Morbimortalidad de recién nacidos prematuros extremos en un centro de referencia de Medellín, Colombia durante el período 2014-2019
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Introducción: El aumento de sobrevida en niños nacidos pretérmino en las últimas décadas obedece a adelantos científicos y formativos del personal sanitario. Objetivo: Estimar la morbimortalidad en recién nacidos extremadamente pretérmino, evaluar la asociación entre edad gestacional temprana y peso al nacer sobre mortalidad intrahospitalaria en un centro de referencia de Medellín, Colombia. Metodología: estudio observacional analítico, incluye los recién nacidos extremadamente prematuros (24/0 a 27/6 semanas de edad gestacional) ingresados a unidad de cuidado intensivo neonatal de un centro de referencia en Medellín, Colombia entre 2014 y 2019. Las variables demográficas, clínicas y desenlace al momento del egreso se tomaron de historias clínicas retrospectivas. Se evaluó el efecto de la edad gestacional y peso sobre la mortalidad a través de regresión logística. Resultados: la edad gestacional encontrada con mayor frecuencia fue 26 semanas (39%), mediana de peso al nacer fue 790 gramos (rango 440 – 1190). Entre los sobrevivientes la morbilidad al egreso fue 95% y la complicación más frecuente fue displasia broncopulmonar con 85%. La mortalidad fue 48%; se encontró asociación significativa entre la mortalidad y la edad gestacional de 24 semanas (OR = 10,5 IC 95%=1,1 – 103,5) y el peso al nacer menor de 750 gramos (OR= 5,9 IC 95%= 2,1 – 16,2). Conclusiones: La mortalidad en neonatos extremadamente prematuros continúa siendo alta y se relaciona de inversamente con la edad gestacional y el peso al nacer; hay elevada proporción de morbilidad en los sobrevivientes.
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Wang D, Yasseen AS, Marchand-Martin L, Sprague AE, Graves E, Goffinet F, et al. A population-based comparison of preterm neonatal deaths (22–34 gestational weeks) in France and Ontario: a cohort study. C Open 2019;7:E159-66. https://doi.org/10.9778/cmajo.20180199. DOI: https://doi.org/10.9778/cmajo.20180199
Smith LK, Morisaki N, Morken NH, Gissler M, Deb-Rinker P, Rouleau J, et al. An international comparison of death classification at 22 to 25 weeks’ gestational age. Pediatrics 2018;142. https://doi.org/10.1542/peds.2017-3324. DOI: https://doi.org/10.1542/peds.2017-3324
Ruth CA, Roos N, Hildes-Ripstein E, Brownell M. ‘The influence of gestational age and socioeconomic status on neonatal outcomes in late preterm and early term gestation: a population based study’. BMC Pregnancy Childbirth 2012;12:62. https://doi.org/10.1186/1471-2393-12-62. DOI: https://doi.org/10.1186/1471-2393-12-62
Johnson CD, Jones S, Paranjothy S. Reducing low birth weight: Prioritizing action to address modifiable risk factors. J Public Heal (United Kingdom) 2017;39:122-31. https://doi.org/10.1093/pubmed/fdv212. DOI: https://doi.org/10.1093/pubmed/fdv212
Nimbalkar SM. Periviable Birth - The Ethical Conundrum: Few concerns: Author’s Reply. Indian Pediatr 2019;56:696-7. PMID: 31477662. DOI: https://doi.org/10.1007/s13312-019-1459-9
Geurtzen R, Van Heijst AFJ, Draaisma JMT, Kuijpers LJMK, Woiski M, Scheepers HCJ, et al. Development of nationwide recommendations to support prenatal counseling in extreme prematurity. Pediatrics 2019;143. https://doi.org/10.1542/peds.2018-3253. DOI: https://doi.org/10.1542/peds.2018-3253
Frey HA, Klebanoff MA. The epidemiology, etiology, and costs of preterm birth. Semin Fetal Neonatal Med 2016;21:68-73. https://doi.org/10.1016/j.siny.2015.12.011. DOI: https://doi.org/10.1016/j.siny.2015.12.011
Zegers MJ, Hukkelhoven CWPM, Uiterwaal CSPM, Kollée LAA, Groenendaal F. Changing Dutch approach and trends in short-term outcome of periviable preterms. Arch Dis Child Fetal Neonatal Ed 2016;101:F391-6. https://doi.org/10.1136/archdischild-2015-308803. DOI: https://doi.org/10.1136/archdischild-2015-308803
Chang JH, Hsu CH, Tsou KI, Jim WT. Outcomes and related factors in a cohort of infants born in Taiwan over a period of five years (2007–2011) with borderline viability. J Formos Med Assoc 2018;117:365-73. https://doi.org/10.1016/j.jfma.2018.01.018. DOI: https://doi.org/10.1016/j.jfma.2018.01.018
Ceriani Cernadas JM. The limits of viability in preterm infants, a growing ethical dilemma. Arch Argent Pediatr 2018;116:170-1. https://doi.org/10.5546/aap.2018.eng.170. DOI: https://doi.org/10.5546/aap.2018.eng.170
Wallenstein MB, Carmichael SL, Stevenson DK. Prematurity and Stillbirth. Avery’s Dis. Newborn Tenth Ed., Elsevier Inc.; 2018, p. 78-81.e3. https://doi.org/10.1016/B978-0-323-40139-5.00008-5. DOI: https://doi.org/10.1016/B978-0-323-40139-5.00008-5
Rysavy MA, Horbar JD, Bell EF, Li L, Greenberg LT, Tyson JE, et al. Assessment of an Updated Neonatal Research Network Extremely Preterm Birth Outcome Model in the Vermont Oxford Network. JAMA Pediatr 2020;174:e196294. https://doi.org/10.1001/jamapediatrics.2019.6294. DOI: https://doi.org/10.1001/jamapediatrics.2019.6294
Pierrat V, Burguet A, Marchand-Martin L, Cambonie G, Coquelin A, Roze JC, et al. Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: The French EPIPAGE-2 cohort study. BMJ Open 2020;10:1-11. https://doi.org/10.1136/bmjopen-2019-035075. DOI: https://doi.org/10.1136/bmjopen-2019-035075
Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991;119:417-23. https://doi.org/10.1016/S0022-3476(05)82056-6. DOI: https://doi.org/10.1016/S0022-3476(05)82056-6
Fenton TR, Nasser R, Eliasziw M, Kim JH, Bilan D, Sauve R. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr 2013;13. https://doi.org/10.1186/1471-2431-13-92. DOI: https://doi.org/10.1186/1471-2431-13-92
Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal Necrotizing Enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7. https://doi.org/10.1097/00000658-197801000-00001. DOI: https://doi.org/10.1097/00000658-197801000-00001
Walsh MC, Kliegman RM, D M. Necrotizing Enterocolitis: Treatment Based on Staging Criter. Pediatr Clin North Am 1986;33:179-201. https://doi.org/10.1016/s0031-3955(16)34975-6. DOI: https://doi.org/10.1016/S0031-3955(16)34975-6
Villanueva LA, Contreras AK, Pichardo M, Rosales J. Perfil epidemiológico del parto prematuro. Ginecol Obstet Mex 2008;76:542-8.
Fanczal E, Berecz B, Szijártó A, Gasparics Á, Varga P. The prognosis of preterm infants born at the threshold of viability: Fog over the gray zone - population-based studies of extremely preterm infants. Med Sci Monit 2020;26:1-12. https://doi.org/10.12659/MSM.926947. DOI: https://doi.org/10.12659/MSM.926947
Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: Comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012;345:1-14. https://doi.org/10.1136/bmj.e7976. DOI: https://doi.org/10.1136/bmj.e7976
Johnson S, Marlow N. Early and long-term outcome of infants born extremely preterm. Arch Dis Child 2017;102:97-102. https://doi.org/10.1136/archdischild-2015-309581. DOI: https://doi.org/10.1136/archdischild-2015-309581
Chung SH, Bae CW. Improvement in the survival rates of very low birth weight infants after the establishment of the Korean neonatal network: Comparison between the 2000s and 2010s. J Korean Med Sci 2017;32:1228-34. https://doi.org/10.3346/jkms.2017.32.8.1228. DOI: https://doi.org/10.3346/jkms.2017.32.8.1228
Isayama T. The clinical management and outcomes of extremely preterm infants in Japan: Past, present, and future. Transl Pediatr 2019;8:199-211. https://doi.org/10.21037/tp.2019.07.10. DOI: https://doi.org/10.21037/tp.2019.07.10
D’Apremont I, Marshall G, Musalem C, Mariani G, Musante G, Bancalari A, et al. Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers. J Pediatr 2020;225:44-50.e1. https://doi.org/10.1016/j.jpeds.2020.05.040. DOI: https://doi.org/10.1016/j.jpeds.2020.05.040
Stoll AJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012. JAMA 2015;314:1039-51. https://doi.org/10.1001/jama.2015.10244.Trends. DOI: https://doi.org/10.1001/jama.2015.10244
de Araújo BF, dÀndretta Tanaka AC. Fatores de risco associados ao nascimento de recém-nascidos de muito baixo peso em uma população de baixa renda Risk factors associated with very low birth weight in a low-income population. Cad Saude Publica 2007;23:2869-77. https://doi.org/10.1590/S0102-311X2007001200008. DOI: https://doi.org/10.1590/S0102-311X2007001200008
Tapia JL, Toso A, Vaz Ferreira C, Fabres J, Musante G, Mariani G, et al. The unfinished work of neonatal very low birthweight infants quality improvement: Improving outcomes at a continental level in South America. Semin Fetal Neonatal Med 2021;26. https://doi.org/10.1016/j.siny.2021.101193. DOI: https://doi.org/10.1016/j.siny.2021.101193
Shinwell ES. Ethics of birth at the limits of viability: The risky business of prediction. Neonatology 2015;107:317-20. https://doi.org/10.1159/000381115. DOI: https://doi.org/10.1159/000381115
Rogers EE, Hintz SR. Early neurodevelopmental outcomes of extremely preterm infants. Semin Perinatol 2016;40:497-509. https://doi.org/10.1053/j.semperi.2016.09.002. DOI: https://doi.org/10.1053/j.semperi.2016.09.002
Silberberg A, Villar MJ, Torres S. Opinions of Argentinean neonatologists on the initiation of life ‐ sustaining treatment in preterm infants 2018:1-6. https://doi.org/10.1002/hsr2.100. DOI: https://doi.org/10.1002/hsr2.100
De Proost L, Verweij EJT, Ismaili M’hamdi H, Reiss IKM, Steegers EAP, Geurtzen R, et al. The Edge of Perinatal Viability: Understanding the Dutch Position. Front Pediatr 2021;9. https://doi.org/10.3389/fped.2021.634290. DOI: https://doi.org/10.3389/fped.2021.634290
Kilpatrick SJ, Menard MK, Zahn CM, Callaghan WM. Obstetric Care Consensus #9: Levels of Maternal Care: (Replaces Obstetric Care Consensus Number 2, February 2015). Am J Obstet Gynecol 2019;221:B19-30. https://doi.org/10.1016/j.ajog.2019.05.046. DOI: https://doi.org/10.1016/j.ajog.2019.05.046
Moreira A, Benvenuto D, Fox-Good C, Alayli Y, Evans M, Jonsson B, et al. Development and Validation of a Mortality Prediction Model in Extremely Low Gestational Age Neonates. Neonatology 2022;119:418-27. https://doi.org/10.1159/000524729. DOI: https://doi.org/10.1159/000524729
Ecker JL, Kaimal A, Mercer BM, Blackwell SC, DeRegnier RAO, Farrell RM, et al. Obstetric Care consensus No. 6: Periviable birth. Obstet Gynecol 2017;130:e187-99. https://doi.org/10.1097/AOG.0000000000002352. DOI: https://doi.org/10.1097/AOG.0000000000002352
Boghossian NS, Geraci M, Lorch SA, Phibbs CS, Edwards EM, Horbar JD. Racial and ethnic differences over time in outcomes of infants born less than 30 weeks’ gestation. Pediatrics 2019;144. https://doi.org/10.1542/peds.2019-1106. DOI: https://doi.org/10.1542/peds.2019-1106
Porta R, García‐Muñoz Rodrigo F, Avila‐Alvarez A, Ventura PS, Izquierdo Renau M, Ginovart G. Active approach in delivery room and survival of infants born between 22 and 26 gestational weeks are increasing in Spain. Acta Paediatr 2023;112:417-23. https://doi.org/10.1111/apa.16625. DOI: https://doi.org/10.1111/apa.16625
Bell EF, Hintz SR, Hansen NI, Bann CM, Wyckoff MH, DeMauro SB, et al. Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA 2022;327:248-63. https://doi.org/10.1001/jama.2021.23580. DOI: https://doi.org/10.1097/01.aoa.0000891644.03402.e8
Ministerio de Salud y Protección Social, Departamento de Ciencia Tecnología e Innovación COLCIENCIAS. Guía de práctica clínica del recién nacido prematuro. Bogotá D.C: 2013. ISBN: 978-958-8838-03-8.