Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Corticosteroides , Nascimento Prematuro , Cuidado Pré-Natal , Recém-Nascido Prematuro , Idade GestacionalAssuntos
Corticosteroides , Nascimento Prematuro , Gravidez , Humanos , Feminino , Recém-Nascido , Recém-Nascido Prematuro , Cuidado Pré-Natal , Idade GestacionalRESUMO
OBJECTIVE: This study aimed to assess if a color scale in the endotracheal tube (ETT) can help operators to correctly select the size and depth of placement of the ETT and decrease the time required to complete the procedure and compared with the usual numeric ETT scale in a mannequin model. STUDY DESIGN: The study was conducted in eight centers. Each size of the ETT was identified with a different color. The experimental ETTs had two different colored areas, one for the mouthpiece and another to identify where the ETT should be taped above the lip (an area of 1 cm. The operators were trained as part of the protocol using an instructional video. Four clinical scenarios requiring endotracheal intubation were designed and randomly assigned. Each operator had to select the size and depth of ETT based on the birth weight (BW), and then had to perform four intubations. RESULTS: A total of 108 operators performed 432 intubations. No differences were found in the correct placement and selection of the ETT. Median time (in seconds) required for intubation using numeric versus experimental tube was: for ETT Ø NRP (Neonatal Resuscitation Program) 2.5, 11.5 versus 8 (p < 0.001), ETT Ø 3, 12 versus 10 (p < 0.001), ETT Ø 3.5, 15.5 versus12 (p = 0.003), ETT Ø 4, 12 versus11 (p = 0.019). CONCLUSION: No significant difference was observed in the selection and correct placement of the ETT. However, the intubation time was significantly shorter using the experimental ETT. This device could improve the effectiveness of intubation by reducing the time needed to properly place the ETT at mid trachea. KEY POINTS: · It is an innovative intervention to try to solve a great inconvenience of daily practice.. · The study also raises the difficulty in maintaining the ability of endotracheal intubation.. · It proposes a scale that ensures the correct location with a safe fixation zone..
Assuntos
Intubação Intratraqueal , Ressuscitação , Humanos , Recém-Nascido , Intubação Intratraqueal/métodos , Traqueia , Peso ao Nascer , Projetos de PesquisaRESUMO
La infección por estreptococo ß-hemolítico del grupo B o Streptococcus agalactiae puede causar morbilidad grave y mortalidad en los recién nacidos, especialmente en prematuros. Las estrategias de prevención actuales han sido eficaces en reducir la frecuencia de sepsis neonatal temprana ocasionada por transmisión vertical. La incidencia de sepsis tardía por dicho microrganismo no se ha modificado y la vía de infección es menos clara. En niños amamantados, la transmisión a través de la leche materna es posible. Se presentan tres casos de infección tardía por estreptococo ß-hemolítico del grupo B en recién nacidos prematuros alimentados con leche materna cuyas madres tenían mastitis. En todos los casos, tanto en el cultivo de la leche materna como en los hemocultivos de los neonatos se desarrolló el mismo microrganismo.
Group B ß-hemolytic Streptococcus or Streptococcus agalactiae is a major cause of morbidity and mortality in neonates, especially in premature infants. Current prevention strategies have been effective in reducing the frequency of early onset neonatal sepsis caused by vertical transmission. The incidence of late onset sepsis due to this microorganism has not changed and the route of infection is less clear. In breastfed infants, transmission through breast milk is possible. We report three cases of late group B ß-hemolytic streptococcal infection in breastfed preterm infants whose mothers had mastitis. In all cases, both the breast milk culture and the blood cultures of the neonates developed the same microorganism.
Assuntos
Humanos , Feminino , Recém-Nascido , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae , Recém-Nascido Prematuro , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Leite HumanoRESUMO
Group B ß-hemolytic Streptococcus or Streptococcus agalactiae is a major cause of morbidity and mortality in neonates, especially in premature infants. Current prevention strategies have been effective in reducing the frequency of early onset neonatal sepsis caused by vertical transmission. The incidence of late onset sepsis due to this microorganism has not changed and the route of infection is less clear. In breastfed infants, transmission through breast milk is possible. We report three cases of late group B ß-hemolytic streptococcal infection in breastfed preterm infants whose mothers had mastitis. In all cases, both the breast milk culture and the blood cultures of the neonates developed the same microorganism.
La infección por estreptococo ß-hemolítico del grupo B o Streptococcus agalactiae puede causar morbilidad grave y mortalidad en los recién nacidos, especialmente en prematuros. Las estrategias de prevención actuales han sido eficaces en reducir la frecuencia de sepsis neonatal temprana ocasionada por transmisión vertical. La incidencia de sepsis tardía por dicho microrganismo no se ha modificado y la vía de infección es menos clara. En niños amamantados, la transmisión a través de la leche materna es posible. Se presentan tres casos de infección tardía por estreptococo ß-hemolítico del grupo B en recién nacidos prematuros alimentados con leche materna cuyas madres tenían mastitis. En todos los casos, tanto en el cultivo de la leche materna como en los hemocultivos de los neonatos se desarrolló el mismo microrganismo.
Assuntos
Infecções Estreptocócicas , Streptococcus agalactiae , Humanos , Recém-Nascido , Lactente , Feminino , Leite Humano , Recém-Nascido Prematuro , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controleRESUMO
AIM: To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain. BACKGROUND: Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported. CASE DESCRIPTION: We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented. CONCLUSIONS: SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found. CLINICAL SIGNIFICANCE: Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants.
Assuntos
Isquemia Encefálica/virologia , COVID-19/complicações , Doenças do Recém-Nascido/virologia , SARS-CoV-2/isolamento & purificação , Aciclovir/uso terapêutico , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/patologia , COVID-19/patologia , Ceftriaxona/uso terapêutico , Febre , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Doenças do Recém-Nascido/patologia , Letargia , Imageamento por Ressonância Magnética , Masculino , Nasofaringe/virologia , Convulsões , Tratamento Farmacológico da COVID-19RESUMO
Introducción. El objetivo de este estudio fue analizar recursos disponibles, guías utilizadas y preparación para la atención de neonatos en maternidades de Argentina durante la pandemia de COVID-19.Método. Estudio transversal mediante una encuesta enviada a equipos médicos y de enfermería. En mayo de 2020, se contactaron instituciones de más de 500 nacimientos anuales en la Argentina, el 58 % del sector público.Resultados. Respondieron 104/147 instituciones (el 71 %). Todas contaban con guías para la atención durante la pandemia, y un 93 % refirió haber recibido capacitación para su uso. No autorizaban la presencia de acompañante en el parto el 26 % de instituciones privadas y el 60 % de las públicas (p < 0,01). El 87 % recomendaba ligadura oportuna del cordón, el 62 % promovía internación conjunta en neonatos asintomáticos, un 70 % recomendaba la puesta al pecho con medidas de protección, y el 23 %, leche materna mediante biberón. El 94 % restringía el ingreso de familiares a Neonatología.Las dificultades incluyeron imposibilidad de contar con habitaciones individuales para neonatos sintomáticos y potencial limitación del personal de salud y equipos de protección personal.Conclusiones. Todas las instituciones conocen las guías nacionales para enfrentar la pandemia. La mayoría cuenta con recursos para respetar las medidas de protección recomendadas. Existe incertidumbre sobre si, ante un aumento significativo en el número de casos, serán suficientes los elementos de protección personal, el personal y el espacio físico disponible en los distintos centros
Introduction. The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic.Method. Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector.Results. In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted.Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment.Conclusions. All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Adulto , Pessoa de Meia-Idade , Estratégias de Saúde , Infecções por Coronavirus , Preparação em Desastres , Equipe de Assistência ao Paciente , Argentina , Medidas de Segurança , Estudos Transversais , Inquéritos e Questionários , Equipamento de Proteção Individual , Maternidades , NeonatologiaRESUMO
INTRODUCTION: The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic. METHOD: Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector. RESULTS: In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted. Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment. CONCLUSIONS: All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly.
Introducción. El objetivo de este estudio fue analizar recursos disponibles, guías utilizadas y preparación para la atención de neonatos en maternidades de Argentina durante la pandemia de COVID-19. Método. Estudio transversal mediante una encuesta enviada a equipos médicos y de enfermería. En mayo de 2020, se contactaron instituciones de más de 500 nacimientos anuales en la Argentina, el 58 % del sector público. Resultados. Respondieron 104/147 instituciones (el 71 %). Todas contaban con guías para la atención durante la pandemia, y un 93 % refirió haber recibido capacitación para su uso. No autorizaban la presencia de acompañante en el parto el 26 % de instituciones privadas y el 60 % de las públicas (p < 0,01). El 87 % recomendaba ligadura oportuna del cordón, el 62 % promovía internación conjunta en neonatos asintomáticos, un 70 % recomendaba la puesta al pecho con medidas de protección, y el 23 %, leche materna mediante biberón. El 94 % restringía el ingreso de familiares a Neonatología. Las dificultades incluyeron imposibilidad de contar con habitaciones individuales para neonatos sintomáticos y potencial limitación del personal de salud y equipos de protección personal. Conclusiones. Todas las instituciones conocen las guías nacionales para enfrentar la pandemia. La mayoría cuenta con recursos para respetar las medidas de protección recomendadas. Existe incertidumbre sobre si, ante un aumento significativo en el número de casos, serán suficientes los elementos de protección personal, el personal y el espacio físico disponible en los distintos centros.
Assuntos
COVID-19/prevenção & controle , Recursos em Saúde/provisão & distribuição , Cuidado do Lactente/organização & administração , Controle de Infecções/organização & administração , Serviços de Saúde Materna/organização & administração , Argentina/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Política de Saúde , Humanos , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Serviços de Saúde Materna/estatística & dados numéricos , Pandemias , Equipamento de Proteção Individual/provisão & distribuição , Guias de Prática Clínica como Assunto , GravidezRESUMO
Infections caused by respiratory viruses in neonates during their stay in the neonatal intensive care unit (NICU) are more frequent than generally suspected. Respiratory syncytial virus (RSV), a highly contagious pathogen, is the most common etiologic agent, and it carries a high risk of nosocomial spread. During the RSV season, overcrowding of the NICU, shortage of staff, and unrestricted visitors are factors predisposing outbreaks. Since signs and symptoms of RSV infections are no specific, a high index of suspicion is essential to prevent or limit epidemics. The etiologic agent should be confirmed and polymerase chain reaction (PCR) is the gold-standard test. Shedding of the virus by infected preterm infants is prolonged and RSV lasts for several hours on countertops and other surfaces. The first case should be isolated and strict cohorting must be instituted. Compliance with hand washing must be warranted. Wearing gowns and gloves may help. The severity of nosocomial RSV infections tends to be higher than that of those community acquired. There is no uniform recommendation to start palivizumab during hospital stay of premature and high-risk infants. The use of this monoclonal antibody to stop or limit the spread of outbreaks is controversial. It is recommended by some professional organizations and not by others but its use during large outbreaks in infants at risk who share the room with infected neonates is not uncommon. KEY POINTS: · During peak community epidemic, NICU outbreaks of RSV infections are not uncommon.. · High index of suspicion is essential as initial signs are nonspecific in preterm neonates.. · Isolation and cohorting, strict hand washing, gowns, gloves, and eventually palivizumab are main tools for management..
Assuntos
Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Surtos de Doenças , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Palivizumab , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Infecções por Vírus Respiratório Sincicial/epidemiologiaRESUMO
OBJECTIVE: To assess whether oxytocin administered before clamping the umbilical cord modifies the volume of placental transfusion. DESIGN: Randomised controlled trial. METHODS: Mothers of term infants born vigorous by vaginal delivery with informed consent provided in early labour were randomly assigned to oxytocin (10 IU) given intravenously within 15 s of birth (group 1) or after clamping the umbilical cord 3 min after delivery (group 2). Soon after birth, all infants were weighed using a 1 g precision scale and subsequently placed on the mother's abdomen or chest. At 3 min, in both groups, the cord was clamped and cut, and the weight was again obtained. The primary outcome (volume of placental transfusion) was estimated by the difference in weights. RESULTS: 144 patients were included. There were no differences in the primary outcome: infants in group 1 (n=70) gained a mean weight of 85.9 g (SD 48.3), and in group 2 (n=74) 86.7 g (SD 49.6) (p=0.92). No differences were found in secondary outcomes, including newborns' haematocrit and bilirubin concentrations and severe maternal postpartum haemorrhage. On the advice of the Data and Safety Monitoring Committee, the trial was stopped due to futility at 25% of the planned sample size. CONCLUSIONS: When umbilical cord clamping is delayed for 3 min, term newborn infants born vigorous receive a clinically significant placental transfusion which is not modified by the administration of intravenous oxytocin immediately after birth. TRIAL REGISTRATION NUMBER: NCT02618499.
Assuntos
Constrição , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Circulação Placentária , Período Pós-Parto , Cordão Umbilical , Adulto , Bilirrubina/sangue , Peso ao Nascer , Parto Obstétrico , Feminino , Hematócrito , Maternidades , Humanos , Recém-Nascido , Injeções Intravenosas , Masculino , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Fatores de Tempo , Aumento de PesoRESUMO
BACKGROUND: Delayed cord clamping allows for the passage of blood from the placenta to the baby and reduces the risk of iron deficiency in infancy. To hold the infant for more than 1 min at the level of the vagina (as is presently recommended), on the assumption that gravity affects the volume of placental transfusion, is cumbersome, might result in low compliance, and interferes with immediate contact of the infant with the mother. We aimed to assess whether gravity affects the volume of placental transfusion METHODS: We did a multicentre non-inferiority trial at three university-affiliated hospitals in Argentina. We obtained informed consent from healthy mothers with normal term pregnancies admitted early in labour. Vigorous babies born vaginally were randomly assigned in a 1:1 ratio by computer-generated blocks and sequentially numbered sealed opaque envelopes to be held for 2 min before clamping the umbilical cord, at the level of the vagina (introitus group) or on the mother's abdomen or chest (abdomen group). Newborn babies were weighed immediately after birth and after cord clamping. The primary outcome was the difference in weight (as a proxy of placental transfusion volume). The prespecified non-inferiority margin was 18 g (20%). We used t test and χ(2) test for group comparison, and used a multivariable linear regression analysis to control for covariables. This trial is registered with ClinicalTrials.gov, number NCT01497353. FINDINGS: Between Aug 1, 2011, and Aug 31, 2012, we allocated 274 newborn babies to the introitus group and 272 to the abdomen group. 77 newborn babies in the introitus group and 78 in the abdomen group were ineligible after randomisation (eg, caesarean section, forceps delivery, short umbilical cord or nuchal cord). Mean weight change was 56 g (SD 47, 95% CI 50-63) for 197 babies in the introitus group compared with 53 g (45, 46-59) for 194 babies in the abdomen group, supporting non-inferiority of the two approaches (difference 3 g, 95% CI -5.8 to 12.8; p=0.45). We did not note any serious adverse events during the study. INTERPRETATION: Position of the newborn baby before cord clamping does not seem to affect volume of placental transfusion. Mothers could safely be allowed to hold their baby on their abdomen or chest. This change in practice might increase obstetric compliance with the procedure, enhance maternal-infant bonding, and decrease iron deficiency in infancy. FUNDING: Foundation for Maternal and Child Health (FUNDASAMIN).