Atención integral del neonato con encefalopatía hipóxico-isquémica en España

• Main Authors: Juan Arnaez (Author), Nuria Herranz-Rubia (Author), Alfredo Garcia-Alix (Author), J. Diez-Delgado (Author), I. Benavente-Fernández (Author), I. Tofé (Author), A.E. Jerez (Author), J.A. Hurtado (Author), J.M. Ceballos (Author), M.L. Millán (Author), M.D. Esquivel (Author), C. Ruiz (Author), M. Baca (Author), E. Tapia (Author), M. Losada (Author), E. Torres (Author), A. Pavón (Author), P.J. Jiménez (Author), F. Jiménez (Author), M.P. Ventura (Author), S. Rite (Author), T. González (Author), R.P. Arias (Author), P.R. Balliu (Author), J.M. Lloreda-García (Author), J.L. Alcaráz (Author), C. Tapia (Author), A. de la Morena (Author), I. Centelles (Author), I. Güemes (Author), J. Estañ (Author), A. Alberola (Author), S. Aparici (Author), R. López (Author), J. Beceiro (Author), B. García (Author), L. Martínez (Author), E. González (Author), L. Arruza (Author), M.D. Blanco (Author), M.T. Moral (Author), B. Arias (Author), F. Mar (Author), J. Jiménez (Author), G. Romera (Author), A. Cuñarro (Author), C. Muñóz (Author), F. Cabañas (Author), E. Valverde (Author), R. Montero (Author), J.C. Tejedor (Author), C. Santana (Author), B. Reyes (Author), S. Romero (Author), A. Orizaola (Author), M. Baquero (Author), D. Hernández (Author), A. Pantoja (Author), C. Vega- (Author), L. Castañón (Author), E.P. Gutiérrez (Author), M. Benito (Author), S. Caserío (Author), G. Arca (Author), M.J. García (Author), M.A. López-Vílchez (Author), L. Castells (Author), M. Domingo (Author), W. Coroleu (Author), H. Boix (Author), R. Porta (Author), A. García-Alix (Author), S. Martínez-Nadal (Author), E. Jiménez (Author), E. Sole (Author), M. Albújar (Author), E.M. Fernández (Author), A.R. Barrio (Author), E. Piñán (Author), A. Avila-Alvarez (Author), M.E. Vázquez (Author), N. Balado (Author), P.A. Crespo (Author), M.L. Couce (Author), A. Concheiro-Guisán (Author), I. Esteban (Author), A. Lavilla (Author), V. Alzina (Author), A. Aguirre (Author), B. Loureiro (Author), I. Echániz (Author), M.D. Elorza (Author), A. Euba (Author)
• Format: Book
• Published: Elsevier, 2020-05-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Resumen: Introducción: Apenas conocemos cómo es la asistencia de los recién nacidos (RN) con encefalopatía hipóxico-isquémica (EHI) en hipotermia terapéutica (HT), especialmente si existen protocolos asistenciales, la neuromonitorización que se realiza o cómo es la aproximación al pronóstico neurológico. Este conocimiento permite detectar e implementar áreas de mejora asistencial. Método: Estudio transversal de los 57 hospitales españoles que realizaban HT en 2015, mediante cuestionario sobre: 1) la disponibilidad de protocolos y de recursos tecnológicos; 2) el uso de herramientas de neuromonitorización; 3) los conocimientos de los profesionales; 4) la información pronóstica que se da los padres, y 5) el informe al alta y del plan de seguimiento. Resultados: El 95% utiliza enfriamiento corporal-total servocontrolado y dispone de protocolos específicos de actuación. El 70% utiliza sedación y el 68% deja al paciente a dieta absoluta. La monitorización con electroencefalografía integrada por amplitud se utiliza en más del 80% de los centros, aunque solo en el 50% la enfermera es capaz de interpretarlo. La saturación de oxígeno cerebral es escasamente monitorizada (16%). Entre los estudios diagnóstico-pronósticos, la neuroimagen es universal, pero los neurobiomarcadores apenas se utilizan (29%). Solo el 21% ofrece información pronóstica antes de las 72 h de vida; sin presencia de la enfermera en el 70%. El seguimiento lo realiza el neuropediatra (84%), con una duración desigual entre centros. Conclusiones: La asistencia del RN con EHI en España es adecuada, con áreas de mejora en: neuromonitorización, sedación, marco temporal de la información pronóstica, trabajo en equipo y estandarización de la duración del seguimiento. Abstract: Introduction: There is not much information about the care of infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) in Spain. This includes whether protocols are routinely used, the type of neuro-monitoring performed, and how information on the neurological prognosis is presented to families. The answers to these would allow to detect and implement areas of improvement. Method: A cross-sectional analysis was performed on the responses to structured questionnaires sent to all the Spanish neonatal units that were performing TH in June 2015. Questions were divided into 5 sections: 1) the availability of protocols and technological resources, 2) the use of neuro-monitoring tools, 3) the knowledge and training of the professionals; 4) the prognostic information given to the parents; and 5) the discharge report and the follow-up plan. Results: Most centres (95%) use servo controlled whole-body cooling methods and have specific management protocols. Sedation is used in 70% of centres, and in 68% of them the onset of enteral feeding is delayed until the end of the cooling period. Amplitude-integrated electroencephalography monitoring is used in more than 80% of the centres, although only in 50% are nurses able to interpret it. Cerebral oxygen saturation is not often monitored (16%). As regards diagnostic-prognostic studies, neuroimaging is universal, but brain damage biomarkers are hardly used (29%). Prognostic information is offered within the first 72 posnatal hours in 21% of the centres, and is given without the presence of the nurse in 70% of the centres. Follow-up is performed by a neuro-paediatrician (84%), with an uneven duration between centres. Conclusions: The care of infants with HIE treated with TH in Spain is generally adequate, although there are areas for improvement in neuromonitoring, sedation, prognostic information, teamwork, and duration of follow-up.

Item Description

1695-4033
10.1016/j.anpedi.2019.05.013