J.M. Rodríguez Miguélez

EARLY ADMINISTRATION OF THE SECOND DOSE OF SURFACTANT (BERACTANT) IN THE TREATMENT OF SEVERE HYALINE MEMBRANE DISEASE

The aim of this study was to demonstrate that administration of the second dose of beractant 2 h after the first one is more effective than 6 h after the initial dose. The inclusion criteria for the recruitment of newborn infants were: age ≪8 h, birthweight 600–2000 g, gestational age 23–36 wk, need for mechanical ventilation with inspiratory oxygen fraction (F io2) ≫0.4 and mean airway pressure (MAP) ≪7cmH2O to obtain arterial oxygen tension (P ao2) values between 70 and 80mmHg, and thoracic X‐ray compatible with hyaline membrane disease (HMD). Newborns with major congenital malformations, hydrops fetalis or severe pulmonary hypoplasia, or being treated with high‐frequency oscillatory ventilation were excluded. In total, 57 premature newborns were studied, 20 of them below 1000 g, who received 100mgkg‐1 of beractant in 2 aliquots and showed an inadequate response, i.e. after 2 h of the first dose the newborn still needed a F io2≫ 0.4 and a MAP ≪ 7 cmH2O to achieve a P ao2 > 70 mmHg. The second dose was randomly administered 2 or 6 h from the first one.

Varicela neonatal: a propósito de un caso con bronconeumonía y edema hemorrágico pulmonar

Se presenta el caso de un recien nacido, hijo de madre con varicela iniciada 20 dias antes del parto, que presento un deterioro brusco del estado general a las 2 h de vida, con cianosis, distres respiratorio y emision de espuma rosada por la boca. Fue diagnosticado de bronconeumonia bilateral de probable etiologia varicelosa, con componente de edema hemorragico pulmonar. Preciso ventilacion mecanica y soporte inotropico durante 48 h, respondiendo de forma favorable al tratamiento intravenoso con aciclovir. Se obtuvo positividad de proteina C reactiva (PCR)-virus de la varicela zoster (VHZ) en liquido cefalorraquideo (LCR) y seroconversion de IgG anti-VHZ a los 10 dias de vida.

Los errores de tratamiento en una unidad neonatal, uno de los principales acontecimientos adversos

INTRODUCTION Neonatal units are one of the hospital areas most exposed to the committing of treatment errors. A medication error (ME) is defined as the avoidable incident secondary to drug misuse that causes or may cause harm to the patient. The aim of this paper is to present the incidence of ME (including feeding) reported in our neonatal unit and its characteristics and possible causal factors. A list of the strategies implemented for prevention is presented. MATERIAL AND METHODS An analysis was performed on the ME declared in a neonatal unit. RESULTS A total of 511 MEs have been reported over a period of seven years in the neonatal unit. The incidence in the critical care unit was 32.2 per 1000 hospital days or 20 per 100 patients, of which 0.22 per 1000 days had serious repercussions. The ME reported were, 39.5% prescribing errors, 68.1% administration errors, 0.6% were adverse drug reactions. Around two-thirds (65.4%) were produced by drugs, with 17% being intercepted. The large majority (89.4%) had no impact on the patient, but 0.6% caused permanent damage or death. Nurses reported 65.4% of MEs. The most commonly implicated causal factor was distraction (59%). Simple corrective action (alerts), and intermediate (protocols, clinical sessions and courses) and complex actions (causal analysis, monograph) were performed. CONCLUSIONS It is essential to determine the current state of ME, in order to establish preventive measures and, together with teamwork and good practices, promote a climate of safety.

Caminando hacia una cultura de seguridad en la unidad neonatal: experiencia de 6 años

INTRODUCTION A safety culture is the collective effort of an institution to direct its resources toward the goal of safety. MATERIAL AND METHODS An analysis is performed on the six years of experience of the Committee on the Safety of Neonatal Patient. A mailbox was created for the declaration of adverse events, and measures for their correction were devised, such as case studies, continuous education, prevention of nosocomial infections, as well as information on the work done and its assessment. RESULTS A total of 1287 reports of adverse events were received during the six years, of which 600 (50.8%) occurred in the neonatal ICU, with 15 (1.2%) contributing to death, and 1282 (99.6%) considered preventable. Simple corrective measures (notification, security alerts, etc.) were applied in 559 (43.4%), intermediate measures (protocols, monthly newsletter, etc.) in 692 (53.8%), and more complex measures (causal analysis, scripts, continuous education seminars, prospective studies, etc.) in 66 (5.1%). As regards nosocomial infections, the prevention strategies implemented (hand washing, insertion and maintenance of catheters) directly affected their improvement. Two surveys were conducted to determine the level of satisfaction with the Committee on the Safety of Neonatal Patient. A rating 7.5/10 was obtained in the local survey, while using the Spanish version of the Hospital Survey on Patient Safety Culture the rate was 7.26/10. CONCLUSIONS A path to a culture of safety has been successfully started and carried out. Reporting the adverse events is the key to obtaining information on their nature, etiology and evolution, and to undertake possible prevention strategies.