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1. Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants

Author

Marisela Madrid-Aguilar, María Cruz López-Herrera, Javier Pérez-López, Julene Escudero-Argaluza, Elena Santesteban-Otazu, Brar Piening, José Ignacio Villate-Navarro, José Ignacio Pijoán-Zubizarreta, Teresa Jesús Agra Laya, Almudena Alonso Ojembarrena, Israel Anquela Sanz, Yolanda Armendáriz Cuevas, Cristina Barcelona Alfonso, José Beceiro Mosquera, María Bengoa Caamaño, Elena Bergón Sendín, Lucía Cabanillas Vilaplana, Fernando Cabañas González, Eva Capdevila Cogul, Javier Casanovas Lax, María Cernada Badía, Gil Daniel Coto Cotallo, Pilar Adelaida Crespo Suárez, María Isabel de las Cuevas Terán, Laura Domingo Comeche, Izaskun Dorronsoro Martín, Pilar Espiño Lorenzo, Marta Estalella Bellart, Francisco Javier Estañ Capell, Belén Fernández Colomer, José Luis Fernández Trisac, Zenaida Galve Pradel, Miguel Ángel García Cabezas, María García Franco, María Jesús García García, Victoria Eugenia García Rodríguez, Rafael García Mozo, Rubén García Sánchez, Fermín García-Muñoz Rodrigo, Silvia Garrido Esteban, Carmen González Armengod, Paloma González Carretero, María González López, María Mercedes Granero Asencio, José María Hernández Hernández, María Elena Infante López, Ana Irasarri Sebastián, Francisco J Jiménez Parrilla, Pedro J Jiménez Parrilla, María Isabel Larburu Aristizabal, Manuela López Azorín, Juan María López de Heredia Goya, Jesús Cecilio López-Menchero Oliva, Salud Luna Lagares, Carmen Luz Marrero Pérez, Emilia María Martínez Tallo, Andrés Martínez Gutiérrez, María Dolores Martínez Jiménez, María de los Ángeles Martínez Fernández, Raquel Mendiola Ruiz, María Leticia Millán Miralles, Alicia Mirada Vives, Jesús Molina Cabrillana, Elisenda Moliner Calderón, Icíar Olabarrieta Arnal, Antonio Pavón Delgado, Alberto Pérez Legorburu, Alejandro Pérez Muñuzuri, Raquel Pinillos Pisón, Segundo Rite Gracia, Sonia M Rivero Rodríguez, Silvia Rodríguez Blanco, Gerardo Romera Modamio, María Dolors Salvia Roigés, Mario Sánchez Fernández, Antonio Segado Arenas, Eduard Solé Mir, Itziar Sota Busselo, Joaquín Suárez Fernández, José Luis Tarazona Fargueta, Cinzia Tripodi, María Purificación Ventura Faci, and Javier Vilas González.

Subjects
Bacteriemia, Infección asociada a catéter, Cuidados intensivos, Sepsis, Neonato, Nosocomial, Pediatrics, RJ1-570
Abstract

Background: Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500 g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. Methods: We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2 NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. Results: Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. Conclusions: The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs. Resumen: Antecedentes: Las sepsis son las infecciones nosocomiales más frecuentes en las Unidades de Cuidados Intensivos Neonatales (UCIN), afectando especialmente a los recién nacidos de muy bajo peso al nacer (RNMBP, ≤ 1.500 g). Un sistema de vigilancia epidemiológica puede contribuir a su prevención mediante una evaluación continua de su frecuencia y factores de riesgo asociados. El objetivo de este artículo es describir la implementación del sistema de vigilancia de las sepsis nosocomiales en RNMBP (NeoKissEs) en un grupo de UCIN españolas. Métodos: Estudio de cohorte de RNMBP con < 28 días de edad ingresados en las UCIN participantes. Dos UCIN tradujeron y adaptaron materiales a partir del sistema original alemán NEO-KISS. Durante la implementación, se desarrollaron 8 talleres formativos, con participación de 210 profesionales. Se creó un sistema web para la introducción de datos de pacientes y episodios de sepsis, su monitorización, análisis comparativo y retroalimentación a las unidades. En cada UCIN, un neonatólogo fue responsable de la implementación, recogiendo información sobre las dificultades percibidas durante el proceso. Resultados: De 50 unidades que aceptaron participar, 45 utilizaron NeoKissEs durante la fase de implementación, registrando 1.108 episodios de sepsis asociados a catéter vascular en 3.638 neonatos, con una tasa de 18,4 episodios por 1.000 pacientes-día con catéter (IC del 95%: 17,8-19,1). Conclusiones: El sistema de vigilancia epidemiológica NeoKissEs representa una fuente útil de información para la comparación estandarizada de la incidencia de sepsis de las UCIN, evaluar factores de riesgo y facilitar la evaluación del efecto de futuras intervenciones preventivas.

Published
2019
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2. Utilidad del propéptido natriurético cerebral en el diagnóstico y manejo del ductus arterioso permeable

Author

Alicia Montaner Ramón, María Pilar Samper Villagrasa, Lorenzo Jiménez Montañés, Zenaida Galve Pradel, Cristina Fernández Espuelas, and Segundo Rite Gracia

Subjects
03 medical and health sciences, Brain natriuretic propeptide, 0302 clinical medicine, Sensitivity, 030225 pediatrics, Pediatrics, Perinatology and Child Health, Specificity, 030212 general & internal medicine, Patent arteriosus ductus, Prematurity, Pediatrics, RJ1-570
Abstract

Resumen: Introducción: El ductus arterioso persistente (DAP) es una patología muy prevalente en el recién nacido pretérmino (RNPT), que puede relacionarse con mayor morbimortalidad en los prematuros más inmaduros. Estudios recientes han valorado la utilidad del propéptido natriurético cerebral (proBNP) en su diagnóstico. El objetivo fue evaluar la eficacia diagnóstica del proBNP como marcador de sobrecarga hemodinámica en el DAP y su capacidad para identificar la necesidad de tratamiento. Pacientes y métodos: Estudio retrospectivo observacional, que incluyó a RNPT menores de 32 semanas de gestación y/o 1.500 g, con estudio ecocardiográfico y determinación de niveles de proBNP. Se comparó por subgrupos en función de la presencia de DAP y sus características hemodinámicas. Resultados: De los 60 pacientes incluidos, el 71,7% presentó DAP, el 86% de los cuales fue hemodinámicamente significativo (DAP-HS). Todos, salvo uno, recibieron tratamiento médico con ibuprofeno o paracetamol. El 29,7% de los DAP-HS precisó cierre quirúrgico.Se encontraron valores superiores de proBNP en los pacientes con DAP-HS (33.338 ± 34.494,47 pg/mL; p = 0,000), respecto a los pacientes con ductus cerrado o no hemodinámicamente significativo. Los pacientes que precisaron cirugía también presentaron valores más elevados (30.596,8 ± 14.910,9 pg/mL; p = 0,004). El grupo en el que se constató cierre ductal tras tratamiento farmacológico presentó mayor descenso de los niveles de proBNP (68 ± 24,69% vs. –12,22 ± 99,4%; p = 0,030). Mediante curva ROC se calculó valor de corte de proBNP para el diagnóstico de DAP-HS que fue de 9.321,5 pg/mL (E 100%, S 94,6%). Conclusiones: Los niveles de proBNP se relacionan con la presencia o ausencia de ductus persistente hemodinámicamente significativo y sus variaciones con la respuesta al tratamiento. Valores elevados también se relacionan con la necesidad de cirugía. Abstract: Introduction: Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent studies have examined the usefulness of brain natriuretic propeptide (proBNP) in the diagnosis of this pathology. The aim of the study was to evaluate the diagnostic efficacy of proBNP as a marker of hemodynamic overload in PDA. Paients and methods: A retrospective study was conducted on preterm infants less than 32 weeks of gestation and/or weight less than 1500 grams. Echocardiogram and determination of proBNP levels were performed on all patients. Comparison was made by subgroups according to the presence of PDA and their haemodynamic characteristics. Results: Of the 60 patients enrolled, 71.7% had PDA, of which 86% had haemodynamically significant patent ductus arteriosus (HS-PDA). All of them, but one, received medical treatment with ibuprofen or acetaminophen. Surgical closure was required in 29.7% of HS-PDA.Higher values of proBNP were found in patients with HS-PDA (33338 ± 34494.47 pg/mL; p = .000) compared with patients with closed or non-haemodynamically significant ductus arteriosus. Higher values were also found in patients who required surgical closure of PDA (30596.8 ± 14910.9; p = .004). A greater decrease inproBNP levels was found in the group of patients which duct closure after pharmacological treatment (68 ± 24.69% vs -12.22 ± 99.4%; p = .030). ProBNP cutoff-level for HS-PDA was calculated by ROC curve and it was 9321.5 pg/mL (Specificity: 100%, Sensitivity: 94.6%). Conclusions: ProBNP levels are related to the presence or absence of haemodynamically significant patent ductus arteriosus; and its variations with treatment response. High values are also related to the need for surgical closure of PDA.

Published
2017

3. [Usefulness of brain natriuretic propeptide in the diagnosis and management of patent ductus arteriosus]

Author

Lorenzo Jiménez Montañés, María Pilar Samper Villagrasa, Alicia Montaner Ramón, Segundo Rite Gracia, Cristina Fernández Espuelas, and Zenaida Galve Pradel

Subjects
Male, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Treatment response, education, Hemodynamics, Pediatrics, Sensitivity and Specificity, RJ1-570, Especificidad, 03 medical and health sciences, 0302 clinical medicine, health services administration, 030225 pediatrics, Management of Technology and Innovation, Internal medicine, Ductus arteriosus, Natriuretic Peptide, Brain, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Protein Precursors, Ductus arterioso persistente, Ductus Arteriosus, Patent, Retrospective Studies, Medical treatment, business.industry, Infant, Newborn, Retrospective cohort study, Ibuprofen, Acetaminophen, Surgery, Propéptido natriurético cerebral, Prematuridad, medicine.anatomical_structure, Cardiology, Gestation, Female, Sensibilidad, business, Infant, Premature, medicine.drug
Abstract

Introduction: Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent studies have examined the usefulness of brain natriuretic propeptide (proBNP) in the diagnosis of this pathology. The aim of the study was to evaluate the diagnostic efficacy of proBNP as a marker of haemodynamic overload in PDA. Paients and methods: A retrospective study was conducted on preterm infants less than 32 weeks of gestation and/or weight less than 1500 g. Echocardiogram and determination of proBNP levels were performed on all patients. Comparison was made by subgroups according to the presence of PDA and their haemodynamic characteristics. Results: Of the 60 patients enrolled, 71.7% had PDA, of which 86% had haemodynamically significant patent ductus arteriosus (HS-PDA). All of them, but one, received medical treatment with ibuprofen or acetaminophen. Surgical closure was required in 29.7% of HS-PDA.Higher values of proBNP were found in patients with HS-PDA (33,338 ± 34,494.47 pg/mL; p = .000) compared to patients with closed or non-haemodynamically significant ductus arteriosus. Higher values were also found in patients who required surgical closure of PDA (30,596.8 ± 14,910.9; p = .004). A greater decrease inproBNP levels was found in the group of patients which duct closure after pharmacological treatment (68 ± 24.69% vs −12.22 ± 99.4%; p = .030). ProBNP cutoff-level for HS-PDA was calculated by ROC curve and it was 9321.5 pg/mL (Specificity: 100%, Sensitivity: 94.6%). Conclusions: ProBNP levels are related to the presence or absence of haemodynamically significant patent ductus arteriosus; and its variations with treatment response. High values are also related to the need for surgical closure of PDA. Resumen: Introducción: El ductus arterioso persistente (DAP) es una patología muy prevalente en el recién nacido pretérmino (RNPT), que puede relacionarse con mayor morbimortalidad en los prematuros más inmaduros. Estudios recientes han valorado la utilidad del propéptido natriurético cerebral (proBNP) en su diagnóstico. El objetivo fue evaluar la eficacia diagnóstica del proBNP como marcador de sobrecarga hemodinámica en el DAP y su capacidad para identificar la necesidad de tratamiento. Pacientes y métodos: Estudio retrospectivo observacional, que incluyó a RNPT menores de 32 semanas de gestación y/o 1.500g, con estudio ecocardiográfico y determinación de niveles de proBNP. Se comparó por subgrupos en función de la presencia de DAP y sus características hemodinámicas. Resultados: De los 60 pacientes incluidos, el 71,7% presentó DAP, el 86% de los cuales fue hemodinámicamente significativo (DAP-HS). Todos, salvo uno, recibieron tratamiento médico con ibuprofeno o paracetamol. El 29,7% de los DAP-HS precisó cierre quirúrgico.Se encontraron valores superiores de proBNP en los pacientes con DAP-HS (33.338 ± 34.494,47 pg/mL; p = 0,000), respecto a los pacientes con ductus cerrado o no hemodinámicamente significativo. Los pacientes que precisaron cirugía también presentaron valores más elevados (30.596,8 ± 14.910,9 pg/mL; p = 0,004). El grupo en el que se constató cierre ductal tras tratamiento farmacológico presentó mayor descenso de los niveles de proBNP (68 ± 24,69% vs. –12,22 ± 99,4%; p = 0,030). Mediante curva ROC se calculó valor de corte de proBNP para el diagnóstico de DAP-HS que fue de 9.321,5 pg/mL (E 100%, S 94,6%). Conclusiones: Los niveles de proBNP se relacionan con la presencia o ausencia de ductus persistente hemodinámicamente significativo y sus variaciones con la respuesta al tratamiento. Valores elevados también se relacionan con la necesidad de cirugía.

Published
2015

4. Neonatal Infection Due to SARS-CoV-2: An Epidemiological Study in Spain

Author

Belén Fernández Colomer, Manuel Sánchez-Luna, Concepción de Alba Romero, Ana Alarcón, Ana Baña Souto, Fátima Camba Longueira, María Cernada, Zenaida Galve Pradell, María González López, M. Cruz López Herrera, Carmen Ribes Bautista, Laura Sánchez García, Elena Zamora Flores, Adelina Pellicer, Clara Alonso Díaz, Cristina Herraiz Perea, Dolores Sabina Romero Ramírez, Isabel de las Cuevas Terán, Isabel Pescador Chamorro, José Luis Fernández Trisac, Luis Arruza Gómez, Luis Miguel Cardo Fernández, Mª Jesús García García, Marta Nicolás López, Miryam Hortelano López, Mónica Riaza Gómez, Natalio Hernández González, Raquel González Sánchez, Sílvia Zambudio Sert, Susana Larrosa Capacés, and Vanesa Matías del Pozo

Subjects
coronavirus disease 2019, SARS-CoV-2 infection, neonates, epidemiology–descriptive, hospital-acquired infection, community-acquired infection, Pediatrics, RJ1-570
Abstract

Objective: Coronavirus disease 2019 (COVID-19) cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to increase worldwide. Although some data from pediatric series are available, more evidence is required, especially in neonates, a group with specific characteristics that deserve special attention. This study aimed to describe general and clinical characteristics, management, and treatment of postnatal-acquired (community and nosocomial/hospital-acquired) COVID-19 neonatal cases in Spain.Methods: This was a national prospective epidemiological study that included cases from a National Registry supported by the Spanish Society of Neonatology. Neonates with postnatal SARS-CoV-2 infection were included in this study. General data and infection-related information (mode and source of transmission, age at diagnosis, clinical manifestations, need for hospitalization, admission unit, treatment administered, and complementary studies performed, hospital stay associated with the infection) were collected.Results: A total of 40 cases, 26 community-acquired and 14 nosocomial were registered. Ten were preterm newborns (2 community-acquired and 8 nosocomial COVID-19 cases). Mothers (in both groups) and healthcare workers (in nosocomial cases) were the main source of infection. Hospital admission was required in 22 community-acquired cases [18 admitted to the neonatal intermediate care unit (NIMCU) and 4 to the neonatal intensive care unit (NICU)]. Among nosocomial COVID-19 cases (n = 14), previously admitted for other reasons, 4 were admitted to the NIMCU and 10 to the NICU. Ten asymptomatic patients were registered (5 in each group). In the remaining cases, clinical manifestations were generally mild in both groups, including upper respiratory airways infection, febrile syndrome or acute gastroenteritis with good overall health. In both groups, most severe cases occurred in preterm neonates or neonates with concomitant pathologies. Most of the cases did not require respiratory support. Hydroxychloroquine was administered to 4 patients in the community-acquired group and to 2 patients in the nosocomial group. Follow-up after hospital discharge was performed in most patients.Conclusions: This is the largest series of COVID-19 neonatal cases in Spain published to date. Although clinical manifestations were generally mild, prevention, treatment, and management in this group are essential.

Published
2020
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