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Biomedical subjects

J Pérez Rodríguez

Publications and source records attributed to J Pérez Rodríguez.

At least 19 recordsLinked to original sources
PubMed2006

[Recommendations for inhaled nitric oxide treatment in the newborn].

The recommendations in this document describe the current indications for inhaled nitric oxide (iNO) treatment in the newborn and clearly distinguish between those supported by scientific evidence and those for which evidence is still lacking, such as its use in preterm infants. The methodology for iNO administration, its dosage and the main secondary effects are discussed, and the reasons for lack of response to this treatment are analyzed.

Administration, Inhalation↗
PubMed2005

[Morbidity at 2 years in infants with a birth weight of < 1,500 g].

OBJECTIVES: To determine morbidity at 2 years' corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. PATIENTS AND METHODS: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87%) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. RESULTS: Among the patients initially included in the study, 87% completed the follow-up; 17.1% had one or more major sequela. We found one case (0.4%) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9% had a development quotient below 85 and 18% had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of 2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. CONCLUSIONS: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years' corrected age.

Cohort Studies↗
PubMed2004

[Rectosigmoidectomy and end to end coloanal anastomosis with mechanical stapler for treatement of Hirschsprung disease].

UNLABELLED: The experience of the Pediatric Surgical Service of the Materno Infantil University Hospital from Málaga on surgical treatment of the Hirschsprung disease by means of a modified technique of Swenson and Rehbein operations is presented. MATERIAL AND METHODS: Between 1992 and 2001 25 patients were operated of a rectosigmoidectomy. Of them, 23 were diagnosed of Hirschsprung's disease, one suffered a rectal angiodisplasia and the other one presented with a rectal stenosis secondary to a previous rectosigmoidectomy. In all of them a transabdominal rectosigmoidectomy with coloanal end to end anastomosis by means of a circular intraluminal stapler was performed. In 10 of them (group A), a modified Rehbein operation with intraabdominal anastomosis was performed. In the remaining 15 patients (group B), a modified Swenson operation with exteriorization of the aganglionic colon through the anus and extrabdominal anastomosis was performed. RESULTS: The postoperative course was evaluated by measuring the postoperative fasting time and the first spontaneous deposition. The medium hospital stay was of 9 days, nevertheless in 16 patients (64%) was lower than 7 days. The postoperative complications are presented. It consists in 1 anastomotic leakage (4%), postoperative enterocolitis 1 case (4%) and transient anastomotic stenosis in 4 patients (16%). All of them were treated with conservative treatment except one case of stenosis which needed a sphincterotomy. CONCLUSIONS: The rectosigmoidectomy and coloanal end to end anastomosis with endoluminal stapler is a safe and easy to do technique to treat the Hirschsprung's disease allowing a deep rectal resection which is very difficult to achieve by manual suture. The anastomosis is located in and extraperitoneal position, with a minimum risk of peritoneal involvement in case of anastomotic leakage. The patients presented a fast recovery, a minimum of complications and good functional result.

Anastomosis, Surgical↗
PubMed1999

[High-frequency oscillatory ventilation as salvage strategy in the newborn infant. Spanish multicenter study. I].

OBJECTIVE: The aim of this study was to evaluate the results of high frequency ventilation (HFV) used as a rescue strategy in newborn infants with severe lung disease who either failed conventional mechanical ventilation (CMV) or had an air block. PATIENTS AND METHODS: From April 1995 to June 1998, 241 infants with severe lung disease and managed according to a common protocol of HFV used as a rescue strategy were prospectively evaluated in the nine participating level III Spanish Neonatal Intensive Care Units. The most frequent diagnoses were respiratory distress syndrome (119), meconium aspiration (24), pneumonia (19) and congenital diaphragm hernia (18). RESULTS: Mean +/- SD gestational age and birth weight were 32.0 +/- 5.5 weeks and 1,187 +/- 1,071 g, respectively. All babies were previously manages with CMV for a mean of 59 hours. HFV was started at a mean postnatal age of 82 hrs, with a mean oxygenation index (OI) of 28.3 +/- 15.3 and an a/A DO2 of 0.10 +/- 0.08. Initial mean HFV settings were: mean airway pressure 12.8 +/- 3.4 mbar, frequency 8.3 +/- 1.4 Hz, amplitude 53 +/- 20 percent, tidal volume 2.2 +/- 0.7 ml/kg and FiO2 0.88 +/- 0.2. At two hours of HFV there was a significant increase in the mean PaO2 (from 48 to 80 mmHg), with a concomitant decrease in FiO2 (from 0.88 to 0.79), PaCO2 (from 60 to 46 mmHg) and OI (from 28 to 18). Mean a/A DO2 increased from 0.10 to 0.19; these changes remained similar thereafter. HFV was suspended after a mean of 95 hrs because of improvement in 70%, death in 19% and failure to improve the clinical condition in the remaining 19%. Intrahospital death rate was 32%. The following complications were observed: pneumothorax (10%), interstitial emphysema (4%), intraventricular hemorrhage grades III and IV (14.5%) and bronchopulmonary dysplasia (35%). CONCLUSIONS: HFV is an effective rescue strategy that improves pulmonary gas exchange within two hours of its initiation.

Female↗
PubMed1996

[Oxygen transport and consumption and oxygen saturation in the right atrium in an experimental model of neonatal septic shock].

UNLABELLED: Mixed venous oxygen saturation monitoring is useful to know about the balance of oxygen supply and consumption in patient with shock as well as a form of assessing the effects of different therapeutic maneuvers. Because of newborn peculiarities this measurement is difficult and therefore, the monitoring of the shock state is limited. OBJECTIVES: To investigate the validity of central venous oxygen saturation at right atria as a reflection of mixed venous oxygen saturation in an experimental model of neonatal sepsis. METHODS: In six newborn piglets septic shock was induced by 180 minutes continuous infusion of Group B Streptococcus. Blood samples were obtained from aortic and pulmonary arteries and from right atrium at baseline and at 30-minutes intervals after the bacterial infusion was begun. Changes in arterial pressures, vascular resistances, cardiac index, oxygen delivery and consumption and the oxygen extraction index were also analyzed. RESULTS: Group B Streptococcus infusion induced significant decreases versus baseline situation of both, oxygen delivery and oxygen tissular extraction index, without changes in oxygen consumption, at 30 minutes of bacterial infusion, with a significant correlation between mixed venous and central venous oxygen saturations. Mixed venous oxygen saturation significantly correlates with right atrium oxygen saturation, r2 = 0,88, along all the period of study. CONCLUSIONS: Mixed venous oxygen saturation is a useful measurement of the oxygen delivery and consumption state in the critically ill newborn infant, and central venous oxygen saturation at the right atrium can be a sure, efficient and easy alternative for the neonatal patient.

Animals↗
PubMed1995

[Adenosine triphosphate (ATP) in the management of paroxysmal supraventricular tachycardia: experience in the neonatal period].

INTRODUCTION AND OBJECTIVE: The management of supraventricular tachycardia (SVT) in infants is somewhat controversial since numerous methods of treatment are effective. Regardless of the treatment chosen, it is important to quickly stop the tachycardia in neonates with SVT because they may suddenly become hemodynamically unstable. METHODS: Seventeen episodes of SVT treated with intravenous ATP are studied in 3 newborns (two were preterm infants: 30 and 34 weeks of pregnancy). Ages at presentation ranged from 2 to 27 days. RESULTS: ATP is effective in all episodes of SVT, with a mean intravenous doses between 0.10 and 0.50 mg/kg/dose. All patients showed short sinus arrest after ATP. No adverse side effects or hemodynamics changes occurred after ATP administration. CONCLUSIONS: ATP is a safe and reliable antiarrhythmic in neonatal period, including prematurity. We reviewed the experience in ATP management of SVT, mainly in pediatric population.

Adenosine↗
PubMed1993

[Balloon (Rashkind) atrio-septostomy in transposition of great vessels in the neonatal period].

Analysis of the balloon atrial septostomy (BA) for treatment of the transposition of the great arteries (TVG) during the neonatal period will allow the evaluation of some of the changes that have occurred in the diagnosis and therapy of this congenital cardiopathy. We performed a retrospective survey of the management, evolution complications of 24 BA as a palliative technique in TGV cases, admitted to the Neonatal Intensive Care Unit during a 5 1/2 year period. The aim of the study was to evaluate the factors that indicated a bad prognosis by comparing patients that are still alive (21) with those that are dead (3). The mean age at BA performance was 4.5 +/- 5.5 days. The biological constants prior to catheterization were normal, maintaining good oxygenation, administering prostaglandins in 80% of the patients and mechanical ventilation in 25% of the patients. BA outcome was considered as good in 68%, moderate in 12% and bad in 20% of the cases. Intra-catheterization complications, mainly hemorrhages and bradycardia, were suffered by 40% of the patients and one patient died during catheterization. We could see a progressive arterial desaturation due to the lack of efficacy of the BA. As bad post-catheterization outcome factors were found: hypotension, arrhythmia, hemorrhage, greater need of dobutamine, volume expansion and mechanical ventilation. Our principal conclusion is that, although BA has improved the prognosis of newborns with TGV, because of the progressive worsening of the patients during the months following the BA, it is necessary to perform early corrective surgery.

Catheterization↗
PubMed1993

[Perioperative management of systemic pulmonary shunts in the neonatal period].

We have analyzed 36 newborns (19 males and 17 females), with cyanotic cardiopathies in whom a systemic-pulmonary shunt had been performed. These patients were admitted to the Neonatal Intensive Care Unite between January 1985 and June 1990. We studied the perioperative events with the aim of describing the general features of this palliative surgery in the neonatal period and to determine the factors which indicate a bad prognosis. The age at admission was 10.5 +/- 16.5 days and at surgery was 19.5 +/- 20 days. Cardiopathy types included: 13 pulmonary atresias, 9 pulmonary stenoses, 6 D-transposition of the great arteries and 8 tetralogies of Fallot. Of these patients, 83% required prostaglandin administration before surgery. Cardiac catheterization was performed in 54% (in 1/3 balloon atrioseptostomy was performed). The mean diameter of the pulmonary branches was 3.5 +/- 0.7 mm. In 89%, a modified Blalock-Taussig shunt and in 11% a central aorto-pulmonary shunt were performed. The size of the prosthetic graft used was 4 mm in diameter in 77% of the cases, 5 mm in 20% and 3 mm in 3% of the patients. The mortality rate was 27% (intraoperative = 0%, early postoperative = 16%, late postoperative = 11%) with two critical periods: the initial 48 postoperative hours and the reoperation. Bad prognosis factors related to mortality are; preoperative (shorter gestational age and low newborn weight), operative (performance of a central aortopulmonary shunt, surgical ligation of the ductus during operation) and postoperative (arrhythmias, metabolic acidosis in the immediate postoperative period, lower oxygen saturation at 24 hours after the operation, hemorrhage). Our data are compared with other reports of systemic-pulmonary shunt in the neonatal period.

Aorta, Thoracic↗
PubMed1992

[Congenital and post-operative chylothorax in the neonatal period].

In a retrospective survey of the patients admitted to the Neonatology Department during a 15 year period (october 1975-september 1990), we found 7 cases of chylothorax: 4 subsequent to cardiac surgery and 3 congenital. The incidence of chylothorax relative to the total number of admissions to NICU was 1.06% and 1.2% in respect to total admissions after cardiac surgery. The clinical outcome was good for all patients except one who died during resuscitation maneuvers following delivery. Only one patient required surgery to control chylothorax and the rest were successfully managed with medical treatment. We found that patients with postsurgical chylothorax drained a larger volume of pleural fluid, needed larger volumes of replacement fluid and required parental nutrition and mechanical ventilation for a longer period of time.

Cardiac Surgical Procedures↗
PubMed1992

[The perioperative management of aortic coarctation in the neonatal period].

Clinical records of 30 neonates with aortic coarctation admitted to neonate ICU from January 1985 to June 1990 are reviewed. We analyzed perioperative data to search for adverse prognostic signs. Patients weights were 2,970 +/- 500 grams and gestational age 38.5 +/- 1.7 weeks. Mean age at admission was 10.5 +/- 10 and mean age of surgery 13 +/- 11 days. 70% had associated congenital heart defects. Surgical technique was patch angioplasty in 86% and subclavian flap in 14%. Early or late mortality among patients with isolated aortic coarctation was nonexistent, and it was 28.5% in patients with other congenital heart defects. 13% has postoperative hypertension and 3.3% recoarctation. Adverse prognosis signs were preoperative (associated congenital heart defects, especially ventricular septal defect and interrupted aortic arch, greater dose of catecholamines and mechanical ventilation), intraoperative (pulmonary artery banding), and postoperative (hypotension, cardiac failure, arrhythmia, oligoanuria, metabolic acidosis, greater need of mechanical ventilation, bleeding and thrombopenia). Date are compared with other neonatal series.

Aortic Coarctation↗
PubMed1990

[Staphylococcus coagulase negative infection in neonates caused by intravascular catheters. Prospective study].

We present a prospective study about 100 intravascular catheters inserted into 88 newborns. 35 positive blood cultures were obtained; 19 with clinical signs of sepsis and 16 in asymptomatic newborns. Coagulase-negative Staphylococci were the most common isolated organisms -84.2% in the symptomatic cases, 100% in the asymptomatic ones. A comparative study was realized between cases of catheter-related sepsis with positive blood culture of coagulase-negative Staphylococcus (n = 14) versus asymptomatic cases with positive blood culture (n = 16). Risk factors in the appearance of symptoms are: prematurity, newborns old age when catheters are inserted and days of catheter placement.

Bacterial Infections↗
PubMed1988

[Dopamine in hypotensive neonates. Study of 31 cases].

We have studied retrospectively the effects of dopamine in 31 hypotensive newborn infants four hours to twenty days of age, which did not improve with conventional therapy. Hypotension aetiology was in 23 septic, cardiogenic and hypovolemic shock, in 6 hemodynamic instability in patients with hyalin membrane disease (HMD), and in two patients after tolazoline treatment in neonatal persistent pulmonary hypertension. Arterial blood pressure significantly increased when doses 5 to 10 mg/kg/min dopamine were used. Diuresis significantly increased comparing 8 hours before and after dopamine infusion. Dopamine was considered to be clinically effective in similar rates in septic (47.6%) and cardiogenic shock (40%), in all cases of hypovolemic shock (after volume infusion) and in hypotension produced by tolazoline; in hypotensive newborn infants with HMD was effective in 83.3%. Tachycardia was present in five infants with high dose (17.4 +/- 8.4 mcg/kg/min.), it returned to normal value when dopamine was decreased or discontinued. Dopamine efficacy and its lack of severe secondary effects justifies its use in neonatal hypotension.

Dopamine↗