RESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Soporte Ventilatorio Interactivo/instrumentación , Soporte Ventilatorio Interactivo/métodos , Soporte Ventilatorio Interactivo , Frecuencia Respiratoria/fisiología , Respiración Artificial/instrumentación , Respiración Artificial/métodos , Respiración Artificial , Ventiladores Mecánicos , Recién NacidoRESUMEN
No disponible
Asunto(s)
Femenino , Humanos , Recién Nacido , Masculino , Conducto Arterial/fisiopatología , Acetaminofén/uso terapéutico , Conducto Arterioso Permeable/tratamiento farmacológico , Recién Nacido de muy Bajo Peso , Resultado del TratamientoRESUMEN
La asistencia respiratoria al recién nacido prematuro puede asociarse a complicaciones locales y sistémicas producto del traumatismo mecánico a los tejidos y la respuesta inflamatoria que en ellos se desencadena. Un objetivo fundamental, por tanto, es reducir su duración y efectos adversos. La ventilación ajustada neuralmente (NAVA), al mejorar la sincronización entre paciente y máquina, y optimizar los volúmenes de gas entregados a las necesidades de aquel, podría ser una herramienta fundamental en la consecución de dicho objetivo. Presentamos 2 casos de pacientes prematuros con síndrome de distrés respiratorio grave que pudieron ser satisfactoriamente destetados y extubados con esta modalidad asistencial. Nuevos estudios son necesarios para evaluar si los beneficios inmediatos se reflejan en mejores resultados a largo plazo
Invasive and non-invasive ventilation of the preterm newborn may be associated with local and systemic complications due to mechanical trauma to lung tissues and their inflammatory response. A key objective of any type of mechanical ventilation, therefore, is to reduce its duration and the side effects related to it. Neurally Adjusted Ventilatory Assist (NAVA) may improve synchronization between patient and ventilator and optimize the gas volume delivered to the lungs, according to the patient needs, eventually reducing volu- and biotrauma. Two preterm babies with severe respiratory distress syndrome are presented, who were successfully weaned and extubated with the help of this ventilatory system. Further studies are needed to assess whether short-term benefits are reflected in better outcomes in the long run
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Soporte Ventilatorio Interactivo/efectos adversos , Soporte Ventilatorio Interactivo , Respiración Artificial , Respiración Artificial/instrumentación , Preparaciones Farmacéuticas/administración & dosificación , Preparaciones Farmacéuticas/análisis , Soporte Ventilatorio Interactivo/mortalidad , Soporte Ventilatorio Interactivo , Respiración Artificial/mortalidad , Preparaciones Farmacéuticas/síntesis química , Preparaciones FarmacéuticasRESUMEN
Invasive and non-invasive ventilation of the preterm newborn may be associated with local and systemic complications due to mechanical trauma to lung tissues and their inflammatory response. A key objective of any type of mechanical ventilation, therefore, is to reduce its duration and the side effects related to it. Neurally Adjusted Ventilatory Assist (NAVA) may improve synchronization between patient and ventilator and optimize the gas volume delivered to the lungs, according to the patient needs, eventually reducing volu- and biotrauma. Two preterm babies with severe respiratory distress syndrome are presented, who were successfully weaned and extubated with the help of this ventilatory system. Further studies are needed to assess whether short-term benefits are reflected in better outcomes in the long run.
Asunto(s)
Extubación Traqueal , Desconexión del Ventilador , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo PesoRESUMEN
INTRODUCCIÓN: El enfriamiento del recién nacido tras el parto puede interferir con la adaptación posnatal debido a posibles efectos metabólicos y hemodinámicos. Los factores relacionados con el mismo, así como su relación con la morbimortalidad neonatal no han sido estudiados de forma sistemática en nuestro medio. OBJETIVOS: Analizar la temperatura al ingreso en la Unidad de Cuidados Intensivos Neonatales (UCIN) de los recién nacidos de muy bajo peso (RNMBP) y/o < 30 semanas de edad gestacional (EG), e identificar las variables perinatales que se asocian con una reducción de la misma, y su relación con la morbimortalidad neonatal. PACIENTES Y MÉTODOS: Se incluyeron 635 RNMBP y/o menores de 30 semanas de EG nacidos en nuestra maternidad desde enero de 2006 a noviembre de 2012. Se llevó a cabo un análisis multivariante entre las variables perinatales y la temperatura al ingreso, y una remisión logística entre esta y las variables de morbimortalidad para establecer asociaciones independientes. RESULTADOS: El peso al nacimiento (PRN) y la EG (media ± DE) fueron 1.137,6 ± 257,6 g y 29,5 ± 2,8 semanas, respectivamente. La temperatura media al ingreso: 35,8 ± 0,6 ° C (rango: 33,0-37,8 °C); temperatura inferior de 36 °C: 44,4%. Las variables perinatales asociadas de forma independiente con la temperatura fueron la corioamnionitis, el PRN, el parto vaginal frente a cesárea y la reanimación cardiopulmonar (RCP) avanzada. Una menor temperatura al ingreso se asoció a un incremento en el riesgo de hemorragia intracraneal (HIV-MG) grados 3 y 4 (OR: 0,377; IC 95%: 0,221-0,643; p < 0,001) y de mortalidad (OR: 0,329; IC 95%: 0,208-0,519; p = 0,012). CONCLUSIONES: La proporción de RNMBP y/o < 30 semanas de EG que ingresan con hipotermia es elevada en nuestro medio. El PRN, el parto vaginal y la RCP avanzada fueron las principales variables relacionadas con la hipotermia, y esta se asoció con un mayor riesgo de HIV-MG y de mortalidad
INTRODUCTION: Heat loss in the newborn after delivery could interfere with post-natal adaptation due to metabolic and hemodynamic instability. Associated perinatal factors and their relationship with morbidity and mortality during the neonatal period have not been systematically studied in our unit. OBJECTIVES: To determine the temperature of very low birth weight (VLBW) infants on admission to our NICU, and to determine the associated perinatal variables, and the association of temperature with morbidity and mortality. PATIENTS AND METHODS: Infants born in our maternity from January 2006 to November 2012, with birth weights (BW) 401 g to 1,499 g and/or less than 30 weeks gestational age, were included. A multivariate analysis was performed using the perinatal variables and the temperature on admission, as well as a logistic regression between these and the morbidity-mortality variables, in order to detect any independent associations. RESULTS: A total of 635 infants were included, with a mean (±SD) birth weight and gestational age of 1,137.6±257.6 g, and 29.5±2.0 weeks, respectively. The mean admission temperature was 35.8±0.6 ◦C (range: 33.0-37.8 ◦C). The proportion of infants with a temperature <36 ◦C was 44.4%. Independently associated perinatal variables were chorioamnionitis, birth weight, vaginal delivery, and advanced cardiopulmonary resuscitation (CPR). Admission hypothermia was associated with severe intraventricular haemorrhage (IVH) (grades 3 and 4) (OR: 0.377; 95% CI: 0.221-0.643; P<0.001), and mortality (OR: 0.329; 95% CI: 0.208-0.519; P=0.012). CONCLUSIONS: Hypothermia on admission is frequent among our VLBW infants. Birth weight, vaginal delivery, and advanced CPR were the principal variables associated with hypothermia. A low temperature on admission was related to an increased risk of IVH and mortality
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Hipotermia/epidemiología , Regulación de la Temperatura Corporal , Indicadores de Morbimortalidad , Factores de Riesgo , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Estudios ProspectivosRESUMEN
INTRODUCTION: Heat loss in the newborn after delivery could interfere with post-natal adaptation due to metabolic and hemodynamic instability. Associated perinatal factors and their relationship with morbidity and mortality during the neonatal period have not been systematically studied in our unit. OBJECTIVES: To determine the temperature of very low birth weight (VLBW) infants on admission to our NICU, and to determine the associated perinatal variables, and the association of temperature with morbidity and mortality. PATIENTS AND METHODS: Infants born in our maternity from January 2006 to November 2012, with birth weights (BW) 401 g to 1,499 g and/or less than 30 weeks gestational age, were included. A multivariate analysis was performed using the perinatal variables and the temperature on admission, as well as a logistic regression between these and the morbidity-mortality variables, in order to detect any independent associations. RESULTS: A total of 635 infants were included, with a mean (± SD) birth weight and gestational age of 1,137.6 ± 257.6g, and 29.5 ± 2.0 weeks, respectively. The mean admission temperature was 35.8 ± 0.6°C (range: 33.0-37.8°C). The proportion of infants with a temperature < 36°C was 44.4%. Independently associated perinatal variables were chorioamnionitis, birth weight, vaginal delivery, and advanced cardiopulmonary resuscitation (CPR). Admission hypothermia was associated with severe intraventricular haemorrhage (IVH) (grades 3 and 4) (OR: 0.377; 95% CI: 0.221-0.643; P<.001), and mortality (OR: 0.329; 95% CI: 0.208-0.519; P=.012). CONCLUSIONS: Hypothermia on admission is frequent among our VLBW infants. Birth weight, vaginal delivery, and advanced CPR were the principal variables associated with hypothermia. A low temperature on admission was related to an increased risk of IVH and mortality.