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"title": "Cuidados al final de la vida en unidades de cuidado intensivo neonatal de Iberoamérica: una mirada desde la perspectiva de enfermería",
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{
"creatorType": "author",
"firstName": "María Teresa",
"lastName": "Montes Bueno"
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{
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"firstName": "Cristian",
"lastName": "Muñoz"
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"lastName": "Rodríguez"
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"abstractNote": "IntroducciónLos cuidados al final de la vida (CFV) son una parte fundamental de la asistencia al recién nacido ingresado en una unidad de cuidados intensivos neonatal (UCIN). El objetivo de este estudio fue explorar cómo se implementan los CFV en UCIN de Iberoamérica. MétodosEstudio transversal realizado en 2022 mediante encuesta vía correo electrónico y redes oficiales de SIBEN a profesionales de enfermería de UCIN de países de Iberoamérica, sobre aspectos relacionados con los CFV. Recolección y análisis de datos con REDCap y STATA 14.0. ResultadosObtuvimos 400 respuestas de enfermeros/as de 11 países, el 73% procedentes de hospitales terciarios. El 86% de los respondedores eran responsables directos de brindar CFV, si bien un 48% dijeron no haber recibido formación. Solo 67 (17%) afirmaron que la UCIN en la que trabajan cuenta con un protocolo. Las acciones que se implementan durante los CFV fueron infrecuentes (≤50%) en todos los ítems explorados y muy poco frecuentes (<20%) en permitir el acceso libre de familiares, contar con privacidad, brindar asistencia psicológica, registrar el proceso en la historia clínica, asistir con los procesos burocráticos u otorgar un plan de seguimiento para el duelo. ConclusiónLa mayoría de los profesionales de enfermería encuestados eran responsables directos de proveer CFV, pero no contaban con protocolos, no habían recibido capacitación y consideraron que los CFV podrían mejorarse significativamente. Las estrategias para los CFV en la región iberoamericana requieren ser optimizadas.",
"publicationTitle": "Anales de Pediatría",
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"date": "2024",
"volume": "100",
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"partTitle": "",
"pages": "97-103",
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"journalAbbreviation": "Anales de Pediatría",
"DOI": "10.1016/j.anpedi.2023.11.008",
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"title": "Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula: A Randomized Clinical Trial",
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"firstName": "Tarah T.",
"lastName": "Colaizy"
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"lastName": "Poindexter"
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"firstName": "Karen J.",
"lastName": "Johnson"
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"firstName": "Dianne E.",
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"firstName": "Abhik",
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"firstName": "Margaret M.",
"lastName": "Crawford"
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{
"creatorType": "author",
"firstName": "Michele C.",
"lastName": "Walsh"
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{
"creatorType": "author",
"firstName": "Rosemary D.",
"lastName": "Higgins"
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{
"creatorType": "author",
"firstName": "Barbara J.",
"lastName": "Stoll"
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{
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"name": "Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network"
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"abstractNote": "Maternal milk feeding of extremely preterm infants during the birth hospitalization has been associated with better neurodevelopmental outcomes compared with preterm formula. For infants receiving no or minimal maternal milk, it is unknown whether donor human milk conveys similar neurodevelopmental advantages vs preterm formula.To determine if nutrient-fortified, pasteurized donor human milk improves neurodevelopmental outcomes at 22 to 26 months’ corrected age compared with preterm infant formula among extremely preterm infants who received minimal maternal milk.Double-blind, randomized clinical trial conducted at 15 US academic medical centers within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants younger than 29 weeks 0 days’ gestation or with a birth weight of less than 1000 g were enrolled between September 2012 and March 2019.Preterm formula or donor human milk feeding from randomization to 120 days of age, death, or hospital discharge.The primary outcome was the Bayley Scales of Infant and Toddler Development (BSID) cognitive score measured at 22 to 26 months’ corrected age; a score of 54 (score range, 54-155; a score of ≥85 indicates no neurodevelopmental delay) was assigned to infants who died between randomization and 22 to 26 months’ corrected age. The 24 secondary outcomes included BSID language and motor scores, in-hospital growth, necrotizing enterocolitis, and death.Of 1965 eligible infants, 483 were randomized (239 in the donor milk group and 244 in the preterm formula group); the median gestational age was 26 weeks (IQR, 25-27 weeks), the median birth weight was 840 g (IQR, 676-986 g), and 52% were female. The birthing parent’s race was self-reported as Black for 52% (247/478), White for 43% (206/478), and other for 5% (25/478). There were 54 infants who died prior to follow-up; 88% (376/429) of survivors were assessed at 22 to 26 months’ corrected age. The adjusted mean BSID cognitive score was 80.7 (SD, 17.4) for the donor milk group vs 81.1 (SD, 16.7) for the preterm formula group (adjusted mean difference, −0.77 [95% CI, −3.93 to 2.39], which was not significant); the adjusted mean BSID language and motor scores also did not differ. Mortality (death prior to follow-up) was 13% (29/231) in the donor milk group vs 11% (25/233) in the preterm formula group (adjusted risk difference, −1% [95% CI, −4% to 2%]). Necrotizing enterocolitis occurred in 4.2% of infants (10/239) in the donor milk group vs 9.0% of infants (22/244) in the preterm formula group (adjusted risk difference, −5% [95% CI, −9% to −2%]). Weight gain was slower in the donor milk group (22.3 g/kg/d [95% CI, 21.3 to 23.3 g/kg/d]) compared with the preterm formula group (24.6 g/kg/d [95% CI, 23.6 to 25.6 g/kg/d]).Among extremely preterm neonates fed minimal maternal milk, neurodevelopmental outcomes at 22 to 26 months’ corrected age did not differ between infants fed donor milk or preterm formula.ClinicalTrials.gov Identifier: NCT01534481",
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