[Factors associated with atelectasis following extubation in very low weight premature newborns]. / Atelectasia por extubación en neonatos prematuros con muy bajo peso. Factores relacionados con su presencia.

BACKGROUND: Atelectasis is a decrease of lung volume caused by airway obstruction or pressure on the external part of the lung. It is common after surgery and extubation. The purpose of this investigation was to determine factors related with alectasis following extubation in preterm neonates with a weight under 1250 g who were referred to a neonatal intensive care unit. METHODS: The study was conducted in neonates admitted to a neonatal intensive care unit requiring mechanically assisted ventilation. Preterm neonates born at 28 to 36 weeks' gestation and with 0 to 28 days' extrauterine life, with mechanically assisted ventilation for at least 24 hours, and that when undergoing planned extubation had a weight under 1250 g were included. Two comparative groups were formed: group A, with alectasis after extubation; group B, without alectasis after extubation. RESULTS: As factors associated with alectasis after extubation, reintubation in two or more occasions and cycling higher than 20 per minute, which were statistically relevant, were identified. CONCLUSIONS: In addition to previous general measures to prevent alectasis, extubation with ventilation not higher tan 20 cycles per minute should be programmed and reintubation should be avoided as much as possible.

INTRODUCCIÓN: la atelectasia es la disminución del volumen pulmonar causada por obstrucción de las vías aéreas o presión en la parte externa del pulmón. Es común después de una cirugía y de la extubación. El objetivo de esta investigación fue determinar los factores relacionados con la atelectasia posterior a extubación en recién nacidos prematuros con peso menor de 1250 g que fueron referidos a una unidad de cuidados intensivos neonatales. MÉTODOS: el estudio se realizó en los neonatos que ingresaron a una unidad de cuidados intensivos neonatales y que ameritaron asistencia mecánica para la ventilación. Se incluyeron los recién nacidos pretérmino de 28 a 36 semanas de gestación y de 0 a 28 días de vida extrauterina, con asistencia mecánica para la ventilación por lo menos durante 24 horas y que al ser extubados en forma planeada tuvieron un peso menor a 1250 g. Se formaron dos grupos comparativos: grupo A, con atelectasias posterior a extubación; grupo B, sin atelectasia posterior a extubación. RESULTADOS: como factores relacionados con la atelectasia posterior a la extubación se identificó la reintubación en dos o más ocasiones y el ciclado mayor de 20 por minuto, que fueron estadísticamente relevantes. CONCLUSIONES: además de las medidas generales previas, para evitar la atelectasia debe programarse la extubación con parámetros de ventilación no mayores de 20 ciclos por minuto y evitar, en la medida de lo posible, las reintubaciones.

Aparición de la osteopenia en recién nacidos de pretérmino en un servicio de neonatología / Time of onset of osteopenia in preterm newborn in a neonatology service

Introducción. La osteopenia es la disminución de la densidad ósea secundaria a menor mineralización del hueso, y puede presentarse como raquitismo, osteomalacia y osteoporosis. El objetivo del estudio fue detectar el momento en que se presenta la osteopenia en prematuros de un servicio de neonatología. Métodos. Se realizó un estudio observacional, prospectivo, comparativo y clínico. Se incluyeron 30 recién nacidos de pretérmino (RNPT) que ingresaron de noviembre del 2010 a agosto del 2011 y cumplieron con los criterios de inclusión. En todos los pacientes se determinaron los niveles séricos de Ca, P y fosfatasa alcalina, y radiografías de huesos largos a las dos, cuatro, seis y ocho semanas a partir del ingreso. Para el análisis de los datos se utilizó estadística descriptiva e inferencial. Se consideró significación cuando p <0.05. Resultados. La población estudiada estuvo conformada por 30 RNPT con una mediana de edad gestacional de 29 semanas. La mediana de peso al nacimiento fue de 1,055 g. En todos los pacientes se manejó nutrición mixta. Los cambios radiológicos sugestivos de osteopenia fueron reportados en 83.3% de los pacientes durante las primeras dos semanas de estudio. Al final del estudio, 86.7% de los pacientes la presentaron (n = 26). La mediana de la edad de detección de la osteopenia fue de 19 días de vida extrauterina. Conclusiones. La osteopenia del prematuro se presenta alrededor de la tercera semana de vida extrauterina. Estos resultados dan un panorama diferente a lo reportado en la literatura. Por ello, la prevención de la desmineralización ósea debe realizarse más tempranamente.

Introduction. Osteopenia is a decrease in bone density secondary to low bone mineralization and can present as rickets, osteomalacia and osteoporosis. The aim of this study is to detect when osteopenia is presented in preterm newborns (PNB) of a neonatal ward. Methods. We carried out an observational, prospective, comparative clinical trial (study cohort) that included 30 PNB admitted from November 2010 to August 2011 and who met the criteria selection. Alkaline phosphatase levels were considered elevated from 280 IU/L. All patients were administered Ca, P, alkaline phosphatase serum. X-rays of long bones at 2, 4, 6 and 8 weeks after admission were taken. Statistical analysis was performed using descriptive and inferential statistics. Significance levels were set at p <0.05. Results. The study population consisted of 30 PNB with a median gestational age of 29 weeks and median birth weight of 1055 g. Parenteral and enteral nutrition (mixed) was managed in all patients. Radiological changes suggestive of osteopenia were reported in 83.3% of patients during the first 2 weeks of study and at the end of the study in 86.7% of patients (n = 26). The median age of detection of osteopenia was 19 days of life. Conclusions. Osteopenia of prematurity occurs at approximately the third week after birth. These results present a different picture to that reported in the literature since the time of reporting these data. Preventing bone disease should be more timely.

[Associated factors with complications of the use of parenteral nutrition in premature infants]. / Factores asociados a complicaciones del uso de nutrición parenteral en recién nacidos prematuros.

INTRODUCTION: Associated factors with complications of the parenteral nutrition (PN) in the preterm infant have not been well studied and there are some controversies in the literature. OBJECTIVE: To identify associated factors with complications of the use of PN in preterm patients Neonatalogy Service. MATERIAL AND METHODS: We performed a longitudinal, observational, retrospective, comparative study (case-control) from January 2008 to December 2010, of the infants who received PN support covering the inclusion criteria (newborns 28 to 36 weeks gestational age from 0 to 28 days after birth, who received PN for at least 6 days). We excluded patients with cholestasis by anatomic obstruction hepatobiliary tract, metabolic disease or congenital metabolic syndrome (inborn errors of metabolism). Statistical analysis was done using descriptive statistics and inferential. The associated factors were investigated through the OR (odds ratio) and multivariate analysis. Significance levels were set at p < 0.05. RESULTS: The total number of patients studied was 67, which is divided into two groups: group A (n = 35) preterm infants with complications secondary to treatment with PN and group B (n = 32), preterm no complications from the procedure. Of all patients in group A, cases, 13 (37%) had mechanical complications; 14 (40%) patients, infectious related with PN or venous catheter (administration via) and 32 (91.4%) patients with metabolic complications as disorders of glucose homeostasis and hyperglycemia predominated (20 patients in group A which corresponds to 57%). In multivariate analysis revealed as protective factors in the use of average protein < 3 g/kg/ day in the first week, osmolarity of the mixture average < 1,200 mOsm/L and relationship non-nitrogenous calories: protein nitrogen > 140:1. CONCLUSIONS: While there are already installed factors that can not be modified, such as prematurity and low birth weight start nutritional therapy, an adequate proportion of nutrients and osmolality of the mixture can reduce the presence of complications associated with PN.

[An index internal diameter ductus arteriosus/body surface area as a need for closure of duct in the preterm newborn]. / Un índice del diámetro interno del conducto arterioso/superficie corporal como necesidad de cierre del conducto en el recién nacido de pretérmino.

OBJECTIVE: To determine a rate of internal diameter (ID), the narrowest of ductus arteriosus (DA)/body surface area (BSA) in preterm newborns (PTNB) for need for closure of DA either medically or surgically. MATERIAL AND METHODS: Prospective (cohort), held in a Neonatology Service in February 2010 to January 2011. Inclusion criteria were PTNB from 28 to 36 weeks of gestation from 0 to 28 days after birth, which confirmed diagnosis of patent ductus arteriosus (PDA) by echocardiogram, taking the narrowest ID, who did not present heart complex congenital or other major malformations in other systems without pulmonary arterial hypertension, that had not received drug treatment with prostaglandin inhibitors to close the DA. The exclusion criteria for complications of mechanical ventilation (air leaks, atelectasis, etc.) before measurements. BSA was determined based on their weight and height. There were two comparison groups during its evolution, those who finally merited either closure medical or surgical closure or was indicated but the poor conditions of the patient by the same PDA mainly, the procedure was not carried out (Group A) and Group B, those that are not operated or not medically closed DA not being hemodynamically significant [corrected]. Statistical analysis was performed using descriptive statistics and inferential. Significance levels were set at p < 0.05. RESULTS: The study population consisted of 32 patients who were divided into two groups: group A of 13 patients and group B with 19 patients. The study population characteristics between the two groups showed significant difference only in the Apgar Score for the Group B. In multivariate analysis found statistically significant as need for closure of DA only a index ID DA/ BSA when it was > 14. CONCLUSIONS: It is important to take into account a number of known ways to assess whether the DA is hemodynamically significant and therefore should be closed medically or surgically and according to this study, a parameter to requiring its closure is an index ID DA/BSA with a value > 14.

[Variations of vital signs and peripheral oxygen saturation in critically ill preterm newborn, after sponge bathing]. / Variaciones de los signos vitales y saturación periférica de oxígeno en el recién nacido de pretérmino críticamente enfermo después del baño de esponja.

OBJECTIVE: To determine the variability of the vital signs (temperature, heart rate and respiratory frequency), skin coloration and peripheral oxygen saturation in critically ill preterm newborns (CI PTNB) before, during and after sponge bathing as well as to determine the possible presence of secondary complications of this procedure. MATERIAL AND METHODS: We performed a quasi-experimental study (experimental, prospective, comparative and clinical study with intervention) May to December 2008, in a Neonatal Intensive Care Unit. We included CI PTNB of 0 to 28 days of extrauterine life who have practiced in the routine sponge bathing. Area of significance was considered when p < 0.05. RESULTS: During or after the events in any of the patients presented any complications after 12 h of monitoring, but it was necessary to increase the inspired fraction of oxygen and temperature in the incubator or radiant heat cradle temporarily. CONCLUSIONS: We conclude that the sponge bath is not safe for a CI PTNB and this should be performed in the shortest time possible, and the medical must be very alert to the possibility that patients require more support than they had prior to sponge bathing, mainly in the temperature of the incubator or radiant heat cradle and inspired fraction of oxygen for the required time according to the evolution of these variables.

[Associated factors to extubation failure of neonates and infants with bronchopulmonary dysplasia]. / Factores asociados a falla en la extubación de recién nacidos y lactantes con displasia broncopulmonar.

INTRODUCTION: The extubation failure is a common problem in newborn (NB) and infants diagnosed with bronchopulmonary dysplasia (BPD), a situation that prolongs the mechanical ventilatory support (MVS) and increases the risk of further laryngotracheal and pulmonary damage that predisposes to fail in the procedure. There are no studies in the literature about this problem. OBJECTIVE: To identify associated factors to extubation failure in newborns and infants with diagnosis of BPD. MATERIAL AND METHODS: We retrospectively included all cases of newborns and infants with BPD who had been admitted to a neonatal intensive care unit (NICU) during the period January 2004 to June 2009 that met the selection criteria. Two groups the A, cases (extubation failure) and group B, controls (no extubation failure) were conformed. Inclusion criteria for both groups were preterm newborns of 28 to 36 weeks gestational age at birth (or corrected) or infants who had been with MVS at least 24 h and who had or does not extubation failure if so, at least on one occasion, both after the diagnosis of BPD in the first 72 h of being extubated and had no major malformations in any organ or system, with extra-uterine life up to 90 days. It was considered extubation failure when the NB or infant extubated after there need reintubated in the first 72 h, and was considered the second extubation failure under the same criteria after having failed the first extubation. Statistical analysis was performed using descriptive and inferential statistics. Significance levels were set at p < 0.05. RESULTS: The study population consisted of 89 patients who were divided into 2 groups: group A (cases) with 69 patients and group B (controls) with 20 patients. The characteristic of the population studied in both groups showed no significant differences between them with p > 0.05. In multivariate analysis before the first extubation showed statistically significant patent ductus arteriosus for cases with p = 0.01. Before the second extubation in the cases group versus before the first extubation in the control group showed also in the multivariate analysis statistical significance only peak inspiratory pressure (PIP) > or = 14 cm H2O (in 3 of 69 cases and in 16 of 20 controls) (p < 0.001), as a protective factor. CONCLUSIONS. Patients with BPD the extubation should be planned closure of the ductus arteriosus when present, even without hemodynamically significant and with ventilator parameters most demanding as PIP would be > or = 14 cm H2O and moreover the latter in the second attempt at extubation, and to take into account other aspects known to decrease the incidence of extubation failure as far as possible, with improved prognosis.

[Features of hospital-acquired infections in newborns with culture-positive]. / Características de las infecciones nosocomiales en el recién nacido con cultivo positivo.

OBJECTIVE: To determine the prevalence of nosocomial infection (NI) in newborns (NB) as well as the etiology, frequency mortality related to these infections in a tertiary-care hospital. MATERIAL AND METHODS: A retrospective epidemiological study was carried out with NB admitted to a tertiary-care neonatology hospital service from January 2006 to December 2008 who complied with selection criteria. All NB between the gestational ages of 25 to 44 weeks, NI supported by positive culture and either local or systemic infection were included. Descriptive statistic was used. RESULTS: NI prevalence in the Neonatal Service was an average of 30.4%. The most common microorganisms isolated in first event cultures (n = 100) were Gram-positive bacteria such as coagulase-negative staphylococci found in 55 patients (55%), followed by Gram-negative bacteria present in 44 patients (44%) and fungi such as Candida albicans and Candida sp. from 8 patients (8%); as to the second event (n = 32), Gram-negative bacteria were isolated from 20 patients (62.5%), Gram-positive bacteria such as coagulase-negative staphylococci were present in 6 patients (18.7%) and fungi such as Candida albicans were found in 5 patients (15.6%). Finally, regarding the third event (n = 18), Gram-negative bacteria were present in 16 patients (88.9%), Gram-positive bacteria were found in 15 patients (83.3%) such as coagulase-negative staphylococci in 10 patients (55.5%), and fungi such as Candida sp. in two (11.1%). Twelve (12%) who died secondary to IN, two suffered three NI events. CONCLUSIONS: Awareness of the various characteristics of NI in the work area (etiology, prevalence, and final outcome) is of great importance to design new interventions.

[Mechanical ventilation parameters associated to barotrauma in a neonatal intensive care unit]. / Parámetros de ventilación mecánica asociados a barotrauma en una unidad de cuidados intensivos neonatales.

OBJECTIVE: To identify the parameters of mechanical ventilation related to barotrauma and to identify associated diseases. MATERIAL AND METHODS: There was a partial retrospective study which included all the files and/or newborns (NB) who were in the Neonatal Intensive Care Unit during March 2003 to April 2008 met the inclusion criteria. Two groups were conformed, the group A, cases (those with barotrauma) and B controls (that did not show it). Area of significance was considered when p < 0.05. RESULTS: In multivariate analysis was only significant relevance in relation to the ventilatory parameters mean airway pressure (MAP) > 10 cm H20 on the eighth day, and as confronted all variables including one different from the ventilator as arterial blood gases in the multivariate analysis also, the oxygenation index (OI) with a value > 10 showed statistical significance as it preceded to the barotrauma. The pathology associated with barotrauma was patent ductus arteriosus (PDA) hemodynamically significant with p < 0.05. CONCLUSIONS: Based on the foregoing its is concluded that when a NB patient with mechanical ventilatory support after the first days, to improve lung compliance should be going down different ventilatory parameters as soon as possible to avoid reaching a MAP > 10 cm H2O above the eighth day of ventilatory management, but OI > 10 at any time would be announcing the possibility of barotrauma and other side to treat the significant hemodynamically PDA either medically or surgically in the shortest time.

[Associated factors to extubation failure in the term newborns from a neonatal intensive care unit]. / Factores asociados para falla en la extubación de recién nacidos de término de una unidad de cuidados intensivos neonatales.

INTRODUCTION: The mechanical ventilator support (MVS) it is a procedure which improves survival of critically ill newborns (NB), but is not risk free one of them is tracheal damage reintubations by extubation failure. Knowledge that there is the medical literature is about preterm infant and there is not information about term NB. OBJECTIVE: To establish that factors are associated to the unsuccessful extubation in the term NB from 37 to 42 weeks of gestational age. MATERIAL AND METHODS: Retrospective study, of case-control in cohort including all the files and/or patient term NB that were interned in the Neonatal Intensive Care Unit of a Neonatology Service during the period of January from the 2004 to December of 2008 that they fulfilled the selection criteria. They were formed two groups: group A of cases (extubation failure) and group B of controls (successful extubation). Extubation failure was considered when there was need for the patient reintubate during first 72 hrs. We take into account to patient of term NB of one to 28 days of extrauterine life that remained with MVS at least 24 hrs and that to extubate was achieved with or without success, previous step for tracheal continuous positive airway pressure (CPAP), and that they were not more than 28 days with MVS. The statistical analysis was carried out by means of the descriptive and the inferential statistic. It was considered area of significance with p < 0.05. RESULTS: Fourty one patients were included divided in two groups: group A (cases) of 17 patients, and group B (controls) with 24 patients. The population's characteristics studied among the two groups didn't show significant differences. Of the variables studied between the two groups showed significant differences of age at start of ventilation, calories and the hemoglobin for controls and the time spent with MVS, reintubations number, and the peak inspiratory pressure (PIP) prior to the passage of the CPAP for cases, all with p < 0.05. In the multivariate analysis they were significant association as factor of risk for the extubation failure when the PIP was > 18 cm H2O, cycles > 15x' and hemoglobin < 13 g/dL. CONCLUSIONS: Based on the above we conclude that in the term NB with MVS before placing in tracheal CPAP for the extubation should have a PIP < or = 18 cm H2O, cycles < or = 15x' and a hemoglobin not smaller than 13 g/dL to avoid this way as much as possible the extubation failure and with it to improve the prognosis.

[Predictors factors for the extubation failure in two or more times among preterm newborn]. / Factores predictores para falla en la extubación en dos o más ocasiones en el recién nacido de pretérmino.

INTRODUCTION: With the ventilatory mechanical attendance has been prolonged the life of the preterm newborn (PTNB) critically sick and during that lapse many occasions it is necessary reintubation to PTNB in two or more times with the subsequent damage that makes enter to the patient to a vicious circle with more damage during the same reintubated. The objective of this study was to determine the factors that predict the extubation failure among PTNB from 28 to 36 weeks of gestational age in two or more times. MATERIAL AND METHODS: It was considered extubation failure when in the first 72 hours of being had extubated the patient; there was reintubation necessity, independent of the cause that originated it. For the second extubation or more took the same approach. During the period of September to December of the 2004 were included in retrospective study to all PTNB that were interned in one hospital of third level that fulfilled the inclusion approaches (one study published where we take account the first extubation failure) and in retrolective study to the patients of the same hospital of January to October of the 2006. They were formed two groups, group A of cases (who failed in extubation two or more times) and the B of controls (who failed in extubation for the first time). The descriptive statistic and the inferential through of Student t test or Mann-Whitney U or rank sum test Wilcoxon, in suitable case; Chi-square or Fisher's exact test was used. Odds ratio (OR) and multivariate analysis for to study predictors factors for the extubation failure was employed. Statistical significance was considered at p < 0.05. RESULTS: The group A it was conformed by 21 patients and the group B for 20 patients. In the multivariate analysis it was association like predictive factor for fail of the second extubation to the presence of postextubation atelectasis with an OR 19.2 with IC to 95% of 3.1-117 (P = 0.001) and preextubation oxygenation index (IO2) >2, OR 5.3, IC to 95% of 1.3-21.4 (P = 0.02). In the bronchoscopy study they were some anatomical alterations that they explained the extubation failure in the second time. CONCLUSIONS: We conclude that it is important to plan an extubation in the PTNB, when there has already been a previous failure, and to avoid the well-known predictors factors for extubation failure as much as possible in the extubation in the PTNB, and that according to that found in this study non to extubate with an IO2 >2, and to manage the atelectasis postextubation intensively. Later to the pursuit of those limits and after a second extubation failure, be probably necessary to pass to bronchoscopy if the patient's conditions allow it.

[Risk factors associated to complications of the mechanical ventilatory assistance in the premature newborn]. / Factores de riesgo asociados a complicaciones de la asistencia mecánica ventilatoria en el recién nacido prematuro.

OBJECTIVE: To determine risk factors associated with the presence of complications with mechanical ventilatory support (MVS) in the preterm infants (PI). METHODS: One hundred thirty medical records of PI that had been discharged by amelioration or death were reviewed retrospectively. They were divided in two groups: group A, PI that had presented complications during MVS (cases) and B, PI with MVS, but that had not presented complications due to the procedure (controls). Statistical significance was considered at p < 0.05. RESULTS: The significative risk factors in the multivariate analysis reached significance for the associated of complications: gestational age (32 weeks or less), orotracheal reintubations three o more times, cycles of 60 per minute or more at the third day of being had initiate the MVS, and the symptomatic patent ductus arteriosus (PDA), all with p < 0.05. CONCLUSIONS: It will be necessary to impact more on the cycles level to diminish him below 60 per minute to the third day when it is feasible, to make the smallest reintubations number, to correct quickly the PDA when it is symptomatic, to avoid this way as much as possible, the complications of the MVS.

[Predictor factors for the production of bronchopulmonary dysplasia in the preterm newborn]. / Factores predictores para la producción de displasia broncopulmonar en el recién nacido de pretérmino.

INTRODUCTION: The bronchopulmonary dysplasia (BPD) is a lung illness chronicle that is developed in preterm newborn (PTNB) mainly, secondary to multiple factors of risk which have not been studied completely. OBJECTIVE: To determine the predictors factors (of risk factors) for the production of BPD in the PTNB of 28 at 36 weeks of gestational age. MATERIAL AND METHODS: Eighty medical records from January 2004 to May 2006 of PTNB that there was received mechanical attendance to the ventilation (MAV) at least 24 hrs were reviewed retrospectively. They were divided in two groups: group A, PTNB that had BPD, composed of 40 patients (cases) and group B, PTNB with MAV but that had not developed BPD due to the procedure of 40 patients too (controls). It was used descriptive and inferential statistic. Odds ratio (OR) and multivariate analysis were used to study predictors factors. Statistical significance was considered with P < 0.05. RESULTS: There was significant difference of the supply of the intravenous (i.v.) fluids the days 2, 3, 4 and 7 of extrauterine life (EUL), of the oxygen inspired fraction (FiO2) of in the day 7 of being had initiate the MAV, of the peak inspiratory pressure (PIP) in the day 1 and 3 of being had initiate the MAV everything to favor of the cases, with P < 0.05. In the multivariate analysis was significative in the intake of i.v. fluids > or = 140 mL x kg of weight x day to the fourth day of EUL, the oxygen arterial pressure (PaO2) > 70 mm Hg for > 4 days, reintubations number (two or more times) and the symptomatic patent ductus arteriosus (PDA), all with P < 0.05. CONCLUSIONS: We concluded that, in critically sick PTNB, they exist one series of well-known risk factors but more specified in this study that they should avoid as much as possible; the handling of the liquids i.v. should be cautious, not to spend of 139 mL x kg x day to the 4th day of EUL, not to be so permissive with the PaO2 maintaining it in values < or = 70 mm of Hg after four days, to avoid as much as possible the reintubations and to treat the but quick the symptomatic PDA still without that it is significant, to diminish this way, the risk of BPD.

[Comparison of oxygen saturation among newborns with bronchopulmonary dysplasia during and after feeding]. / Comparación de la saturación de oxígeno en lactantes con displasia broncopulmonar antes, durante y después de la alimentación.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is associated with frequent events of hypoxemia specially during feeding. OBJECTIVE: Determine peripheral oxygen saturation (SpO2) among infants with BPD before, during and after feeding. METHODS: Patients with diagnosis of BPD were prospectively studied between July-September, 2005. SpO2 was measured with a manual digital pulsioxymeter 5 times during feeding. Alpha levels were set at p<0.05. RESULTS: 67 events were studied in 18 patients. For each participant, oxygen saturation was measured five times yielding a total of 335 recordings. Frequent desaturation episodes were recorded during feeding, (SpO2<88%) in 16 of the 18 cases. SpO2 reached 80% for some recordings among 67% of participants (n=12), with p<0.001. CONCLUSION: Among BDP patients, SpO2 decreases during feeding, reaching severe desaturations (SpO2<80%) among in two thirds of the cases. Oxygen concentration must be sufficiently increased during feeding in order to rise the level of SpO2 to a minimum of 88%.

Comparación de la saturación de oxígeno en lactantes con displasia broncopulmonar antes, durante y después de la alimentación / Comparison of oxygen saturation among newborns with bronchopulmonary dysplasia during and after feeding

Antecedentes: La displasia broncopulmonar se relaciona con eventos frecuentes de hipoxemia, en especial durante la alimentación. El objetivo de este estudio fue determinar la saturación periférica de oxígeno (SpO2) en lactantes con displasia broncopulmonar, antes, durante y después de la alimentación. Métodos: Prospectivamente se estudiaron pacientes con displasia broncopulmonar del 1 de julio al 30 de septiembre de 2005, realizando mediciones de SpO2 a través de un pulsioxímetro digital de mano en cinco ocasiones con relación a la alimentación. Se consideró zona de significancia con p<0.05. Resultados: En 18 pacientes se estudiaron 67 eventos, midiendo en cada uno la SpO2 en cinco ocasiones, para un total de 335 mediciones; hubo momentos de desaturación frecuentes (SpO2 menor de 88%) en 16 pacientes de los 18, y SpO2 por debajo de 80% en alguna medición, en 67% de ellos (n=12), con p<0.001. Conclusiones: La SpO2 en pacientes con displasia broncopulmonar disminuye durante la alimentación llegando a niveles severos (menos de 80%) en las dos terceras partes de los casos, por lo que se sugiere que durante la misma se incremente la concentración de oxígeno lo suficiente como para llevarlos a una saturación de 88%, por lo menos.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is associated with frequent events of hypoxemia specially during feeding. OBJECTIVE: Determine peripheral oxygen saturation (SpO2) among infants with BPD before, during and after feeding. METHODS: Patients with diagnosis of BPD were prospectively studied between July-September, 2005. SpO2 was measured with a manual digital pulsioxymeter 5 times during feeding. Alpha levels were set at p<0.05. RESULTS: 67 events were studied in 18 patients. For each participant, oxygen saturation was measured five times yielding a total of 335 recordings. Frequent desaturation episodes were recorded during feeding, (SpO2<88%) in 16 of the 18 cases. SpO2 reached 80% for some recordings among 67% of participants (n=12), with p<0.001. CONCLUSION: Among BDP patients, SpO2 decreases during feeding, reaching severe desaturations (SpO2<80%) among in two thirds of the cases. Oxygen concentration must be sufficiently increased during feeding in order to rise the level of SpO2 to a minimum of 88%.

[Oxygen peripheral saturation using pulse oxymetry among healthy term newborns at Mexico's altitude (2240 m)]. / Saturación periférica de oxígeno por oximetría de pulso en recién nacidos clínicamente sanos a la altitud de la Ciudad de México (2240 m).

BACKGROUND: Oxygen peripheral saturation (SpO2) is crucial for an adequate management of critically-ill newborns infants (NB). The objective of the present study was to determine SpO2 by pulse oxymetry among healthy term and preterm NBs at an altitude of 2240 m above sea level. METHODS: Observational, cross-sectional and comparative. 218 NBs were prospectively studied between January to April 2004. Eighty nine were term and 128 were preterm. Alpha levels were set at p<0.05. RESULTS: The recorded lower value for SpO2 was 88%, and the maximum was 99%. We observed a significant SpO2 difference among the term NB (93.5+/-2%) and preterm NBs (92.9+/-2%), p=0.01. CONCLUSIONS: SpO2 in Mexico City's altitude is on average lower when compared to that observed at sea level. In general with a minimum and maximum values found in our study the SpO2 needed to maintain a critically sick NB with supplementary O2, is suggested. Values should be kept at between 88% and 94% to avoid hypoxemia and hyperoxemia.

[Final outcome of preterm neonates with and without surgical treatment of patent ductus arteriosus]. / Evolución final de recién nacidos prematuros operados y no operados por persistencia del conducto arterioso.

BACKGROUND: Patent ductus arteriosus (PDA) in the preterm neonate (PTN) with respiratory distress is frequent and there are controversies related to its medical and/or surgical treatment. The goal of the present study was to compare the outcome between the two groups of newborns with PDA, operated (group A) and not operated on (group B); and to determine the internal diameter (DI) in ductus arteriosus (DA) on outcome. MATERIAL AND METHODS: The clinical records of PTN hospitalized from January 1999 to January 2002, discharged either by improvement or death, were retrolectively analyzed. Statistical analysis was carried out using the descriptive and inferential statistic. The statistical significance was considered at p<0.05. RESULTS: The was significant difference in DI in DA in favor group A with p<0.01; and DI of 2 mm or more showed significant difference too in favor of group A with a p=0.0006. The mortality was similar in the two groups. CONCLUSIONS: We concluded that in the PTN with significant PDA should intervene medical or surgically and without those data but with DI of 2 mm or more of DA, also.

Saturación periférica de oxígeno por oximetría de pulso en recién nacidos clínicamente sanos a la altitud de la Ciudad de México (2240 m) / Oxygen peripheral saturation using pulse oxymetry among healthy term newborns at Mexico's altitude (2240 m)

Antecedentes: La saturación periférica de oxígeno (SpO2) es importante para monitorizar al recién nacido (RN) críticamente enfermo. Se llevó a cabo un estudio prolectivo, observacional, transversal y comparativo para determinar la SpO2 por oximetría de pulso en RN de término y pretérmino clínicamente sanos a una altitud sobre el nivel del mar de 2240 m. Métodos: Se estudiaron de enero a abril de 2004, 218 RN, 89 de término y 128 pretérmino. Se consideró zona de significancia a una p<0.05. Resultados: La SpO2 más baja registrada fue de 88% y la máxima de 99%. Hubo diferencia de la SpO2 entre los RN de término (93.5±2%) y los pretérmino (92.9±2%), con p=0.01. Conclusiones: La SpO2 a la altitud de la Ciudad de México se encuentra en promedio menor respecto a la hallada a nivel del mar, pero en general con un mínimo y máximo similar a esa altitud. La SpO2 para mantener a un RN críticamente enfermo con O2 suplementario se sugiere debe de ser igual a lo ya conocido, entre 88 y 94 %, para evitar hipoxemia e hiperoxemia a la altitud estudiada.

BACKGROUND: Oxygen peripheral saturation (SpO2) is crucial for an adequate management of critically-ill newborns infants (NB). The objective of the present study was to determine SpO2 by pulse oxymetry among healthy term and preterm NBs at an altitude of 2240 m above sea level. METHODS: Observational, cross-sectional and comparative. 218 NBs were prospectively studied between January to April 2004. Eighty nine were term and 128 were preterm. Alpha levels were set at p<0.05. RESULTS: The recorded lower value for SpO2 was 88%, and the maximum was 99%. We observed a significant SpO2 difference among the term NB (93.5+/-2%) and preterm NBs (92.9+/-2%), p=0.01. CONCLUSIONS: SpO2 in Mexico City's altitude is on average lower when compared to that observed at sea level. In general with a minimum and maximum values found in our study the SpO2 needed to maintain a critically sick NB with supplementary O2, is suggested. Values should be kept at between 88% and 94% to avoid hypoxemia and hyperoxemia.

Evolución final de recién nacidos prematuros operados y no operados por persistencia del conducto arterioso / Final outcome of preterm neonates with and without surgical treatment of patent ductus arteriosus

Antecedentes: La persistencia del conducto arterioso (PCA) en el recién nacido prematuro con problema respiratorio es frecuente y su manejo es controvertido. El objetivo del presente estudio fue comparar la evolución final entre dos grupos de recién nacidos pretérmino con PCA operados (grupo A) y no operados (grupo B) y determinar el papel del diámetro interno del conducto arterioso en la evolución final. Material y métodos: Retrolectivamente se analizaron los expedientes de pacientes recién nacidos pretérmino de enero de 1999 a enero de 2002 que egresaron vivos o muertos. Se utilizó la estadística descriptiva y la inferencial. Se consideró zona de significancia con p<0.05. Resultados: Hubo diferencia estadísticamente significativa en el diámetro interno del conducto arterioso a favor del grupo A, con p<0.01; también hubo diferencia significativa a favor del grupo A cuando el diámetro interno del conducto arterioso fue ≥2 mm, con p=0.0006. La mortalidad fue similar en los dos grupos. Conclusiones: Se concluye que en todo recién nacido pretérmino con PCA significativo debe intervenirse médica o quirúrgicamente, y sin esos datos pero con diámetro interno ≥2 mm del conducto arterioso, también.

BACKGROUND: Patent ductus arteriosus (PDA) in the preterm neonate (PTN) with respiratory distress is frequent and there are controversies related to its medical and/or surgical treatment. The goal of the present study was to compare the outcome between the two groups of newborns with PDA, operated (group A) and not operated on (group B); and to determine the internal diameter (DI) in ductus arteriosus (DA) on outcome. MATERIAL AND METHODS: The clinical records of PTN hospitalized from January 1999 to January 2002, discharged either by improvement or death, were retrolectively analyzed. Statistical analysis was carried out using the descriptive and inferential statistic. The statistical significance was considered at p<0.05. RESULTS: The was significant difference in DI in DA in favor group A with p<0.01; and DI of 2 mm or more showed significant difference too in favor of group A with a p=0.0006. The mortality was similar in the two groups. CONCLUSIONS: We concluded that in the PTN with significant PDA should intervene medical or surgically and without those data but with DI of 2 mm or more of DA, also.

[Predictive factors of failure extubation among preterm infants]. / Factores predictores de falla en la extubación en recién nacidos de pretérmino.

OBJECTIVE: To determine the factors that lead to extubation failure among preterm newborns (PTN). MATERIAL AND METHODS: Failure was determined when patients had to be reintubated during the first 72 hours. Critically-ill preterm newborns needing mechanical assisted ventilation at least during 24 hours were studied prospectively. Two groups were included: Group A, who failed in extubation for the first time and Group B, a control group who did not fail. Significance was set a p <0.05. RESULTS: Gestational age and birth weight showed significant differences in Group B (control group). Significant factors in the multivariate analysis were gestational age < 32 weeks, caloric intake < or = 100 calories/kg/day and mean airway pressure (MAP) > or = [corrected] 4.5 cm H2O. CONCLUSIONS: According to our results, an extubation should be planned whenever a patient is a PTN, has a gestational age of <32 weeks, a caloric intake >100 cal/kg/day, and its ventilator MAP is <4.5 cm H2O.

Factores predictores de falla en la extubación en recién nacidos de pretérmino / Predictive factors of failure extubation among preterm infants

Objetivo: Determinar los factores que originan la falla en la extubación en recién nacidos de pretérmino (RNPT). Material y métodos: Se consideró falla en la extubación cuando hubo necesidad de reintubar al paciente en las primeras 72 horas. Se estudiaron en forma prospectiva a los RNPT críticamente enfermos que habían estado con asistencia mecánica ventilatoria durante por lo menos 24 horas. Se integraron 2 grupos: un grupo A (casos) con RNPT que tuvieron fallas en la primera extubación y un grupo B (control) con RNPT que no tuvieron fallas en la extubación. Se consideró zona de significancia con p menor a 0.05. Resultados: La edad gestacional y el peso al nacer mostraron diferencias significativas a favor del grupo B (control). Los factores que mostraron significancia en el análisis multivariado, fueron la edad gestacional (< 32 semanas), el aporte calórico (≤ 100 cal/Kg/ día) y la presión media de vías aéreas (PMVA) (≥ 4.5 cm H2O). Conclusiones: De acuerdo con lo encontrado en este estudio, antes de realizar la extubación habrá que considerar si el RNPT tiene menos de 32 semanas de edad gestacional, por lo menos un aporte calórico superior a 100 cal/Kg/día y una PMVA en el ventilador menor a 4.5 cm H2O.

OBJECTIVE: To determine the factors that lead to extubation failure among preterm newborns (PTN). MATERIAL AND METHODS: Failure was determined when patients had to be reintubated during the first 72 hours. Critically-ill preterm newborns needing mechanical assisted ventilation at least during 24 hours were studied prospectively. Two groups were included: Group A, who failed in extubation for the first time and Group B, a control group who did not fail. Significance was set a p <0.05. RESULTS: Gestational age and birth weight showed significant differences in Group B (control group). Significant factors in the multivariate analysis were gestational age < 32 weeks, caloric intake < or = 100 calories/kg/day and mean airway pressure (MAP) > or = [corrected] 4.5 cm H2O. CONCLUSIONS: According to our results, an extubation should be planned whenever a patient is a PTN, has a gestational age of <32 weeks, a caloric intake >100 cal/kg/day, and its ventilator MAP is <4.5 cm H2O.