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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.
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Extubação , Doenças do Prematuro/etiologia , Atelectasia Pulmonar/etiologia , Extubação/métodos , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/terapia , Terapia Intensiva Neonatal , Intubação Intratraqueal , Masculino , Atelectasia Pulmonar/diagnóstico , Atelectasia Pulmonar/prevenção & controle , Respiração Artificial/métodos , Fatores de RiscoRESUMO
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.
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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.
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Doenças do Prematuro/etiologia , Nutrição Parenteral/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Estudos RetrospectivosRESUMO
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.
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Antropometria , Superfície Corporal , Permeabilidade do Canal Arterial/patologia , Permeabilidade do Canal Arterial/cirurgia , Canal Arterial/patologia , Doenças do Prematuro/patologia , Doenças do Prematuro/cirurgia , Ligadura , Comorbidade , Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/diagnóstico por imagem , Feminino , Idade Gestacional , Hemodinâmica , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico por imagem , Ligadura/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Ultrassonografia , Procedimentos DesnecessáriosRESUMO
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.
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Banhos/efeitos adversos , Temperatura Corporal , Cuidados Críticos/métodos , Estado Terminal , Frequência Cardíaca , Cuidado do Lactente/métodos , Doenças do Prematuro/fisiopatologia , Recém-Nascido Prematuro/fisiologia , Oxigênio/sangue , Respiração , Banhos/métodos , Contraindicações , Feminino , Humanos , Hipotermia/etiologia , Hipotermia/prevenção & controle , Hipóxia/etiologia , Hipóxia/prevenção & controle , Incubadoras para Lactentes , Recém-Nascido , Recém-Nascido Prematuro/sangue , Doenças do Prematuro/sangue , Doenças do Prematuro/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Masculino , Oxigênio/administração & dosagem , Oxigenoterapia , Estudos Prospectivos , Taquicardia/etiologia , Taquicardia/prevenção & controle , Taquipneia/etiologia , Taquipneia/prevenção & controleRESUMO
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.
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Extubação , Displasia Broncopulmonar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Falha de TratamentoRESUMO
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.
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Barotrauma/etiologia , Unidades de Terapia Intensiva Neonatal , Respiração Artificial/efeitos adversos , Respiração Artificial/normas , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
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.
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Infecção Hospitalar , Bactérias/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência , Estudos RetrospectivosRESUMO
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.
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Desmame do Respirador , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Falha de TratamentoRESUMO
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.