medigraphic.com
Órgano Oficial del Hospital Angeles Health System

2016, Número 1

<< Anterior Siguiente >>

Acta Med 2016; 14 (1)


Estabilización temprana del recién nacido pretérmino menor de 1,200 gramos

Nuñez PAJR, Orozco GA

Idioma: Español
Referencias bibliográficas: 51
Paginas: 25-31
Archivo PDF: 159.92 Kb.


RESUMEN

Se establecen los objetivos de monitorización e intervención terapéutica durante las primeras 24 horas de vida en recién nacidos con peso menor de 1,200 g, los cuales son: diagnosticar bajo flujo sistémico y por órganos mediante detección de antecedentes y datos clínicos como asfixia perinatal, sepsis, sangrado, ventilación mecánica, hipotensión, hipoperfusión tisular, acidosis metabólica y falla renal. Establecer manejo ventilatorio adecuado obteniendo metas como pH 7.25-7.40, PCO2 mayor de 35 hasta 55 mmHg y PO2 entre 30 y 60 mmHg en muestras capilares. Mantenimiento de la perfusión cerebral adecuada mediante la obtención de presión arterial media óptima (15% por encima de la edad gestacional en semanas) a través de medidas como pinzamiento tardío u ordenamiento de cordón umbilical y el uso de fármacos vasoactivos en caso necesario. Monitorización de alteraciones cerebrales tempranas mediante electroencefalograma de amplitud integrada y ultrasonografía Doppler cerebral. La monitorización y conocimiento de límites fisiológicos de las constantes vitales y la estratificación de variaciones en este periodo modifica el curso clínico mediante el reconocimiento y manejo temprano de las alteraciones ventilatorias, hemodinámicas y de perfusión.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Pellicer A, Valverde E, Elorza MD, Madero R, Gayá F, Quero J, Cabañas F. Cardiovascular support for low birth weight infants and cerebral hemodynamics: a randomized, blinded, clinical trial. Pediatrics. 2005; 115 (6): 1501-1512.

  2. Osborn D, Evans N, Kluckow M; Diagnosis and Treatment of Low Systemic Blood Flow in Preterm Infants; NeoReviews. 2004; 5: 109.

  3. Pellicer A, Gaya F, Madero R, Quero J, Cabañas F. Noninvasive continuous monitoring of the effects of head position on brain hemodynamics in ventilated infants. Pediatrics. 2002; 109: 434-440.

  4. Aladangady N, Mc Hugh S, Aitchison T et al. Infants’ blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics. 2006; 117: 93-98.

  5. Gutierrez A, Velasquez R, Iriarte M. Analysis of clinical course in term patients with early and delayed umbilical cord clamping after birth. The Internet Journal of Pediatrics and Neonatology. 2009; 11(2).

  6. Singhal N, Niermeyer S. Neonatal resuscitation where resources are limited. Clin Perinatol. 2006; 33: 219-228.

  7. Mercer J, Vohr B, McGrath M et al. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized controlled trial. Pediatrics. 2006; 117: 1235-1242.

  8. Strauss RG, Mock DM, Johnson K et al. Circulating RBC volume, measured with biotinylated RBCs, is superior to the Hct to document the hematologic effects of delayed versus immediate umbilical cord clamping in preterm neonates. Transfusion. 2003; 43 (8): 1168-1172.

  9. Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics. 2015; 136: 61-69.

  10. Kluckow M, Evans N. Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2000; 82 (3): F188-F194.

  11. Aladangady N, Aitchison TC, Beckett C, Holland BM, Kyle BM, Wardrop CA. Is it possible to predict the blood volume of a sick preterm infant? Arch Dis Child Fetal Neonatal Ed. 2004; 89 (4): F344-347.

  12. Fanaroff JM, Wilson-Costello DE, Newman NS, Montpetite MM, Fanaroff AA. Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants. Pediatrics. 2006; 117: 1131-1135.

  13. Soll R, Morley CJ. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews. 2001; I (2): CD000510.

  14. Kattwinkel J, Bloom BT, Delmore P et al. Prophylactic administration of calf lung surfactant extract is more effective than early treatment of respiratory distress syndrome in neonates of 29 through 32 weeks’ gestation. Pediatrics. 1993; 92: 90-98.

  15. Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database of Systematic Reviews. 1999; (4): CD001456.

  16. Durand D, Mickas N. 17 Blood gases: technical aspects and interpretation. In: Goldsmith JP, Karotkin EH. Assisted ventilation of the neonate. 5th ed. Elsevier, 2011. pp. 292-305.

  17. Ambalavanan N, Carlo WA. Hypocapnia and hypercapnia in respiratory management of newborn infants. Clin Perinatol. 28:517, 2001.

  18. Varughese M, Patole S, Shama A, Whitehall J. Permissive hypercapnia in neonates: the case of the good, the bad, and the ugly. Pediatr Pulmonol. 2002; 33: 56-64.

  19. Gleason CA, Short BL, Jones MD. Cerebral blood flow and metabolism during and after prolonged hypocapnia in newborn lambs. J Pediatr. 1989; 115: 309-314.

  20. Fabres J, Carlo W, Phillips V, Howard G, Ambalavanan N. Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants. Pediatrics. 2007; 119: 299-305.

  21. Wiswell TE, Graziani LJ, Kornhauser MS et al. Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation. Pediatrics. 1996; 98: 918-924.

  22. Blanchette V, Doyle J, Schmidt B et al. Hematology. In: Avery GB, Fletcher MA, MacDonald MG, ed. Neonatology, pathophysiology and management of the newborn. Philadelphia: J.B. Lippincott; 1994. pp. 972-973.

  23. Guyton AC, Grainger HC, Coleman TJ. Autoregulation of the total systemic circulation and its relation to control of cardiac output and arterial pressure. Circ Res. 1971; 28 (Suppl 1): 93-97.

  24. Dudell G, Cornish JD, Bartlett RH. What constitutes adequate oxygenation? Pediatrics. 1990; 85: 39-41.

  25. Stenson B, Brocklehurst P, Tarnow-Mordi W. Increased 36-week survival with high oxygen saturation target in extremely preterm infants. N Engl J Med. 2011; 364: 1680-1682.

  26. Nijland R, Jongsma H, Nijhuis J et al. Arterial oxygen saturation in relation to metabolic acidosis in fetal lambs. Am J Obstet Gynaecol. 1995; 172: 810-819.

  27. Tin W, Wariyar U. Giving small babies oxygen: 50 years of uncertainty. Semin Neonatol. 2002; 7: 361-367.

  28. Tin W. Oxygen therapy: 50 years of uncertainty. Pediatrics. 2002; 110: 615-616.

  29. Cole CH, Wright KW, Tarnow-Mordi W et al. Resolving our uncertainty about oxygen therapy. Pediatrics. 2003; 112: 1415-1419.

  30. Sola A. Oxygen saturation in the newborn and the importance of avoiding hyperoxia-induced damage. Neoreviews. 2015; 16: e393-e405.

  31. Claure N, Bancalari E. Oxygen saturation targeting by automatic control of inspired oxygen in premature infants. Neoreviews. 2015; 16: e406-e412.

  32. Hegyi T, Carbone MT, Anwar M et al. Blood pressure ranges in premature infants, I: the first hours of life. J Pediatr. 1994; 124: 627-633.

  33. Phillipos EZ, Robertson MA. A randomized blinded trial of dopamine versus epinephrine for inotropic support in the sick newborn. Proc 2nd World Congress PCCS. 1997: 897-899.

  34. Seri I, Evans J. Addition of epinephrine to dopamine increases blood pressure and urine output in critically ill extremely low birth weight neonates with uncompensated shock. Pediatr Res. 1998; 43: 194A.

  35. Pellicer A, Bravo MC, Madero R, Salas S, Quero J, Cabañas F. Early systemic hypotension and vasopressor support in low birth weight infants: impact on neurodevelopment. Pediatrics. 2009; 123 (5): 1369-1376.

  36. Barrington K, Brion LP. Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants. Cochrane Database of Systematic Reviews. 2002; 3: CD003213

  37. Lemmers PM, Toet M, van Schelven LJ, van Bel F. Cerebral oxygenation and cerebral oxygen extraction in the preterm infant: the impact of respiratory distress syndrome. Exp Brain Res. 2006; 173: 458-467.

  38. Meek JH, Elwell CE, McCormick DC et al. Abnormal cerebral haemodynamics in perinatally asphyxiated neonates related to outcome. Arch Dis Child Fetal Neonatal Ed. 1999; 81: F110-F115.

  39. Dietz V, Wolf M, Keel M, von Siebenthal K, Baenziger O, Bucher H. CO2 reactivity of the cerebral hemoglobin concentration in healthy term newborns measured by near infrared spectrophotometry. Biol Neonate. 1999; 75: 85-90.

  40. Menke J, Voss U, Moller G, Jorch G. Reproducibility of cerebral near infrared spectroscopy in neonates. Biol Neonate. 2003; 83: 6-11.

  41. Tsuji M, Saul P, du Plessis A et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics. 2000; 106: 625-632.

  42. Seri I, Tan R, Evans J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics. 2001; 107: 1070-1074.

  43. Burdjalov VF, Baumgart S, Spitzer AR. Cerebral function monitoring: a new scoring system for the evaluation of brain maturation in neonates. Pediatrics. 2003; 112: 855-861.

  44. Klebermass K, Kuhle S, Olischar M, Rucklinger E, Pollak A, Weninger M. Intra- and extrauterine maturation of amplitudeintegrated electroencephalographic activity in preterm infants younger than 30 weeks of gestation. Biol Neonate. 2006; 89: 120-125.

  45. Hellström-Westas L, Rose’n I, Svenningsen N. Cerebral function monitoring during the first week of life in extremely small low birthweight (ESLBW) infants. Neuropediatr. 1991; 22: 27-32.

  46. William D. Rhine, Francis G. Blankenberg; Cranial ultrasonography. Neoreviews. 2001; 2 (1): e3-e11.

  47. Volpe JJ. Intracranial hemorrhage: germinal matrix-intraventricular hemorrhage of the premature infant. In: Volpe JJ, ed. Neurology of the newborn. 4th ed. Philadelphia, PA: WB Saunders; 2001. pp. 428-493.

  48. Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J et al. Part 15: neonatal resuscitation 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122 (18 suppl 3): S909-S919.

  49. Finer NN. Nasal cannula use in the preterm infant: oxygen or pressure? Pediatrics. 2005; 116: 1216-1217.

  50. Kilgannon JH, Jones AE, Shapiro NI, Angelos MG, Milcarek B, Hunter K; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010; 303 (21): 2165-2171.

  51. Chow LC, Wright KW, Sola A; CSMC Oxygen Administration Study Group. Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics. 2003; 111 (2): 339-345.




2020     |     www.medigraphic.com