RESUMEN

OBJECTIVE: To report the process and results of the first neonatal clinical consensus of the Ibero-American region. DESIGN AND METHODS: Two recognized experts in the field (Clyman and Van Overmeire) and 45 neonatologists from 23 countries were invited for active participation and collaboration. We developed 46 questions of clinical-physiological relevance in all aspects of patent ductus arteriosus (PDA). Guidelines for consensus process, literature search and future preparation of educational material and authorship were developed, reviewed and agreed by all. Participants from different countries were distributed in groups, and assigned to interact and work together to answer 3-5 questions, reviewing all global literature and local factors. Answers and summaries were received, collated and reviewed by 2 coordinators and the 2 experts. Participants and experts met in Granada, Spain for 4.5 h (lectures by experts, presentations by groups, discussion, all literature available). RESULTS: 31 neonatologists from 16 countries agreed to participate. Presentations by each group and general discussion were used to develop a consensus regarding: general management, availability of drugs (indomethacin vs. ibuprofen), costs, indications for echo/surgery, etc. Many steps were learnt by all present in a collaborative forum. CONCLUSIONS: This first consensus group of Ibero-American neonatologists SIBEN led to active and collaborative participation of neonatologists of 16 countries, improved education of all participants and ended with consensus development on clinical approaches to PDA. Furthermore, it provides recommendations for clinical care reached by consensus. Additionally, it will serve as a useful foundation for future SIBEN Consensus on other topics and it could become valuable as a model to decrease disparity in care and improve outcomes in this and other regions.

Asunto(s)

RESUMEN

OBJECTIVE: To assess the short- and long-term outcome of infants

Asunto(s)

RESUMEN

Objetivo Evaluar los resultados a corto y largo plazo de la reanimación cardiopulmonar en sala de partos (RCP-SP) en neonatos 1.250 g o menos. Métodos En una cohorte de neonatos con y sin RCP-SP con peso de 1.250 g o inferior nacidos entre enero de 2000 y diciembre de 2003, comparamos las tasas de mortalidad, hemorragia intracraneana severa (HIC-S), leucomalacia periventricular (LPV) y las variables combinadas (VC) adversas a corto plazo; a los 18 meses de edad posconcepcional (EPC) comparamos los índices del desarrollo mental (IDM) y psicomotor (IDP) según la escala de Bayley-II. Resultados En 397 niños, los 53 (13 %) que habían recibido RCP-SP tuvieron mayor riesgo de mortalidad, HIC-S, LPV y VC adversas. A los 18 meses de edad posconcepcional la puntuación de IDM e IDP fue más baja en el grupo con RCP-SP (67,7 ± 18,3 frente a 81,3 ± 17,7; p = 0,006) y (74,4 ± 19,9 frente a 85,1 ± 17,2; p = 0,027), respectivamente. Conclusión La RCP-SP en recién nacidos de 1.250 g o menos está asociada con mayor mortalidad y con peores tasas de morbilidad, en el corto plazo y en el seguimiento a largo plazo

Objective To assess the short- and long-term outcome of infants <= 1250 grams who have received delivery room cardiopulmonary resuscitation (DR-CPR). Methods In a cohort of infants <=1250 grams born between 01/2000 and 12/2003, we compared the rates of death, severe intraventricular hemorrhage (S-IVH), periventricular leukomalacia and combined poor short-term outcome (CO). At 18 months post- conception age (PCA) we compared DR-CPR and non-DR-CPR groups on the Bayley II Mental and Psychomotor Developmental Indices (MDI and PDI). Results Of 397 infants who met enrollment criteria, the 53 (13%) who received DR-CPR had a higher risk for mortality, S-IVH, PVL and CO. At 18 months PCA, MDI and PDI scores were lower in the DR-CPR group (67.7 ± 18.3 vs. 81.3 ± 17.7; p = 0.006) and (74.4 ± 19.9 vs. 85.1 ± 17.2; p = 0.027), respectively. Conclusion DR-CPR in infants < 1250 grams is associated with higher mortality and greater short- and long-term morbidity

Asunto(s)

RESUMEN

Recently, we reported that erythropoietin attenuates neonatal brain injury caused by focal cerebral ischemia. The long-term effects of erythropoietin on focal cerebral ischemia-induced injury to the developing brain and the potential gender differences in these long-term effects have not been studied in detail. The current study demonstrated a similarity in the mean infarct volume in both the vehicle-treated male and female rats at 6 and 12 weeks after focal cerebral ischemia. On the other hand, erythropoietin treatment (1000 U/kg x three doses after focal cerebral ischemia) caused a significant reduction in the mean infarct volume in both males and females at 6 weeks after focal cerebral ischemia when compared with the corresponding vehicle-treated animals (males: 141.4+/-48.2 mm3 vs. 194.0+/-59.2 mm3, P<0.05; females: 85.4+/-31.6 mm3 vs. 183.4+/-46.3 mm3, P<0.05). Interestingly, the reduction in the mean infarct volume in the erythropoietin-treated males was significantly less than that in the erythropoietin-treated females at 6 weeks after focal cerebral ischemia (141.4+/-48.2 mm3 vs. 85.4+/-31.6 mm3, P<0.05). At 12 weeks after focal cerebral ischemia, the mean infarct volume in the erythropoietin-treated males significantly increased to 181.0+/-50.4 mm3 (P<0.05). In contrast, the mean infarct volume in the erythropoietin-treated females remained stable (87.0+/-41.7 mm3). Additionally, erythropoietin treatment significantly improved sensorimotor function recovery with a misstep number similar to the sham-operation group at 6 and 12 weeks after focal cerebral ischemia. Moreover, the mean number of missteps in the erythropoietin-treated females was less than that in males at 6 (13.5+/-2.0 vs. 24.5+/-2.5, P<0.05) and 12 (12.5+/-2.0 vs. 20.0+/-2.0, P<0.05) weeks after focal cerebral ischemia. These results indicate that erythropoietin administration after focal cerebral ischemia produces a significant long-term neuroprotective benefit on the developing brain, and that this effect is more beneficial in the female rats.

Asunto(s)

Asunto(s)

RESUMEN

No disponible

No disponible

Asunto(s)

Asunto(s)

RESUMEN

No disponible

Asunto(s)

RESUMEN

La compresnsión de los fenómenos metabólicos y nutricionales del neonato de muy bajo peso es fundamental para su cuidado clínico exitoso. Sin embargo el conocimiento es incompleto para los neonatos de menos de 1000 gramos. La importancia de la nutricion es primordial para disminuir la morbilidad

Asunto(s)

RESUMEN

Este artículo podrá servir de guía para uno de los desafíos más importantes de la neonatología intensivaLa ventilación es sólo una parte de su manejo integral y complejo, pero de ser mal utilizada se asocia con mortalidad innecesaria o con morbilidad que puede durar el resto de la vida

Asunto(s)

RESUMEN

OBJECTIVE: To determine neonatal survival, short-term morbidities, and cost per survivor in pregnancies delivered at 24-26 weeks' gestation in a center in which antenatal steroids and exogenous surfactant are standard care. METHODS: A retrospective cohort study compared survival, short-term outcome, and initial hospital charges for pregnancies delivered at 24-26 weeks during 1990-1994. We calculated hospital costs for each year by using the corresponding institutional cost-charge ratio. RESULTS: There were 138 infants after excluding those with severe anomalies. Survival was 43%, 74%, and 83% at 24, 25, and 26 weeks, respectively (P = .006). The majority of women received antenatal steroids, and the majority of surviving neonates received exogenous surfactant. Severe retinopathy of prematurity and chronic lung disease decreased significantly from 24 to 26 weeks (P < or = .026). The likelihood of having a surviving infant without chronic lung disease or severe retinopathy of prematurity was 35% at 24 weeks and 78% at 26 weeks. Hospital costs for the 29 nonsurvivors were $1.46 million and for the 94 surviving infants were $16.9 million. The cost per day was similar at each gestational age, whereas the cost to produce a survivor was $294,749, $181,062, and $166,215 at 24, 25, and 26 weeks, respectively. CONCLUSION: Survival at 24 weeks was only 43% despite treatment with antenatal steroids and exogenous surfactant. The cost per survivor for infants born at 24 weeks was higher than the cost for those born after 1 more week in utero. Outcome improved markedly between 24 and 26 weeks, and small differences in gestational age lead to large economic differences. All efforts should be attempted to prolong pregnancy, and if prolongation is unsuccessful, treatment options including nonintervention should be available to parents of 24-week gestations.

Asunto(s)

Asunto(s)