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      ESTUDIO SOBRE NEONATOS VENTILADOS EN CIUDAD DE LA HABANA, 2004 Translated title: Study of newborns that required mechanical ventilation. Havana City, 2004

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          Abstract

          Un estudio prospectivo y multicéntrico se realizó en Ciudad de La Habana. Fueron estudiados un total de 241 recién nacidos, quienes recibieron ventilación mecánica en seis unidades de cuidados intensivos neonatales entre enero y diciembre de 2004. Sólo 60 (24,8%) fallecieron. El objetivo del estudio fue investigar la relación existente entre diferentes variables seleccionadas y la mortalidad de los recién nacidos ventilados. Se aplicó la prueba de x 2 (Ji Cuadrado), considerando significativo (p<0.01) y se calculó el exponencial de b como una medida del riesgo de fallecer. Las variables que guardaron relación con la mortalidad fueron la edad gestacional, el exceso de base y el empeoramiento de las funciones ventilatoria, hemodinámica, neurológica y renal. El recién nacido de muy bajo peso al nacer tuvo alta correlación con la mortalidad; 37 pacientes pesaron menos de 1500 gramos , 19 de ellos (51,3%) fallecieron. La mayor mortalidad se presentó en los que tuvieron hipertensión pulmonar persistente, 17 fallecidos de 40 (42,5%), mientras la hemorragia intraventricular tuvo una significativa mortalidad, 8 de 12 (66,6%) niños con hemorragia intraventricular grado III-IV fallecieron. Concluimos que los neonatos de muy bajo peso al nacer son los que presentan mayor riesgo de muerte, así como los que presentan disfunción multiorgánica.

          Translated abstract

          A prospective and multicenter study was made in Havana city between January and December, 2004. Two hundred and forty-one newborns admitted to six intensive care units that required mechanical ventilation were enrolled. Only 60 babies died which represented 24,8%. The objective of this study was to investigate the relationship between different variable and mortality; we also wanted to evaluate the most common diseases that affected our ventilated patients. Very low birth weight was an important factor of neonatal mortality. Thirty seven neonates weighed less than 1500grams; 19 of them (51,3%) died. The great mortality was in those babies who suffered from persistent pulmonary hypertension; seventeen infants died out of 40 (42,5%) while intraventricular haemorrhage had a significant mortality; 8 of 12 (66,6%) infants with intraventricular haemorrhage grade III-IV died. We concluded that very low birth weight infants and those who suffered multiple organ dysfunctions had a significant mortality.

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          Perinatal care at the threshold of viability.

          In the United States, an increase in the number of births of extremely preterm infants and in their survival potential has occurred over the last decade. Determining the survival prognosis for the infant of a pregnancy with threatened preterm delivery between 22 and 25 completed weeks of gestation remains problematic. Many physicians and families encounter the difficulty of making decisions regarding the institution and continuation of life support for an infant born within this threshold period. This report addresses the process of counseling, assisting, and supporting families faced with the dilemma of an extremely preterm delivery.
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            The heavier the better? Birthweight and perinatal mortality in different ethnic groups.

            Mother's ethnicity is associated with her baby's birthweight and risk of perinatal mortality. Given the close relation between birthweight and perinatal mortality, we explored whether ethnic differences in birthweight explain ethnic differences in perinatal mortality. Data on all births to mothers born in Norway (808 658), Pakistan (6854), Vietnam (3283) and North Africa (1461) from 1980 to 1995 were obtained from the Medical Birth Registry of Norway. The associations between birthweight and perinatal mortality among ethnic groups were analysed using univariate and multivariate methods. Mean birthweights were low for Vietnamese and Pakistani mothers (3202 g, 3244 g) and high for Norwegian and North African mothers (3530 g, 3559 g). Mean birthweights were largely unrelated to perinatal mortality, which was lowest for Vietnamese (8.2/1000, 95% CI: 5.1-11.3) and highest for Pakistanis (14.9/1000, 95% CI: 12.0-17.7). Intermediate perinatal mortality rates were found among Norwegians (9.5/1000, 95% CI: 9.3-9.7) and North Africans (9.6/1000, 95% CI: 4.6-14.6). Further comparison of weight-specific mortality rates between the two largest ethnic groups showed the low birthweight paradox, where among low-weight births, perinatal mortality was lower among Pakistani than among Norwegian babies. However, adjustment to a relative birthweight scale (units of standard deviations from population-specific mean value) revealed higher rates of weight-specific mortality among Pakistanis across the entire range of birthweights. Multivariate adjustment for relative birthweight and other factors did not change these results. Differences in perinatal mortality between the ethnic groups were not explained by differences in mean birthweight. Paradoxical differences in birthweight-specific mortality rates could be resolved by adjustment to a relative scale.
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              Survival of very-low-birth-weight infants according to birth weight and gestational age in a public hospital.

              To determine the survival rates for infants weighing 500 - 1 499 g according to birth weight (BW) and gestational age (GA). This was a retrospective cohort study. Pregnancy and delivery data were collected soon after birth and neonatal data at discharge or at death. Chris Hani Baragwanath Hospital (CHBH), a public-sector referral hospital, affiliated to the University of the Witwatersrand. Live births weighing between 500 g and 1 499 g delivered at or admitted to CHBH from January 2000 to December 2002. BW and GA-specific survival rates for all live infants born at CHBH and for those admitted for neonatal care. Seventy-two per cent of infants survived until discharge. The survival to discharge rate was 32% for infants weighing < 1 000 g, and 84% for those weighing 1 000 - 1 499 g. Survival rates at 26, 27 and 28 weeks' gestation were 38%, 50% and 65% respectively. Survival rates for infants admitted to the neonatal unit were better than rates for all live births, especially among those weighing < 1 000 g or with a GA < 28 weeks. There was a marked increase in survival between the 900 - 999 g and 1 000 - 1 099 g weight groups. Provision of antenatal care, caesarean section, female gender and an Apgar score more than 5 at 1 or 5 minutes were associated with better survival to hospital discharge. Survival among infants weighing less than 1 000 g is poor. In addition to severe prematurity, the poor survival among these infants (< 1 000 g) is most likely related to the fact that they were not offered mechanical ventilation. Mechanical ventilation should be offered to infants weighing < 1 000 g as it may improve their survival even in institutions with limited resources.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rhcm
                Revista Habanera de Ciencias Médicas
                Rev haban cienc méd
                Universidad de Ciencias Médicas de la Habana (La Habana )
                1729-519X
                June 2007
                : 6
                : 2
                : 0
                Affiliations
                [1 ] Dirección Provincial de Salud Cuba
                Article
                S1729-519X2007000200008
                ae792076-83e4-4b05-bda7-c0eae4f75a97

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=1729-519X&lng=en
                Categories
                HEALTH CARE SCIENCES & SERVICES

                Health & Social care
                mechanical ventilation,neonatal mortality,very low birth weight,Ventilación mecánica,mortalidad neonatal,muy bajo peso

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