Umbilical Catheter Research Articles

A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore.

Umbilical venous catheters (UVCs), commonly inserted in neonates for vascular access, are not without complications. A single-centre retrospective cohort study that reviewed complications related to UVC insertion in neonates was conducted in a tertiary neonatal unit in Singapore from January 2016 to July 2017. Ideal UVC position was defined as catheter tip within 0.5 cm above or below the diaphragm. Catheter-related sepsis was defined as clinical or biochemical abnormalities suggesting any new-onset or worsening sepsis 72 hours before or after removal of UVCs, with or without positive culture. Catheter-associated bloodstream infection (CABSI) was defined as positive microbiological growth in one or more blood cultures obtained from a symptomatic infant up to two days after UVC placement or within 48 hours of catheter removal. 108 patients had UVC insertions. Mean gestational age and birth weight were 30.4 ± 4.0 weeks and 1,536.2 g ± 788.9 g, respectively. Mean UVC duration was 6.6 days. The UVC was in an ideal position in 27 (25.0%), deep in 13 (12.0%) and short in 35 (32.4%) neonates. One-third of the UVCs (n = 33) were malpositioned. Catheter-related sepsis was observed in 16 (14.8%) neonates, with 5 (4.6%) having CABSI. The most common organism was coagulase-negative Staphylococcus. Other complications include peritoneal extravasation in 3 (2.8%) patients, with two requiring surgical intervention. Venous thrombosis occurred in 2 (1.9%) neonates and was managed conservatively. Although complication rates were in line with international norms, UVCs were associated with serious complications and should be judiciously used.

Prevalence, Risk Factors and Intra-Hospital Outcomes Relating to Peri-Intraventricular Hemorrhage in Premature Newborns of Gestational Age Less than 34 Weeks

Peri-intraventricular hemorrhage is one of the main causes of neurological impairment in premature newborns. To control their risk factors is necessary in view of the increasing survival of extreme preterm infants. Objective: To evaluate the prevalence of peri-intraventricular hemorrhage in premature newborns, identify the risk factors and observe the frequencies of intra-hospital outcomes of interests. Methods: This study was done in Brazil. This was an observational, analytical longitudinal and prospective study. The subjects included were newborns of gestational age less than 34 weeks who were admitted to two public hospitals between May and November 2015. To assess possible associated factors, obstetric, perinatal and neonatal data were analyzed (chorioamnionitis, antenatal corticosteroids, gestational age, newborn weight, Apgar score at 1 and 5 minutes, resuscitation in the delivery room, surfactant in the delivery room, newborn transferred from another hospital, respiratory distress syndrome: RDS, sepsis, umbilical vein catheterization, assisted ventilation, exogenous surfactant in the Neonatal ICU, use of sodium bicarbonate, inotropic agents, adrenaline, volume expanders and blood products). The hospital outcomes studied were assisted ventilation time, hospital stay and death. The data analysis was performed by chi-square test or Fisher’s test, with a significance level of 5%. Results: Out of 156 newborns, 46 (29.9%) presented peri-intraventricular hemorrhage and 28.2% of these had a severe form of the disease. There were significant associations (p 0.05) with the following risk factors: gestational age, birth weight, low Apgar score, delivery room resuscitation, RDS, surfactant use, sepsis, packed red blood cell transfusion, mechanical ventilation and umbilical vein catheterization. The newborns with peri-intraventricular hemorrhage presented longer times on assisted ventilation, longer hospital stays and higher risk of death. Conclusion: The prevalence of peri-intraventricular hemorrhage was high in the population studied, especially the severe form. Perinatal and neonatal risk factors were associated with a higher risk of developing the disease and the outcomes studied were more evident in these newborns.

Intraperitoneal extravasation of total parenteral nutrition: A rare but life-threatening complication of umbilical vein catheter, two case reports

Umbilical vein catheter (UVC) is a commonly used intervention in neonatal intensive care units for total parenteral nutrition (TPN), antibiotic therapy, and investigations, especially in very low birth weight infants. In this report, a rare but life-threatening complication of UVC developed in two preterm infants was presented. Of two infants admitted to our neonatal intensive care unit due to prematurity, the first infant developed abdominal distension and a decreased urinary output on the 2nd day and the second infant on the 5th day. Enteral intake of the patients was discontinued with the presumed diagnosis of necrotizing enterocolitis, and broad-spectrum antibiotic therapy was initiated. There were free ascites on the abdominal ultrasonography. Macroscopic and microscopic examination of the fluid sample taken by paracentesis was compatible with TPN. Intraperitoneal extravasation of UVC, which is a rare but life-threatening complication of UVC and can be confused with necrotizing enterocolitis, should be kept in mind, especially in infants receiving TPN infusion from the UVC.

Relato de caso: derrame pericárdico com “swimming heart” após cateterismo venoso umbilical

Umbilical vein catheterization (UVC) in newborns (NB) is frequently used as a vascular access. Due to its invasive characteristics, complications may occur, such as cardiac tamponade. The aim of this article is to report a case of pericardial effusion with “swimming heart” resulting from a newborn UVC and to propose preventive approaches to avoid UVC-related complications.

The predictive factors for poor outcomes in preterm infants with coagulase-negative staphylococci infection

Background: The main pathogen for neonatal nosocomial infections is coagulase-negative staphylococci (CoNS), particularly in very low-birth-weight and premature newborns. The current study is aimed to assess the outcomes of preterm infants with CoNS infection via a retrospective analysis, to determine the correlation between the clinical profile and mortality and morbidity, and to determine the factors associated with poor outcomes. Materials and Methods: This retrospective case–control study was conducted in the Children's and Women's Health Centre of King Fahad Medical City neonatal intensive care unit in Saudi Arabia. The study period was from January 2013 to December 2019. Results: There were 1333 controls and 137 cases of CoNS infection. There was a significant association between total parenteral nutrition use, surgical insertion of a central line, inotrope use, and spontaneous intestinal perforation and CoNS infection. There was a significant association between umbilical vein catheter (UVC) and peripherally inserted central catheter (PICC) line use and CoNS infection. The use of a UVC or PICC line significantly impacted. The presence of patent ductus arteriosus also significantly impacted. Conclusions: There was a significant association between UVC and PICC line use and outcome. The presence of patent ductus arteriosus or a perforated bowel and the need for inotrope use in CoNS infection was associated with poor outcomes. Mortality, retinopathy of prematurity, and necrotizing enterocolitis requiring surgery were more common in infants with CoNS infections.

Síndrome de Pfeiffer tipo 2: relato de um caso

OBJECTIVE: Report a rare case of Pfeiffer’s syndrome type 2 in a male newborn. CASE REPORT: Newborn male, preterm term of 33 weeks and 2 days, serial ultrasound suggesting presence of craniosynostosis and other abnormalities such as irregular and narrow vertebrae, pachygium, and ventriculomegaly in the second trimester, being confirmed later with magnetic resonance imaging. There was no need for obstetrical medications and maneuvers for the birth. Apgar score 4, heart rate less than 100bpm, precarious respiratory evolution, orotracheal intubation, umbilical venous catheterization and orogastric tube were required. With 2 hours of life presented bradycardia along with hemodynamic instability evolved to a cardiorespiratory arrest with no success in cardiopulmonary resuscitation. He passed away 3 hours after birth. COMMENTS: Pfeiffer’s syndrome is rare, being type 2 the most lethal because it has a clover-shaped skull. It is associated with the genetic mutations in fibroblast growth receptors FGFR1, FGFR2, and FGFR3. Premature fusion of the cranial sutures prevents normal skull growth by interfering with the shape of the face and head. The prognosis is associated with the severity of the anomalies and the early diagnosis through the gestational and family history, through detailed physical examinations and images (three-dimensional ultrasonography and MRI). The patient should have multidisciplinary treatment at birth.

Preparing A University Hospital Neonatal Intensive Care Unit for Covid-19 Pandemic and Country Lockdown

Jordan is one of the earliest countries that took a very strict approach to contain COVID-19 pandemic by declaring a country lock down. Our neonatal intensive care unit is a level three 30 beds unit. The shortage of neonatal nurses, doctors, and of respiratory support devices are the major existing challenges. During COVID-19 pandemic, those two issues were magnified. This paper will shortly discuss the measures taken as a preparedness for COVID-19 Pandemic in our unit. Team development and work schedule: The medical knowledge about COVID-19 was foggy, however; teamwork is the only ev-ident thing. Our team included, the neonatologists, pediatric intensivist, pediatric pul-monologists, in addition to the infectious disease specialist. The team also included three of our senior residents, and the neonatal unit head nurse. To enhance communication, we created a WhatsApp group (Peds COVID -19). Among this group, unidentified Patients’ information, in addition to recent publications and sci-entific opinions, were shared. Meeting with the obstetric department was done to famil-iarize both teams with the measures taken on both sides. The neonatal care is provided by two neonatologists. The in-house care providers are the pediatric residents. Senior residents are well-trained on neonatal resuscitation, endotra-cheal intubation, and umbilical venous catheterization. During COVID-19 lock down, residents were split into separate teams. Neonatal team, the pediatric floor team, and the emergency room team, each team had their sleeping room and lounges. The consultants did rounds daily, the in-house team consisted of two senior residents, and a junior resident. they did a 24-hour shift every four days and are off duty for the next three days. Regarding the nursing staff schedule, their work schedule changed from an 8- hour shift to a 12- hour shifts schedule. The aim was to promote staff well-being, minimize the number of staff who could potentially be exposed to a COVID-19 case, and therefore will need to be quarantined. Visitation policy: Mothers could come at any time, but fathers could visit briefly. Parents were requested to wear gowns and face masks. We continued to encourage breast feeding, and we continued to receive expressed breast milk from mothers at home. Neonatal isolation area: A separate area was designated for isolating asymptomatic infants born to COVID-19 positive or suspected mothers, another area was designated for sick newborns, both areas were outside the current NICU. A separate nursing staff were assigned to take care of the isolated newborns. Infection control measures: The unit medical and nursing staff were instructed to stay home if feeling unwell, with fever or respiratory illness. They were also instructed to declare any contact with sick individuals. Wearing face mask and maintaining social distancing whenever possible, is a policy we adopted very early. When providing medical care to suspected cases, the staff were instructed to follow the hospital protocol. Management plan: After reviewing the available literature of COVID-19 infection a management flow chart was constructed to standardize the care. It contains the main steps and principles of management. It was circulated to all residents, the hospital administration, and to the hospital infection control unit (Table1). This chart is designed to help with the initiation of the care. The management process might vary according to the patient situation, in addition to the change of the current COVID-19 knowledge that will mandate a change in the implemented guidelines. Neonatal units should have an in-house policy that will guarantee standardization of care, better communication with different disciplines, and most importantly policies that could decrease the transmission risk of the corona virus among the staff and neonatal patients. Infection control measures, minimum staff on duty, and shorter contact time, are the most important items in such policies.

An observational study of acute kidney injury in critically ill neonates at Chris Hani Baragwanath Academic Hospital, South Africa

Background: Acute kidney injury (AKI) is common in critically ill, hospitalised neonates. Epidemiological data on AKI in children are scarce in South Africa. This study aimed to determine the incidence and outcomes of AKI in critically ill neonates. Methods: This single-centre, prospective, observational study was conducted in the neonatal unit of the Chris Hani Baragwanath Academic Hospital, a tertiary-level hospital in Johannesburg, South Africa. Neonates with AKI, defined using the AKI Network criteria, were recruited over a three-month period in 2019. Risk factors and demographic data were collected for all study participants, who were followed up over the period to observe an outcome of either recovery or death. Results: Fifty-one cases of AKI were identified, representing 7.8% of all admissions (95% CI 5.9–10.2%). The overall mortality of enrolled patients was 29.4% (95% CI 26.3–56.1%). Mortality was significantly associated with extremely low birth weight (OR 11.4, p < 0.01), umbilical catheterisation (OR 6.3, p = 0.01), sepsis (OR 5.4, p = 0.01), phototherapy (OR 4.4, p = 0.03) and prematurity (p = 0.04). The most frequent risk factor associated with AKI was intravenous nephrotoxic medication. Conclusion: The incidence of AKI in our study was higher than expected. Further epidemiological and interventional studies are warranted to identify and improve the long-term outcome of AKI in the newborn in our setting.

Preterm Bebeklerde Nazal Aralıklı Pozitif Basınçlı Ventilasyon (NIPPV) Desteği kullanılarak LISA ile INSURE Tekniğinin Karşılaştırılması: Randomize Kontrollü Bir Çalışma

Objective: Surfactant administration is usually performed by endotracheal intubation under mechanical ventilation. Less invasive surfactant administration (LISA) technique has became widespread in recent years, in order to prevent the risk of barotrauma and volutrauma caused by mechanical ventilation and intubation. The aim of this prospective study is to evaluate the effectiveness of surfactant administration via a thin catheter during spontaneous breathing on NIPPV and to compare with INSURE method. Method: Seventy-eight preterm infants who were born at university hospital with less than 34 weeks of gestational age and who received surfactant therapy were enrolled. The intratracheal administration of poractant alfa (CUROSURF®) was performed using umbilical catheters in LISA group (n= 42). INSURE group had 36 infants who were intubated, received surfactant then extubated and placed on NIPPV. Results: There were no statistically significant differences between two groups in terms of intubation in the first 72 hours and re-administration of surfactant, the duration of NIPPV and the occurence of pneumothorax, pulmonary hemorrhage, patent ductus arteriosus, intraventricular hemorrhage, early onset neonatal sepsis, necrotising enterocolitis, bronchopulmonary dsyplasia and mortality (p>0.05). The pCO2 values decreased faster in LISA group when compared to INSURE group and this difference was statistically significant (p<0.05). Conclusions: LISA procedure under NIPPV seems to provide better pCO2 levels and does not increased the mortality and morbidity due to technique. Although the results seem to be promising, we need further investigations and larger series.

Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates I-The group difference of partial pressure of oxygen and carbon dioxide between umbilical artery and vein in newborns

Objective: The fetus has no actual respiration, and the newborn begins to breathe after birth. We assume that the first breath dominantly generated by hypoxia. In this study, the changes and lowest limit of blood oxygen partial pressureof umbilical artery (PuaO2) after chemoreceptor were analyzed to explore the mechanism of neonatal spontaneous breathing. Methods: With signed consent form by all fetal parents before birth, 14 newborns successfully completed the umbilical artery or vein catheterization and drawn blood according to the heartbeat. All blood samples analyzed by blood gas analyzer,calculated and analyzed the similarities and differences between umbilical vein(Puv) and umbilical artery(Pua). Results: Although we completed 14 newborns, there were only 9 cases of umbilical artery samples and 8 cases of umbilical vein samples were collected. Only 3 cases collected both Pua and Puv blood samples at the same time (see serial paper II). PuaO2 in gradually decreased with time (heartbeat frequency), until Pua contracted after spontaneous breathing produced about 8~10 heartbeats, and then could not get enough blood samples. Only 3 newborns were able to take blood samples after spontaneous breathing for 8~10 heartbeats, and their PuaO2 were jumped to 186.0, 137.0 and 93.8 mmHg respectively. The mean value of PuaO2 was (25.94±6.79, 18.04~37.51)mmHg, the highest value was (29.11±6.46, 23.00~45.90)mmHg, and the lowest value was (21.34±5.54, 14.00~33.60)mmHg. Although PuvO2 decreased gradually with time (heartbeat) too, most of them also showed the tendency of alternately rising and falling with the regularity of mother's respiration. The mean value of PuvO2 was (53.35±21.35, 32.56~100.73)mmHg, the highest value was (90.38±48.44, 43.40~153.00)mmHg, and the lowest value was (36.96±14.90, 24.80~73.80)mmHg. Although there were large individual differences, the mean, highest and lowest values of PuvO2 were significantly higher than those of PuaO2 (P<0.05); although PuvCO2 slightly lower than PuaCO2, it was no significant difference (P>0.05). Conclusion: PuaO2 decreases gradually with time before spontaneous breathing after the delivered fetus as a newborn, and it induces the first inhalation to start spontaneous breathing when it reaches the threshold of triggering breathing.

Complete thrombosis of the abdominal aorta in a neonate with advanced lower limbs ischemia: Etiological diagnosis, prognosis, and surgical approach

Introduction: Neonatal aortic thrombosis is a rare but some cases have been described in the literature. It is associated with high mortality. The main etiology is umbilical vessel catheterization, but others cause coagulopathy, so sepsis could not be excluded. We reported a case

Use of silver-impregnated umbilical venous catheters for prevention of catheter associated bloodstream infection in neonates

Use of silver-impregnated umbilical venous catheters for prevention of catheter associated bloodstream infection in neonates

Portal Venous Gas after Insertion Umbilical Venous Catheter: A Case Report

Portal Venous Gas after Insertion Umbilical Venous Catheter: A Case Report

Elevated liver enzymes in association with vasopressin use in a neonate

Vasopressin has been used in neonates for refractory hypotension. Elevation in liver enzymes due to mesenteric mucosal hypoperfusion has been associated with the use of vasopressin in adults. We present a case of a neonate that develop elevated liver enzymes in association with vasopressin use and migration of umbilical venous catheter.

Klebsiella Pneumoniae sepsis, clinical features and early outcome among Newborns in neonatal intensive care unit Zawia teaching hospital

Background: Klebsiella pneumonia is one of the most common infections that cause neonatal sepsis globally. It is responsible for a significant proportion of hospital-acquired infections including septicemias, urinary tract infections, pneumonia, and soft tissue infections especially in the immunocompromised hosts such as the neonate. Aim of study: to identify, clinical features and the outcomes associated with K. pneumonia, in all newborn at NICU at Zawia teaching Hospital – Libya. Materials and Methods: Retrospective case series study conducted at neonatal intensive care unit in Zawia teaching hospital /Libya. during one year period (1st of January -30st December 2012). Four hundred and eleven neonates who were admitted to Intensive Care Unit (ICU) in pediatric department were selected. The following data was obtained from the patient’s medical records sex, birth weight, gestational age, mode of delivery, time of admission (Season), blood cultures strain of the isolates, maternal history, clinical diagnosis and features association problems mechanical ventilator, blood exchange, umbilical vein catheterization, respiratory distress syndrome, birth asphyxia, CRP for risk patient, CRP on deterioration, platelets concentrate transfusion and outcome. Result: The study results reported that 13 neonates had positive klebsiella pneumonia.9 (69.2%) preterm,9(69.2%)were males 4(30.8%)were females with 2:1 male to female ratio ,10 (76.9%) had low birth weight ,8(61.5%) were delivered by caesarean section , regarding maternal age 53.8% were between 31-40 years with mean maternal age 32.15 years and 5.5 standard deviation ,61.5% were infected at the second half of the year p value, History of PROM in 6( 46%), pre eclampsia (30.8 %) maternal fever in 1(7.7%),maternal infection (7.7%). 9(69.5%) had respiratory distress,53.8%,7 (53.8%) developed hyperbilirubenmia,4(30%) had necrotizing enterocolities ,1(7%) had acute myocarditis,1patient presented with fever and proved to have UTI with sepsis, mechanical ventilation was needed in8 (61.5%).one patient developed Pnemothorax (7.7%)and drained under water seal by insertion of chest tube. Umbilical vein catheterization inserted only in one patient7.7% Exchange blood transfusion was done in one baby 7.7%. all had negative CRP test on admission 13 (100%) and CRP was positive in all patients (100%) with positive klebsiella pneumoniae (p value 0.0001) when sepsis was suspected.10 (76.9%) of the neonates required platelets transfusion which indicate the higher rate of thrombocytopenia. Regarding neonatal outcome, the result reported that 10(76.9%) of neonates with positive klebsiella pneumonia were alive and only 3 (23.1%) died, Two due to respiratory failure and the 3rd one died due acute myocarditis complicated by heart failure. The mortality rate about 23%. 66.6%were preterm low birth weight .100% were males and due to ESBL producing strains. Conclusion: The main risk factors for the infection was preterm babies, males gender, low birth weight, caesarean section delivery, prolonged pre labor rupture of membrane (PR0M). mostly infected at the second half of the year and hospital stay, The clinical presentations are non specific, Acute myocarditis is a rare presentation with fatal prognosis. CRP is valuable for early detection of klebsiella pneumoniae infection. Thrombocytopenia is very common The mortality rate was relatively high and all deaths were male, due to ESBL producing K.pnemoniae strains which was similar to many studies in other countries.

MANAGEMENT OF CENTRAL VENOUS ACCESS IN UKRAINE. SURVEY RESULTS AND REVIEW OF CURRENT GUIDELINES

Central vein catheterization is one of the most frequently performed invasive interventions in intensive care patients. There are many recommendations to minimize the risks of a vein puncture and avoid various complications during the operation of a central venous catheter. These recommendations are adjusted when new evidence of the effectiveness or harm of certain approaches appears. Comparing current activities with current evidence-based guidelines is the way to improve the practice of central venous access management.Objective. Evaluate clinical practice of central venous access in intensive care unit for adults, children and newborns in order to identify specific disadvantage, and based on the results and taking into account international recommendations to propose steps to improve management of central venous catheters.Methods. Free anonymous online survey of anesthesiologists and pediatric anesthesiologists about their practice of management central venous access.Results. We conducted a survey in which 766 intensive care physicians took part. When working with both adults and children, the majority prefers catheterization of the subclavian vein (69,9% and 69,8%, respectively). In neonatal intensive care units, 57,3% of doctors perform umbilical vein catheterization and 50,6% - central vein catheterization from peripheral access. 44,6% of the respondents do not have a central venous access protocol, 54,7% are guided by local, national or international recommendations. 28,2% of doctors use ultrasound navigation to provide central venous access, 54,6% – do not have the opportunity to use ultrasound. After catheterization of the central vein, control of the position of the catheter tip is always performed by 29,9%, 14,4% of respondents never control, 38% – sometimes, when they are in doubt, 9,9% – when it is possible, and 7,8% of respondents have no opportunity to control. For skin preparation before catheterization of the central vein, the majority, 45,6% use iodine-containing solutions and alcohol, 38,1% - only alcohol, 15,8% - a solution with chlorhexidine and alcohol. In the absence of blood sampling from the catheter, or its thrombosis, 34,8% remove the catheter and provide catheterization from another access, 14,7% change the catheter using a guidwire, and 47,9% try to restore patency using a guidewire or rinsing the catheter with a solution of 0,9% NaCl or heparin. The majority of respondents, 88,9%, do not use in their practice special solutions for the prevention of catheter-associated sepsis. With long-term use of the catheter for the prevention of thrombotic occlusion, the majority, 56,4%, use in their practice the routine administration of heparin, 36,7% consider this tactic ineffective. The majority, 55%, believe that the local use of antimicrobial agents at the site of the catheter entry into the skin contributes to the development of fungal infection and resistance to antimicrobial drugs, 19,9% of respondents use such tactics for the prevention of catheter-associated infection, 21,3% – sometimes use. To cover the catheter entry site into the skin, 42,9% use transparent stickers with or without chlorhexidine, 40,9% use the material that is available, 10,4% use ordinary adhesive plaster. 13,6% of the respondents use checklists when working with a central venous catheter, while 63,6% do not use it, but consider this tactic expedient.Conclusions. The survey results found heterogeneity in management of central venous access in patients of different age groups. Most of the answers that correspond to the current standards of central venous access management have been received from neonatal intensive care units’ doctors. Uncorrected management ofcentral venous access in some approaches is due to poor logistic of intensive care units. The practice of central venous access management should be standardized according current evidence-based guidelines.

Prevalencia de Hipertensión Arterial en una unidad de cuidados intensivos neonatales

La prevalencia de hipertensión arterial neonatal en las unidades de cuidados intensivos neonatales (UCIN) varía entre el 3 y el 9%, sin embargo, no existe información actualizada de Latinoamérica.Objetivo: Estimar la prevalencia de hipertensión arterial y evaluar su asociación con causas previamente relacionadas con esta condición.Pacientes y Método: Estudio transversal que incluyó a todos los niños internados en una UCIN durante un año, excluidos aquellos trasladados a cirugía cardiovascular. Se registraron variables maternas y neonatales, hipertensión arterial materna, vía de parto, edad gestacional, edad, sexo, peso de nacimiento, Apgar, antecedente de maduración pulmonar con corticoides y cateterismo de vasos umbilicales. Se consignó motivo de ingreso a UCIN, medicamentos y complicaciones durante la hospitalización. La tensión arterial se registró con oscilómetro automatizado considerando hipertensión arterial según tablas para edad gestacional. La prevalencia se expresó como porcentaje (intervalo de confianza 95%, IC95%). La estadística descriptiva se presenta como mediana (rango) o frecuencia de presentación (porcentajes) y se buscó asociación con el Test de Wilcoxon, Chi2 o Fisher según correspondiera (p &lt; 0,05).Resultados: Se reclutaron 169 pacientes (60% sexo masculino). Edad gestacional: 38 semanas (rango 26-42), 38% prematuros. Peso 3.000 g (rango 545-4.950), 32% bajo peso. Ocho pacientes presentaron hipertensión arterial (prevalencia 4,7%, IC95% 2,4-9). La presencia de hipertensión arterial se asoció con prematurez (p = 0,0003), bajo peso (p = 0,01), maduración pulmonar con corticoides (p = 0,002), cateterismo umbilical (p = 0,03), uso de ≥ 2 drogas nefrotóxicas (p = 0,02), tratamiento con cafeína (p = 0,0001), injuria renal aguda (p = 0,02) e hipertensión intracraneal (p = 0,04). Solo un paciente requirió medicación antihipertensiva y en todos los casos se normalizó durante el seguimiento.Conclusión: La prevalencia de hipertensión arterial neonatal fue de 4,7% y en todos los casos se presentó en niños prematuros con factores previamente reconocidos como asociados a esta condición.

Prevalence of Arterial Hypertension in a neonatal intensive care unit

The prevalence of neonatal hypertension in neonatal intensive care units (NICU) ranges between 3 and 9%. However, there is no current data on Latin America. To estimate the prevalence of neonatal hypertension and to assess its association with causes previously related to this condi tion. cross-sectional study. All patients admitted to the NICU during one year were included, excluding those transferred to the cardiovascular NICU. The following maternal and neonatal variables were registered: maternal arterial hypertension, type of delivery, gestational age, age, sex, birth weight, Apgar score, history of pulmonary maturation with corticosteroids, and umbilical vessel catheterization as well as the reason for admission to the NICU, medications, and complications during hospitalization. Blood pressure was measured with an automated oscillometric device, defining neonatal hypertension according to standards in gestational age. Prevalence was ex pressed as percentage (confidence interval 95%, CI95%). Descriptive data were reported as median (range) and frequency of presentation (percentage). Finally, we used the Wilcoxon, Chi2 o Fisher exact test to identify factors related to NH as applicable (p < 0.05). 169 patients were in cluded (60% males). Gestational age was 38 weeks (range 26-42 weeks), 38% were preterm. Birth weight was 3000 g (range 545-4950 g) and 32% presented low birth weight. Eight patients presented hypertension during hospitalization (4.7% prevalence, CI95% 2.4-9). The presence of hypertension was associated with prematurity (p = 0.0003), low birth weight (p = 0.01), prenatal corticosteroid treatment (p = 0.002), umbilical catheterization (p = 0.03), administration of ὅ 2 nephrotoxic drugs (p = 0.02), caffeine treatment (p = 0.0001), acute kidney injury (p = 0.02), and intracranial hyper tension (p = 0.04). Only one patient required antihypertensive pharmacologic treatment and in all cases, hypertension was resolved during follow-up. Prevalence of neonatal hypertension in our NICU was 4.7% and in all cases occurred in preterm newborns with previously recognized factors associated with this condition.

Clinical-epidemiological characterization of neonatal necrotizing enterocolitis of seven public hospitals

Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. To describe the clinical/epidemiological behavior of newborns who underwent NEC. Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

50 Years Ago in TheJournalofPediatrics: Umbilical Catheters—Then and Now

50 Years Ago in TheJournalofPediatrics: Umbilical Catheters—Then and Now