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OBJECTIVE: To develop and validate a model for very low birth weight (VLBW) neonatal mortality prediction, based on commonly available data at birth, in 16 neonatal intensive care units (NICUs) from five South American countries. STUDY DESIGN: Prospectively collected biodemographic data from the Neonatal del Cono Sur (NEOCOSUR) Network between October 2000 and May 2003 in infants with birth weight 500 to 1500 g were employed. A testing sample and crossvalidation techniques were used to validate a statistical model for risk of in-hospital mortality. The new risk score was compared with two existing scores by using area under the receiver operating characteristic curve (AUC). RESULTS: The new NEOCOSUR score was highly predictive for in-hospital mortality (AUC=0.85) and performed better than the Clinical Risk Index for Babies (CRIB) and the NICHD risk models when used in the NEOCOSUR Network. The new score is also well calibrated - it had good predictive capability for in-hospital mortality at all levels of risk (HL test=11.9, p=0.85). The new score also performed well when used to predict in hospital neurological and respiratory complications. CONCLUSIONS: A new and relatively simple VLBW mortality risk score had a good prediction performance in a South American network population. This is an important tool for comparison purposes among NICUs. This score may prove to be a better model for application in developing countries.

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OBJECTIVE: This study was undertaken to evaluate whether the administration of meperidine decreases the length of labor in patients with a diagnosis of dystocia during the first stage of labor. STUDY DESIGN: Women with term singleton pregnancies who received a diagnosis of dystocia and required an active management of labor were randomly assigned to receive either 100 mg of meperidine or placebo. The primary outcome measure was length of labor. RESULTS: Four hundred seven pregnant women were included. There were no significant statistical differences between meperidine and placebo groups in length of labor and operative delivery rates such as forceps and cesarean section by intention-to-treat analysis. Low Apgar scores, umbilical artery acidosis, and admission to neonatal care units were increased in the meperidine group. CONCLUSION: Because of the absence of any benefits in patients with dystocia in labor and the presence of harmful effects on neonatal outcomes, meperidine should not be used during labor for this specific indication.

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En este estudio tuvimos como objetivo principal la descripción del uso de tres equipos utilizados para la reanimación en la Maternidad del Centro Hospitalario Pereira Rossell, y como objetivo secundario valorar las indicaciones de la reanimación, los métodos utilizados, así como algunos indicadores que nos permitan mejorar los resultados. Para ello se hizo un uso randomizado por día de los equipos a utilizar, y se valoraron la aparición de complicaciones, la evolución a través de los días de asistencia ventilatoria, días de oxigenoterapia, mortalidad. También se hizo una encuesta entre los médicos que realizaron las reanimaciones sobre los distintos problemas que tuvieron, y sobre algunas de sus preferencias en cuanto al uso de los equipos usados. Los resultados no encontraron diferencias significativas entre los tres equipos usados, salvo en la aceptación por parte de los operadores. En cuanto a la valoración de la reanimación, creemos que puede utilizarse menor frecuencia de intubación como método inicial de la reanimación respiratoria, así como la escasa necesidad de recurrir a medicación en la reanimación de los recién nacidos.

Neste estudo tivemos como objetivo principal a descrição do uso de 3 aparelhos utilizados para a reanimação na Maternidade do Centro Hospitalário Pereira Rosell, e como objetivo secundário valorizar as indicações da reanimação, os métodos utilizados, também como alguns indicadores que nos permitam melhorar os resultados. Com esse objetivo se fez um uso randomizado por dia dos aparelhos a utilizar, e se valorizou a aparição de complicações, e a evolução, através dos dias de assistência ventilatória, dias de oxigenoterapia , mortalidade. Também se fez uma pesquisa entre os médicos que realizaram as reanimações, referente aos diferentes problemas que tiveram, e sobre algumas de suas preferências, relacionadas aos aparelhos usados. Os resultados não apontam diferenças significativas entre os aparelhos usados, exceto na aceitação por parte dos operadores. Referente à valorização da reanimação, acreditamos que podemos utilizar com menos freqüência a intubação, como método inicial da reanimação respiratória, como também a escassa necessidade de recorrer a medicação na reanimação dos RN.

The principal outcome in this paper was to compare the use of three devices applied in reanimation of neonates in Maternity of Centro Hospitalario Pereira Rossell, and as secondary outcome, the indications in reanimation, mortality, complications, and study some indicators. We also did a survey among the physicians that attended the newborns about the problems they had with the devices, and their preferences in using them. We found no differences in all the complications and in the evolution of the babies, using the three different equipments, but yes in the preference of users. About reanimation methods, we think that it could be used intubation less frequently than it is, as inicial method of reanimation, and the scarce need of medication in the recovery to newborns.