptadas por enfermería. En lassalas de hospitalización, los recién nacidos enfermosse ven sometidos a numerosas maniobras dolorosas.Algunos reciben analgésicos mayores, sinembargo esta medida parece excesiva para la mayoríade las maniobras que se realizan de forma repetidaen los recién nacidos ingresados. Las solucionesazucaradas, asociadas o no a una succiónno nutritiva, el método canguro o la lactancia maternahan sido estudiadas durante la realización depunciones y su eficacia analgésica está altamentedemostrada

For many time, it has been postulated that the newborn is not able to sense pain. However, nowadayswe know that there are anatomic and physiologicalevidences that demonstrate that the newborn, evenpremature, is able to sense pain.As pain is a personal emotional experience, it hasto be evaluated by the patient itself. In newborns it isnot possible, so there are objective methods to evaluatepain. These methods are mainly based in theobservation of physiological and behaviour parameters.These parameters are integrated in severalscales. The most used scales are PIPP (PrematureInfant Pain Profile) and CRIES. Both of them aresimple, fast and well-accepted by infirmary staff.In hospitalization rooms, newborns are submittedto many painful handlings. Some of them are givenmajor analgesics, however this measure looks excessivefor most of the handlings. Sugar-solutions,associated or non-associated to a non-nutritive suction,the skin-to-skin contact or breastfeeding havebeen studied during the use of punctures, and itsanalgesic efficiency is highly demonstrated

[Nasal continuous positive airway pressure in preterm infants: comparison of two low-resistance models]. / Presión positiva continua en la vía aérea por vía nasal en el recién nacido prematuro: estudio comparativo de dos modelos de baja resistencia.

OBJECTIVE: To compare the safety and efficacy of two low expiratory resistance models of nasal continuous positive airway pressure (n-CPAP) in preterm infants. MATERIAL AND METHODS: A 1-year prospective trial was performed in the Neonatal Intensive Care Unit of La Fe Hospital to compare the Infant Flow (IF) and Medijet (MJ) devices. All preterm infants requiring n-CPAP for respiratory distress at birth (group I), infants weighting less than 1500 g requiring postextubation (group II) and those with apnea-bradycardia syndrome (ABS) (group III) were included. The patients were randomly assigned to IF or MJ. RESULTS: A total of 125 patients received 226 treatments (IF: n 5 126: MJ: n 5 110). The mean gestational age was 29.4 weeks and the mean birth weight was 1340 g.Efficacy. In group I (n 5 73) no difference were found between systems and 6 hours' after initiation of n-CPAP decreases in FiO2, CO2 and respiratory effort were similar. The need for intubation was also similar (IF: 34.6 %; MJ: 24.1 %). In group II (n 5 73) the need for reintubation at 48 hours was similar with both treatments (IF:19 %; MJ: 8 %). In group III (n 5 80) resolution of ABS was similar after 24 hours of n-CPAP (IF: 46 %; MJ: 58 %). The need for intubation was also similar (IF: 26 %; MJ: 10 %).Complications. Air leaks occurred in six preterm infants (IF: 4; MJ: 2). Severe abdominal distension occurred in 5 % with both systems. Five infants had significant nasal lesions (IF: 1; MJ: 4). CONCLUSIONS: The efficacy and safety of both systems was similar in the variables studied and no significant differences were found.

Presión positiva continua en la vía aérea por vía nasal en el recién nacido prematuro: estudio comparativo de dos modelos de baja resistencia / Nasal continuous positive airway pressure in preterm infants: comparison of two low-resistance models

Objetivo: Comparar la eficacia y seguridad de dos modelos diferentes de presión positiva continua en la vía aérea por vía nasal (CPAP-n) de baja resistencia, en recién nacidos pretérminos. Material y métodos: Estudio prospectivo realizado en cuidados intensivos neonatales del Hospital La Fe durante un año, comparando los sistemas Infant Flow (IF) y Medijet (MJ). Se incluyeron todos los pretérminos que precisaron CPAP-n por distrés respiratorio al ingreso (grupo I), postextubación en menores de 1.500 g al nacimiento (grupo II) y síndrome apneico-bradicárdico (grupo III); asignación aleatoria a uno u otro sistema. Resultados: Estudiamos 125 pacientes, que recibieron 226 tratamientos; 126 con IF y 110 con MJ. Media edad gestacional, 29,4 semanas, y peso al nacimiento, 1.340 g. Eficacia. Grupo I (n 73): no hubo diferencias entre los 2 modelos consiguiéndose a las 6 h del inicio de CPAP-n descensos de la fracción inspiratoria de oxígeno (FiO2), presión parcial de dióxido de carbono (pCO2) y esfuerzo respiratorio; necesidad similar de intubación y ventilación (34,6 por ciento IF y 24,1 por ciento MJ). Grupo II (n 73): porcentaje de reintubación semejante a 48 h (19 por ciento IF y 8 por ciento MJ). Grupo III (n 80): tras 24 h de CPAP-n desaparecieron las apneas en proporción similar (46 por ciento IF y 58 por ciento MJ); precisaron intubación y ventilación 24 por ciento del IF y 10 por ciento del MJ. Complicaciones. Escapes aéreos: 6 pacientes (4 IF y 2 MJ). Distensión abdominal grave: similar con ambos sistemas (5 por ciento). Lesión nasal significativa: 5 pacientes (1 IF y 4 MJ).Conclusiones Los dos sistemas de CPAP-n han sido efectivos y seguros en los supuestos estudiados, sin diferencias significativas en los resultados (AU)

Adenomatosis quística pulmonar: nuestra experiencia en los últimos diez años / Congenital cystic adenomatoid malformation of the lung: our experience over the past ten years

La adenomatosis quística pulmonar es una causa inusual de distrés respiratorio neonatal; sin embargo, es la masa torácica de diagnóstico prenatal más frecuente. Describimos diez casos de adenomatosis quística pulmonar diagnosticados durante la primera infancia. Su clínica, radiología y hallazgos patológicos son analizados y comparados con los datos de la literatura (AU)

Perforación aislada de intestino delgado en pretérmino de muy bajo peso al nacer / Small bowel perforation in a very low birth weight

La supervivencia de recién nacidos prematuros de muy bajo peso al nacer conlleva el diagnóstico de patologías poco frecuentes, como las perforaciones aisladas de intestino delgado. Se presenta el caso clínico de una perforación aislada de intestino delgado en un prematuro con antecedentes perinatales de riesgo isquémico intestinal, que debutó a los 26 días de vida con un cuadro de abdomen agudo y neumoperitoneo. Se analizan las características más sobresalientes de esta patología en relación con la enterocolitis necrotizante (AU)