Perinatologia y Reproduccion Humana最新文献

Introduction

Vascular catheters are considered an essential procedure for the management of newborns in neonatal intensive care units. However, their insertion and length ot time used are considered risk factors for neonatal complications. The focus of this study was to determine the technical aspects, complications and morbidity associated with vascular catheters in the Mexican National Institute of Perinatology (Instituto Nacional de Perinatología).

Material and methods

A descriptive, prospective and longitudinal study was conducted including all newborns in whom a central vascular catheter was inserted between January and December of 2015. The types of catheter, infectious and non-infectious complications were registered. Central tendency measurements were used for the data analysis.

Results

Mean weight and gestational age were 1,330 g and 29 weeks, respectively. The mean time the catheter was inserted was 12.9 days. The incidence of complications was 31.5 per 1,000 catheter-days, with 14.1 per 1,000 in the non-infectious complications and 17.3 per 1,000 in the infectious complications group. Percutaneous catheters were the most frequently used type of catheter. Sepsis associated with catheters was the most common complication found, with a frequency of 17.3 episodes per 1,000 days-catheter.

Conclusion

The incidence of complications associated to vascular catheters continues to be a problem in every neonatal intensive care unit; sepsis is the most common complication and also the one with the higher impact on neonatal morbidity and mortality.

Introduction

Gram-negative pathogens have been shown in the literature to be the main cause of healthcare-associated infections.

Material and methods

An analyse is performed on the results of the antimicrobial resistance of the main gram-negative pathogens obtained by different cultivation methods collected by means of an healthcare-associated infections epidemiological surveillance control system during the year 2006, in order to compare them with those obtained in the year 2012.

Results

A total of 10 organisms Gram-negative organisms were identified from a total of 387 isolations, with a higher prevalence in 2012 (0.37) vs 2006 (0.36). The 4 most important pathogens were: Klebsiella pneumoniae (113, 29.1%), Escherichia coli (88, 22.7%), Enterobacter cloacae (65, 16.7%), and Pseudomonas aeruginosa (63, 16.2%). There were others with less frequent isolations, but were on the whole within the “ESKAPE-E” (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) group of pathogens. These are causes of healthcare-associated infections since 2006, but in a lower proportion of events and with better antimicrobial susceptibility. In contrast to 2012, when the resistances to most of antibiotics increased by little more than 20%. There were multi-drug-resistant alerts especially for Klebsiella pneumoniae, Escherichia coli, and Klebsiella oxytoca. Few antibiotics (imipenem, meropenem, gentamycin and amikacin) maintained their activity profile in both periods, and others like ertapenem and quinolones that were not used in 2006, appeared in 2012 with good antimicrobial susceptibility.

Conclusions

The “ESKAPE-E” pathogens are a real problem for public health and the multidrug antibiotic resistance allows them to evade many of the available therapeutic options. In addition to the fact of there are no new antimicrobials to perform studies and create maps of bacterial resistances in our institutions, it would help us to make better decisions on having initiated empirical therapies.

Central congenital hypoventilation syndrome, also known as Ondine's Curse, is a rare disease characterised by abnormal ventilation control in the absence of pulmonary, neuromuscular, neurological or cardiac disease. In twenty percent of the cases this condition is associated with Hirschsprung disease (called Haddad syndrome), and other altered development of neural crest-derived structures and/or tumours of neural crest origin (neuroblastoma, ganglioneuroma, and ganglioneuroblastoma). A case is presented, showing its clinical and genetic aspects, aetiology and treatment of a newborn with central hypoventilation and Hirschsprung disease.

Objective

To present the results obtained in the development of a simplified method, with a direct extraction of breast milk and detection by reverse phase high-performance liquid chromatography of retinol and α-tocopherol.

Materials and methods

An experimental 2x3 factorial design was used, with temperature variables, type of solvent and antioxidant effect, at 2 levels. Subsequent to the extraction, the samples were saponified with potassium hydroxide in methanol, then extracted with petroleum ether, and dried and reconstituted with ethanol. The chromatography conditions were established using microbondapak columns with UV/visible detector: methanol/water (96:4) mobile phase, wavelength for retinol 325, and 290 nm for α-tocopherol.

Results

The analytics parameters were: linearity; r² = 0.9955 (retinol), r² =0.9808 (α-tocopherol); detection and quantification limits: 1.1 μg/dL and 2.7 μg/dL (retinol), 0.9 μg/dL and 2.3 μg/dL (α-tocopherol). Method accuracy: the within-day relative standard deviation was 4.5%, and a between-day relative standard deviation of 4.8% for retinol, and 4.9% within-day and 4.1% between-day forα-tocopherol. For accuracy, recovery = 85.8 ± 7.8% for retinol and 98 ± 1.9% for α-tocopherol. Once validated, the method was applied to the quantification of retinol and α-tocopherol in 100 samples of breast milk. The values obtained were 63.9 ± 5.2 μg/dL for retinol and 359.0 ± 115.0 μg/dL for α-tocopherol.

Conclusion

The method is selective, linear, precise, sensitive and accurate. These characteristics together with their simplicity make the validated method convenient for the determination of retinol and α-tocopherol in breast milk.

Objective

To compare plasma lipids and lipoproteins concentrations in newborns with intrauterine growth restriction and alterations of umbilical artery end-diastolic velocity.

Material and methods

A study was conducted on pregnant women with a diagnosis of intrauterine growth restriction who attended at Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. The cases were divided into, reversed umbilical artery end-diastolic velocity (group A), absent umbilical artery end-diastolic velocity (group B), and umbilical artery end-diastolic velocity present and positive (group C). Plasma concentrations of cholesterol, triglycerides, and low- and high-density lipoproteins were also measured in newborns.

Results

Reversed umbilical artery end-diastolic velocity was present in 33 cases, with 71 cases of absent umbilical artery end-diastolic velocity, and 146 cases with umbilical artery end-diastolic velocity present. The newborns in groups A and B had significantly higher plasma concentrations of cholesterol and triglycerides compared with group C (p < .05). High-density lipoproteins were significantly lower in group A and B compared with group C (p < .05). There were no significant differences found in low-density lipoproteins between the three groups (p > .05).

Conclusion

Newborns with intrauterine growth restriction and absent or reversed umbilical artery end-diastolic velocity showed significant alterations in plasma lipids and lipoproteins concentrations.

Objective

To establish the usefulness of plasma concentrations of angiopoietin-1 in the second trimester as a predictor of the development of pre-eclampsia.

Material and methods

A prospective and observational study was conducted on 504 nulliparous pregnant women between 17 and 20 weeks gestation who attended the Antenatal Clinic of the Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. An evaluation was made of the general characteristics, plasma angiopoietin-1 concentrations, and prognosis efficacy.

Results

The cases were 41 pregnant women who developed pre-eclampsia (group A), and 463 pregnant women that were considered as controls (group B). No significant differences were found in maternal age, gestational age, and systolic and diastolic blood pressure at the time of the ultrasound evaluation (p = ns). Gestational age at the time of pre-eclampsia diagnosis in group A was 35.0 ± 3.2 weeks. Significant differences were found in the plasma angiopoietin-1 concentrations between patients in group A (11.8 ± 2.8 ng/mL) and patients in group B (5.9 ± 1.7 ng/mL; P < .0001). A cut-off value of 8 ng/mL had an under the curve value of 0.97, a sensitivity of 80.4%, a specificity of 97.4%, a positive predictive value of 73.3%, and a negative predictive value of 98.2%.

Conclusion

Plasma angiopoietin-1 concentrations in the second trimester could predict the development of pre-eclampsia in nulliparous pregnant women without any other concomitant factor.

Introduction

Haemodynamically significant patent ductus arteriosus increases morbidity-mortality rates in premature newborns.

Objective

To determine the incidence of patent ductus arteriosus in our population, as well as the closure rates of success and failure with ibuprofen and other related causes for failure.

Materials and methods

A retrospective study was conducted on of 42 patients treated with one or 2 cycles of ibuprofen for patent ductus arteriosus closure from June 2011 to October 2012 at Instituto Nacional de Perinatología, Mexico City. The initial dosage was10 mg/kg/day, and 2 additional doses of 5 mg/kg/day.

Results

There were 64 cases out of 295 admissions. Age at diagnosis: 5.0 days (± 3.1); age at beginning of treatment: 5.3 days (± 5.6). Rate of success for first cycle: 47.7%. If a second cycle was necessary the age at treatment was 9 days (± 2.9), the success rate was 42.8% and the failure rate was 57.1%. If surgical closure was necessary, treatment was administered at 19.1 days (± 7). Four patients (6%) developed acute renal failure associated with the use of ibuprofen.

Conclusions

There were no statistical differences in the rate of success for the closure of patent ductus arteriosus with the first or second cycle of ibuprofen (47.7% vs 42.8%) (p = 1). With ibuprofen dosages actually used, the success rate for the closure of PDA is less with the second cycle than with the first one, but is not significant. There were no differences as regards IV fluids, neonatal sepsis, mechanical ventilation, or diuretics. Starting treatment after the 5th day is associated with an increase in the failure rate.

The improvement in prenatal and perinatal care techniques has led to achieving better survival rates of premature babies with increasingly lower gestational ages. It is known that their immaturity makes them more susceptible to the development of diseases in different organs and systems, with comorbidities that can affect their growth and quality of life. The brain is one of the most important organs because it is related with the comprehensive functionality of the individual, and complications (temporary or permanent) in health care management can lead to a wide range of clinical manifestations ranging from delayed neurodevelopment to cerebral palsy. For this reason, the neonatologist must be aware of this in order to prevent adverse outcomes, doing their best to ensure improved assisted ventilation strategies, adequate nutrition, drug therapies, early intervention therapies, timely rehabilitation, and long-term follow-up. It is important to remember that neurodevelopmental disorders (intellectual, sensorial, and motor alterations) may affect up to one third of preterm patients.