Neopágina Diciembre 2018 Tabla de contenido 1. Hipotermia terapéutica, asfixia perinatal y sepsis de inicio precoz. Página 3. 2. Lactancia materna : manejo y almacenamiento de leche materna en domicilio. Página 10. 3. Oximetría retinal y niveles de oxígeno arterial sistémico. Pagina 17. 4. Cafeína y flujo de arteria mesentérica superior en prematuros. Página 61. 5. Glicemia neonatal y neurodesarrollo. Página 66. 6. Outcomes neurodesarrollo de prematuros con peso nacimiento ≤ 500 grs. Página 77 7. Peso de nacimiento y curva Intergrowth. Página 87. 8. Sindrome de abstinencia neonatal. Página 94. 9. Displasia broncopulmonar y moduladores de inflamación. Página 99. 10. Displasia broncopulmonar : prevención con surfactante y esteroides. Página 111. 11. Displasia broncopulmonar : diagnóstico y manejo. Página 120. 12. Displasia bronco pulmonar : fisiopatología y tratamiento. Página 132. 13. Displasia broncopulmonar : variación genética en respuesta a corticoides. Página 152. 14. Displasia broncopulmonar : factores predisponentes neonatales. Página 177. 15. Displasia broncopulmonar : outcomes pulmonar y neurodesarrollo. Página189. 16. Displasia broncopulmonar : manejo al alta. Página 196. 17. Avances en Pediatría Neonatal. 7 a 10 Mayo-2019 Página 203. 3 Original Paper Neonatology 2019;115:127–133 Received: May 5, 2018 DOI: 10.1159/000493358 Accepted after revision: August 27, 2018 Published online: November 12, 2018 Outcome of Infants with Therapeutic Hypothermia after Perinatal Asphyxia and Early-Onset Sepsis a b c d Mariam Hakobyan Koen P. Dijkman Sabrina Laroche Gunnar Naulaers e f g Monique Rijken Katerina Steiner Henrica L.M. van Straaten h i j Renate M.C. Swarte Hendrik J. ter Horst Alexandra Zecic k a Inge A. Zonnenberg Floris Groenendaal a Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht and Utrecht b University, Utrecht, The Netherlands; Department of Neonatology, Máxima Medical Centre, Veldhoven, c d The Netherlands; Department of Neonatology, University Hospital, Antwerp, Belgium; Department of e Neonatology, University Hospital, Leuven, Belgium; Department of Neonatology, Leiden University Medical f Center, Leiden, The Netherlands; Department of Neonatology, Radboud University Medical Center, Radboud g Institute for Health Science, Amalia Children’s Hospital, Nijmegen, The Netherlands; Department of Neonatology, h Isala Clinics, Zwolle, The Netherlands; Department of Neonatology, Erasmus Medical Center Sophia, Rotterdam, i The Netherlands; Department of Neonatology, Beatrix Children’s Hospital, University Medical Centre Groningen, j k Groningen, The Netherlands; Department of Neonatology, University Hospital, Gent, Belgium; Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands Keywords 42 infants (gestational age 36.1–42.6 weeks and birth weight Early-onset sepsis · Perinatal asphyxia · Therapeutic 2,280–5,240 g) with proven sepsis (n = 14) and probable sep- hypothermia · Cerebral palsy · Neurodevelopmental sis (n = 28) was analyzed. Death, cerebral palsy, or a delayed impairment · Group B streptococcus development at 2 years was considered an adverse out- come. Results: Sepsis was caused mostly by group B strep- tococci (n = 17), other Gram-positive bacteria (n = 5), and Abstract Candida albicans (n = 1). Of the 42 infants, 9 (21.4%) died, and Background: Animal models suggest that neuroprotective 5 (11.9%) showed impairments on follow-up. The outcome effects of therapeutic hypothermia (TH) after perinatal as- is comparable to the previously reported outcome of infants phyxia are reduced in infants with early-onset sepsis. Objec- with TH without early-onset sepsis. Conclusion: A good out- tives: To assess the outcome of infants with perinatal as- come was reported in the majority of infants with perinatal phyxia, neonatal encephalopathy, and TH in the presence of asphyxia, TH, and early-onset sepsis. Cooling should not be early-onset sepsis. Methods: In a retrospective cohort of withheld from these infants. © 2018 The Author(s) 1,084 infants with perinatal asphyxia and TH, the outcome of Published by S. Karger AG, Basel © 2018 The Author(s) Floris Groenendaal Published by S. Karger AG, Basel Department of Neonatology, Room KE.04.123.1 Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6 E-Mail [email protected] This article is licensed under the Creative Commons Attribution- NL–3584 EA Utrecht (The Netherlands) www.karger.com/neo NonCommercial-NoDerivatives 4.0 International License (CC BY- NC-ND) (http://www.karger.com/Services/OpenAccessLicense). E-Mail F.Groenendaal @ umcutrecht.nl Usage and distribution for commercial purposes as well as any dis- tribution of modified material requires written permission. Introduction a good aEEG background pattern on admission, TH was started because of a high Thompson score. In all infants, aEEG was used routinely, and patterns were ana- Neonatal encephalopathy (NE) following perinatal as- lyzed as described previously [14]. Clinical and/or aEEG-detected phyxia in term neonates is still a common and serious seizures were treated according to the Dutch/Flemish neonatal sei- condition. The prevalence of NE after perinatal asphyxia zure protocol which includes phenobarbital with midazolam and/ is approximately 1–6 per 1,000 full-term live births [1, 2]. or lidocaine as add-on therapy [15]. Brain imaging (cranial ultra- It is well known that infants with moderate-to-severe NE sound and MRI) was collected from the files. MRI abnormalities were reported as watershed lesions, lesions in the basal ganglia and carry a high risk of adverse outcome, such as cerebral pal- thalamus (BGT), or near total injury [16]. sy (CP), neurodevelopmental impairment, or mortality, even after therapeutic hypothermia (TH) [1, 3, 4]. In ad- Outcome dition, early-onset sepsis which is mostly caused by group After discharge, follow-up assessments were performed in the B streptococcus (GBS) or Gram-negative organisms, such participating hospitals at regular intervals up to at least 18 months in the routine follow-up program. Death, CP, neurodevelopmental as Escherichia coli, carries a high risk of an adverse out- impairment of > 3 months, a Griffiths’ developmental quotient come [5]. The outcome of infants with perinatal asphyxia, < 88 (–1 standard deviation, SD), or a score on the Bayley Scales of early-onset sepsis, and TH has not been reported in much Infant and Toddler Development-III < 85 (–1 SD) were all consid- detail. It has been suggested that encephalopathic new- ered an adverse outcome. In addition, infants (n = 4) with a normal borns with early-onset sepsis may have a worse outcome MRI at birth and having no neurological abnormalities at the age of 6 months, and 2 additional infants with a normal MRI and no compared to nonseptic neonates [6]. Studies in adults follow-up data were categorized in the group with no adverse out- with sepsis did not show benefits of hypothermia [7]. In come. addition, in the study by Geurts et al. [8] an increased risk for pneumonia and sepsis was observed, although Statistical Analysis the overall infection risk was not significantly higher. At Mortality and adverse neurodevelopmental outcome data were compared to the data reported previously in our units [3] and a present, little is known about the interplay of hypother- Cochrane review [4], using χ2 tests, Fisher tests, or analysis of vari- mia and sepsis. Several animal models have examined the ance (ANOVA) where appropriate. Data were expressed as mean neuroprotective effect of TH in the presence of bacterial ± SD, median with interquartile range (IQR), or in percentages. infections and results are inconclusive [9–12]. With the number of 42 patients, it would be possible to compare In the present study, the outcome of infants with peri- neuroprotective effects of hypothermia in septic patients (both proven and probable sepsis combined) with all hypothermia pa- natal asphyxia, NE treated with hypothermia, and early- tients presented in the studies mentioned above [3, 4] with an al- onset sepsis was assessed. pha of 0.05 and a power of 0.80. This retrospective study was ap- proved by the local ethics committee, and the requirement to ob- tain informed consent for this study with anonymous data analysis Subjects and Methods was waived according to national regulations. Infants with a gestational age between 36 + 0 and 42 + 0 weeks with perinatal asphyxia, NE, and TH admitted to one of the level III participating Neonatal Intensive Care Units (NICU) in the Results Netherlands or Flanders, Belgium, between January 2008 and De- cember 2016 were included. During this period, 1,084 infants were Between January 2008 and December 2017, 42 infants treated with TH in the participating hospitals. Retrospectively, data were collected from the medical files. Growth percentiles were with perinatal asphyxia and TH showed early-onset sep- calculated according to the Netherlands Perinatal Registry Birth sis. Of these 42 infants, 14 infants had proven sepsis and Weight centiles (www.perined.nl) [13]. 28 probable sepsis. Clinical data of our patients are pre- Infants with positive blood cultures within 48 h after birth and sented in Table 1. Clinical data were not significantly dif- clinical signs of sepsis were considered to have a proven sepsis. In- ferent between the proven and probable sepsis groups. fants with clinical signs of early-onset sepsis and an elevated CRP Gestational age and birth weight were lower in the neo- (≥50 mg/L)