OBJECTIVE: Analyze the usefulness of the midline catheter in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population requiring admission to the NICU.
METHODS: Analytical and observational of a prospective cohort (December 2021-November 2023) compared to a historical cohort (January 2020-November 2021).
METHODS: 9-bed Neonatal Intensive Care Unit (NICU, level III hospital.
METHODS: 288, 66 midline group and 222 control group.
METHODS: newborns from 24 to 42 weeks of gestation who required short peripheral or midline cannulation and treatment longer than 3 days.
METHODS: Follow-up during NICU stay and comparison with retrospective data from a historical cohort.
METHODS: Sociodemographics, success rate (permanence of the same vascular catheter without complications until finish the prescribed treatment), number of catheters, cannulation rate per patient, indwell time, complications.
RESULTS: The midline group showed a higher success rate (54.2% vs 5.6%, p < 0.001), a lower number of canalizations per patient (p < 0.001), a longer indwell time (p < 0.001) and a lower number of extravasations (p < 0.001).
CONCLUSIONS: The midline catheter has advantages over short peripheral catheters, being a useful alternative in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population that requires admission to the NICU.

OBJECTIVE: Serratia marcescens (SM) may cause nosocomial outbreaks in Neonatal Intensive Care Units (NICU). We describe an outbreak of SM in a NICU and propose additional prevention and control recommendations.
METHODS: Between March 2019 and January 2020, samples were taken from patients in the NICU (rectal, pharyngeal, axillary and other locations) and from 15 taps and their sinks. Control measures were implemented including thorough cleaning of incubators, health education to staff and neonates\'relatives, and use of single-dose containers. PFGE was performed in 19 isolates from patients and in 5 environmental samples.
RESULTS: From the first case in March 2019 to the detection of the outbreak, a month elapsed. Finally, 20 patients were infected and 5 colonized. 80% of infected neonates had conjunctivitis, 25% bacteremia, 15% pneumonia, 5% wound infection, and 5% urinary tract infection. Six neonates had two foci of infection. Among the 19 isolates studied, 18 presented the same pulsotype and only one of the isolates from the sinkhole showed a clonal relationship with those of the outbreak. Initial measures established were ineffective to control de outbreak and were implemented with exhaustive cleaning, use of individual eye drops, environmental sampling and changing sinks.
CONCLUSIONS: This outbreak presented a high number of neonates affected due to its late detection and torpid evolution. The microorganisms isolated from the neonates were related to an environmental isolate. Additional prevention and control measures are proposed, including routine weekly microbiological sampling.

OBJECTIVE: Klebsiella oxytoca can cause nosocomial infections, affecting vulnerable newborns. There are few studies describing nosocomial outbreaks in the neonatal intensive care units (NICU). In this study, a systematic review of the literature was carried out to know the main characteristics of these outbreaks and the evolution of one is described.
METHODS: We conducted a systematic review in the Medline database up to July 2022, and present a descriptive study of an outbreak with 21 episodes in the NICU of a tertiary hospital, between September 2021 and January 2022.
RESULTS: 9 articles met the inclusion criteria. The duration of outbreaks was found to be variable, of which 4 (44.4%) lasted for a year or more. Colonization (69%) was more frequent than infections (31%) and the mortality rate was 22.4%. In studies describing sources, the most frequent was the environmental origin (57.1%). In our outbreak there were 15 colonizations and 6 infections. The infections were mild conjunctivitis without sequelae. Molecular typing analysis made it possible to detect 4 different clusters.
CONCLUSIONS: There is an important variability in the evolution and results of the published outbreaks, highlighting a greater number of colonized, use of PFGE (pulsed-field gel electrophoresis) techniques for molecular typing and implementation of control measures. Finally, we describe an outbreak in which 21 neonates were affected with mild infections, resolved without sequelae and whose control measures were effective.

BACKGROUND: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow.
METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4.
RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p = 0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6 min (range, 6-30 min). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns.
CONCLUSIONS: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

BACKGROUND: Monitoring the partial pressure of CO2 (PCO2) in newborns who require ventilation would allow avoiding hypocapnia and hypercapnia. The measurement of end-tidal carbon dioxide (ETCO2) is an alternative rarely implemented in this population.
OBJECTIVE: To evaluate the relationship between ETCO2 and PCO2 in newborns.
METHODS: Cross-sectional study comparing two PCO2 measurement methods, the conventional one by analysis of blood samples and the one estimated by ETCO2. The study included hospitalized newborns that required conventional mechanical ventilation. The ETCO2 was measured with a Tecme GraphNet® neo, a neonatal ventilator with an integrated capnograph, and we obtained the ETCO2-PCO2 gradient. We conducted correlation and Bland-Altman plot analyses to estimate the agreement.
RESULTS: A total of 277 samples (ETCO2 / PCO2) from 83 newborns were analyzed. The mean values ​​of ETCO2 and PCO2 were 41.36mmHg and 42.04mmHg. There was a positive and significant correlation between ETCO2 and PCO2 in the overall analysis (r=0.5402; P<.001) and in the analysis of each unit (P<.001). The mean difference was 0.68 mmHg (95% CI, -0.68 to 1.95) and was not significant. We observed a positive systematic error (PCO2 > ETCO2) in 2 of the units, and a negative difference in the third (PCO2 < ETCO2).
CONCLUSIONS: The correlation between ETCO and PCO2 was significant, although the obtained values ​​were not equivalent, with differences ranging from 0.1mmHg and 20mmHg. Likewise, we found systematic errors that differed in sign (positive or negative) between institutions.

Since the COVID-19 pandemic was declared in March 2020, we have learned a lot about the SARS-CoV-2 coronavirus, and its role in pediatric pathology. Children are infected in a rate quite similar to adults, although in most cases they suffer mild or asymptomatic symptoms. Around 1% of those infected require hospitalization, less than 0.02% require intensive care, and mortality is very low and generally in children with comorbidities. The most common clinical diagnoses are upper or lower respiratory infections, gastrointestinal infection and, more seriously, multisystemic inflammatory syndrome (MIS-C). Most episodes do not require treatment, except for MIS-C. Remdesivir has been widely used as a compassionate treatment and its role has yet to be defined. The newborn can become infected, although vertical transmission is very low (<1%) and it has been shown that the baby can safely cohabit with its mother and be breastfed. In general, neonatal infections have been mild. Primary care has supported a very important part of the management of the pandemic in pediatrics. There has been numerous collateral damage derived from the difficulty of access to care and the isolation suffered by children. The mental health of the pediatric population has been seriously affected. Although it has been shown that schooling has not led to an increase in infections, but rather the opposite. It is essential to continue maintaining the security measures that make schools a safe place, so necessary not only for children\'s education, but for their health in general.

Right ventricle (RV) function plays an important role during fetal and neonatal transitional circulation. Despite the published echocardiography guidelines in children including neonates, there is scare evidence on RV assessment using echocardiography in Mexican neonates. This study was aimed at assessing RV function and anatomical measures in healthy term newborns and defines normal values in this cohort of patients.
A prospective study involving healthy term newborns in a single center were enrolled in the study to assess RV, all patients were recruited within 24-72 h after birth. The right ventricular assessment was performed as per American Society of Echocardiography\'s guidelines.
Seventy healthy term newborns with a median gestational age of 38 (38.5 ± 2.7) weeks had RV function assessment and anatomical structures measures with a predefined ten echocardiographic parameters protocol. The mean values for: tricuspid valve diameter was 13 mm ± 1.8, basal diameter of the RV 16.7 mm ± 2, RV length 27.8 mm ± 2.2, mid cavity diameter 14.3 mm ± 1.7, RV-anteroinferior basal diameter 21.5 mm ± 2.5, tricuspid regurgitation gradient 13.3 mmHg ± 5.9, tricuspid annular plane systolic excursion 8.7 mm, right ventricular fractional area change (RVFAC) 4 chamber (%) 40.6 ± 7.5, tricuspid E/A 0.7 ± 0.5, myocardial velocities (cm/s) E´ 8 ± 2.7, A´ 9.6 ± 2.4, S´ 6.9 ± 1.2, myocardial performance index 0.5 ± 0.1, RVFAC 3 chamber (%) 37.8 ± 15.8, and pulmonary acceleration time mean value 58.8 ± 14.9. Flattening of interventricular septum was seen in 13% infants.
This study describes echocardiographic parameters for anatomical structures and assessment of RV function in healthy term newborns during transitional circulation. We reported novel anatomical measures of the RV; this information can provide normal reference range values and be referenced while assessing RV function in normal and sick newborns during transitional circulation.
Realizar una valoración ecocardiográfica de parámetros anatómicos y funcionales del ventrículo derecho (VD) en recién nacidos de término (RNT) sanos durante el periodo transicional.
Estudio prospectivo en RNT sanos de la Unidad de Cuidados Intensivos Neonatales del Hospital Español. Todos los pacientes fueron estudiados en las primeras 24-72 horas de vida, con base en las guías de la American Society of Echocardiography.
Se estudiaron 70 RNT sanos con una media de edad gestacional de 38 semanas de gestación (38.5 ± 2.7); en estos pacientes se obtuvieron 10 parámetros ecocardiográficos. El valor medio obtenido para la válvula tricúspide fue de 13 ± 1.8 mm, diámetro basal del VD 16.7 ± 2 mm, longitud 27.8 ± 2.2 mm, cavidad media del VD 14.3 ± 1.7 mm, diámetro basal anteroinferior 21.5 ± 2.5 mm, gradiente de insuficiencia tricuspídea 13.3 ± 5.9 mmHg, tricuspid annular plane systolic excursion (TAPSE) 8.7 mm, Fracción de acortamiento del VD (FAVD) 4 cámaras (%) 40.6 ± 7.5, E/A tricuspídeo 0.7 ± 0.5, velocidades miocárdicas (cm/s) E´ 8 ± 2.7, A´ 9.6 ± 2.4, S´ 6.9 ± 1.2, índice de rendimiento miocárdico 0.5 ± 0.1, FAVD 3 cámaras (%) 37.8 ± 15.8, tiempo de aceleración pulmonar 58.8 ± 14.9.
Este estudio describe parámetros anatómicos y funcionales del VD en RNT sanos durante el periodo de transición. Se reportan valores de normalidad que pueden servir como referencia.

Human parechovirus (HPeV) is one of the members of the family Picornaviridae that has been associated with fever of unknown origin, gastroenteritis, clinical sepsis, meningitis, or encephalitis in very young infants. HPeV detection is not routinely performed in most clinical microbiology laboratories in Argentina and, therefore, its real prevalence is unknown. We here report three cases of HPeV CNS infection that presented to our hospital with different clinical features after the implementation of a multiplex PCR meningitis/encephalitis panel. Molecular diagnostic techniques could help improve patient care and understand the real prevalence of this infection in Argentina.

BACKGROUND: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow.
METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4.
RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p=0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6minutes (range, 6-30minutes). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns.
CONCLUSIONS: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

Despite being an international reference in donation and transplantation, Spain needs to improve pediatric donation, including donation after the circulatory determination of death. The present article, a summary of the consensus report prepared by the Organización Nacional de Trasplantes and the Spanish Pediatrics Association, intends the facilitation of donation procedures in newborns and children and the analysis of associated ethical dilemma. The ethical basis for donation in children, the principles of clinical assessment of possible donors, the criteria for the determination of death in children, intensive care management of donors, basic concepts of donation after the circulatory determination of death and the procedures for donation in newborns with severe nervous system\'s malformation incompatible with life, as well as in children receiving palliative care are commented. Systematically considering the donation of organs and tissues when a child dies in conditions consistent with donation is an ethical imperative and must become an ethical standard, not only because of the need of organs for transplantation, but also to ensure family centered care.