Perinatologia y Reproduccion Humana最新文献

Introduction

Due to the risk of premature infants suffering from hyperoxic reperfusion injury, it is reasonable to control the oxygen supply without exposing them to excessive levels.

Objective

To determine the oxygen requirements and saturation levels, at 5 and 10 minutes during neonatal resuscitation, and their association with neonatal morbidity in premature neonates between 27 and 30 weeks of gestational age.

Material and methods

An observational and analytical study was conducted. The inclusion criteria were, neonates between 27 and 30 weeks of gestational age, and the exclusion criteria were, major congenital defects, and death before 36 weeks of gestational age. They were divided into two groups: Group 1, those with gestational age of 27-28 weeks, and Group 2, those with 29-30 weeks. An analysis was performed on the prenatal and neonatal variables, oxygen requirements, oxygen saturation, and neonatal morbidity.

Results

There were 39 patients in Group 1, and 31 in Group 2. The fraction inspired average of oxygen for Group 1 at 5 minutes was 77.56% and for Group 2 it was 64.9%, P = .045. Group 1 required a higher concentration of oxygen to reach saturations > 80%. An increased risk of intraventricular haemorrhage was observed in Group 1 (OR 3.21, 95% CI; 1.07-9.60). As regards the morbidity of both groups, there was no relationship with oxygen saturation during the neonatal resuscitation.

Conclusion

Neonatal morbidity is multifactorial. In this study no relationship was found between neonatal morbidity and oxygen saturation during resuscitation.

Introduction

Skin-to-skin contact (CPP) is the placement of the naked newborn on the mother's breast, covered only with a cap, sheet or gown.

Objective

To determine the effect of skin-to-skin contact in the breastfeeding of infants in the National Institute of Perinatology.

Material and methods

Prospective, descriptive, observational, and cross-sectional study was performed, including a search for the information in the database of the Immediate Care Unit for the Newborn from 1 August 2015 to 31 July 2016. The data obtained were Gestational age, weight, Apgar, maternal pathology, skin-to-skin contact, duration, and feeding.

Results

There were 3175 births, with 2228 term neonates. CPP was performed in 1486 neonates (78.95%), with a weight of 2,045 to 4,200 g. The majority of patients who were breastfed (78.7%) had had skin-to-skin contact. Likewise, it was observed that CPP significantly favoured breastfeeding (RR=143.28; 95% CI: 75.5-271.7).

Discussion

CPP favours breastfeeding (99.2%), making the first food human milk, and reducing the use of substitutes.

Conclusions

Skin-to-skin contact is the best opportunity for the initiation of breastfeeding. The separation of mothers and their children at birth has become a common practice in the delivery and operating rooms, due to hospital routines, placing the infant in a cradle of radiant heat, and initiating breastfeeding after one hour of life.

Introduction and objective

Mothers enjoy the experience of skin-to-skin contact immediately after birth, and this raises the possibility that such contact can help these mothers feel more secure with their babies.

Objective

To describe the experience of mothers during skin-to-skin contact immediately after birth by normal delivery and caesarean section.

Material and methods

A cross-sectional, descriptive, observational, and prospective study was carried out in the Toco-Surgical Unit of the National Institute of Perinatology, in Mexico City, in order to describe the experience of mothers during skin-to-skin contact at birth in healthy term newborns, during the period from 1 September 2015 to 31 July 2016. The mothers were asked to describe their experience during skin-to-skin contact at birth. The results were analysed using Wizard Pro Version 1.9.7.

Results

Interviews were carried out over an 11-month period on 779 mothers that experienced skin-to-skin contact at birth. This was categorised by level of satisfaction as, very satisfactory, satisfactory, and not very satisfactory, with 570 cases (73.2%) being found as very satisfactory, 201 (25.8%) cases as satisfactory, and 8 cases (3%) as not very satisfactory. There was no statistically significant difference (P = .212) as regards the level of satisfaction and the birth route; thus it may be inferred that the level of satisfaction of the mother is independent of the birth route.

Conclusions

The placing of the newborn on the mother's breast after birth is a happy and very satisfying experience for the vast majority of mothers.

Introduction

Intraventricular haemorrhage (IVH) is the most frequent neurological complication of the premature infant, and is associated with an adverse neurological outcome. The objective of this study was to identify risk factors associated with IVH in preterm infants less than 1500 g in the NICU.

Material and methods

A cohort of preterm infants less than 1500 g, admitted to the NICU during 2016, were followed up during their hospital stay until their discharge to home, or death. Perinatal and neonatal variables were analysed. For the statistical analysis, those that developed IVH were compared with those that did not, using the chi-squared test, Student's t-test, odds ratio (OR), and mean difference, with a 95% confidence interval.

Results

IVH was present in 45 (33.3%) neonates, out of a total of 135, being grade 1 in 22 (16%), grade 2 in 6 (4.4%), grade 3 in 8 (5.9%), and grade 4 in 9 (6.6%). C-section had a favourable effect on those babies without IVH (OR: 0.18; 95% CI: 0.07-0.45). The mortality was higher in babies with IVH (OR: 4.63; 95% CI: 1.76-12.11). The birth weight and gestational age were less in those with IVH (887 vs 979 g, and 28.1 vs 29.26 GW). The mortality in severe IVH (grade 3+4) was 64.7%, and in grade 1+2 IVH it was 10.7% (P=.0006).

Conclusions

IVH in infants less than <1500 g is a frequent morbidity, especially in those with low gestational age and birth weight. Severe IVH was associated with mortality.

Introduction

With the advances of perinatal and neonatal care, the survival of premature infants has increased. The birth weight and gestational age are the most important determinants of morbidity and neonatal mortality rates. The objective of this study was to determine the morbidity and mortality of neonates with birth weight < 1500 g who required admission into NICU.

Material and methods

An analysis of a cohort of neonates < 1500 g admitted to the NICU was carried out consecutively from January to December 2016, with the determination of prenatal care variables (prenatal steroids, use of magnesium sulphate, delivery mode), and neonatal variables (birth weight, gestational age, morbidity and mortality). Statistical analyses in the group of neonates who survived and those who died, included the calculation of chi squared test, Student t test, and Odds Ratio, with 95% confidence interval (OR, 95% CI).

Results

The study included 135 neonates, 113 (83.71%) of whom survived and 22 (16.29%) died. Birth weight was significantly lower for patients who died (969 g vs 842 g, P = .0074) as well as gestational age (29 vs 27.9, P = .01). As regards the morbidity of those who survived, severe BPD was present in 38%, severe IVH grade III/IV in 20%, and severe ROP in 2.6%. The principal cause of mortality was sepsis.

Discussion

In this study, mortality was similar to other countries such as Norway, Spain, and some Latin American countries.

Conclusion

Survival occurred with increasing gestational age and birth weight, with a mortality of 16.29%.

Background

The incidence of multiple pregnancies has been increasing steadily for more than 30 years. The aim of this study is to analyse the clinical outcomes of mothers and triplets born by different pregnancy methods.

Material and methods

A longitudinal, observational, and analytical study conducted on a cohort of triplets born from January 2000 to December 2010.

Results

The analysis included a total of 82 sets of triplets, 246 (100%) neonates, with 12 (4.8%) deaths. The distribution of pregnant women according to the method was: 28 (34.1%) spontaneous pregnancies, 20 (24.3%) ovulation inducers 13 (15.8%), artificial insemination, and 21 (25.6%) by IVF-ET. The most frequent pathologies, in general, of all pregnancies were urinary tract infection 13.4%. The mean gestational age was 32.6 ± 1.7, range 25-36. The mean weight was 1561.52 ± 271.6, range 620-2460 g. Although intrauterine growth retardation occurred in 34% of all methods, there was no statistical difference. Respiratory disease was present in 34.6% of the total sample, with a statistical difference, P=.00014, respiratory distress syndrome was present in all methods P=.00014. Sepsis for the entire sample was 23.5%, and was distributed evenly for all methods. Only 2 cases of enterocolitis 2A were seen.

Conclusion

The highest percentage of pregnancies was spontaneous. All neonates were premature with low birth weight <2500 g. Respiratory problems (RDS, TTNB, and PAS) were statistically significant.

Introduction

Saturation is a basic physiological factor that reflects the delivery of oxygen to the tissues, and has become a crucial tool in neonatology, particularly especially in patients receiving oxygen therapy.

Objective

To obtain the values of peripheral saturation by pulse oximetry in term newborns without respiratory disease and compare them with the term newborns admitted to the Mother and Baby Unit.

Material and methods

An observational, cross-sectional analytical study was carried out on term neonates, born in the National Institute of Perinatology. The pulse oximetry values were taken in the first hours of life, for up to 2 days. The data were processed using the SPSS program, version 13.

Results

No statistically significant differences were found between the oxygen saturation patterns during the day, or between the groups. In the group of newborns admitted to the Minimal Invasion Therapy (MIT) unit, a significant decrease in oxygen levels was observed in the pulse oximetry 5 minutes after starting feedings.

Conclusions

Newborns admitted to the Mother and Baby Unit have less desaturation compared to newborns in the MIT. This may be because they are exclusively breastfed, which promotes better coordination in sucking, swallowing and breathing, a situation that is reflected in the saturation blood levels.

Background

The current recommendation for vaccination in preterm infants is to start it at the chronological age, regardless of their birthweight or gestational age.

Objective

To describe the vaccination status of premature infants born under 1500 g, that were part of the INPer paediatric follow-up program.

Material and methods

A retrospective, cross-sectional and descriptive cohort study, conducted on infants who attended their clinics from June 2008 to June 2009, and born between 2004 and 2008. The vaccination dates were obtained from their national immunisation record book and, where applicable, the cause of the administration delay was questioned.

Results

The study included 158 infants, of whom 78.5% received all their vaccines in the public sector. A total of 54.5 ± 30.2 days elapsed between discharge and the first application of some immunogen. The vaccination coverage against influenza, with two doses in the first year of life, was: 18.9%, against rotavirus with two doses: 59.5%, acellular pentavalent, three doses: 73.5%, pneumococcus, three doses: 28.2%, BCG: 98.1%, MMR: 100%, and hepatitis B three doses: 77.8%. All immunogens were administered late. The three most frequent causes of immunisation rejection were: low weight and /or prematurity, lack of vaccines, and a history of transfusions.

Conclusions

In premature infants there was a delay in the administration of all the immunogens as regards to the national vaccination recommendation. It is necessary to review the current indications for the administration of immunogens in this population.

Urogenital infections are common causes of male infertility. This type of infections include orchitis, epididymitis, prostatitis, seminal vesiculitis, and urethritis.

Semen analysis reflects its presence due to impared seminal caracteristics for the establishment of microbes in the genital tract, as well as their replication. Spermatogenesis, sperm maturation and transport can be affected by infection. Not only the site of infection is important for the diagnosis and treatment, but also the type of microorganism.

This work involves the principal groups of microorganisms associated with urogenital infection, impaired seminal characteristics, a pathophysiological approach of the mechanisms related to infertility and its trascendence in assisted reproduction treatments.