18 results on '"Mariani, Gonzalo L."'
Search Results
2. Withdrawing Assisted Nutrition in Neonates: A Survey on Attitudes and Insights in Argentina.
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Mariani, Gonzalo L. and Konikoff, Laura L.
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NEONATOLOGISTS , *PEDIATRIC nurses , *CROSS-sectional method , *PARENTS , *HEALTH attitudes , *NEONATAL intensive care units , *TERMINATION of treatment , *FLUID therapy , *NEONATAL intensive care , *PHYSICIANS' attitudes , *FUTILE medical care , *MULTIVARIATE analysis , *DESCRIPTIVE statistics , *INFANT nutrition , *SURVEYS , *ENTERAL feeding , *NURSES' attitudes , *QUALITY of life , *ARTIFICIAL respiration , *TERMINAL care , *NEONATAL nursing , *DIET therapy - Abstract
Objective This study aimed to assess beliefs and attitudes of Argentinean neonatologists and neonatal nurses regarding end-of-life care of newborn infants, including withdrawal of clinically assisted nutrition and hydration (CANH). Study Design A five-domain survey was sent to 465 neonatal health care workers, which included demographic data, general ethical concepts, participation in end-of-life decisions, beliefs about end-of-life care practices, and presentation of four clinical scenarios. Standard statistical tests were used, and a multivariable analysis was done to evaluate variables independently associated with rejecting the withdrawal of CANH. Results A total of 227 questionnaires were anonymously completed, 60% by physicians and 40% by nurses. More respondents agreed to withdraw mechanical ventilation in comparison to CANH in patients under certain circumstances (88 vs. 62%, p < 0.01). The most accepted variables when deciding to withdraw care were the quality of life perceived by parents (86%) and their religious beliefs (73%). A total of 93% agreed that parents should be included in the decision, but only 74% acknowledged they are included in real practice. Considering the scenario of a newborn with severe and irreversible neurological compromise, 46% of respondents were opposed to suspending enteral nutrition. No independent variables were found to be associated with opposing the withdrawal of CANH. Of those agreeing to withdraw enteral feeds under certain circumstances, for the severely neurologically affected neonate 58% would either refuse to limit enteral feeds or consult with an ethics committee before doing so. When given the scenario of their own severe and irreversible neurological compromise, 68% agreed to have enteral feeds withdrawn to themselves, and they were more likely to agree with withdrawing feeds for the severely compromised neonate (odds ratio: 7.2; 95% confidence interval: 2.7–24.1). Conclusion While most health care providers agreed to withdraw life-sustaining support under certain conditions, many were reluctant to suspend CANH. Many responses differed when being asked as general statements versus actual clinical scenarios. Key Points Withdrawal of assisted nutrition is supported by the American Academy of Pediatrics in certain scenarios. Many neonatal intensive care units health care providers from Argentina are reluctant to suspend assisted nutrition. There is a need to learn how to deal with complex bioethical issues. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Prevalence and risk factors associated with the need for surgical intervention due to necrotizing enterocolitis in very low birth weight infants
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Bruno, Maria Ailen, primary, Galletti, Maria Fernanda, additional, Brener Dik, Pablo H., additional, Gonzalez, Álvaro, additional, Nieto, Ricardo, additional, and Mariani, Gonzalo L., additional
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- 2023
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4. The rising incidence and impact of non-medically indicated pre-labour cesarean section in Latin America
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Mariani, Gonzalo L. and Vain, Nestor E.
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- 2019
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5. The Alarm Fatigue Challenge in the Neonatal Intensive Care Unit: A “before” and “after” Study
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Stiglich, Yanin Fontana, additional, Dik, Pablo H. Brener, additional, Segura, Maria S., additional, and Mariani, Gonzalo L., additional
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- 2023
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6. Withdrawing Assisted Nutrition in Neonates: A Survey on Attitudes and Insights in Argentina
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Mariani, Gonzalo L., additional and Konikoff, Laura L., additional
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- 2023
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7. Meconium Stained Newborns: Ethics for Evidence in Resuscitation
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Vain, Nestor E., Musante, Gabriel A., and Mariani, Gonzalo L.
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- 2015
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8. Heated Humidifier versus Heat-and-Moisture Exchanger During Positive Pressure Ventilation With a T-Piece Resuscitator in Rabbits
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Bernatzky, Agustín, primary, Galletti, María F, additional, Fuensalida, Santiago E, additional, and Mariani, Gonzalo L, additional
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- 2020
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9. Cuantificación de Bisfenol-A libre en sangre de cordón umbilical humano a nivel de trazas
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Cases, Gabriel Guillermo, Calinski, Gustavo J., Méndez, Mariana L., Vidal, Flavia A., Otaño, Lucas, Mariani, Gonzalo L., Figar, Silvana, and Giménez, María I.
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Bisfenol A ,purl.org/becyt/ford/3.3 [https] ,CIENCIAS MÉDICAS Y DE LA SALUD ,Ciencias de la Salud ,LC/MS ,purl.org/becyt/ford/3 [https] ,Salud Pública y Medioambiental ,Disruptor endócrino ,Sangre de cordón - Abstract
El Bisfenol-A (BPA) es ampliamente utilizado en la producción de plásticos de policarbonato, por lo que está presente en productos de uso masivo. Es un disruptor endócrino e incide en el desarrollo gonadal y del sistema nervioso central. La exposición de mujeres embarazadas al BPA es particularmente preocupante para el feto en desarrollo, debido a que atraviesa la placenta pasando a la sangre de cordón y al líquido amniótico. Esto se suma a la escasa o nula actividad enzimática fetal para biotransformarlo en BPAglucurónido inactivo, causando posibles efectos nocivos a la descendencia a dosis muy bajas y sostenidas. Con el propósito de estudiar la exposición al BPA y sus efectos en la población de Argentina se desarrolló y validó un método analítico por cromatografía líquida acoplada a espectrometría de masa, que permite la cuantificación de trazas de BPA libre (forma estrogénica, activa) en plasma de cordón umbilical. La técnica consiste en la precipitación de proteínas de la sangre de cordón por agregado de acetonitrilo y posterior centrifugado e inyección del sobrenadante. Se utilizó una elución isocrática en la cromatografía líquida, y la espectrometría de masa se realizó empleando Electrospray negativo en modo de monitoreo de reacciones múltiples. Los valores de BPA libre cuantificados están en el rango de 1,0 a 12,1 ng/mL, límite de detección: 0,6 ng/mL. Bisphenol-A (BPA) is widely used in the production of polycarbonate plastics and therefore, it is present in products of massive use. It is known as an endocrine disruptor and has an impact on gonadal and central nervous system development. Exposure of pregnant women to BPA is particularly worrying for the developing fetus because it crosses the placenta into the cord blood and amniotic fluid, coupled with little or no fetal enzymatic activity to biotransform it into inactive BPA-glucuronide, causing possible harmful effects to the offspring at very low and sustained doses. With the aim to study the exposure to BPA and its effects on the population of Argentina, an analytical method was developed and validated by liquid chromatography coupled to mass spectrometry, which allows the quantification of trace amounts of free BPA (estrogenic, active form) in plasma of umbilical cord. The method involves protein precipitation by the addition of acetonitrile and subsequent centrifugation and injection of supernatant. An isocratic elution was used in liquid chromatography, and mass spectrometry was performed using negative Electrospray mode in multiple reaction monitoring. Quantified free BPA values are in the range of 1.0 to 12.1 ng/mL, Detection Limit: 0,6 ng/mL. Fil: Cases, Gabriel Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad de Microanálisis y Métodos Físicos en Química Orgánica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Unidad de Microanálisis y Métodos Físicos en Química Orgánica; Argentina. Hospital Italiano; Argentina Fil: Calinski, Gustavo J.. Hospital Italiano; Argentina Fil: Méndez, Mariana L.. Hospital Italiano; Argentina Fil: Vidal, Flavia A.. Hospital Italiano; Argentina Fil: Otaño, Lucas. Hospital Italiano; Argentina Fil: Mariani, Gonzalo L.. Hospital Italiano; Argentina Fil: Figar, Silvana. Hospital Italiano; Argentina Fil: Giménez, María I.. Hospital Italiano; Argentina
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- 2018
10. Randomized Controlled Trial of Nonsynchronized Nasal Intermittent Positive Pressure Ventilation versus Nasal CPAP after Extubation of VLBW Infants.
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Estay, Alberto S., Mariani, Gonzalo L., Alvarez, Claudio A., Milet, Beatriz, Agost, Daniel, Avila, Claudia P., Roldan, Liliana, Abdala, Daniel A., Keller, Rodolfo, Galletti, María F., and González, Alvaro
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POSITIVE pressure ventilation , *EXTUBATION , *RANDOMIZED controlled trials , *NASAL cannula , *CONTINUOUS positive airway pressure , *RESPIRATORY distress syndrome , *PREMATURE infants - Abstract
Background and Objectives: Nasal continuous positive airway pressure (NCPAP) is a useful method of respiratory support after extubation. However, some infants fail despite CPAP use and require reintubation. Some evidence suggests that synchronized nasal intermittent positive pressure ventilation (NIPPV) may decrease extubation failure in preterm infants. Nonsynchronized NIPPV (NS-NIPPV) is being widely used in preterm infants without conclusive evidence of its benefits and side effects. Our aim was to evaluate whether NS-NIPPV decreases extubation failure compared with NCPAP in ventilated very low birth weight infants (VLBWI) with respiratory distress syndrome (RDS). Methods: Randomized controlled trial of ventilated VLBWI being extubated for the first time. Before extubation, infants were randomized to receive NCPAP or NS-NIPPV. Primary outcome was the need for reintubation within 72 h. Results: 220 infants were included. The mean ± SD birth weight was 1,027 ± 256 g and gestational age 27.8 ± 1.9 weeks. Demographic and clinical characteristics were similar in both groups. Extubation failure was 32.4% for NCPAP versus 32.1% for NS-NIPPV, p = 0.98. The frequency of deaths, bronchopulmonary dysplasia, intraventricular hemorrhage, air leaks, necrotizing enterocolitis and duration of respiratory support did not differ between groups. Conclusions: In this population of VLBWI, NS-NIPPV did not decrease extubation failure after RDS compared with NCPAP. [ABSTRACT FROM AUTHOR]
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- 2020
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11. Surfactant Administration through Laryngeal Mask Airway: A Randomized Controlled Study in Rabbits.
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Bernardo, Cristian A., Mariani, Gonzalo L., de los Ángeles Virasoro, María, Burgos, Sebastián, Labanca, María J., and Otero, Pablo
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REACTIVE oxygen species , *ANIMAL experimentation , *BRONCHOALVEOLAR lavage , *ENDOSCOPIC surgery , *OXYGEN in the body , *PULMONARY gas exchange , *RABBITS , *RESPIRATION , *SURFACE active agents , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *POSITIVE pressure ventilation , *CONTINUOUS positive airway pressure , *FEEDING tubes , *LARYNGEAL masks - Abstract
Background Minimally invasive techniques for surfactant administration for infants with respiratory distress syndrome (RDS) of moderate severity have been proposed. The laryngeal mask airway (LMA) helps in securing the airway without the need of laryngoscopy, but still requires the use of positive pressure ventilation (PPV) to flush surfactant into the lungs. Objective This article compares the effectiveness of two techniques for LMA surfactant administration, instillation into the LMA lumen followed by PPV versus direct laryngeal instillation through a preinserted feeding tube inside the LMA during spontaneous respirations. Study Design This is a randomized controlled trial (RCT) of 18 rabbits with acquired respiratory distress after lung lavage. After surfactant was given, the rabbits remained on continuous positive airway pressure (CPAP). Gas exchange parameters were assessed at baseline and at 30 minutes and lung parenchyma pathology features were analyzed. Results Time required for surfactant administration, oxygenation improvement, and histopathologic findings did not differ between groups. The new technique decreased the need of PPV (p < 0.05). Conclusion In this animal model, surfactant administration through a preinserted feeding tube within the LMA lumen is safe and effective while providing the benefits of a minimally invasive approach. This technique reduces the need of PPV and may prevent its potential risks. [ABSTRACT FROM AUTHOR]
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- 2018
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12. Ventilatory Management in Neonates: Science or Art?
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Mariani, Gonzalo L., primary and Carlo, Waldemar A., additional
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- 1998
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13. The Alarm Fatigue Challenge in the Neonatal Intensive Care Unit: A "before" and "after" Study.
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Stiglich YF, Dik PHB, Segura MS, and Mariani GL
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- Humans, Cross-Sectional Studies, Infant, Newborn, Female, Male, Alert Fatigue, Health Personnel prevention & control, Reaction Time, Clinical Alarms, Intensive Care Units, Neonatal
- Abstract
Objective: Alarm fatigue (AF) happens when professionals are exposed to many alarms and they become desensitized to them. It is related to proliferation of devices, not standardized alarm limits, and high prevalence of "nonactionable alarms," i.e., false alarms (triggered by equipment issues) or nuisance alarms (physiological change not requiring clinical action). When AF happens, response time seems to be longer and important alarms could be dismissed. After evaluating the situation in our neonatal intensive care unit (NICU), an alarm management program (AMP) was developed to reduce AF. The objective of this study were to compare the proportion of true alarms, nonactionable alarms, and to measure response time to alarms in the NICU before and after implementing an AMP and also to determine variables associated with nonactionable alarms and response time., Study Design: This was a cross-sectional study. A total of 100 observations were collected between December 2019 and January 2020. After an AMP was implemented, 100 new observations were collected between June 2021 and August 2021. We estimated the true and nonactionable alarms proportion. Univariate analyses were performed to determine variables associated with nonactionable alarms and response time. Logistic regression was performed to assess independent variables., Results: The proportion of true alarms before and after AMP was 31 versus 57% ( p = 0.001), whereas the proportion of nonactionable alarms was 69 versus 43% ( p = 0.001). Median response time was significantly reduced (35 versus 12 seconds; p = 0.001). Before AMP, neonates with less intensive care needs had a higher proportion of nonactionable alarms and a longer response time. After AMP, response time was similar for true and nonactionable alarms. For both periods, the need of respiratory support was significantly associated with true alarms ( p = 0.001). In the adjusted analysis, response time ( p = 0.001) and respiratory support ( p = 0.003) remained associated with nonactionable alarms., Conclusion: AF was highly prevalent in our NICU. This study shows that after the implementation of an AMP, response time to alarms and the proportion of nonactionable alarms can be significantly reduced., Key Points: · AF happens when professionals are exposed to many alarms and they become desensitized to them.. · The presence of AF can compromise patients' safety.. · The implementation of an AMP can reduce AF.., Competing Interests: None declared., (Thieme. All rights reserved.)
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- 2024
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14. Prevalence of osteopenia of prematurity before and after implementing an early strategy with the use of calcium and phosphate.
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Carrascal Gutiérrez MP, Janis MC, Brener Dik PH, Galletti MF, and Mariani GL
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- Infant, Newborn, Infant, Humans, Phosphates, Prevalence, Calcium Phosphates, Calcium, Bone Diseases, Metabolic epidemiology, Bone Diseases, Metabolic prevention & control
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Introduction. With the use of aggressive parenteral nutrition in very low birth weight infants, alterations in calcium and phosphate metabolism were detected. In 2016, a prevention strategy was implemented through calcium phosphate monitoring and early supplementation. Our objective was to study whether this strategy reduces the prevalence of osteopenia and to identify associated risk factors. Population and methods. Quasi-experiment comparing the prevalence of osteopenia between two groups: one after implementing the calcium phosphate monitoring and supplementation strategy (01/01/2017-12/31/2019) and another prior to such intervention (01/01/2013-12/31/2015). Results. A total of 226 patients were included: 133 in the pre-intervention period and 93 in the post-intervention period. The overall prevalence of osteopenia was 26.1% (95% CI: 20.5-32.3) and it was reduced from 29.3% (95% CI: 21.7-37.8) in the pre-intervention period to 21.5% (95% CI: 13.6-31.2) in the post-intervention period, with no statistical significance (p = 0.19). In the multivariate analysis, the NEOCOSUR score for risk of death at birth, use of postnatal corticosteroids, and the intervention period were independently associated with osteopenia. Being born after the intervention reduced the probability of alkaline phosphatase > 500 IU/L by 71%, regardless of the other variables included in the model. Conclusion. Calcium phosphate monitoring and early supplementation is a protective factor against the development of osteopenia in very low birth weight infants., (Sociedad Argentina de Pediatría.)
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- 2024
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15. Preparedness strategies in neonatology units during the COVID-19 pandemic: A survey conducted at maternity centers in Argentina.
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Geffner SC, Ávila AS, Etcharrán ML, Fernández AL, Mariani GL, and Vain NE
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- Argentina epidemiology, COVID-19 epidemiology, Cross-Sectional Studies, Female, Health Care Surveys, Health Policy, Humans, Infant Care statistics & numerical data, Infant, Newborn, Infection Control instrumentation, Infection Control methods, Infection Control statistics & numerical data, Male, Maternal Health Services statistics & numerical data, Pandemics, Personal Protective Equipment supply & distribution, Practice Guidelines as Topic, Pregnancy, COVID-19 prevention & control, Health Resources supply & distribution, Infant Care organization & administration, Infection Control organization & administration, Maternal Health Services organization & administration
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Introduction: The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic., Method: Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector., Results: In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted. Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment., Conclusions: All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly., Competing Interests: None, (Sociedad Argentina de Pediatría.)
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- 2021
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16. Risk factors associated with mortality in newborn infants with congenital diaphragmatic hernia.
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Galletti MF, Giudice C, Brener Dik PH, Fernández Jonusas S, Baldini L, and Mariani GL
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- Female, Hernias, Diaphragmatic, Congenital diagnosis, Humans, Infant, Newborn, Male, Multivariate Analysis, Prognosis, Retrospective Studies, Risk Adjustment, Risk Factors, Survival Analysis, Clinical Decision Rules, Hernias, Diaphragmatic, Congenital mortality, Severity of Illness Index
- Abstract
Introduction: Morbidity and mortality are high in congenital diaphragmatic hernia. Some tools help to predict survival, both prenatally (observed/expected lung-to-head ratio [OELHR], presence of the liver in the chest) and postnatally (Congenital Diaphragmatic Hernia Study Group [CDHSG] score). Our objective was to identify the risk factors associated with mortality and estimate the risk-adjusted mortality in the prenatal period in the subgroup of patients with isolated left-sided hernia., Poulation and Methods: Retrospective and analytical study of patients born at Hospital Italiano de Buenos Aires between 2011 and 2018. A multivariate analysis was done to assess mortality-associated risk factors. For riskadjusted mortality in the prenatal period, the ratio between the observed mortality and the mean "expected" mortality based on the OELHR was estimated., Results: A total of 53 patients were included. Their median gestational age was 38 weeks, and their mean birth weight was 3054 g. Isolated hernia was observed in 73 % of patients. Overall mortality was 45 %, and higher in patients with associated malformations. In the multivariate analysis, the presence of severe pulmonary hypertension estimated by postnatal echocardiogram was independently associated with mortality (adjusted odds ratio: 6.4, 95 % confidence interval: 1.02-40). The observed overall mortality in patients with isolated left-sided hernia was similar to that expected (ratio: 1.05)., Conclusion: Overall mortality was similar to that expected based on the OE-LHR. In our population, severe pulmonary hypertension after birth was a determining factor of mortality., Competing Interests: None, (Sociedad Argentina de Pediatría.)
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- 2020
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17. Impact of the volume of blood collected by phlebotomy on transfusion requirements in preterm infants with birth weight of less than 1500 g. A quasi-experimental study.
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Brener Dik PH, Galletti MF, Carrascal MP, De Gregorio A, Burgos Pratx L, Gómez Saldaño AM, and Mariani GL
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- Anemia therapy, Female, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases therapy, Logistic Models, Male, Risk Factors, Treatment Outcome, Anemia etiology, Erythrocyte Transfusion statistics & numerical data, Infant, Premature, Diseases etiology, Infant, Very Low Birth Weight, Phlebotomy adverse effects, Phlebotomy methods
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Introduction: Anemia is a complication in very low birth weight (VLBW) infants, and lab tests are a predominant risk factor. At least one red blood cell transfusion is given in more than 50 % of cases. Transfusions are associated with a higher risk for infections, intracranial hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia. In 2012, Hospital Italiano de Buenos Aires implemented a strategy to collect a lower blood volume by phlebotomy. The objective of this study was to assess its association with the number of transfusions., Methods: Before-and-after, quasi-experimental study. The number of transfusions was compared between two groups of VLBW preterm infants with different blood collection volumes. The correlation between the collection volume and the number of transfusions was assessed estimating Spearman's coefficient. A logistic regression model was used to adjust for confounders., Results: The study included 178 patients with a mean gestational age of 29.4 weeks (standard deviation: 2.7) and a birth weight of 1145 g (875-1345). The baseline red series profile was similar between both groups. The number of transfusions (p = 0.017) and the transfusion volume (p = 0.048) decreased significantly. The correlation coefficient was 0.83. In the multivariate analysis, collection volume and birth weight were associated with a requirement of more than three transfusions., Conclusion: A lower blood collection volume in VLBW preterm infants is independently associated with fewer transfusion requirements., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)
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- 2020
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18. Bronchopulmonary dysplasia: incidence and risk factors.
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Brener Dik PH, Niño Gualdron YM, Galletti MF, Cribioli CM, and Mariani GL
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- Female, Humans, Incidence, Infant, Newborn, Infant, Very Low Birth Weight, Male, Retrospective Studies, Risk Factors, Time Factors, Bronchopulmonary Dysplasia epidemiology
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Introduction: Bronchopulmonary dysplasia is the most common chronic pulmonary sequela among very low birth weight infants. The objective of this study was to estimate its incidence in our Neonatal Unit over the past 5 years and analyze associated risk factors., Population and Methods: An observational and analytical study was conducted in a retrospective cohort, using data obtained from a prospective database of infants born at Hospital Italiano de Buenos Aires with a birth weight of less than 1500 grams between January 2010 and December 2014. The incidence of bronchopulmonary dysplasia and its association with several secondary outcome measures were studied., Results: Two hundred and forty-five patients were included. The incidence of moderate/severe bronchopulmonary dysplasia was 22%, and it was associated with a younger gestational age and lower birth weight. A significant association was observed with surfactant use, mechanical ventilation requirement, and length of mechanical ventilation. Patients with moderate/severe bronchopulmonary dysplasia had a higher incidence of patent ductus arteriosus and late-onset sepsis. A lower birth weight (adjusted odds ratio |-#91;aOR|-#93;: 0.99, 95% confidence interval |-#91;CI|-#93;: 0.991-0.997, p< 0.001) and the length of mechanical ventilation (aOR: 1.08, 95% CI: 1.01-1.15, p < 0.01) remained associated following adjustment for other outcome measures. In addition, an association was observed among patients with intrauterine growth restriction born at less than 32 weeks of gestational age (OR: 4.71, 95% CI: 1.68-13.2)., Conclusions: The incidence ofbronchopulmonary dysplasia in our unit was associated with a lower birth weight and the length of mechanical ventilation. Among infants born at less than 32 weeks of gestation, intrauterine growth restriction accounted for an additional risk.
- Published
- 2017
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