Acute kidney injury (AKI) is classified based on prerenal, intrinsic, and postrenal causes. In the newborn, AKI can occur after an insult during the prenatal, perinatal, or postnatal period. AKI is usually an underrecognized condition and its true incidence is unknown. AKI may result from the administration of a number of different nephrotoxic medications, which are often used concurrently in critically ill neonates, exponentially increasing the risk of renal injury. Drug toxicity may also compromise the formation and development of nephrons, and this is particularly important in preterm infants, who have incomplete nephrogenesis. Little is known about the pharmacokinetics and pharmacodynamics of different medications used in neonates, especially for the most immature infant, and the use of most medications in this population is off label. Strategies to prevent AKI include the avoidance of hypotension, hypovolemia, fluid imbalances, hypoxia, and sepsis as well as judicious use of nephrotoxic medications. Treatment strategies aim to maintain fluids and electrolytic and acid-base homeostasis, along with an adequate nutritional status. Neonates are especially prone to long-term sequelae of AKI and benefit from long-term follow-up. This review summarizes the most relevant aspects of nephrotoxicity in neonates and describes the prevention, treatment, and follow-up of AKI in neonates.

Background: Congenital anomalies (CAs) are a leading cause of fetal and infant mortality and morbidity worldwide. They may be identified prenatally, at the moment of birth or later in life. Purpose: To describe the cases of CAs registered over the last 15 years at a level III hospital, comparing individuals who were detected through prenatal (preN) diagnosis with those detected through postnatal (postN) diagnosis. Methods: All records were collected from the Registo Nacional de Anomalias Congenitas (RENAC) online platform between 1 st January 2000 to 31 st December 2014, in a level III hospital, where cases of CAs were notified voluntarily (n = 1,222). We tested differences for selected variables between the years in study. A multivariate analysis was performed to identify potential factors associated to preN diagnosis. Results: We observed a total of 1,510 anomalies, being 493 (40.3%) circulatory, 252 (20.6%) chromosomal, 187 (15.3%) musculoskeletal, 138 (11.3%) digestive, 133 (10.9%) urinary, 117 (9.6%) nervous, 37 (3.0%) respiratory, 35 (2.9%) genital, 25 (2%) anomalies of the eye, ear, face and neck, 20 (1.6%) cleft lip/cleft palate and 73 (6.0%) others. Time of diagnosis was known for all subjects: 770 (63.0%) were diagnosed prenatally and 452 (37.0%) were diagnosed at birth or during the first month of life. We found statistically significant differences between groups for several variables. Assisted reproduction techniques (p = 0.023), maternal medications during the first trimester of pregnancy (p = 0.004) and the number of anomalies per individual (p ≤ 0.001) had a statistically significant impact on receiving preN diagnosis. Conclusion: Our data confirm the importance of both RENAC national database and preN diagnosis in improving perinatal healthcare. However, in order to determine the national prevalence of CAs and understand any involved factors, it is desirable to enhance the notification in the whole country, facilitating the adjustment of national protocols to achieve a better perinatal counseling and surveillance.

OBJECTIVE:This study aimed to examine the differences between mothers of preterm multiples and mothers of preterm singletons regarding perceived stress and maternal psychological symptoms, and to explore the putative adverse amplified effect of socioeconomic disadvantage. METHOD:Ninety-five mothers of 1-year-olds born preterm participated in this cross-sectional study. Data collection was carried out in two public hospitals from Northern Portugal. To assess maternal perceived daily stress and psychological symptoms, mothers completed two questionnaires. Mothers reported on socioeconomic factors, including family poverty, parent unemployment, and low education, and two groups of family socioeconomic disadvantage were created. A child medical risk index was calculated. RESULTS:Results indicated that mothers of preterm multiples reported higher levels of stress than mothers of preterm singletons. Moreover, and specifically regarding psychological functioning, mothers of preterm multiples reported more symptoms than mothers of preterm singletons, but only when living in a context of socioeconomic adversity. CONCLUSIONS:The results of the present study have important implications for practice. Mothers of preterm multiples are at higher risk to present mental health difficulties, in comparison to mothers of singletons, especially when exposed to socioeconomic adversities. The development of psychosocial intervention programs and public policies are of decisive importance in helping mothers of multiples adjust to parenthood.

Theme: Complex health care and chronic disease management.

The birth of a preterm or a sick infant represents a well-known emotional crisis for parents and family. It has been documented that a multidisciplinary approach to the care of newborns hospitalized in Neonatal Intensive Care Units (NICUs) is essential for the development of these children. The presence of parents 24 hours a day, participating in the care of their children, is a reality in our NICU since its opening in July 1983. Aspects related to the optimization of care for these immature newborns, as well as the relationship between parents and professionals, are also mentioned.

Introdução: a monitorização não invasiva da pressão parcial arterial de dióxido de carbono em recém-nascidos submetidos a ventilação mecânica poderá ser útil na prevenção de complicações relacionadas com a hipocapnia e hipercapnia. Objectivo: determinar a acuidade da monitorização da pressão parcial de dióxido de carbono do ar expirado (capnometria) em recém-nascidos submetidos a ventilação mecânica. Material e métodos: registo de 117 pares de valores de pressão parcial de dióxido de carbono obtidos em simultâneo por capnometria e análise do sangue arterial, de um grupo de 26 recém-nascidos apresentando uma idade gestacional média de 32,4 semanas e um peso médio de 1780 g, submetidos a ventilação mecânica convencional.O índice a/A 02 (razão tensão de oxigénio arterial/alveolar) foi usado como um índice indirecto da relação ventilação perfusão pulmonar (V/Q). Foram definidos três subgrupos com base no peso (<1500g; 1500-2500g; >2500g) e um subgrupo de doentes do foro cirúrgico sem patologia pulmonar (a/A020,3).Foi utilizada a correlação de Pearson na avaliação da relação entre os valores de pressão parcial de dióxido de carbono obtidos por capnometria e análise do sangue arterial, quer para a amostra total, quer para subgrupos definidos por a/A02 e peso. Resultados: foram encontrados os seguintes coeficientes de correlação (r ): amostra total - a/A02<0,3 r = 0,40 (p=0,005) / a/A020,3 r = 0,49 (p<0,001); peso<1500g - a/A02<0,3 r = 0,31 (p=0,295) / a/A020,3 r = 0,27 (p=0,109); peso 1500-2500g - a/A02<0,3 r = 0,68 (p=0,001) / a/A020,3 r = 0,89 (p<0,001); peso>2500g - a/A02<0,3 r = 0,34 (p=0,215) / a/A02W,3 r = 0,46 (p=0,040); doentes cirúrgicos - r = 0,65 (p=0,004). Conclusão: este estudo mostra uma fraca correlação entre os valores de pressão parcial de dióxido de carbono obtidos por capnometria e análise do sangue arterial, pelo que esta técnica não deve ser utilizada isoladamente na monitorização da pressão parcial arterial de dióxido de carbono em neonatologia.

BACKGROUND:Plasma brain-type natriuretic peptide (BNP) is secreted by cardiac myocytes in response to pressure or volume overload. Recently, an assay to measure the N-terminal segment of the pro-hormone (NT-pro-BNP) was developed.AIMS:(1) To determine the plasma levels of NT-pro-BNP in premature neonates without congenital heart disease; (2) to determine the relationship between the severity of respiratory distress syndrome (RDS) and plasma levels of NT-pro-BNP.METHODS:Plasma levels of NT-pro-BNP were measured in premature neonates (<34 wks gestation) at 24 hours, and days 7 and 21 of life. Levels of NT-pro-BNP were compared between neonates with and without RDS.RESULTS:45 neonates, 25/20 (F/M), gestational age 30 (25-33) weeks, birthweight 1290 (500-2220) g. RDS occurred in 21 (47%) neonates: RDS I (mild) = 7; RDS II (moderate) = 10; RDS III (severe) = 4. Comparative analysis revealed a significant increase in plasma level of NT pro-BNP at 24 hours (p = 0,001) and day 7 (p = 0,015) of life in patients with RDS. Plasmatic levels of NT-pro-BNP at 24 hours of age were significantly increased in patients with severe RDS than in patients with mild (p < 0,001) or moderate RDS (p < 0,002), after adjustment for gestational age and birthweight.CONCLUSIONS:plasma levels of NT-pro-BNP are directly related to increasing severity of RDS in neonates, suggesting a close relation to the functional impairment of pulmonary haemodynamical changes.

Plasma brain-type natriuretic peptide (BNP) is secreted by cardiac myocytes in response to pressure or volume overload. Recently, an assay to measure the N-terminal segment of the pro-hormone (NT-pro-BNP) was developed.(1) To determine the plasma levels of NT-pro-BNP in premature neonates without congenital heart disease; (2) to determine the relationship between the severity of respiratory distress syndrome (RDS) and plasma levels of NT-pro-BNP.Plasma levels of NT-pro-BNP were measured in premature neonates (

OBJECTIVE:In congenital diaphragmatic hernia (CDH) the severity of pulmonary hypertension (PH) is considered, by several authors, determinant of clinical outcome. Plasmatic N-terminal-pro-B type natriuretic peptide (NT-proBNP) might be useful in diagnosis and management of PH in newborns, although its interest in CDH infants remains to be defined. Early NT-proBNP levels were assessed in CDH infants and correlated with cardiovascular echocardiographic parameters.PATIENTS AND METHODS:28 newborns, CDH and age-matched controls were enrolled in a prospective study. Clinical condition, NT-proBNP plasmatic levels, echo parameters of PH and biventricular function were assessed at 24 h after delivery as well as survival outcome.RESULTS:Estimated mean pulmonary pressure and NT-proBNP were significantly higher in CDH than control infants. NT-proBNP significantly correlated with estimated pulmonary artery pressure, right ventricular Tei index, and tricuspid E/A ratio. Additionally, we found that CDH infants with NT-proBNP >11,500 pg/ml experienced a worse prognosis.CONCLUSIONS:We demonstrated that PH is associated with NT-proBNP elevation and diastolic impairment in CDH infants. Early elevations in NT-proBNP levels seem to alert for a subset of CDH infants with worse prognosis.