Neonatal Therapeutic Intervention Scoring System Research Articles

Associations between Early Thyroid-Stimulating Hormone Levels and Morbidities in Extremely Preterm Neonates

Introduction: High-end cutoffs of thyroid-stimulating hormone (TSH) have been emphasized for hypothyroidism therapy in extremely preterm infants, but the significance of low TSH levels remains unknown. This study hypothesized that the spectrum of TSH levels by newborn screening after birth signifies specific morbidities in extremely preterm neonates. Methods: The multicenter population cohort analyzed 434 extremely preterm neonates receiving TSH screening at 24–96 h of age in 2008–2019. Neonates were categorized by blood TSH levels into group 1: TSH <0.5 µU/mL, group 2: 0.5 ≤ TSH <2 µU/mL, group 3: 2 ≤ TSH <4 µU/mL, and group 4: TSH ≥4 µU/mL. Neonatal morbidities were categorized using the modified Neonatal Therapeutic Intervention Scoring System. Results: The four groups differed in gestational age, birth weight, and the postnatal age at blood sampling so did the proportions of mechanical ventilation usage (p = 0.01), hypoxic respiratory failure (p = 0.005), high-grade intraventricular hemorrhage (p = 0.007), and periventricular leukomalacia (p = 0.048). Group 1 had higher severity scores for respiratory distress syndrome (RDS; effect size 0.39 [95% confidence interval [CI]: 0.18–0.59]) and brain injury (0.36 [0.15–0.57]) than group 2, which remained significant after adjusting for gestational age, birth weight, dopamine usage, and the postnatal age at TSH screening (RDS: mean + 0.45 points [95% CI: 0.11–0.79]; brain injury: +0.32 [0.11–0.54]). Conclusions: Low TSH levels in extremely preterm neonates are associated with severe RDS and brain injuries. Studies recruiting more neonates with complete thyroid function data are necessary to understand central-peripheral interactions of the hypothalamic-pituitary-thyroid axis.

A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities.

Hospitalized neonates are vulnerable to natural and man-made disasters because of their persistent requirement for medical resources and may need to be evacuated to safe locations when electricity and medical gas supply become unreliable. In Japan, a triage system for hospitalized neonates, or the Simple Triage and Rapid Treatment for Neonates, Revised (START-Neo-R), has been used to determine whether neonates are in suitable conditions for transportation. However, this scale is not useful to determine the evacuation order of neonates because a considerable number of evacuees are classified into the same categories. To solve this problem, a novel triage system, Neonatal Extrication Triage (NEXT) was developed. This study tested the validity and reproducibility of both triages and compared them with a standardized prognostic scoring system for hospitalized neonates, the Neonatal Therapeutic Intervention Scoring System (NTISS). In this retrospective observational study, physicians and nurses independently assessed each neonate hospitalized at a tertiary neonatal intensive care unit (NICU) twice weekly using NEXT and START-Neo-R. The NEXT system comprises six questionnaires regarding medical resources required during transition and transportation, providing composite scores on a 12-point scale. The START-Neo-R classified neonates into five levels based on the severity of disease and dependence on medical care. Inter-rater reliability of both systems was assessed using Cohen's kappa coefficient, whereas the criterion validity with NTISS was assessed using Spearman's correlation coefficient. Overall, 162 neonates were assessed for 49 days, resulting in triage data for 1,079 accumulated patients. Both NEXT scores and START-Neo-R ranks were well-dispersed across different levels without excessive accumulation in specific categories. Inter-rater reliability of NEXT (kappa coefficient, 0.973; 95% confidence interval, 0.969-0.976) and START-Neo-R (kappa coefficient, 0.952; 95% confidence interval, 0.946-0.957) between physicians and nurses was sufficiently high. The correlation coefficient of NEXT and START-Neo-R scores with NTISS scores were 0.889 (P <.001) and 0.850 (P <.001), respectively. Both START-Neo-R and NEXT had good reproducibility and correlation with the severity of neonates indicated by NTISS. With its well-dispersed scores across different levels, the NEXT system might be a powerful tool to determine the priority of evacuation objectively.

LABORATORY DIAGNOSTIC CRITERIA OF RENAL IMPAIRMENT IN PREMATURE NEWBORNS WITH SEVERE PERINATAL PATHOLOGY

Introduction: Critically ill neonates are at high risk of developing renal impairment (RI), including acute kidney injury (AKI), which is associated with short- and long-term pathological outcomes and increased mortality. The incidence of acute kidney injury varied by gestational age (GA) group.&#x0D; Aim: Identify laboratory diagnostic criteria of RI in premature newborns (PNs) with different GA who had severe heterogeneous perinatal pathology.&#x0D; Methods: The study was a prospective cohort of patients admitted electively to the III level Neonatal Intensive Care Unit at the Clinical Maternity Hospital 2 (Chernivtsi, Ukraine) between December 2015 and January 2018. One hundred sixty three PNs were treated at the hospital, from which a total of 68 patients were recruited into the study. Inclusion criteria: the GA is more than 24 weeks and less than 37 weeks; birth body weight is more than 500 g and less than 2500 g; presence of clinical signs of severe perinatal pathology. The severity of the perinatal pathology was classified on the basis of the neonatal Therapeutic Intervention Scoring System. The PNs were divided into three groups according to the GA: Group I consisted of 25 newborns born at the GA of 24-31 weeks, Group II – 25 newborns born at the GA 32-33 weeks, Group III – 18 newborns were born in a GA of 34-36 weeks.&#x0D; The levels of sodium, potassium, calcium and chlorine, alanine aminopeptidase, and aspartate aminopeptidase were measured in serum. The levels of creatinine and urea were measured in serum and urine. The concentration of total protein, albumin, α1-microglobulin, and β2-microglobulin was measured in urine.&#x0D; Findings and results: All PNs had signs of severe perinatal pathology and a neonatal Therapeutic Intervention Scoring System score of 10 or higher during the early neonatal period. There was no statistically significant difference in most serum biochemical parameters between groups of the study, excluding the level of serum chlorine. Our results demonstrated no significant difference in levels of urinary total protein and albumin between groups of the study, but showed a progressive increase the level of urinary creatinine and urea with increasing GA. The maximum level of urinary β2-microglobulin was found in “Late-Preterm” newborns who were born at 34-36 weeks, the minimal level of urinary α1-microglobulin was detected in patients with GA 32-33 weeks.&#x0D; Conclusions: Our results demonstrated that most PNs with severe perinatal pathology have some aspects of impaired tubular and glomerular functions. This is evidenced by changes in urinary new biomarkers. We found direct correlations between GA and serum creatinine (r=0.31, p&lt;0.05), urinary creatinine (r=0.40, p&lt;0.05), urinary α1-microglobulin (r=0.37, p&lt;0.05), and urinary β2-microglobulin (r=0.51, p&lt;0.05). Longer longitudinal cohort studies on PNs are required to determine the prognostic and diagnostic criteria of RI in these patients.

Neonatal Therapeutic Intervention Scoring System (NTISS) in Rural Country: Mortality and Length of Stay (LOS) Predictive Score in Preterm Infant

Background: Preterm infants need comprehensive management due to high risk of mortality and morbidity. Proper treatment in NICU can decrease the mortality risk in them, but some of them may take long time before they can go home. Neonatal Therapeutic Intervention Scoring System (NTISS) hopefully can be a predictive score for the mortality and Length of stay (LOS) of a preterm infant, yet, it’s use is still very limited in Indonesia. The authors aim to analyze NTISS to predict mortality and length of stay of preterm infants in Indonesia. Method: This retrospective study conducted in March 2017 and collected medical record data of preterm infants treated in NICU from July 2016 - March 2017. The inclusion criteria were infants with gestational age &lt;37 weeks, treated at NICU&gt; 24 hours and complete medical record data. NTISS total scores are collected after 24 hours at the NICU. Results: A total of 108 infants met the inclusion criteria. The ratio of NTISS scores had an area under the curve (area under curve / AUC) of 0.879 (95% CI 0.259-0.913) with cutoff at 20.2. it had 91.3% and 74.1% in sensitivity and specificity respectively; 48.8% and 96.9% in positive and negative predictive value respectively; positive likelihood ratio 3.52; negative likelihood ratio 0.12; and 77% inaccuracy. There was no correlation between NTISS scores and length of stay (p = 0.084). Conclusion: NTISS can be used to predict the mortality of preterm infants.

Early Gut Microbiota Changes in Preterm Infants with Bronchopulmonary Dysplasia: A Pilot Case-Control Study.

Bronchopulmonary dysplasia (BPD) is a complex chronic lung disease that primarily affects premature or critically ill infants. This pilot study investigated early changes in gut microbiota composition in BPD patients and explored the potential risk factors associated with these changes. Preterm infants admitted to our neonatal intensive care unit with a gestational age of 26 to 32 weeks were prospectively surveyed and eligible for stool collection on days 7 and 28 of postnatal age between February 2016 and June 2017. A 16S rRNA sequencing approach was applied to compare the gut microbiota composition between the BPD group and controls. Multiple linear regression analysis was used to identify the predictor variables. Eight subjects in the BPD group and 10 subjects in the preterm group were analyzed during the observation period. Actinobacteria, Proteobacteria, Bacteroidetes, and Firmicutes were the four dominant bacteria phyla of intestinal microflora. A significantly lower diversity of gut microbiota was observed in the BPD group compared with the preterm group on day 28 (number of observed operational taxonomic units, p = 0.034; abundance-based coverage estimator, p = 0.022; Shannon index, p = 0.028). Multiple linear regression analysis revealed that high Neonatal Therapeutic Intervention Scoring System score (≧19) at 24 hours was statistically significant in predicting the proportion of aerobic with facultative anaerobic bacteria on day 28 (p = 0.002). Infants with BPD are prone to develop gut dysbiosis in early life. A higher severity of illness and treatment intensity may indicate a higher risk of disrupting an anaerobic environment in the gut during the first month of life. · BPD patients are prone to develop gut dysbiosis.. · Lower diversity of gut microbiota.. · Higher risk of disrupting anaerobic environment..

Providing clarity around ethical discussion: development of a neonatal intervention score.

To develop a Neonatal Intervention Score (NIS) to describe the clinical trajectory of a neonate throughout their neonatal intensive care unit (NICU) admission. The NIS was developed by modifying the Neonatal Therapeutic Intervention Scoring System (NTISS) to reflect illness severity, dependency on life-sustaining interventions and overall life trajectory on a longitudinal basis, rather than illness burden. Validity for longitudinal use within the NICU was tested by calculating the score for 99 preterm babies born less than 28weeks at predetermined time points throughout their admission to tertiary level care at two institutions. A total of 1333 NISs were analysed, ranging from 0 to 32.5 (mean 9.77, SD 5.4). Internal consistency (Cronbach alpha) reached 0.8. NIS moderately correlated to both SNAPPE-II and SNAP-II (Spearman's rho=0.47, p=<0.001) within the first 24hours. The NIS is a useful and reliable descriptive tool of relative illness severity and degree of medical interventions throughout a baby's admission. Integrating a longitudinal description of medical dependency of a patient may assist both clinical and ethical decision-making and empirical research by providing an objective account of a baby's clinical trajectory. Establishment of validity within individual institutions is required.

Identificação da gravidade e do uso de intervenções em recém-nascidos com asfixia perinatal

Objetivo: identificar a gravidade e o uso de intervenções em recém-nascidos com asfixia perinatal. Métodos: estudo documental, realizado com 48 prontuários de recém-nascidos com asfixia perinatal em Unidade de Terapia Intensiva Neonatal, baseado no sistema de escore para intervenção terapêutica neonatal. Dados analisados por meio de estatística descritiva e inferencial. Resultados: os recém-nascidos avaliados apresentaram complicações como infecção neonatal presumida (63,2%), insuficiência respiratória (59,1%), sepse (38,7%) e convulsão (39,7%). Durante a internação, 35,4% foram a óbito. As intervenções mais utilizadas foram transporte e sinais vitais (100,0%), ambiente termorregulado (97,9%), ventilação mecânica invasiva (91,6%), antibióticos (77,0%), intubação (75,0%), flebotomia (72,9%) e cateter venoso central (68,7%). Conclusão: a média de pontuação do escore Neonatal Therapeutic Intervention Scoring System foi de 19,9, sendo verificadas médias estatisticamente diferentes entre as categorias das variáveis Duração da internação, Desfecho clínico e Escolaridade da mãe.

Zonulin: A Potential Marker of Intestine Injury in Newborns.

Introduction Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology. Material and Methods Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC), rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns). ZO concentration was compared to C-reactive protein (CRP) and procalcitonin (PCT) values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS). Results Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0–43.2) and 20.3 (1-3Q: 17.7–28.2) ng/ml, resp.) versus controls (3.5 (1-3Q: 2.7–4.8) ng/ml). Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ZO levels were not related to NTISS, CRP, and PCT. Conclusions Zonulin is a promising biomarker of intestinal condition, markedly elevated in rotavirus infections. Its role in defining the severity of necrotizing enterocolitis and the risk for perforation is not well described and needs further evaluation. An increase in zonulin may not be parallel to the release of inflammatory markers, and low CRP should not exclude an injury to neonatal intestine.

Factors limiting usefulness of serum and urinary NGAL as a marker of acute kidney injury in preterm newborns

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is postulated to be a highly sensitive and specific marker of acute kidney injury (AKI). The aim of this study was to assess the factors affecting serum and urine total NGAL in preterm newborns, limiting the role of this new potential marker of AKI. Methods: Serum and urinary total NGAL concentrations were determined in 57 preterm infants admitted to the Neonatal Intensive Care Unit in the following points of time: first week of life, between 8 and 14 days of life, and after the fourth week of life. Patients’ clinical conditions were evaluated based on NTISS (Neonatal Therapeutic Intervention Scoring System). Two gestational age subgroups were distinguished: ≤29 and 30 to 35 weeks of gestation. We sought correlation between total NGAL values and gestational age, birth weight, Apgar score and severity of clinical condition, with particular interest in inflammatory status. Results: Serum and urinary total NGAL concentration correlated with inflammatory markers, such as CRP and procalcitonin, as well as with NTISS values. Birth weight and gestational age influence urinary NGAL (uNGAL) values in the first two weeks of life. In AKI (N = 8) patients uNGAL values were significantly higher than in non-AKI newborns. Conclusions: We conclude that inflammatory status and prematurity limits the specificity of total NGAL measurement as a marker of AKI.

PO-0634 Factors Limiting Usefulness Of Serum And Urinary Ngal As A Marker Of Acute Kidney Injury In Preterm Newborns

<h3>Background and aims</h3> Neutrophile gelatinase-associated lipocaline (NGAL) is postulated to be a highly sensitive and specific marker of acute kidney injury (AKI). The aim of this study was to assess the factors affecting serum and urine total NGAL in preterm newborns, limiting the role of this new potential marker of AKI. <h3>Methods</h3> Serum and urinary total NGAL concentrations were determined in 57 admitted to the Neonatal Intensive Care Unit preterm infants in the following points of time: first week of life, between 8 and 14 day of life, and after the fourth week of life. Patients’ clinical condition was evaluated based on NTISS (Neonatal Therapeutic Intervention Scoring System). Two gestational age subgroups were distinguished: &lt;30 and 30 to 35 weeks of gestation. We seek correlation between total NGAL values and gestational age, birth weight, Apgar score and severity of clinical condition with particular interest in inflammatory status. <h3>Results</h3> Serum and urinary total NGAL concentration correlated with inflammatory markers, such as CRP and procalcitonin as well as with NTISS values. Birth weight and gestational age influence uNGAL values in the first two weeks of life. In AKI (N=8) patients uNGAL values were significantly higher than in non-AKI newborns. <h3>Conclusions</h3> We conclude that inflammatory status and prematurity limits the specificity of total NGAL measurement as the marker of AKI. <h3>Acknowledgement</h3> This study was supported by the grant from Medical University of Silesia (KNW–1–057/P/2/0).

Predictive Power of Serial Neonatal Therapeutic Intervention Scoring System Scores for Short-term Mortality in Very-low-birth-weight Infants

The Neonatal Therapeutic Intervention Scoring System (NTISS) is used to indicate disease severity for neonates who need intensive care. We examined the ability of serial NTISS scores to predict mortality in very-low-birth-weight preterm infants. We reviewed the medical records of all preterm infants that had a birth weight of <1500g and were admitted to a neonatal intensive care unit from 2007 to 2011. We calculated the NTISS scores at 24 hours, 48 hours, and 72 hours after admission, and assessed the predictive power for mortality using receiver-operating characteristic curve and area under the curve analysis. We also constructed a predictive model with gestational age, birth weight, and NTISS scores to predict mortality in these very-low-birth-weight infants. In total, 172 infants were enrolled into this study. Eighteen (10.5%) infants died in the first 7 days after birth. The area under the curve of the NTISS score was 0.913 at 24 hours, 0.955 at 48 hours, and 0.958 at 72 hours. However, there was no significant difference in the overall average NTISS scores between 48 hours and 72 hours. The NTISS score at 48 hours was a better predictor of mortality than that at 24 hours after admission. Combining gestational age, birth weight, and NTISS score at 48 hours, birth weight was found to contribute little to the predictive power of mortality. The model with gestational age and NTISS score at 48 hours had a better predictive power than the NTISS score alone (area under the curve=0.99). The NTISS score at 48 hours seemed to be effective to predict mortality in preterm infants whose birth weight was less than 1500g. In addition, gestational age played a more important role in predicting mortality than birth weight.

Serum and Urinary NGAL in Septic Newborns

Neutrophil gelatinase-associated lipocalin (NGAL) is postulated to be a potentially new and highly specific/sensitive marker of acute kidney injury (AKI). The aim of this study was to assess the impact of inflammation on serum and urine NGAL in newborns that were treated due to infection. We determined serum and urine NGAL concentrations in 73 infants (51 with sepsis; 22 with severe sepsis) admitted to the Intensive Care Unit in the first month of life, for three consecutive days during the course of treatment for infection. 29 neonates without infection served as the control group. Septic patients, in particular, severe sepsis patients, had increased serum and urinary NGAL levels in the three subsequent days of observation. Five septic patients who developed AKI had elevated serum and urinary NGAL values to a similar extent as septic neonates without AKI. A strong correlation was found between the concentration of serum and urinary NGAL and inflammatory markers, such as CRP and procalcitonin. Serum and urinary NGAL levels were also significantly associated with NTISS (neonatal therapeutic intervention scoring system) values. We conclude that increased serum and urinary NGAL values are not solely a marker of AKI, and more accurately reflect the severity of inflammatory status.

Uso de medicamentos off-label e não licenciados em unidade de tratamento intensivo neonatal e sua associação com escores de gravidade

OBJECTIVE: To analyze the frequency of unlicensed (UL) and off-label (OL) prescriptions in neonates admitted to the neonatal intensive care unit of a tertiary care hospital and to determine their association with patients' severity. METHODS: Observational cohort study including drugs prescribed during hospitalization of neonates over a 6-week period between July and August 2011. The drugs were classified as UL and OL for dose, frequency, presentation, age group, or indication, according to an electronic list of drugs approved by the Food and Drug Administration. Patients were followed until hospital discharge or 31 days of hospitalization, with daily records of the Neonatal Therapeutic Intervention Scoring System (NTISS). RESULTS: We identified 318 prescription items for 61 patients (average of five items/patient); there were only 13 patients with appropriate use of medications (21%). A prevalence of 7.5% was identified for UL prescriptions and 27.7% for OL, and the most prevalent OL use was that related to age group - 19.5%. Fifty-seven medications were computed - one patient received 10 UL/OL drugs during hospitalization. The prevalence of OL uses was higher in preterm infants < 35 weeks and in those with higher severity scores (p = 0.00). CONCLUSIONS: The prevalence of neonates exposed to UL/OL drugs during hospitalization was high, especially for those with higher NTISS scores. Although there is general appreciation that neonates, especially preterm infants, have a high rate of drug use, an assessment including different cultures and countries is still needed to prioritize areas for future research in the pharmacotherapy of this vulnerable population.

Use of off-label and unlicensed drugs in the neonatal intensive care unit and its association with severity scores

To analyze the frequency of unlicensed (UL) and off-label (OL) prescriptions in neonates admitted to the neonatal intensive care unit of a tertiary care hospital and to determine their association with patients' severity. Observational cohort study including drugs prescribed during hospitalization of neonates over a 6-week period between July and August 2011. The drugs were classified as UL and OL for dose, frequency, presentation, age group, or indication, according to an electronic list of drugs approved by the Food and Drug Administration. Patients were followed until hospital discharge or 31 days of hospitalization, with daily records of the Neonatal Therapeutic Intervention Scoring System (NTISS). We identified 318 prescription items for 61 patients (average of five items/patient); there were only 13 patients with appropriate use of medications (21%). A prevalence of 7.5% was identified for UL prescriptions and 27.7% for OL, and the most prevalent OL use was that related to age group - 19.5%. Fifty-seven medications were computed - one patient received 10 UL/OL drugs during hospitalization. The prevalence of OL uses was higher in preterm infants < 35 weeks and in those with higher severity scores (p = 0.00). The prevalence of neonates exposed to UL/OL drugs during hospitalization was high, especially for those with higher NTISS scores. Although there is general appreciation that neonates, especially preterm infants, have a high rate of drug use, an assessment including different cultures and countries is still needed to prioritize areas for future research in the pharmacotherapy of this vulnerable population.

822 Describing the Use of Neonatal Therapeutic Intervention Scoring System in a University Hospital in Brazil - A Pilot Study

Background and AimsThe Neonatal Therapeutic Intervention Scoring System (NTISS) is an index of intensity of use of technologies with significant association to mortality risk. We intended to analyze this score...

Risk prediction using a neonatal therapeutic intervention scoring system in VLBW and ELBW preterm infants

The Neonatal Therapeutic Intervention Scoring System (NTISS) is a therapy-based severity-of-illness index, The aim of the present study was to evaluate whether: (i) NTISS can predict the severity of illness with the same accuracy both in very low-birthweight (VLBW) and extremely low-birthweight (ELBW) infants, using all parameters; and (ii) the performance of NTISS can be increased by using only the significant variables. All inborns <1500 g, and all outborns <1500 g transferred in the first 12 h of postnatal life, were included. NTISS using 63 variables was assessed for all infants at the 24th hour. Predictive performance for the overall variables was assessed using area under the curve (AUC) for group 1 (500-1499 g), 2 (1000-1499 g) and 3 (500-999 g). Variables with good prediction were identified for each group and a second AUC was assessed using only sensitive variables. Receiver operating characteristic (ROC) curve area for all variables was compared with the ROC area for sensitive variables. A total of 364 preterm infants fulfilled the eligibility criteria. The AUC of groups 1, 2 and 3 with all variables were 0.851; 0.834 and 0.749, respectively. The number of parameters with good prediction was 33 in group 1, 30 in group 2 and 18 in group 3. The AUC for sensitive variables was 0.848 in group 1; 0.821 in group 2 and 0.823 in group 3. When compared, increase in the description of outcome was significant only for group 3 patients (P = 0.02). NTISS using all parameters seems to be less predictive in ELBW infants. It is probably related to the use of some interventions, done as a routine procedure in almost all ELBW preterm infants, therefore NTISS may be modified according to birthweight in order to obtain a more sensitive prediction.

Herramienta para el cálculo de personal de cuidado intensivo neonatal

La gestión del cuidado de enfermería supone la utilización de métodos y herramientas que de manera práctica permitan una aproximación a las necesidades de cuidado de los pacientes y ayuden a planear los requerimientos humanos y técnicos para tal fin. Objetivo: identificar la utilidad del Neonatal Therapeutic Intervention Scoring System (NTISS) en el cálculo de personal de enfermería en la unidad de cuidado intensivo (UCIN) e intermedio neonatal (UCEN) de la Clínica Universitaria Bolivariana (CUB) en Medellín, Colombia. Método: estudio descriptivo, transversal, realizado durante el mes de abril de 2007. La población estuvo conformada por los neonatos ingresados y hospitalizados en la UCIN y UCEN, para lo que fue necesario aplicar el instrumento al final de cada turno. Se calculó una muestra de 384 instrumentos (proporción desconocida y un intervalo de confianza de 0,5). La consistencia interna del instrumento se determinó con el alfa de Cronbach (0,8). Resultados: se recolectaron 425 instrumentos diligenciados de 22 neonatos. Las patologías más frecuentes fueron las de tipo respiratorio. El puntaje total de los NTISS analizados fue de 5.200 puntos, con un promedio de 12,3, equivalentes a 123 minutos de trabajo de enfermería por turno de 6 horas. Del total de intervenciones el 62% están asignadas a las enfermeras, el 22% a las auxiliares de enfermería y el 16% a terapia respiratoria. Se calculó el requerimiento de 4 enfermeras por turno en la UCIN y UCEN. Conclusiones: el NTISS es útil para la asignación y el cálculo del personal de enfermería y contribuye a mejorar los procesos de gestión del cuidado.

Length of life and treatment intensity in infants diagnosed prenatally or postnatally with congenital anomalies considered to be lethal

The objectives of this study were (1) to compare age at death and the intensity and cost of medical treatment for infants diagnosed prenatally or postnatally with congenital anomalies considered to be lethal. (2) To determine whether greater treatment intensity is associated with longer life. This is a retrospective cohort study of all fetuses and neonates with congenital anomalies classified as lethal who were diagnosed or treated at the University of North Carolina Hospitals from January 1998 to December 2003. The cohort consisted of 192 fetuses and infants: 160 were diagnosed prenatally, 2 were diagnosed perinatally, and 30 were diagnosed postnatally. In all, 115 (72%) pregnancies were terminated. Of the liveborn infants, 75% died before 10 days of age and 90% before 4 months of age. Compared with postnatally diagnosed infants, prenatally diagnosed infants received less intense treatment (median average daily Neonatal Therapeutic Intervention Scoring System score 8.3 versus 14.0; P=0.02), at less cost (median direct cost of hospitalization $1550 versus $8474; P=0.03) and died sooner (median age at death <1 day versus 4 days; P=0.01). Greater treatment intensity did not correlate with longer survival (r=-0.04; P=0.66). Although some kinds of medical therapy may be appropriate for newborns with lethal congenital anomalies, highly aggressive interventions did not prolong survival and should not be offered. Even when pregnancy termination is not elected, infants diagnosed prenatally receive less intense care.

PROTEIN C CONCENTRATE AS ADJUVANT TREATMENT IN NEONATES WITH SEPSIS-INDUCED COAGULOPATHY

The objective of the study is to describe safety and effects of protein C concentrate (PCConc) administration in neonates with sepsis-induced coagulopathy. Eighteen neonates (12 preterm and 6 full term) aged between 1 and 28 days who have severe sepsis (n = 6) or septic shock (n = 12), with coagulopathy and acquired protein C (PC) deficiency received PCConc (i.v. bolus of 100 IU/kg, followed by 50 IU/kg every 6 h for 72 h). Platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, C-reactive protein (CRP), antithrombin (AT), PC, CRP, and neonatal therapeutic intervention scoring system (NTISS) were assessed before and 24, 48, and 72 h after the study entry. According to Clinical Risk Index for Babies II score (CRIB II score), the expected mortality in preterms was 10%. After 24 h of treatment, PC activity levels increased from an average of 19% to 57%, and they were within normal limits before the last PCConc bolus. During the treatment period, a shortening of PT (P = 0.04) and activated partial thromboplastin time (P = 0.02), and an increase in antithrombin levels (P < 0.0001) were observed, along with a reduction in CRP (P = 0.005) and NTISS values (P = 0.003). No adverse events were observed. This pilot study shows that in neonatal severe sepsis, normalization of PC levels is safe and probably effective in modulating the inflammatory response and in controlling coagulopathy. However, for the potential beneficial effects of PCConc administration on morbidity and mortality, a placebo-controlled, double-blind study is required.

Evaluation of the neonatal outcomes of the kangaroo mother method in Brazil

To evaluate the results of the kangaroo mother method in Brazil. A prospective cohort study comparing 16 units that have or do not have the second phase of the kangaroo mother method: eight were national centers of excellence for the kangaroo mother method (study group) and eight were part of the Brazilian Neonatal Research Network (control group). A total of 985 newborn infants with birth weights of 500 to 1,749 g were enrolled. Multivariate analyses employed multiple linear regression and Poisson regression with robust adjustment. The adjusted analysis (controlled for birth weight, gestational age, Score for Neonatal Acute Physiology Perinatal Extension II, Neonatal Therapeutic Intervention Scoring System, and maternal age and educational level) demonstrated that mean length of hospital stay (p = 0.14) and intercurrent clinical conditions in the intermediate or kangaroo unit were equal for both groups. Weight (p = 0.012), length (p = 0.039) and head circumference (p = 0.006) at 36 weeks' corrected gestational age were all lower at the kangaroo units. The kangaroo units exhibited superior performance in relation to exclusive breastfeeding at discharge (69.2 vs. 23.8%, p = 0.022). The evidence suggests that the humanization strategy adopted by the Brazilian Ministry of Health is a safe alternative to conventional treatment and a good strategy for promoting breastfeeding.