Publication: Sepsis nosocomial en el recién nacido menor de 1500 gramos. Análisis epidemiológico en dos períodos de tiempo
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2018-04-12
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Universidad Complutense de Madrid
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Abstract
Durante las últimas décadas se ha producido un aumento de la supervivencia de los recién nacidos pretérmino gracias a las mejoras en los tratamientos que estos pacientes reciben, entre los que se incluye el tratamiento con surfactante pulmonar, mejoras en los aparatos de ventilación mecánica, utilización de nutrición parenteral e inicio precoz de la nutrición enteral. Parte de este tratamiento incluye la prevención y detección y manejo de las infecciones de los recién nacidos menores de 1500 g (RNMBP), entre los que la sepsis de inicio tardío tiene una alta incidencia, mayor cuanto menor es el peso o la edad gestacional del recién nacido. Material y métodos. Ventajas y sesgos del estudio. Se analizaron con el programa SPSS 15.0 las características perinatales, factores de riesgo y morbimortalidad asociada a la prematuridad en relación con la aparición de un primer episodio de sepsis de inicio tardío en 222 pacientes ingresados en el Hospital Clínico San Carlos (HCSC) en los años 2007, 2008, 2011 y 2012. Se realizó un análisis univariado de cada una de las variables estudiadas en relación con la variable principal del estudio (primer episodio de sepsis con confirmación microbiológica de inicio tardío) y posteriormente se ajustaron por edad gestacional y se compararon con los datos disponibles de los hospitales miembros del grupo SEN1500 de la Sociedad Española de Neonatología y con la literatura científica disponible. Para evitar el sesgo de mala clasificación se recogieron los datos según las variables consensuadas y estandarizadas del protocolo aprobado por el grupo SEN1500 y, en aquellos casos en los que éste no hubiese descrito, se recurrió a las definiciones recogidas por otras sociedades científicas. Objetivos y resultados. Se valoraron los principales antecedentes maternales de los pacientes. En el análisis univariado solo se encontró asociación estadísticamente significativa entre parto vaginal y desarrollo de sepsis de inicio tardío, asociación que desapareció al ajustar por edad gestacional los datos. No se encontró asociación con el resto de variables de la historia materna (etnia, uso de antibioterapia preparto, uso de corticoides antenatales, embarazo múltiple o fecundación in vitro)...
Over the last decades there has been an increase in the survival of the preterm infants thanks to the improvements in the treatments that these patients receive, among pulmonary surfactant treatment, improvements in mechanical ventilation, use of parenteral nutrition and early initiation of enteral nutrition. Part of this treatment includes the prevention and detection and management of infections in very low birth weight (VLBW), among whom late-onset sepsis (LOS) has a higher incidence, the greater the lower the weight or the gestational age of the newborn. Materials and Methods. Advantages and biases The perinatal characteristics, risk factors and morbimortality associated with prematurity in relation to the appearance of a first episode of LOS in 222 patients admitted to the Hospital Clínico San Carlos (HCSC) in the years 2007, 2008, 2011 and 2012 were analysed with the SPSS 15.0 program. We performed a univariate analysis of each of the variables studied in relation to the main variable of the study (first episode of LOS with microbiological confirmation) and subsequently adjusted for gestational age and compared with the data of the SEN1500 group of the Spanish Neonatology and the available scientific literature. To avoid poor classification bias, the data were collected according to the consensus and standardized variables of the protocol approved by the group SEN1500 and, in those cases in which it had not been described, other scientific societies definitions were used. Objetives and results. The main maternal antecedents of the patients were evaluated. In the univariate analysis only a statistically significant association was found between vaginal delivery and LOS, association that disappeared when gestational age adjusted the data. Do not Association with the rest of the variables of maternal history (ethnicity, antenatal antibiotic therapy, use of antenatal corticosteroids, multiple pregnancy or fecundation in vitro)...
Over the last decades there has been an increase in the survival of the preterm infants thanks to the improvements in the treatments that these patients receive, among pulmonary surfactant treatment, improvements in mechanical ventilation, use of parenteral nutrition and early initiation of enteral nutrition. Part of this treatment includes the prevention and detection and management of infections in very low birth weight (VLBW), among whom late-onset sepsis (LOS) has a higher incidence, the greater the lower the weight or the gestational age of the newborn. Materials and Methods. Advantages and biases The perinatal characteristics, risk factors and morbimortality associated with prematurity in relation to the appearance of a first episode of LOS in 222 patients admitted to the Hospital Clínico San Carlos (HCSC) in the years 2007, 2008, 2011 and 2012 were analysed with the SPSS 15.0 program. We performed a univariate analysis of each of the variables studied in relation to the main variable of the study (first episode of LOS with microbiological confirmation) and subsequently adjusted for gestational age and compared with the data of the SEN1500 group of the Spanish Neonatology and the available scientific literature. To avoid poor classification bias, the data were collected according to the consensus and standardized variables of the protocol approved by the group SEN1500 and, in those cases in which it had not been described, other scientific societies definitions were used. Objetives and results. The main maternal antecedents of the patients were evaluated. In the univariate analysis only a statistically significant association was found between vaginal delivery and LOS, association that disappeared when gestational age adjusted the data. Do not Association with the rest of the variables of maternal history (ethnicity, antenatal antibiotic therapy, use of antenatal corticosteroids, multiple pregnancy or fecundation in vitro)...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Pediatría, leída el 13/06/2017