Juan Carlos Barrera-de León

Higher prolactin and vasoinhibin serum levels associated with incidence and progression of retinopathy of prematurity

Background:Retinopathy of prematurity (ROP) is a potentially blinding, retinal neovascular disease. Systemic prolactin accesses the retina to regulate blood vessels. Prolactin is proangiogenic and can be cleaved to antiangiogenic vasoinhibins. We investigated whether circulating prolactin and vasoinhibins associate with incidence and progression of ROP.Methods:A prospective, longitudinal, case–control study covering postnatal weeks 1 to 9 measured serum prolactin, vasoinhibins, and vascular endothelial growth factor (VEGF) weekly in 90 premature infants diagnosed as ROP or control.Results:Prolactin levels were higher in ROP than in control patients before (106.2 ± 11.3 (SEM) vs. 64.7 ± 4.9 ng/ml, postnatal week 1) and during (120.6 ± 10 vs. 84.7 ± 7.5ng/ml, postnatal week 5) ROP diagnosis. Prolactin, but not gestational age, birth weight, Apgar score, sepsis, or ventilation time, correlated with ROP. The relative risk (RR) of developing ROP increased if Prolactin (PRL) levels were higher than thresholds of 80 ng/ml (RR = 1.55, 95% CI: 1.06–2.28), 100 ng/ml (RR = 1.63, 95% CI: 1.14–2.34), or 120 ng/ml (RR = 1.95, 95% CI: 1.41–2.68). Vasoinhibin levels were 39.7% higher (95% CI: 4.5–77.5) in the circulation of ROP than in control patients at postnatal week 1 and similar thereafter, whereas VEGF serum levels were always similar.Conclusion:High serum prolactin and vasoinhibin levels predict and may impact ROP progression.

Propofol for Procedural Anaesthesia During Laser Treatment of Retinopathy of Prematurity in the Neonatal Intensive Care Unit (NICU)

Background: Anaesthesia in preterm neonates poses certain risks due to such patients’ systemic instability and concurrent pathologies, as the procedure itself can accentuate such instability and morbidity in these patients. Anaesthesia for LASER procedures for ROP must be a safe procedure that ensures the patient’s stability during and after the procedure. The purpose of this paper is to describe the anaesthesia techniques used in the neonatal intensive care units (NICUs), and evaluate their results. Methods: Retrospective cross-sectional study carried out from January to December 2012, which included 79 out of 102 patients operated on during such period using laser photocoagulation for ROP under general anaesthesia with intravenous Fentanyl and Propofol administered by a Paediatric Anaesthesiologist. Results: The anaesthesia had a median duration of 75 minutes, and no periods of hypotension were reported. Seventy-eight patients (98%) were extubated at the end of the surgery and one patient remained intubated due to hemodynamic instability related to sepsis. Additionally, it was necessary to re-intubate 2 patients (3%) and 1 patient (1%) required nasal cannulas for 12 hours due to low O2Sat. Conclusions: In the NICU, a combination of Fentanyl and Propofol-without administration of muscle relaxants— is a safe, useful technique for treatment of preterm neonates undergoing brief surgical procedures such as laser photocoagulation. The rapid recovery associated to this technique helps to meet the increasing demand for ROP surgeries and reduces the length of hospitalization. A multivariate regression model considering the complications of intravenous general anesthesia with propofol as the dependent variable was carried out. We observed that the Durbin-Watson test score presented independence of errors (2,135). For the regression model with independent variables, we found that none of them explains the variance of the dependent variable as shown in Table 5. The ANOVA of the regression model with these variables indicates that this does not significantly improve the prediction of complication DV (F = 1.607 and p = 0.129). For the coefficients of the regression model, T-scores reflect that the variables taken into account do not significantly contribute to the prediction model, and therefore that the values obtained can not be generalized to the greater population

Aptitud de padres para prevenir abuso sexual en menores después de una intervención educativa participativa

Objective. To evaluate the aptitude of parents regarding the educational impact of equity education for children to prevent child sexual abuse using participatory strategies. Material and Methods. Quasi-experimental design. Ninetytwo parents with children in preschool were included in the study. The parents were given a course using participatory educational strategies for one hour daily over a period of 20 days. Prior to the course, a group of experts in child education and sexology prepared a questionnaire with 20 sentences. A Wilcoxon test was used to compare intergroup differences Results. We found statistically significant differences in the parents’ responses before and after the educational intervention, with a median (range) of 10(2-12)/18(6-20), p<0.01. Conclusions. A significant change in aptitude was noted when parents attended classes using a participatory strategy to learn about the impact of educational equity for the prevention of child sexual abuse. Thus, it is imperative to continue evaluating different educational strategies.

Complicaciones asociadas al catéter percutáneo en recién nacidos pretérmino y a término

espanolObjetivo: Identificar las complicaciones asociadas al cateter percutaneo en recien nacidos pretermino y a termino. Metodo: Estudio transversal comparativo. Se incluyeron recien nacidos que tenian insertado un cateter percutaneo, con resultados de cultivo de sangre y segmento distal del cateter. Se formaron dos grupos: pretermino y a termino. Se calcularon la razon de momios (RM) y el intervalo de confianza del 95% (IC 95%). Resultados: Se analizaron datos de 50 recien nacidos por grupo. En los pretermino y a termino se encontro un valor de la media de edad gestacional de 30 ± 3 y 40 ± 2, respectivamente (p = 0.01), y unos porcentajes de sepsis por cateter del 36 y el 18% (p = 0.02; RM: 2.56; IC 95%: 1.02-7.17), de cateter infectado del 50 y el 22% (p = 0.01; RM: 5.92; IC 95%: 1.66-23.12), de cateter colonizado del 24 y el 14% (p = 0.01; RM: 3.58; IC 95%: 1.32-9.90), de infeccion local del 14 y el 8% (p = 0.03; RM: 1.87; IC 95%: 1.45-8.29), de infiltracion del 18 y el 4% (p = 0.02; RM: 5.27; IC 95%: 1.17-59), de retiro accidental del 6 y el 22% (p = 0.02; RM: 0.23; IC 95%: 0.05-0.87) y de rotura del cateter del 10 y el 28% (p = 0.02; RM: 0.29; IC 95%: 0.08-0.98). Conclusiones: Se encontro mayor asociacion de infecciones e infiltraciones por cateter percutaneo en los pretermino, y de retiro accidental y rotura del cateter en los nacidos a termino. EnglishObjective: Identify percutaneous catheter-related complications in preterm and term newborns. Methods: Comparative cross-section. Were included newborns whit percutaneous catheter insertion, blood culture results and distal catheter segment. Were formed two groups: Preterm and term. Results: Were analyzed the data of preterm (n = 50) and term (n = 50) newborn, the gestational age was 30 ± 3 and 40 ± 2 (p = 0.01). The frecuency in preterm and term newborn was respectively, sepsis catheter 36 and 18% (p = 0.02; OR: 2.56; 95% CI: 1.02-7.17), infected catheter 50 and 22% (p = 0.01; OR: 5.92; 95% CI: 1.66-23.12), colonized catheter of 24 and 14% (p = 0.01; OR: 3.58; 95% CI: 1.32-9.90), local infection 14 and 8% (p = 0.03; OR: 1.87; 95% CI: 1.45-8.29), infiltration 18 and 4% (p = 0.02; OR: 5.27; 95% CI: 1.17-59), accidental removal 6 and 22% (p = 0.02; OR: 0.23; 95% CI: 0.05-0.87) and catheter rupture 10 and 28% (p = 0.02; OR: 0.29; 95% CI: 0.08-0.98). Conclusions: We found a higher association of infections and infiltrations by percutaneous catheter in preterm and term prevailed in accidental removal and catheter rupture.