Biomedical subjects

M López Maestro

Publications and source records attributed to M López Maestro.

5 recordsLinked to original sources

PubMed2006

[Developmental centered care. Evaluation of Spanish neonatal units].

INTRODUCTION: Developmental and family centered care (DC) is a framework that aims to enhance the neurodevelopment of the infant. Over the last few years Spanish neonatal units have been working toward introducing this type of care. OBJECTIVE: To evaluate DC in Spanish neonatal units by assessing certain features of the care provided to very low birth weight infants and their families. MATERIAL AND METHOD: Spanish hospitals attending infants under 1,500 g were identified. A cross sectional study was performed using a telephone questionnaire with 25 DC-related items. RESULTS: Of the 100 hospitals attending infants under 1,500 g, 83 hospitals from all the Autonomous Communities in Spain participated in the survey. Of these, 31 % had noise pollution controls, 72 % controlled light intensity, 75 % bound the infants, and 29 % used saccharose as an analgesic. Ten percent allowed unrestricted parental visits. Twenty-two percent used kangaroo care without restriction. Sixty-three percent of the units reported difficulties when introducing DC-related changes. CONCLUSIONS: Practically all neonatal units have some type of DC activity, although in certain areas, such as unrestricted parental visits, the rate of implementation is low.

Cross-Sectional Studies↗

PubMed2006

[The use of the continuous positive airway pressure for early stabilization in very low birthweight infants].

BACKGROUND: The introduction of continuous positive airway pressure (CPAP) in neonatal units provides a new strategy in the management of infants weighing less than 1500 g, and especially in those weighing less than 1000 g, allowing a reduction in the use of surfactant without negatively affecting prognosis. OBJECTIVES: To compare the rate of surfactant use in very low birthweight (VLBW) infants before and after the introduction of CPAP for early stabilization. To compare the frequency of pneumothorax, bronchopulmonary dysplasia (BPD), mortality, severe brain injury, length of hospital stay, and days of intubation in both groups of VLBW infants. METHODS: We performed a before-after study comparing VLBW infants born in a tertiary care hospital in two periods: group 1 consisted of 78 VLBW infants born in 2001 and group 2 consisted of 80 VLBW infants born from June 2003 to February 2004. Group 1 received conventional management (intubation and administration of surfactant in the delivery room). In group 2, CPAP was introduced for early stabilization. RESULTS: The mean weight was 1059+/-309 g in group 1 and 1127+/-295 g in group 2 (p = 0.15). The mean gestational age was 29 +/- 3.3 weeks in group 1 and 29 +/- 2.8 weeks in group 2 (p = 1). Fifty-four percent of the neonates in group 1 were intubated in the delivery room versus 31 % of those in group 2 (p = 0.004). Surfactant was used in 68 % of neonates in group 1 versus 49 % of those in group 2 (RR = 1.34 [1.06-1.83]). The mean number of days of intubation was 4 +/- 11 in group 1 versus 2.7 6 5.8 in group 2 (p 5 0.15). Bronchopulmonary dysplasia at a corrected age of 36 weeks occurred in 19 % of neonates in group 1 and in 14.5 % of those in group 2 (RR = 1.34 [0.63-2.84]). The mean number of days on oxygen was 34 6 47 and 21 6 25 respectively (p = 0.04). Necrotizing enterocolitis occurred in 3.8 % of neonates in group 1 and in 8.7 % of those in group 2 (RR= 0.43 [0.11-1.63]). The mortality rate and frequency of pneumothorax were similar in both groups. In the subgroup of VLWB infants with a gestation age of < 28 weeks, no differences were found between the two periods. CONCLUSIONS: The use of CPAP for early stabilization of VLBW infants is not associated with an increase in neonatal morbidity. This therapy allows the use of surfactant to be decreased, and even allows the number of days on oxygen to be reduced, without adverse effects. However, data on long-term follow-up are not yet available.

Continuous Positive Airway Pressure↗

PubMed2003

[Determinants of uremia elevation in the first days of life in premature infants born before 30 weeks of gestation].

OBJECTIVE: To identify the determinants associated with uremia elevation in the first days of life in extremely premature infants. METHODS: We performed a prospective cohort study in a cohort of neonates born at less than 30 weeks of gestation. RESULTS: Forty-eight preterm infants were included, of which 10 died. The mean fluid administration was 55, 72, 88 and 124 mL/kg on the first, second, third and seventh days of life. Amino acid doses were low in the first two days of life and were unrelated to uremia elevation. Thirty-one percent of the infants presented hypernatremia. Uremia was measured in 31 infants between the fifth and tenth days of life and 12 infants (38.7 %) had uremia values of 100 mg/dL or higher, without creatinine elevation. All of these infants were born at less than 27 weeks of gestation, weighed less than 850 grams at birth, and showed greater weight loss (19.2 % vs. 13.8 %; p 5 0.037) and higher natremia (150.2 mEq/L vs. 146.6 mEq/L; p 5 0.023). The use of furosemide increased the risk of elevated uremia (relative risk: 2.54; 95 % confidence interval: 1.05 6.14). CONCLUSIONS: Total uremia of 100 mg/dL or higher was associated with dehydration, greater weight loss, higher natremia, furosemide use, lower gestational age, and lower birth weight.

Age Factors↗

PubMed2002

[Loss to follow-up and cerebral palsy].

BACKGROUND: The longer follow-up programs last, the greater the loss to follow-up. These losses to follow-up may undermine the completion of health care goals and the validity of study results. OBJECTIVES: 1) To compare neonatal characteristics in children easily followed-up and in those lost to follow-up. 2) To trace and assess children lost to follow-up. 3) To estimate the occurrence of cerebral palsy in children easily followed-up and in those lost to follow-up. METHODS: From 1991 to 1997, 601 neonates with a birth weight under 1,500 g were admitted to the Neonatology Department. At discharge, 447 infants were included in the follow-up program. Moderate-to-severe cerebral palsy was assessed when the children were aged 2 years. A specific search strategy was implemented to find those children lost to follow-up. Data on the development of those traced were updated through a standardized telephone questionnaire. RESULTS: Twenty percent of the children were lost to follow-up before the age of 2 years. Fifty-seven percent of those not available at this age were assessed by telephone interview. No differences were found in the neonatal characteristics of infants easily followed-up and those lost to follow-up except in situations of critical social disadvantage: 10 % in followed-up infants, 41 % in infants lost to follow-up. Disabling cerebral palsy was observed in 7 % of children easily followed-up and in 23 % of those lost and traced (relative risk: 3.1, 1.5-5.5). CONCLUSIONS: The risk of having disabling cerebral palsy is three times higher in children lost to follow-up than in those easily followed-up. Dismissing this source of bias may underestimate disability rates when assessing health care programs or when interpreting study results.

Cerebral Palsy↗

PubMed2001

[Medication errors in a neonatal unit].

INTRODUCTION: Medication errors occur as a result of human mistakes or system flaws and could be prevented by studying and modifying the conditions that predispose to errors. In recent years, interest in medical errors has increased because of their health and economic implications. OBJECTIVES: To evaluate the frequency and types of prescribing errors in the Neonatology Unit of the Hospital 12 Octubre before and after an intervention to raise awareness of errors among the medical staff by comparing the frequency of error before and after the intervention. PATIENTS AND METHODS: We conducted a prospective pilot study in two phases. In the first phase, we studied prescribing errors by reviewing 100 prescriptions for newborns admitted to the Intensive or Intermediate Care Units. When the prescriptions were written, the neonatologists were unaware that the study would be performed. Legibility, dose, units used to express medications, route of administration, use of abbreviations, specification of dosage per kilogram of body weight and use of brand names were evaluated. The information was analyzed and an information-training intervention was performed in which the results were made known in a clinical session and recommendations for improving prescriptions were made. In the second phase, another 100 prescriptions were reviewed. The results were compared with those obtained before the intervention using the chi-squared test. RESULTS: In the first phase, 22 % of prescriptions were illegible or doubtful, 4 % contained dose errors and 28 % did not specify the route of administration. After the intervention, 8 % (p 0.005) of prescriptions were illegible, 4 % contained dose errors and 5 % (p 0.0001) did not specify the route of administration. Regarding other quality markers, the percentage of prescriptions specifying dosage per kilogram of body weight increased from 46 % to 78 %. Brand names were used in 21 %. Units were always expressed in abbreviations. All errors were severity index 0 or 1. CONCLUSIONS: The first step in prevention is recognition of mistakes. Increasing awareness among the medical staff of the consequences of errors improved the quality of prescriptions in our department. Awareness of the frequency and type of errors is the first step towards implementing strategies to reduce iatrogeny.

Humans↗