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Biomedical subjects

A Valls i Soler

Publications and source records attributed to A Valls i Soler.

At least 19 recordsLinked to original sources
PubMed2006

[Medication prescription and transcription errors in a neonatal unit].

BACKGROUND: Medication errors occur because of pitfalls in one or more of the steps involved in the process of drug administration and should be considered as system errors. They should never be considered as human errors with assignment of responsibility. Rather, their causes should be analyzed to prevent repetition. The ultimate aim should be to improve working procedures to avoid these errors. PATIENTS AND METHODS: A total of 122 prescriptions were prospectively analyzed, along with their corresponding transcription to the nursing notes. Their legibility, dose, units, route of administration, and administration interval were evaluated. Units per kilogram of body weight and the use of generic names were also recorded. RESULTS: Prescription errors were detected in 35.2 % of the prescriptions reviewed. The most frequent errors were related to dosing (16.4 %). Analysis of the quality of the prescriptions revealed that 61.5 % of the drugs were prescribed by their generic name, but only 4.1 % specified the dose per kilogram of body weight. Errors were detected in 21.3 % of transcriptions, the most frequent being the absence of the administration route (7.4 %). The generic name was used in 57.4 % of the transcriptions. CONCLUSIONS: In the busy and complex environment of neonatal units, medication errors can be frequent. However, most of these errors are trivial and do not harm patients. Medication errors are indicators of the quality of the healthcare provided. Therefore, their detection and systematic analysis of their causes can contribute to their systematic prevention, thus improving the healthcare delivery process.

Humans↗
PubMed2006

[Do neonates have the same pharmacotherapeutic opportunities as adults?].

INTRODUCTION: The use of drugs in pediatrics, specially in neonates, poses two main problems: the legal conditions for their use in this population and the lack of commercial formulations suitable for pediatric dosing. PATIENTS AND METHODS: We reviewed the drug prescriptions of all patients admitted to our neonatal intensive care unit over 46 days, chosen at random between September and November 2005. RESULTS: A total of 2,558 drug prescriptions were issued, corresponding to 62 different drugs. Overall, 5.2 % of prescriptions were for drugs not authorized for use in pediatric patients. In neonates, this percentage increased to 8.4 %. A total of 22.6 % of the drugs were not authorized for use in neonates. Formulations prepared by the hospital pharmacists were required in 17.2 % of drug prescriptions. CONCLUSIONS: In the last few years, information on drugs in pediatric patients has increased. However, continued efforts are required in this field so that drugs with proven clinical efficacy in pediatric patients become authorized for use in this population. Because of the lack of suitable commercial formulations for use in pediatric patients, preparation of formulations by the hospital pharmacist and the use of drug dilutions at the bedside are mandatory, both of which are a source of possible preparation and administration errors.

Adult↗
PubMed2005

[Postnatal growth up to 2 years of corrected age in a cohort of very low birth weight infants].

OBJECTIVE: To study postnatal somatic growth up to 2 years of corrected postnatal age (CPA) in a cohort of very low birth weight infants (VLBWI) in our unit, according to their intrauterine growth status at birth. PATIENTS AND METHODS: We performed an observational follow-up study of postnatal growth in a cohort of VLBWI (birth weight < 1,500 g) attended from January 1, 1994 to December 31, 1999. Weight, length, and head circumference were assessed at birth and again at 2 years CPA. Infants were classified as small-for-gestational age (SGA) if weight was below 2 standard deviations (SD) of the reference population mean. RESULTS: The cohort consisted of 260 VLBWI (18.5% SGA). Mean gestational age (SD) was 29 (2.7) weeks, weight was 1,150 (223) g, length was 37.4 (2.7) cm, and head circumference was 27 (1.8) cm. At birth Z-scores were -0.82, -0.92 and -0.8 for weight, length and head circumference. The corresponding mean Z scores at 2 years' CPA were -1.44, -1.49 and -0.31. At 2 years' CPA, more SGA infants still had a weight below the 3rd percentile than those with normal birthweight (26% vs. 16%). SGA infants had a higher daily weight increase during their hospital stay (27.5 vs. 21.2 g/day, p > 0.5). Gender did not significantly influence the growth pattern. CONCLUSIONS: Weight showed the lowest postnatal increase, particularly in infants < 1,000 g. Head circumference showed the greatest catch-up growth pattern, almost reaching the mean for the general population by 2 years' CPA. Growth retardation in SGA continued up to 2 years' CPA.

Anthropometry↗
PubMed2004

[Prenatal corticosteroid and early surfactant therapy in infants born at < or = 30 weeks gestation].

BACKGROUND: Prenatal corticosteroid (PNC) exposure and postnatal surfactant therapy improve outcome in very low birth weight infants (VLBWI). However, the efficacy of PNC in the prevention of chronic lung disease is debated. OBJECTIVE: To study the effects of PNC exposure on outcome in VLBWI born at < or = 30 weeks' gestation. PATIENTS AND METHODS: We performed a multicenter, longitudinal study. The Spanish Surfactant Group database (n 5 1,275) was searched and 211 VLBWI born at < or = 30 weeks who received early surfactant therapy (< or = 30 min) were identified. Perinatal events, neonatal management and rates of mortality and complications were evaluated. Data on the subgroup of infants who received PNC (157, 74.4 %) were compared with data on 54 infants who did not receive this therapy. RESULTS: Mean (+/- SD) birth weight and gestational age were 944 (226) g and 27 (1.8) weeks. Surfactant was given at 16 +/- 13 min (61 % < or = 15 min). A total of 124 infants (58.8 %) developed respiratory distress syndrome. No differences were found in birth weight, gestational age, or Apgar score at 1 and 5 min. However the age at first surfactant dose was lower in infants exposed to PNC. PNC-exposed infants required fewer doses of surfactant, were extubated earlier (58.9 vs. 161 h) and needed a lower FiO2 at 48 h (0.28 vs. 0.35). Moreover, neonatal mortality (15.9 vs. 27.8 %), the incidence of intraventricular hemorrhage (25.2 vs. 50 %), ductus arteriosus (40.3 vs. 63.5 %) and necrotizing enterocolitis (9 vs. 19.2 %) were lower in infants receiving PNC. However, the incidence of chronic lung disease was similar in both groups. CONCLUSIONS: PNC exposure of VLBWI born at < or = 30 weeks receiving early surfactant therapy reduced mortality and the incidence of certain complications but did not decrease the incidence of chronic lung disease.

Adrenal Cortex Hormones↗
PubMed2003

[The Europe against immature lung (EURAIL) project. Strategies for the prevention and treatment of lung immaturity in neonates].

OBJECTIVE: To determine clinical practice variability in the prevention and postnatal treatment of lung immaturity in Spain. PATIENTS AND METHODS: Cross-sectional study within a larger study in 13 European countries. Data were obtained from the medical records of all very low birth weight (VLBW) infants born in participating centers, without other instrumentation. RESULTS: A questionnaire was sent to 213 centers. Seventy-two (34 %) responded, with 162,157 births (40 % of total births in 1999). Eight percent of infants were of low birth weight, 1.2 % (2,015) of very low birth weight and 0.45 % were of extremely low birth weight. A total of 52.2 % of VLBW infants received at least one dose of prenatal steroids, 28.8 % received a full course and 9.3 % received more than one cycle. All centres used surfactant and 76.8 % had a written protocol. Forty-one percent of VLBW infants were intubated, 47.6 % required mechanical ventilation for more than 6 hours, and 5 % underwent continuous positive airway pressure. A total of 80.4 % used postnatal steroids, half of them for chronic lung disease prevention, and 83.4 % used steroids to treat this disease. Steroids were most frequently indicated at 7-14 days of life for 3-9 days. The most important causes of neonatal morbidity were chronic lung disease in 14 %, ductus arteriosus in 16.7 %, intraventricular hemorrhage in 8.5 %, and necrotizing enterocolitis in 7.3 %. CONCLUSIONS: Prenatal exposure to steroids was low. Repeat cycles and postnatal steroid use to prevent chronic lung disease was high. Recent scientific evidence on the use of pre- and postnatal steroids should be more widely disseminated.

Betamethasone↗
PubMed2003

[Morbidity and mortality of very-low-birth-weight infants as an indicator of the quality of perinatal care].

OBJECTIVE: To compare the clinical outcomes of a cohort of very low birth weight (VLBW) infants who received healthcare in our unit from 1994-2000 with all the variables included in the Vermont-Oxford Network (VON) database. METHODS: A historical cohort of 417 VLBW live infants born in our center from 1994-2000 was evaluated. The 80 variables of the VON already prospectively included in the unit's database were used and a further 20 variables were added through retrospective review of medical records. The rates of perinatal risk factors, interventions, and causes of morbidity were analyzed and the periods 1994-1997 and 1998-2000 were compared. We also compared these rates with those reported by the VON. RESULTS: Comparison of the results in both periods showed an increase in the percentage of multiple pregnancies and prenatal corticosteroid exposure, as well as in the early use of surfactant and continuous positive pressure. The incidence of intraventricular hemorrhage decreased, but no differences were observed in other outcomes. Our rates of Cesarean sections and multiple births, as well as the use of prenatal steroids, were higher than those of the VON. The outcomes of infants receiving healthcare in our unit were similar to those of the VON but mortality in infants weighing < 800 g was slightly higher, coinciding with higher rates of late sepsis. CONCLUSION: Morbidity rates in VLWB infants receiving care in our unit decreased during the period studied and compared favorably with those reported by the VON. Alltogether, our results indicate that the quality of care in our perinatal center is good. General use of this methodology would permit comparison of outcomes and quality of care across regions and nations, as well as across Europe, in a recently established network (EuroNeoNet.com).

Child Health Services↗
PubMed2001

2nd European symposium on liquid ventilation.

After the successful meeting in Berlin, advances and research results in the understanding of liquid ventilation has been performed. About 80 applied and basic scientists met in the 1st European Symposium, from clinicians (pediatricians, neonatologists, intensivists, etc.) to other basic scientists (physiologists, biologists, bioengineerings, etc.). Furthermore, we also invited representatives of pharmaceutic industry interested in this hot topic. Our main goal is to provide an opportunity for all liquid researchers in this field to meet together and with the top scientists of Liquid Ventilation Research. We planned to provide both a scientific and a friendly atmosphere to enhance the exchange of experiences and to facilitate future plans. We hope this 2nd European Symposium will be a continuation point for collaboration of groups in Europe, to study all research aspects of the technique to carry on future trials. There are still a lot of unanswered questions to be solved. Among the unsolved issues and practical questions we would like to point out the following items: 1. Perfluorocarbon: which product to use and how to deliver it. 2. Perfluorocarbon interactions in the lung. 3. Perfluorocarbon. Toxicity and cytoprotection. 4. Partial Liquid Ventilation: ventilatory strategies from delivering to weaning. 5. Impact of Partial Liquid Ventilation Experimental and clinical aspects. 6. General discussion and plan for the future. We know that none of these questions can be completely answered now, but hope collaboration and communication will bring us closer to achieve these goals. Moreover, concerted actions should be started to search for research grant founding. For all those reasons we would like to thank all active and passive participants, who came to Bilbao to present, discuss and foster future work in Liquid Ventilation.

Acute Disease↗
PubMed2000

Prenatal dexamethasone rescues heart hypoplasia in fetal rats with congenital diaphragmatic hernia.

BACKGROUND/PURPOSE: Patients and rats with congenital diaphragmatic hernia (CDH) have lung and heart hypoplasia. Prenatal steroids improve lung hypoplasia in CDH rats. The current study tests the hypothesis that prenatal dexamethasone could rescue heart hypoplasia in rats with CDH. METHODS: Timed pregnant rats received intragastrically either 100 mg nitrofen or oil on day 9.5, and other animals had the same treatment with, in addition, either 0.25 mg/kg dexamethasone intraperitoneally or no treatment on days 19 and 20. Fetuses were recovered on day 21, and heart weight to body weight ratios, heart DNA, protein, and glycogen were measured in fresh specimens. Left-to-right ventricular diameter and aortic-to-pulmonary diameter ratios were measured after formalin fixation. RESULTS: Wet heart weight to body weight, left-to-right ventricular diameter, and aortic-to-pulmonary root diameter ratios, which were lower in fetuses exposed only to nitrofen than in their oil controls, were similar in those exposed to nitrofen plus dexamethasone than in their corresponding oil plus dexamethasone controls. Total heart DNA, which was decreased in fetuses exposed to nitrofen with CDH in comparison with their controls, was increased in those receiving nitrofen and dexamethasone in comparison with theirs. Protein to DNA ratio was decreased in all rats with CDH irrespective of their exposure or not to dexamethasone. Glycogen to DNA ratio was higher in all dexamethasone-treated fetuses than in those without this treatment. No gross histologic differences were seen among groups. CONCLUSIONS: Heart hypoplasia in rats with CDH is in part rescued by prenatal dexamethasone treatment as expressed by increased number of smaller myocytes with higher glycogen content. Prenatal steroids could modify heart involvement in human fetuses with CDH as well.

Animals↗
PubMed1998

Transient response to inhaled nitric oxide in meconium aspiration in newborn lambs.

To compare the effects of the sustained exposure to inhaled nitric oxide (NO) on pulmonary gas exchange, cardiovascular function and lung mechanics in newborn lambs with pulmonary hypertension induced by tracheal instillation of meconium. Fifteen newborn lambs (<6 d old) were studied in three groups (n = 5): control, and pulmonary hypertension (5 mL x kg[-1] of a 20% meconium solution) with or without inhaled NO (20 ppm) exposure. Heart rate, systemic and pulmonary arterial pressures, arterial pH and blood gases, cardiac output, and pulmonary mechanics were measured. The exposure to inhaled NO in lambs with pulmonary hypertension, induced by experimental meconium aspiration, produced a transient response. There were a transient improvement in gas exchange, a decrease in pulmonary arterial pressure and airway resistance, without changes in cardiovascular profile. The transient and incomplete response to inhaled NO in experimental MAS might be related to the fact that hypoxemia is not only due to pulmonary vasoconstriction but also to parenchymal lung disease. We hypothesize that this poor and transient response could probably be avoided if strategies that increase lung recruitment, were applied before inhaled NO exposure.

Administration, Inhalation↗
PubMed1997

[Extracorporeal membrane oxygenation (ECMO). I. Is it really needed in Spain?].

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a cardiorespiratory support technique used to treat newborns with severe respiratory insufficiency. ECMO has not been used yet in newborns in Spain, with its necessity being question. The aim of this study was to evaluate the need for ECMO for respiratory or cardiac cases in our neonatal population, as well as to study the predictive capacity of several respiratory indices. PATIENTS AND METHODS: A retrospective observational study was carried out. Data from 2,133 newborns admitted during a 48 month period was reviewed. Babies were considered ECMO candidates if they died of respiratory failure or after surgery for a cardiac defect and if they had no ECMO exclusion criteria. The capacity of several respiratory indices to predict mortality was analyzed. RESULTS: We considered 16 babies who died to be ECMO candidates, 6 with respiratory failure (1/3,028 live births) and 10 with cardiac defects 3 of them inborn (1/6,057). The total ECMO need was 1/2019 live births. None of the oxygenation indices studied accurately predicted the 80% mortality rate. CONCLUSIONS: In Spain, it is necessary to start several neonatal ECMO programs since some 200 newborn infants with severe respiratory failure or cardiac defects could benefit from such a program annually.

Extracorporeal Membrane Oxygenation↗
PubMed1997

[Extracorporeal membrane oxygenation (ECMO). II. The development of an experimental model in newborn lambs].

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a technique used for cardiorespiratory support in the treatment of newborns with severe respiratory insufficiency. ECMO has not been used yet in newborns in Spain. The aim of this work was to develop an experimental veno-arterial ECMO model in newborn lambs for training the NICU medical and nursing staff before the clinical application of this technique. MATERIAL AND METHODS: Six newborn lambs were anesthetized, traqueotomized and connected to a neonatal ventilator. The right jugular vein and left carotid artery were cannulated and the catheters were located in the right atrium and aortic arch, respectively. A venous-arterial ECMO was performed during three hours, with an experimental ECMO circuit developed by us. Arterial pH and blood gases, systemic and airway pressures, heart rate, and rectal temperature were monitored. RESULTS: The experimental ECMO circuit developed by use had a very low cost, but was capable of maintaining adequate gas exchange, acid-base balance and a normal rectal temperature. CONCLUSIONS: The development of an experimental ECMO model in newborn lambs may allow the establishment of an initial training program and to maintain the expertise of the NICU staff of a perinatal center planning to start an ECMO program.

Animals↗
PubMed1996

[Continuous hemofiltration. Development of an experimental model].

OBJECTIVE: Continuous hemofiltration is an extracorporeal technique used to eliminate water and solutes by convective transport through a hemofilter. The aim of this study was to develop an experimental model of arterio-venous and veno-venous continuous hemofiltration in order to gain experience before its clinical application in human neonates. MATERIALS AND METHODS: Twelve white New Zealand adult rabbits were anesthetized, tracheotomized and connected to a continuous flow neonatal ventilator. Continuous arterio-venous hemofiltration (n = 6) was performed via catheters placed in the carotid artery and jugular vein and veno-venous hemofiltration (n = 6) by a double-lumen catheter located in the inferior vena cava. Heart rate, arterial pressure, pH and blood gases, and the volume of ultra-filtrate were monitored and recorded for a three hour period. RESULTS: In both groups a high rate of ultrafiltration was achieved. The volume of ultrafiltration decreased somewhat during the second hour and remained stable thereafter. No hemodynamic changes were detected. CONCLUSIONS: The development of an experimental model for continuous arterio-venous and veno-venous hemofiltration in rabbits, facilitated the implantation of these techniques in human neonates. The model may be used to train the staff of the Neonatal Intensive Care Unit and to eliminate difficulties with vascular access and the care of extracorporeal lines.

Acute Disease↗
PubMed1992

[Pulmonary surfactant in experimental congenital diaphragmatic hernia].

This paper examines the amounts of tensoactive phospholipids in the lung tissue of rat fetuses treated with Nitrofen (TOK) and in control animals. The herbicide led to congenital diaphragmatic hernia (CDH) in some fetuses and to pulmonary hypoplasia (PH) in all. The amounts of phosphatidylcholine (PC), phosphatidylglycerol (PG), phosphatidylinositol (PI) and phosphatidylethanolamine (PE) per gram of fresh lung tissue were significantly increased in comparison with the control animals, those of phosphatidylserine (PS) and sphingomyelin (SM) were also increased, but not significantly. Fetuses with HP alone had intermediate values. These findings are in agreement with our previous demonstration of an excess of type II pneumocytes in this model, and point to the existence of some trouble of the secretion or release of surfactant in it; although they do no clarify whether the amount of alveolar surfactant is in fact decreased.

Animals↗
PubMed1992

[Pulmonary mechanism in preterm neonates without respiratory problems].

Pulmonary function was measured by computerized pneumotacography in 26 preterm-newborn infants without respiratory problems. Mean (+/- SD) for birth weight, gestation and postnatal age were 2,034 +/- 412 g, 34.1 +/- 1.7 weeks, and 2.2 +/- 1.6 days, respectively. An esophageal balloon, a differential transducer and nasal prongs were used to measure pressure and flow. The following parameters were measured in each respiration by the mean squares method: Dynamic compliance (Cdyn), total respiratory resistance (RRt) and work (WRt), respiratory time constant (KTt), rate (f) and maximal inspiratory and expiratory flows (PIF, PEF). Replication of the method was found to be good, as the differences between two determinations were not significant (p less than 0.05). The mean differences were less than 6.26%. The mean (+/- SD) and the 3rd and 97th percentiles for each parameter were the following: f: 52 +/- 7 (39-66) r.p.m., Tv: 6.6 +/- 1.1 (4.5-8.7) ml/kg, Vmin: 342 +/- 82 (128-502) ml/min, Cdin: 3.7 +/- 1.1 (1.5-6) ml/cm, RRt: 83 +/- 47 (37-204) cm/L/sec, TRt: 27 +/- 15 (2-57.1) g/cm/kg, PIF: 2.2 +/- 0.5 (1.1-3.2) L/min and PEF: 1.9 +/- 0.6 (0.7-3) L/min.

Airway Resistance↗
PubMed1992

[Treatment of preterm neonates with severe respiratory distress syndrome using exogenous natural surfactants of porcine origin].

From September 1989 to September 1990, a total of 25 newborn infants with severe RDS (on mechanical ventilation and with a FiO2 above 0.6) were treated with porcine surfactant (Curosurf), since its efficacy has been demonstrated in a prior clinical trial (Pediatrics 1988; 82: 683-91). The mean birth weight and gestational age were 1,327 +/- 566 g and 29.5 +/- 3.8 weeks, respectively. Twenty-four percent of the babies had an arterial pH below 7.1. At a mean postnatal age of 9.1 +/- 10.7 hours, a dose of 200 mg/Kg of Curosurf was given by the tracheal route. Mean paO2 rose from 47 +/- 14 mm Hg to 166 +/- 64 mm Hg (p less than 0.001). The paO2 increased in 24 of the 25 cases and in 20 (80%) the post-treatment paO2 was a least two times higher than the pre-treatment value. An hour after surfactant treatment, the paCO2 decreased from 58 +/- 21 mm Hg to 45 +/- 16 mm Hg (p less than 0.01) and the pH increased from 7.19 +/- 0.15 to 7.28 less than 0.11 (p less than 0.001). The following complications were observed: pulmonary interstitial emphysema (16%), pneumothorax (8%), patent ductus arteriosus (36%), intraventricular hemorrhage (28%) and bronchopulmonary dysplasia (24%). The neonatal survival rate and the survival rate after discharge from the hospital were 76% and 64%, respectively. The combined survival and absence of DBP was 32%. Nonsurvivors had lower birth weights and gestation ages, as well as lower paO2 5 min after treatment and higher FiO2 24 hours after surfactant treatment than did the survivors.

Animals↗
PubMed1990

[Pulmonary function in the full-term newborn infant without respiratory problems].

Pulmonary function was measured by computerized pneumotacography in 13 term newborn infants without respiratory problems. Mean (+/- SD) for birth weight, gestation and postnatal age were 3149 +/- 366 g, 39.1 +/- 0.9 weeks, and 4.7 +/- 2.4 days. Esophageal balloon, differential transducer and nasal progs were used. The following parameters were measured in each respiration by the mean squears method: Dynamic compliance (Cdyn), total respiratory resistance (RRt) and work (WRt), respiratory time constant (KTt), rate (RR) and maximal inspiratory and respiratory flows (PIF, PEF). Reproductiveness was found to be good, as the differences between two determinations were not significant (p less than 0.05). The mean differences but for Cdyn (11.9%) were of less than 5%. The mean (+/- SD) and the 3 and 97 percentiles for each parameter studied were: RR 43.8 +/- 7.6 (32.6-61.2) rpm, Tv 6.6 +/- 0.7 (5.8-7.9) ml/kg, Vmin 285 +/- 55.6 (201-405) ml/min, Cdin/kg 1.64 +/- 0.31 (1.13-2.17) ml/cm/kg, RPt 65.2 +/- 21.6 (28.4 +/- 111.4) cm/L/seg, TRt 30.6 +/- 13.7 (15.3-58.8) g/cm/kg, PIF 2.9 +/- 0.6 (1.8 +/- 4.4) L/min y PEF 2.4 +/- 0.7 (1.2-4) L/min.

Humans↗