A. Melgar Bonís’s research while affiliated with Hospital Universitario 12 de Octubre and other places

Introduction Unplanned extubations (UE) of mechanically ventilated newborns involves an undesirable increase in morbidity and mortality. Objective A 2-stage study compared the frequency of UE in a Neonatal Intensive Care Unit before and after the implementation of a program of preventive measures to decrease UE. Patients and methods A before and after prospective study included all mechanically ventilated newborns participating in the 2 stage study from May-December 2011 and June-December 2012. In stage 1, the rate of UE per 100 intubated patient days was calculated and the characteristics of unplanned extubated newborns, circumstances of UE occurrence and need for re-intubation were studied. Consequently, a program of preventive measures for UE was designed and implemented, with the same variables being analysed in stage 2. Results No differences were found in patient characteristics during the two stages. Stage 1, incidence of UE was 5/100 intubated patient days; Stage 2, 4.5 UE/100 intubated patient days (P=.657). In both stages, most UE occurred during patient handling with re-intubation incidence at 77.4% and 67.7%, respectively. The combined rate of both stages during summer months of July, August and September was 6.2 UE/100 intubation days, in contrast with the remaining months of both stages: UE incidence rate, 3.4 UE/100 intubation days (p=.043). Conclusions The implementation of a preventive measures program did not significantly reduce the incidence of UE. The summer period showed the highest incidence of UE.

Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<.01). The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits.

Unplanned extubations (UE) of mechanically ventilated newborns involves an undesirable increase in morbidity and mortality. A 2-stage study compared the frequency of UE in a Neonatal Intensive Care Unit before and after the implementation of a program of preventive measures to decrease UE. A before and after prospective study included all mechanically ventilated newborns participating in the 2 stage study from May-December 2011 and June-December 2012. In stage 1, the rate of UE per 100 intubated patient days was calculated and the characteristics of unplanned extubated newborns, circumstances of UE occurrence and need for re-intubation were studied. Consequently, a program of preventive measures for UE was designed and implemented, with the same variables being analysed in stage 2. No differences were found in patient characteristics during the two stages. Stage 1, incidence of UE was 5/100 intubated patient days; Stage 2, 4.5 UE/100 intubated patient days (P=.657). In both stages, most UE occurred during patient handling with re-intubation incidence at 77.4% and 67.7%, respectively. The combined rate of both stages during summer months of July, August and September was 6.2 UE/100 intubation days, in contrast with the remaining months of both stages: UE incidence rate, 3.4 UE/100 intubation days (p=.043). The implementation of a preventive measures program did not significantly reduce the incidence of UE. The summer period showed the highest incidence of UE.

Resumen Introducción La incidencia de secuelas neurológicas en los recién nacidos pretérmino (RNPT) con displasia broncopulmonar (DBP) es considerablemente mayor que la de aquellos que no la presentan. Conocer la cronología de adquisición de los hitos motores puede servir para proporcionar mejor información a los padres acerca de la posible existencia de un retraso en el desarrollo. El objetivo del presente estudio es estimar la influencia que tiene la DBP sobre las edades de adquisición de la sedestación y la marcha en los RNPT < 1.500 g con exploración neurológica normal a los 2 años. Pacientes y métodos Estudio longitudinal con una cohorte de 885 RNPT con peso al nacimiento inferior a 1.500 g, ingresados en el Hospital 12 de Octubre entre enero de 1991 y diciembre de 2003. Las edades a las que se alcanzaban los hitos motores evaluados se establecían mediante entrevista con los padres. La comparación de medias se realizó mediante la t de Student y el test de Bonferroni. Resultados Los pacientes con DBP alcanzaron la sedestación a los 7,8 ± 2m vs 7,1 ± 1,3 m en los RNPT sin DBP y la marcha a los 14,5 ± 3,8m vs 13,4 ± 2,5m (p < 0,001). Los pacientes con DBP tenían mayor riesgo de adquirir ambos hitos motores por encima del p90 (OR = 2,6 (1,6-4,1) para la sedestación y OR = 2,8 (1,6-4,8) para la marcha), efecto que se mantuvo tras ajustar por edad gestacional y peso al nacimiento. Conclusión La DBP, en el grupo de RNPT < 1.500 g con exploración neurológica normal a los 2 años, implica un retraso en la adquisición de la sedestación y la marcha.

Adverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age. A longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital "12 de Octubre" between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate. Both motor skills were acquired later in the group with BPD (7.8±2m vs. 7.1±1.3m for sitting unsupported and 14.5±3.8m vs. 13.4±2.5m for walking) (P<.001). BPD was associated with delayed acquisition (above p90) of these skills, OR=2.6 (1.6-4.1) for sitting and OR=2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight. BPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years.