El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica
The research work carried out is aimed at knowing relevant and novel aspects of the newborn (RN) with moderate-severe hypoxic-ischemic encephalopathy (HIE) who receives treatment with hypothermia (HT). The thesis has been structured in three main objectives whose justification and main results are:1...
| Autor: | |
|---|---|
| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Universidad de Valladolid |
| Repositorio: | UVaDOC. Repositorio Documental de la Universidad de Valladolid |
| OAI Identifier: | oai:uvadoc.uva.es:10324/59939 |
| Acceso en línea: | https://doi.org/10.35376/10324/59939 https://uvadoc.uva.es/handle/10324/59939 |
| Access Level: | acceso abierto |
| Palabra clave: | Medicine Pediatrics Encephalopathy Encefalopatía Hypothermia Hipotermia Perinatal asphyxia Asfixia perinatal Hypoxic ischemic Hipoxico isquémico 3201.10 Pediatría |
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El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica |
| title |
El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica |
| spellingShingle |
El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica Vega del Val, Cristina Medicine Pediatrics Encephalopathy Encefalopatía Hypothermia Hipotermia Perinatal asphyxia Asfixia perinatal Hypoxic ischemic Hipoxico isquémico 3201.10 Pediatría |
| title_short |
El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica |
| title_full |
El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica |
| title_fullStr |
El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica |
| title_full_unstemmed |
El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica |
| title_sort |
El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica |
| dc.creator.none.fl_str_mv |
Vega del Val, Cristina |
| author |
Vega del Val, Cristina |
| author_facet |
Vega del Val, Cristina |
| author_role |
author |
| dc.contributor.none.fl_str_mv |
Paz Fernández, Félix Jesús de Arnáez Solís, Juan Universidad de Valladolid. Escuela de Doctorado |
| dc.subject.none.fl_str_mv |
Medicine Pediatrics Encephalopathy Encefalopatía Hypothermia Hipotermia Perinatal asphyxia Asfixia perinatal Hypoxic ischemic Hipoxico isquémico 3201.10 Pediatría |
| topic |
Medicine Pediatrics Encephalopathy Encefalopatía Hypothermia Hipotermia Perinatal asphyxia Asfixia perinatal Hypoxic ischemic Hipoxico isquémico 3201.10 Pediatría |
| description |
The research work carried out is aimed at knowing relevant and novel aspects of the newborn (RN) with moderate-severe hypoxic-ischemic encephalopathy (HIE) who receives treatment with hypothermia (HT). The thesis has been structured in three main objectives whose justification and main results are:1. Evolution of the incidence of HIE, severity and mortality in the era of HT. Multicenter cross-sectional study of RNs ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE in the first 6 h of life in a large region of Spain between 2011 and 2019 to detect trend changes over time in annual incidence, degree of neurological and multisystem involvement and neonatal death caused by HIE.The annual incidence rate of moderate to severe HIE was 0.84 (95% confidence interval (CI) 0.7–0.97) per 1,000 births, with no trend changes over time (p = 0.8), although the proportion of severe cases showed an average annual decrease of 0.86 points (95% CI 0.75 to 0.98). There were 102 (70%) RN diagnosed with moderate HIE and 44 (30%) with severe HIE. HT was offered at 139/146 (95%) RN. Lower clinical and/or electrical seizures were observed with a trend ranging from 56 to 28% (p = 0.006). Mortality decreased but without statistical significance (p = 0.4) and the severity of systemic damage remained unchanged (p = 0.3). Obstetric characteristics remained similar, while over time higher perinatal pH (p = 0.03) and Apgar (p = 0.05) values were found with less need for resuscitation (p = 0.07). 2. Challenges in the implementation of HT. We lack population data in Spain on the application of HT. The objective was to examine adherence to management standards during HT of RNs with HIE. An observational cohort study was conducted, multicenter from the beginning of HT (2010) in a Spanish region, until 2019.We included 133 patients, 72% with moderate HIE and the rest with severe HIE. The accessibility to HT in this Spanish region is very satisfactory. The precocity in reaching the target temperature and the implementation of therapy agree with the established standards. There are aspects of improvement in the application of the treatment such as a) reducing the differences in the age at which the target temperature is reached; b) in those with severe HIE, implement the study of MRI and biomarkers of harm in the time interval of decision-making on care redirection; (c) reduce the use of aminoglycosides; and d) improve the integration of the family in the care of RN with EHI in HT.3. Use of functional echocardiography (EcoFn) in the care of RN with HIE during treatment with HT. To know the reality of the use of this tool in the integral management of the RN with EHI that receives HT, a national cross-sectional study was carried out in Spain in 2015 through a questionnaire sent to the 57 level III units that offered HT. Almost half of the hospitals report not having professionals with experience in echocardiography, with knowledge of EcoFn clearly insufficient in 50% of the centers. 77% of the centers do not perform EcoFn as part of the study of factors that may contribute to influencing the evolution of neurological injury, and none took into account the Information of the EcoFn in the prognosis of death or disability in the long term. |
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2022 |
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2022 |
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https://doi.org/10.35376/10324/59939 https://uvadoc.uva.es/handle/10324/59939 |
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https://doi.org/10.35376/10324/59939 https://uvadoc.uva.es/handle/10324/59939 |
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Español |
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Español |
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info:eu-repo/semantics/openAccess http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéuticaVega del Val, CristinaMedicinePediatricsEncephalopathyEncefalopatíaHypothermiaHipotermiaPerinatal asphyxiaAsfixia perinatalHypoxic ischemicHipoxico isquémico3201.10 PediatríaThe research work carried out is aimed at knowing relevant and novel aspects of the newborn (RN) with moderate-severe hypoxic-ischemic encephalopathy (HIE) who receives treatment with hypothermia (HT). The thesis has been structured in three main objectives whose justification and main results are:1. Evolution of the incidence of HIE, severity and mortality in the era of HT. Multicenter cross-sectional study of RNs ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE in the first 6 h of life in a large region of Spain between 2011 and 2019 to detect trend changes over time in annual incidence, degree of neurological and multisystem involvement and neonatal death caused by HIE.The annual incidence rate of moderate to severe HIE was 0.84 (95% confidence interval (CI) 0.7–0.97) per 1,000 births, with no trend changes over time (p = 0.8), although the proportion of severe cases showed an average annual decrease of 0.86 points (95% CI 0.75 to 0.98). There were 102 (70%) RN diagnosed with moderate HIE and 44 (30%) with severe HIE. HT was offered at 139/146 (95%) RN. Lower clinical and/or electrical seizures were observed with a trend ranging from 56 to 28% (p = 0.006). Mortality decreased but without statistical significance (p = 0.4) and the severity of systemic damage remained unchanged (p = 0.3). Obstetric characteristics remained similar, while over time higher perinatal pH (p = 0.03) and Apgar (p = 0.05) values were found with less need for resuscitation (p = 0.07). 2. Challenges in the implementation of HT. We lack population data in Spain on the application of HT. The objective was to examine adherence to management standards during HT of RNs with HIE. An observational cohort study was conducted, multicenter from the beginning of HT (2010) in a Spanish region, until 2019.We included 133 patients, 72% with moderate HIE and the rest with severe HIE. The accessibility to HT in this Spanish region is very satisfactory. The precocity in reaching the target temperature and the implementation of therapy agree with the established standards. There are aspects of improvement in the application of the treatment such as a) reducing the differences in the age at which the target temperature is reached; b) in those with severe HIE, implement the study of MRI and biomarkers of harm in the time interval of decision-making on care redirection; (c) reduce the use of aminoglycosides; and d) improve the integration of the family in the care of RN with EHI in HT.3. Use of functional echocardiography (EcoFn) in the care of RN with HIE during treatment with HT. To know the reality of the use of this tool in the integral management of the RN with EHI that receives HT, a national cross-sectional study was carried out in Spain in 2015 through a questionnaire sent to the 57 level III units that offered HT. Almost half of the hospitals report not having professionals with experience in echocardiography, with knowledge of EcoFn clearly insufficient in 50% of the centers. 77% of the centers do not perform EcoFn as part of the study of factors that may contribute to influencing the evolution of neurological injury, and none took into account the Information of the EcoFn in the prognosis of death or disability in the long term.El trabajo de investigación realizado está dirigido a conocer aspectos relevantes y novedosos del recién nacido (RN) con encefalopatía hipóxico-isquémica (EHI) moderada-grave que recibe tratamiento con hipotermia (HT). La tesis se ha estructurado en tres objetivos principales cuya justificación y principales resultados son: 1. Evolución de la incidencia de la EHI, gravedad y mortalidad en la era de la HT. Estudio transversal multicéntrico de los RN ≥ 35 semanas de edad gestacional diagnosticados de EHI moderada-grave en las primeras 6 h de vida en una extensa región de España entre los años 2011 y 2019 para detectar cambios de tendencia a lo largo del tiempo en la incidencia anual, el grado de compromiso neurológico, multisistémico y en la muerte neonatal causada por EHI. La tasa de incidencia anual de EHI de moderada a grave fue de 0,84 (intervalo de confianza [IC] del 95 %: 0,7–0,97) por 1.000 nacimientos, sin cambios de tendencia en el tiempo (p = 0,8), aunque la proporción de casos graves mostraron una disminución anual promedio de 0,86 puntos (IC del 95%: 0,75 a 0,98). Hubo 102 (70%) RN diagnosticados de EHI moderada y 44 (30%) de EHI grave. Se ofreció HT a 139/146 (95%) RN. Se observaron menores convulsiones clínicas y/o eléctricas con una tendencia que varía del 56 al 28% (p = 0,006). La mortalidad disminuyó pero sin significación estadística (p = 0,4) y la gravedad del daño sistémico permaneció sin cambios (p = 0,3). Las características obstétricas se mantuvieron similares, mientras que con el tiempo se encontraron valores de pH perinatal (p = 0,03) y Apgar (p = 0,05) más altos con menor necesidad de reanimación (p = 0,07). 2. Desafíos en la implementación de la HT. Carecemos de datos poblacionales en España sobre la aplicación de la HT. El objetivo fue examinar la adherencia a los estándares de manejo durante la HT de los RN con EHI. Se realizó un estudio observacional de cohortes, multicéntrico desde el inicio de la HT (2010) en una región española, hasta el año 2019. Se incluyeron 133 pacientes, el 72% con EHI moderada y el resto con EHI grave. La accesibilidad a la HT en esta región española es muy satisfactoria. La precocidad en alcanzar la temperatura diana y la implementación de la terapia concuerdan con los estándares establecidos. Existen aspectos de mejora en la aplicación del tratamiento como son a) reducir las diferencias en la edad a la que se alcanza la temperatura diana; b) en aquellos con EHI grave, implementar el estudio de RM y de biomarcadores de daño en el intervalo temporal de la toma de decisiones sobre redirección del cuidado; c) reducir la utilización de aminoglucósidos; y d) mejorar la integración de la familia en los cuidados del RN con EHI en HT. 3. Utilización de la ecocardiografía funcional (EcoFn) en la asistencia al RN con EHI durante el tratamiento con HT. Para conocer la realidad del uso de esta herramienta en el manejo integral del RN con EHI que recibe HT, se realizó en España en 2015 un estudio transversal nacional mediante un cuestionario enviado a las 57 unidades de nivel III que ofertaban HT. Casi la mitad de los hospitales refieren no contar con profesionales con experiencia en ecocardiografía, con conocimiento de la EcoFn claramente insuficiente en el 50% de los centros. El 77% de los centros no realizan EcoFn como parte del estudio de factores que pueden contribuir a influir en la evolución de la lesión neurológica, y ninguno tuvo en cuenta la información de la EcoFn en el pronóstico de muerte o discapacidad a largo plazo.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la SaludPaz Fernández, Félix Jesús deArnáez Solís, JuanUniversidad de Valladolid. Escuela de Doctorado2022info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.35376/10324/59939https://uvadoc.uva.es/handle/10324/59939reponame:UVaDOC. Repositorio Documental de la Universidad de Valladolidinstname:Universidad de ValladolidEspañolinfo:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc-nd/4.0/oai:uvadoc.uva.es:10324/599392026-06-13T12:44:47Z |
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