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BACKGROUND: The high prevalence of suspected early-onset neonatal sepsis among preterm infants leads to immediate antibiotic administration upon admission. Notably, most blood cultures for suspected early-onset neonatal sepsis do not yield a causative pathogen. This study aimed to assess polymerase chain reaction (PCR) targeting the variable region V4 of the 16S ribosomal gene (16S rDNA) and Sanger sequencing for bacterial identification in preterm infants with suspected early-onset neonatal sepsis. METHODS: Therefore, this prospective study was conducted. Preterm infants with suspected early-onset neonatal sepsis were included in this study. The three groups were formed based on the risk of infection and clinical sepsis. Blood samples were collected upon admission to the neonatal unit for culture and molecular analysis. PCR amplification and subsequent Sanger sequencing of the V4 region of the 16S rDNA were performed. RESULTS: Twenty-eight patients were included in this study. Blood cultures were negative in 100% of the patients. Amplification and sequencing of the V4 region identified bacterial genera in 19 patients across distinct groups. The predominant taxonomically identified genus was Pseudomonas. CONCLUSIONS: Amplifying the 16S rDNA variable region through PCR and subsequent Sanger sequencing in preterm neonates with suspected early-onset neonatal sepsis can enhance the identification of microbial species that cause infection, especially in negative cultures.

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OBJECTIVE: Neonates with moderate-to-severe perinatal asphyxia often develop acute kidney injury (AKI). Additionally, therapeutic hypothermia (TH) can affect renal blood flow. This study aimed to evaluate the association between renal regional oxygen saturation (rSrO2) during TH and AKI in neonates with moderate and severe perinatal asphyxia. STUDY DESIGN: This retrospective longitudinal study included neonates with moderate-to-severe asphyxia who required TH. The primary outcome was the occurrence of AKI, classified as a rate of decrease in creatinine levels of <33% at 72 hours of TH. rSrO2 was continuously monitored by near-infrared spectroscopy during the hypothermia and rewarming phases. Data analysis involved dividing the average rSrO2 levels into 12-hour periods. We analyzed the association between AKI and rSrO2 levels using univariate and multivariate logistic regression models. Furthermore, we assessed the predictive capacity of rSrO2 for AKI by analyzing the area under the receiver operating characteristic curve. RESULTS: Ninety-one patients were included in the study. On average, patients with AKI exhibit lower rSrO2 levels during TH. Specifically, rSrO2 levels within the first 12 hours and between 25 and 72 hours of TH demonstrated the highest predictive capability for AKI. Multivariate logistic regression analysis revealed that rSrO2 levels within the initial 12 hours (adjusted odds ratio [aOR] = 1.11, 95% confidence interval [CI]: 1.01-1.21) and between 61 and 72 hours (aOR = 0.85, 95% CI: 0.78-0.92) were significantly associated with AKI. CONCLUSION: An increase in rSrO2 during the first 12 hours of TH and lower rSrO2 levels between 61 and 72 hours of treatment were associated with the development of AKI in asphyxiated neonates undergoing TH. KEY POINTS: · Neonates with asphyxia often develop AKI.. · Renal saturations are affected by hypothermia and asphyxia. · Patients with AKI initially show higher rSrO2, then lower rSrO2.. · Monitoring rSrO2 identifies early AKI..

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INTRODUCTION: Perinatal asphyxia, a leading cause of neonatal mortality and neurological sequelae, necessitates early detection of pathophysiological neurologic changes during hypoxic-ischaemic encephalopathy (HIE). This study aimed to review published data on rScO2 monitoring during hypothermia treatment in neonates with perinatal asphyxia to predict short- and long-term neurological injury. METHODS: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study identification was performed through a search between November and December 2021 in the electronic databases PubMed, Embase, Lilacs, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). The main outcome was short-term (Changes in brain magnetic resonating imaging) and long-term (In neurodevelopment) neurological injury. The study protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews) with CRD42023395438. RESULTS: 380 articles were collected from databases in the initial search. Finally, 15 articles were selected for extraction and analysis of the information. An increase in rScO2 measured by NIRS (Near-infrared spectroscopy) at different moments of treatment predicts neurological injury. However, there exists a wide variability in the methods and outcomes of the studies. CONCLUSION: High rScO2 values were found to predict negative outcomes, with substantial discord among studies. NIRS is proposed as a real-time bedside tool for predicting brain injury in neonates with moderate to severe HIE.

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AIM: The aim of the study was to determine whether overcooling (temperature <33°C) during passive hypothermia when transporting neonates with perinatal asphyxia increased the risk of short-term neurological injury. METHODS: A retrospective observational study was performed. Newborns transferred to the LaCardio neonatal unit between January 2021 and April 2022 with moderate and severe perinatal asphyxia and who received passive hypothermia during transport were included. A temperature of <33°C was considered overcooling. A composite outcome of neurological injury was defined by the presence of abnormalities on brain magnetic resonance imaging, video telemetry, seizure before discharge or both. RESULTS: The study included 101 newborns. A total of 18 neonates had a temperature <33°C after transportation. Neurological injuries were present in 21.8% of the temperature <33°C group and 78.2% of the temperature ≥33°C group. Temperature <33°C at the end of transport (aOR 9.2, 95% CI 1.1-77.3) were associated with neurological injury before discharge from the unit. CONCLUSION: During transportation, overcooling in neonates with asphyxia increases the risk of neurological injury before discharge from the neonatal unit. It is important to qualify the transport team with adequate training and equipment for therapeutic hypothermia.

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Introduction: Pediatric and neonatal sepsis is one of the main causes of mortality and morbidity in these age groups. Accurate and early etiological identification is essential for guiding antibiotic treatment, improving survival, and reducing complications and sequelae. Currently, the identification is based on culture-dependent methods, which has many limitations for its use in clinical practice, and obtaining its results is delayed. Next-generation sequencing enables rapid, accurate, and unbiased identification of multiple microorganisms in biological samples at the same time. The objective of this study was to characterize the etiology of neonatal and pediatric sepsis by metagenomic techniques. Methods: A systematic review of the literature was carried out using the PRISMA-2020 guide. Observational, descriptive, and case report studies on pediatric patients were included, with a diagnostic evaluation by clinical criteria of sepsis based on the systemic inflammatory response, in sterile and non-sterile biofluid samples. The risk of bias assessment of the observational studies was carried out with the STROBE-metagenomics instrument and the CARE checklist for case reports. Results and Discussion: Five studies with a total of 462 patients were included. Due to the data obtained from the studies, it was not possible to perform a quantitative synthesis (meta-analysis). Based on the data from the included studies, the result identified that mNGS improves the etiological identification in neonatal and pediatric sepsis, especially in the context of negative cultures and in the identification of unusual microorganisms (bacteria that are difficult to grow in culture, viruses, fungi, and parasites). The number of investigations is currently limited, and the studies are at high risk of bias. Further research using this technology would have the potential to improve the rational use of antibiotics.

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Background and objectives: In low- and middle-income countries, the leading cause of neonatal mortality is perinatal asphyxia. Training in neonatal resuscitation has been shown to decrease this cause of mortality. The program "Helping Babies Breathe" (HBB) is a program to teach basic neonatal resuscitation focused on countries and areas with limited economic resources. The aim of the study was to determine the effect of the implementation of the HBB program on newborn outcomes: mortality and morbidity. Material and Methods: A systematic review was carried out on observational studies and clinical trials that reported the effect of the implementation in low- and middle-income countries of the HBB program on neonatal mortality and morbidity. We carried out a meta-analysis of the extracted data. Random-effect models were used to evaluate heterogeneity, using the Cochrane Q and I2 tests, and stratified analyses were performed by age and type of outcome to determine the sources of heterogeneity. Results: Eleven studies were identified. The implementation of the program includes educational strategies focused on the training of doctors, nurses, midwives, and students of health professions. The poled results showed a decrease in overall mortality (OR 0.67; 95% CI 0.57, 0.80), intrapartum stillbirth mortality (OR 0.62; 95% CI 0.51, 0.75), and first-day mortality (OR 0.70; 95% IC 0.64, 0.77). High heterogeneity was found, which was partly explained by differences in the gestational age of the participants. Conclusions: The implementation of the program HBB in low- and medium-income countries has a significant impact on reducing early neonatal mortality.

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ANTECEDENTES: Los biomarcadores actuales para el diagnóstico de sepsis neonatal tienen una exactitud limitada. El desarrollo de la medicina de precisión basada en tecnologías ómicas ofrece una oportunidad para mejorar el diagnóstico de la sepsis neonatal. OBJETIVOS: Evaluar la sensibilidad y especificidad de las pruebas basadas en tecnologías ómicas (metabolómica, proteómica y genómica/transcriptómica) para el diagnóstico de sepsis neonatal. METODOLOGÍA: Se realizó una revisión sistemática en bases de datos electrónicas. Se incluyeron estudios observacionales y ensayos clínicos que evaluaran las pruebas basadas en tecnologías ómicas en neonatos comparado con el cultivo para el diagnóstico de sepsis neonatal. Dos revisores independientes realizaron la evaluación de la calidad de los estudios y la extracción de los datos. Para el metaanálisis se realizó un modelo de efectos aleatorios y se planeó una evaluación de la heterogeneidad a través de un análisis de subgrupos por prueba ómica, edad gestacional y tiempo de establecimiento de la sepsis. RESULTADOS: Se observa expresión diferencial del genoma, proteoma y metaboloma entre los neonatos con y sin sepsis, identificando diferentes biomarcadores. El metaanálisis mostró una medida de resumen combinada para la sensibilidad de 0,88 (IC 95% 0,72-0,96), especificidad de 0,76 (IC 95% 0,62-0,85). CONCLUSIÓN: Las pruebas basadas en ómicas tienen una alta sensibilidad, siendo las de mejor rendimiento las basadas en genómica/transcriptómica. Los estudios tienen alta heterogeneidad.

BACKGROUND: Current biomarkers for the diagnosis of neonatal sepsis llave limited accuracy. The development of precision medicine based on omic's technologies offer an opportunity to improve the diagnosis of neonatal sepsis. AIM: To evalúate the sensitivity and specificity of tests based on omic technologies (metabolomics, proteomics and genomics) for the diagnosis of neonatal sepsis. METHODS: A systematic review was carried out in electronic databases. Observational studies and clinical trials evaluating tests based on omic technologies in neonates compared to culture for the diagnosis of neonatal sepsis were included. For the meta-analysis, a random effects model and an evaluation of heterogeneity were proposed through a subgroup analysis by omic test, gestational age and time of establishment of sepsis. RESULTS: Differential expression of the genome, proteome and metabolome is observed between neonates with and without sepsis, identifying different biomarkers. The meta-analysis showed a pooled summary measure for sensitivity of0.88 (95% CI 0.72, 0.96), specificity of0.76 (95% CI 0.62, 0.85). CONCLUSION: Omics-based tests have a high sensitivity, with the best performing ones being those based on genomics / transcriptomics. The studies have high heterogeneity.

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RESUMEN Objetivo: La incertidumbre de una posible transmisión posnatal por SARS-CoV-2 genera un desafío entre aplicar o evitar los cuidados esenciales del recién nacido para prevenir la transmisión. La revisión sistemática tiene como objetivo describir el impacto de los cuidados esenciales del neonato en la transmisión posnatal del SARS-CoV-2. Métodos: Se realizó una revisión sistemática en bases de datos electrónicas, se incluyeron estudios observacionales, serie de casos y reporte de casos. Dos investigadores de forma independiente evaluaron los criterios de inclusión, la calidad metodológica y la extracción de datos. Resultados: Se tamizaron 208 estudios para una inclusión final de 9 artículos relevantes. El reporte de transmisión del virus SARS-CoV-2 está centrado en la posibilidad de transferencia por la leche materna y ausencia de información acerca de la transmisión por otros cuidados esenciales, sin embargo, se observa un bajo uso en la práctica clínica de los cuidados esenciales del recién nacido hijo de madre con COVID- 19. Conclusiones: La información es limitada sobre la posible transmisión del SARS-CoV-2 a través de los cuidados esenciales del recién nacido, sin embargo, la pandemia ha impactado de forma importante los mismos. Según los hallazgos en la literatura, es mayor el beneficio de estas intervenciones y las recomendaciones científicas promueven su aplicación empleando las medidas de protección personal para la madre y el personal de salud.

ABSTRACT Objective: The uncertainty of a possible postnatal transmission by SARS-CoV-2 creates a challenge between applying or avoiding essential newborn care to prevent transmission. The objective of the systematic review is to describe the impact of essential neonate care on the postnatal transmission of SARS-CoV-2. Methods: A systematic review was carried out in electronic databases, observational studies, case series, and case reports. Two investigators independently assessed the inclusion criteria, methodological quality, and data extraction. Results: 208 studies were screened for a final inclusion of 9 relevant articles. The transmission report of the SARS-CoV-2 virus is focused on the possibility of transfer through breast milk and the absence of information about transmission by other essential care, however, a low use, in clinical practice, of essential care for the newborn child of a mother with COVID-19, is observed. Conclusions: Information is limited on the possible transmission of SARS-CoV-2 through essential newborn care; however, the pandemic has had a significant impact on them. According to the findings in the literature, the benefit of these interventions is greater, and the scientific recommendations promote their application, using personal protection measures for the mother and the healthcare personnel.

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BACKGROUND: Current biomarkers for the diagnosis of neonatal sepsis llave limited accuracy. The development of precision medicine based on omic's technologies offer an opportunity to improve the diagnosis of neonatal sepsis. AIM: To evalúate the sensitivity and specificity of tests based on omic technologies (metabolomics, proteomics and genomics) for the diagnosis of neonatal sepsis. METHODS: A systematic review was carried out in electronic databases. Observational studies and clinical trials evaluating tests based on omic technologies in neonates compared to culture for the diagnosis of neonatal sepsis were included. For the meta-analysis, a random effects model and an evaluation of heterogeneity were proposed through a subgroup analysis by omic test, gestational age and time of establishment of sepsis. RESULTS: Differential expression of the genome, proteome and metabolome is observed between neonates with and without sepsis, identifying different biomarkers. The meta-analysis showed a pooled summary measure for sensitivity of0.88 (95% CI 0.72, 0.96), specificity of0.76 (95% CI 0.62, 0.85). CONCLUSION: Omics-based tests have a high sensitivity, with the best performing ones being those based on genomics / transcriptomics. The studies have high heterogeneity.

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RESUMEN Objetivo: La automedicación en niños tiene una prevalência mundial del 50 %. La enfermedad diarreica aguda y la infección del tracto respiratorio son enfermedades prevalentes de la infancia, y se ven afectadas por esta práctica. El objetivo fue establecer la prevalencia de automedicación en niños que consultan a un servicio de pediatría y explorar posibles factores asociados. Materiales y métodos: Se realizó un estudio de corte transversal. Se incluyeron niños que consultaron por infección respiratoria aguda y/o enfermedad diarreica aguda. Se desarrolló un instrumento (encuesta) para la recolección de la información. Con el objetivo de explorar los posibles factores asociados con la automedicación se realizaron análisis bivariados y se construyó un modelo de regresión logística. Se estimó como medida de efecto el OR con su intervalo de confianza. Se estableció el valor de significancia estadística con un valor de p< 0,05. Resultados: Se incluyeron 300 menores. La prevalencia de automedicación fue del 46 %. Los medicamentos más usados fueron el acetaminofén (78 %) y el ibuprofeno (15 %). Se encontró posible asociación de la automedicación con el antecedente de previo de automedicación y la edad del niño. Conclusiones: La prevalencia de automedicación es alta y similar a la encontrada en la literatura. Los posibles factores asociados a la automedicación en niños son la experiencia previa de automedicación y la edad del niño. Desde la atención primaria se deben realizar campañas educativas a la población de los riesgos de la automedicación.

ABSTRACT Objective: Self-medication in children has a worldwide prevalence of 50%. Acute diarrheal disease and respiratory tract infection are prevalent childhood diseases and are affected by this practice. The objective was established the prevalence of self-medication in children who consult a pediatric service and explore possible associated factors. Materials and methods: A cross-sectional study was conducted, children who consulted for acute respiratory disease or acute diarrheal disease were included. An instrument for information collection was developed and applied. In order to explore the possible risk factors associated with self-medication, bivariate analyzes were performed and a logistic regression model was constructed. The OR with its confidence interval was estimated as an effect measure. The statistical significance value was established with a value of p <0.05. Results: 300 children were included. The prevalence of self-medication was 46 %. The most used medications were acetaminophen (78 %) and ibuprofen (15 %). Association of self-medication was found with the history of prior self-medication and the child's age. Conclusions: The prevalence of self-medication is high and like that found in the literature. Possible associated factors are previous self-medication experience and the child's age. From primary care it is appropriate to carry out educational campaigns to the population of the risks of self-medication.

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Resumen Objetivos: Explorar la relación entre las variables sociodemográficas presentes en la madre y en la familia con el bajo peso al nacer en los recién nacidos atendidos en una clínica universitaria en Chía (Cundinamarca, Colombia). Métodos: Estudio de corte transversal. Se incluyó a 301 recién nacidos de la Clínica Universidad de La Sabana entre el 1° de julio y 31 de diciembre de 2015. Se midieron variables sociodemográficos y factores de la madre y del recién nacido. Se realizó un análisis bivariado para determinar la relación entre las variables de exposición y bajo peso; para este se aplicó la prueba de chi2 o de Fisher. Posteriormente se realizó un modelo de regresión logística para explorar la asociación entre las variables de exposición y el bajo peso al nacer. Resultados: La frecuencia de bajo peso al nacer fue del 18.27 %. Se halló asociación entre el bajo peso al nacer y el nivel educativo bajo de la madre (OR 2.65; IC 95 %: 1.17 - 5.97). Como factor protector para el bajo peso al nacer se encontró el asistir a 4 o más controles prenatales (OR 0.34; IC 95 %: 0.14 - .084). Conclusiones: La frecuencia de bajo peso al nacer en la población estudiada está por encima del promedio nacional y regional. Se encontró como factor de riesgo el nivel educativo bajo, y como factor protector, el número de controles prenatales. Es importante continuar con el adecuado control social en las madres y familias de estratos bajos como factor preventivo primario del bajo peso al nacer.

Abstract Objectives: To explore the relationship between sociodemographic variables present in the mother and in the family with low birth weight infants attended at a university clinic in Chia, Colombia. Methods: Cross-sectional study. 301 newborns from the Clinica Universidad de La Sabana were included between July 1 and December 31, 2015. Socio-demographic variables and maternal and newborn factors were analyzed. A bivariate analysis was performed to determine the relationship between the variables and low-birth weight, the chi2 or Fisher test was applied. A logistic regression model was performed to explore the association between exposure variables and low birth weight. Results: The frequency of low birth weight was 18.27 %. We found an association between low birth weight and low maternal education (OR 2.65,95 % CI: 1.17 - 5.97). As a protective factor for birth weight was found to attend four or more prenatal controls (OR 0.34, 95 % CI: 0.14 - .084). Conclusions: The frequency of low birth weight is above the national and regional average. The low educational level was found as a risk factor and as a protective factor the number of prenatal controls. It is important to continue with adequate social control in low-income mothers and families as a primary preventive factor of low birth weight.

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La apendicitis neonatal es una patología infrecuente, de difícil diagnóstico y con una mortalidad elevada. Se han estudiado diversas teorías sobre su etiología que consideran que la apendicitis en el periodo neonatal podría corresponder a una manifestación de inmadurez inmunitaria. El cuadro clínico de apendicitis en este grupo etáreo no tiene las características clásicas, incluyendo signos y síntomas inespecíficos, que pueden corresponder a patologías más frecuentes como la enterocolitis necrotizante. La perforación intestinal constituye la complicación más frecuente y el diagnóstico se realiza usualmente de forma intraoperatoria. En el presente artículo, se describen dos neonatos con diagnóstico intraoperatorio de apendicitis, nacidos en la Clínica Universidad de La Sabana en el año 2016. En ellos, se destaca el cuadro clínico de presentación y manejo quirúrgico, los cuales permitieron identificar esta patología.

Neonatal appendicitis is a rare condition, difficult to diagnose, and with a high mortality. Several hypotheses on its etiology have been postulated, since appendicitis in the neonatal period may correspond to a manifestation of immune immaturity. The clinical condition of appendicitis in this age group does not have the classic features, which include signs and nonspecific symptoms that may correspond to most frequent pathologies, such as necrotizing enterocolitis. Intestinal perforation is the most frequent complication and the diagnosis is usually intraoperative. The cases described in here correspond to two newborns with intraoperative diagnosis of appendicitis, delivered in the Universidad de La Sabana Clinic in 2016. Highlights on the aforementioned clinical condition are included. Surgical management, which allowed us to identify this pathology, was described.

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Introducción: Ha aumentado la sobrevida de los neonatos críticamente enfermos, lo que ha llevado a los profesionales encargados del cuidado de estos bebés a enfrentar frecuentemente decisiones éticas. En el presente trabajo se plantea el objetivo de caracterizar las situaciones éticas que enfrentan, el criterio que utilizan y la forma en que se toman las decisiones en los dilemas éticos por parte de los pediatras y neonatólogos. Métodos: Se realizó un estudio de corte transversal. Se invitaron a participar 87 neonatólogos y/o pediatras que quisieran contestar de forma voluntaria la encuesta para la caracterización y trabajaran en unidades neonatales de Chía y Bogotá entre el 1 de octubre de 2014 y 31 de enero de 2015, de los cuales aceptaron participar 45 profesionales (51.7%). Se realizó un análisis exploratorio de los datos, utilizando estadística descriptiva. Resultados: De los profesionales que contestaron la encuesta, el 100.0% se ha enfrentado a problemas éticos, el 60.0% han recibido algún tipo de capacitación en bioética, 33.0% se apoya en comités de ética, 98.0% tienen algún límite de viabilidad para iniciar reanimar y el 93.0% ha limitado el esfuerzo terapéutico; el 98.0% incluye a los padres en las decisiones y registra la decisión en la historia clínica. Conclusiones: Son frecuentes los conflictos éticos en la unidad neonatal. La mayoría cuenta con capacitación y comité de ética para la toma de decisiones. Entre los especialistas hay opiniones heterogéneas sobre ciertos problemas éticos en las unidades neonatales.

The survival of critically ill neonates has increased, which has led to professional caregivers of these babies to face ethical decisions about it. This paper outlines the aim of characterizing ethical situations that caregivers face, the criterion they use and how decisions on ethical dilemmas are taken by Pediatricians and Neonatologists. Methodology: A cross-sectional study was performed. 87 neonatologists and/or Pediatricians, who work in neonatal care units in Chia and Bogota between October 1 of 2014 and January 31 of 2015, were invited to participate and answer a characterization survey voluntarily, but only 45 professionals (51.7%) agreed to take part in it. An exploratory data analysis was performed by using descriptive statistics. Results: Professionals who answered the survey, 100.0% of them has faced ethical problems, 60.0% of them has received some training in bioethics, 33.0% relies on ethics committee, 98.0% has a viability limit to start reanimating and 93.0% has limited the therapeutic effort; 98.0% includes parents in decisions and registers the decision in the medical record. Conclusions: Ethical conflicts in the neonatal care unit are frequent. Most professionals have training and an ethics committee for decision-making. Among the specialists there are heterogeneous views on certain ethical problems in neonatal care units.

Introdução: O aumento da sobrevivência de recém-nascidos criticamente doentes, o que levou a cuidadores profissionais para esses bebês muitas vezes enfrentam decisões éticas. Objetivo: Neste trabalho é caracterizar as situações éticas e os critérios utilizados por pediatras e neonatologistas no jeito como tomam as decisões, frente aos dilemas éticos surgidos. Métodos: O estudo realizado foi de tipo transversal. De 87 neonatologistas e / ou pediatras convidados a participar no estudo realizado entre 01 de outubro de 2014 e 31 de janeiro de 2015, 45 profissionais (51,7%), que trabalham nas unidades neonatais de Chia e Bogotá (Colȏmbia), aceitaram livremente responder as perguntas. Os dados foram estudados por meio de estatística descritiva. Resultados: As respostas da pesquisa mostraram que 100,0% dos professionais tem enfrentado problemas éticos, 60,0% receberam alguma preparação em bioética, 33,0% se apoia na comissão de ética, 98,0% têm um limite de viabilidade para começar a reanimação e 93,0% tem limitado o esforço terapêutico; 98,0% inclui os pais nas decisões e o registra no prontuário. Conclusões: Os conflitos éticos são frequentes na unidade neonatal. A maioria tem formação e conta com a comissão de ética para tomar as decisões. Entre os especialistas há pontos de vista heterogêneos sobre certos problemas éticos nas unidades neonatais.

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