Actualització de la cartera de serveis i dels criteris de planificació per a l’atenció als nounats: recomanacions generals i detall per als nounats complexos

Nounats; Planificació; Cartera de serveis; Centres hospitalaris; SISCATRecién nacidos; Planificación; Cartera de servicios; Centros hospitalarios; SISCATNewborns; Planning; Portfolio of services; Hospital centers; SISCATEl CatSalut proposa com a objectiu principal actualitzar els criteris operatius de planificació i cartera de serveis establerts en relació amb l’atenció dels nounats als centres hospitalaris del SISCAT de Catalunya prenent com a referència principal el Pla estratègic d'ordenació de l’atenció maternoinfantil de l’any 2008. Per tal d’aconseguir aquest propòsit, es defineixen els objectius específics següents: Actualitzar els nivells d’atenció neonatal i la prestació de serveis associada a cada nivell. Actualitzar els indicadors i criteris d’activitat associat a cada nivell. Valorar els criteris d’organització i recursos en relació amb les cures intensives i intermèdies

Perfil neurocognitivo y conductual del trastorno del espectro alcohólico fetal

La exposición prenatal al alcohol es la principal causa prevenible del déficit cognitivo en los países desarrollados y puede dar lugar al trastorno del espectro alcohólico fetal (TEAF). Este término engloba una gran variedad de efectos físicos, mentales, conductuales y cognitivos que derivan del daño causado por la exposición al alcohol durante la vida intrauterina. El consumo de esta sustancia entre la población general es frecuente en los países de la Europa del Este y, especialmente, entre las mujeres en riesgo de exclusión social, que son las mayores afectadas en procesos de pérdida o renuncia de custodia de sus hijos. Un elevado número de estos niños son adoptados en España y muchos de ellos presentan alteraciones neurocognitivas y conductuales, convirtiendo el TEAF en un problema de salud pública en nuestro país. En muchas ocasiones, este cuadro clínico está infradiagnosticado debido a la superposición de los síntomas neuropsicológicos causados por el abandono y la falta de apego. Hasta el momento, no se ha descrito un perfil neurocognitivo y conductual específico del TEAF y muchos de los síntomas son comunes a otras etiologías. El objetivo de este trabajo es revisar el perfil neuropsicológico en el diagnóstico de TEAF

Distinguishing outcomes of neonatal intestinal volvulus: review of our experience over the last 20 years

Aim: There are two types of intestinal volvulus: midgut (MGV) and segmental (SV). Patients with different types of intestinal volvulus are often included in the same case series, which may affect the perception of how severe "intestinal volvuli" are. We aimed to compare both types of intestinal volvulus. Methods: This is a retrospective observational study including all patients with MGV and SV up to 28 days of life admitted to a tertiary hospital in Spain over a 20-year-period (1999-2019). A comparison between groups and a logistic regression model for mortality were done. Results: We identified 32 patients: 23 MGV and 9 SV. Malrotation was exclusive of MGV. Prenatal diagnosis, cystic fibrosis, and intestinal resection were significantly more frequent in SV. Surgery was performed at a significantly lower age in SV. The mortality observed in acute MGV with intestinal compromise (41.7%) is four times higher than the mortality of SV (11.1%). The overall mortality of all MGV patients (21.7%) is almost twice that of SV. Mortality was best predicted by the presence of hemodynamic instability (OR 27.5 95% CI 2.50-302.17; p = 0.007). Conclusion: SV and MGV have a different clinical presentation. Hemodynamic instability is the major risk factor for death

Analgesic effect of inhaled lavender essential oil for frenotomy in healthy neonates: a randomized clinical trial

Background: Neonatal pain may affect long-term neurodevelopment and must be treated. Frenotomy is a painful procedure wherein a common strategy to relieve pain (sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic properties and has been successfully used to treat pain during heel puncture and vaccination. Our aim was to demonstrate if the use of inhaled LEO is effective in reducing pain during frenotomy in healthy, full-term neonates. Methods: We conducted a randomized clinical trial in neonates who underwent a frenotomy between August 2020 and April 2021. We assessed pain using pre and post-procedure heart rate and oxygen saturation, crying time and Neonatal Infant Pain Scale (NIPS) score. Patients with type 3 tongue tie were randomized into the "experimental group" and "control group". In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for two minutes. In the experimental group, we also placed a gauze pad with one drop of LEO under the neonate's nose for two minutes prior to and during the frenotomy. Results: We enrolled 142 patients (71 per group). The experimental group showed significantly lower NIPS scores (1.88 vs 2.92) and cried almost half the amount of time (14.8 vs. 24.6 seconds, P = 0.006). Comparing with the control group, we observed no side effects in either of the groups. Conclusions: We observed a significant decrease in crying time and lower NIPS scores in the neonates who received inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we recommend using inhaled LEO during neonatal frenotomies

Comparison of the analgesic effect of inhaled lavender vs vanilla essential oil for neonatal frenotomy: a randomized clinical trial (NCT04867824)

It is necessary to treat neonatal pain because it may have short- and long-term adverse effects. Frenotomy is a painful procedure where sucking, a common strategy to relieve pain, cannot be used because the technique is performed on the tongue. In a previous randomized clinical trial, we demonstrated that inhaled lavender essential oil (LEO) reduced the signs of pain during neonatal frenotomy. We aimed to find out whether inhaled vanilla essential oil (VEO) is more effective in reducing pain during frenotomy than LEO. Randomized clinical trial with neonates who underwent a frenotomy for type 3 tongue-ties between May and October 2021. Pain was assessed using pre and post-procedure heart rate (HR) and oxygen saturation (SatO2), crying time, and NIPS score. Neonates were randomized into "experimental" and "control" group. In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for 2 min. We placed a gauze pad with one drop of LEO (control group) or of VEO (experimental group) under the neonate's nose for 2 min prior to and during the frenotomy. We enrolled 142 neonates (71 per group). Both groups showed similar NIPS scores (2.02 vs 2.38) and crying times (15.3 vs 18.7 s). We observed no differences in HR increase or in SatO2 decrease between both groups. We observed no side effects in either of the groups. Conclusions: we observed no appreciable difference between LEO and VEO; therefore, we cannot conclude which of them was more effective in treating pain in neonates who underwent a frenotomy

Neonatal immune neutropenia due to isoantibodies against the granulocyte receptor FcγRIIIb

Introduction: neonatal neutropenia is often secondary to sepsis, low birth weight, pregnancy-induced maternal hypertension, and other conditions. Case report: we report a case of asymptomatic isoimmune neutropenia in a pair of preterm twins. Genotyping confirmed that the mother was negative for HNA-1a, 1b, and 1c, consistent with an FcγRIIIb deficiency. The father was 1(a+b+c-) and the neonates were 1(a-b+c-). A strongly positive result was observed in the granulocyte immunofluorescence test against paternal neutrophils (IgG antibodies). IgG anti-CD16b isoantibodies were detected in the mother's breast milk. Neutropenia resolved after 28 days without requiring any specific treatments. Discussion: even though neonatal alloimmune neutropenia (NAN) is usually benign and self-limiting, some patients pre-sent with delayed separation of the umbilical cord, mild skin infections, omphalitis, or severe infections like pneumonia, sepsis, and meningitis. Thus, it is important to rule out NAN in case of neonatal neutropenia