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Arriaga-Redondo M, Rodríguez-Sánchez de la Blanca A, Zunzunegui JL, Ballesteros-Tejerizo F, Rodríguez-Ogando A, González-Navarro P, Blanco-Bravo D, Sánchez-Luna M. Impact of catheterized ductal closure on renal and cerebral oximetry in premature neonates. Eur J Pediatr 2024:10.1007/s00431-024-05541-3. [PMID: 38558310 DOI: 10.1007/s00431-024-05541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Percutaneous catheter-based closure is increasingly utilized in premature newborns. While near-infrared spectroscopy (NIRS) has been examined for assessment of interventional closure in surgical ligation, its application in percutaneous transcatheter closure remains unexplored. This study aims to assess cerebral and renal hemodynamic changes using NIRS during percutaneous closure compared to surgical closure in preterm infants. A prospective observational study enrolled preterm infants born at 32 weeks of gestation or less and diagnosed with hsPDA between January 2020 and December 2022. These infants received either surgical or catheter-based closure of the PDA. Cerebral and renal oxygen saturation was monitored using the INVOS 5100 device from 12 h before the intervention until 24 h after. Linear mixed-effects models were used to analyze time-dependent variables. Twenty-two patients were enrolled, with catheter-based closure performed in 16 cases and conventional surgery in 6 cases. Following ductal closure, a significant increase in renal and cerebral oximetry was observed alongside a decrease in renal and cerebral tissue oxygen extraction. These changes were particularly pronounced in the renal territory. No differences were detected between catheterization and surgical closure. Conclusion: An improvement in cerebral and renal oximetry following hsPDA closure was observed. However, we did not identify differences in this pattern based on the type of interventional procedure for PDA, whether surgery or catheterization. What is Known: • The presence of a significant ductus is common in premature patients. Studies have shown that it affects cerebral and renal hemodynamics negatively, leading to decreased oximetry values in these areas. It has been reported that closure of the ductus, either pharmacologically or surgically, results in improved oximetry values. What is New: • This study assess the impact of percutaneous closure of ductus, revealing increased oximetry values in cerebral and renal territories without significant differences compared to surgical ligation. Notably, renal oximetry values showed a greater increase, underscoring the importance of multi-location monitoring.
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Affiliation(s)
- María Arriaga-Redondo
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain.
| | | | - José Luis Zunzunegui
- Pediatric Cardiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | - Pablo González-Navarro
- Unidad de Investigación Materno Infantil-Fundación Familia Alonso (UDIMIFFA)-Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Dorita Blanco-Bravo
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain
| | - Manuel Sánchez-Luna
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain
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Pérez-Pérez A, González-Pacheco N, Arriaga-Redondo M, Ramos-Navarro C, Rodríguez-Corrales E, de la Blanca ARS, González-Navarro P, Santos-González M, Sánchez-Luna M. Impact on cerebral hemodynamics of the use of volume guarantee combined with high frequency oscillatory ventilation in a neonatal animal respiratory distress model. Eur J Pediatr 2024; 183:157-167. [PMID: 37851085 DOI: 10.1007/s00431-023-05245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
High-frequency oscillatory ventilation (HFOV) is an alternative to conventional mechanical ventilation (CMV). Recently, the use of volume guarantee (VG) combined with HFOV has been suggested as a safe strategy capable of reducing the damage induced by ventilation in immature lungs. However, the possible impact of this new ventilation technique on cerebral hemodynamics is unknown. To evaluate the cerebral hemodynamics effect of HFOV combined with VG in an experimental animal model of neonatal respiratory distress syndrome (RDS) due to surfactant deficiency compared with HFOV and CMV+VG (control group). Eighteen newborn piglets were randomized, before and after the induction of RDS by bronchoalveolar lavage, into 3 mechanical ventilation groups: CMV, HFOV and HFOV with VG. Changes in cerebral oxygen transport and consumption and cerebral blood flow were analyzed by non-invasive regional cerebral oxygen saturation (CrSO2), jugular venous saturation (SjO2), the calculated cerebral oxygen extraction fraction (COEF), the calculated cerebral fractional tissue oxygen extraction (cFTOE) and direct measurement of carotid artery flow. To analyze the temporal evolution of these variables, a mixed-effects linear regression model was constructed. After randomization, the following statistically significant results were found in every group: a drop in carotid artery flow: at a rate of -1.7 mL/kg/min (95% CI: -2.5 to -0.81; p < 0.001), CrSO2: at a rate of -6.2% (95% CI: -7.9 to -4.4; p < 0.001) and SjO2: at a rate of -20% (95% CI: -26 to -15; p < 0.001), accompanied by an increase in COEF: at a rate of 20% (95% CI: 15 to 26; p < 0.001) and cFTOE: at a rate of 0.07 (95% CI: 0.05 to 0.08; p < 0.001) in all groups. No statistically significant differences were found between the HFOV groups. CONCLUSION No differences were observed at cerebral hemodynamic between respiratory assistance in HFOV with and without VG, being the latter ventilatory strategy equally safe. WHAT IS KNOWN • Preterm have a situation of fragility of cerebral perfusion wich means that any mechanical ventilation strategy can have a significant influence. High-frequency oscillatory ventilation (HFOV) is an alternative to conventional mechanical ventilation (CMV). Recently, the use of volume guarantee (VG) combined with HFOV has been suggested as a safe strategy capable of reducing the damage induced by ventilation in immature lungs. Several studies have compared CMV and HFOV and their effects at hemodynamic level. It is known that the use of high mean airway pressure in HFOV can cause an increase in pulmonary vascular resistance with a decrease in thoracic venous return. WHAT IS NEW • The possible impact of VAFO + VG on cerebral hemodynamics is unknown. Due the lack of studies and the existing controversy, we have carried out this research project in an experimental animal model with the aim of evaluating the cerebral hemodynamic repercussion of the use of VG in HFOV compared to the classic strategy without VG.
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Affiliation(s)
- Alba Pérez-Pérez
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain.
| | - Noelia González-Pacheco
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
| | - María Arriaga-Redondo
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
| | - Cristina Ramos-Navarro
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
| | - Elena Rodríguez-Corrales
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
| | | | - Pablo González-Navarro
- Unidad de Investigación Materno Infantil Fundación Familia Alonso (UDIMIFFA) - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Martín Santos-González
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
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Gregorio-Hernández R, Sánchez-Luna M. Reply to: Lung ultrasound in neonates with congenital diaphragmatic hernia and the need for a quantitative evaluation. Eur J Pediatr 2023; 182:5715-5716. [PMID: 37847264 DOI: 10.1007/s00431-023-05256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Affiliation(s)
- R Gregorio-Hernández
- Neonatology Department, Gregorio Marañón Hospital, O'Donnell 48 street, 28009, Madrid, Spain.
| | - M Sánchez-Luna
- Neonatology Department, Gregorio Marañón Hospital, O'Donnell 48 street, 28009, Madrid, Spain
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Corsini I, Rodriguez-Fanjul J, Raimondi F, Boni L, Berardi A, Aldecoa-Bilbao V, Alonso-Ojembarrena A, Ancora G, Aversa S, Beghini R, Meseguer NB, Capasso L, Chesi F, Ciarcià M, Concheiro A, Corvaglia L, Ficial B, Filippi L, Carballal JF, Fusco M, Gatto S, Ginovart G, Gregorio-Hernández R, Lista G, Sánchez-Luna M, Martini S, Massenzi L, Miselli F, Mercadante D, Mosca F, Palacio MT, Perri A, Piano F, Prieto MP, Fernandez LR, Risso FM, Savoia M, Staffler A, Vento G, Dani C. Lung UltrasouNd Guided surfactant therapy in preterm infants: an international multicenter randomized control trial (LUNG study). Trials 2023; 24:706. [PMID: 37925512 PMCID: PMC10625281 DOI: 10.1186/s13063-023-07745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT. Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group. METHODS/DESIGN In this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks' gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group. DISCUSSION Based on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05198375 . Registered on 20 January 2022.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | | | - Francesco Raimondi
- Division of Neonatology, Federico II University of Naples, Naples, Italy
| | - Luca Boni
- SC Epidemiologia Clinica IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Policlinico Universitario Modena, Modena, Italy
| | - Victoria Aldecoa-Bilbao
- Neonatal Intensive Care Unit, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Gina Ancora
- Neonatal Intensive Care Unit, Ospedale Infermi Di Rimini, Rimini, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Renzo Beghini
- Neonatal Intensive Care Unit, AOUI Verona, Verona, Italy
| | | | - Letizia Capasso
- Division of Neonatology, Federico II University of Naples, Naples, Italy
| | - Francesca Chesi
- Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Ana Concheiro
- Neonatal Intensive Care Unit, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit IRCCS AUOBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Luca Filippi
- Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jesus Fuentes Carballal
- Neonatal Intensive Care Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Coruña, Spain
| | - Monica Fusco
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Sara Gatto
- Neonatal Intensive Care Unit, Ospedale Dei Bambini "V.Buzzi", Milan, Italy
| | - Gemma Ginovart
- Neonatal Intensive Care Unit. Hospital Germans Trias I Pujol, Badalona, Spain
| | | | - Gianluca Lista
- Neonatal Intensive Care Unit, Ospedale Dei Bambini "V.Buzzi", Milan, Italy
| | | | - Silvia Martini
- Neonatal Intensive Care Unit IRCCS AUOBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Francesca Miselli
- Neonatal Intensive Care Unit, Policlinico Universitario Modena, Modena, Italy
| | - Domenica Mercadante
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marta Teresa Palacio
- Neonatal Intensive Care Unit, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Francesca Piano
- Neonatal Intensive Care Unit, Ospedale Infermi Di Rimini, Rimini, Italy
| | | | | | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | | | | | - Giovanni Vento
- Neonatal Intensive Care Unit, Policlinico Gemelli, Rome, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Gregorio-Hernández R, Ramos-Navarro C, Vigil-Vázquez S, Rodríguez-Corrales E, Pérez-Pérez A, Arriaga-Redondo M, Sánchez-Luna M. Lung ultrasound and postoperative follow-up of congenital diaphragmatic hernia. Eur J Pediatr 2023; 182:3973-3981. [PMID: 37368006 DOI: 10.1007/s00431-023-05074-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
Lung ultrasound (LU) has emerged as a valuable tool for assessing pulmonary aeration noninvasively, rapidly, and reliably in different neonatal conditions. However, its role in the preoperative and postoperative evaluation in congenital diaphragmatic hernia (CDH) is still poorly analyzed. We present a cohort of 8 patients diagnosed with CDH who underwent lung ultrasound examinations at various time points before and after surgical correction. The lung ultrasound patterns were compared between two groups: mechanical ventilation ≤ 7 days (MV ≤ 7) and mechanical ventilation > 7 days (MV > 7). The ultrasound findings were also compared to CT scans and chest X-ray images to assess its diagnostic capacity for identifying postoperative complications: pneumothorax, pleural effusion, and pneumonia. Group MV ≤ 7 exhibited a normal pattern even at 48 h postsurgery, while group MV > 7 presented interstitial or alveolointerstitial pattern in both lungs for prolonged periods (2-3 weeks). Furthermore, contralateral LU pattern may be predictive of respiratory evolution. Conclusion: Lung ultrasound is a valuable tool for evaluating the progressive reaeration of the lung following surgical correction in CDH patients. It demonstrates the ability to diagnose common postoperative complications without the need for radiation exposure while offering the advantages of quick and serial assessments. These findings highlight the potential of lung ultrasound as an effective alternative to conventional imaging methods in the management of CDH. What is Known: • Lung ultrasound evaluates lung aeration and predicts respiratory outcomes in neonatal patients. What is New: • Lung ultrasound is useful in the postsurgical management of congenital diaphragmatic hernia patients, detecting reaeration and respiratory complications.
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Affiliation(s)
| | - C Ramos-Navarro
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - S Vigil-Vázquez
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | | | - A Pérez-Pérez
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | | | - M Sánchez-Luna
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
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6
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Vigil-Vázquez S, Manzanares Á, Hernanz-Lobo A, Carrasco-García I, Zamora Del Pozo C, Pérez-Pérez A, Rincón-López EM, Santiago-García B, Pintado-Recarte MDP, Alonso-Fernández R, Sánchez-Luna M, Navarro-Gómez ML. Serologic evolution and follow-up to IgG antibodies of infants born to mothers with gestational COVID. BMC Pregnancy Childbirth 2023; 23:623. [PMID: 37648971 PMCID: PMC10469412 DOI: 10.1186/s12884-023-05926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND It is known that SARS-CoV-2 antibodies from pregnant women with SARS-CoV-2 infection during pregnancy cross the placenta but the duration and the protective effect of these antibodies in infants is scarce. METHODS This prospective study included mothers with SARS-COV-2 infection during pregnancy and their infants from April 2020 to March 2021. IgG antibodies to SARS-CoV-2 spike protein were performed on women and infants at birth and at two and six months during follow-up. Anthropometrical measures and physical and neurological examinations and a clinical history of symptoms and COVID-19 diagnosis were collected. Simple linear regression was performed to compare categorical and continuous variables. To compare the mother's and infant's antibody titers evolution, a mixed linear regression model was used. A predictive model of newborn antibody titers at birth has been established by means of simple stepwise linear regression. RESULTS 51 mother-infant couples were included. 45 (90%) of the mothers and 44 (86.3%) of the newborns had a positive serology al birth. These antibodies were progressively decreasing and were positive in 34 (66.7%) and 7 (13.7%) of infants at 2 and 6 months, respectively. IgG titers of newborns at birth were related to mothers' titers, with a positive moderate correlation (Pearson's correlation coefficient: 0.82, p < 0,001). Fetal/maternal antibodies placental transference rate was 1.3 (IQR: 0.7-2.2). The maternal IgG titers at delivery and the type of maternal infection (acute, recent, or past infection) was significantly related with infants' antibody titers at birth. No other epidemiological or clinical factors were related to antibodies titers. Neurodevelopment, psychomotor development, and growth were normal in 94.2% of infants in the third follow-up visit. No infants had a COVID-19 diagnosis during the follow-up period. CONCLUSIONS Transplacental transfer of maternal antibodies is high in newborns from mothers with recent or past infection at delivery, but these antibodies decrease after the first months of life. Infant's IgG titers were related to maternal IgG titers at delivery. Further studies are needed to learn about the protective role of maternal antibodies in infants.
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Affiliation(s)
- Sara Vigil-Vázquez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Calle O'Donnel 48, Madrid, 28009, Spain.
| | - Ángela Manzanares
- Pediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Pediatrics Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alicia Hernanz-Lobo
- Pediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Pediatrics Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Itziar Carrasco-García
- Pediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Pediatrics Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Clara Zamora Del Pozo
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alba Pérez-Pérez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Calle O'Donnel 48, Madrid, 28009, Spain
| | - Elena María Rincón-López
- Pediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Pediatrics Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Begoña Santiago-García
- Pediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Pediatrics Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Roberto Alonso-Fernández
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Sánchez-Luna
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Calle O'Donnel 48, Madrid, 28009, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María Luisa Navarro-Gómez
- Pediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Pediatrics Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Gregorio-Hernández R, Chimenti-Camacho P, Aguado Del Hoyo A, Sánchez-Luna M. A case of neonatal tuberous sclerosis diagnosed by lung ultrasound. An Pediatr (Barc) 2023:S2341-2879(23)00127-8. [PMID: 37301683 DOI: 10.1016/j.anpede.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/14/2023] [Indexed: 06/12/2023] Open
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Gregorio-Hernández R, Chimenti-Camacho P, Aguado del Hoyo A, Sánchez-Luna M. Esclerosis tuberosa diagnosticada por ecografía torácica POCUS. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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9
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Pérez-Pérez A, Vigil-Vázquez S, Gutiérrez-Vélez A, Solís-García G, López-Blázquez M, Zunzunegui Martínez JL, Medrano López C, Gil-Jaurena JM, de Agustín-Asensio JC, Sánchez-Luna M. Chylothorax in newborns after cardiac surgery: a rare complication? Eur J Pediatr 2023; 182:1569-1578. [PMID: 36646910 DOI: 10.1007/s00431-023-04808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
UNLABELLED The aim of this study was to analyze patients diagnosed with chylothorax after congenital heart disease surgery among a cohort of neonatal patients, comparing the evolution, complications, and prognosis after surgery of patients who were and were not diagnosed with chylothorax, and to analyze possible risk factors that may predict the appearance of chylothorax in this population. Retrospective and observational study included all neonates (less than 30 days since birth) who underwent congenital heart disease surgery in a level III neonatal intensive care department. We included infants born between January 2014 and December 2019. We excluded those infants who were born before 34 weeks of gestational age or whose birth weight was less than 1800 g. We also excluded catheter lab procedures and patent ductus arteriosus closure surgeries. Included patients were divided into two groups depending on whether they were diagnosed with chylothorax or not after surgery, and both groups were compared in terms of perinatal-obstetrical information, surgical data, and NICU course after surgery. We included 149 neonates with congenital heart disease surgery. Thirty-one patients (20.8%) developed chylothorax, and in ten patients (32.3%), it was considered large volume chylothorax. Regarding the evolution of these patients, 22 infants responded to general dietetic measures, a catheter procedure was performed in 9, and 5 of them finally required pleurodesis. Cardiopulmonary bypass, median sternotomy, and delayed sternal closure were the surgical variables associated with higher risks of chylothorax. Patients with chylothorax had a longer duration of inotropic support and mechanical ventilation and took longer to reach full enteral feeds. As complications, they had higher rates of cholestasis, catheter-related sepsis, and venous thrombosis. Although there were no differences in neonatal mortality, patients with chylothorax had a higher rate of mortality after the neonatal period. In a multiple linear regression model, thrombosis and cardiopulmonary bypass multiplied by 10.0 and 5.1, respectively, the risk of chylothorax and have an umbilical vein catheter decreases risk. CONCLUSION We have found a high incidence of chylothorax after neonatal cardiac surgery, which prolongs the average stay and causes significant morbidity and mortality. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during the neonatal period. WHAT IS KNOWN • Acquired chylothorax in the neonatal period usually appears as a complication of congenital heart disease surgery, being the incidence quite variable among the different patient series (2.5-16.8%). The appearance of chylothorax as a complication of a cardiac surgery increases both mortality and morbidity in these patients, which makes it a quality improvement target in the postsurgical management of this population. WHAT IS NEW •Most of the published studies include pediatric patients of all ages, from newborns to teenagers, and there is a lack of studies focusing on neonatal populations. The main strength of our study is that it reports, to the best of our knowledge, one of the largest series of neonatal patients receiving surgery for congenital heart disease in the first 30 days after birth. We have found a high incidence of chylothorax after cardiac surgery during the neonatal period compared to other studies. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during this period of life.
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Affiliation(s)
- Alba Pérez-Pérez
- Neonatology Department, Hospital General Universitario Gregorio Marañón, O'Donnell 48, Madrid, 28009, Spain.
| | - Sara Vigil-Vázquez
- Neonatology Department, Hospital General Universitario Gregorio Marañón, O'Donnell 48, Madrid, 28009, Spain
| | - Ana Gutiérrez-Vélez
- Neonatology Department, Hospital General Universitario Gregorio Marañón, O'Donnell 48, Madrid, 28009, Spain
| | | | - María López-Blázquez
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Juan Miguel Gil-Jaurena
- Pediatric Cardiac Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Manuel Sánchez-Luna
- Neonatology Department, Hospital General Universitario Gregorio Marañón, O'Donnell 48, Madrid, 28009, Spain
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10
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Merino-Hernández A, Sánchez-Barriopedro L, Villar-Castro S, Aguado-Del Hoyo A, Marsinyach-Ros I, Sánchez-Luna M. Cost-effectiveness of a cytomegalovirus screening strategy in neonates born after 34 weeks small for gestational age. An Pediatr (Barc) 2023; 98:41-47. [PMID: 36528494 DOI: 10.1016/j.anpede.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/05/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Infection by cytomegalovirus (CMV) is one of the most common congenital infections, with a global prevalence of 0.3%-2.4%. In Spain, CMV screening is not performed during pregnancy, but rather in neonates with risk factors, and, in many hospitals, in those born small for gestational age (SGA). Screening is usually performed by measurement of the viral load in urine by polymerase chain reaction (PCR) and/or head ultrasound in search of compatible features. The aim of the study was to assess the yield of the CMV PCR test in urine and head ultrasound examination in asymptomatic neonates born SGA after 34 weeks' gestation. The secondary objective was to assess the cost-effectiveness of this strategy. DESIGN AND METHODS We conducted an observational and retrospective study between January and December 2019 in a tertiary care hospital. It included neonates delivered after 34 weeks, SGA and without additional risk factors assessed with a CMV PCR test in urine and/or head ultrasound. RESULTS The sample included 259 patients. It was divided in 2 groups: group 1, patients with a head circumference, weight and length below the 10th percentile (53 patients; 20.5%), and group 2, patients in whom only the weight was below the 10th percentile (206 patients; 79.5%). The incidence of late preterm birth, twin pregnancy, neonatal admission and exposure to illicit drugs during gestation was higher in group 1. A total of 186 urine PCR tests and 223 head ultrasounds were performed overall, and both tests were performed more frequently in group 1 (P=.002). There was only 1 positive CMV PCR test result in the sample (0.54%), corresponding to a patient in group 2 with no abnormal sonographic findings who remained asymptomatic throughout the follow-up. Two head ultrasound examinations yielded abnormal findings, in both cases unrelated to congenital CMV infection. We performed a cost-effectiveness analysis and determined that the cumulative cost of head ultrasound examinations and urine CMV PCR tests in our sample amounted to Є17 000 for the detection of a single asymptomatic positive case. CONCLUSION In our population, screening for congenital CMV infection in asymptomatic late preterm and term newborns whose only risk factor is SGA does not seem to be cost effective. It would be necessary to expand the sample to other populations.
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Affiliation(s)
- Amaia Merino-Hernández
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Sonia Villar-Castro
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Itziar Marsinyach-Ros
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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11
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Solís-García G, Ramos-Navarro C, González-Pacheco N, Sánchez-Luna M. Lung protection strategy with high-frequency oscillatory ventilation improves respiratory outcomes at two years in preterm respiratory distress syndrome: a before and after, quality improvement study. J Matern Fetal Neonatal Med 2022; 35:10698-10705. [PMID: 36521851 DOI: 10.1080/14767058.2022.2155040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) remains one of the major challenges of extreme prematurity. High-frequency oscillatory ventilation (HFOV) with volume guarantee (HFOV-VG) can be used as an early-rescue ventilation to protect developing lungs. However, the studies exploring the impact of this ventilatory strategy on neonatal respiratory morbidity are very limited. This study aimed at documenting the improvement in respiratory outcomes in mechanically ventilated preterm newborns, after the implementation of a new mechanical ventilation respiratory bundle. METHODS A prospective, quality improvement study was conducted between January 2012 and December 2018 in a third level NICU in Madrid, Spain. Infants born <32 weeks of gestation with severe respiratory distress syndrome (RDS) and requiring invasive mechanical ventilation were included. The intervention consisted of a new ventilation respiratory care bundle, with HFOV as early rescue therapy using low high-frequency tidal volumes (Vthf) and higher frequencies (15-20 Hz). Criteria for HFOV start were impaired oxygenation or ventilation on conventional ventilation, or peak inspiratory pressures >15 cmH2O. Two cohorts of mechanically ventilated patients were compared, cohort 1 (2012-2013, baseline period) and cohort 2 (2016-2018, after implementation of the new bundle). Clinical outcomes at 36 weeks and 2 years of postmenstrual age were compared between the groups. RESULTS A total of 216 patients were included, the median gestational age was 26 weeks (IQR 25-28) and median birth weight was 895 g (IQR 720-1160). There were no significant differences in survival between the groups, but patients with the protective ventilation strategy (cohort 2) had higher survival without BPD 2-3 (OR 2.93, 95%CI 1.41-6.05). At 2 years of postmenstrual age, patients in cohort 2 also had a higher survival free of baseline respiratory treatment and hospital respiratory admissions than the control group (adjusted OR 2.33, 95%CI 1.10-4.93, p=.03). The results did not suggest significant differences in neurologic development. CONCLUSIONS In extreme premature related severe respiratory failure, the use of a lung protective HFOV-VG strategy was proven to be a useful quality improvement intervention in our unit, leading to better pulmonary outcomes at 36 weeks and additional improved respiratory prognosis at two years of age.
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Affiliation(s)
- Gonzalo Solís-García
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Neonatology Division, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Cristina Ramos-Navarro
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Noelia González-Pacheco
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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12
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Solis-Garcia G, González-Pacheco N, Ramos-Navarro C, Vigil-Vázquez S, Gutiérrez-Vélez A, Merino-Hernández A, Rodríguez Sánchez De la Blanca A, Sánchez-Luna M. Lung recruitment in neonatal high-frequency oscillatory ventilation with volume-guarantee. Pediatr Pulmonol 2022; 57:3000-3008. [PMID: 35996817 DOI: 10.1002/ppul.26124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 08/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES The optimal lung volume strategy during high-frequency oscillatory ventilation (HFOV) is reached by performing recruitment maneuvers, usually guided by the response in oxygenation. In animal models, secondary spontaneous change in oscillation pressure amplitude (ΔPhf) associated with a progressive increase in mean airway pressure during HFOV combined with volume guarantee (HFOV-VG) identifies optimal lung recruitment. The aim of this study was to describe recruitment maneuvers in HFOV-VG and analyze whether changes in ΔPhf might be an early predictor for lung recruitment in newborn infants with severe respiratory failure. DESIGN AND METHODS The prospective observational study was done in a tertiary-level neonatology department. Changes in ΔPhf were analyzed during standardized lung recruitment after initiating early rescue HFOV-VG in preterm infants with severe respiratory failure. RESULTS Twenty-seven patients were included, with a median gestational age of 24 weeks (interquartile range [IQR]: 23-25). Recruitment maneuvers were performed, median baseline mean airway pressure (mPaw) was 11 cm H2 O (IQR: 10-13), median critical lung opening mPaw during recruitment was 14 cm H2 O (IRQ: 12-16), and median optimal mPaw was 12 cm H2 O (IQR: 10-14, p < 0.01). Recruitment maneuvers were associated with an improvement in oxygenation (FiO2 : 65.0 vs. 45.0, p < 0.01, SpO2/FiO2 ratio: 117 vs. 217, p < 0.01). ΔPhf decreased significantly after lung recruitment (mean amplitude: 23.0 vs. 16.0, p < 0.01). CONCLUSION In preterm infants with severe respiratory failure, the lung recruitment process can be effectively guided by ΔPhf on HFOV-VG.
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Affiliation(s)
- Gonzalo Solis-Garcia
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,The Hospital for Sick Children, Toronto, Canada
| | - Noelia González-Pacheco
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Ramos-Navarro
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Sara Vigil-Vázquez
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Gutiérrez-Vélez
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Amaia Merino-Hernández
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | | | - Manuel Sánchez-Luna
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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13
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Vazquez-Alejo E, Tarancon-Diez L, Carrasco I, Vigil-Vázquez S, Muñoz-Chapuli M, Rincón-López E, Saavedra-Lozano J, Santos-Sebastián M, Aguilera-Alonso D, Hernanz-Lobo A, Santiago-García B, de León-Luis JA, Muñoz P, Sánchez-Luna M, Navarro ML, Muñoz-Fernández MÁ. SARS-CoV2 Infection During Pregnancy Causes Persistent Immune Abnormalities in Women Without Affecting the Newborns. Front Immunol 2022; 13:947549. [PMID: 35911743 PMCID: PMC9330630 DOI: 10.3389/fimmu.2022.947549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 12/21/2022] Open
Abstract
SARS-CoV2 infection in pregnancy and exposed newborns is poorly known. We performed a longitudinal analysis of immune system and determined soluble cytokine levels in pregnant women infected with SARS-CoV2 and in their newborns. Women with confirmed SARS-CoV2 infection and their exposed uninfected newborns were recruited from Hospital General Universitario Gregorio Marañón. Peripheral blood mononuclear cells (PBMCs), cord cells and plasma were collected at birth and 6 months later. Immunophenotyping of natural killer (NK), monocytes and CD4/CD8 T-cells were studied in cryopreserved PBMCs and cord cells by multiparametric flow cytometry. Up to 4 soluble pro/anti-inflammatory cytokines were assessed in plasma/cord plasma by ELISA assay. SARS-CoV2-infected mothers and their newborns were compared to matched healthy non-SARS-CoV2-infected mothers and their newborns. The TNFα and IL-10 levels of infected mothers were higher at baseline than those of healthy controls. Infected mothers showed increased NK cells activation and reduced expression of maturation markers that reverted after 6 months. They also had high levels of Central Memory and low Effector Memory CD4-T cell subsets. Additionally, the increased CD4- and CD8-T cell activation (CD154 and CD38) and exhaustion (TIM3/TIGIT) levels at baseline compared to controls remained elevated after 6 months. Regarding Treg cells, the levels were lower at infected mothers at baseline but reverted after 6 months. No newborn was infected at birth. The lower levels of monocytes, NK and CD4-T cells observed at SARS-CoV2-exposed newborns compared to unexposed controls significantly increased 6 months later. In conclusion, SARS-CoV2 infection during pregnancy shows differences in immunological components that could lead newborns to future clinical implications after birth. However, SARS-CoV2 exposed 6-months-old newborns showed no immune misbalance, whereas the infected mothers maintain increased activation and exhaustion levels in T-cells after 6 months.
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Affiliation(s)
- Elena Vazquez-Alejo
- Immunology Section, Laboratory of ImmunoBiology Molecular, Hospital General Universitario Gregorio Marañón (HGUGM), HIV-HGM BioBank, Madrid, Spain
| | - Laura Tarancon-Diez
- Immunology Section, Laboratory of ImmunoBiology Molecular, Hospital General Universitario Gregorio Marañón (HGUGM), HIV-HGM BioBank, Madrid, Spain
| | - Itzíar Carrasco
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Sara Vigil-Vázquez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
| | - Mar Muñoz-Chapuli
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
| | - Elena Rincón-López
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Jesús Saavedra-Lozano
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Mar Santos-Sebastián
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - David Aguilera-Alonso
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Alicia Hernanz-Lobo
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Begoña Santiago-García
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Juan Antonio de León-Luis
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón (HGUGM), CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Sánchez-Luna
- Department of Neonatology, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Luisa Navarro
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Mª Ángeles Muñoz-Fernández
- Immunology Section, Laboratory of ImmunoBiology Molecular, Hospital General Universitario Gregorio Marañón (HGUGM), HIV-HGM BioBank, Madrid, Spain
- *Correspondence: M Ángeles Muñoz-Fernández,
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14
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Vigil-Vázquez S, Carrasco-García I, Hernanz-Lobo A, Manzanares Á, Pérez-Pérez A, Toledano-Revenga J, Muñoz-Chapuli M, Mesones-Guerra L, Martínez-Lozano A, Pérez-Seoane B, Márquez-Isidro E, Sanz-Asín O, Caro-Chinchilla G, Sardá-Sánchez M, Solaz-García Á, López-Carnero J, Pareja-León M, Riaza-Gómez M, Ortiz-Barquero MC, León-Luis JA, Fernández-Aceñero MJ, Muñoz-Fernández MÁ, Catalán-Alonso P, Muñoz-García P, Sánchez-Luna M, Navarro-Gómez ML. Impact of Gestational COVID-19 on Neonatal Outcomes: Is Vertical Infection Possible? Pediatr Infect Dis J 2022; 41:466-472. [PMID: 35363644 PMCID: PMC9083309 DOI: 10.1097/inf.0000000000003518] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The vertical transmission of severe acute respiratory coronavirus-2 (SARS-CoV-2) remains highly debated. Here, we evaluated SARS-CoV-2-transmission in newborns with intrauterine conditions. METHODS This was a prospective, observational and multicentric study involving 13 Spanish hospitals included in the GEStational and NEOnatal-COVID cohort. Pregnant women with microbiologically confirmed SARS-CoV-2 infection during any trimester of pregnancy or delivery and their newborns were included from March to November 2020. Demographic, clinical and microbiological data were also obtained. Viral loads were analyzed in different maternal and newborn biological samples (placenta, breast milk and maternal blood; urine, meconium and newborn blood). RESULTS A total of 177 newborns exposed to SARS-CoV-2 were included. Newborns were tested by reverse transcriptase-polymerase chain reaction using nasopharyngeal swabs within the first 24-48 hours of life and at 14 days of life. In total 5.1% were considered to have SARS-CoV-2 infection in the neonatal period, with 1.7% considered intrauterine and 3.4% intrapartum or early postnatal transmission cases. There were no differences in the demographic and clinical characteristics of the pregnant women and their newborns' susceptibility to infections in their perinatal history or background. CONCLUSIONS Intrauterine transmission of SARS-CoV-2 is possible, although rare, with early postnatal transmission occurring more frequently. Most infected newborns remained asymptomatic or had mild symptoms that evolved well during follow-up. We did not find any maternal characteristics predisposing infants to neonatal infection. All infected newborn mothers had acute infection at delivery.Although there was no presence of SARS-CoV2 in cord blood or breast milk samples, SARS-CoV-2 viral load was detected in urine and meconium samples from infected newborns.
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Affiliation(s)
- Sara Vigil-Vázquez
- From the Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Itziar Carrasco-García
- Grupo de Investigación en Infectología Pediátrica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERINFEC, ISCIII, Madrid, Spain
| | - Alicia Hernanz-Lobo
- Grupo de Investigación en Infectología Pediátrica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángela Manzanares
- Grupo de Investigación en Infectología Pediátrica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alba Pérez-Pérez
- From the Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Mar Muñoz-Chapuli
- Servicio de Ginecología y Obstetricia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lara Mesones-Guerra
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrea Martínez-Lozano
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Olga Sanz-Asín
- Hospital Reina Sofía, Tudela, Spain
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | | | | | | | | | | | - Juan Antonio León-Luis
- Servicio de Ginecología y Obstetricia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Pilar Catalán-Alonso
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz-García
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- From the Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro-Gómez
- Grupo de Investigación en Infectología Pediátrica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERINFEC, ISCIII, Madrid, Spain
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15
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Arriaga-Redondo M, Bravo DB, Del Hoyo AA, Arrondo AP, Martín YR, Sánchez-Luna M. Prognostic value of somatosensory-evoked potentials in the newborn with hypoxic-ischemic encephalopathy after the introduction of therapeutic hypothermia. Eur J Pediatr 2022; 181:1609-1618. [PMID: 35066625 DOI: 10.1007/s00431-021-04336-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED To establish the ability of somatosensory-evoked potentials (SEPs) to detect neurological damage in neonatal patients with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Retrospective study including 84 neonates ≥ 36 weeks of gestational age with HIE and TH with SEPs performed in the first 14 days of life. SEPs from the median nerve were performed after completion of TH. Either unilateral or bilateral absence of N20, or unilateral or bilateral latency ≥ 36 ms, was considered pathological. All newborns underwent a cerebral resonance imaging (MRI) at between days 7 and 14 of life and a neurodevelopmental evaluation using the Brunet-Lezine test at two years of age; a global Brunet-Lezine test score < 70 was considered unfavorable. The risk of moderate-to-severe alteration on basal ganglia-thalamic (BGT) and/or white matter areas on MRI for pathological SEPs was as follows: odds ratio 95% IC: 23.1 (6.9-76.9), sensitivity 78.6%, specificity 86.3%, positive predictive value 75.9%, and negative predictive value 88%. The BGT and internal capsule were the areas with the greatest risk of lesion with an altered SEPs: odds ratio 95% IC 93.1 (11.1-777.8). The risk of neurodevelopmental impairment for pathological SEPs was odds ratio 95% IC: 38.5 (4.4-335.3), sensitivity 91.7%, specificity 77.8% positive predictive value 52.4%, and negative predictive value 97.2%. CONCLUSION The present study demonstrates the good predictive capacity of SEPs performed in the first two weeks of life in newborns with HIE and TH to detect an increased risk of neuroimaging lesions and neurodevelopmental impairment at two years of age. WHAT IS KNOWN • Bilateral absence of the N20 cortical component of somatosensory evoked potentials has been associated with poor neurological outcome in neonates with hypoxic-ischemic encephalopathy. WHAT IS NEW • This work confirms the predictive capacity of SEPs by adding two important aspects: the value of latency when interpreting SEPs results and the absence of effect of the hypothermia method used on the results of SEPs.
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Affiliation(s)
- María Arriaga-Redondo
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain.
| | - Dorotea Blanco Bravo
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain
| | | | - Ana Polo Arrondo
- Neurophysiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Manuel Sánchez-Luna
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain
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16
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Gregorio-Hernández R, Pérez-Pérez A, Alonso-Ojembarrena A, Arriaga-Redondo M, Ramos-Navarro C, Sánchez-Luna M. Neonatal pneumothoraces with atypical location: the role of lung ultrasound. Eur J Pediatr 2022; 181:1751-1756. [PMID: 34845527 DOI: 10.1007/s00431-021-04329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/02/2023]
Abstract
UNLABELLED Neonatal pneumothorax (NP) is a potentially life-threatening condition. Lung ultrasound (LUS) has shown higher sensitivity and specificity in diagnosis compared to x-rays, but evidence regarding its usefulness in complex NP is lacking. We report four neonates suffering from cardiac or esophageal malformations who developed lateral and/or posterior pneumothoraces, in which LUS helped, making NP diagnosis and management easier and faster. CONCLUSION LUS is an easy-to-use, fast, simple, and accurate tool when evaluating newborns with NP, also in atypical positions such as in surgical patients. WHAT IS KNOWN • Lung ultrasound (LUS) has higher sensitivity and specificity than x-rays in the diagnosis of pneumothorax in neonatal patients. WHAT IS NEW • This is the first report about neonatal pneumothorax in non-conventional areas (lateral/posterior) diagnosed by lung ultrasound and how obtaining this information is critical in order to optimize management.
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Affiliation(s)
| | - Alba Pérez-Pérez
- Neonatology Department, Gregorio Marañón University Hospital, Madrid, Spain
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Solís-García G, Maderuelo-Rodríguez E, Perez-Pérez T, Torres-Soblechero L, Gutiérrez-Vélez A, Ramos-Navarro C, López-Martínez R, Sánchez-Luna M. Longitudinal Analysis of Continuous Pulse Oximetry as Prognostic Factor in Neonatal Respiratory Distress. Am J Perinatol 2022; 39:677-682. [PMID: 33075845 DOI: 10.1055/s-0040-1718877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Analysis of longitudinal data can provide neonatologists with tools that can help predict clinical deterioration and improve outcomes. The aim of this study is to analyze continuous monitoring data in newborns, using vital signs to develop predictive models for intensive care admission and time to discharge. STUDY DESIGN We conducted a retrospective cohort study, including term and preterm newborns with respiratory distress patients admitted to the neonatal ward. Clinical and epidemiological data, as well as mean heart rate and saturation, at every minute for the first 12 hours of admission were collected. Multivariate mixed, survival and joint models were developed. RESULTS A total of 56,377 heart rate and 56,412 oxygen saturation data were analyzed from 80 admitted patients. Of them, 73 were discharged home and 7 required transfer to the intensive care unit (ICU). Longitudinal evolution of heart rate (p < 0.01) and oxygen saturation (p = 0.01) were associated with time to discharge, as well as birth weight (p < 0.01) and type of delivery (p < 0.01). Longitudinal heart rate evolution (p < 0.01) and fraction of inspired oxygen at admission at the ward (p < 0.01) predicted neonatal ICU (NICU) admission. CONCLUSION Longitudinal evolution of heart rate can help predict time to transfer to intensive care, and both heart rate and oxygen saturation can help predict time to discharge. Analysis of continuous monitoring data in patients admitted to neonatal wards provides useful tools to stratify risks and helps in taking medical decisions. KEY POINTS · Continuous monitoring of vital signs can help predict and prevent clinical deterioration in neonatal patients.. · In our study, longitudinal analysis of heart rate and oxygen saturation predicted time to discharge and intensive care admission.. · More studies are needed to prospectively prove that these models can helpmake clinical decisions and stratify patients' risks..
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Affiliation(s)
- Gonzalo Solís-García
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Teresa Perez-Pérez
- Department of Statistics, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Ana Gutiérrez-Vélez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Ramos-Navarro
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Raúl López-Martínez
- Information Technology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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18
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Ramos-Navarro C, Maderuelo-Rodríguez E, Concheiro-Guisán A, Pérez-Tarazona S, Rueda-Esteban S, Sánchez-Torres A, Sánchez-Solís M, Sanz-López E, Sánchez-Luna M. Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network. Eur J Pediatr 2022; 181:789-799. [PMID: 34596741 DOI: 10.1007/s00431-021-04248-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/12/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
GEIDIS is a national-based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow-up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1755 preterm patients diagnosed with BPD. Of the total sample, 90.6% (n = 1591) were less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8-28.5) and median birth weight 885 g (740-1,070 g). A total of 52.5% (n = 922) were classified as mild (type 1), 25.3% (n = 444) were moderate (type 2), and 22.2% (n = 389) were severe BPD (type 3). In patients born at under 30 weeks' gestation, most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, nosocomial pneumonia, and the length of exposure to MV. Conclusion: In this national-based research-net registry of BPD patients, the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO2 > .30 at 36 weeks' postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2 < .30. What is Known: • BPD is a highly complex multifactorial disease associated with preterm birth. What is New: • The length of exposure to mechanical ventilation is the most important postnatal risk factor associated to bronchopulmonary severity which modulate the effect of most pre and postnatal risk factors. • Among patients with BPD, the requirement for FiO2 >.30% at 36 weeks of postmenstrual age is associated with greater morbidity during hospitalization and at discharge.
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Affiliation(s)
- Cristina Ramos-Navarro
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain.
| | - Elena Maderuelo-Rodríguez
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
| | - Ana Concheiro-Guisán
- Neonatologist at Neonatology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
| | | | - Santiago Rueda-Esteban
- Pediatric Pulmonologist at Pulmonology Department, San Carlos University Hospital, Madrid, Spain
| | - Ana Sánchez-Torres
- Neonatologist at Neonatology Department, La Paz University Hospital, Madrid, Spain
| | - Manuel Sánchez-Solís
- Pediatric Pulmonologist at Pulmonology Department, Virgen Arrixaca University Hospital Murcia, Murcia, Spain
| | - Ester Sanz-López
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
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Sánchez-Luna M. A New Era in the Respiratory Support of the Sick and Immature Neonate. Clin Perinatol 2021; 48:xix-xx. [PMID: 34774217 DOI: 10.1016/j.clp.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Manuel Sánchez-Luna
- Director of the Neonatology Division, University Hospital Gregorio Marañon, Professor of Pediatrics, Complutense University of Madrid, O'Donnell 48, Madrid 28009, Spain.
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20
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Pescador MI, Zeballos SE, Ramos C, Sánchez-Luna M. LÍMITE DE VIABILIDAD: ¿DÓNDE ESTAMOS Y HACIA DÓNDE VAMOS? Revista Médica Clínica Las Condes 2021. [DOI: 10.1016/j.rmclc.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Guinea J, Mezquita S, Gómez A, Padilla B, Zamora E, Sánchez-Luna M, Sánchez-Carrillo C, Muñoz P, Escribano P. Whole genome sequencing confirms Candida albicans and Candida parapsilosis microsatellite sporadic and persistent clones causing outbreaks of candidemia in neonates. Med Mycol 2021; 60:6413549. [PMID: 34718724 DOI: 10.1093/mmy/myab068] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/01/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
Abstract
Whole genome sequencing has been extensively used to describe infection outbreaks, although with limited application on Candida albicans and Candida parapsilosis.We retrospectively studied all patients admitted to the neonatal care unit diagnosed with candidemia caused by C. albicans (n = 46) or C. parapsilosis (n = 31) between 2007 and 2010 (Period 1) and 2011 and 2014 (Period 2). All isolates were genotyped by microsatellite markers. A cluster was defined as a group of ≥ 2 patients infected by strains with identical genotypes. For the validation of microsatellite markers and outbreak investigation, phylogenetic analyses and whole genome pairwise strain comparisons were performed.The number of episodes was significantly higher in Period 1 than in Period 2 (51 vs 32; P = 0.003); the reduction in the number of cases coincided with the educational campaign for catheter care implementation in 2011. Overall, eight genotypes were clusters involving 29 patients. All C. albicans (n = 5) and C. parapsilosis (n = 3) clusters were found during Period 1 before the educational campaign. No statistically significant differences were found between the percentage of C. albicans and C. parapsilosis clusters, but the percentage of patients associated to the clusters was significantly higher for C. parapsilosis clusters in comparison to C. albicans clusters (52% vs 28.2%; P = 0.03). Whole genome sequencing confirmed microsatellite-defined clusters with high bootstrap values.Whole genome sequences confirmed microsatellite-defined clusters, corroborating the presence of outbreaks. Persistent or sporadic Candida clusters causing candidemia in neonates disappeared after the implementation of catheter care educational campaigns. LAY ABSTRACT We retrospectively studied all patients admitted to the neonatal care unit diagnosed with candidemia caused by C. albicans or C. parapsilosis. Reliable whole genome sequences confirmed microsatellite-defined clusters, corroborating the presence of outbreaks before educational campaigns for catheter care.
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Affiliation(s)
- Jesús Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Spain
| | - Sergio Mezquita
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Gómez
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Belén Padilla
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Spain
| | - Elena Zamora
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Pediatrics Department, Faculty of Medicine, Universidad Complutense de Madrid
| | - Carlos Sánchez-Carrillo
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Spain.,Medicine Department, Faculty of Medicine, Universidad Complutense de Madrid
| | - Pilar Escribano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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22
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Solís-García G, González-Pacheco N, Ramos-Navarro C, Rodríguez Sánchez de la Blanca A, Sánchez-Luna M. Target volume-guarantee in high-frequency oscillatory ventilation for preterm respiratory distress syndrome: Low volumes and high frequencies lead to adequate ventilation. Pediatr Pulmonol 2021; 56:2597-2603. [PMID: 34107176 DOI: 10.1002/ppul.25529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Respiratory distress syndrome (RDS) and ventilation-induced lung injury lead to significant morbidity in preterm infants. High-frequency oscillatory ventilation with volume-guarantee (HFOV-VG) has been used as a rescue therapy and might lead to lower rates of death and bronchopulmonary dysplasia, especially when using low tidal volumes and high frequencies. The aim of the study was to define HFOV-VG parameters leading to adequate ventilation in the first 72 h of preterm RDS using a low volume and high-frequency strategy. DESIGN AND METHODS Retrospective cohort study in a tertiary-level neonatology unit. Infants <32 weeks with severe respiratory insufficiency needing HFOV-VG were included. Patients were ventilated following a standard mechanical ventilation aiming for low tidal volumes and high frequencies. Clinical data, perinatal characteristics and high-frequency parameters corresponding with adequate ventilation were recorded. RESULTS 116 patients were included. Median gestational age was 25 weeks (interquartile range [IQR] = 24-27), median birth weight 724 g (IQR = 600-900 g). HFOV-VG was started at 2 h, median high-frequency tidal volume was 1.63 ml/kg (IQR = 1.44-1.84) and median frequency was 16 Hz (IQR = 15-18). Weight-adjusted tidal volumes did not depend on gestational age, antenatal corticosteroids nor chorioamnionitis, and were inversely correlated with frequencies (R 2 = -0.10, p = .001). CONCLUSION HFOV-VG can reach adequate ventilation at high frequencies when using adequate volumes, providing a feasible ventilation strategy that might be of help in preterm infants with RDS.
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Affiliation(s)
- Gonzalo Solís-García
- Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Manuel Sánchez-Luna
- Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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23
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Carrasco I, Muñoz-Chapuli M, Vigil-Vázquez S, Aguilera-Alonso D, Hernández C, Sánchez-Sánchez C, Oliver C, Riaza M, Pareja M, Sanz O, Pérez-Seoane B, López J, Márquez E, Domínguez-Rodríguez S, Hernanz-Lobo A, De León-Luis JA, Sánchez-Luna M, Navarro ML. SARS-COV-2 infection in pregnant women and newborns in a Spanish cohort (GESNEO-COVID) during the first wave. BMC Pregnancy Childbirth 2021; 21:326. [PMID: 33902483 PMCID: PMC8072086 DOI: 10.1186/s12884-021-03784-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.
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MESH Headings
- Adult
- Anti-Bacterial Agents/therapeutic use
- Antiviral Agents/therapeutic use
- COVID-19/epidemiology
- COVID-19/physiopathology
- COVID-19/therapy
- COVID-19 Nucleic Acid Testing
- Carrier State/epidemiology
- Cesarean Section/statistics & numerical data
- Cohort Studies
- Comorbidity
- Cough/physiopathology
- Diabetes, Gestational/epidemiology
- Dyspnea/physiopathology
- Female
- Fever/physiopathology
- Gestational Age
- Humans
- Hypertension/epidemiology
- Hypothyroidism/epidemiology
- Immunologic Factors/therapeutic use
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Intensive Care Units/statistics & numerical data
- Lung/diagnostic imaging
- Male
- Obesity, Maternal/epidemiology
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pregnancy
- Pregnancy Complications/epidemiology
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/therapy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Premature Birth/epidemiology
- Radiography, Thoracic
- Respiration, Artificial
- Risk Factors
- SARS-CoV-2
- Severity of Illness Index
- Spain/epidemiology
- COVID-19 Drug Treatment
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Affiliation(s)
- Itzíar Carrasco
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain.
| | - Mar Muñoz-Chapuli
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Vigil-Vázquez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Aguilera-Alonso
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Hernández
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - César Sánchez-Sánchez
- Department of Paediatric Gastroenterology Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Oliver
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mónica Riaza
- Department of Paediatrics, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Marta Pareja
- Department of Paediatrics, Hospital General de Albace, Castilla La Mancha, Spain
| | - Olga Sanz
- Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Juan López
- Department of Paediatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Elena Márquez
- Department of Paediatrics, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Sara Domínguez-Rodríguez
- Paediatric Infectious Diseases Unit, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Alicia Hernanz-Lobo
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Antonio De León-Luis
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sánchez-Luna M, Fernández Colomer B, de Alba Romero C, Alarcón Allen A, Baña Souto A, Camba Longueira F, Cernada Badía M, Galve Pradell Z, González López M, López Herrera MC, Ribes Bautista C, Sánchez García L, Zamora Flores E. Neonates Born to Mothers With COVID-19: Data From the Spanish Society of Neonatology Registry. Pediatrics 2021; 147:peds.2020-015065. [PMID: 33479162 DOI: 10.1542/peds.2020-015065] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe neonatal and maternal characteristics of the largest prospective cohort of newborns from mothers with coronavirus disease 2019 (COVID-19), the data of which were prospectively collected from the nationwide registry of the Spanish Society of Neonatology. METHODS Between March 8, 2020, and May 26, 2020, the data of 503 neonates born to 497 mothers diagnosed with COVID-19 during pregnancy or at the time of delivery were collected by 79 hospitals throughout Spain. RESULTS Maternal symptoms were similar to that of the general population, with 5% of severe forms. In 45.8% of asymptomatic women at the time of delivery, severe acute respiratory syndrome coronavirus 2 infection was detected because of recommendations established in Spain to perform COVID-19 screening in all women admitted to the hospital for labor. The rate of preterm deliveries was 15.7% and of cesarean deliveries, 33%. The most common diagnostic test was detection of viral RNA by polymerase chain reaction of nasopharyngeal swabs at a median age of 3 hours after delivery (1-12 hours). Almost one-half of neonates were left skin-to-skin after delivery, and delayed clamping of umbilical cords was performed in 43% of neonates. Also, 62.3% of asymptomatic neonates were managed with rooming-in. Maternal milk was received by 76.5% of neonates, 204 of them as exclusive breastfeeding. CONCLUSIONS The current study indicates that there is no need for separation of mothers from neonates, allowing delayed cord clamping and skin-to-skin contact along with maintenance of breastfeeding in a high percentage of newborns from mothers with COVID-19.
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Affiliation(s)
- Manuel Sánchez-Luna
- Department of Neonatology, Hospital General Universitario Gregorio Marañón and Complutense University of Madrid, Madrid, Spain;
| | - Belén Fernández Colomer
- Neonatology Service, Department of Pediatrics, Hospital Central Universitario de Asturias, Oviedo, Spain
| | | | - Ana Alarcón Allen
- Department of Neonatology, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Ana Baña Souto
- Neonatology Service, Department of Pediatrics, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Fátima Camba Longueira
- Department of Neonatology, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Cernada Badía
- Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - María González López
- Department of Neonatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Carmen Ribes Bautista
- Department of Neonatology, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Elena Zamora Flores
- Department of Neonatology, Hospital General Universitario Gregorio Marañón and Complutense University of Madrid, Madrid, Spain
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Solís-García G, Gutiérrez-Vélez A, Pescador Chamorro I, Zamora-Flores E, Vigil-Vázquez S, Rodríguez-Corrales E, Sánchez-Luna M. Epidemiology, management and risk of SARS-CoV-2 transmission in a cohort of newborns born to mothers diagnosed with COVID-19 infection. An Pediatr (Barc) 2021; 94:173-178. [PMID: 33521167 PMCID: PMC7834971 DOI: 10.1016/j.anpede.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/12/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. Methods Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. Results 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37–40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. Conclusions Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.
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Affiliation(s)
- Gonzalo Solís-García
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Gutiérrez-Vélez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Elena Zamora-Flores
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Vigil-Vázquez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Manuel Sánchez-Luna
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Solís-García G, Gutiérrez-Vélez A, Pescador Chamorro I, Zamora-Flores E, Vigil-Vázquez S, Rodríguez-Corrales E, Sánchez-Luna M. [Epidemiology, management and risk of SARS-CoV-2 transmission in a cohort of newborns born to mothers diagnosed with COVID-19 infection]. An Pediatr (Barc) 2020; 94:173-178. [PMID: 33431332 PMCID: PMC7833088 DOI: 10.1016/j.anpedi.2020.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. METHODS Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.
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Affiliation(s)
- Gonzalo Solís-García
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Ana Gutiérrez-Vélez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | - Elena Zamora-Flores
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Sara Vigil-Vázquez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Manuel Sánchez-Luna
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Ramos-Navarro C, Sánchez-Luna M, Zeballos-Sarrato S, Pescador-Chamorro I. Antenatal corticosteroids and the influence of sex on morbidity and mortality of preterm infants. J Matern Fetal Neonatal Med 2020; 35:3438-3445. [DOI: 10.1080/14767058.2020.1819977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Pérez A, Gregorio R, Gómez P, Ruiz Y, Sánchez-Luna M. Cerebral air embolism in neonates. Anales de Pediatría (English Edition) 2020. [DOI: 10.1016/j.anpede.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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González-Pacheco N, Sánchez-Luna M, Arribas-Sánchez C, Santos-González M, Orden-Quinto C, Tendillo-Cortijo F. DCO 2/PaCO 2 correlation on high-frequency oscillatory ventilation combined with volume guarantee using increasing frequencies in an animal model. Eur J Pediatr 2020; 179:499-506. [PMID: 31823075 DOI: 10.1007/s00431-019-03503-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/12/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
To examine the correlation DCO2/PaCO2 on high-frequency oscillatory ventilation (HFOV) combined with volume guarantee (VG) throughout increasing frequencies in two different respiratory conditions, physiological and low compliance. Neonatal animal model was used, before and after a bronchoalveolar lavage (BAL). HFOV combined with VG was used. The frequency was increased from 10 to 20 Hz, and high-frequency tidal volume (VThf) was gradually decreased maintaining a constant DCO2. Arterial partial pressure of carbon dioxide (PaCO2) was evaluated after each frequency and VThf change. Six 2-day-old piglets were studied. A linear decrease in PaCO2 was observed throughout increasing frequencies in both respiratory conditions while maintaining a constant DCO2, showing a significant difference between the initial PaCO2 (at 10 Hz) and the PaCO2 obtained at 18 and 20 Hz. A new DCO2 equation (corrected DCO2) was calculated in order to better define the correlation between DCO2 and the observed PaCO2.Conclusion: The correlation DCO2/PaCO2 throughout increasing frequencies is not linear, showing a greater CO2 elimination efficiency at higher frequencies, in spite of maintaining a constant DCO2. So, using frequencies close to the resonant frequency of the respiratory system on HFOV combined with VG, optimizes the efficiency of gas exchange.What is Known: • The efficacy of CO2removal during high-frequency oscillatory ventilation (HFOV), described as the diffusion coefficient of CO2(DCO2) is related to the square of the high-frequency tidal volume (VThf) and the frequency (f), expressed as DCO2= VThf2× f.What is New: • The correlation between DCO2and PaCO2throughout increasing frequencies is not linear, showing a greater CO2elimination efficiency at higher frequencies. So, using very high frequencies on HFOV combined with volume guarantee optimizes the efficiency of gas exchange allowing to minimize lung injury.
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Affiliation(s)
- Noelia González-Pacheco
- Neonatology Division, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Hospital General Universitario "Gregorio Marañón", C/Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Manuel Sánchez-Luna
- Neonatology Division, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Hospital General Universitario "Gregorio Marañón", C/Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Cristina Arribas-Sánchez
- Neonatology Division, Clínica Universidad de Navarra, C/Marquesado de Sta. Marta, 1, 28027, Madrid, Spain
| | - Martín Santos-González
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Spain
| | - Cristina Orden-Quinto
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Spain
| | - Francisco Tendillo-Cortijo
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Spain
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Fernández Colomer B, Sánchez-Luna M, de Alba Romero C, Alarcón A, Baña Souto A, Camba Longueira F, Cernada M, Galve Pradell Z, González López M, López Herrera MC, Ribes Bautista C, Sánchez García L, Zamora Flores E, Pellicer A, Alonso Díaz C, Herraiz Perea C, Romero Ramírez DS, de Las Cuevas Terán I, Pescador Chamorro I, Fernández Trisac JL, Arruza Gómez L, Cardo Fernández LM, García García MJ, Nicolás López M, Hortelano López M, Riaza Gómez M, Hernández González N, González Sánchez R, Zambudio Sert S, Larrosa Capacés S, Matías Del Pozo V. Neonatal Infection Due to SARS-CoV-2: An Epidemiological Study in Spain. Front Pediatr 2020; 8:580584. [PMID: 33194912 PMCID: PMC7644848 DOI: 10.3389/fped.2020.580584] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: Coronavirus disease 2019 (COVID-19) cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to increase worldwide. Although some data from pediatric series are available, more evidence is required, especially in neonates, a group with specific characteristics that deserve special attention. This study aimed to describe general and clinical characteristics, management, and treatment of postnatal-acquired (community and nosocomial/hospital-acquired) COVID-19 neonatal cases in Spain. Methods: This was a national prospective epidemiological study that included cases from a National Registry supported by the Spanish Society of Neonatology. Neonates with postnatal SARS-CoV-2 infection were included in this study. General data and infection-related information (mode and source of transmission, age at diagnosis, clinical manifestations, need for hospitalization, admission unit, treatment administered, and complementary studies performed, hospital stay associated with the infection) were collected. Results: A total of 40 cases, 26 community-acquired and 14 nosocomial were registered. Ten were preterm newborns (2 community-acquired and 8 nosocomial COVID-19 cases). Mothers (in both groups) and healthcare workers (in nosocomial cases) were the main source of infection. Hospital admission was required in 22 community-acquired cases [18 admitted to the neonatal intermediate care unit (NIMCU) and 4 to the neonatal intensive care unit (NICU)]. Among nosocomial COVID-19 cases (n = 14), previously admitted for other reasons, 4 were admitted to the NIMCU and 10 to the NICU. Ten asymptomatic patients were registered (5 in each group). In the remaining cases, clinical manifestations were generally mild in both groups, including upper respiratory airways infection, febrile syndrome or acute gastroenteritis with good overall health. In both groups, most severe cases occurred in preterm neonates or neonates with concomitant pathologies. Most of the cases did not require respiratory support. Hydroxychloroquine was administered to 4 patients in the community-acquired group and to 2 patients in the nosocomial group. Follow-up after hospital discharge was performed in most patients. Conclusions: This is the largest series of COVID-19 neonatal cases in Spain published to date. Although clinical manifestations were generally mild, prevention, treatment, and management in this group are essential.
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Affiliation(s)
| | - Manuel Sánchez-Luna
- Neonatology Department, Complutense University, Madrid, Spain.,Division of Neonatology, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Ana Alarcón
- Department of Neonatology, Sant Joan de Déu University Hospital, Barcelona, Spain
| | - Ana Baña Souto
- Department of Neonatology, Clinical Hospital de Santiago, Santiago de Compostela, Spain
| | | | - María Cernada
- Division of Neonatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - María González López
- Department of Neonatology, Regional de Málaga University Hospital, Málaga, Spain
| | | | | | | | - Elena Zamora Flores
- Division of Neonatology, Gregorio Marañón University Hospital, Madrid, Spain
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Clara Alonso Díaz
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | | | | | - Luis Arruza Gómez
- Department of Neonatology, Clinical Hospital San Carlos, Madrid, Spain
| | | | | | - Marta Nicolás López
- Department of Neonatology, Germans Trias i Pujol University Hospital, Badalona, Spain
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Ramos-Navarro C, Sánchez-Luna M, Zeballos-Sarrato S, González-Pacheco N. Three-year perinatal outcomes of less invasive beractant administration in preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med 2019; 33:2704-2710. [PMID: 30526187 DOI: 10.1080/14767058.2018.1557633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To assess the impact of beractant treatment using the less invasive surfactant administration (LISA) technique on perinatal outcomes in a prospective cohort of preterm infants with respiratory distress syndrome (RDS).Design: Single-center prospective study conducted in a Department of Neonatology of a tertiary care university-affiliated hospital in Madrid, Spain.Methods: Preterm infants born at <31 + 6 weeks' gestation attended in the neonatal intensive care unit (NICU) between 2012 and 2016. The main outcome was the need of invasive mechanical ventilation during the first 3 days of life. Beractant (100 mg; 4 mL/kg) was administered using the intubation-surfactant-extubation (INSURE) method during 2012 and 2013, and using the LISA procedure between 2014 and 2016.Results: The study population included 512 infants, 232 in the first period and 280 in the second period. Mechanical ventilation exposure during hospitalization showed a significant reduction in the second study period, with an adjusted OR of 0.61, 95% CI 0.39-0.96. Also, an increase of free-bronchopulmonary dysplasia (BPD) survival was found (adjusted OR 2.14, 95% CI 1.29-3.55). These significant differences in perinatal outcomes were observed only in the group of infants of 26 + 0 to 28 + 6 gestational weeks. The success rate of the first dose of beractant using LISA regarding no need of intubation during the first 3 days of life was 54% increasing to 69% in the group of 26 + 0-28 + 6 weeks of gestation. The success rate regarding free-BPD survival was 63.5% in the whole series of LISA treated patients and 72.4% in the group of 26 + 0-28 + 6 weeks. Oxygen reduction after surfactant administration (OR 39.6, 95% CI 6.1-255.8, p < .001) was predictor of LISA success, whereas LISA failure was an independent factor for air leak (OR 18.92, 95% CI 1.31-272.32, p = .031) and Death or BPD outcome (OR 19.3, 95% IC 2.5-147.4, p = .004). Gestational age was inversely associated with the need of intubation after LISA (OR 0.53, 95% CI 0.32-0.87, p = .013).Conclusions: Beractant administration by LISA technique effective reduced the need of intubation during the first 3 days of life and was associated with an increase in survival-free BPD in the group of infants born at 26 + 0 and 28 + 6 weeks' gestation.
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Affiliation(s)
- Cristina Ramos-Navarro
- Neonatology Department, Gregorio Marañon University Hospital, Biomedical Research Institute Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatology Department, Gregorio Marañon University Hospital, Biomedical Research Institute Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Susana Zeballos-Sarrato
- Neonatology Department, Gregorio Marañon University Hospital, Biomedical Research Institute Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Noelia González-Pacheco
- Neonatology Department, Gregorio Marañon University Hospital, Biomedical Research Institute Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
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Sánchez-Luna M, González-Pacheco N, Belik J, Santos M, Tendillo F. New Ventilator Strategies: High-Frequency Oscillatory Ventilation Combined with Volume Guarantee. Am J Perinatol 2018; 35:545-548. [PMID: 29694993 DOI: 10.1055/s-0038-1637763] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
High-frequency oscillatory ventilation (HFOV) has been proposed as an alternative method of invasive ventilation in immature infants to prevent ventilator lung injury. To better control the size of the high-frequency tidal volume and to prevent large tidal volumes, a new strategy of controlling the tidal volume during HFOV (VThf) has been developed, HFOV-volume guarantee (VG). Data from preclinical, neonatal animal studies in normal and surfactant-depleted lungs have demonstrated the feasibility of this technique to directly control the VThf in the normal compliance and low compliance situations. Different I:E ratios also can modify the effect of CO2 washout during HFOV combined with VG in a different way as without the VG modality. Finally, clinical use of this technique in newborn infants has demonstrated the possibility of using very high frequency combined with constant very low VThf to decrease the risk of lung trauma related to the ventilator.
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Affiliation(s)
- M Sánchez-Luna
- Division of Neonatology, Instituto de Investigación Sanitaria Gregorio Marañón, Complutense University of Madrid, Hospital General Universitario "Gregorio Marañón," Madrid, Spain
| | - N González-Pacheco
- Division of Neonatology, Instituto de Investigación Sanitaria Gregorio Marañón, Complutense University of Madrid, Hospital General Universitario "Gregorio Marañón," Madrid, Spain
| | - J Belik
- Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M Santos
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - F Tendillo
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
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Pérez A, Vigil S, Pescador I, Fernández B, Jiménez L, Agra C, de Rojas T, Sánchez-Luna M. Infantile hemangiopericytoma leading to hypovolemic shock in a neonate. Pediatr Blood Cancer 2018; 65:e26950. [PMID: 29314578 DOI: 10.1002/pbc.26950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Alba Pérez
- Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Vigil
- Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Pescador
- Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Fernández
- Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lidia Jiménez
- Pediatric Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carolina Agra
- Pathology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Teresa de Rojas
- Medical and Translational Research Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Manuel Sánchez-Luna
- Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sobrino-Fernández E, Campos-Domínguez M, Gregorio-Hernández R, Huerta-Aragonés J, Beléndez-Bieler C, Lancharro-Zapata Á, Franco-Fernández ML, Bernardo-Atienza B, Sánchez-Luna M. Kaposiform Hemangioendothelioma Presenting as Hydrops Fetalis. Pediatr Dermatol 2017; 34:e128-e129. [PMID: 28318049 DOI: 10.1111/pde.13101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We describe the case of a 33-week preterm infant who developed nonimmune hydrops fetalis secondary to a kaposiform hemangioendothelioma (KHE). The tumor was successfully treated with vincristine, prednisone, ticlopidine, and aspirin. KHE can be an unusual cause of hydrops fetalis; in such cases, diagnosis can be challenging since generalized edema can obscure KHE.
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Affiliation(s)
- Elena Sobrino-Fernández
- Section of Neonatology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Minia Campos-Domínguez
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rebeca Gregorio-Hernández
- Section of Neonatology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Huerta-Aragonés
- Section of Pediatric Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Beléndez-Bieler
- Section of Pediatric Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Lancharro-Zapata
- Section of Pediatric Radiology, Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Franco-Fernández
- Section of Neonatology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Belén Bernardo-Atienza
- Section of Neonatology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Section of Neonatology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sánchez-Luna M, González-Pacheco N, Santos M, Blanco Á, Orden C, Belik J, Tendillo FJ. Effect of the I/E ratio on CO2 removal during high-frequency oscillatory ventilation with volume guarantee in a neonatal animal model of RDS. Eur J Pediatr 2016; 175:1343-51. [PMID: 27595847 DOI: 10.1007/s00431-016-2770-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/04/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED The objective of this study was to analyze the effect of I/E ratio on carbon dioxide (CO2) elimination during high-frequency oscillatory ventilation (HFOV) combined with volume guarantee (VG). Five 2-day-old piglets were studied before and after a bronchoalveolar lavage (BAL). The effect of an I/E ratio of 1:1 and 1:2 with (VG-ON) and without VG (VG-OFF) on PaCO2, as well as delta and mean airway pressures at the airway opening (∆Phf-ao, mPaw-ao) and at the tracheal level (∆Phf-t, mPaw-t) were evaluated at frequencies of 5, 8, 11, and 14 Hz. With the VG-ON, PaCO2 was significant lower with the I/E ratio of 1:2 at 5 Hz compared with the 1:1. mPaw-t was higher than mPaw-ao, with 1:1 I/E ratio, and on VG-ON, this difference was statistically significant. CONCLUSION "In this animal study and with this ventilator, the I/E ratio of 1:1 compared to 1:2 in HFOV and VG-ON did not produce a higher CO2 lavage as when HFOV was used without the VG modality. Even more, a lower PaCO2 was found when using the lower frequency and 1:2 ratio compared to 1:1. So in contrast to non-VG HFOV mode, using a fixed tidal volume, no significant changes on CO2 elimination are observed during HFOV when the I/E ratios of 1:1 and 1:2 are compared at different frequencies." WHAT IS KNOWN •The tidal volume on HFOV is determinant in CO 2 removal, and this is generated by delta pressure and the length of the inspiratory time. What is New: •HFOV combined with VG, an I/E ratio of 1:2 is more effective to remove CO 2 , and this is not related to the tidal volume.
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Affiliation(s)
- Manuel Sánchez-Luna
- Neonatology Division, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, University Complutense of Madrid, Madrid, Spain.
| | - Noelia González-Pacheco
- Neonatology Division, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, University Complutense of Madrid, Madrid, Spain
| | - Martín Santos
- Medical and Surgical Research Unit, Instituto de Investigación Sanitatia Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Ángel Blanco
- Anaesthesia and Critical Care Department, Instituto de Investigación Sanitatia Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Cristina Orden
- Medical and Surgical Research Unit, Instituto de Investigación Sanitatia Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jaques Belik
- Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Francisco J Tendillo
- Medical and Surgical Research Unit, Instituto de Investigación Sanitatia Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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Arriaga Redondo M, Rodriguez Sánchez de la Blanca A, Lowy Benoliel A, Navarro Patiño N, Villar Castro S, Blanco Bravo D, Sánchez-Luna M. Stridor in neonates with hypoxic-ischaemic encephalopathy subject to selective cerebral or whole body hypothermia. Anales de Pediatría (English Edition) 2016. [DOI: 10.1016/j.anpede.2015.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gregorio-Hernández R, Sanz-López E, Hoyo AAD, Manrique-Martín G, De-Agustín JC, Sánchez-Luna M. A Rare Complex Case of Congenital Umbilical Arteriovenous Malformation and Review of Literature. AJP Rep 2016; 6:e216-21. [PMID: 27294008 PMCID: PMC4900887 DOI: 10.1055/s-0036-1584239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Congenital umbilical arteriovenous malformations (AVMs) are extremely rare. We present the first case of congenital umbilical AVM with feeding arteries originating not only from abdominal but also from the mammary arteries. Case Report A 34-week gestational age newborn was transferred to our hospital with a supraumbilical murmur. Abdominal Doppler ultrasound (US) showed a large vascular AVM, with multiple feeding arteries and several venous drainage structures to the umbilical vein and also a persistent ductus venosus. She developed signs of heart failure on the 12th day of life. Computed tomography angiogram revealed an umbilical congenital AVM with feeding arteries originating from the external iliac, hypogastric, epigastric, and mammary arteries and a dilated umbilical vein draining the cluster. Also, a patent ductus venosus was observed. At 14 days of life, laparotomy was performed but due to the complexity of the feeding arteries of the AVM, complete exeresis was not performed, but only ligation of these arteries was made, to reduce the surgical risk. Conclusion To our knowledge, this is the first time that no complete excision was made but only ligation of the arteries. The infant was discharged home on postoperative day 14 being asymptomatic. Follow-up Doppler US showed thrombosed vascular structures.
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Affiliation(s)
| | - Ester Sanz-López
- Department of Neonatology, Gregorio Marañón Hospital, Madrid, Spain
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Ramos-Navarro C, Sánchez-Luna M, Zeballos-Sarrato S, González-Pacheco N. Less invasive beractant administration in preterm infants: a pilot study. Clinics (Sao Paulo) 2016; 71:128-34. [PMID: 27074172 PMCID: PMC4785853 DOI: 10.6061/clinics/2016(03)02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess the efficacy and feasibility of a new, less invasive surfactant administration technique for beractant replacement using a specifically designed cannula in preterm infants born at <32 weeks of gestation and to compare short- and long-term outcomes between this approach and standard treatment, consisting of intubation, administration of surfactant and early extubation to nasal continuous positive airway pressure. METHOD This was a single-center, prospective, open-label, non-randomized, controlled pilot study with an experimental cohort of 30 patients treated with less invasive surfactant administration and a retrospective control group comprising the 30 patients most recently treated with the standard approach. Beractant (4 ml/kg) was administered as an exogenous surfactant in both groups if patients on nasal continuous positive airway pressure during the first three days of life were in need of more than 30% FiO2. Clinicaltrials.gov: NCT02611284. RESULTS In the group with less invasive surfactant administration, beractant was successfully administered in all patients. Thirteen patients (43.3%) in the group with less invasive surfactant administration required invasive mechanical ventilation for more than 1 hour during the first 3 days of life, compared with 22 (73%) in the control group (p<0.036). The rate of requiring invasive mechanical ventilation for more than 48 hours was similar between the infants in the two groups (46% vs. 40%, respectively). There were no differences in other outcomes. CONCLUSION The administration of beractant (4 ml/kg) using a less invasive surfactant administration technique with a specifically designed cannula for administration is feasible. Moreover, early invasive mechanical ventilation exposure is significantly reduced by this method compared with the strategy involving intubation, surfactant administration and early extubation.
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Cano Giménez E, Sánchez-Luna M. Providing parents with individualised support in a neonatal intensive care unit reduced stress, anxiety and depression. Acta Paediatr 2015. [PMID: 26194814 DOI: 10.1111/apa.13135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Evelyn Cano Giménez
- Neonatology Division; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - Manuel Sánchez-Luna
- Paediatrics Neonatology Division; Instituto de Investigación Sanitaria; Hospital General Universitario Gregorio Marañón; Madrid Spain
- Universidad Complutense; Madrid Spain
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Cano Giménez E, Sánchez-Luna M. Providing parents with individualised support in a neonatal intensive care unit reduced stress, anxiety and depression. Acta Paediatr 2015; 104:e300-5. [PMID: 25703857 DOI: 10.1111/apa.12984] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 02/02/2015] [Accepted: 02/19/2015] [Indexed: 11/30/2022]
Abstract
AIM This study assessed the effectiveness of an individualised intervention to reduce parental stress, anxiety and depression in a neonatal intensive care unit (NICU). METHODS Parents of infants admitted to the NICU for a minimum of 4 weeks underwent a five-step individualised intervention programme delivered by a psychologist. RESULTS The study population comprised 40 mothers and 25 fathers in the intervention group and 40 mothers and 29 fathers in the control group who received the standard support. Similar stress levels were observed in both groups before the intervention. However, after 15 days, the group that received the individualised intervention showed a statistically significant lower level of anxiety, with none of the mothers and fathers in the intervention group reporting anxiety, compared with 2.5% of mothers and 10.3% of fathers in the control group. At discharge, 50% of mothers and 80% of fathers in the intervention group reported no level of depression, compared to all the mothers and fathers in the control group. CONCLUSION An intervention programme individualised to the needs of mothers and fathers with infants admitted to a NICU for at least 4 weeks was effective in reducing anxiety and depression compared to the standard care.
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Affiliation(s)
- Evelyn Cano Giménez
- Neonatology Division; Instituto de Investigación Sanitaria; Hospital General Universitario Gregorio Marañón; Universidad Complutense; Madrid Spain
| | - Manuel Sánchez-Luna
- Neonatology Division; Instituto de Investigación Sanitaria; Hospital General Universitario Gregorio Marañón; Universidad Complutense; Madrid Spain
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Díez-Domingo J, Pérez-Yarza EG, Melero JA, Sánchez-Luna M, Aguilar MD, Blasco AJ, Alfaro N, Lázaro P. Social, economic, and health impact of the respiratory syncytial virus: a systematic search. BMC Infect Dis 2014; 14:544. [PMID: 25358423 PMCID: PMC4219051 DOI: 10.1186/s12879-014-0544-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 10/06/2014] [Indexed: 01/30/2023] Open
Abstract
Background Bronchiolitis caused by the respiratory syncytial virus (RSV) and its related complications are common in infants born prematurely, with severe congenital heart disease, or bronchopulmonary dysplasia, as well as in immunosuppressed infants. There is a rich literature on the different aspects of RSV infection with a focus, for the most part, on specific risk populations. However, there is a need for a systematic global analysis of the impact of RSV infection in terms of use of resources and health impact on both children and adults. With this aim, we performed a systematic search of scientific evidence on the social, economic, and health impact of RSV infection. Methods A systematic search of the following databases was performed: MEDLINE, EMBASE, Spanish Medical Index, MEDES-MEDicina in Spanish, Cochrane Plus Library, and Google without time limits. We selected 421 abstracts based on the 6,598 articles identified. From these abstracts, 4 RSV experts selected the most relevant articles. They selected 65 articles. After reading the full articles, 23 of their references were also selected. Finally, one more article found through a literature information alert system was included. Results The information collected was summarized and organized into the following topics: 1. Impact on health (infections and respiratory complications, mid- to long-term lung function decline, recurrent wheezing, asthma, other complications such as otitis and rhino-conjunctivitis, and mortality; 2. Impact on resources (visits to primary care and specialists offices, emergency room visits, hospital admissions, ICU admissions, diagnostic tests, and treatments); 3. Impact on costs (direct and indirect costs); 4. Impact on quality of life; and 5. Strategies to reduce the impact (interventions on social and hygienic factors and prophylactic treatments). Conclusions We concluded that 1. The health impact of RSV infection is relevant and goes beyond the acute episode phase; 2. The health impact of RSV infection on children is much better documented than the impact on adults; 3. Further research is needed on mid- and long-term impact of RSV infection on the adult population, especially those at high-risk; 4. There is a need for interventions aimed at reducing the impact of RSV infection by targeting health education, information, and prophylaxis in high-risk populations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0544-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Eduardo G Pérez-Yarza
- Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia-Instituto Biodonostia, San Sebastián, Spain. .,Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain. .,Department of Pediatrics, University of the Basque Country (UPV/EHU), San Sebastián, Spain.
| | - José A Melero
- National Center of Microbiology and CIBER of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain.
| | - Manuel Sánchez-Luna
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | | | - Noelia Alfaro
- Advanced Techniques in Health Services Research, Madrid, Spain.
| | - Pablo Lázaro
- Advanced Techniques in Health Services Research, Madrid, Spain.
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Guembe M, Pérez-Parra A, Gómez E, Sánchez-Luna M, Bustinza A, Zamora E, Carrillo-Álvarez A, Cuenca A, Padilla B, Martín-Rabadán P, Bouza E. Impact on knowledge and practice of an intervention to control catheter infection in the ICU. Eur J Clin Microbiol Infect Dis 2012; 31:2799-808. [PMID: 22565225 DOI: 10.1007/s10096-012-1630-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
Abstract
Information on the impact of care bundles has been mainly acquired in adult intensive care units (ICUs). However, specific data for educational programs are scarce. Our objective was to analyze the impact of an educational program on the knowledge and prevention of catheter-related bloodstream infection (CRBSI) in two pediatric intensive care units (P-ICUs). A prospective study was carried out at a large teaching institution in Madrid, Spain. Healthcare workers' (HCWs) knowledge of guidelines for the prevention of CRBSI was assessed before and after the educational program using a questionnaire covering 12 issues. A 20-min program was offered to all HCWs on each ICU shift. The incidence density of CRBSI was assessed before, during, and after the educational program. A total of 174 questionnaires were completed by HCWs from both the neonatal ICU (N-ICU) and the P-ICU before the intervention and 54 were completed after the intervention (120 participants were not present during this period). The incidence density of CRBSI before, during, and after the intervention was 6.2, 5.2, and 9.3 in the N-ICU and 2.2, 3.1, and 2.9 in the P-ICU (p > 0.05). A single 20-min educational intervention on the prevention of CRBSI significantly improved HCWs' knowledge, but was not enough to reduce the incidence density of CRBSI.
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Affiliation(s)
- M Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense, C/. Dr. Esquerdo 46, 28007 Madrid, Spain.
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Abstract
BACKGROUND Ventilator injury has been implicated in the pathogenesis of bronchopulmonary dysplasia. Avoiding invasive ventilation could reduce lung injury, and early respiratory management may affect pulmonary outcomes. OBJECTIVE To analyze the effect of initial respiratory support on survival without bronchopulmonary dysplasia at a gestational age of 36 weeks. DESIGN/METHODS A prospective 3-year observational study. Preterm infants of <32 weeks gestational age were classified into 4 groups according to the support needed during the first 2 hours of life: room air, nasal continuous positive airway pressure, intubation/surfactant/extubation and prolonged mechanical ventilation (defined as needing mechanical ventilation for more than 2 hours). RESULTS Of the 329 eligible patients, a total of 49% did not need intubation, and 68.4% did not require prolonged mechanical ventilation. At a gestational age of 26 weeks, there was a significant correlation between survival without bronchopulmonary dysplasia and initial respiratory support. Preterm infants requiring mechanical ventilation showed a higher risk of death and bronchopulmonary dysplasia. After controlling for gestational age, antenatal corticosteroid use, maternal preeclampsia and chorioamnionitis, the survival rate without bronchopulmonary dysplasia remained significantly lower in the mechanically ventilated group. CONCLUSIONS In our population, the need for more than 2 hours of mechanical ventilation predicted the development of bronchopulmonary dysplasia in preterm infants with a gestational age >26 weeks (sensitivity =89.5% and specificity = 67%). The need for prolonged mechanical ventilation could be an early marker for the development of bronchopulmonary dysplasia. This finding could help identify a target population with a high risk of chronic lung disease. Future research is needed to determine other strategies to prevent bronchopulmonary dysplasia in this high-risk group of patients.
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Affiliation(s)
- Ester Sanz López
- Hospital General Universitario Gregorio Marañón - Neonatology, Madrid, Spain.
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Menéndez C, Fariñas M, Parente A, Laín A, Fanjul M, Chimenti P, Carrera N, Huerga A, Corona C, Marsinyach I, Cañizo A, Villar S, Sánchez-Luna M, Vázquez J. [Long-term results of patients with congenital diaphragmatic hernia]. Cir Pediatr 2009; 22:205-209. [PMID: 20405656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Introduction of advanced therapeutic modalities for diaphragmatic congenital hernia (CDH) has allowed to reach considerable improvements in survival rate. Nevertheless, there are few studies which analyze the clinical evolution of the long-term survivors. The aim of this work is to analyze the outcomes of the patients with CDH in our hospital. METHODS Fifty-five neonates with CDH were treated in our center between 1998 and 2005. We included in the study those patients that were alive at the moment of first hospital discharge (72%; n=40 patients). ECMO therapy was needed in 6 of them during neonatal treatment. A descriptive transverse review of the clinical record as well as a telephonic interview to the parents was performed for the respiratory, cardiological, digestive and neurological conditions, following standard diagnostic studies in every case. The mean age of the children in the moment of the study was 4.2 years (1-9). RESULTS The 8.3% of the children needed domiciliary oxygen therapy during a maximum of 3 months in all the cases. 22% of the cases suffered from respiratory problems, being bronchiolitis and pneumonia the most frequent diagnoses. Only a patient developed asthma. The gastroesophageal reflux is the most frequent long-term condition (47%), but only 8.3% needs surgical treatment. Regarding to cardiological problems, 14% developed pulmonary hypertension, being slight - moderate in all the cases but in one case who was the only deceased of the series. Regarding to neurological problems only 1 patient developed serious alterations (brain paralysis), having suffered a hemorrhage parenquimatosa during the treatment with ECMO. No other patient presents motor, visual nor auditory alterations in the development, last mild alteration in language (4 patients). Differences do not exist with the group of patients that did not need ECMO during the treatment in cardiological and digestive complications, being higher percentage with respiratory problems. CONCLUSION In our sample only 2 patients present serious sequels (5%). Of this preliminary study we can conclude that the comorbility in the CDH is very low having these patient a good development and good quality of life.
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Affiliation(s)
- C Menéndez
- Servicio Neonatología, Hospital Infantil Gregorio Marañón, Madrid
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Sánchez-Carrillo C, Padilla B, Marín M, Rivera M, Cercenado E, Vigil D, Sánchez-Luna M, Bouza E. Contaminated feeding bottles: the source of an outbreak of Pseudomonas aeruginosa infections in a neonatal intensive care unit. Am J Infect Control 2009; 37:150-4. [PMID: 19059675 DOI: 10.1016/j.ajic.2008.04.259] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 04/09/2008] [Accepted: 04/14/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Outbreaks of Pseudomonas aeruginosa have been reported in relationship with contamination of staff fingernails, hands, water baths, hand lotions and others. To our knowledge, contamination of milk and feeding bottles as a source of an outbreak of P aeruginosa infections has not been reported. The incidence of P aeruginosa infection/colonization in our neonatal intensive care unit increased from 1.9 per 1000 patient-days in August 2004 to 8.8 per 1000 patient-days in September 2004. METHODS Samples were collected including hand and body lotions, water from the incubator humidifying system, the health care worker hands, and the feeding bottle preparation room. Strains were epidemiologically characterized by pulsed-field gel electrophoresis of SpeI-digested genomic DNA. P aeruginosa was isolated from a total of 30 neonates during the period September 2004 to December 2004. RESULTS All cultures (139) of hand and body lotions, water from the incubator humidifying system, and hands of health care personnel were negative. Nine out of 48 samples collected from the feeding bottle preparation room were positive for P aeruginosa (6 samples of in-house prepared milk and 3 samples of water from dishwashers). Pulsed-field gel electrophoresis with SpeI showed that the strains isolated from neonates and from environmental samples were identical. Discontinuation of in-house preparation of feeding bottles and incorporation of unidose milk bottles stopped the outbreak. CONCLUSION The preparation and solution of milk from multidose powder preparation may be a source of P aeruginosa infections in a neonatal intensive care unit. The use of manufactured, nonmanipulated, unidose feeding bottles should be considered more adequate.
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Affiliation(s)
- Carlos Sánchez-Carrillo
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Parente A, Cañizo A, Laín A, Sánchez O, Cerdá J, Molina E, García-Casillas MA, Romero R, Matute JA, Bernardo B, Sánchez-Luna M, Vázquez J. [Are there some clinical factors that indicate the best moment of the surgery in the congenital diaphragmatic hernia?]. Cir Pediatr 2006; 19:232-5. [PMID: 17352113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
AIM To determine if the needs of cardiopulmonary support of neonates with congenital diaphragmatic hernia (CDH) they can be indicators for the election of the most suitable moment to the surgery. METHODS We treated 16 consecutive neonates with congenital diaphragmatic hernia (CDH) from 2004 to 2005. Mean birth weight was 2900.63 +/- 531.51 g. Patients was divided in 2 groups. Group A: newborns without adrenaline nor noradrenaline like vasoactive drugs and conventional respiratory assistant; the surgery was performed during the first 48 hours of life. Group B: newborns with adrenaline or noradrenaline like vasoactive drugs, high-frequency oscillatory ventilation or extracorporeal membrane oxygenation; surgery was delayed (10.66 +/- 8.26 days). RESULTS Four neonates died during the first 24 hours of life without surgical treatment not fulfilling criteria of support ECMO. Five patients were operated during the first 48 hours, fulfilling all of them the clinical criteria of the group A. Mortality does not exist in this group. Seven patients were operated late fulfilling the criteria of the group B. They all needed VAFO. Two patients of this group needed support ECMO. The survival rate in this group was 83.3%. DISCUSSION In our opinion, the patients with CDH that need initially high cardiopulmonary support, VAFO and/or ECMO would be necessary a time of wait to realize the surgery. In those patients who don't need this level of treatment the delay would not justify itself in the surgical intervention.
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Affiliation(s)
- A Parente
- Servicio Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid.
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Figueras Aloy J, Castillo Salinas F, Elorza Fernández D, Sánchez-Luna M, Pérez Rodríguez J. [Recommendations for inhaled nitric oxide treatment in the newborn]. An Pediatr (Barc) 2006; 64:260-6. [PMID: 16527094 DOI: 10.1157/13085514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The recommendations in this document describe the current indications for inhaled nitric oxide (iNO) treatment in the newborn and clearly distinguish between those supported by scientific evidence and those for which evidence is still lacking, such as its use in preterm infants. The methodology for iNO administration, its dosage and the main secondary effects are discussed, and the reasons for lack of response to this treatment are analyzed.
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Affiliation(s)
- J Figueras Aloy
- Hospital Clínico, Instituto Clínico de Ginecología, Obstetricia y Neonatología, Unidad Integrada de Pediatría, Universidad de Barcelona, Spain.
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Figueras Aloy J, Quero J, Doménech E, López Herrera MC, Izquierdo I, Losada A, Perapch J, Sánchez-Luna M. [Recommendations for the prevention of respiratory syncytial virus infection]. An Pediatr (Barc) 2006; 63:357-62. [PMID: 16219256 DOI: 10.1157/13079818] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Premature babies < or = 35 weeks gestation, with or without chronic lung disease (CLD), and infants affected by severe congenital heart disease should be considered high risk population for RSV infection and hospitalization. Hygienic measures and RSV monoclonal antibodies (palivizumab) have been found useful in decreasing rates of RSV hospitalization in these patients. Guidelines for their administration include: a) strongly recommended use in premature babies < or = 28 weeks gestation, or born between 29-32 weeks gestation and less than 6 months at start of RSV station or discharged along it, or affected by CLD in treatment during last 6 months or by severe congenital heart disease. Last two groups could be prophylaxed for two RSV seasons. b) Recommended use among premature babies between 32-35 weeks gestation and less than 6 months of age and presenting two or more risk factors: chronologic age < 10 weeks at start of RSV station, breastfeeding < or = 2 months (physician prescription), sibling < 14 years old, day-care assistance, family history of wheezing, > or = 4 adults at home, airways malformation or neuromuscular disease.
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Affiliation(s)
- J Figueras Aloy
- Hospital Clínic, Institut Clínic de Ginecología, Obstetricia y Neonatología, Universitat de Barcelona, Spain.
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Doménech Martínez E, Perapoch López J, Sánchez-Luna M, Losada Martínez A, Izquierdo Macián I, López-Herrera MC. ¿Está indicado realizar un lavado gástrico a los recién nacidos sanos? An Pediatr (Barc) 2005; 63:514-5. [PMID: 16324617 DOI: 10.1016/s1695-4033(05)70251-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- E Doménech Martínez
- Miembros de la Comisión de Estándares de la Sociedad Española de Neonatología, Spain.
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50
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Romero R, Matute JA, Bernardo B, García-Casillas MA, Sánchez R, Cerdá JA, Zamora E, Arias B, Sánchez-Luna M, Vázquez J. [Respiratory deadspace and compliance measurements in neonates with congenital diaphragmatic hernia]. Cir Pediatr 2002; 15:57-62. [PMID: 12601993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The mortality rate of infants with congenital diaphragmatic hernia (CDH) remains high, despite clinical improvements. Many attempts have been made to find accurate and reliable predictors of outcome. Deadspace (Vd/Vt) and dynamic compliance (DC) measured by single breath CO2 analysis may be useful to evaluate pulmonary function and perfusion. In the present study we analyse both parameters in patients with CDH. Nine patients with CDH were included for Vd/Vt and DC study. Measurements of arterial blood gases (pH, PO2, pCO2) were obtained, oxygenation index and alveolo-arterial difference calculated at diagnosis, preoperatively and postoperatively. Vd/Vt and DC were measured at the same moments by analysis of the CO2 espirogram. Statistical analysis was performed using Fisher exact test, ANOVA and Mann Whitney and Chi-square. The Vd/Vt was significant lower for the group of patients who survived (0.39 +/- 0.07 vs 0.64 +/- 0.14, p = 0.038). DC was significantly higher in the survivors group (1.39 +/- 0.30 vs 0.5 +/- 0.07, p = 0.011). The analysis of the evolutive Vd/Vt and DC (initial and preoperative) showed significant differences within both groups. Respiratory deadspace can be easily quantified in neonates with congenital diaphragmatic hernia providing an important insight regarding the efficiency of the airway-alveolus and its relationship to pulmonary blood flow. Vd/Vt and DC measurement constitute a reliable method to predict outcome in patients with CDH.
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Affiliation(s)
- R Romero
- Servicio de Cirugía Pediátrica, Unidad de Cuidados Intensivos Neonatales, Hospital Infantil Universitario Gregorio Marañón, C/Doctor Castelo, 49, 28009 Madrid
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